chirurgical TREATISES.   

TRactatus hi Chirurgici si prelo mandentur, magno id commodo Medicis pariter ac Chirurgis cessurum judicamus.  


Georg. Ent Eques Auratus, Colleg. Regal. Med. Lond. Praeses, M.D.  
Tho. Cox, Elector & Censor, M. D.  
Dan. Whistler, Regestarius ac Censor, M. D.  
Humphr. Brooke, Censor, M. D.  
Tho. Franckland, Censor, M. D.     

SEVERAL chirurgical TREATISES.  
By RICHARD WISEMAN, Serjeant-Chirurgeon.  
LONDON, Printed by E. Flesher and J. Macock, for R. Royston Bookseller to His Most Sacred Majesty, and B. Took at the Ship in St. Paul's Churchyard, Anno Dom. 1676.   

TO THE MOST SACRED MAJESTY OF CHARLES II. KING OF GREAT BRITAIN, FRANCE and IRELAND, etc. ARE HUMBLY DEDICATED THESE chirurgical Labours OF His MAJESTY'S most faithful Servant, and loyal Subject,  
Ri. Wiseman.   

THE EPISTLE TO THE READER.  
Reader,  
THE nobility and dignity of Chirurgery are too well known to want the help of an Orator to set them forth. If a Panegyric were necessary, it were best made by running through the Particulars of the Art, and the History of the Diseases cured thereby. He that shall duly consider the deplorable misery of mankind, and how much it wanteth relief in such a multitude of Instances, must needs acknowledge us to be what Antiquity hath long since called us, viz. The Hands of God. Indeed the ancient Grecians in the days of Ignorance and Idolatry did not stick to testify their reverence of the Eminent men of the Profession, by referring them into the number of the Gods which they worshipped. Nor have the latter times, though wiser than to rise to such extravagancy, been backward in expressing their esteem of us; which notwithstanding they have guided with more discretion and usefulness. In stead of such Deification and fabulous Stories, they have rewarded us with Honour, Wealth, and Collegiate Foundations both in Universities and great Cities. Among which sort our own Society in the City of London, established by Kings, and frequently encouraged by fresh Grants from them, aught to have an honourable mention; the Professors of which have contributed so much to the improvement of the Faculty, and to the honour of the Nation. The Anatomiall part hath been signally promoted in it, so as to tender it famous all over Europe, and every year to invite Foreigners to attend our Lectures from beyond the seas. It had like to have done as great things in the Institutionary part of Chirurgery, had the learned Lectures of that excellent Chirurgeon Doctor Read been continued by a succession of such Professors. It being reasonable to imagine, that the Curiosity and Industry that hath been so eminent in our Nation in the anatomical part, would have been the like in that also. Since it hath been our unhappiness to have that neglected, I hope it will not be ill taken if we that are Members of it do supply this defect by our own private Labours. This hath been already done by Mr. Clowes, Mr. Woodall, and some others, whose laudable Example I have adventured to follow, and to put my own Papers in print; that what was at first intended for my private satisfaction, may be useful to others as well as to myself. In doing this, Reader, I have made a virtue of necessity, and employed those hours for the public service, which a frequently-repeated Sickness hath for this twenty years' last passed denied me the use of in my private occasions. It hath pleased God by casting me into such a condition to give me opportunity of reading and thinking, as well as practising. Both which are necessary to the accomplishment not only of an Author, but indeed of a Chirurgeon. I cannot be so uncharitable to my Brethrens, as to wish them the like Sickness to oblige them to the like Retirements for contemplation and study. But I do hearty wish, that what was necessity in me may be choice in them, viz. that they would set apart some time for reflection upon their Labours, and for comparing the Empirical part of the Prefession with the Rational. They will soon found how many Gaps do still lie open in this goodly Fabric, and how much is wanting to make the Building complete. What defects do remain even in the History of Diseases themselves, and the plain practical things, wherein in every expert Chirurgeon can correct the Authors he reads? This well considered cannot but spur him on to add his Observations to the bulk of what hath been heretofore heaped up for this purpose, and to contribute his endeavours to the finishing of what hath been begun, and thus far carried on, by other hands. As to my own performance, Reader, I must tell thee, that what I have chief aimed at in this Book hath been, perspicuity and conciseness in the Institutionary part of the same, and aptness in the annexed Observations; that so the whole may be made easy to the young Chirurgeon, and as instructive as may be. In all which I doubt not but the farther he goeth on in practice, the more of clearness and plainness he will found; and the whole so much better performed than a mere Academic could have done it, without being a Practitioner himself, as a Traveller can describe a Country to one that is taking a journey into it more sensibly and usefully, than one that hath only read of it and seen it in Maps.  
Know, Reader, that as to these Treatises, though in preparation to them I have read all the eminent chirurgical Authors, yet in the writing of them I was more conformed to my own judgement and experience, than other men's authority. This will consequently make them liable to the Censure of many sorts of men. Such ancient Practitioners as are unwilling to be now learning a new Lesson, will be angry that those Definitions and Descriptions, and sometimes Methods of Cure, are receded from, which they learned when young; those being the basis on which they have built the whole superstructure of their Practice. I desire such men to content themselves with neglecting them; they being not written for their use, but for younger men, who have their Principles and Maxims of Chirurgery yet to choose. Others, wholly taken up with the Novelties wherewith this Age aboundeth, will be angry that all the new Notions are not here pursued to nicety, and many little both anatomical and Chemical Punctilios inserted and brought in on all occasions, in stead of the old way of expressing the Accidents of Diseases, with their Causes and Cure. I would have these men consider, that I am a Practiser, not an Academic: that I delight in those things as far as they are useful to life, but thought it too great a digression from my present purpose to stuff up a practical Book with such Philosophical Curiosities, which become it just as well, as it would become a Divine to fill a practical Discourse with School-distinctions.  
However, I resolving not to trust myself wholly with a case of this nice difficulty, did choose a Friend to whose Judgement I did permit the whole, I mean the Learned Doctor Walter Needham of the , who, upon perusal of my Papers, was pleased to approve of my intention, and withal to altar what he thought fit in them, and always to cut of the Theory, when it adventured upon controversial Discourses; still urging, that this was not intended for a Book of Controversy, but of plain Institution; not to make men subtle Disputants, but good Practisers. I do confess he did gratify my humour in it, whose inclinations lie wholly that way: But withal I made bold sometimes to please my own fancy, in not always following his advice, or obeying the Corrections he made. His pardon I easily got for so doing, he not affecting a Tyranny in Friendship: and I hope I shall thine, (Reader,) if among many things that are here delivered, thou findest some not altogether to thy palate. Let what thou dost found acceptable to thee in this Treatise excuse the impertinence of the rest.  
Thou art farther to be informed, that the writing of so large a Volume as thou now art presented with is but a late design, to which several of the particular Tracts, some of which were published four years since, others written about that time, did encourage me. One attempt drew on another, till at length it grew to the bulk thou seest. Which I do allege in excuse of the Method of this Book; which, if it had been all written at once, might have been contrived all into a piece. But the lesser Treatises being written before the greater, I was not willing to dismember them again, or to writ new Discourses on those Subjects which I had already handled fully. The young Chirurgeon will reap benefit by it, finding some of the most troublesome Diseases in Chirurgery treated of wholly under one view, which otherwise he must have found piecemeal delivered in several places. This Apology I chief made for the Treatise of the King's Evil, where many Diseases are discoursed of which other Writers handle in other places of Chirurgery. It is sufficient to say, that I think most instances of those Diseases to partake at lest of that Malady, if not entirely to be that: and therefore when I wrote the particular Treatise, it was fit to handle them there; and that being done, I saw no reason for taking them out again, to supply other parts of the Book.  
After all things are considered and weighed in this and other chirurgical Discourses that are public, and they compared with our success in Practice, we shall soon found cause of lamenting our own weakness and inability in the carrying on of so great a work, as the recovery of Mankind out of those many Distempers to which various Misfortunes, and many repeated successions of Intemperance, and other Accidents both without and within, have betrayed us for so many ages together. When the young Chirurgeon shall found the Cure easy in the Theory, and appear so at first in the Practice too, yet suddenly deceive him with a Relapse, and not only once, but often, delude his best endeavours: when the Bystanders and persons concerned shall begin to accuse him of Knavery in his proceeding, and think him to pull back a Cure, whilst he is only rolling Sisyphus his Stone, which will tumble down whether he will or not: He will than wish, that all other Practisers had done what I have in this Treatise, viz. recommended their Observations, both successful and unsuccessful, thereby increasing knowledge in our Profession, and leaving Sea-marks for the discovery of such Rocks as they themselves have split upon before. For my part, I have done it faithfully, and thought it no disgrace to let the world see where I failed of success, that those that come after me may learn what to avoid: there being more of instructiveness often in an unfortunate case than in a fortunate one; and more ingenuity in confessing such misfortunes which are incident to mankind, and which have attended all my Brethrens as well as myself, and will attend thee also, Reader, in spite of all thy care and diligence, if thou undertake the employment. Thou wilt also learn one necessary piece of Humility, viz. not to trust too much on thy own judgement, especially in difficult cases; but to think fit to seek the advice of other Physicians or Surgeons, whose long experience hath enabled them to assist thee in preventing the Accidents, and encourage thee to go on in the work, or forewarn thee of the danger. After thou hast thus defended thyself from the censure of Rashness, proceed boldly, and let thy sincerity in thy acting be thy warrant to hope for God's Bl●ssing on thy endeavours: and if th' see Papers prove any advantage to thee in them, remember with kindness the Labours of  
Thy Friend and Servant, Richard Wiseman. May 24. 1676.   

ERRATA.  

PAg. 41. l. 24. for his, read her.  
Ibid. l. penult. for cleansed, read dried.  
Pag. 144. l. 20 for betae, read cerae.  
Pag. 192. l. 29, 30. read, of Turbith mineral. the next day, and it gave, etc.  
Pag. 257. l. 19 read, balls. Peruvian.  
Pag. 266. l. 42. for modestly, read modishly.  
l. 45. for Dand, read Dacre.  
Pag. 272. l. 7. read, materia polenta.  
Pag. 276 l. 6. read, The other Strumae.  
Pag. 315. l. 5●. read, beaten to a froth with a piece of Alum.  
Pag. 327. l. 8. for siccat. read excortic.   
What other faults the Reader shall meet with, he is desired to amend and excuse.   

A TABLE Of the several TREATISES and CHAPTERS In this BOOK.  

TREATISE I. Of TUMOURS.  
CHAP. I. OF tumors in general. Page 1  
CHAP. II. Of humoral tumors in general. Page 3  
CHAP. III. Of Inflammation or Phlegmon. Page 14  
CHAP. iv Of tumors from Milk. Page 25  
CHAP. V Of Abscesses and corrosive Ulcers arising from distempers of the Vterus in Childbed. Page 29  
CHAP. VI Of an Erysipelas. Page 34  
CHAP. VII. Of a Furuncle or Boil. Page 42  
CHAP. VIII. Of Epinyctis and Terminthus. Page 44  
CHAP. IX. Of Inflammatory tumors of the Glandules. Phyma. Page 45 Phygethlon. Page 46 Bubo. Page 47 Parotis. Page 49  
CHAP. X. Of a Carbuncle. Page 52  
CHAP. XI. Of Paronychia. Page 55  
CHAP. XII. Of Pterygion. Page 59  
CHAP. XIII. Of Pernio. Page 62  
CHAP. XIV. Of a Varix. Page 64  
CHAP. XV. Of an Ecchymosis. Page 66  
CHAP. XVI. Of an Aneurisma. Page 70  
CHAP. XVII. Of an Herpes'. Page 77  
CHAP. XVIII. Of an Oedema. Page 81  
CHAP. XIX. Of a Scirrhus. Page 90  
CHAP. XX. Of Warts and Corns. Page 95  
CHAP. XXI. Of a Cancer. Page 98  
CHAP. XXII. Of Noli me tangere. Page 118  
CHAP. XXIII. Of Waterish tumors. Page 119 Hydrocele. Page 124 Hydrocephalus. Page 131  
CHAP. XXIV. Of Scabs and Itch. Page 134  
CHAP. XXV. Of Lepra or Elephantiasis. Page 138  
CHAP. XXVI. Of Gutta Rosacea. Page 141  
CHAP. XXVII. Of Flatuous tumors. Page 143  
CHAP. XXVIII. Of Hernia. Page 147   

TREATISE II. Of ULCERS.  
CHAP. I. OF Ulcers in general. Page 163  
CHAP. II. Of a Simple Ulcer. Page 168  
CHAP. III. Of Ulcers with Intemperies. Page 171  
CHAP. iv Of Ulcers with Pain. Page 176  
CHAP. V Of Ulcers with Fluxion. Page 179  
CHAP. VI Of Ulcers with Hypersarcosis. Page 182  
CHAP. VII. Of Ulcers with Caries in the Bones. Page 183  
CHAP. VIII. Of Ulcers with Callous Lips, etc. Page 189  
CHAP. IX. Of Putrid Ulcers. Page 190  
CHAP. X. Of Phagedaena, Nomae, Dysepulota. Page 193  
CHAP. XI. Of Ulcers with Varices. Page 200  
CHAP. XII. Of Sinuous Ulcers. Page 202   

TREATISE III. Of the Diseases of the ANUS.  
CHAP. I. OF Haemorrhoids. Page 211  
CHAP. II. Of Procidentia Ani. Page 219  
CHAP. III. Of Condyloma, Ficus, Thymi, etc. Page 222  
CHAP. iv Of Phyma. Page 225  
CHAP. V Of Sinuous Ulcers and Fistulae in Ano. Page 226   

TREATISE iv Of the KING'S-EVILL.  
CHAP. I. OF the Cure of the Evil by the KING's Touch. Page 245  
CHAP. II. Of the Definition and Causes of the Disease. Page 248  
CHAP. III. The History of the Disease, with the Diagnosticks and Prognostics. Page 250  
CHAP. iv Of the Method of Cure. Page 254  
CHAP. V Of Ophthalmia. Page 313 Lippitudo. Page 321  
CHAP. VI Of Aegilops, Anchylops, etc. Page 322  
CHAP. VII. Of the tonsils. Page 329  
CHAP. VIII. Of Ranula. Page 334   

TREATISE V Of WOUNDS.  
CHAP. I. OF Wounds in general. Page 339  
CHAP. II. Of Wounds of the Veins and Arteries. Page 353  
CHAP. III. Of Wounds of the Nerves, Tendons and Ligaments. Page 357  
CHAP. iv Of Wounds of the Face. Page 361  
CHAP. V Of Wounds penetrating the Oesophagus and Aspera arteria. Page 363  
CHAP. VI Of Wounds of the Limbs. Page 364  
CHAP. VII. Of Wounds of the Breast. Page 366  
CHAP. VIII. Of Wounds of the Belly. Page 371  
CHAP. IX. Of Wounds of the Head. Page 374  
An Additionall Discourse of Wounds of the Brain. Page 400   

TREATISE VI Of GUNSHOT WOUNDS.  
CHAP. I. OF Gun-shot Wounds in general. Page 407  
CHAP. II. Of the Cure of Gun-shot Wounds; and first, of Extraction of Bullets, etc. Page 409  
CHAP. III. Of Dressing Gun-shot Wounds after Extraction. Page 412  
CHAP. iv Of Accidents befalling Gun-shot Wounds, and of Sinuous Ulcers. Page 415  
CHAP. V Of Gun-shot Wounds with Fracture. Page 419  
CHAP. VI Of Gun-shot Wounds in the Joints. Page 429  
CHAP. VII. Of Gun-shot Wounds in the Belly. Page 431  
CHAP. VIII. Of Gun-shot Wounds in the Thorax. Page 434  
CHAP. IX. Of Symptoms of Gun-shot. Page 436  
An APPENDIX to the Treatise. Page 439  
CHAP. I. Of Burns with Gunpowder, etc. Page 440  
CHAP. II. Of Gangrene and Sphacelus. Page 443  
CHAP. III. Of Fistulae. Page 457   

TREATISE VII. Of FRACTURES and LUXATIONS.  
CHAP. I. OF Fractures. Page 463  
CHAP. II. Of Luxations in general. Page 478  
CHAP. III. Of Luxation of the lower Jaws. Page 482  
CHAP. iv Of Luxation of the Clavicle or Collar-bone. Page 484  
CHAP. V Of Luxation of the Shoulder. Page 486  
CHAP. VI Of Luxation of the Elbow-joynt. Page 491  
CHAP. VII. Of Luxation of the Carpus, Metacarpus, and Fingers. Page 493  
CHAP. VIII. Of Luxation of the Hip. Page 494  
CHAP. IX. Of Luxation of the Knee. Page 496  
CHAP. X. Of Luxation of the Ankle-bones. Page 497  
CHAP. XI. Of Luxation of the Spine. Page 498   

TREATISE VIII. (misprinted VII.) Of LVES VENEREA.  
CHAP. I. OF Lues Venerea. Page 3  
CHAP. II. Of the Remedies generally used in the Cure. Page 7  
CHAP. III. Of the Specificks in this Disease. Page 15  
CHAP. iv Of the Cure of the Symptoms. Page 19  
CHAP. V Of Gonorrhoea. Page 57  
CHAP. VI Of the ill Consequences of a Gonorrhoea. Page 66    

A TREATISE OF tumors.   

OF tumors. The First Book.  

CHAP. I. Of tumors in general.  
WHat a Tumour is (when we understand a Disease by the word) is so sufficiently explained by Galen, 
Definition.  that I shall not trouble myself with any farther disquisition about it. It is by him defined, A Disease in which the parts of the body recede from their natural state by an undue increase of their bigness.  
Now by what Names the Ancients did express a Tumour in general, many of which were afterwards appropriated to the particular Species of it, as Oedema, Apostema, Phyma, etc. I shall leave to the Critics and men of leisure to inquire: it shall suffice me, that my Definition tells you what I mean.  
The Causes of tumors are variously delivered by sundry Authors, 
'Cause of tumors.  with a larger repetition of which I shall not here trouble you. What my own thoughts suggest to me out of them upon this subject is this in short, viz. that they must be considered either with regard to their Time and Place, or to the Matter of which they consist.  
I. In regard to their Time and Place we call them, 1. Antecedent, 2. Conjunct.  
1. By an Antecedent 'Cause I mean that which yet hath not actually produced a Tumour, but is throughly mixed with the Blood, 
Antecedent.  or otherwise lodged in some convenient place where it is not troublesome to nature, at lest not to this Part; though it have a great inclination to be so, and, if not prevented, doth produce the feared effect. Of this sort I reckon all Impurities in the Blood which do not yet start out into the solid parts: as the Matter of an Erysipelas, Phlegmon, Parotis, Bubo, etc. before a Crisis is made; so also any Tumour in the body, which, lying in any part of it, is apt to be translated to another. This, though it may be the conjunct cause of the Tumour of the part where it is now lodged, is the antecedent cause of that Tumour which it raiseth in another place, to which it may be after derived, etc.  
2. By a Conjunct Cause I mean the very Matter of the Tumour that is already impacted into the part, by others called the causa continens: 
Conjunct.  upon the increase of which the Tumour increaseth; on the diminution of it it diminisheth.  
II. In regard of the Matter of which they are made, we do usually attribute their Original to, 1. Humour, 2. Wind, 3. the Interposition of a solid Body.  
First, 
Humour: by Fluxion;  Humour produceth Tumour by, 1. Fluxion, 2. Congestion.  
1. Fluxion is the sudden motion of Humours in the body to any part, and commonly depends upon one or more of these following causes: 1. the part transmitting; 2. the part recipient; 3. the condition of the Humour.  
(1.) The part transmitting doth cause sudden Fluxion, when, being itself strong, it is provoked by the heat, sharpness, quantity, or other fault of a Humour, and, being so provoked, translates it to some weaker part, whether external, or internal. This is most evident in the Crisis of Fevers, from which the Humour is often discharged inwardly by the way of Phlegmon upon the inward viscera; or outwardly in the form of an Erysipelas, Bubo, Parotis, Carbunculus, etc.  
(2.) The part recipient is the Cause of tumors either, 1. passively, or, 2. actively.  
1. Passively, when it receives Humours, and cannot expel them: whether it be through its weakness, laxity of Pores, over-widenesse of Vessels, as in a Varix; or their too great straightness or obstruction, its position in a declining part, or its being disabled by external accidents, as Bruise, Fall, etc.  
2. Actively, when it attracts Humours to itself: either, 1. through heat, whether created by Humours already flowed, or by hot Medicines, blistering Plasters, the Sun, Fire, Cupping-glasses, etc. or, 2. pain from corroding Medicines, wounds, bruises. I know this latter Head of Attraction may be quarrelled at by some, who will reduce all Attraction to Pulsion, and so tender other reasons of these accidents: But that troubles not me, who handle the notion in a practical way, leaving the speculation to curious men.  
(3.) The condition of the Humour is the third and, indeed, great Cause from which tumors do arise: in the explaining of which we must consider either the Plenitude of Vessels, or the Impurity of the Humours themselves.  
1. The Plenitude of Vessels, otherwise called Plethora, when it happens, causeth an Extravasation of blood, either by Ruption or Apertion of them: either of which, if they fall inwardly upon the Brain or some noble part, are of great danger; as in Apoplexia, etc.  
2. Impurity or Cacochymia (to which some will also reduce Plethora) is a Degeneration of the Humours into a preternatural state, from which Degeneration a multitude of Diseases do arise.  
2. 
by Congestion.  Congestion is than said to be the Cause of a Tumour, when the growth of it is slow and without pain, it commonly owing its original to a fault of Concoction in the Part, or at lest a weakness in the expulsive faculty; sometimes also to the want of heat, and the density of the skin, which hinders perspiration. These tumors are generally cold, whereas those made by Fluxion are most frequently hot. The Matter of these is either thin and serous, or thick and phlegmatic, or apt to coagulate and grow hard, as many scirrhous tumors and Exostoses, or made up of nutritious juices, as Sarcoma, Hernia carnosa, etc.  
Secondly, 
Wind.  As Humour, so Wind begetteth tumors: which though it seldom appeareth alone, but usually mixed with some Humour which is the cause of it; yet getting predominancy it denominateth tumors, and is called Emphysema.  
Thirdly, 
Interposition of a solid Body.  The Interposition of a solid Body is frequently the Cause of a Tumour; as in the Hernia intestinalis, zerbalis, Exomphalos.  
Now from the variety of these Causes ariseth a great variety of tumors, which do receive their several denominations from them.  
I shall not trouble you with all the several divisions and enumerations, which, according to Sennertus' Arithmetic, make 226 in all: but I shall briefly instance in these following Heads, to which the rest may without difficulty be reduced.  
1. The Blood itself is the matter of many tumors; and that two several ways.  
(1.) When the serum is so extravasated as to carry something of the read or grumous part with it into the Tumour. In which case we found the Inflammation or Phlegmon, and the consequences of that, viz. Gangraena, or Sphacelus of which we have treated elsewhere: also Erysipelas, Furunculus, Epinyctis, Tereminthus, Phyma, Phygethlon, Bubo, Parotis, Carbunculus, Paronychia, Pernio, and Pterygion.  
(2.) When the whole mass of Blood is so driven into a Tumour, as that the grumus is either principally concerned, or at lest equally mixed with the serum. Examples of this are Varix, Ecchymosis, Aneurisma.  
2. From Choler proceedeth Herpes'.  
3. From Phlegm, Oedema.  
4. From Melancholy, Scirrhus.  
5. From Atra bilis, Cancer, etc.  
6. From waterish Humours, Hernia aquosa, Hydrops, Hydrocephalus.  
7. From salt Humours, Scabies, Lepra, etc.  
8. From Wind, Emphysema.  
9 From interposition of a solid body, Hernia.  
I have thus cursorily given you a summary view of the chief Heads of Discourse which are usually handled by our Chirurgical Writers, as a Preparatory to what I myself have to say. And first we shall treat of Humoral tumors in general, descending from thence to as many of the Particulars as will be necessary for the Instruction of the young Artist.   

CHAP. II. Of Humoral tumors in general.  
THe Causes of these tumors have been sufficiently handled in the First Chapter, where we have discoursed how tumors from Humours are produced: I shall here discourse the Diagnostic, Prognostic, and Cure.  
If a Humoral Tumour be made by any external Cause, as by a Wound, 
Signs.  Bruise, etc. it is easily discerned: but if there were no such preceding Cause, you may conclude that it ariseth from within. In this latter case you may judge whether a Tumour be made by Fluxion or Congestion thus.  
That which is made by Congestion riseth gradually, 
tumors by Congestion.  and is collected into a compact Tumour without any preceding cause or sign of Fluxion, and is made with little pain, unless it begin in the Joints, or parts of exquisite Sense. And than also in little Children the Tumour is some times made before it is discovered, and supposed a luxation of that Joint, the Skin retaining its natural colour: yet as the Tumour increaseth, the veins are frequently swelled in the surface of it, and as the Matter makes its way outward, if some times inflames and becomes painful.  
If the Tumour be made by Fluxion, the part is affected with pain, 
tumors by Fluxion.  and swelleth suddenly, and is accompanied with Tension, Pulsation, and Fever. Now when the Tumour appears either before or with the Fever, no other Disease having preceded it, this is to be called Fluxion in the strictest sense of the word. But there are two other sorts of tumors reducible to Fluxion, and those are made by, 1. Translation, 2. Attraction.  
First, 
tumors by Translation.  The Translation of an Humour, in the sense I here mean it is, is that sort of Fluzion which happens from within upon the Crisis of some foregoing Disease; which though it be really Fluxion, yet it differs from that which is strictly so called by these circumstances. 1. In Translation another Disease preceded; in this, none at all. 2. In Fluxion, strictly so called, the Skin is first affected, and by degrees the neighbouring parts; in Translation it is affected last, the Matter working itself from within outwards, insomuch that you may found Matter in the Tumour before the Skin is much changed. 3. In Translation there is often a real Extravasation of the serum of the blood between the Interstices of the Muscles, which falleth from some higher place; nay, Pus itself may be bred above in some inward Cavity, and fall down thither actually form before the Tumour gins: which is quite otherwise in Fluxion strictly so called.  
Secondly, 
tumors by Attraction.  The other sort of tumors reducible to Fluxion are those that are made by Attraction: which if they do hap, some of the visible Causes mentioned Chap. 1. did precede.  
tumors made by Fluxion have their several degrees and times, 
Times of tumors made by Fluxion.  as their Beginning, Augment, State, and Declination. Their Beginning is with the extension of the part affected: the Increase, when it riseth into a conspicuous Tumour, and is than accompanied with Symptoms increasing accordingly: the State is when the Tumour is made, and the Symptoms at the highest: the Declination is when the Tumour becomes lesle, and the Symptoms abate.  
The Prognostics of tumors in general are taken from the Part affected, 
Prognostics.  as it is of more excellence and use; also as it is internal, or external. By how much the more noble the Part is, by so much the more dangerous. The internal more dangerous than external. Prognostics are also taken from the greatness of the Tumour, and Accidents that attend it; and from the quality of the Humour that raiseth it, whether hot or cold, thick or him, malign or benign: for according to these circumstances the Cure is more or lesle difficult.  
The manner of its Termination is to be considered: whether by Discussion, viz. insensible Transpiration; or Suppuration, i.e. the converting the Humour (which raised the Tumour) into Matter; or by Corruption, when the part affected is overcome by the ill quality of the matter, and putrefies; or by Induration, when the Tumour is hardened, and the Symptoms of pain diminished; or by Retraction, when the Tumour suddenly disappears, going back into the Body.  
All tumors which own their original to Humours terminate one of these five ways.  

1. 
Signs of Discussion.  The Signs of Discussion are the Relaxation, Diminution, and ease of the part, without Suppuration.  
2. 
Of Suppuration.  The Signs of Suppuration are Pain, Pulfation, etc. with Fever, according to Aphor. Hipp. Dum Pus conficitur, dolores ae febres accidunt. But the Matter being made, those Accidents cease, and the Tumour riseth in a Cone, and appears whitish: also the Matter fluctuates under your fingers. Yet it frequently happens in crude tumors, and those that lie deep amongst the Muscles, that Matter is not so easily discovered.  
3. 
Of Corruption.  The Signs of Corruption are a livid or blackish colour of the part affected, together with a sinking of the Tumour.  
4. 
Of Induration.  The Signs of Induration are, Diminution of the Tumour and Pain, with increase of Hardness.  
5. 
Of Retraction.  The Sign of its Retraction is, a sudden disappearing of the Tumour without Discussion or Suppuration: which, if it be from an inward cause, is always evil, and there ariseth Fever, (if there were none before) together with grievous Symptoms from the return of the Matter.   
In the Cure of tumors two things are chief to be considered: 
Cure.  1. the nature of the Part; 2. the nature of the Tumour.  

I. 
Things to be considered in the Part.  In the Part itself we are to consider, 1. its Temperament, 2. its Conformation, 3. Situation, 4. Sense, 5. Use. 

1. In Temperament, some are hot, as the Muscles; some cold, as the Tendons, Glandules, and other exanguous parts. Some are moderately moist in themselves, and require to be treated with Medicines of the like nature, such as are neither violently drying, nor too much moistening, as the Fleshy parts: others dry in themselves, yet requires exiccants; as Bones: others again overwhelmed with perpetual Moisture, by reason of their situation and spongy substance; as the parts about the Anus, Vterus, Axillae, Inguina, etc.  
2. Conformation of the Part regards either its outward Figure, or inward Composition: which latter may consist of several other lesser, whether similar or organical; as a Thigh, of Bone, Muscles, Veins, Arteries, Nerves, Membrances, etc. all which are duly to be considered, that so the nature of the Fluxion, the Vessels that feed it, the disadvantages or advantages of the Part, the best way of Revulsion, Discussion, etc. may be the more readily suggested to the fancy. We may also thereby be informed what Cavities or Interstices may be there for the receipt of Humour; and how great the degeneration is from the natural state or figure.  
3. Situation of the Part is of great importance: which, if it depend too much, must of necessity be raised; otherwise the Fluxion will be increased. Therefore if it be a Hand or Arm, it must be raised to the Breast; if a Leg, it must be laid on a Bed, Stool, or the like.  
4. The Sensibleness of Parts is of much moment in the Cure of tumors: which, if they light upon such as are of over-acute sense, produce exquisite torments, such as require often a more peculiar care of the Chirurgeon than the Tumour itself. Also its neighbourhood to such a place obligeth us to prevent its reaching to it.  
5. The Use of a Part, as it is more or lesle noble, is very much to be attended: whether it be of immediate importance to Life, as the Liver, Brain, Lungs, Heart, etc. or to great and noble uses; whether of sense, as the Eye, Nose, Ear; or of common excretion, as the Bladder, Anus; or of generation, as the Testicles, Vterus, etc. Of all which Circumstances great care is to be had, that they may be treated accordingly.    
II. 
Things to be considered in the Tumour.  Having thus considered the nature of the Part, you are next to attend to the Tumour it slf, both as to its Time and other circumstances. As to its Time, if it be already in the State, you have no more to do but to regard the conjunct cause, viz. the Matter already lodged there; the due removal of which sufficiently disposeth it to Cure: but if it be only beginning, than the antecedent causes are to be likewise considered, and to be removed out of hand; the Fluxion to be checked by evacuation of the Humour, by bleeding and purging, or by revulsion, derivation, interception, repulsion, discussion, etc.   
These several intentions will best be judged of by viewing the quality of the Tumour. If it be hot, and made by Fluxion, than it is to be treated by the aforesaid Method. If it be cold, and made by Congestion, than purging only with resolvents, discutients, and strengtheners of the Part, are to be made use of. Where the tumors are mixed, the intentions of Cure aught to be so too. Where Attraction is the cause of Tumour, the cause of the Attraction aught to be removed; whether it be too much heat, drawing Medicines, blistering Plasters, or the like. All which things as they will be sufficiently handled in the Particulars when we come to them; so it will be much for the advantage of the young Artist, if we do here say something of them in general.  
Now since tumors caused by Fluxion are like to employ the former part of this Treatise, I shall begin with those, and consider them in their several estates, of Beginning, Increase, State, and Declination.  
In the Beginning I have already told you of Bleeding, 
Bleeding.  which potently checketh Fluxion, and aught to be proportioned to the greatness and violence of the Disease. In tender bodies and small tumors the evacuation needs not be much: but if otherwise the Fluxion be great, and the body strong, we must take away large quantities.  
Besides Bleeding, 
Purging.  evacuation by Stool will be requisite: and, indeed, immediately before or after bleeding a Clyster or some other Lenitive aught to be exhibited. Nor is that to be rested in, but further purging, either by milder or stronger medicines, to be attempted, suitably to the condition of the Patient. It is true that in hot tumors there may seem to be only a Plethora, which notwithstanding will require evacuation by purging as well as bleeding; it being seldom found that a Tumour is caused by a mere Plethora without Cacochymia; which Cacochymia, if it doth not precede the Tumour, certainly accompanieth it, (as will be made more manifest when we come to treat of particular Heads) and therefore requires the method now mentioned.  
Lenitive Purges are Sena, Rhubarb, Cassia, Tamarinds, Manna, with Cremor Tartar, Electuar. lenitiv. Diaprun. lenitiv. Diacass. cum manna, syr. rosar. solut. syr. de Rhabarb. etc. which is as high as we aught to go, if the Humour be hot. In cold ones stronger Catharticks are advisable: of which more anon.  
These two are premised in regard of the antecedent cause: but that is not enough, unless the conjunct cause be also removed; which, being the very matter of the Tumour, admits of several intentions. They are reducible to these two Heads.  

1. Translation to some other Part in the body: which is performed by, 1. Revulsion, 2. Derivation, 3. Repulsion.  
2. Evacuation out of it: and that is obtained by, 1. Discussion, 2. Suppuration, 3. the Discharge of the matter by Apertion.   
Translation, 
Revulsion.  and, 1. by Revulsion, is chief intended for the defence of some noble Part which is endangered by the Tumour, or else for the lessening of the Matter when it is excessive. This intention regards as well the antecedent cause as the conjunct. The antecedent, when by Venaesection, Cupping-glasses, Leeches, etc. the whole mass of Humours is diminished: of which already. The conjunct, when the Tumour itself is lessened, or quite taken of, by translating it either into the mass of Blood, or into some other remote Part.  
The former of which is often very innocently done in the beginning of a Tumour, whilst the serum is yet only extravasated, and not otherwise altered in its quality; so that being remixed with the mass, it is capable of Concoction, and consistent with the health of the Patient. The latter is, when by Cupping, Blistering, Ligatures, Frictions, or the like, we raise a Tumour in the contrary part, and give Nature occasion of discharging the Matter in a place far distant, which otherwise she would have lodged here: in doing of which she often sucketh in the Humour again which she had before separated into the former place.  
2. 
Derivation.  Derivation differs from Revulsion only in the measure of the distance and the force of the Medicines used. If we draw it to some very remote, or, it may be, contrary part, we call that Revulsion: if only to some neighbouring place, and by gentle means, we call it Derivation.  
3. 
Repulsion.  To the making of either of these effectual Repulsion is also necessary. For Humour that is already impacted will not so easily be drawn out by former remedies, if something be not applied to the Part to drive it back.  
These Medicines are all astringent more or lesle. The milder sort of them, which are the most usual in all hot Inflammations, as Lettuce, Purslane, Navel-wort, Plantain, Bramble-tops, read Roses, Knotgrass, Horse-tail, House-leek, and, where the pain is more vehement, Poppy, Mandrakes; these may be applied liquid, or in the forms of Liniments, Cerots, Cataplasms, or Emplasters: of which this Book will give you examples. The more astringent are Pomegranate rinds and flowers, Medlars, Quinces, Sloes, Acorns, Cypress-nuts, Mulberries, Sumach, , sanguis draconis, Vinegar, read Wine, etc. Compounds of both sorts are, Ol. omphacin. ol. rosar. unguent. rosar. popul. album, unguent. nutrit. cerat. refrigerans Galeni, Empl. è bolo, de minio camphorat. oxycratum, oxyrrhodinum, oxelaeum. ℞ succi solani, plantag. sempervivi, an. ℥ ij. aceti optimi ℥ i ss. mucilag. sem. psyllii, cydon. extract. cum aq. rosar. an. ℥ j Misc. in which you may dip , and apply them to the Parts affected, renewing them often; or you may add to it pulv. gland. flor. ros. rub. ballast. an. ℥ ij. Bol. armen. ℥ iij. olei myrtillor. unguent. rosatis, an. q.ss. fiat mixtura. Apply it in the form of an Emplaster over and about the diseased Part.  
Concerning these foregoing Medicaments it is to be cautiously observed, 
Cautions.  1. That they are proper only in the beginning of the Tumour, whilst you intent to prevent it by driving it quite back into the Blood again. For if the Humour be so impacted as not to be repellible, but that is must have its evacuation in the place by Suppuraiton, than if by bleeding you hinder concoction of the Matter, you prolong the Disease; Nature in that case wants all its heat and all its serum. Much more do you hurt it if you use Repellents, which, being commonly cold and astringent, do close up the Pores, and keep out both the natural heat and the serum of the blood, the affluence of which and its mixing with the Humour is necessary to the dilution and the digestion of it; so that both being hindered, the Part will grow livid and mortify.  
2. Caution is to be used in the application of these Medicines where the Tumour is malign, or the Crisis of a malignant Fever: for in all such cases the Retraction into the blood is of very dangerous consequence: wherefore we than rather use Cupping-glasses and other Attractions to draw it out.  
3. It is to be noted that these Repellents are often applied above the Tumour, as defensatives or intercipients: in which case they have regard to the antecedent cause, and in a strict discourse should have been handled under that Head; but I rather accommodate myself to the method of Operation.  
Evacuation is necessary for the discharge of that Matter out of the body by some more immediate way, which either cannot, or aught not, by the former intentions be driven back. Now that is of three sorts.  
1. 
Discussion.  Insensible, by Discussion or Resolution; which is nothing else but a breathing out the Humour by insensible transpiration. Therefore the Humour so to be discharged aught to be thin, and the skin lax and rare: for if it be otherwise, or lie deep amongst the Muscles, it will not easily yield to Transpiration. The Medicaments called Discutients aught to be hot and of a subtle quality, powerfully penetrating: which quality renders them improper to be applied in the beginning of Inflammations; (for thereby the Part would be too much heated, and consequently the Tumour made great;) but they are proper being mixed with Repellents: in the beginning of the Augment, when the Tumour is hard, and not fit to be treated longer with Repellents alone.  
These Medicaments are to be proportioned as the Matter and conformation of the Part requireth. 
Discutients and Emollients.  The milder are emollient and rarifying, proper in soft bodies where there is Inflammation with hardness: and they are Radices & folia althaeae, malvae, violar. sem. lini, foenug. flor. chamaemel. meliloti, sambuci, far hordei, lentium, orobi, lupinor. wihch may be made up in Cataplasms with some of these following, which are of the same quality, viz. salad-oil, butter, axung. porcin. anseris, anatis, gallinae, sevum ovinum, vitulinum, vaccinum. The more recent these Fats are, the more emollient; and the more rancid, the more discutient. Mel and cera are reckoned amongst the Discutients: also ol. cham. lumbricorum, sambuci, lini, irinum, etc. Empl. diachyl. simple. cum gummi, ireatum, de mucilag. de meliloto, etc. The milder Discutients mixed with Repellents may be thus made: ℞ fol. & rad. althaeae M. j flor. cham. M ss. coq. in sero lactis, & fiat cataplasma S. A. addendo in fine coctionis ol. ros. & cham. an. q. s. Or, ℞ fol. malvar. parietariae, plantag. an. M.j. sem. lini, foenug. an. ℥ j summitat. absinthii, florum sambuci, an. M ss. flor. ros. rub. M.j. coq. in ss. q. vin. tenuis, addendo farinae hordei ℥ iiij. & ol. olivar. immatur. q. s. fiat catapl. S. A. As the Humour discusseth, you may foment it with a Decoction of summitat. absinth. flor. cham. ros. rub. ballast. bacc. myrtill. or the like, in wine and water, by which you may dry up the remaining Matter, and strengthen the relaxed Part.  
In tumors where the Matter lieth deeper, ℞ rad. althaeae, ebuli, irid. recent. an. ℥ ij. rad. bryoniae, cucum. agrest. an. ℥ i ss. flor. cham. meliloti, summitat. anethi, an. M.j. sem. lini, foenug. an. ℥ j fiat catapl. S. A. addendo axung. anseris, anatis, an. ℥ j mell. come. ℥ ij.  
These following are yet more attenuating, and proper in crude tumors: summitates origani, thymi, calaminth. pulegii, rorismarini, hyperici, centaur. min. bacc. lauri, juniperi, sem. cymini, rutae, etc. Gumm. galbanum, ammoniac. bdellium, opopanax; also sulphur viv. alumen, calx lota, sal nitri, cineres ligni quercini, sarmentor. vitis, brassicae. The compounds are, ol. scorpion. nardin. euphorbium, petroleum, oleum philosophor. unguent. aregon, martiat. Empl. de ranis cum & sine Mercurio, Empl. diasulphuris, de baccis lauri, cicutae cum ammoniaco, etc. The Matter may also be disposed for resolution by such like Fomentation: ℞ rad. enulae campanae, bryoniae, an. ℥ ij. summitat. pulegii, origani, scabiosae, abrotoni, an. M. j bacc. lauri, juniperi, an. ℥ j sem. cymini, ℥ ss. coq. in aqu. font. & vin. alb. an. lib. ij. colat. add aceti vin. ℥ ij. salis nitri ℥ j Misce. ℞ salis, nitri, ciner. sarmentor. an. ℥ j ol. vet. ℥ vj. cerae ℥ iij. terebinth. clarae ℥ j fiat Cerat. If the Matter be so gross and viscid as it yields not to the Remedies above prescribed, it may be reasonable to attempt it by Suffumigation with vinegar sprinkled upon the lap. pyritis, which sometime disposeth them well to Discussion. 
Caution.  But in the use of these stronger Discutients you are to be careful, that whilst you endeavour Resolution, you do not breathe out the thin Humour, and fix the more gross, and so tender the Part scirrhous.  
2. 
Suppuration.  If after the use of the milder Discutients proposed in hot tumors the Symptoms of pain and inflammation do not lessen, you shall than forbear the farther use of Discutients, and hasten Concoction or Suppuration; which is indeed the work of Nature, by the benefit of whose heat the Humours are digested, and pus generated. If the heat be strong, the Matter is for the most part well concocted; and being so, it is white and of good consistence, and not ill scented: but if the heat be weak, the Matter is otherwise. It is therefore our work to cherish and increase the native heat in the affected Part, to perfect its Concoction: and that is furthered by hindering Transpiration, and defending it from outward air; also by proportioning the quality of the Medicaments to the temper of the Part, and quality of the Tumour. And forasmuch as our natural heat is temperate and moist, such also aught the Medicaments to be: they aught also to be emplastic. Yet it is not unfrequent to see a Suppuration made accidentally by cold Medicaments, which by a light, gentle astriction of the Pores do perform the office of Emplasticks; as Vnguentum album, Sorrell roasted in embers. Nay, in cold tumors I have seen Suppuration caused by the stronger Discutients.  
tumors do suppurate sooner or later according to the Humour of which, or the Place in which, they are generated. Those which are of Blood, and in Fleshy parts, do easiest come to maturity. Those which arise from other Humours, and are near or in the Joints, or Parts endued with little heat, (especially those contained in a Cystis) do difficultly suppurate.  
The Matter differeth according to the variety and mixture of the Humours. Of Blood always proceeds laudable Matter, especially if the native heat be strong: but if other Humours be mixed with it, as they get predominancy, so is the Matter more or lesle crude. In Furuncles or Boils it is clammy, and not unlike pith.  
In Abscesses made by Translation the Matter is purulent, sometimes white and well-coloured, other times partaking of a yellow or green, sometimes of a brown colour; and is more or lesle foetid according to the time it hath there remained.  
tumors made by Translation have sometimes Matter in them from their first appearance: but it being commonly lodged deep under the Muscles, the Matter is not felt till it hath raised the Tumour; which is not done without pain, pulsation, etc. as in a Phlegmon, but deeper, and doth not affect the skin with Inflammation till the Matter reach near it. In these tumors we do not attend the Symptoms of Suppuration, but open them as soon as any quantity of Matter offers itself. Whilst the Matter is making, the native heat of the Part is to be preserved and increased by Medicaments which may alleviate the pain, and further concoction.  
Suppuratives are of two sorts: 
Suppurative Medicaments of two sorts.  some are simple, others are compound. The simple are Aqua tepida, with which if you foment the lesser Phlegmons, it will suppurate, (and sometimes by continuing its use it will discuss them, where the Matter is not fit for Suppuration.) Hydrelaeum moderately heats and digest. Oleum maturum cherisheth the native heat, and supples and concocts Matter. Butter is maturative, and is profitably mixed with Anodynes and Suppuratives, especially in soft delicate bodies. Oesypum is also maturative; and so are the Fats of all domestic Creatures. Fol. malvae, viol. parietaeriae, mercurialis, brancae ursinae, decocted in hydrelaeo cum farina tritici, butyro, & vitellis ovorum, are Suppuratives. A raw Onion is sharp and biting; but roasted under embers loseth its acrimony, and suppurates tumors that are difficult to digest. The Lilly-root is a known Suppurative. Out of these Simples Cataplasms are made: as, ℞ radic. althaeae, lilior. albor. an. ℥ ij. fol. tussilag. malvae, bismalvae, an. M. j coq. in brodio, terantur, adjectis far. sem. lini ℥ j far. tritici ℥ ij. axung. porcinae, butyri rec. an. ℥ i ss. croci pulv. ℈ ij. vitello ovi unius; Misc. fiat Cataplasmae. In cold tumors, or where the Matter lies deep, ℞ radic. bryoniae, lapathi acuti, an. ℥ ij. coq. & cribrentur per setaceum, addendo cappar. & allior. sub cineribus coctorum an. ℥ iij. fermenti acris ℥ ij. pulv. sem. lini & foenug. an. ℥ j tritici ℥ ij. axung. porcinae ℥ ij. mell. come. axung. anseris ℥ j croc. pulv. ʒ j Misc. Where the Matter is tough, gum. galban. ammoniac. bdell. Empl. de mucilaginibus, etc. The Tumour being suppurated, be the Matter what it will, the evacuation of it is necessary, jest it corrupt within, and corrode the Veins, Arteries, Nerves, Tendons, or the Bone, if it lie near one: in which cases it is lawful to open it before the Tumour is all suppurated. So also in the Joints, and in the Head, if the Abscess lie over the Sutures: likewise in Abscesses in ano, where, through the weakness of the Part, a putrefaction is apt to follow; or in the fauces, where the neighbouring parts may suffer by consent, and the Patient be in hazard of strangling. In these cases we wait not for perfect Suppuration, but by deep Scarification discharge the serous blood, and prevent an Abscess. There is also care to be taken in Abscesses of the Breast and Belly, where the Matter is in danger of breaking inwards. Yet by opening these too soon they sometimes apostemate again, or become crude, and difficult to digest and cure.  
3. 
Two ways of Opening. Incision.  The way of Opening them is twofold; by Knife, or Caustick. They are of use according to the place that is affected, and the quantity of Matter which is to be discharged. In the Face, where the Cicatrix may be unseemly, Incision of them is best: but in large Abscesses, where the quantity of Matter is great, or where we would keep the Abscess long open, or in a place where Bandage cannot be made to retain the Tent in, there a Caustick is most proper. Authors do not generally approve so well of the Caustick; yet Sennertus proposeth it in a Hernia aquosa, where it is lest safe: for in truth those cold tumors do especially require to be opened by Incision; yet when the habit of body hath been tolerable, I have in that also used the Caustick with good success, as I shall show in the Cure thereof, and do commend it in the opening of large Abscesses as most safe and easy, the Matter being thereby discharged plentifully. And if the Caustick be applied in the declining part, the Abscess is sometimes near cured before the Escar separates, (if the Matter be not contained in some peculiar Cystis) and that without dilatation or Tents. 
Caution.  Yet you aught to be wary how you make fontanelles with them in hydropic or very fat people, by reason of the weakness of their natural heat.  
Of Caustics there are various sorts; 
Caustics.  as of the lixivium saponis, cinerum sarment. vitis siliquarum fabar. etc. boiled to a solid consistence: or in the boiling you may add to them vitriolum Roman. pulver. from ʒ j to ʒ ij. also opium ℈ ij. to ℥ vj. of the lixivium: or by a mixture of calx viva & lixiv. saponis you may make a Caustick. These are the stronger sorts in use amongst us: not but that there are Caustics made with Arsenic, etc. but, unless it be in great Sarcomata or such like, I use only a mild preparation of calx viva with a little common soap, and a third part of the Caustick-stone. In children and tender soft bodies I often use calx viva made into paste with a little black soap. In these two latter there is no fear of their spreading; a Pledgit of dry Lint and an Emplast. diachalciteos, or the like, is sufficient defence, leaving them on till the next morning. 
Caution.  But in the application of the stronger Caustick there is more caution required. Those we endeavour to keep within compass by small snips of Emplast. hoping thereby to defend the parts about: but, in spite of all our endeavours, they will spread farther than was designed, if they lie any while on the Part out of our sight. For though the Part be outwardly defended with Emplasters, they will found a way under the skin, or at lest under the cuticula, to spread, according to the quantity of the liquid salt in the Caustick. They do your work in lesle than an hour.  
The Escar being made, you may divide it, and stupe the part affected with wine or milk, and dress it up with unguent. busilicon dipped in ol. lilior. warm, applying an Empl. diachalc. simple. dissolved in some of the same oil to the consistence of a Cerat: or apply an anodyne Cataplasm, and bind it up.  
In the opening an Apostem by Incision, you aught to take care that the Apertion be made in that place where the Matter is most contained, the skin being for the most part thinnest there: and if it be not the most declining part, yet you may draw your knife towards it, for the more easy discharge of the Matter, than that the Incision be made according to the rectitude of the Fibres. If it be in the Groin or Armpit, it aught to be obliqne: in other parts make it according to the length of the member.  
In making the Incision you are to avoid wounding the Vein, Artery, or Nerve: nor must you discharge the Matter at once, especially in great Abscesses, jest you over-weaken the heat of the Part, or cause fainting.  
The Instruments proper in opening Apostemations are made choice of according to the Part that is affected, and the greatness of the Abscess. Ambr. Parey proposeth some whereby you may more covertly open them: but we make use of Lancet or Knife, of which our Instrument-makers furnish us with choice. If the Fauces be affected, the Handle of your Knife aught to be long, and the Blade short; some thereof crooked, and cutting on one or both sides. Your Instruments aught to be kept clean, for your credit; and sharp, that you may perform the work with lesle pain.  
The Incision being made, the Accidents or Symptoms that attend it are to be removed. In the first place the Bleeding is to be restrained, if any such hap, (which is very rare) with pulv. Galeni ex thure & aloe mixed cum albumine ovi. How you shall dress it if opened by Caustick, I have already shown you.  
Fainting, 
Fainting.  which sometimes happeneth through weakness or timorousness in the Patient, may be relieved by laying the Patient upon his back, and sprinkling a little cold water on his face. But if the Fainting proceeded from some preceding sickness, and is continued by the greatness of the evacuation and noisome corrupt Matter, you shall in such cases provide some cordial Juleps or Electuaries, of which he may take at pleasure. As, ℞ spec. diamarg. frig. ʒ ss. confect. alcherm. ℈ j syr. è succo citr. Rhaead. an. ʒiij. aq. melissae, buglossae, cinnam. hordeat. an. ℥ i ss. Misc. Or, ℞ confect. de hyacinthoʒ ss. syr. garyophyll. rubi Idaei, an. ʒiij. aq. dracontiis, card. benefict. Stephani, an. ʒi ss. Or, ℞ cons. borrag. melissae, court. citr. conduit. ros. rub. an. ℥ j rad. ering. conditae, nucis mosoat. conditae, an. ʒi ss. spec. aromat. rosat. ʒij. confect. alcherm. ʒiij. ol. cinnam. gut. iv. cum syrupo de court. citr. q. s. fiat Electuarium. Of which the Patient may take a morsel any hour in the day. Mithridate and theriaca Veneta are proper in such cases alone, or mixed with cons. lujulae, or any of the forementioned Syrups or Conserves.  
The spirits may also be refreshed with Epithemata made up of some of the aforesaid distilled Waters and cordial Species with acet. ros. etc. which for want of a Physician you may prescribe.  
You are in the next place to consider the Abscess, whether after the evacuation of Matter there remain nay considerable hardness, either by reason that the Tumour was not enough suppurated, as in large Abscesses it frequently happens; 
Fomentation.  or that it be affected with pain and inflammation. Therefore at your next dressing it may be reasonable that you have a Fomentation ready of summitat. malvae, bismalvae, flor. cham. summitat. absinth. out of which a Stupe may be wrung, and applied over the Abscess, to give a breathing to it, and you leisure to consider how to dress it.  
If it was opened by Incision, 
Digestion.  it requires Digestion; to which purpose this may be proper: ℞ terebinth. ℥ j far. triticiʒij. croci pulv. ℈ j vitell. ovi q. s. Misce. But if the lips of the Ulcer be painful, a little of the Yolk of laid Egg with ol. ros. upon a proportionable Tent may be sufficient, and an Empl. of diachyl. simple. with a mixture of unguent. dialthaeae applied in the form of a Cerat: or, in case of pain and hardness, this; ℞ mucil. sem. lini, foenug. althaeae extract. in decoct. hordei ℥ ij. olei lilior. oesyp. amygd. dulc. an. ℥ i ss. terebinth. ℥ j cerae ℥ vj. aut q. s. fiat Ceratum. Than with compress and Bandage roll it moderately, and after it is digested you may deterge, as shall be prosently showed.  
In tumors by Congestion foment with decoct. 
Fomentation.  absinth. flor. sambuci, ros. rub. baccar. myrtill. sem. foenug. in wine and water, adding afterwards some sp. vini. These Abscesses requiring to have their heat kept up, and the relaxed parts strengthened. If the Opening was made by Caustick, dress it with a Pledgit dipped in a mixture of unguent. basil. with ol. lilior. hot: or, to rouse up the heat in the Part, and hasten separation of the Escar, add a few drops of ol. terebinth. and apply Empl. diachyl. ireat. or Empl. de minio cum sapone, malaxed with ol. lini. After separation of the Escar, you may deterge with Mundif. 
Mundif. Paracels.  Paracelsi thus made: ℞ terebinth. clarae, mellis despumati, an. ● ss. vitell. ovor. num. iij. coq. ad consist. unguenti. If there be required stronger Detersion, you may add Merc. praecip. ʒj. to an ounce; you may also add alumen ust. but that will make the ulcer painful: 
Mundif▪ Apii.  however some crude Ulcers may admit of it. Mundif. ex apio is also proper, as it is in the Pharmacopoeia Lond. or this: ℞ succ. absinth. ℥ ij. succ. brassicae, chelidon. an. ℥ j mellis rosati colati ℥ ij. terebinth. ℥ iij. coq. ad succorum consumptionem, addendo pulv. myrrhae, sarcocollae, an. ʒi ss. pulv. rad. ireosʒj. rad. aristoloch. rot. pulv. ʒij. far. triticiʒiij. far. orobi, lupin. an.ʒj. Misce. If the Matter do not well discharge, you must help it by compression and Bandage: or if the Tumour was large, and the Opening but small or not enough in the declining part, lay it more open; for without a convenient Orifice, whereby the Matter may plentifully discharge between Dress, you cannot hope for a speedy Cure. That way of dilating by Piths or Sponges is mere trifling, unless it be to thin the skin for the more easy Incision.  
If you deterge not with too sharp Medicaments, they may also serve to incarn: 
Urguentum incarnativum. Vnguentum Nicetianae.  or you may use this, or such like; ℞ terebinth. Venet. ℥ iiij. pulv. aristoloch. rot. ireos, thuris, an. ʒiij. mastic. myrrhae, aloes, an ℥ ss. cadmiaeʒ vj. mell. ros. q. s. fiat Vnguentum. Or, ℞ succ. Nicotianae lbj. picis, resinae, ol. olivar. immatur, an ℥ iij. terebinth. Venet. ℥ vj. cerae q. s. fiat Vnguentum. If the flesh grow lose or spongy, touch it with a Vitriol or Alume-stone moderately, and it will daily waste it, with little or no pain, and dispose the Ulcer to cicatrize: of which Stones you may have some fitted in Quills for your use.  
The Ulcer being incarned, you may cicatrize with unguent. lethargy: ℞ lithargyr. 
Vnguentum lethargy.  aur. & argent. an. ℥ iij ss. calcis decies lotae subtiliss. pulverzatae ℥ ij. cerussae ℥ ij. tutiaeʒ vj. olei myrtillor. ℥ vj. ol. rosati lb j ss. sevi vitulini ℥ viij. succour. plantag. laciucaes, solani, an. ℥ iv. coq. sevum lento igne cum oleis & succis usque ad consumptionem succour. deinde colentur; colaturae addantur unguenti rosati ℥ ij. cerae albae q. s. iterum coq. unieâ ebullitione; postea auferatur ab igne, baculo agitando, cum mineralibus praedictis priùs optimè pulverizatis, & fiat Vnguentum. Or with unguent. desiccat. rub. aq. calcis. Or else you may cicatrize with this Water; 
Aqua cicatrizans.  ℞ myrobalan. citr. ballast. an. ʒ ij. alum. rup. ʒ ss. aq. germin. quere. equiseti, an. ℥ ij. vini albi ℥ j bulliant parùm, & colentur pro usu: in which Pledgits may be dipped and pressed out. You must take care that the Ulcer be cicatrized seemly, neither too high nor too low.  
Having thus treated of tumors by Fluxion, we shall now say something of those made by Congestion; which, though capable of most of the former intentions more or lesle, yet differ in the manner of governing them, viz.  
Bleeding aught in this case to be lesle frequent; but Purging more strong, with agaric, hermodactyles, scammony, jalap, aloes, colocynth, pill. rudii, cochiae, Cornachini, benedict. laxat. confect. hamech, elect. è succo rosarum, purging Diet-drinks, etc. as in the Chapter of Oedema, to which I refer you. The Revulsion hath little or no place here.  
Derivation by Issues and Seton's are usual. Repulsion is proper in many of them, especially that of Bandage in oedematous Swell of the Legs, Arms and Hands.  
But Discussion is the principal intention of the Chirurgeon in this place, and aught to be done with hot Medicines: of which sort I have set you down some already, and more you will meet with in our particular Discourse of those tumors.  
Suppuration seldom happeneth in these tumors, unless there be an admixture of blood with it: in which case treat them with Suppuratives, as hath been said, and open them.  
After Apertion, the method of healing differs little from that of Abscesses made by Fluxion: but of their Cure you shall be more informed in the Chapter of Oedema.  
The next thing that offers itself to our consideration is Diet: 
Diet.  and that is of two sorts; the one regarding tumors made by Fluxion, the other those by Congestion.  
In hot tumors made by Fluxion we are to propose such moderation as may take of from the great ferment in the Blood, whereby it may be rendered lesle apt to flow into the weak Part. To which purpose the Ancients prescribed such a slender Diet as might only support their Strength: yet with a regard to Custom, the Age and Constitution of the Patient, and greatness of the Inflammation. If the body be strong and abound with Humours, and the Inflammation great, their Diet may be the more sparing and cooling; as Water-gruel, Panado, and such like. Where the Inflammation is lesle, or the Patient weak, Chicken-broath, with wood-sorrel, Lettuce, Purslane, or a boiled Chichen, a potched Egg, etc. and such like meats of easy digestion. To others, Mutton, Veal, Pullet, Rabbit, and some sorts of the firmest Fish. In great Inflammations there is commonly Fever attending, in which case they have little inclination to eat. Their Drink should be Ptisans, or small well-boiled Ale. If Wine be allowed, it aught to be small, or allayed with water. Falopius, in his Discourse of hot tumors, saith, he was want where there was Plethora, to prescribe panem lotum in aqua, asperso succo aurantiorum cum modico zuccari, a little Bread dipped in water, and sprinkled with juice of an Orange and Sugar, and that but twice the day; and their Drink not better than water. Galen forbids Wine; yet permits it to them qui habent ventriculum debilem, for their Stomached sake: which is necessary to be observed; for unless that be kept up, in vain are all our endeavours.  
The Air aught to be temperate by art or nature.  
All Exercise is to be forborn: for the Blood is thereby heated, and the Humours made more fluid. Sleeping in the day is also forbidden, out of hopes they may rest better in the night.  
In tumors by Congestion we allow such a Diet as is heating and attenuating; their Meat rather roasted than boiled, and of good nourishment; as Mutton, Veal, Kid, Pullet, Rabbit, Chicken, Pheasant, Partridge, Cock, Snipe, etc. All White-meats, Fish, Fruits, Salads, are forbidden. Their Drink may be Ale or Beer: Wine is also allowed in these cases: and their Drink may be medicated with Sarsaparilla, China, lign. guaiaci, lentiscinum; as you may see more particularly hereafter.  
The Air aught to be warm and attenuating. Sleep in the day is absolutely forbidden, and aught to be moderated in the night. Passions of the mind are to be avoided both in this and all other Diseases.   

CHAP. III. Of Inflammation, or Phlegmon.  
HItherto I have discoursed of tumors in general. I shall now descend to particulars, and begin with Phlegmon, or Inflammation: both because it is the first degeneration from good blood, and in its own nature nearest of kin to it; and also because it is the most frequent of tumors happening in Diseases, Wounds, Contusions, Fractures, Luxations, etc. It being also the usual forerunner of many mischiefs that hap in many of those cases, and consequently the most obvious occasion of exercising the Surgeon's Skill.  
I define it, 
Definition.  a large Tumour, hot, of a read colour, with pain, pulsation, tension, and a circumscribed hardness.  
The Differences of it are either from the Situation; 
Differences.  inward, or outward. Or from the Part affected, whence it taketh a name. As inwardly in the Lungs it is called Peripneumonia; in the Pleura, Pleuritis; on the Diaphragma, Paraphrenitis, in the Brain, Phrenitis; in the Throat, Angina: outwardly, on the Throat, Angina notha; in the Eyes, Ophthalmia, etc. Or, lastly, from the Matter: which if simple, it is a simple Phlegmon; if compound, it hath its denomination from the Humour with which it is compounded, and so is called Erysipelatodes, Phlegmatodes, Oedematodes, Scirrhodes.  
The Cause of Phlegmon is generally a Plethora, 
Causes.  having some acrimonious mixture in the serum of the Blood; which latter is the usual matter of a Phlegmon, being cast out of the vessels, and lodged in the pores of the Skin, or other Part affected with it. This serum being accompanied by the thinner parts of the Blood grows read and angry, and, wanting its due regress into the Mass, first gathers into a hard Swelling, and in few days (if it be not discussed) ripens into Matter, and so dischargeth.  
The Signs of Phlegmon are, 
Signs.  great pain, heat, inflamed read colour, and swelling, with hardness, pulsation, and tension. The Tumour growing big and more collected, a Suppuration succeeds, and than the Symptoms abate. As the Tumour riseth into a Cone, so the Matter may be felt to fluctuate, and the Skin becomes thin and pale, viz. of the colour of the subjacent Matter.  
The Prognostic is good, 
Prognostics.  when the Tumour insensibly exhales and resolves: in which case the ebullition abates, and the Blood, being lesle violent in its motion, passeth gently by, and by degrees swalloweth up that Humour into its channels again which it had in the time of its ebullition cast out; or at lest, having suffered the thinner parts to transpire, it receiveth the rest.  
Next to this way of terminating a Phlegmon, Suppuration is best, when the Matter of the Tumour ripens into a kindly pus.  
But it is of ill consequence if the Tumour disappear without abatement of Accidents, and the Fever still continued. In this case either a Gangrene or some other grievous Symptom succeeds: or, if it were the Crisis of a Fever, that increaseth, and the Life of the Patient is in great danger.  
It is also ill when the Matter, in stead of resolving, hardens, and the pain ceaseth. It foreshoweth a scirrhous Tumour approaching.  
Fat people are not so easily cured as lean. Nervous and tendinous Parts have worse Symptoms, and are harder of Cure, than fleshy ones.  
If after great Abscesses the Body be not purged and regulated, they are apt to fall into some other Disease: otherwise they occasion much Health.  
The modern Authors have reduced the Cure of these tumors to four heads: 
Cure.  1. to the manner of Living; 2. to the preventing the Influx of Humours; 3. to the evacuating the Humours already inflowed; 4. the correcting of the Accidents to which they are subject.  

1. The manner of Living consists in the moderation of the six non naturales. As, that the Diet be slender, cooling, and moistening, whereby the increase of blood may be moderated, and rendered lesle apt to flow into the weak Part: from which consideration the Ancients, as I told you, allowed only enough to preserve their Strength, with regard to their Habit of Body and Custom of living. They generally prescribed Panadoes, Barley-grewell, and such like Spoon-meat. Chicken-broth is the highest whilst the Humour is fermenting; but after Suppuration and discharge of Matter, greater liberty is permitted. Air, Exercise, Watching, Passions of the mind, etc. are to be regulated; as hath been said in the preceding Chapter of tumors in general.  
2. The second intention is performed by removing the Cause of the Tumour, which is the Plenitude and Cacochymia: the former whereof requires Bleeding, the latter Purging. Bleeding is here proposed as the speedy remedy, both for lessening the Tumour, and appeasing the Pain; and is made by opening a vein near to the Part affected. According to Galen, debemus venam secare ad deliquium animi, we aught to draw blood to very fainting. Yet we are therein to consider the Constitution and habit of body, and greatness of the Inflammation. Cupping, Friction and Deligation of the opposite Parts may be hereto necessary before the Tumour is made.   
To take of the Cacochymia Purging with Lenients is proper; as elect. lenitivum, diaprun. lenitivum, diacatholicon, cassia, tamarindi, manna; cremor tartari, Infusions of Senna, Rhubarb, and opening Apozems; as hath been said in the former Chapter. In the next place it will be proper to prescribe such Draughts as may quiet the motion of the Humours, and temper the heat of them, viz. Emulsions of the greater and lesser cold Seeds made with decoct. hordei; also Juleps, with syr. de papavere, Rhoead. paralyseos, violar. è succo citri, etc. in proper Vehicles.  
3. The third intention regards the Part affected more immediately, and is the removing of the conjunct Matter. How that is done by Revulsion, Derivation, etc. I have showed you in the former Chapter; as also how you are by Repellents to withstand the influx of Humour in the very beginning; and of what quality the Medicaments proper thereto are, and in what cases they are not to be applied; as in malign tumors, or those in the Emunctories, etc. I shall here only insert some few Prescriptions that are most peculiar in the several cases, and begin with Repellents in the first place: of which sort is cerat. Galeni. ℞ cerae alb. ℥ iv. ol. rosati omphac. lb j. novies laventur aq. font. deinde aceto subigantur. Or this: ℞ Empl. diachalc. ℥ iij. boli armen. ʒ iij. baoc. myrtill. ʒ ij. aceti vini cochl. iv. ol. myrtill. q. s. fiat Ceratum. Or this: ℞ far. hordei ℥ vj. court. granat. pulv. ℥ ij. ballast. pulv. ℥ ss. succ. sedi maj. ℥ iij. vini rub. q. s. coq. ad consist. catapl. & in fine cociionis add ol. myrtill. ℥ ij. Either of the two latter, if timely applied, will not only resist the Influx, but dry up the inflowed Humour. They must be renewed daily, jest they dry too much, and thereby increase the heat in the Part.  
In the increase of Inflammation and Tumour, when it gins to be hard, you are to apply Resolvents with Repellents. ℞ fol. malu. parietariae, plantag. an. M. j far. hoard. & fabar. an. ℥ i ss. flor. ros. rub. pulv. ℥ ss. coq. in aq. font. fiat Catapl. S. A. addendo in fine ova integra num. ij. ol. cham. ros. q. s.  
When the Tumour is more formed and harder, forbear Repellents, and apply Discutients and Emollients. ℞ rad. & fol. althaeae an. M. j sem. lini & foenug. an. ʒ vj. flor. cham. meliloti pulv. an. ʒ ij. far. hoard. & tritici an. ℥ vj. fiat Catapl. addendo mell. come. ℥ ij. ol. sambucini & axungiae anseris an. ℥ j If the Tumour decline, ℞ fol. parietariae M.ij sem. lini, foenug. an. ℥ ss. summitat. absinthii, anethi, flor. cham. sambuci pulv. an. ʒ iij. flor. ros. rub. ℥ ss. far. lentium & fabar. ℥ iv. coq. in vino, & fiat Catapl. addendo ol. lumbricorum, anethi, an. ℥ ij. mellis comm. ℥ i ss. ℞ Empl. de mucilag. Empl. oxycrocei, an. ℥ ij. diachyl. ireat. ℥ j ol. anethi q. s. fiat Ceratum.  
4. The fourth intention is, to remove the Accidents that frequently accompany these Inflammations; amongst which Pain is the chief: for that not only tireth and exhausteth the Spirits of the Patient, but also increaseth Fluxion, and destroys the Temperament of the Part. Therefore you aught to have especial regard thereto, and by Anodynes appease the Pain. To which purpose I shall offer you this following Cataplasim. ℞ fol. visci pomorum cum fructibus an. M.j. fol. hyoscyami M.ij fol. paepaver. M.j. sub cineribus coquantur; addendo tandem mic. pranis albi in lacte tepido macerati lb ss. vitell. ovi num. ij. pulv. crociʒ j ol. chamaemeli & rosarum an. q. s. fiat Cataplasma S. A.  
The Fever which attends Pain is removed by Venaesection, or by the resolution or suppuration of the Tumour. If it shall unhappily indurate or gangrene, I refer you to those Chapters of Scirrhus and Gangraena: yet I think, if the method be rightly observed which hath been proposed, there will need no such reference.  
The most safe and speedy way of curing Phlegmons is by Resolvents. In Wounds, Contusions and Ulcers, Inflammations for the most part go of so: and so would the greatest Phlegmons, if the foresaid method were truly observed. But the neglect of timely Bleeding, and the too hasty application of Pultices of White-bread and Milk, tender them incapable of Repellents; and for the most part of Discussion: whence followeth a necessity of Suppurating.  
The Medicaments that further Suppuration are suitable in their temper to the heat of the Part, so as to cherish it, and of an emplastic quality, hindering Transpiration. So Oils and Grease, which are scarce permitted in Discutients, (farther than to give good consistence to the Medicine) are here proper. These following are Suppuratives. ℞ radic. althaeae, lilior. albor. an. ℥ iv. branc. ursinae M. j coq. in brodio aut lacte ad mollitiem; deinde adde medullae panis albi lb ss. sem. lini pulv. ℥ ij. axung. porcinae & gallinaceae an. ℥ ij. vitell. ovor. num. ij. crociʒ j Misc. fiat Cataplasma. Or this: ℞ rad. lilior. ℥ iij. cepar. coct. sub cineribus ℥ ij. summitat. althaeae M. ij. caricas pingues tossed. num. 6. coq. & contusis add far. tritic. ℥ ij. pulv. sem. lini ℥ j axung. porcinae ℥ ij. unguent. basilici simple. ℥ j ol. lilior. q. s. cum vitell. ovor. & croco: fiat Cataplasma. Whilst you endeavour Suppuration, you must expose the Tumour as little to the air as may be.  
The going of of the Accidents of pain, heat, pulsation, etc. are good signs of Suppuration: but if the Matter lie deep, the Symptoms do not cease till it be discharged; nor is the Suppuration discerned in some of them otherwise than by the fluctuation between your hands. In such cases, if you doubt Suppuration, continued the latter Cataplasm: for if the Tumour be opened before the Matter be well concocted, it will be the slower in healing.  
If the Tumour become more compact, and thrust out in a Cone, and look pale, defer not the opening of it. For as the opening of Apostems before the Suppuration be perfected weakens the heat, and renders them crude: so the letting the Matter lie long after it is made gives way to its putrefaction, whereby the Parts underneath corrupt, and the Abscess becomes sinuous.  
The manner of opening by Incision or Caustick, together with all directions necessary thereunto, have been sufficiently treated of in the former Chapter. The Cure of it, by digesting, deterging, incarning and cicatrizing, you will see in the Treatise of Ulcers, and in the following observations.  
I shall begin them with some instances of Phlegmons in their very first appearance: though I may doubt whether you will allow them for such, they being than so inconsiderably small, that the Patient himself thinketh it not worth while to sand for a Chirurgeon. Nay, when the pain hath increased the Inflammation, and raised the Swelling big and hard, they for the most part permit them to be dressed by the next pretender to Chirurgery with Pultices, as I have said, of White-bread and Milk, and do not consult us till the Tumour be in its state; and than it is too late to repel them. Sometimes we may discuss them, but more frequently they suppurate, and are of longer Cure. Upon the considerations forementioned, it seemeth not easy for me to give you such instances of the beginning of a Phlegmon as may be suitable to the design of this Discourse: therefore I have set down the fewer of them, and taken them from such accidental causes as do generally make great tumors, (if ill handled,) that you may thereby learn how to prevent their growth by the timely applications proposed in the method of Cure.  
A Man of about thirty six years old, 
1. Observation, of the beginning of a Phlegmon in the right Hip.  after a hard Journey on horseback, sitting upon a cold bench, was seixed with a pain in his right Hip, insomuch that he was scarce able to get up to his chamber. The next morning he complained to me of his ill night's rest by reason of that pain, he not being able to move that Joint. I embrocated the Part with ol. ros. cum aceto, and applied an Empl. diachalcit. cum bolo, and let him blood in the Arm about ℥ x. ordered him a Clyster that afternoon, and an Anodyne draught the night following of ʒ vj. syr. de meconio in aq. papaver. cum aqua cinnamomi hordeat. whereby he rested better. I continued the Embrocation and Emplaster, by which after a day or two the Fluxion was seemingly wasted; yet he complained of a pain deeper in the Joint. I than caused a Bryony-root to be digged fresh out of the earth, and being washed, cut and beaten to a pulp in a Stone-mortar, I chafed the pained Hip with it, and applied it in the form of a Cataplasm. It did not lie well on, but by the use of it two or three days it discussed his pain, and he was cured. This began like a Phlegmon, and afterwards threatened a Sciatica: whither it would have tended I leave others to judge; but from such little beginnings the greatest Phlegmons have taken their rise.  
A Woman aged thirty four years walking in the street one evening, 
2. Observat of a Phlegmon.  and passing near a Coach and horses, was bit in the right Breast by one of them. The next day she came to me, complaining of the pain, and shown me her Breast. It was swelled to the bigness of a Hen's egg, with Inflammation and hardness, the print of the horse's teeth remaining in the skin near two inches distant from each side. I dressed it with unguentum basilic. and embrocated the Tumour with ol. ros. cum aceto, and applied an Empl. è bolo over all; than let her blood, and sent her that night an Anodyne draught of aq. papaver. rhoead. cinnam. hordeat. cum syrupi de meconioʒ vj. She was purged the next day with an Infus. senae, etc. By this method the pain and inflammation were remitted, and a great part of the hardness: the remainder was totally resolved by the application of unguent. basilic. spread thick in the form of an Emplaster, and by repeating Purgations twice or thrice.  
A Man of about forty years of age, 
3. Observat. of a Phlegmon.  of a full body, having (as he thought) heated himself in walking, took cold, and was seized with a stiffness and pain in his left Thigh, about four finger's breadth above his Knee. The morning after I saw it swelled and somewhat inflamed. I embrocated it come ol. ros. & aceto, and applied an Empl. oxal. than let him blood about ten or twelve ounces, and advised a Clyster that afternoon, and desired him to forbear full meals and strong drink. The day after he was purged with pulvis Cornachin. and by repeating of the Embrocations and Emplaster was cured of his Distemper.  
A Maidservant about twenty six years of age, 
4. Observat. of a Phlegmon with an Herpes'.  by reason of a suppression of the Menstrua, was seized with a pain in her right Thigh on the outside. It growing more painful by the application of gummy Emplasters, I was sent for, and saw an hard collected Tumour of an oval figure lying under the musculus membranosus with Inflammation; also an Herpes' overspreading the Tumour and that side of the Thigh. It was certainly raised by their improper Applications. I let her blood at lest twelve ounces, and purged her the next day with pill. cochiae. By repeating the same Purgative three or four times, intermitting a day or two between, and afterwards by the application of unguent. nutritum alone, the Inflammation was cooled, the herpes extinguished, and the Tumour wasted.  
A Woman of about forty years of age, 
5. Observat. of a Phlegmon discussed.  scorbutical, and of a full body, was pained in her right Thigh on the inside. Somewhat she applied herself, but it growing more painful, I was permitted to see it. There was a hard Swelling with Inflammation, Pulsation, etc. as in a Phlegmon in its increase. I let her blood about ten ounces, and embrocated it with ol. ros. & chamaemeli, and applied cerat. Galeni on it; and some hours after I sent her that Cataplasm ex fol. malu. pariet. plantag. cum sem. Cydon. etc. which she applied. A Clyster was that afternoon adminished, and an Anodyne prescribed. The next day she was purged with this following Apozeme. ℞ fol. senae ℥ ss. rhabarb. ʒ ij. flor. sambuci, macis, ℈ ij. fiat infus. in aq. matricariae ℥ viij. succ. aurantior. ℥ iv. colat. add mannae ℥ i ss. syr. de spina cervinaʒ vj. dividatur pro duabus dosibus. By the continued application of the Cataplasm the Tumour diminished with the hardness. In the declining of it I left out the Repellents, and added pulver. ballast. & baccar. myrtillor. and boiled them in Wine, and added only Mell in the place of the Oil: by which I dried up the remaining Humour, and restored the Part to its former health. Yet she would not be satisfied without the application of an Emplaster, which was Empl. è bolo.  
One of about fifty five years of age, 
6. Observat. of a Phlegmon discussed.  of a full body, subject to Gout and Scurvy, was taken with a Fever, which after a few days terminated in a pain of his right Arm about the Biceps, with Swelling and Inflammation. Cataplasms were applied of White-bread and Milk: but the parts were thereby relaxed and rendered more subject to Fluxion, which swollen the Arm round and deep amongst the Muscles. A Chirurgeon was fetched, who, finding the Patiented weak and treated by unhappy hands, declined the meddling with it, as not having been consulted more timely; or, indeed, doubting how the Cure would succeed. I was than fetched, and observing the Tumour great, and threatening the destruction of the Member, I stuped it with Wine, to give a breathing to it, till I could make a Fomentation more for my purpose; which I hastened by putting a shovell-full of Wood-ashes into a quantity of water with a few herbs; as summitat. absinthii, centaur. cardui bened. flor. sambuci, chamaemeli, sem. foenugraeci, etc. Which being boiled and strained, I added Brandywine to it, and fomented the swelled Arm, and the while made a Cataplasm ex far. hordei & fabar. with some of the aforementioned Ingredients boiled in some of the same Fomentation, with the addition of mel come. and applied it. Being thus left alone to act without a Physician, I let him blood in the other Arm, and prescribed a Clyster and a Cordial Julep of aq. dracont. cardui bened. & citr. spec. de hyacintho, cum syr. de succo citr. & caryophillor. with aq. epidemica, also an Anodyne draught to dispose him to rest that night; which he did better than he had done many nights before. By the use of the Fomentation and Cataplasm the Swelling discussed, and our work went hopefully on: the Fever appearing than but symptomatical lessened also, as the heat and pain mitigated. My next work was by Emollients to resolve the hardness which possessed the Muscles and Tendons of the Arm and Elbow-joynt. To which purpose I fomented them with a Decoction of fol. & radic. althaeae, malvae, tapsi barbati, rad. lilior. flor. chamaemeli, meliloti, sem. lini, foenugraeci, etc. made in Flesh-broath, and embrocated them with a mixture of unguent. dialthaeae cum ol. lumbric. ex pedibus bovinis, and applied ceratum Agrippinae, with moderate Bandage over all. Thus I resolved the hardness, and somewhat restored the Joint: but the Arm continues weak to this day.  
A young man aged about twenty years, 
7. Observat. of a Phlegmon suppurated in the Arm.  riding a long journey in the heat of Summer, put his blood into a ferment, which affected his Bridle-hand with great pain, and produced an Inflammation with Tumour in that Wrist. To remedy which, he was let blood in the other Arm, and the Part diseased was embrocated with ol. ros. cum aceto, and an Empl. è bolo was applied; and the second day after he was purged with an Infus. senae, etc. The Swelling increasing, with Inflammation and hardness, the moderate repelling and discutient Cataplasm ex malu. pariet. plantag. etc. was applied. But this Patient being of a very ill habit of body, the Tumour increased, and, collecting more round, shown its inclination to suppurate: wherefore I left our the Repellents, and added rad. lilior. albor. etc. by the application whereof it suppurated in few days after. I opened it by Caustick, and discharged a proportionable quantity of Matter well concocted, and hastened the fall of the Escar by Lenients. During the Fluxion (which was in the Wrist amongst the Tendons) he complained of a foreness in that Axilla, but took little notice of it, till, after the opening this, (the pain diminishing there) he felt that in his Armpit more sore. I also felt a small Gland there, and applied an Empl. de mucilaginibus, supposing that would resolve it. After the separation of the Escar, whilst I was digesting that Abscess, he was again purged: but the Swelling increased in the Axilla, and suppurated, and was likewise opened by Caustick, and endeavours used to digest that. But whilst the former Abscess cured, this latter became more crude and sinuous, and the Patient was seized with a Rigour, and a Fever followed; for the Cure of which he was let blood again and purged, by Doctor Walter Needham his prescription, with an Infusion of sena in a decoct. tamarindor. with the addition of manna, syr. de pomis purge. & syr. de spina cervina. By the repeating of this he was freed of his Fever, but the Abscess would not digest three days together by any application: upon which consideration we prescribed him decoct. sarsaes, lign. Guaiaci. etc. By the drinking thereof a few days the Abscess digested, and healed soon after to a wonder.  
A Maid of about twenty eight years old, 
8. Observat. of a Phlegmon suppurated in the Breast.  of a gross body, receiving by accident a blow on her right Breast, it swollen, and grew hard and painful. After several applications, the hardness and pain rather increasing, she, suspecting a Cancer, came to me. I viewed it, but saw no Symptoms of it. I embrocated it cum oleo & aceto rosac. and applied an Empl. de minio cum sapone, and the day after let her blood, and than purged her with Whey, Manna and Cremor Tartar; by which the hardness was seemingly resolved for some time: but she being irregular in her appetite, it swollen again as when I first saw it. Upon which consideration I applied Emollients; and seeing the Tumour increase, and she impatient at the sight of it, I applied a Suppurative Cataplasm ex rad. & fol. althaeae, rad. lilior. alb. etc. By the continued use of it in a few days it suppurated well, and I opened it by Caustick in the declining part, and discharged a large quantity of Matter. I dressed the Abscess with lenients, and continued the use of the Cataplasm till the Escar separated: than I deterged with mundif. Paracelsi, and applied Empl. de mucilag. and shortened the Tent. The Orifice growing lesle, and somewhat of the hardness yet remaining, I put in a short Cannicula of Lead, and kept the Orifice open, till the hardness was totally resolved, and that it mattered very little, or not at all; than threw out the Tent, and applied a Pledgit of unguent. diapompholig. and permitted it to heal: which it did in few days. This was a pure Phlegmon, and lay deep in the Breast, and owed its speedy Cure to the perfect Suppuration was made in it before the Opening. For otherwise such Abscesses in large Breasts do frequently terminate in sinuous Ulcers, and grow callous, by reason of their laxity and want of natural heat.  
A Gentleman of about fifty six years of age, 
9 Observat. of a Phlegmon.  standing long in the cold to see some extraordinary Show, was taken with a pain above his left Hip, and the second day after sent to me for an Emplaster. The messenger not telling me the name of the Patient, nor where he lodged, I sent him an Emplast. è bolo, proper to resist, and defend a Part from, Fluxion. The fourth day after he sent to me for another Emplaster, signifying to me that his pain was much increased; and two days after sent for me. I went, and saw a large Tumour lying upon the Ilium backwards, with great Inflammation and hardness, with all the Symptoms of a Phlegmon near its state. I directed a Cataplasm to be made ex summitat. malvae, bismalvae, absinthii, flor. sambuci, meliloti, sem. lini, foenugraeci, far. hordei, with an addition of mel commun. ol. cham. vitell. ovor & croc. and in the interim let him blood, and advised a Clyster to be administered that afternoon. If this person had been of a temperate life, and been let blood when he sent for the first Emplaster, this Tumour might have been happily repelled; but it was now too late to discuss it: yet I repeated the application of that Cataplasm till I saw it more collected, and than I hastened Suppuration, by one of the milder Suppuratives set down in the method of Cure; by the use of which the Tumour was more collected and raised into a Cone, and by its pale colour and thinness of the skin gave an assurance of a perfect Suppuration. Than I applied some of the milder Caustick, with an Empl. diachyl. simple. over it, and the Cataplasm over all. The next day I took of the Dress, with design to divide the Escar: but it was done to my hands, and a large quantity of a well-digested Matter was discharged. I fomented the Abscess with a Stupe wrung out of Milk, and dressed the Escar with a Pledgit of unguent. basilic. dipped in ol. ros. and continued the application of the Cataplasm. Thus in few days the Swelling assuaged, and the Escar separated. I than endeavoured Detersion with mundif. Paracelsi: but the Abscess being large, and the Suppuration in the middle, and the Part not very capable of Bandage, there remained a large hollowness, which put me upon a necessity of laying it more open, for the speedy effecting the Cure; which I did with a pair of Probe-scissors. This work is necessary in such large Phlegmons; and therefore it is, I suppose, that Sennertus places his Chapter de Sinubus next to that of a Phlegmon. After I had made this Incision, I dressed it with that Digestive ex terebinth. cum vitello ovi, etc. and having digested it, I incarned, by adding pulv. rad. iridis, aristoloch. rot. sarcocol. etc. to the Digestive: and by the help of the Vitriol and Alume-stones, unguent. tutiae and Emplast. diachalciteos, I cicatrized it.  
In the time of the Civil Wars a Gentleman in the West-country was sorely pained with an Inflammation and Swelling upon the os Ilium on the left side. 
10. Observat. of a Phlegmon gangrened by improper applications.  Some one applied to Cataplasm to it of White-bread and Milk with Hogs-lard; a Medicament proper to assuage pain, but being applied in the augment in a full body, it relaxed the parts, and made way for the influx and increase of the Tumour. Upon farther complaint, some other of his acquaintance advised the application of Houseleek, etc. by which the native heat suffocated, and the Part gangrened. Sir Alexander Frasier, chief Physician to his Majesty, and myself were fetched, and saw the Tumour black and sunk the compass of the palm of an hand. We made deep Scarifications, and washed it with a Solution of Aegyptiac. in spir. vini, and filled the incised parts, especially in the circumference between the sound and gangrened parts, with Merc. praecipitat. and applied over all a Cataplasm, such as you will found set down in the Chap. of Gangraenae. Where we had applied our Precipitate, we found a perfect white Matter: it was but little in quantity, but by the use of the same Powder we saw the Mortification stopped, and the Escar in few days after separated with good digestion. The Ulcer was afterwards deterged with mundif. Paracelsi, and cured by Epuloticks, as in the Cure of Ulcers.  
As Phlegmons are subject to mortification through unseasonable application of Medicaments in time of their state; 
11. Observat. of a Phlegmon gangrened after Opening.  so also in fat bodies they are apt to gangrene after Opening, if that Fat be not speedily digested out. Thus it happened to a person labouring of a Phlegmon on the Os sacrum. After the discharge of Matter the Ulcer became crude and gangrened. Another Chirurgeon was consulted, who scarified the Abscess, and by his warm applications supposed he had extinguished the Mortification: but it appearing otherwise, I was fetched, and saw the lips and parts within gangrened and gleeting. We scarified the lips: but finding them to be gangrened more within than without, we pared them of round, than scarified the Abscess within, and cut out the putrefied Fat, and with an armed Probe dipped in oleo garyophyllor. hot cleansed the Abscess, and filled the Scarifications with Merc. praecipitat. We than dressed up the Abscess with a mixture of unguent. basilicon & ol. terebinth. and applied Cataplasms and Fomentations, as is usual in such cases. The next day we came provided with actual Cauteries, but found the Abscess warm, and disposing to digestion in the lips and fleshy parts: and from that time it digested well. But in the basis of the Ulcer, where the Mortification had reached to the Periosteum, the slough separated more slowly: but by the warm application of Lenients it came of, and the Ulcer happily incarned.  
Over-strict Bandage is a frequent cause of Phlegmon, of which I do make observation for the cautioning of the young Surgeons in the case of fontanelles.  
A person of a plethoric body, aged about thirty years, being subject to hot Defluxions of sharp Rheum, 
12. Observat. of strict Bandage.  was advised to make a fontanel in her Arm by Caustick. I applied the milder, with an Emplaster and moderate Bandage to retain it on, with advice to slacken it, if there appeared cause. The next morning she told me the bandage had been easy all the day, upon which account she had not slackened it; but it pained her in the night, and swollen her Arm. It did not seem too straight; nay, I think if it had been slacker, it would have slipped down her Arm, being taper-grown: but the Tumour shown the Bandage to be too hard. I loosened it, and took of the Caustick; where finding a small Escar, I divided it, and dressed it with unguent. basilic. with an Emplaster to retain it on, leaving the Arm at liberty. She was easy that day; but about twelve of the clock at night she was wakened with the pain, and sent to me. The fontanel not being in fault, I returned her a glass with ol. cum aceto to embrocate her Arm. The next morning I visited her: there appeared lesle fullness and no heat, but she complained of a numbness in her Hand. I left her to the use of the Oil: it wore of in a day or two. After the separation of the Escar, I put in a Pea, and fitted it with Bandage: from which time it continued easy. I foresaw this disturbance, and advised her to bleed and purge first, but could not prevail.  
In fat fleshy Arms you may produce the like by a moderate strict Bandage, when the Humours are in a fermenting disposition. The way to avoid such inconvenience is, first to make evacuation by bleeding or purging: for from such little beginnings greater evils do follow. And if this fontanel had been made by the lapis causticus, it had penetrated deep, and might by such a flux of Humours have been shrewdly disturbed: or if it had beem made by Incision, it would have been inflamed; and than the conclusion would have been, that it was made upon a Nerve or Tendon; though possibly in such fat Arms there is none within half an inch under it.  
I shall give you another instance in a Gentleman who came out of the Country, 
13. Observat. of over-strict Bandage.  and put himself into the hands of a Chirurgeon, in which case I was consulted. The Tumour was in his left Arm upon the Biceps, and was caused by over-strict binding of his Issue. It was raised below the Bandage; and as it abounded with Matter, it discharged itself into the fontanel. The Cure was performed by the application of a Caustick upon the lower part of the Tumour, and the Matter was let out by cutting deep into the Escar; after which it was digested and incarned by the said Chirurgeon, as in other Abscesses is usual.  
Many instances we have of this kind in Infants, who cannot express their grievances, especially where Issues are cut in their Arms. The Nurses sometimes binding them too slack, whereby the Pea slides out, and the Issue being almost closed before the next dressing, they, to recover their error, force in another, and by too hard Bandage raise a Tumour with Inflammation, to the great disturbance of the Child.  
Thus somewhile since a Child in my neighbourhood was seized with an Inflammation from the Shoulder down to the Elbow, 
14. Observat. of Gangrene from over-strict Bandage.  and from thence an oedematous Tumour reached to the Finger's ends, the fontanel itself gangrened. I threw out the Pea, and scarified the lips of the Ulcer, and dapt it with ol. terebinth. hot with an armed Probe, and applied Pledgits dipped in a mixture of the said Oil and unguent. basilicon; and having fomented it well with a decoct. absinthii, etc. I applied a Cataplasm ex far. hordei & fabar. decocted in Oxymel oever that part of the Arm, and upon the remote parts I applied cerat. Galeni with good Bandage from the Hand upward. By this means the Humour was modrately repressed, and breathed forth, the Escar also separated in the fontanel; after which the Ulcer incarned with common sarcotics, and the Ulcerations about it were cured by unguent. tutiae and such like Epuloticks.  
A people of about forty five years of age, 
15. Observat. of Phlegmon erysipelutodes.  subject to various Diseases from plenitude and cacochymia, as Lethargy, etc. was lately in danger of sinking under an apoplectical Fit, but was freed of it by a translation of those Humours into his right Leg, with great pain, and an Inflammation of a deep read colour possessing only the skin; but the Swelling was great, reaching from the gartering to the very Toes. It was Phlegmon erysipelatodes, and in his case required to be breathed forth by Medicaments of a temperate quality, yet somewhat cooling. To which purpose I presently fomented it with Claret-wine, and applied ceratum Galeni over all the Leg, with a moderate Bandage; than let him blood, and directed him a Clyster. The next morning I took of the Dress, and found his Leg in a better condition. I bathed it with Claret-wine wherein I had boiled summitat. absinthii, salviae, flor. sambuci, ros. rub. and applied the cerat. Galeni as before, and continued that method some days; he purging himself the while with Whey, Manna, and cremor Tartar. Thus the heat remitted, and the Swelling relaxed: yet the Cuticula was fretted of in several parts, and I felt a small collection of Matter under the skin on the inside of the Ankle, which I gave vent to by an Apertion with a Lancet, and discharged about a spoonful of a thin white Matter. I applied a Pledgit of basilicon upon it, and dressed the Vesiacations with unguent. tutiae; by which in three or four days they were cured: after which I put him a laced Stocking on that Leg, whereby it was reduced to its right tone. I had made him fontanelles inter scapulas heretofore, which he continues to good purpose.  
A Maid aged twenty four years was seized with a pain in her Head and Rigour of a Fever; 
16. Observat. of Phlegmon erysipelatodes.  the second or third day she had an Inflammation in her right Leg a little above her Knee and so downward. After several applications of Persley, Butter, etc. I saw it. The Inflammation was in the Skin, and reached down from the Knee in a read streak about four finger's breadth to the Instep: that inflamed Skin was tense, but seemed to have Matter lying under it. I made Apertion with a Lancet on the Knee, and discharged a well-concocted white Matter. I than made another Apertion lower, and another in the lowest part, with like success: the blood also trickled down in good quantity from the little wounds in the skin. I permitted them to bleed, she having need of such an Evacuation; than dressed them up with unguent. basilici cum vitello ovi upon Pledgits of Lint, and applied cerat. Galeni over them with convenient Bandage. The next day she was purged with Elect. lenitiv. and her Leg was stuped with decoct. salviae, betonicae, flor. ros. rub. We dressed the Apertions as before. This Maid was lately come out of the Country, and, by reason of the change of Air and course of life, abounded with Humours which required Evacuation: therefore during her Cure I let her blood, and purged her twice or thrice, by which she was restored to health; and the Matter having been so opportunely let out, the Inflammation went of, and the Apertures cured by a few dress of unguent. tutiae.  
A Man aged about forty years, 
17. Observat. of Phlegmon by Translation.  of a healthful complexion, hastening from London (in the time of the last great Sickness) to his house in the Country by great journeys on horseback, to avoid Infection, which the Inns on the Road were subject to, chose to rest himself on his way by lying down in the fields, whilst his horse baited on the grass near him. But having heated his body by journeying, he took cold by lying upon the ground, and in rising felt a great pain in the region of his right Kidney, and returned to his house very ill. He consulted the Physicians in his Neighbourhood. They at first suspected some Disease in that Kidney: but there being no Symptoms of it in his Urine, they imputed it to other causes, and prescribed Remedies accordingly. But the Cure not succeeding, they advised him to Buckstone Waters in the County of Derby: whither he went, and returned more pained. I, being at that time in a neighbouring County, was sent for, and found him in his bed much emaciated. From the region of that Kidney down to his Hip and Thigh there appeared a more than ordinary fullness, and in that Groin there was a painful Swelling, in which there seemed to be Matter, but it lay deep: I applied to it a suppurative Cataplasm ex foliis & rad. althaeae, rad. lilior. albor. etc. to suppurate it. To the other pained parts I applied Empl. è bolo. By the use of the Cataplasm the Tumour in Inguine appeared daily more full of Matter, and seemed to me to be made by Translation; therefore I did not attend a perfect Suppuration, but applied a Caustick, and, cutting into the Escar deep, discharged a much greater quantity of Matter than that Cavity was capable of; besides, by its foetid smell it seemed to have been long made. I dressed it up with Lenients. From this Dressing his pain lessened; but the Matter which discharged daily from it was very much. I made a search with a Probe, and felt it pass under the Pubes into the Muscle Psoas, (as I conjectured:) upon sight of which I contented myself in keeping the Orifice open for the discharge of the Matter, and prescribed him Vulneraries. The fullness from the region of that Kidney to the Hip continuing exceeding painful, I made a Seton upon the latter, hoping thereby to give a vent to that Humour. The first three or four days it mattered little; but afterwards, in drawing the Seton, the Matter burst forth in great quantity: upon sight whereof I cut the two Orifices into one, and took out the Seton, and dressed it up with Lenients. This was a foetid purulent Matter, and seemed to be of the same kind with the other which discharged from his Groin. His next great complaint was of pain in the region of that Kidney. I supposing that the original Matter might arise from thence, and pass inwardly to the Groin, and outwardly to the Hip, thought, if I could give a vent there, it might possibly intercept the Matter in its course to the other Abscesses. I therefore applied a Caustick upon the most likely part. The first four or five days after the division of the Escar there appeared no Matter; but before it was quite separated it made its way plentifully out, and the other Abscesses were more governable, and the Patient was certainly much relieved. But one afternoon, while he was lying in bed, and telling us a Story of some pleasant passages in his Profession, he suddenly died, we supposed from an eruption of the great Artery; for we found much blood poured forth from all the Abscesses, but especially that on the region of that Kidney. During the time of his sickness his Urine was without Blood or Matter, and passed freely without the lest disturbance. I would gladly have opened his body, but was not permitted.  
Observatio casûs non vulgaris de Sarcomate in arteria axillari reperto, communicata à Cl. viro Ed. Duke, M. D.  
Die quinto Aprilis Puella quaedam 16 annorum, Filia Nobilis viri, febricitavit, & capite dolebat. 
18. Observat.  Die sequente de cervice rigida & dolente conquesta fuit. Tertio Tumor occupavit humerum. Quarto vocatus adfui, Febre laborautem inveni, & Tumore circa humerum gravatam. Huic menses paulò antea substiterunt, & fallaci impetu in massam sanguinis traducii ejus molem adauxerunt, collisisique ad invicem particulis putridis Febrem excitaverunt, cujus ope natura partem sanguinis concitati ductilis que in humerum (sui levandi causâ) transtulit. Apparatus sanè pro Phlegmone notha struenda idoneus. Hisce perpensis, Revulsio instituitur per phlebotomiam in latere opposito, praemisso Clystere, nec non discutientia Tumori adhibentur, Febrisque pro more suo tractatur. Septimo die Chirurgum vocavi Artis peritissimum, Dominum R. Wiseman. Ad trutinam res denuo revocatur; & ex indicatis ducimur Revulsionem repetere, placidéque per media conferentia humorem ducere, sine taedio & incommodo Suppurationis. Elapso autem biduo adsunt Abscessus maturescentis indicia, & commodùm satìs Materia in musculo Deltoide circa ejus initium praesentiam sui testabatur, cui per Causticùm datur exitus. Aperto Apostemate effluxit illico pus laudabile, quod per intervalla debita & partitim fuit eliminatum. Tertio post apertionem die consistentia Materiae tenuior & malè olens: quinto autem in saniem degener, cum foetore insigni & cadaveroso. Chirurgus' ad mundificantia progreditur: sed sub examine cavitatis occurrit nescio quid grumosum, seu potiùs densa & thrombo magìs cohaerens substantia cruenta. Stylo igitur exploratorio undiquaque per Abscessûs cavernam circumacto, ductus versus interiora detegitur: cautè interim tractatur ulcus, nè sanies effusior vires attereret: ultro tamen per noctis intervalla effunditur, & certitudinem erosi vasis confirmavit. Jam tandem Catarrho perpètim in fauces depluente, aphthis os & gulam obsdientibus, Febréque scintillante in Materia maligna, quae sparsa & indomabilis sub uniformi naturae concoquentis opificio subigi recusavit, virtus vitalis fatiscit, & morbus insolens vigesimo primo ab invasione die de natura triumphavit. Aperto cadavere, ecce, cruentum illud coagulum seu figmentum sanguinis ad latera claviculae conspicitur, pérqune semitam arteriae axillaris frequenti hujus substantiae conspectu ducimur rectà ad cordis ventriculum sinistrum; quo loci ad ovi columbini magnitudinem congestum invenimus Sarcoma pelliculâ densâ circumvestitum. Mirum sanè, hospitem tam malè moratum palatio illo augusto toto frui, sine ullo viventis de dolore cordis sensu, vel symptomate laesarum ejus exinde actionum eminenti. Imò per totum morbi decursum interrogata quomodo se haberet, quàm optimè se corde valere respondit; & sponte etiam non longè ante obitum in eadem verba prorupit.   

CHAP. IU. Of tumors from Milk.  
MIlk (though I cannot say that it is often the matter) is certainly the occasion of many tumors of divers kinds. I know Authors make it the material Cause of many of the Diseases of the Breasts: but such men must be understood warily. For if by Milk in this assertion they mean Milk actually generated, and separated from the Blood, than I know but few cases in which that can be supposed to be the matter of a Distemper: for when it is in that condition, it is laid up in certain tubuli lactei, which, being spread all over the Breast, do unite their branches after the manner of Veins, still growing into bigger trunks, till they do end at last in the Nipple. Now the motion of this Milk being de vasis minoribus in majora, what is once separated from the Blood in the Glands' of it into those Vessels hath nothing to stop its progress till it comes to the very place of its Exit from the Nipple. If any stop preternatural; y hap, as the compression of the Vessel by some Tumour of a Glandule, or the like, than indeed a varicosity of the lacteous Vessels may arise: of which case you may see an Observation in the Chap. of Varix.  
This case is rare; but there be others very frequent: viz. That the Glandules through which Milk is separated may either through fault of the Ferment by which they make that separation produce divers variety of Distempers, or through an indisposition of their Pores not permit a due percolation of it from the Blood. When any of these things hap, there is a disturbance in the Circulation, and Fluxion doth arise, which soon produceth a Tumour suitable to the Humour so stirred up; viz. Phlegmon, Oedema, Scirrhus, Scrophula, yea sometime Cancer.  
This Discourse may serve for a general account of the Causes of the milky tumors of the Breasts, and may easily be enlarged to such particular cases as may emerge.  
The Differences may thus be enumerated. 
Differences.  If the Ferment of the Breast be overactive and vigorous, it separates Milk with too great violence, causing thereby an over-fermentation in the Part, which usually produceth a Phlegmon, if the serum be hot, or partake much of Blood: otherwise it raiseth an Oedema; or, if Matter dispose to coagulation, a Scrophula: which are the most frequent species of tumors generally reputed to arise from Milk. Any of these three may degenerate into a Scirrhus, and that Scirrhus into a Cancer.  
The Signs are visible. 
Signs.  If the first hap, there are all the Symptoms of a Phlegmon, heat, redness, tension, pulsation, etc. if the second, large distension, with pain, but no heat: if a Scrophula, than hard kernels are easily felt and distinguished, etc.  
tumors made by the over-eagerness of the lacteous Ferment go easily of, 
Prognostic.  if no other Symptom attend them: sucking and drawing the Breast for the most part dischargeth the Milk as fast as it can be generated, and than all the evil is over. But if the Fermentation produce any disorder in the Blood, the Patient finds more or lesle of danger according to the quality of the Tumour produced: viz. a Phlegmon endangereth them of a Fever; oedematous tumors are apt to grow ulcerous, and sometimes scrofulous and scirrhous, and become long of Cure, etc.  
Forasmuch as it frequently happeneth to women in Childbed, that their Breasts do extraordinarily swell by reason of the abundance of Milk which floweth into them, and that it stirreth up Inflammations, Apostemations, etc. therefore their Diet aught to be slender, and of such quality as may lesle dispose the Humours to ferment: to which purpose I shall refer you to the regulation prescribed in a Phlegmon.  
The Medicaments proper to diminish the Milk are, 
Cure of a Phlegmon in the Breast.  Lettuce, Purslane, Endive, Succory, Smallage, etc. The seeds of wild Rue, Cummin, Basil, powdered and given to the quantity of ʒj. daily in Broth, will dry up the Milk, as Authors writ.  
The Milk is usually drawn out of the Breasts by the infant's sucking them: but in case the Child be so weak it cannot suck, or doth not enough empty them, some others are to be admitted to help them; or they may put young Whelps to suck them, or some neighbouring woman. But the Mother may draw her own Breasts herself by an Instrument sold for that purpose.  
The Tumour made by the Milk is restrained by the application of Nightshade, Lettuce, Plantain, Vine-tops, Bramble-buds, Horse-tail, etc. or ol. ros. myrtill. cum aceto, etc. as we usually treat Phlegmons in the beginning.  
It may be discussed by the application of Mints, Catmints, Rue, sem. foenugraec. cumini, foeniculi, etc. or dried up by the applying  dipped in aqua calcis, or a Solution of sacchar. Saturni in aqua sermat. ranar. during which time fine Tow may be sprinkled with Ceruse, and applied to the Armpits. But in the beginning of Fluxion we are rarely consulted.  
Where I have by chance come in to women that have been much pained with swelling in their Breasts from Milk, I have applied Emplast. è b●lo, or a Cataplasm of far. hordei, fabar. lentium, decocted in oxymel, or cerat. oxelaeum, or santalinum, and at the same time Tow dipped in oxycrate under their Arms.  
If the Inflammation be gone too far towards a Suppuration, (which usually is before we are called) than it must be promoted with Suppuratives, and opened by Incision or Caustick, and treated as a Phlegmon hath been.  
Where the Swelling hath been hard, and not inflamed, ℞ summitat. absinth. 
Cure of oedematous tumors of the Breast.  pulv. ʒij. sem. lentium, foenugraeci, foeniculi, an. ℥ j suc. hyoscyami, cicut. an. ℥ iij. unguent. dialthaeae ℥ ij. axung. anatis, anseris, an. ℥ j sevi cervini ℥ ij. styracis liquidae ℥ ss. cerae q. s. fiat Ceratum.  
Cicuta boiled in Wine and beaten up with axung. porcin. 
Caution.  resolves the hardness in the Breasts; but applied alone stirs up heat, and ulcerates the Skin. Green Mints or Chickweed are common applications, and of good use, either alone, or mixed with other Medicaments, in all the hard Swell of the Breast occasioned by Milk. All Emplasters applied to the Breasts aught to have a hole snipt in them for the Nipples, jest they be fretted by them; especially that the Milk may be drawn forth while the Medicaments lie on.  
A Young Gentlewoman, 
1. Observat.  endeavouring to dry up her Milk when it was too late, put her Breast upon Apostemation. I prescribed her an anodyne Cataplasm, and a day or two after applied a Caustick, and gave vent to the Matter; than dressed the Escar with unguent. basilic. and applied cerat. dialthaeae over the whole Breast, and left her of the same Medicaments to dress herself with, and once in two or three days visited her. After the Escar separated, and the Matter was well discharged, I dressed her with unguent. diapompholyg. and left her of the same to finish the Cure. Many of these, where the Matter hath lain superficial, I have cured as easily.  
A young Women after Childbed was vexed with a Swelling in her Breast. 
2. Observat,  One was fetched who possessed her Relations that it was a Cancer, and treated her accordingly. But her Breast growing more painfully, her Father, much apprehending the danger of such a Disease, came to Sir Fran. Pr. and acquainted him with his Daughter's Distemper, and the Judgement that had been given of it; desiring that he would instantly go with him to see his Daughter. The Physician, wary in giving his Judgement in Chirurgery where there might hap any dispute, advised the Father to take me along with them. We went together, expecting to see a Cancer in the Breast: we found her in bed bemoaning her condition. I viewed her Breast, and saw it very big and inflamed, and felt it all apostemated, and the Matter perfectly well suppurated, the Skin thin and ready to break. I could scarce believe what I felt and saw. I declared the swollen Breast to be a Phlegmon well suppurated, and fit to open. The Physician looked and felt it; but, being prepossessed with the contrary, did not readily give credit to what he felt. I than proposed the applying a Cataplasm of White-bread and Milk, assuring them before morning they should found a Porrenger-full of Matter discharged. They consented unto it. We took our leaves, and left them to apply it; they did so: and the next morning the old Gentleman made the Physician a visit, and confirmed the truth of what I had foretold, and by the use of unguent, basilicon cured it without farther trouble.  
The Matter being well suppurated, and a convenient Opening made for discharge, they generally heal of themselves, if the Habit of body be good: but where it is otherwise, or irregularly treated, there it is vexatious in the Cure.  
While I was dressing a Patient in a Citizen's house, 
3. Observat,  I was desired to look upon the Breast of the Gentlewoman of the house. She had lately lain in, and from abundance of Milk and ill handling her right Breast had been apostemated, and was broken out in many holes. A woman famous in the City for dressing sore Breasts was her Chirurgeon. I observed that the Breast had at first broke in the upper part in a small pin-hole; and the Matter, not having had sufficient discharge, had subsided, and so made the other Openings, and afterwards passed an inch lower than any of the Openings, and could not be discharged otherwise than as it filled up the Sinus, and ran over, or was pressed from below upward with her hand. By this means the Breast continued inflamed and apostemated; insomuch as it was impossible to cure it by that method till it had apostemated the whole Breast. I pitied the Patient, and wondered that a woman so famed for such Cures could be so ignorant, and yet preserve her credit with that Sex.  
I shown the Patiented the cause of her pain, and the unlikelihood of being suddenly cured by such a Chirurgeon, and prevailed with her to permit me to lay on a Caustick upon the depending Part; and having made an Escar the compass of threepences, opened it, and gave vent to the Matter, and left her a little unguent. basilic. to apply daily upon that Orifice, and some unguent. tutiae to dress the rest. By the use of which she was cured in few days without more directions from me. Yet the good Gentlewoman, I dare say, is of so kind a nature, as she would quarrel in defence of her Sho-Chirurgeon.  
A young Gentlewoman after Childbed being indisposed in her health, 
Observat.  her left Breast became diseased, and swelled. They contented themselves with such help as those about them could afford. But after some days it growing more painful and swelled, the Apothecary brought in his Brother, who endeavoured Suppuration, and after some while gave vent to the Matter, and proceeded in the Cure. But while he was dressing that Opening, the Fluxion increased, and other Abscesses were raised, and from the several Apostemations sinuous Ulcers were afterwards made. Thus the work became difficult. I was consulted. In the pulling out one of the Tents, a thin white Matter issued out in great quantity: my Brother Chirurgeon called it Milk; but I thought it Matter, and observed the Abscess to have begun deep in the body of the Glands', which, through length of time corrupting them, rendered the Swelling hard, and the Tent stopping in the Matter between Dress had occasioned that large discharge we than met with. The method of Cure consisted in the enlarging of that Orifice where the Matter seemed to be detained, and than to proceed with Detersives, etc. They entertained me in the Cure, and I continued my Brother Chirurgeon. We began with the application of a Caustick to the Part round about the Orifice, stopping the hole with Lint; by which means in a short time we made an easy way for the Matter, and saw no reason afterwards to think it Milk.  
As the Escar separated, a Fungus thrust forth, which we sprinkled with pulv. praecipit. rub. dressing up the Escar with unguent. basilic. and the other Openings with unguent. diapomphol. and cerat. dialthaeae over all. After a more full separation of that Escar, we, observing the Fungus to rise more large, applied a Stupe wrung out of a decoct. summitat. absinth. rutae, menth. flor. ros. rub. ballast. made in wine and water; and the while sent for some chalcanthum, which we applied upon the Fungus, and Pledgits of unguent. tutiae over the ulcerated parts. The second day after we took of Dress, and found an Escar made by the Cathaeretick, which we thrust of, and dressed it again with the same, and continued the use of Escaroticks. During those applications we applied over the Breast the Empl. è bolo to restrain the Influx: but yet the Fungus increased upon us, and raised a Swelling between that and the other Orifices. Upon which consideration we applied a large Caustick upon that Swelling, which laid some of the other Orifices into this; than divided the Escar, and dressed it up with Lenients, and covered the Fungus with Escaroticks, wherever it began to thrust out, by which it was kept down. But after the separation of this later Escar, we seeing the Fungus great, and the way of extirpating it by Escaroticks slow, and fearing the ill consequences of it, I pressed with my finger under it, and at once broke into it, and pulled it but in pieces; than filled up the place with Merc. praecip. and mundif. Paracels. upon Pledgits, with the foresaid Emplast. over the whole Breast, and bound it up. The second day after that we opened it again. And by this same method often repeated we subdued the remainder of the Fungus, and raised a firm basis on which we incarned, with an addition of pulv. rad. ireos, myrrhae, sarcocollae, to the forementioned Mundificative; and than applied cerat. agrippae over the Breast, and in few days cicatrized it with a smooth Cicatrix, the lips falling in by the benefit of nature, which was assisted the while by Traumatick Decoctions, etc. as in such cases is usual.  
It happeneth very often, when we have cured one Breast, the other swelleth, from the abundance of Milk, and grows hard and apostemates. Sometimes we have both Breasts thus diseased at one time. 
5. Observat.  Such was the case of a Gentlewoman in Clerkenwell: both her Breasts had been long swelled, and after apostemated, by reason of the pain; several Abscesses were, made, and their Matter discharged by such Openings. In progress of time the Ulcers became sinuous and callous, with induration of the Glands'. I was entertained her Chirurgeon, and began my work with Fomentations and Cataplasms discutient and resolving, as rad. & fol. althaeae, hyoscyami, summit. cicutae, menthae, rutae, flor. sambuci, sem. foenug. lini, etc. with far. lentium, hordei, axung. porc. anatis, anseris, etc. and in dilating the Orifices, and deterging with mundif. Paracelsi, with Merc. praecip. and alumen, as I saw cause. While I was thus trying my endeavours by the method abovesaid, new disturbances arose within, which put me upon the necessity of laying such places open by Caustick as might best serve for the discharge of Matter. After separation of the Escar, I again deterged and healed them, as hath been showed in such like Ulcers.  
How they are to be treated when they are strumous, scirrhous, or cancerous, you may see in their proper places.   

CHAP. V Of Abscesses and corrosive Ulcers arising from Distempers of the Uterus in Childbed.  
BUT it is not the Breasts only that are troublesome to Women by the frequent production of such painful Diseases. The Vterus is (though not altogether so frequently, yet) much more terribly affected in Childbed, producing Fevers of very malignant and venomous natures, and soon making Phlegmons or worse tumors, sometimes in the Vterus itself, and sometimes in other parts of the body, there being none of them on which the Uterine ferment hath not an influence. The exorbitancies or degenerations of that, whether from a hurt in Labour, from part of the Afterbirth left behind, from cold taken, or the Lochia stopped, do soon produce such virulent Distempers in the blood as make it cast out a Tumour, either upon the Part itself, or else outwardly upon the Muscles of the body, where when they light they prove corrosive, sometimes eating out the flesh in which they lodged, which falls of in whole pieces, without that change of colour in the Skin which is in Gangrenes; insomuch that sometimes the Bone itself is laid bore by them.  
The Causes are, 
Causes.  (as I have said) hard Labour, the Vterus hurt, or part of the Secundine left behind, cold taken in Childbed, and a predisposition in the Humours by reason of their peccancy in quantity or quality.  
The Signs may be taken from their Causes, 
Signs.  and the manner of the Abscess may demonstrate its malign nature and evil quality.  
The Prognostic may be taken from the largeness or other qualifications of the Abscess, 
Prognostic.  and the Symptoms that hap to the body thereupon. If the Tumour hap only from some little disturbance done to the Womb of a person otherwise of a good Habit of body, the Cure is hopeful: if part of the Afterbirth be retained, there is no hopes of Cure till that be removed; nay, if it stay so long as to induce a putrefaction of the Part, it will be too late than to remove it.  
If the body be cacochymical, the tumors are apt to degenerate into very venomous and malignant Abscesses; which if they do not suddenly kill, do at lest produce ill-conditioned Ulcers hard of Cure, and for the most part mortal in the long run of the Disease.  
In the Cure of these Abscesses you are to inform yourself how the Womb is disturbed, 
Cure.  and appease that: and if any part of the Afterbirth be left behind, to endeavour the bringing that away, and by good Sudorificks, Cordials, etc. to expel the venom, and fortify the spirits against the malignity that is thereby contracted, and to contemperate the heat and acrimony by Juleps and Emulsions.  
The Swell arising from these require to be treated in their beginning with moderate Repellents and Discutients. Afterward, accordingly as the Matter predominates, make way for its discharge; and cure them as in the Treatise of Ulcers is showed.  
A Young woman after Childbed was seized with a great pain and Swelling in her left Groin and Thigh with Fever. 
1. Observat.  Sir Charles Scarburgh and Doctor Weatherly were consulted. They prescribed Bleeding and lenient Purgatives, to evacuate the Humours; also cordial Juleps, etc. to contemperate the heat, and fortify her spirits against malignity. I was also called in, and by moderate Repellents mixed with Discutients in Fomentations and Emplasters with Bandage dispersed the Humour in the Thigh, and restored that Part to its former temper: but in the mean time the Tumour increased in that Groin. I suppurated it after the manner of a Bubo, opened it, and endeavoured Detersion: but the Sinus reaching down the Twist, the Matter could not be discharged without laying it more open, as in sinuous Ulcers; by which method I cured it.  
A Gentlewoman in Childbed was seized with a Fever, 
2. Observat.  and the ninth day complained of a pain in her right Foot. Sir John Hinton was the Physician, who treated her in the Fever, and had prescribed Discutients, to breathe out the impacted Matter in her Foot: but the pain increasing, I assisted, and saw the upper part of the Foot from the Instep to the Toes oedematous, but from the inside of the Ankle to the middle of the Sole of her foot inflamed, and seeming to apostemate. We, doubting the ill consequences of an Apostemation in that Part amongst the Tendons and Bones, and where the Skin is usually so hard and tough as our strongest Caustics will difficultly penetrate, resolved to endeavour a restraint of the Influx, and so dry up the Humour affecting the Part: to which purpose we applied this; ℞ far. hordei ℥ vj. sem. lini pulv. ʒuj. flor. cham. sambuci pulv. an. ʒiij. flor. ros. rub. ballast. an. ℥ j These were boiled in read Wine, with the additon mell. ros. & ol. myrtill. to the consistence of an Emplaster. It being night, she was laid to rest with an Anodyne draught.  
The next morning I found the Patient somewhat relieved, and taking of the Dress saw the Tumour and Inflammation lesle. I continued the way of dressing, and applied Empl. è bolo, as an Intercipient, about the Ankle and upper part of the Foot, and by Compress and Bandage dressed it up. By the application of these Medicaments we dried up the Humour in few days, and the Foot was seemingly well; but (whether it was for want of purging, there being some reason against it, or that the Humour was only restrained by virtue of the Dress) there appeared again a Swelling on the Foot, and it apostemated in the Sole of the foot in three several places; which I opened by Caustick, to prevent the increase of Matter, and, dividing the Escars, gave vent to it, dressing them up with Lenients, Pledgits of unguent. basilicon, and the Emplast. as before. I endeavoured daily by Compress and Bandage to hinder the flowing down of the Matter: but the position of the Foot gave way, and it sunk lower, and put me upon the necessity of intercepting its farther descent to the Heel by applying another Caustick, which proved effectual to the discharge, so that the upper Orifices healed. But this last Escar separated slowly, and left the great Tendon bore. I furthered its separation by the use of ol. terebinth. with unguent. basilic. applied warm, and incarned the Tendon with a Sarcotick composed of a mixture of pulv. ireos, myrrh. sarcocollae, & Merc. praecipitat. with mel rosar. and terebinth. and cicatrized the Ulcer with Epuloticks. After it was cicatrized, the Sole of her foot was so relaxed and tender, that upon the setting it on the ground it became very much subject to pituitous Swelling: upon which account I caused such a Fomentation to be made as is proposed in the Cure of Oedema, and put on a laced Sock, by which the weak parts were strengthened, and she cured.  
A Lady in the Country of about twenty eight years of age, 
3. Observat.  having gotten some hurt in Childbed, was taken with a Fever, and about four days after was disturbed with a pain in her right Groin near the Os ilion, which in a few days after swelled with Inflammation, and became a large Tumour, reaching from thence over the Belly to the Os pubis like a roll of White-bread. They sent for Mr. Robert Morrey, an expert Chirurgeon of Chester, who met Doctor Smith, an eminent Physician of Shrewsbury. The Lady did not permit them to see the Tumour, whereupon they could give no certain Judgement of it, but prescribed an anodyne Cataplasm, which her women applied. Some few days after the Abscess broke, and than Mr. Morrey was fetched again, and admitted to dress it. The Abscess was large, and discharged a great quantity of crude Matter making its way through the Skin by many eruptions. He purposed the laying them into one: but the Patient not admitting of it, the Matter insinuated itself deep amongst the Muscles of that part of the Belly. She was than advised to take a Journey to London, but would not yield to it. In progress of time the discharge of Matter rendered her lean and hectic: and at last, when she was almost wasted with her Disease, she was brought to London in a Litter. Sir Fr. Pr. and myself, being sent for, consulted with Mr. Morrey. We viewed the Ulcer, and found it seated above the Os pubis, stretching towards the Os ilion, discharging a purulent Matter. We dressed it with a proportionable Tent armed with unguent. basilicon, Merc. praecipitat. and Empl. diachalcit. It was upon consultation resolved that the Sinus should be laid open in order to the Cure; which accordingly was snipt up about two inches with a pair of Probe-scissors, and the incised Lips dressed with the common Digestive ex terebinth. cum vitell. ovi. We afterwards proceeded with Detergents, mundif. Paracelsi, etc. After which Mr. Morrey took his leave of the Lady, and returned to Chester. Whilst I treated this sinuous Ulcer, she took her Vulnerary drinks and Balsamicks, also cordial Juleps made out of distilled Milk wherein had been infused proper ingredients to dispose her blood to a better temper. But she continued weak notwithstanding all our endeavours, and the Ulcer would not cure farther than it was laid open. Therefore with one snip more I laid it open to the very end, and dressed it with Digestives, with good hopes of Cure. But after some days, finding the Matter not lessen, I made a search, and felt a Sinus penetrate into the cavity of the Belly under the Os ilion. Considering the original of the Distemper, I judged it to penetrate into the Vterus or neighbouring Glands, which I presumed were much swelled and ulcerated, and would be a work of time; therefore proposed to her the removing to some neighbouring Village, to take the benefit of the air. She did so, and while she was there I cured the Sinus to the very penetration, and did hope that it might have been kept as a Fontanel. But it continued to matter very much. Upon which a Consultation was called, wherein the deceased Mr. Ed. Molins advised a Salivation by Merc. dulcis. She assented unto it, and to that purpose she was brought again to her Lodging in Town; and by a few Doses of Merc. dulcis a Salivation was raised, by which the Matter lessened, and the Ulcer dried. But a Soreness affecting her Mouth, as is usual in Salivation, gave occasion to a Chirurgeon, since dead, to insinuate himself into the Lady's Family, where he inveighed so much against the proceeding by Mercury, as lessened my credit with them; so that I was not capable afterwards to serve the Lady. Yet I prevailed so far, as that Sir Alex. Frasier was consulted; to whom (in their presence) I represented the condition of the Patient, and the method of our proceed. He approved of what had been given, and assured the Lady it was the only way to cure her; and that if she would drink a good Decoction of Sarsa, with the Specificks usually prescribed in such cases, and afterwards put herself into a diet of Ass' milk, she might enjoy a good health, and be obliged to acknowledge the good service I had done her. But she was prepossessed with the scandal of Salivating, and went out of Town a few days after, and, I suppose not following the method prescribed, proper after Mercury, languished under a Consumption, as such people generally do. No Mercury doing well, where the prescribed method is not observed.  
An Apothecary's wife living in my neighbourhood in the Old-Baily, 
4. Observat.  after a hard Childbed Labour, was seized with a Fever, and great pain in her right Thigh, from the Groin and Hippolito downward to the Knee, swelling the Member round, without Inflammation or discolouring the Skin. Sir Fr. Pr. was the Physician, and I think Sir. C. Scarb. The Surgeons were Mr. Bing and myself; and in the time of my Sickness Mr. Meredith a Chirurgeon dressed her. We fomented the Parts diseased with decoct. summitat. absinth. majoranae, beton. flor. ros. rub. cham. meliloti, summit. anethi, sem. lini, foenug. in wine and water, and made a Cataplasm of the same Faeces with the addition of far. fabar. orobi and lentium, with oxymel, ol. cham. etc. But the whole Member being oppressed and weakened by the Influx, it apostemated, and Matter was felt to fluctuate in several parts. We opened the most likely places by Caustics, and gave vent to a large quantity of purulent Matter. Than dressing the Escar with Lenients, we applied the Cataplasm and rolled it up. She was somewhat relieved, but rested ill that night. At the next dressing we enlarged the Opening with a pair of Scissors, and gave more way to the discharge of the Matter. Afterwards we continued our care in dressing her, and made other Apertions in parts more declining, and endeavoured Detersion by mundif. ex apio, etc. and by Injections made of rad. aristoloch. rad. consolid. ireos, sarcocollae, thuris, myrrhae, decocted in aq. hordei with mel ros. Many endeavours were used to cure these Ulces; but the Matter grew more corrosive, and the flesh within dissolved, and we felt the Thighbone bore. The Humours all emptied themselves upon this weak Part; and, notwithstanding all our endeavours, the Patient languished, and died in the space of eight weeks.  
I was also called to another, 
5. Observat.  who in Childbed laboured of an Ulcer in her left Hip; the Flesh was corroded round the breadth of the palm of a hand, the whole piece separated and fell of from the Bone, leaving it bore, and the lips of the Ulcer sordid without Inflammation or Tumour. I dressed the Bone with extract. scordii dissolved in spir. vini, and the Ulcer with mundif. Paracels. cum Merc. praecipitat. Traumatick Decoctions, Balsamicks, Cordials, Opiates, Juleps, were prescribed, and our work went on successfully a while, the Bone exfoliating from the edges; and the lips of the Ulcer digested and incarned with sarcotics myrrhae, aloes, sarcocollae, cum syr. de ros. siccis. But in the while a vehement pain seized the other Thigh, and it apostemated. We opened it on the outside, and felt the Bone carious: we gave vent to a foetid Matter. I treated it as hath been said in the former Observation: the Matter daily poured out, and the Abscess grew more hollow. To add to her affliction, she was tormented with a pain in her right Shoulder and in her left Knee, so that she was necessitated to lie upon her Hips, which exasperated them. At length the great discharge of Matter and extremity of pain wasted her, Oedematous Swell arose in her Legs and Feet, and she languished and died.  
A young Gentlewoman was brought to bed in the Country, and, 
6. Observat.  being ill delivered, became indisposed with a Fever, and was pained in several parts of her body. I found her grievously afflicted with corrosive Ulcers lying deep in the flesh to the Bone: whole pieces of flesh separated from the Os coccygis, and came of, leaving the Bones bore as that of a Skeleton. The flesh also fell of in round pieces from some other parts of her body. Upon the left Side, a little below her Breast, whilst I was with her, I saw it begin with a round crack in the Skin, the compass of a Five-shilling-piece in Silver, without Inflammation or Swelling, or other Matter than a little Sanies. It penetrated deeper every day, and in three or four days fell of from the Periosteum that covered the Ribs. I was much at a loss what to dress these Ulcers with while they were cracking, for they were dry and without tumefaction of the lips. What the actual Cautery might here have done, I do not know. I sprinkled Merc. praecipitat. in some places, and in others alumen ustum mixed with Praecipitate. I fomented some of them with lenient Decoctions, as rad. althaeae, consolid. fol. malvae. sem. cydon. psyllii, and the like. Others I treated with decoct. absinth. rutae, scordii, centaurii, cardui benedict. made in a Lixivie, and Cataplasms were accordingly applied; but nothing checked them. After the Skin and Flesh were separated, the remaining lips looked as flesh parboiled; yet they afterwards digested, and became better-conditioned; but this creature had so many places of her Body diseased, as she had not one free part to lie on. Our whole endeavours (after she was dressed) were, how to contrive Pillows to give her ease. The women's work was, to quilt them several ways, and make this and that part hollow suitably to the case: some parts of the Pillows had to that purpose holes cut in them. Many ways were proposed, but all to little purpose. She was always restless, frequently removing, and roaring for ease. I being quite tired, Mr. Newman a Chirurgeon was sent for, and relieved me. I soon returned again, and stayed till I grew diseased myself, and with much difficulty returned home; than another Chirurgeon was sent thither: and before I recovered of my own Sickness, I heard that she died most painfully.   

CHAP. VI Of an Erysipelas.  
AN Erysipelas is generated of a hot Serum in the Blood, 
Description.  and affects the superficies of the Skin with a shining, pale, read or citron colour, without Pulsation or circumscribed Tumour, spreading from one place to antoher. It gins for the most part with some little Rigour, and is continued with a Fever.  
This Serum, 
Differences.  according to its several degrees of recess from its natural state towards that of Choler, doth produce several Diseases. When the Recess is lesle, and the sharpness of it but little, than it doth only 'cause a radish Blush upon the Skin: from which the name of Erysipelas is, or at lest may be, derived; which is therefore by some great Authors reckoned amongst the sanguineous tumors, because its colour represents Blood. But what will they than say of an Erysipelas that appears yellow, as most of them do? why should not this colour give it a new name from Choler? But I shall in this submit to the minds of others. However I dare adventure to add, that a farther progress towards acrimony maketh an Herpes'; and if the access of acrimony be very great, it maketh an Herpes' exedens.  
These tumors are not always simple, but do usually mix themselves with other Humours, and from thence get additional Epithets; as Erysipelas oedematodes, phlegmonoïdes, scirrhodes, etc. But that which I propose to treat of is the Erysipelas à Sanguine bilioso, from choleric Blood, which affects only the outward Parts, none of which escape its tenuity and subtilness, the Face, Head, Breast, Back, Emunctories, Thighs, Legs and Arms▪ nay, when Bones lie bore, (and so become as it were external Parts exposed to Air) they are also subject to the same Malady; as we too frequently found in Wounds of the Scull and other Fractures.  
The Humour itself simply considered is very thin and sharp, much affecting the Pores of the Skin, in which it usually lodgeth; and in a great measure oweth its confinement thither to an occlusion of them, they being covered with a Cuticula, whose density hinders transpiration, from whence vexed with a Cuticula, whose density hinders transpiration, from whence pain and redness arise: and oftentimes other Humours are invited thither, so that the Tumour enlargeth, and becometh compound. Whilst it is simple, the Skin only is the seat of it, or the Periosteum, or a Bone that lieth bore: when it is compound, it will affect the Flesh also, and other neighbouring Parts.  
The Matter of this Erysipelas is already described to be a thin choleric Humour. 
Causes.  The Fountain of it is the Blood, which by its capillary Arteries dischargeth it upon that Part, as often as in bilious or malignant and pestilential Fevers it is provoked thereunto. And this, if the discharge be sufficient, is called Critical: if it be not sufficient, but that Nature, having discharged part of the Matter, lieth down under the rest, we call it Symptomatical. So also when it appears in the beginning of a Fever, it is than reckoned as a Symptom thereof. Sometimes the Fever is vulgarly esteemed a Symptom of it, viz. when the Erysipelas is first taken notice of, as if it had preceded the Fever: whereas indeed there is no Erysipelas that hath not a Fever, either visible or latent, going before it.  
Externall Causes do also concur to the production of an Erysipelas; as Contusions, 
Externall Causes.  Fractures, and such like; also the heat of the Sun, Fire, sharp Medicaments, etc. All which have this effect in choleric Bodies, where the Blood, being turgid with that Humour, meets with any occasion of separation of Parts.  
The Signs of an Erysipelas are, 
Signs.  a shining yellowish colour mixed with read here and there vehement, heat, with a pricking pain blistering the Skin, and creeping from one place to another. How it differeth from a Phlegmon may easily be discerned by comparing them: This lieth scattering in the Skin, scarce raising a Tumour; whereas the Phlegmon lieth deep amongst the Muscles, with elevation and circumscription, and is of a deep read colour.  
A simple Erysipelas is not accompanied with cruel Symptoms: 
Prognostic.  there is a Fever, but that diminisheth as the Erysipelas increaseth, according to an Aphorism of Hippocr. When the Matter is sent from within outward, the viscera are relieved, and the Patient recovers. This we see frequently in great Diseases. But ab exteriori introredire malum, the sudden return of the Humour inward is a bad sign, ill Symptoms frequently following, yea Death, especially if the Emunctories were affected. Suppuration in an Erysipelas is not good, according to Galen in his Commentaries on the same Aphorism, speaking of malign Erysipelas, which in suppurating do for the most part corrupt; as we see by the discoloured Pustulae which arise about them. Also an Erysipelas upon a bore Bone is ill; and if a Delirium hap, the hopes is lesle. That Erysipelas which goeth of by Transpiration is best.  
In the Cure of an Erysipelas you are to consider the Habit of body: 
Cure.  for whilst it abounds with bilious Humours, there is no admitting of Repellents; and by Discutients you will increase the heat, and consequently the Disease. Therefore we proceed in the Cure of this, as hath been said in a Phlegmon, by Diet, Pharmacy, and Chirurgery.  
Their Diet aught to be, as in hot tumors, very sparing, Grewells, Panadoes, and Chicken-broth, with cooling Herbs: their Drinks, Ptisans, Barley-cream, Emulsions, and Juleps made of distilled Waters, as aqu. borrag. endiviaes, acetosae, lactucae, portulacae, etc. cum syr. è succo citr. limon. granat. rub. idaei. violar. and the like; avoiding Wine in these Diseases. The Ancients allowed only Water, and to weaker stomaches Beverage. Rest and Quiet of mind is here to be desired, and the Belly to be kept soluble.  
Concerning Phlebotomy there hath been much dispute amongst Writers; but they all agreed that the Patient be let blood, in case the Erysipelas flow upon Wounds and such like accidents, or where it affecteth the Head or Throat. In the former of them it is allowed to prevent a Phrenitis, which otherwise might ensue; and in the latter a Squinancy, in which there is danger of suffocation. But if the Erysipelas be simple, and but in the Skin; we are than by Purgations only to evacuate the redundancy of Humours, and prevent the ebullition of Choler. The Purgatives aught to be lenient, such as have been prescribed in a Phlegmon: as cassia, tamarinds, manna, cremor tartar. rhabarb. etc. in Whey, or in Decoctions of Barley and opening Roots, with Syrups è cichor. cum rhabarb. and the rhabarb. de ros. solutiv. also the Elect. lenitivum, diacathol. diaprun. è succo ros. Clysters are also most proper in these Diseases. Having thus emptied the bowels, you may make Revulsion by Friction, Cupping, etc. and by Vomit, if the Erysipelas be in the nether Parts.  
In your applications to the Part affected you are to consider whether the Erysipelas was from an internal Cause, or external; also whether it be great, or little. If it arise from an external Cause, you may safely apply Refrigerants without any preceding Evacuation, because the Disease took its original merely from the disaffection of the Part, whether it was from the scorching heat of the Sun, sharp Medicines, Contusion, or Fracture, etc. and not from the peccancy of the Humours. Therefore in such cases you are obliged to appease the pain in the first place by lenient and cooling Medicaments.  
If from an internal Cause, than evacuation by Purgatives is always to precede, unless the Erysipelas be remote from the principal Parts, or that the heat affecting the Member be vehement; in which case you shall not insist upon Evacuation, but apply the milder Refrigerants to contemperate the heat, and afterwards proceed in evacuation of the bilious Humours.  
But if it be in the Head or Face, 
Caution.  you are than to be cautious in your Applications, (Abstinence or a very slender Diet being the best remedy to begin with) and to forbear to treat the Parts affected till the Erysipelas have a while made its progress, and in some degree spent its heat. But if something must be done to satisfy the Relations and Bystanders, let the Topick rather be of an exsiccant quality than repellent, jest some ill accident ensue.  
We shall begin with an Erysipelas proceeding from external Causes. The Medicaments generally prescribed in such cases are of a cooling humecting quality, not too much astringent, jest you dry the Skin, and prohibit Transpiration, and the Humour included become sharp, corroding the Parts, or stir up Apostemation. The Simples are, umbilicus Veneris, polygonum, plantag. trifolium palustre, portulac. psyllium, sempervivum, solanum. The Compounds are of various sorts. ℞ cerussae ℥ viij. lithargyr. auri ℥ iv. mucilag. sem. psyllii, cydon. extract. in aq. solani, succi solani, umbilici Vener. an. ℥ iij. aceti cochl. iv. ol. ros. & myritill. an. lb ss. sevi vitulini ℥ iv. coq. ad succour. consumpt. deinde adde thuris pulv. ʒx. cerae q. s. fiat Ceratum. Ceratum Galeni is also proper in these, so is unguent. nutritum, with a third part of populeon. Linen dipped in any of the aforesaid Juices may be applied: but than they must be renewed as often as they dry; otherwise they may increase the heat, and excoriate the Part.  
They who do use stronger Repellents aught to be careful jest, 
Caution.  in repressing the Inflammation, they do extinguish the natural heat of the Part, or strike the Humour inward upon the Viscera.  
In the Erysipelas proceeding from internal Causes decoctum salviae with a Solution of Castle-soap is a good Fomentation; and ceratum Galeni applied after it is sufficient. In those which are critical, a Cerote of ol. olivar. cum cera alba hath hitherto served my purpose. If the heat be vehement, I renew the application daily; otherwise every other day sufficeth: and as the Blisters arise, I cut them, to prevent Erosion. If afterwards they do excoriate, I dress them with unguent. tutiae, or the following Unguent upon Pledgits of Lint, by which the serous Humour may be imbibed, and the Ulceration healed. If a Fomentation be necessary, that of obibanum and Myrrh decocted in Wine may be used. ℞ troch. alb. Rhas'. & tutiae pulver. an. ʒiss. plumbi ustiʒj. camphorae ℈ ss. cerussae ℥ iss. ol. ros. ℥ vj. sevi agnini ℥ iij. cerae alb. q. s. fiat Vnguentum in mortario plumbeo per duas horas agitatum. This will cicatrize them. In those of the Head Aetius proposeth nidum birundinis pulver. & cum melle mixtum. He anointed the Erysipelas with a feather, and delivereth it to us as a Medicament drying without any repelling quality. The Decoction of Coleworts is also commended to bathe them. But, unless there be great Excoriation, it will be safer to leave the Cure of such Erysipelas to Nature, and evacuate and contemperate the heat by internal Medicaments. Nor aught we to be overforward in our applications to the Face or parts about it: yet in my Practice I have commonly used aq. calcis with ol. lini well shaken together with good success; as also these following, where I thought more Exsiccation necessary. Take distilled Vinegar in which hath been boiled a piece of Lithargyr. or minium: after it is settled, pour of the clearest of it, and filter it: put some of this into a glass, and add ol. ros. to it, and shake them together. Or, in case of present use, take saccharum Saturni, and beaten it up with the said oil. Either of these applied with a feather twice or thrice a day will serve your purpose.  
The Accidents which attend Erysipelas are the same as in a Phlegmon, 
Correction of Accidents.  and do hap through the unseasonable use of Repellents: therefore when you see the heat go of, and the Skin relax, or when the Patient feeleth himself eased of that burning and pricking pain, forbear the use of your Repellents, and apply Resolvents and Discutients, to corroborated the Part, and restore it to its natural tone. For though the Erysipelas do not arise with any circumscribed Tumour, yet in its progress the Member is swelled, and remains so after the Erysipelas is breathed forth, and for want of Discussion doth frequently become oedematous. Therefore to prevent that, it may be reasonable to foment the relaxed Parts with decoct. summitat. absinth. flor. cham. sambuci, ros. rubr. etc. in Wine, with an addition of Brandy. If an Emplaster be necessary, ℞ farinae fabar. orobi, an ℥ iv. sem. foenug. ʒj. flor. sambuci, ros. rub. an. ℥ iss. pulverizentur, coq. in hydromelite ad consumptionem humiditatis; deinde add ol. anethi & cham. q. s. fiat Emplastrum. But if the Erysipelas terminate in a hard Tumour, ℞ rad. althaeae, lilior. an. lb ss. sem. lini & foenug. an. ℥ ij. coq. in brodio capitis vervecini, & extrahatur mucilag. cui add ol. ex pedibus bovinis, pingued. gallinae, ol. amygd. dulc. an. ℥ ij. adip. agnin. & vitulia. an. ℥ iss. medullae ℥ ij. lethargy aur. ℥ iv. cerae q. s. fiat Ceratum.  
A Person of quality, 
1. Observat.  labouring under some indisposition of body and apprehension of a Fever, was by her Physician's advice let blood about ℥ viij. in the left Arm. The second day after she felt that Arm pained, but most about the Bend of it near where the Vein was opened. I looked upon her Arm, and saw it was spread with a burning heat of a palish yellow colour, mixed with read here and there: the Skin was tense and shining, also rimpled and blistered down from the Bend of the Arm to the Hand: from the Elbow to the Shoulder it was of an inflamed read colour. The whole Arm was swelled by the influx of the Humour. This Erysipelas was thrust forth by the strength of nature, and possibly it might be invited thither by the Bandage. However it were, the Patient was relieved thereby; she acknowledging herself more affected with the pricking and burning heat in her Arm than any Sickness: yet she was not without some Fever. I thought it not safe to be too busy with Repellents in this case: for though I might thereby have prevented the increase, and cured it sooner; yet her Fever might have been by that means augmented, and her Recovery hazarded, she being than with Child. Therefore I resolved to give way for the Humour to spend itself by Transpiration: to which purpose I fomented with a decoct. salviae with Castle-soap dissolved in it, and the while made a Cerote of ol. olivar. and Wax, and applied it in several pieces upon the Arm, with Bandage to retain it on; during which her body was kept soluble Lenients, and a Pearl-Julep prescribed to refresh her Spirits. Her Diet was Chicken-broth, Grewells, and the like. As the Blisters arose, we snipt them, and to some of the biggest of them applied unguent. tutiae upon Pledgits. During these Applications the heat went of from the Parts it had first affected, and spread up higher to the Breast and Scapula; it also affected the Hand and Fingers with Blisters: but the tops of them being cut of, they healed, the Inflammation breathed forth in four or five days after, and she recovered; but by reason of the Fluxion her Arm was swelled. For the removal of which I directed them to foment it with the Decoction prescribed in the Method of Cure, by which, with the help of Bandage, it discussed. The roughness of the Skin was afterwards cleared with Pomatum.  
A Youth about seven or eight years old, 
2. Observat.  labouring under a complication of Diseases from his Mesentery and Kidneys, was ordered by his Physician to have a fontanel made in his left Arm: I made it, and left it well digested. About ten days after that Arm was overspred with an Erysipelas from the Shoulder to the Wrist, here and there blistered. I threw out the Pea, and dressed the Ulcer with unguent. basilicon and Praecipitate, than fomented the Arm with Milk, applying over it ceratum Galeni with Bandage. By this I designed to give transpiration to the Part whilst the Physician did treat the Fever. The next day I renewed the Dress in his presence, and the Ulcer being somewhat digested, I put in a Pea by his advice, and dressed the Arm as before, thereby curing the Erysipelas in few days: but the Child remaining indisposed, the Erysipelas burst forth againg, and was also cured by the same method. Than the Patient was purged, and sent into the Air near Barnet, where he drank those Waters, and being thereby relieved, was brought back to his Parents. But within sew days after he relapsed, and an Erysipelas discharged itself again on the same Arm, with a small Phlegmon below the Elbow on the outside. It suppurated, and was opened by a Caustick, and cured according to that Method. The Erysipelas was also cured by the Cerote as before. After this the Child broke out of the Smallpox, and by the great endeavours of the Physicians was freed of that Disease; but languished and died soon after. Upon the opening of his body, as Stone of the bigness and shape of an Almond was found in his left Ureter. We remembered the constant pain he had in his Back long before the first Erysipelas, and thought that might be the occasional cause of all these Maladies; viz. the continuation of pain caused many reiterated Fevers and Fermentations in the blood, of which these forementioned Diseases were the effects. A thing not rare in Chirurgery, to found the Smallpox produced by the pain of an Ulcer, as also to break out after the curing of them.  
A Gentleman of about sixty years of age, 
3. Observat.  having laboured many years under an Asthma, was seized with a pain in his left Side, and a Pleurisy followed, with great oppression in his Lungs, his former accustomed way of discharge by expectoration being suppressed. Doctor Jasper Nedham was sent for. By his prescription the Patient was let blood ten ounces: Lohochs and Pectoralls, also opening Apozems, were prescribed, and Venaesection repeated; by which the Patient was relieved. Than a fontanel was cut in his left Arm, which being digested, the Physician and Chirurgeon were dismissed. A few days after the Patient relapsed, and an Erysipelas thrust out the whole length of his Arm. I was fetched, and saw it swollen, the Cuticula vesicated, and shining with a burning heat of a citron colour from the fontanel downward, but upward to the Shoulder it was more read. His Friends and himself thought the Inflammation to proceed through default of the fontanel, as not made in the right place. But that was an error in them: for it was a translation of part of that Humour which affected his Lungs, and was by the strength of nature discharged upon this Part, to which the too strict Bandage might possibly contribute; there being nothing more ordinary than such discharges upon fontanelles: and it was well for him that it there disburdened itself. The Physician and myself concluded it a pure Erysipelas, and that it required to be breathed forth: to which purpose I applied a Cerote of Wax and Oil over all the Arm, and put a lesser Pea into the fontanel, with a Pledgit of unguent. diapompholyg. and Emplast. diachalcit. rolling up the Arm from the Hand to the Shoulder. The next day in dressing him I snipt the Blisters, to let out the serous Humour, which might otherwise have ulcerated the Skin. The day after, observing the heat to go of, I put in a larger Pea, and dressed his Arm as I did the day before. In two or three days after, the Arm being as it were freed of the Erysipelas, I fixed the fontanel, (which he keeps to this day:) but the Erysipelas spread to that Scapula and Clavicle, and so down to his Breast and Back. I dressed it with the same Cerote, and left him enough of it for his Servants to dress him with: during which Purgatives were repeated, and he was cured by the application of the said Cerote.  
A person of about sixty four years of age, of a melancholic dry Constitution, 
4. Observat.  was in the Winter-season taken with a Quartan-ague, and after the second Fit was seized with a pain in his left Leg, which increasing, he sent for me. The Leg was inflamed from the Knee to the Foot: the Inflammation of the Skin was of a more deep read colour than is usually seen in a true Erysipelas, it indeed partaking somewhat of a Phlegmon; but the Swelling was without circumscription; it was tense and shining, made by a Translation of his Ague: so that by this, if well managed, he was in a possibility of being freed of that. Therefore I proposed by Lenients to moderate the heat, and breath out the Humour. Having satisfied him, that it was necessary to proceed deliberately with it, I treated it as in the former Observation hath been said, and dressed it twice or thrice with the said Cerote; and, having assuaged the heat and pain in it, I shown his Servants how to dress it, and gave directions to the Patient in the regulation of his Diet, etc. and took my leave; advising them not to dress it too often, jest upon so doing the Inflammation should go of before the morbific Matter were spent. From the time the Inflammation was made in his Leg he had no more Fits of his Ague, and his Leg became well without the application of other Medicaments. Upon the going of of the Inflammation I made him a fontanel in that Leg, which he continueth still.  
A Gentleman of about sixty years of age, of a full Body, 
5. Observat.  with a short Neck, and of a sanguine Complexion, having long laboured under the apprehension of an Apoplexy, his Mouth having some while been a little distorted by a Paralysis of his Cheek and Tongue, was let blound in the Neck about ten ounces. The night after he was seized with a pain in his right Leg from his Knee to his Toes, with great Inflammation. For the appeasing of which a Fomentation was brought him by some Pretender in Chirurgery, and applied with course woollen Stupes; one of which was bound upon his Leg. This Leg growing from that time more painful, I was fetched to him; when, taking of the Stupes, I found the Leg exceedingly inflamed and blistered, so that the Stupe sticking in the Sores had excoriated the Part with great pain and Fluxion, which drew after it a small Phlegmon. There was in this Patient great need of making a Revulsion from his Head; but this was by woollen Stupes was of too much danger to be continued. I wanted a Fomentation to cleanse and refresh the Part, and, being in haste, caused some water to be heated, with a handful of Wheat-bran: which being strained, I bathed the Member with a Sponge; than applied unguent. tutiae upon Pledgits of Lint on the Excoriations, and a Cerote of Wax and Oil over the Leg, and an anodyne Cataplasm on the Tubercle. These Dress were renewed daily, till the Accidents were diminished, and the Tumour suppurated. Than I gave a vent to the Matter, and proceeding by Digestion, made no haste in the Cure, but expected rather that the Plethora should be carried of the while by Purgatives, and the Patient relieved in his Head. The Physicians were of another mind, affirming that it would be time enough when his Leg should be cured. I was therefore obliged to hasten: however I made him a couple of Issues inter Scapulas; and having well-near cured that Tubercle in his Ham, I left a Pea in it to keep it open as a Fontanel. Though that Leg was not so fit for it, by reason of the great Inflammation it had laboured under; yet I thought all little enough for Derivation, and would gladly have continued the Leg more sore: but I obeyed my order, and left him cured of his Leg.  
A Gentlewoman of about forty years of age, 
6. Observat.  of a full Body, was taken with Rigour and Fever. After some days she complained of a pain in her left Shoulder, and a pricking heat in that Arm. I was sent for, and perceived it to be an Erysipelas thrusting out: wherefore thinking she might be much relieved thereby, I dissuaded her from applying any thing to it. But the heat and pain increasing, she was advised to apply some cooling Ointment to it, which was thought excellent for Inflammations. She permitted it; and it did indeed check the Inflammation, but her Fever increased, with a Delirium. She was let blood, cupped and blistered, and all things were done to draw back the Matter; but she died.  
A Man of about 27 or 28 years old, 
7. Observat.  riding abroad wit some Friends in hot weather, his body being heated by Good-fellowship, was seized with an Erysipelas in his Face. I presently let him blood, and bathed it with a decoct. salviae cum sapone Veneto, and left directions to wet his Face often with it. I also directed a Clyster to be given him that night, and a Cordial Julep upon occasin. In the morning he was hot, and had rested ill, and the Erysipelas was spread to his Neck, and affected his left Ear with great pain, and reached up to his Forehead amongst the Hair. I let him blood again, and advised him to keep his bed, and put himself into a Sweat with a draught of Posset-drink wherein had been boiled a little Hartshorn, a few opening Roots and Marigold-flowers. I also sent him a glass of aqua calcis with ol. lini beaten in it, with direction to anoint his Face with a feather, it being very much heated and swelled: he was also purged with Lenients, some of those which have been set down in the method of Cure. By this method the Erysipelas went quite of in 10 or 12 days. Than I bathed it with decoct. malvae, viol. etc. to bring of the Scurf, and afterwards with Buttermilk, to suppling it, and anointed his face with Pomatum.  
A Gentleman some years since, 
8. Observat.  very curious and neat in wearing his Hair, was persuaded to permit it to be boiled as it grew on his Head: by which doing an Erysipelas was raised in the hairy Scalp. I let him blood in the Arm, and purged him with Lenients; all things else were done for Revulsion: but, by reason of his Hair, there were no applications made to relieve the Part affected; whereupon a Suppuration followed; which put me upon a necessity of cutting it of, and applying Fomentations discutient and drying. I met with much difficulty in curing the Ulcer; but at last it was cured as a corrosive Ulcer, to which I refer you.  
An Erysipelas arising from an internal Cause affecting the Head requires the timely advice of a Physician, it frequently causing grievous Accidents, as Fever, Delirium, etc. and, being subject to great Ulcerations with putrefaction, doth frequently corrupt the Flesh to the Bone. Sad instances may be given of these; (they ending for the most part in Death:) therefore it were to be wished in such cases, that the Hair be timely cut of, for it contributes much to the Erosion that happens.  
An Erysipelas affecting the Face of a Person of Honour, 
9 Observat.  he consulted Sir Ch. Scarburgh and other Physicians: they prescribed Bleeding to the quantity of eight ounces, also Clysters and lenient Purgatives to keep his body soluble. During the time of Inflammation he was feverish and indisposed, also subject to Fainting and the like. In consideration whereof he was advised to keep his bed, and sometimes to dispose himself to breathing Sweats with the Countess of Kent's Powder: cordial Juleps were also prescribed him. The Erysipelas shifted from one part to another in and about his Face. They applied no Medicaments to the Parts diseased. In the declination of it I saw it arise again fresh in his Forehead with a Swelling very high, only from the straightness of his Cap: which I taking notice of, and advising it to be slackened, the Swelling sunk again few hours. I instance this only to show how small a thing will raise this disturbance where the bilious Humours are in ferment. As his Erysipelas spent itself, they purged him, and he recovered. An Erysipelas sometime affecting one particular part of the Head or Face, as the Eye, Nose or Ear, hath given mech trouble to the Physician and Chirurgeon in removing it.  
It is not many days since I was called to one labouring of an Erysipelas on his right Ear. It had been diseased four or five days before I came: 
10. Observat.  it was prodigiously swelled and inflamed; and, by reason of the acrimony of the Humour which was included between the Folds of the Ear and the Ear and Scalp, there was great Excoriation. I fomented it with decoct. salviae cum sapone, dressed it with that Preparation of acet. litharg. cum ol. ros. above proposed in the method of Cure, and left her some of it to dress herself as occasion should offer; than let her blood, and directed a Clyster to be given her. The next day I purged her with Whey and Manna, and repeated it again and again. She lived a few miles out of Town, which put me upon the necessity of committing the Cure of it to themselves, with Directions, and Medicaments such as I have above proposed. It dried up the external heat; but the Fluxion, which lay more internally, after all apostemated, and was cured accordingly.  
I was called in by my kind neighbour Doctor Denton to a young Woman who had been afflicted with an Erysipelas, which had spread over all her Face: 
11. Observat.  it had shifted often: at length she was cured thereof by the said Physician; yet was the right Eye closed with the Inflammation and Swelling from the relics of that Erysipelas, and the lower Lid apostemated, and the Matter was ready to make its way inwardly into the hollow of the Eye. We opened it by Incision, discharging a proportionable quantity of Matter; the remainder of which we digested and cleansed to a perfect Cicatrice by unguent. diapompholygos, discussing the Tumour in the mean while by Fomentations.   

CHAP. VII. Of a Furuncle or Boil.  
FVrunculus is a painful Tubercle of the bigness of a Pigeon's Egg, 
Description.  with a broad basis, arising in a Cone. It is generally called a Boil, and in its state is accompanied with Inflammatio, Pulsation, and Tension.  
It proceedeth from a gross vicious blood separated from the rest a unprofitable, 
Cause.  and is cast forth by the strength of nature into the external parts of the body.  
It differeth as it is greater or lesle, 
Differences.  and as it affects the Skin or lies deeper in the Flesh: it is also accounted malign, or benign. Those that are more deep partake of the nature of a Carbuncle, and are mistaken for such, but are not of so adust or corrupt an Humour. Furunculus differeth also from a Carbuncle, in that this cometh to Suppuration, which the other never doth.  
A Furuncle is in its beginning round, 
Signs.  hard, and inflamed; and as it increaseth it riseth up with an acute head, and sometimes a Pustule: and than it is more inflamed and painful, (whence ariseth that expression, As sore as a Boil,) especially when it arrives at its state, which is about the eighth or ninth day. If the Boil be malign, it is of a black dusky colour: there is also a Fever and other untoward Symptoms, and a thin Sanies issueth from it; and if it doth digest, it is with much difficulty.  
Boils are for the most part without danger. 
Prognostic  The common sort do predict Health, and frequently cure though nothing be applied to them; for they come to maturity and break of their own accord. But when they arise in nervous parts of the Arms or Legs, they affect the neighbouring Emunctory. In the Nose or Ears they are very painful, and vexatious to cure.  
The Cure consists in the regulation of Diet and in Evacuation, 
Cure.  like as in a Phlegmon; only the Applications in these aught to be maturative, they always terminating in Matter, and being, as you may perceive by the toughness of the Matter, not capable of Resolution.  
The Maturatives are, rad. & fol. althaeae, malvae, rad. lilior. uvae passae, ficus, and all the emollient Gums, galbanum. ammoniac. etc. The Compounds are, Empl. diachyl. cum gummi, de meliloto, tripharmacon, de mucilaginibus. In the extremity of pain you may assuage the heat with this or such like: ℞ mucilag. sem. psyllii, altaeae, lini, an. ℥ jss. far. hordei ℥ ij. ol. llior. axung. gallinae, an. ℥ j butyri recent. ℥ ss. croci ℈ j come vitell. ovi fiat Cataplasma. When the Tumour is broken, deterge that tough Matter with mundif. ex apio, and apply this or such like Cerote over the Tumour; ℞ sevi cervini & vitulini an. ℥ iij. axung. anseris ℥ j terebinth. ℥ jss. cerae q. s. fiat Ceratum.  
IN a Man of about fifty years of age, 
1. Observat.  of a healthy strong Body, journeying to London, a Boil rose upon his Wrist. He applied to it an Emplaster of Shoemakers-wax. When he came to me it was hard and inflamed. I dressed it with the abovesaid Cataplasm, by which it suppurated. As the Pustule fretted of, a hot Sanies issued forth in a small quantity. I dressed the Pustule with unguent. basilic. cum vitell. ovi upon a Pledgit, and continued the application of the Cataplasm over all. The next day I took of the Dress, and found the Cuticula cast of, and the acute end of the Boil read, and a thick white Matter sticking in it. I dressed it as before, and the second day after again, and saw the Cone or head of the Boil broken of, and that thick tough Matter lying in it; which Matter likewise appeared round about through the several Eruptions it had made. I dressed it with mundif. ex apio, and applied the Cerote Sevi cervini over it. The second day after I found the Openings broke one into another, and the tough Matter sticking in them as in a Honeycomb. At that time the Ulcer was near as broad as a Half-crown. I continued the Mundificative and Cerote, and dressed it every other day. As this tough Matter digested out, it incarned underneath, and contracted, and healed as fast, and cicatrized by the application of unguent. tutiae, leaving little Scar, and no hardness, behind it.  
Some years since I was sent for early one morning to a Gentleman about forty years of age, 
2. Observat.  who was extremely pained with a Boil on th' outside of his left Thigh. I pulled of the Emplaster, which was of galbanum, and saw the Boil was in its state, and ready to break. It was much inflamed, and the Pustule was of a livid colour. I dressed the Pustule with ol. ros. cum vitell. ovi, and applied over the inflamed Boil an Emplaster of bailicon. I returned that night, and dressed it with the Cataplasm above prescribed, by which it suppurated, the Cuticula broke of, and a thin Sanies with some little Matter discharged. As the Boil came more to maturity, the Pustule or head broke of, and made way for the Matter to digest out: and accordingly the Ulcer cured. An Empirick, angry that his Medicaments were thrown of, and mine applied, complained to a Person of Honour, whose Family I than attended, that this Gentleman laboured under a Carbuncle or Plague-fore: but I cleared myself to that Person, and shall show you in its proper place, that a Carbuncle is another kind of Boil.  
A Gentleman near seventy years old was sorely afflicted with a Furuncle within his Nostrils, and about his Nose with great Inflammation and hardness. 
3. Observat.  I fomented the diseased Parts with decoct. summitat. althaeae, malvae, viol. flor. chamaem. meliloti, sem. lini & psyllii, and with a Syringe injected some of the same liquor into his Nostrils, and applied the forementioned Cataplasm over his Nose. I purpose the letting him blood in the Arm, but it would not be admitted by reason of his age: but by setting on Leeches behind his Ears I took away some blood; also by blistering the Neck and Shoulders I endeavoured Revulsion, by Clysters kept his body soluble, and continued the Applications, by which his pain was somewhat mitigated. After five or six days the Skin became thin, and a white Matter shown itself in several places within and about his Nose, and gradually made its way through many small Openings. I made it more way here and there with the point of a Lancet, and dressed them come vitell. ovi & ol. lilior. and continued the use of the Fomentation, and applied the Cerote. I was much troubled to think what would become of his Nose, the exterior and interior parts being all stuffed with that clammy Matter, so that it would not issue out; and, when it should, I doubted it would leave little coverture for the Cartilagues. To hasten it out, I daily dropped in a mixture of mel ros. cum succo apii decocted; and by conveying a big Tent dipped in the same into each Nostril, I pressed the Matter outward, and sometimes pulled it away with my Forceps. It came out as if it had been broken pieces of the Spinalis medulla, and burst some of the Openings into one another; which I was sorry to see. But the Matter not being accompanied with acrimony, the hollowness filled up, and the distended Lips, falling near one another, agglutinated as the Matter digested out: and by the Compression I made with my Tents within the Nostrils I enlarged them, and furthered the well cicatrizing of the Ulcer; which was effected in few days after with Cicatrices not unseemly.   

CHAP. VIII. Of Epinyctis and Terminthus.  
THere are yet two sorts of painful Tubercles' which I have met with in my Practice: they are taken notice of by the Ancients under the names of Epinyctis and Terminthus; a couple of angry Pustules, affecting the Skin in the Arms, Hands and Thighs. They do not differ much one from another, so may well be entered together.  
The Epinyctis is of the bigness of a Lupin, 
Description.  of a dusky read, and sometimes of a livid and pale colour, with great Inflammation and pain. It dischargeth first a Sanies, than a bloody Matter. Terminthus is somewhat lesle, of a blackish colour: it breaks and gleets, and within a day or two the Pustule separates, and comes away in a Slough, and from that time it digests and heals.  
They both proceed from an excessive heat in the Blood, 
Cause.  but are without malignity or danger, and cure with little difficulty, if there be no error committed in Chirurgery.  
The Cure consists in Evacuation by Bleeding, 
Cure.  Purging, and regulation in Diet, etc. as in a Phlegmon.  
The external Applications commended to us by the Ancients are, fol. cientae, solan. plantag. cum polenta; or, ℞ uvas passas mundatas, & contusas superpone: and to wash them with aqua salita, to dry up the Matter, and prevent Erosion; afterwards to dress them with a mixture of equal parts of sulphur viv. and spum. argenti cum vino. I never was consulted in these till they were arrived at their height, and than found Anodynes of most use, and applied such as have been prescribed in the former Chapter, and afterwards healed them with unguent. tutiae.  
A Maid came recommended to me with the former of these Tubercles' on the inside of her Arm of the bigness of the greater sort of Lupins, 
1. Observat. of an Epinyctis.  of a livid colour, with a small acute Pustule rising up in the middle of it. It was accompanied with great Inflammation, affecting the Tendons with hardness in the Joint. I prescribed her that Cataplasm ex mucilag. sem. psyllii, althaeae, lini, etc. as in the Chapter of Furuncle, and embrocated the Tendons affected with ol. ros. & cham. By this the Tubercle was brought near Suppuration, the Pustule first brake, and discharged a thin Sanies. I dressed it cum vitello ovi, and about two days after the Tubercle itself thrust out a bloody Matter. I dressed it with unguent. basilic. added to the vitell. ovi, and applied cerat. dialthaeae, and continued the Embrocation. The Matter from that time was daily better digested, and the pain diminished: it was healed with unguent. diapompholyg. and Empl. è bolo.  
A young Gentleman having such another on the outside of his Wrist was recommended to some body who opened it by Incision: 
2. Observat. of an Epinyctis.  but from that time it became more exceeding painful. He came to me with it hard and dry, and it had communicated its Anguish all along by the Tendons and Nerves to that Axilla with several Glands'. I embrocated the Arm from the Axilla to the Knuckles of that Hand with ol. ros. cum aceto, and applied Empl. è bolo upon those Glands'. To the Tubercle I applied unguent. basilic. cum ol. ros. spread indifferent thick in the form of an Emplaster, and dressed it so twice a day. I purposed the next morning to have let him blood; but he was easier: and the same night I felt the Tubercle softer, and saw a bloody Matter thrust out. From that time it digested better, and the Accidents diminished: in four or five days after the Glands' resolved, and the Ulcer cured by the application of unguent. tutiae, etc.  
Of the latter sort there arose one in the Knuckle leading to the Forefinger of a Gentlewoman of about forty years of age. 
3. Observat. of a Terminthus.  An old acquaintance of mine called me to the sight of it. It was a small Tubercle inflamed round its basis, having a black head, and a long inflamed Streak passing from it to a Fontanel which she had on that Arm. Whether it did run upward from the Pustule to the Fontanel, and affect it, or descend from it to the Pustule, I know not: however it was, there were marks of communication from one to the other, and both were painful, and the Patient was indisposed with a Fever. In the Fontanel there was a small Orenge-pea, which I cast out, and put in a common one, and dressed it with Lenients, and an Emplaster to retain them on. I dressed the Pustule with unguent. basilic. cum vitell. ovi, and applied the forementioned Cerote prescribed in Furuncle. It suppurated the next day, and the head of it cast of in a Slough. I clipped of the lose skin from it, and dressed it with unguent. tutiae, and in five or six days cicatrized it. During the Cure the Patient was afflicted with a Diarrhaea, which was purged of. After which she was hot and feverish, and troubled with a Rheumatismus; for which she was let blood, and cured.   

CHAP. IX. Of Inflammatory tumors of the Glandules.  
UNder this Head I comprehend all those tumors of the Glandules which have Blood for their essential ingredient. They are usually reckoned Phyma, Phygethlon, Bubo, Parotis. It is true that Strumae and Scrofulae do sometimes partake of Blood and become Phlegmonoide, etc. but that is not essential to them: witness the great numbers that never come to inflame or suppurate.  
OF those that are essentially bloody tumors, 
Phyma.  though few of them pure Phlegmons, PHYMA is the first; 
Description.  which is an Inflammation affecting the Glandules under the Jaws. I mean the conglobate Glands': viz. neither the internal salivary, which is Ranula; nor the external, which is Parotis. The name of Phyma is also given to the Phlegmonoïde tumors in and about the Anus, because of their near resemblance to glandulous tumors, if they be not really such.  
They are caused by a mixture of impure Blood with Pituita. 
Cause.  Children are most subject to them; and in them they are hastened by their wearing of Stays, a way to keep their Head-cloaths on.  
The Tumour is round and hard; 
Signs.  in time of Suppuration it inflames, and is accompanied with Pulsation, Tension, etc. as in a Phlegmon, but doth sooner suppurate.  
They have been taken by some for Strumae: 
Difference.  but they differ from a Struma, which, being contained in a Cystis, doth require to be eradicated by Escaroticks after Suppuration and discharge of its Matter; but these after discharge of Matter are cured either of themselves, or by the ordinary intentions of Digestion, etc. They are without danger, and easy of Cure.  
The method of Cure is the same with that of the little Phlegmon: 
Cure.  only these do not admit of Repellents; but from their very beginning must either be discussed, or brought to suppurate. And indeed all that I have ever seen did terminate by Suppuration. In the beginning we treat them with Empl. diachyl. cum gummi, de meliloto, and the like: or, in case of pain, with maturative Cataplasms, as hath been set down in Phlegmon and Furunculus; as rad. althaeae, lilior. sem. lini, psyllii, etc.  
A Gentleman fetched me one night from my house to see his only Child, 
1. Observat.  about a year old, labouring of one of those tumors under the right Jaw: it was round and hard, of a pale colour, and was supposed the King's Evil. I applied Empl. diachyl. cum gummi, and, in stead of the Stay, put on a folded linen  about it, to retain the Dressing. After three or four days I visited the Child again, and saw the Tumour read, tending to Suppuration. I than dressed with unguent. basilic. and a Plaster; and the third day after, feeling the Tumour well suppurated, opened it by the milder Caustick, and discharged a Matter of good colour and consistence. I dressed it with Lenients, and after separation of the Escar disposed it to incarn by the common sarcotics, and by the use of the Vitriol-stone; and afterwards with unguent. de lithargyro cured it in few days.  
Such another, 
2. Observat.  but bigger, was that in a Girl of about nine years old, where Doctor Rugely was the Physician. She had been diseased with a Fever, and some Relics of that Matter discharged themselves in a Swelling under the right Jaw as big as a Pullet's egg. It was suppurated, and required vent, which I gave it by Incision; but could not cure it till I had applied a Caustick upon the depending part. The place not being very capable of Bandage, it could not be treated so advantageously when opened by Incision, and dressed with Tents: but after the laying it more open by Caustick, the Matter plentifully discharged, and the Abscess cured as the former. Many of these have been brought to me upon suspicion of the King's Evil: some of which my Servants have cured by my directions after the abovesaid manner. You will meet with more of this Tumour in the Treatise of the Diseases of the Podex.  
PHYGETHLON is a Tumour affecting the glandulous parts under the Jaws, 
Phygethlon. Difference.  and is called Panus. It differeth from Phyma, in that it hath a mixture with Bilis, as the other had with Pituita, and lies round and flat as a Cake under the Jaws.  
It is cured after the same manner as the other; 
Cure.  so will not be worth the troubling the Reader with many Instances of it. I shall give you one, whereby you may distinguish it from Phyma and other tumors.  
A little Girl was brought to me upon a supposition of having the Evil. 
Observation.  She had a flat, hard, round Tumour lying under her Chin and part of the right Jaw down towards her Throat: it was of a yellowish read colour, not unlike that in an Erysipelas, but without Vesication. I directed one of my Servants to make a Cataplasm ex rad. lilior. alb. etc. by the application of which it suppurated in three or four days, and discharged a well-digested Matter; during which the hardness resolved, and it cured in seven days by the only use of that Cataplasm.  
THE Tumour called BUBO is an Inflammation of the Glandules in the Emunctories of the Groin or Armpit. 
Bubo.   
It taketh its Differences from the quality of the Humour: 
Differences.  and so they are either benign, or malign. The latter sort are either venereal, or pestilential.  
The Causes of Bubo are internal, or external. 
Causes.  The former are vicious Humours abounding in the Blood or in the Nerves excreted sometimes critically, sometimes symptomatically. The external Causes may be pain affecting the exterior Parts: so a Wound in the Hand or Arm, nay the Finger, will affect the Armpit with a Tumour. You have an Instance of it in Phlegmon. A Cancer in the Breast doth the same. So an Ulcer in the Foot affects the Groin. In the Treatise of Struma you may see some Instances of it.  
A Fontanel in the Leg distempered with pain caused a swelling of the Glands' in Inguine. I was consulted about the Swelling, and, 
Observat.  enquiring of the reason of the sudden Tumour, found the Fontanel disturbed by walking much that day. I dressed the Fontanel with Lenients; and the tumors of the Glands' in Inguine, which were risen like so many Scrofulae, relaxed, and were scarce to be felt the next day.  
A Bubo ariseth in the Emunctories with pain, Inflammation, hardness, 
Signs.  etc. as in a Phlegmon. If it was made by Crisis, than a Fever preceded: if there were none, than other Causes must be enquired after: as, whether pain preceded in some remote Part; also, whether it be pestilential, or venereal.  
Buboes that are neither malign nor contagious are not dangerous, 
Prognostic.  if they suppurate kindly, and are timely opened: but if the contrary hap, they may degenerate into Fistulae, and than are not without danger. If they proceed from a Translation of Matter, (as sometimes from the Parts near the head of the Vena cava and top of the Breast or bottom of the Neck into the Armpits, or from the lower parts of the Belly in the Glands' and other Parts near the Rami iliaci into the Inguina) the Cure is difficult: and if the Lungs above, or the Vterus, Bladder, or Rectum below, partake in the Tumour, it is more desperate.  
A Bubo, according to the usual method of Practice, 
Cure.  aught not to be repelled: therefore in order to the Cure you are to consider the Cause; and if it were by Crisis, you are either to breathe it forth by Discutients, or hasten Maturation. If the Crisis be imperfect by reason of the weakness of the expulsive faculty, you aught by Attraction to help it forward, either by Cupping-glasses, or by the application of sour Leaven, black Soap, sterc. columbin. sem. sinapis, urticae, Figs, roasted Onions, etc. Or, ℞ cepam magnam, excavetur, & impleatur cavitas theriaca; deinde papyro involuta coq. sub cineribus calid. & cum ol. scorpion. fiat Cataplasma, addendo fermenti acer. ℥ ss. Misc. Or, ℞ Empl. diachyl. cum gummi ℥ ij. picis Burgund. ammoniac. solut. an. ℥ ss. pulv. aristoloch. rot. rad. gentianae, an.ʒj. cum ol. scorpion. fiat Ceratum. All the hot Gums are hereto proper. But if it be symptomatical, it betokeneth Plethora, which aught to be removed by Bleeding. Purging is also necessary, both to carry of the quantity, and also to amend the evil quality of the Humour, Plethora in this case being usually cacochymical: yet must not our purging be too violent, but only such as may assist nature in making a due separation of the peccant Humours from the mass of Blood. And if it was caused by pain from some other Part, you aught by Lenients to assuage that pain, and by moderate Discutients mixed with Repellents scatter that Humour in the Emunctories. But if it will come to Suppuration, you shall hasten the Opening of it, and digest, incarn and cicatrize it, as is said in the general Chapter of Abscesses, and will be showed in the following Observations.  
A Man of about fifty years old, 
1. Observat.  of a full Body and strong Constitution, was taken with a pain under his right Arm with hardness and Inflammation. I was sent for, and, concluding it a Bubo; thrust forth by the strength of nature, applied Empl. diachyl. cum gummi, designing not to dress it again till it was near suppurated: but the Tumour increasing with great pain and inflamed redness, I was put upon a necessity of applying anodyne Cataplasms. Within few days after, it being suppurated, I opened it by Incision, and discharged a well-concocted Matter: than dressed it with unguent. basilicon cum vitell. ovi upon a Tent, and applied an Empl. diachyl. simple. malaxed with unguent. dialthaeae, and afterwards dressed it with mundif. Paracels. Having so disposed it to heal, I left Dress, and after three or four days visited the Patient again: when, observing the hardness digested of, and the Abscess fit to cicatrize, I left of the use of the Tent, and dressed it with a Pledgit of unguent. diapomphol. and the Cerote over it, and left them wherewithal to finish the Cure. But a few days after they sent for me again. I found it swelled, and the Matter issuing from it thin and foetid, much more in quantity than I could expect. I enlarged the Opening by Incision, and there came forth a Tent which in his Servants Dressing had slipped into the Abscess. From that time the Matter lessened, and the Abscess cured without relapse by the method aforesaid.  
A married Wife, 
2. Observat.  of about thirty four years of age, having been long diseased with Hysterical Fits, with a complication of other Maladies, after many unsuccessful attempts, was put into the hands of Sir Fra. Pr. who prescribed Merc. dulc. ℈ j in cons. cichorii. The second Dose salivated her sixteen or seventeen days, whereby she was relieved for some months: but than she complained of a pain in her left Groin, which growing bigger, and raising the Parts about it into a Tumour, she embrocated it by my advice with ol. lumbric. After a few days, the Tumour more increasing with Inflammation and hardness, I applied Emplast. mucilag. with a third part of Emplast. diachyl. cum gummi. The fourth day after, feeling the Tumour suppurated, I opened it by a Caustick, and discharged a proportionable quantity of Matter well digested; than dressed it with Lenients, to hasten the separation of the Escar. While the Escar was separating, a long Streak of read appeared stretching down from the Inguen along the middle of the Thigh toward the Ham. I embrocated it with ol. ros. and applied cerat. Galeni. The next day I felt Matter in it, and saw the inflamed Streak stretch lower down. I applied a little of my milder Caustick upon the upper part of it, which was about three fingers breadth from the Tumour in Inguine, and gave vent to a little digested Matter, dressing it with Lenients. This while the Abscess in the Groin was in good temper, and disposed to heal: but the aforesaid inflamed Streak passed down to the Ham, and so along the Musculus gastrocnemius to the great Tendon of it which leads to the Heel, and had Matter in it the whole length. In lesle space than four days I made Apertions in it in five several places, all by Caustics; the lowermost in the lower part of the Calf of the leg. These discharged the Matter, and were cured in few days (after the Escars were separated) by the use of unguent. tutiae and the like.  
After some months she was seized with Convulsive twitches, which she observed to arise from the lower part of the Calf of the leg that had been affected with the Apostemations, and in the same place where the Matter before terminated. Upon which consideration the Physician prescribed a fontanel to be made in the very Part; which accordingly I made, and kept open by a Pea, with an Emplaster and laced Stocking: by which means she was freed of her Fits, and enjoyed a tolerable measure of health a long time after.  
So a Lady labouring under such like Fits, which began on the outside of the Os tibiae near the Shin, was cured by making a fontanel in that place, when other Remedies failed. She continueth it to this day, I suppose.  
In another we made a fontanel between the Thumb and Forefinger; and in another in the Breast; and in a Child behind the Ear: those Fits beginning there.  
PAROTIS is a Tumour in the Glandules behind and about the Ears, 
Parotis. Description.  generally called the Emunctories of the Brain; though indeed they are the external Fountains of the Saliva of the Mouth, as modern Authors do agreed.  
The immediate Cause is the Blood offending in quantity or quality, 
Cause.  as it hath admixture with the Ferment of the Part, or with other Humours. It also happeneth by an external Cause, as Bruise or Wound, whereby blood is extravasated, and cast out into these Glands' behind the Ear on one side or other, making a Parotid Tumour.  
They differ according to the Humour, and manner of generation. 
Difference.  To the Humour; as whether the Blood be mixed with Choler, Phlegm, or Melancholy. To the manner of generation; and so a Parotis is a Symptom of a Fever, or a Crisis of it. Those Fevers be usually malignant that cast out such tumors: but sometimes a Parotis riseth simply.  
The Parotis is known by the Part it affects with Tumour, 
Signs.  Pain and Inflammation, as having generally a great proportion of blood mixed with other Humours, according as they are predominant. If it be malign or pestilential, there is Fever joined with it. Whether it proceeded symptomatically or critically, the time of the Disease and Signs may demonstrate.  
A Parotis without a Fever is lesle malign or dangerous than that which ariseth with one. They are also lesle dangerous which attend long Fevers, 
Prognostic.  than those which follow acute ones. Those which are thrust forth by a Crisis are salutary and easily cured: but those which hap after great Evacuations, or Fever, without remission of it, are pernicious and dangerous. Those which break forth symptomatically, and arise from vicious ill-disposed Humours, are of difficult Cure, and dangerous.  
In the Cure of this Tumour, 
Cure.  you are to consider whether it be symptomatical, or critical, or of what kind of Matter generated.  
If it be critical, and come out kindly, the business is than by Lenients to mitigate the pain, and further Suppuration; as hath been said before in Bubo. But whether it be symptomatical or critical, with little or much Tumour, malign or benign, you aught not to use Repellents, jest thereby you return the Matter from without inward. If the Inflammation be great, and the Accidents high, and Blood abound, let it out, evacuating the Humour by lenient Purgatives, regulating the Patient's Diet, contemperating the Humours as in Phlegmon, and embrocating with ol. lumbric. chamaem. etc. But if through any defect nature do not thrust the Tumour out as you would, you may further it by Cupping-glasses and Attractives, as in Bubo hath been said. Or if the Matter be crude and viscid, you may apply powerful Discutients, and with Emollients if you fear induration. But if after all it tend to Suppuration, than further it with Suppuratives; as, ℞ rad, lilior. cepar. sub cineribus coctar. an. ℥ iv. mucilag. sem. lini, ℥ jss far. tritic. ℥ iij. axung. procinae, unguent. basilic. an. ℥ jss. vitell. ovor. ij croci ℈ ij. fiat Cataplasma. The Matter concocted, you are to give it vent, and proceed in the Cure, as hath been said in the former Chapter of Bubo.  
A Child aged about three years, 
1. Observat.  by accident of a Fall, was seized with a Dizziness and some twitches of a Convulsion. A Fontanell was made in the Neck, and a Vesicatory applied inter Scapulas: but the Child was not thereby much relieved. A Tumour afterwards thrust out behind that Ear. I made a fontanel under it, and derived the Matter thither, and thereby the Child recovered.  
In Concussions and Fractures of the Cranium these tumors are frequent, and are discussed by. ol. cham. etc. or the Matter may, as hath been said, by a fontanel there-under be happily spent.  
The perspiration in these Parts is to be regarded; for the checking of it hath caused Convulsions, yea Death, in little Infants.  
A Gentlewoman aged about thirty years, 
2. Observat.  of a strong healthful Constitution, was taken one night with a pain behind her right Ear; it increased, and became very troublesome. After three of four days she sent for me. The pain affected the Temporal Muscle with heat and Tumour, and her Head with Twitchings and frequent Start. She kept her bed, and was faint and weak; she had neither purged nor bled. I felt her Pulse small, which I judged to be rather from oppression than weakness, there being no considerable cause for the latter. I persuaded her to be let blood, which with some unwillingness she yielded to. I opened a Vein in her right Arm: the blood flowing out in a full stream, and being serous, I took away ten ounces; than embrocated the Tumour with ol. cham. warm, and dipped Wool in it, and applied it upon the Part affected. A Clystes was given her some hours after, and an Emulsion prescribed her, of which she drank a good draught that night, and repeated it at pleasure. The pain continuing, a Cataplasm was applied ex rad. lilior. fol. malvae, violar. flor. cham. sem. foenug. made up with a few crumbs of White-bread, Saffron, Yolk of an egg, and ol. sambuci; the Parts being first fomented with some of the Decoction, and part of the Liquor cast in with a Syringe; Wool also was dipped in the same, and put into the Ear. By these Applications an Apostemation discharged itself thereout; yet the Tumour did not much slacken. Therefore I purged her with an Infusion of sena, rhabarb. etc. in which was diffolved Manna, and syr. ros. pallid. whereby she was somewhat relieved. A day or two after I purged her with Whey, Manna, and Crem. tartar. and afterwards repeated it: the Tumour the while discussed, her Menses came down, and she recovered.  
I was sent for to a Child of about two years of age diseased with a large Tumour of an oval figure, 
3. Observat.  hard and inflamed, under the right Ear. I embrocated the Tumour with ol. lilior. & cham. and directed a Cataplasm to be applied of a few malvae & viol. with the Crumbs of a White loaf boiled in Milk. and made up with axung. porcin. Yolk of an egg, and a little Saffron. And the day after, calling there again, and seeing the Tumour hard, I advised a Lilly-root to be roasted under embers, and beaten up with the remaining Cataplasm: by which in two or three days it suppurated. I opened it by Caustick, and discharged a well-concocted Matter, and in few days after cured it by Digestion, etc.  
Amongst the many diseased people that came to me at the public Healing in November 1673. 
4. Observat.  there was a Child of about two years of age diseased with a hard inflamed Tumour lying round behind the left Ear. I directed one of my Servants to apply an Emplast. diachyl. cum gummi malaxed with unguent. dialthaeae: and the fourth day after, feeling it suppurated, we opened it by a Caustick about half an inch long in the declining Part, and gave vent to a well-concocted Matter. From that time it was dressed with unguent. basilic. in the form of a Cerote. Thus the hardness was resolved, and, as the Matter discharged, the Abscess healed within in few days with little or no pain or trouble: whereas if it had been opened by Incision, it must have been kept open by a Tent, and been rendered more painful and slow of Cure. After the Escar separated, a Pledgit of unguent. diapompholygos and a touch sometimes of the Vitriol-stone deterged, incarned, and cicatrized it.  
An old Gentleman, a Servant to the King below stairs, brought his Son to me, 
5. Observat.  an infirm Youth of about thirteen years of age, having a large Tumour behind his right Ear arising from a crude Matter. It had been of some years' growth. I applied Emplastr. ad strumas cum stercore columbino, to discuss it, but it heated: whereupon I applied a Cataplasm, one of the Suppuratives above mentioned, and concocted it; than opened it by Caustick, and discharged a mixed crude Matter. The Ulcer being sordid, I laid it more open, and dressed it with mundif. Paracelsi, with alum. ust. and Merc. praecipitat. and dressed the Escar and incised Lips with Digestives. After the separation of the Escar, I deterged the Abscess more powerfully by the use of the Vitriol-stone and Praecipitate, and afterwards incarned by the common Incarnative used in such cases, and cicatrized it smooth without any remaining hardness: and the Youth enjoys his health well since.  
A person of about fifty years of age, 
6. Observat.  having long laboured under scorbutical affections, was seized with a slow Fever; his Head was affected with Vapours, and his Spirits oppressed: during which a Tumour arose behind his left Ear, and reached down under that Jaw, growing big and hard, of a dark read colour. We endeavoured by discutient and emollient Cataplasms and Embrocations of various sorts; but it would not yield to any of them. We repeated Venaesection, and made him fontanelles inter Scapulas; Purgations were also repeated: but without successs. I than applied an Emplast. ad strumas, and continued it without removal the space of fix or seven days, supposing thereby the Tumour would suppurate or resolve: yet it continued hard amongst the Muscles. I repeated the use of the Emplaster; and the third or fourth day after, feeling the Matter fluctuate under it, I took of the Emplaster, applied a Caustick on the depending Part about an inch in length, divided that Escar, and gave a discharge to a crude serous Matter, than dressed it with Lenients, and applied Emplast. de mucilag. with a third part of diachly. cum gummi. After separation of the Escar, I deterged with the Vitriol-stone and basilicon and Merc. praecipitat. and at other Dress dipped them in pulv. praecipitati. Having thus deterged, I incarned, and by Epuloticks cicatrized it firm. During the while he was often purged, and Traumaticks and Antiscorbutics were prescribed: but a hardenss remained notwithstanding. Whereupon, doubting a Recidivation, I applied another Caustick the length of that Induration; and, having thereby penetrated deep into it, divided that Escar to the quick: and by separation of the Escar, and Digestion of the lips of the Ulcer, that hardness was breathed forth, and the Patient cured, and enjoys a good health to this day.   

CHAP. X. Of a Carbuncle.  
A Carbuncle is a round hard Tumour arising somewhat like an angry Boil, 
Description.  of a dark read colour, accompanied with the highest circumstances of pain and Inflammation, with many Vlcuscula round about it, never coming to digestion till it hath corrupted the Part which it seizeth, so that the whole piece cometh away, if the Patient recover.  
It oweth its Original to a very high Degeneration of the Blood into a Humour that is of a caustick quality, 
Original.  which suddenly arising seizeth the Part and corrupteth it, burning it as it were to a coal, from whence it hath its Name.  
The Causes of these Degenerations of the Blood are divers. 
Causes.  The most usual is a pestilential Infection. But it is not seldom found that the Humours of some bodies do corrupt into so great a degree of virulency, as to 'cause such a Tumour when there is no appearance of a Plague. Hence it is that they are divided into pestilential, and not pestilential: which distinction hath reference more to the antecedent 'Cause than to the Tumour itself.  
Therefore it is that, 
Signs.  let the Carbuncle be of which sort it will, the Symptoms attending it are much alike; viz. nausea, vomiting, dejection of appetite, tremor, palpitation of the heart, frequent swooning, delirium, etc.  
The pestilent is distinguished from the non-pestilent by the greatness of the Symptoms, and the Infection that is in the air.  
A great Carbuncle is more dangerous than a small one, 
Prognostic.  and the black is more pernicious than the inflamed read one. Those that are in the Emunctories, Throat, or near any principal Part, have more of danger than those that are seated remote in the Limbs, especially in the musculous Flesh. The most dangerous Symptom of all is the return of the Matter of the Carbuncle into the Blood again.  
In the Cure of a Carbuncle two things offer themselves to our consideration: 
Cure.  1. the antecedent Cause, the overheated corrupt Blood abounding in the Body; 2. the conjunct, or the Humour affecting the Part, and making the Carbuncle.  
In order to the first, a regulation in Diet aught to be observed, and the hot Blood fermenting in the body to be evacuated by Venaesection, especially in those that are not pestilential, and that to fainting: but in the pestilential it is judged not so safe, jest thereby the malignity be drawn inward; but if you do let blood, it must be in the beginning, whilst the body is strong to bear it. And forasmuch as Bleeding scarce evacuates all the depraved Humours, therefore Purging is prescribed, jest by the abounding of corrupt Humours the native heat should be extinguished. But in pestilential Carbuncles there is also a Caution required upon the same consideration as in Bleeding: therefore we content ourselves with Clysters and lenient Purgatives, as manna, cassia, electuar. lenitiv. diaprun. and the like; and proceed in resisting the malignity by alexipharmaca, viz. theriaca, Mithridat. elect. de ovo, confect. alkerm. de hyacintho, etc. The heat of the blood may be contemperated by syrup. è succo citr. limon. acetoes. borrag. bugloss. etc. Or, ℞ cons. borrag. bugloss. lujulae, an. ℥ j spec. de hyacinthoʒj. court. citr. conditi, nucis moschat. an. ʒiij. cum syr. è succo citr. fiat Electuarium. After a morsel of which, a draught of such like Julep may be drank and repeated once in four hours: ℞ aquar. scordii, dracont. citr. an. ℥ iij. spec. de hyacinthoʒj. aq. theriacalis ℥ iij. syr. è succo citr. q. s. Misce. Also Epiphemata may be made ex aquis melissae, ros. damase. borrag. nymphaeae, cum aceto sambucin. rosac. etc.  
In treating the Carbuncle as it relates to the conjunct Cause, you aught to consider the strength of the Patient; and if it be not likely to thrust forth kindly, you are to endeavour by Attraction to assist nature in the bringing it outward, by the application of a such like Cataplasm: ℞ summitat. rutae M.ij fermenti acris ℥ ij. ficus vet. num. viij. piperis albiʒij. salis come. ʒiij. Misce. Or that Cataplasm proposed in the Discourse of Bubo ex theriaca coct. in cepa excavata. And, if there be occasion, Cupping-glasses may be applied to help it forward. But if the Body be strong and plethoric, and the Carbuncle thrust forth with raging heat and pain, than that Cataplasm prescribed by Galen, ex foliis plantag. pan. tritic. decocted in Wine, may be of good use, it being by him commended to have the virtue moderately to repress the heat, and to digest. Others have proposed an Emplaster of Plantane-leaves, Galls, Lentils, and Wheat-bran, beaten up with Vinegar, and having thus mitigated its heat, they endeavour Suppuration.  
But I never saw a true Carbuncle suppurate: therefore if the aforesaid Medicaments avail not, I advice the scarifying or cutting deep into it, to give a breathing to the Humour; than dress it with some Escarotick that may resist its malignity, as troch. Andronis, polyidae. Some Authors have proposed the Caustick. Without doubt the actual Cautery timely applied on some of them would save the Patiented much pain, and shorten the Cure: for the malignity being thereby consumed, the Escar might without much difficulty be digested, the heat about the Carbuncles alleviated the while by one of the  Cataplasms, and the Ulcer cured by the common method. But I refer this to the consideration of the Chirurgeon; and shall give you an Instance of a Carbuncle to confirm what I have delivered.  
IN the time of the last great Plague a Person of Honour, 
1. Observat.  about sixty years of age, of a gross Body and highly scorbutical, was after dinner seized with a Rigour and Vomiting. His Physcian Sir Francis Prujean being out of Town, he sent for me. I suspecting it to be the beginning of some malign Fever, desired to be excused, his condition requiring rather a knowing Physician than a Chirurgeon: but I was afterwards fetched by a more powerful messenger, and found the Patient in his bed, vomiting, and in a burning Fever. I advised the giving him Carduus Posset to further his Vomiting; during which I sent for a mixture of theriaca Veneta & cons. lujulae, and cordial Julep of aq. dracont. etc. as it is above set down in the method of Cure; of the former I gave him a morsel, and some of the Julep after it, and advised his Servants to repeat the use of them once in four hours. He rested very disquietly that night, but in the morning I found him more calm. I let him blood, and directed a Clyster to be given that afternoon. As I was taking my leave of him, he disired me to look upon his Back, it being very sore. I supposed his fontanelles (which he had long continued inter Scapulas) were uneasy; and, making way to look upon them, I found his Malady four fingers breadth beneath the right fontanel. It was a dark read Swelling, about the bigness of a small Chesnut, lying very hard between the musculous Flesh and Skin, with many small white Wheals about it of the simple Herpes'. I was somewhat surprised at the sight, and dressed it hastily up with unguent. basilic. and retired to my house to make ready that Cataplasm of Galen's, which I soon after applied, and continued the use of it some days: during which the Carbuncle increased in breadth and hardness, the Vlcuscula also spread round it. Upon which consideration I applied the suppurative Cataplasm above mentioned, to endeavour Maturation; and on the Vlcuscula and Parts about unguent. nutritum, to calm the burning heat. The Patient's Body was kept soluble by Clysters and lenient Purgatives; the cordial Electuary and Julep were also frequently repeated, and his Diet was Broths with wood-sorrel and such like Contemperatives boiled in them. Nevertheless the Fever continued, and the Patient lay dozed and somewhat delirious, as also troubled with a Singultus and Aphthae. Observing him daily more indisposed, and the Carbuncle increasing in bulk, and not likely to suppurate, I scarified deep into it, washed it with a Solution of theriaca Veneta & mel Aegyptiac. in aceto vini, than filled the Incisions with pulver. troch. polyidae, and applied a Cataplasm over all ex farina orobi decocted in Oxymel. By the use of these Applications the Vlcuscula dried, and the Carbuncle gleeted, but by the use of Lenients it digested after a few days; and as the Escar separated, a well-concocted Matter discharged in great quantity daily more and more: yet the separation of the mortified Carbuncle had left a very large Opening, and there appeared no considerable Swelling whereby one might judge the Cavity large. But feeling the Parts about, and pressing my hand upon the right Clavicle and under that Axilla, the Matter poured out abundantly: yet these Parts were not inflamed during the growth of the Carbuncle. This put me upon a necessity of making an Incision proportionably, and, cutting of the flapping Lips to prevent the retention of Matter, I than dressed the Abscess with mundificat. ex apio, and the tender Lips with the common Digestive ex terebinth. cum vitello ovi; and applied a Cataplasm ex farina hordei, fabar. flor. ros. rub. etc. decocted in Oxymel, with Compress and Bandage. We had often proposed the consulting a Physician, but those of his acquaintance were out of Town. Accidentally I met with Doctor Tho. Cox about the twentieth day near the Patient's house, and prevailed with him to visit this Person. He saw the Abscess dressed, and the Patient labouring under the Singultus and Aphthae, also so dozed as he scarce spoke to the Physician. He prescribed the Patiented Cordials, and what else he thought necessary, and left several Prescriptions for the Family. Until than they suspected not the Disease; though the Servants that washed his Linen broke out in Blanes on their Hands and Arms as far as they were in the Soap-suds. From the time I made that large Opening the Matter lessened, and the Cavities healed up by agglutination, the Ulcer incarned, and was cicatrized by the common Epuloticks.  
The same year I was fetched to a Child at nurse in Westminster, 
2. Observat.  that had been some days sick of a pestilential Fever, during which a Carbuncle thrust forth in the right Breast a little below the Clavicle, of the compass of a broad Shilling; but it was than sunk, and of a black colour. I divided it, and gave vent to a bloody serum, and saw the Flesh underneath it sound: it was without Inflammation. I dressed it up with warm Digestives, and applied an Emplaster of Mithridate on it; than gave it some Elect. de ovo dissolved in a spoonful of aq. theriacalis. I came too late, for the Child died a few hours after.   

CHAP. XI. Of a Paronychia.  
PAronychia, so called by the Greeks, 
Description.  is a small Swelling about the Nails and ends of the Fingers, known amongst the Latins by the name of Panaritium: 
Names.  by the vulgar people amongst us it is generally called a Whitflaw.  
There are two sorts of Paronychiae: 
Differences.  they both affect one and the same Part, and are frequently taken one for the other, but are very different in their Symptoms. We shall distinguish them by the names of benign, and malign. The former rise superficially under the Cuticula, and come suddenly to Suppuration: whereas the malign Paronychia lieth deep amongst the Ligaments and Tendons, and is slow in coming to maturity. I suppose it is that which is commonly called a Felon.  
The benign or milder Species takes its Original from a bilious hot serum: 
Causes.  the other is commonly said to proceed from Adustion in the Blood, with a mixture of Choler or salt Phlegm.  
Paronychiae may truly be reckoned amongst the Inflammations, 
Signs.  they arising with great pain and burning heat, with Pulsation and Tension. The benign comes soon to maturation, and may be discerned by change of colour in the Cuticula, the Matter appearing under it as in a Blister.  
The Signs of a malign Paronychia are an intense vehement pain deep amongst the Ligaments and Tendons, with Fever, Fainting, and a slow Suppuration.  
The Prognostic may be made by what hath been delivered of them, 
Prognostic.  viz. that the benign cometh soon to Suppuration, and is as easily cured: the worst danger that can behappen it is but a loss of the Nail.  
The other, which lieth deep, is of a malign quality; and, if it be not speedily removed, will corrupt the Periosteum, rot the Bone, and soon extend its putrefaction to the next Joint, and threaten the welfare of the Hand.  
In the Cure of Paronychiae Authors generally make no distinction. 
Cure The method of the Ancients.  They propose evacuation by Bleeding, and the observance of a slender Diet, as in a Phlegmon. Concerning Topics, they commend Repellents in the beginning of the Fluxion, but not with much astringency, (unless as Intercipients upon the Parts above) jest the Matter should thereby be impacted in the Part, and corrupt the Bone: yet the Medicaments they than prescribe do all partake of that quality; as, ℞ ol. ros. & myrtill. cum succo solani & bol. Armen. and, ℞ gallas virides cum aceto mixed. Others mix Lenients with them, as that of succ. solani, plantag. portulac. umbilic. Vener. mucilag. sem. psyllii, cum dictis succis vel aceto extract. to which they add bol. Armen. gallas & camphor. cum ol. ros. & myrtill. and unguent. alb. popul. etc. Others mix Discutients with Repellents: as that of Paracels. galla cum melle mixta; or, ℞ ol. mastic. ol. olivar. matur. an. ℥ j antimonii crud. ʒ ss. thurisʒ iij. resin. pini & cerae, an. q. s. Misce; or that sulphuris vivi, fuliginis, allii, sal. come. sem. carui, an. p. aeq. Misce. In case of pain, ℞ fol. malvae, byoscyami, rad. althaeae, sem. psyllii, lini, foenugraeci: and these are Suppuratives, of which divers others are prescribed by them. All which are proper in the benign Paronychia, as they are set down, and some of them may be applied to the malign one in its very beginning; but while you endeavour Suppuration in it, the Bone will certainly corrupt. Therefore if the pain go not of by the first Applications, give a breathing to the Humour by cutting deep into the Part most affected, and than dress it up by such like Lenients as follow: ℞ sem. lini, foenug. pulv. an. ℥ ss. mucilag. sem. psyllii ℥ j vitell. unius ovi, croci, an. ℈ j pingued. gallinae aut butyri recent. q. s. fiat Cataplasma. Or, dress it with unguent. basilic. by which the Wound will cure, if the Humour hath not altered the Part: if it hath, proceed as shall be showed in the following Observations.  
I shall begin with the benign or milder Species, commonly called a Whitflaw. It is a Disease so common, that I think there is none but knows what it is, and how to cure it. Yet I shall give you two or three Instances, the better to distinguish it from the other.  
A Child of about four years of age was brought to me while I was dressing a Patient in a Noble Family. 
Paronychia benigna. 1. Observat.  The Child was pained with a small read Swelling about the inside and root of the Nail of one of the Fingers. I applied a little cerat. Galeni upon it. The second day after I found the Matter shine under the Skin, and the Swelling lie like a Blister about part of the Nail. I opened it, as I had often seen the common people, by passing a Needle through the Skin: it discharged a thin yellow Matter, and by two Dress with unguent. basilic. it cured.  
Such another I met with in the Finger of a Friend lying upon one side of the Nail. 
2. Observat.  I opened it with a Lancet, and after the discharge of the Matter pared away that side of the Nail, and dressed the Blister with a Pledgit of unguent. tutiae. Himself cured it with some of the same in two or three days.  
A Gentleman came to me not long since with one of these very large upon the pulp of one of his Thumbs; 
3. Observat.  it lay like a great Blister. I let it out with my Lancet, and dressed it up with unguent. basilic. and gave him some of the same to cure it.  
Another I saw lie under the forepart of the Nail and Finger, 
4. Observat.  very painful for the while, but it quickly suppurated by Lenients. The Matter being let out, and part of the Nail cut away, it cured in a few days. But when this happens in scrofulous Children, or where acrimony abounds, the Cure is vexatious enough: but it doth seldom corrupt the Bone, nor is the pain considerable compared with that which passes under the name of a Felon or malign Paronychia; of which I shall now give you some Instances.  
A Gentlewoman came to my house one night late, 
Paronychia maligna. 1. Observat.  complaining exceedingly of a pain in the pulp of one of her Fore-fingers. I looked upon it, and felt it hot, but saw nothing of Swelling whereby I could judge it so ill. She seemed ready to swoon with the pain. I proposed the making Incision into it to the Bone, not imagining so fearful a creature would have permitted it; but she readily assented: whereupon I presently made a Puncture deep in the most pained part to the Bone, and suffered it to bleed while I made a Dressing of unguent. basilicon to apply upon it with an Emplast. è bolo; which being applied, she complained of the smarting of the Wound, but said it was nothing to the pain she felt before. The next day I waited upon her at her Lodging: she had slept well that night and in perfect ease. I took of the Dressing, and saw the Wound agglutinated, than dressed it as the night before, and from that time dressed it not more. After the same manner I have freed many in the beginning of the Disease.  
A young Fellow attending in a Nobleman's house was seized with a grievous pain in the pulp of one of his Fore-fingers, 
2. Observat.  and came to me bemoaning his condition. The Part affected felt hot, but seemed neither inflamed nor much swelled. I pressed in the point of my Incision-knife into the place where he was most pained, and in the drawing out the Knife enlarged the Wound a little. There seemed to issue out only a little Blood, which I permitted a while to flow, than dressed it up with a Pledgit of unguent. basilicon and an Emplastr. è bolo. The second day after I met him, took of the Dress, and saw the Wound cured: and he said the pain went of that night he went from me.  
Another Young man serving in a Noble Family was afflicted with a pain in the pulp of one of his Thumbs, 
3. Observat.  and after three or four days trial of several Applications he was commended to me. His Thumb being inflamed and swelled, I made Incision into it to the Bone: this not only bled, but gleeted a few drops. I dressed it with Lenients, and rolled it moderately, hoping thereby to agglutinate it. The second day after I took of the Dress, and, finding the Wound open and undigested, dressed it up with a Dossill dipped in Merc. praecipitat. with Emplaster and Bandage. The third day after I dressed it again. The Dossill came of with a Slough, and left the Ulcer disposed to Digestion. I dressed it with a lesle Dossill spread with basilicon and Praecipitate, with a Pledgit of unguent. diapompholygos, and an Emplaster over it. From that day it digested, and cured in six or seven. The occasion of it's not healing by Agglutination, as the others did, was from the alteration (I suppose) the Ichor had begun to make in the bottom of the Wound: which may, I think, enough show the necessity of laying these tumors open more timely, unless they have discovered some other way of discussing the Humour; which I confess I have not been able to make out, though I have tried many Medicaments commended in such cases. Forestus, in his fifth Book and sixteenth Observation, sets down some arcana in the Cure of it: but after the trial of them, we found him foiled in the Cure of his Patient, and the same Patient cured by another Chirurgeon, by the laying it open, and taking the rotten Bone out.  
I shall now show you what they are when they have been longer treated by Suppuratives, and the like.  
A Servant to an Officer of the Court was brought to me sorely afflicted with one of these Paronychiae in his Forefinger by the side of the Nail. 
4. Observat.  He had been under hands that had treated it with Medicaments till the putrefaction within had rotten the Ligaments and Periosteum, and bared the Bone of the first Joint, and apostemated it to the third Joint. I laid it open by Incision from the very end of the Finger downwards the length of the Abscess, and dressed it with Merc. praecipitat. applying Dossills' over it spread with a Digestive to keep the Lips of the Wound distended, and with long snips of Empl. diachalcit. rolled it up, leaving way between for the Matter to discharge, over which I repeated a moderate Bandage to press out the Matter in the Part, and restrain the Influx, and reduce the Finger to its former shape. The third day I dressed it again, and, finding the Ulcer sordid and overgrown with lose flesh, rubbed it with the Vitriol-stone, filling the Ulcer again with Merc. praecipitat. and dressed it up as before. By this method I deterged the Ulcer, and with sarcotics incarned it, and by the application of Epuloticks with Bandage cicatrized it, and reduced the Finger to its natural shape, so that he recovered the use of it.  
A Lady commended a Poor woman to me, who brought her Child, 
5. Observat.  a little Boy of about five years of age, grievously diseased of a Paronychia on the very end of the Forefinger and under the Nail. The end of the Finger was rotten away, and the Bone sticking out bore: the Nail was also rotten, and heaved up by the putrefaction underneath it. I took hold of the Nail with my Forceps, designing to cut it of, (it lying in my way;) but it separated of from the root more easily. I also pinched of as much of the end of the Bone as was naked, rubbed the lose Flesh and the remaining Bone with my Vitriol-stone, and applied a Pledgit of Lint dipped in a Solution of tincture. vitrioli next the Bone, than filled the Ulcer with Praecipitate, laying over it an Emplastr. unguent. è lithargyro with a moderate Bandage. The third day I dressed it again, and found a separation of the corrupt flesh: but the Matter was more than I could reasonably expect from such an Ulcer. Whereupon I made a farther search, and found a Sinus running the length of the second Joint. I presently made an Incision that length, and filled up the Opening with Dossills' dipped in Lenients, than dressed the more corrupt parts with the same Medicaments as before, and rolled it up. The third day after I took of the Dress, and found the Bone covered with its Periosteum in the Sinus I had last opened: but it was full of a lose Flesh the whole length. I dressed it as I had done the former; the Vitriol-stone being of great use in these Ulcers which so abound with luxurious Flesh amongst the Tendons: for by it the corrupt Flesh is dried up without offending the Nerves, Tendons, or other sound Parts; and the Ulcer may be deterged, according as it is touched, more or lesle; and the Bone itself, where it is bore or carious, may be dried by it, and disposed to moulder of. Where the Hypersarcosis was great, there I also sprinkled it with Praecipitate, whereby I more speedily freed the Ulcer of its putrefaction; and by the application of long snips of Emplaster rolled about the Finger I restrained the influx of Humour. By moderate Compression I restored the Finger to its true shape, and by the common Epuloticks cicatrized it, without more loss of the Bone than what I cut of at the first Dressing, the Stump exfoliating insensibly.  
Whilst I had the honour to attend the King at the Hague, 
6. Observat.  a Woman related to one of the Princess Royall's Servants had been lamentably afflicted with one of these malign Ulcers in the Forefinger of her right Hand: by reason of the long application of Supputatives the Bones of the first and second Joint were rotten, and the putrefaction had spread round, and corrupted their Ligaments. I made Incision the length of the Abscess, and upon farther search feeling the Bones not only rotten, but loof, I took them both out, and separated the Nail from some part of the Ligament to which it adhered; than deterged the Ulcer by filling it with Praecipitate, dressed the Lips with Digestives, and rolled it up. After I had thus deterged it, and by Compresses and Bandage reduced the Finger to a better figure, I left of the use of Dossills', and by long pieces of Emplaster brought the Lips together, and left the Finger well shaped, and a Nail thrust out again: but it, having lost its Supporters, was of little use. Whether afterwards any Callus thrust out to supply the place of the Bones, I doubt: but in strumous and some other Ulcers you may see how such defect hath been recompensed.  
Some years since I was fetched into the City to a Gentlewoman who was much afflicted with one of these malign Ulcers in the very first Joint of one of her Fingers. 
7. Observat.  The Chirurgeon that attended it had been suppurating it, but the while the Bone corrupted. I proposed the laying it open by Incision, and to have proceeded by Detersion. She assented to it, and accordingly it was laid open. After a Dressing or too I left it to the Chirurgeon. But about ten days after she sent for me again, and was much unsatisfied in the proceed. I looked upon it, and, seeing it was like to be a tedious and an unsuccessful work, advised the cutting of of her Finger: which, after some deliberation, she submitted unto.  
The Wise of a Bitmaker attending the Court, 
8. Observat.  whilst we were at S. Johnston's in Scotland, was seized with a pain in the end of her Forefinger, and desired my advice. I told her the nature of the Disease, and shown her the necessity of making a Puncture with an Incision-knife into the pained Part: but she went murmuring away from me, and made use of some other, who endeavoured to suppurate it. In the while I made her a visit or two to persuade her from that methold; but she would not permit me to open it. Some while after, the putrefaction being increased, it made its way out, and discharged some of its Sordes. This they called Suppuration, and promised themselves a speedy Cure, censuring me for advising her to open it before Maturation. But in these Abscesses the Suppuration is false, and rarely happens till the Bone and Ligaments are corrupted: which after a while she finding too true, made friends to me; at whose desire I visited her, and found the Finger miserably swelled, and the Ulcer sordid, the Bone lying rotten in it. I dressed it with Detersives, and offered to her consideration, whether she would permit the Ulcer to be cut open, (for Caustics are of ill use in Ulcers with Caries in these Parts,) and dressed with such Medicaments as might cleanse it, and dispose the Bone to exfoliate, which would be a long work, and uncertain; or that she would without more delay permit it to be cut of, and thereby have it speedily cured. After some demur, she submitted to the latter; and I cut it of with a Chisell, dressed up the Stump with pulv. Galeni cum albumine ovi▪ and rolled it on. The second day after I dressed it come terebinth. & vitell. ovi, etc. and digested it; and afterwards I incarned it with the common sarcotics, and cicatrized it in few days with unguent. desiccat. rubr. and Pledgits dipped in aqua calcis. She gave me a great many good words for the ridding her of such a painful Finger, but never forgave me the neglect (as she called it) of dressing it with Suppuratives; she supposing that I could so have cured it, and would not. It was a crime which might be the easilier forgiven her, since we meet with it so often in some of our own Profession.   

CHAP. XII. Of Pterygion.  
PTerygion is an Excrescence of flesh about the Nails of the Fingers or Toes. 
Cause.  A Whitflaw arising about the Nails is often the Cause of this Disease in the Fingers: it is also caused by some Bruise of the flesh under or about the Nails. Sometime an Excrescence ariseth from the root of the Nails by reason of some Pustule that preceded; in which case the Membrane underneath is often concerned.  
It happeneth also in the Toes through some Bruise or pressure of the Nail, especially where the Nail is thick and hard, as some overgrown Nails are, whence pain and Inflammation is stirred up, and an eruption of Matter followeth, which being exasperated by a continual pricking or pressure of the Nail, the Ulceration spreads and corrupts it, and thrusts out Excrescences and lose flesh round about. When this happeneth in poor people, who travel much in the wet and dirt, and want that accommodation which is necessary to keep their feet dry and clean, the Matter corrupts the Tendons and Bones; as I have frequently seen amongst our common Soldiers in the time of the Civil Wars, and amongst some of the poor people that come out of the Country in the time of public Healing, to be touched for the King's Evil.  
They take their Difference from the Cause, 
Difference.  and Part which they affect: some rising superficially in the sides of the Nail with erosion; whereas others, arising from the Tendons, corrupt the Bones.  
The Signs are evident, 
Signs.  viz. the Ulceration and Excrescences appearing about the root or sides of or under the Nails with pain. If it affect the Tendons or Membrane under the Nail, the pain is more vehement: if the Bone be corrupted, the putrefactive Smell will discover it.  
In the Pterygion affecting the Skin there is no great difficulty of Cure: 
Prognostic.  if the Nail be pared away, the Ulceration will soon heal. But if it arise from the Tendons or Membrane at the root of the Nail, the work is more hard, and in old people, or Bodies ill habited, it is apt to gangrene.  
In the Cure of the superficial Ulcerations with lose flesh arising about the Nail, 
Cure.  you are in the first place to cut away the Nail, that you may apply your Medicaments to the Ulceration, which may consume or dry the lose flesh and cicatrize it: in which case you may use a little dry Lint, or Lint dipped in aq. calcis and dried, or pulv. court. granat. ballast. terr. sigillat. lap. tutiae; in stronger habits, Merc. praecipitat. You are to avoid the application of moist or greasy Medicaments, for they rot the Nails, and increase the Ulceration. The Excrescences arising from the Tendons or Membrane to the roots of the Nails require Medicaments more powerfully dying; such as are aes ustum, squamae aeris, calx viva, troch. polyidae, Andronis, Musae: yea the Caustick-stone warily used, Merc. praecipit. and the Vitriol or Alume-stone, may serve to cicatrize the Ulcer.  
A Young Lady having bruised her Forefinger accidentally, and neglected the Cure, 
1. Observat. of Excrescences about the Nail of the Forefinger.  it corrupted under the Nail, and became very sore. I was sent for, and found the inside of the Nail lose, the skin at the root of the Nail raised up, and full of spongy flesh. I presently cut away the side of the Nail, to give discharge to the Matter, than dressed it with dry Lint, and applied a Pledgit of unguent. tutiae over it. The Excrescence rising from the root of the Nail I dressed with Merc. praecipitat. and laid a Pledgit of unguent. tutiae over that Swelling, with a snip of Emplastr. diachalcit. as an intercipient, and rolled it up. The Ulceration on the side where I cut the Nail away cicatrized by the foresaid Dress; but that at the root of the Nail I found swelled; the Praecipitate had crusted the lose flesh and stopped the Matter in. I scraped it away, and filled the Ulcer again with the same Praecipitate, and applied a Pledgit and Emplaster over it, as before. The second day after I dressed it again, and found it more hollow, the lose flesh coming away in a Slough. I than left of the use of the Praecipitate, and applied a Pledgit of unguent. tutiae with an Emplaster, and made a moderate Compression over the Ulcer to unite the Cavity, and thereby agglutinated it in three or four Dress, and cicatrized the lax edges with the Alume-stone and dry Lint. This Nail being cast of, a new one thrusting forth restored the Part to its natural figure. From such Ulcerations at the roots of the Nails there often arise great Excrescences, especially from the Thumbs, and are extremely painful and difficult to cure.  
I was sent for to one who was grievously afflicted with such an Excrescence: it was as big as a Cherry-stone; 
2. Observat. of an Excrescence on the Thumb-nail.  it was hard and gleeted, and the parts about it much inflamed. I applied a snip of Emplaster between the Excrescence and the Nail: than I rubbed the Excrescence with a Caustick-stone, and with an armed Probe dried up the Salt as it dissolved in the working. After I had consumed the Excrescence, I washed out the Salts in the Escar with a little Wine warm, pulled away the snip of the Emplaster which I had laid to defend the Nail form the Caustick, and covered the Escar with Praecipitate, applying a Pledgit of basilicon, and an Empl. è bolo over it. I dressed it the next day jest the gleet should offend the Nail; but I found it dry, and Patient easy from an hour after I had last dressed it up. I continued the use of Lenients, and, after the Slough separated, rubbed the remaining root with Vitriol-stone, covering it with Praecipitate again; and afterwards by dressing it twice or thrice with Praecipitate dried it up.  
A Gentleman, 
3. Observat. of the Nail of the great Toe.  having lain some while under Physic and Chirurgery for an Ulceration about the Nail of his great Toe, consulted me. I saw the Matter flow round the Nail, yet the Nail was not lose, nor did it seem to press into the flesh; for there had been a Corn-cutter who had cleared it: and in truth I supposed the Matter to arise from behind the root of the Nail, it being there hollow and inflamed. To make a farther discovery, I filled all the chinks with Merc. praecipitat. and with a dry Pledgit of Lint and Emplastr. de minio dressed it up. A day or two after when we dressed it, we found the Nail overflowed with Matter, and could make no certain judgement of its original: whereupon we dressed one side with Praecipitate, the other with dry Lint, and that behind the Nail with unguent. diapompholyg. and thereby it appeared that the Matter arose from behind the Nail. For by this way of dressing the sides dried, but after we filled that Cavity over and behind the root of the Nail, the Matter burst out under the Nail, and was seen to lie in the sides. Upon which Physic was again proposed, to purge of the naughty Humours: but indeed the Cure consisted in the cutting of that callous Skin behind the root of the Nail. But my Brother Chirurgeon dissenting, the Patient complied with him to avoid the pain. Yet after a farther experiment by dressing two or three days, I prevailed, and with an Incision-knife cut of that callous Skin, than digested it with unguent. basilicon, and in as few days cicatrized it: and from that time there appeared no more Matter or Sore.  
A Gentleman of about 70 years of age, 
4. Observat.  having Nails on his great Toes very big, hard and crooked, the one of them pressed so straight upon the Membrane underneath it as to make an Ulceration, which increasing with putrefaction, he came to Town. It seemed to me to be gangrened underneath the Nail; wherefore I presently passed my Knife under the Nail; and made a separation of it. The sides of the Nail lay very deep, and in some parts tied fast by its Ligament. It being removed, I washed the Ulcer with Wine; but it bleeding too fast to make any farther judgement of it at that time, I covered it with Praecipitate, and retained it on by Pledgits of Lint and Emplaster. The second day after I found it crusted with the Praecipitate, but a corrupt Matter bursting through it in several parts, and the Ulcer appearing deep, I took of that Crust, and dressed it with unguent. basilicon mixed with Praecipitate and alúm. ust. and by Detergents and Epuloticks, as hath been showed in the preceding Observations, I deterged and cicatrized it: than causing the Nail of the other great Toe to be rasped and cut round, to prevent the like accident, I dismissed him.  
Sometime in elderly people a crude Humour diseases the Tendons and Membranes at the root of the Nail, and through defect of the natural heat corrupts it, and if it be not timely succoured a Mortification follows.  
A Gentleman of above 70 years of age, 
5. Observat.  complaining of a Sore at the root of the Nail of one of his great Toes, was commended to my care. The Ulcer was crude, and had corrupted the Flesh and part of the Ligament. I dressed it up with Merc. praecipitat. with a Pledgit of dry Lint upon the Nail; and over the Part affected applied unguent. basilic. with Emplastr. diachalcit. The second day after, opening it again, but finding no digestion, I dressed it as before, and the next day fomented it with a Lixivium wherein was decocted absinth. etc. I cleansed the Ulcer of the Praecipitate, and dressed it with a Dossil dipped in oleo terebinth. hot and unguent. basilic. with an Emplaster over it. The next day I dabbled it hot with ol. terebinth. upon an armed Probe, filled it with Praecipitate, dressed it up as the day before, and desired that a Physician might be called to see the evil quality of the Ulcer, I suspecting it would not digest. The second day after Doctor Jasper Nedham met me, and saw the Ulcer dressed. There than lay a hard dry Escar without either Matter or Gleet, which I took for a good Sign, and with my Knife made a little Separation of the Escar, to give vent to it, and dressed it up with Lenients, to hasten the fall of the Escar. It was seven or eight days in separating, and than it came of with a well-digested Matter, incarned, and in few days cicatrized.  
When these Ulcers corrupt the Bone, the best way is to cur of that rotten Joint, to preserve the rest.  
Thus one being affected with a putrefactive Ulcer to the Bone, 
6. Observat.  part whereof lay bore under the Nail of one of her great Toes, I advised the cutting of that Joint: which she consenting too▪ (as being the most easy and speedy way to prevent farther mischief) I sent for a Mallet and Chisell, and cut if of. Than having permitted it to bleed some ounces, I dressed it up with pulv. Galeni cum albumine ovi, with some snips of an Emplaster cross over the Stump, and a piece of a Sheep's bladder with Bandage to retain the Dress close. The second day after I dressed it cum terebinthina & vitello ovi, and thereby digested it, than incarned it with unguent. diapomphol. and with the help of the Vitriol-stone and Pledgits dipped in a Solution of sacch. Saturni in sp. vini cicatrized it in few days.   

CHAP. XIII. Of Pernio.  
PErnio is a peculiar Inflammation, 
Description.  and belongeth to Blood▪ it raiseth a thick read Swelling with itching pain in the Hands and Feet.  
Those affecting the Hands are generally called Chilblains, 
Differences.  and under that notion I have seen them in the Faces of some tender persons, who do not often expose them to the air without a mask. When they affect the Feet they are called Kibes.  
This Disease happens sometimes in people of age, but more often in Children.  
The outward Cause is the nipping cold air in the Winter season, 
Causes.  which pierceth the Skin, maketh painful Swell, and at the same time shutteth up the Pores so as the Humour cannot transpire, whereupon it corrupts, and raises little Wheals or Blisters, which ulcerate the Cuticula, and corrode into the Skin, and sometimes deeper, as in Kibes is frequently seen.  
The internal Cause may be taken from some indisposition of the Blood.  
The Signs are manifest in the back of the Hands and Fingers, 
Signs.  they appearing, as we generally express them, swelled with cold. They are of a thick read colour, and thrust out many small Wheals which itch very much, and being rubbed do ulcerate and chop the Skin, and discharge a thin Humour. Kibes appear after the same manner in the Heels.  
Chilblains are exempt from danger, 
Prognostic.  but are vexatious, and not easy to cure whilst the cold weather lasts, and being cured are apt to return yearly. The Kibes may prove dangerous, and difficult to cure, if they be any whit neglected, the Matter being apt to ulcerate the Flesh to the Bone, and sometimes gangrene.  
In the Cure the manner of living is to be considered, 
Cure.  especially that they defend themselves from cold, and keep their Feet dry and warm. Of the Medicaments proper in this Disease some are preservative, while the Skin is whole; and others are curative, and necessary when they are whealed and ulcerated.  
The Preservatives are, as I have said, to  the Parts warm, that the Pores may be open to give a breathing to the Humour: to which purpose furred Gloves and woollen Mittens and Socks are to be commended, also Dogskin Gloves for the poorer sort; the richer may have oiled Gloves. Socks dipped in Brandywine and worn are preventive. The Mariners to prevent this Disease in their Hands dip their Mittens in Sea-water, and having wrung out the water, draw them on. All Fomentations, whether it be fresh water, or Beef or Fish-broth, are proper to further Transpiration. In the Cure we commend the Decoction of warm Plants, as Wormwood, Southernwood, Mugwort, Margerum, Thyme, Hyssop, Rue, Rosemary, Bays and Juniper, with their Berries. Turnips are the specific, and if they be frozen they are more efficacious. Unguent. rosat. cum oleo terebinth. in a roasted Turnip is an approved remedy in the Cure of them: also this, ℞ mannae, thuris, an. ℥ j court. pini ℥ ij. axung. porcinae & anserin. an. ℥ iij. cerae q. s. fiat Ceratum. If the Ulceration be large, it requires to be cured as in an Ulcer with Fluxion.  
In the Cure of Chilblains we are never consulted unless they be complicated with some other Disease, or are passed the Cure of common Applications.  
A Girl of about nine years of age, of a very ill Habit of body, 
1 Observat. of Chilblains and Kibes.  was the last hard Winter very much troubled with Chilblains upon her Hands and Fingers. She had also Kibes on her Heels, and about one of her Ankles, and on the small of the other Leg. I directed a Fomentation of a Decoction of some of the aforesaid Plants, with an addition of Brandywine, with which they were all bathed. The excoriated Chilblains I dressed with unguent. de lithargyr. upon Pledgits of Lint lying at such distance as the Matter might get out between. The clusters of Wheals were dapt with a Solution of sacchar. Saturni in spir. vini, and the forementioned Cerote applied over all. From the Kibes, which were ulcerated and sordid, I clipped the lose Cuticula, and dressed them with unguent. basilic. cum Merc. praecipitat. and sprinkled some of them first with Merc. praecipitat. The Excoriations about them were dressed with unguent. tutiae, etc. according as they required, during which she was purged, and happily cured.  
A Gentlewoman of about forty years of age, 
2. Observat. of Chilblains in Face▪ Ears and Hands.  abounding with sharp Humours, was some Winter's past grievously afflicted with Chilblains on her Hands and Fingers, which terminated in great Excoriations: they also affected her Face and Ears. I let her blood about ℥ viij. and dressed the Ulcerations with unguent. tutiae, and washed the Parts whealed and swelled with spir. vini wherein was dissolved sacchar. Saturni. The next day she was purged with an Infusion of sena, rhabarb. cum syr. ex infus. ros. cum agarico. I bathed her Face and Hands with Barnet-posset, and dressed the Ulcerations with unguent. de lithargyr. She was prescribed a medicated Ale with sarsaparilla, China, etc. with the antiscorbuticall Plants and was sometimes purged with calomel. and resina Jalapii: by which method she was cured, but hath been since subject to Chilblains, and I believe will be so every Winter as long as she lives.  
I was fetched to a Youth about ten years of age who had Kibes on both his Heels. 
3. Observat. of kibed Heels.  I bathed them at that time with Beef-broth out of the pot, and clipped away the Cuticula which hung over them and shut in the Matter. That being removed, I dressed the Ulcers which were sordid with Detergents, unguent. basilic. Praecipitate, and alum. ustum, etc. as abovesaid, and the Excoriations with Epuloticks: but the long continuance of the Ulcers had produced a Fluxion, which swollen the Parts about. They not being so capable of Bandage, I caused laced Socks to be made and put on, by which having restrained the descent of the Humours, I fomented the diseased Parts with a Decoct. salviae, beton. flor. ros. rub. ballast. nuc. cupress. in Wine, than applied Compresses dipped in the same, and by good equal Compression disposed the Ulcers to incarn and cicatrize, and cured them as Ulcers abounding with humidity.   

CHAP. XIV. Of a Varix.  
HItherto I have treated of tumors arising from the serous part of the Blood: I shall now deliver somewhat of those which take their original from pure Blood; and they are of three sorts, Varix, Ecchymosis, and Aneurisma.  
Varix is the dilatation of a Vein: it happeneth in divers parts of the Body; but for the most part the Thighs and Legs, the Testicles and haemorrhoïdall Veins, and in Women the Belly, are frequently affected.  
It proceedeth from the restagnation of gross Blood, 
Cause.  which being transmitted into the Veins, either by reason of the depending of the Part, or from some other pressure upon the Vessel, or else by its own grossness, proves unapt for Circulation. Than, in stead of continuing its current proportionably to the other Parts, it stops in the place and coagulates, and by degrees increaseth itself by the accession of the like particles out of the succeeding Blood; and, enlarging its bulk, dilateth its Vessels into a capacity big enough to receive it. This coagulation of Blood in a Varix is not so entire as to stop the passage wholly up. For the succeeding current always forceth at lest its thinner parts by the sides of the Coagulum, and consequently helpeth the dilatation. But it lieth lazily there, and suffers the rest of the stream to pass by it. This most commonly happens in cutaneous Vessels, where the Veins have no assistence from muscular Flesh, which by frequent pressure would otherwise be apt to squeeze it forwards. To which it may be added, that the Valves of the Vein so swelled, whether naturally or accidentally, are weakened, and do not sufficiently support the Blood in its ascent; so that, falling down upon the sides of the Vessel, the weight of it is too great to be driven forward by the venal motion of the Blood.  
All parts of the Body are capable of Varices, though they are most commonly in the depending ones, as the Thighs, Belly, haemorrhoïdall Veins, the Testicles, etc. for the reason aforesaid. But in other places, where depending cannot be the cause of the Check of Circulation, we do see Varices to grow.  
In some places it oweth its original to natural Causes; as to the generation of Milk in the Breasts, and of the Foetus in the Womb: in both which cases, Nature being obliged to spend the nutritious Serum upon the uses there intended, the Blood returns thick, and is apt to restagnate, and usually increaseth the Veins at those times to six or seven, it may be ten, times their natural bigness: which very accident is by Doctor Walter Needham (in his Book De formatu foetûs) made use of as an argument to prove, that the nutritious juices are carried to those places by the Arteries, and not by any peculiar Vessels. But it also preternaturally falleth out so in tumors of the Breasts and other Parts: in all which (but most visibly in Cancers) the Vessels enlarge, and the Veins become varicous. The cause of which may be referred either to the coagulation of the Serum, or grumousness of the Blood, or to the obstruction of the Vein somewhere in its passage by some angustation upon it by part of the Tumour; from whence it will often hap that the Vein beyond it hath its current stopped, and is forced to swell. Nay, not only the contraction of the Vessels by preternatural tumors doth this, but also any other Pressure. As in a Woman with Child, the burden lying upon the Ramus iliacus on either side of the body, makes the Thigh and Leg on all that side varicous. Straight gartering doth the like in the Leg. So the weight of the Testicles, or the pressure of a Bolster-Truss, in case of Rupture, renders them varicous. Riding much on horseback doth the like, by reason of the pressure that is made upon the inside of the Thigh by the Saddle, to which it usually clings; especially if you ride with long Stirrups. So also by much walking and in Labouring-people Varices usually hap, being occasioned, as I suppose, by the perpetual contraction the Muscles are put upon in standing, which being so contracted do press upon the upper branches of the Veins in the Thigh, and straighten them, thereby hindering the free ascent of the Blood.  
They are easily known, in what external Parts soever they are, 
Signs.  by the turgency, the crooked figure of the Veins, and azure colour, which is more or lesle apparent as the Veins lie superficial or deep.  
The Sign of a Hernia varicosa is, the unequal knotted Tumour in the Vein leading to the Testicle, with a relaxation of the same Testicle: and when the Testicles are inflated with Wind, the Vein in also distended and painful. What the Signs are of the Haemorrhoïdal Varices, and how they are to be treated, you may see in their peculiar Treatise.  
Varices are not dangerous in themselves, 
Prognostic.  they rather free the Patient from imminent Diseases, especially those of Melancholy; according to that Aphorism of Hypocrates, Insanis si varices vel haemorrhoïdes superveniunt, fit insaniae solutio. Which words are to be understood of Veins if they grow very large, or if they break and run: but if they flow intemperately, Cachexia, Dropsy, Consumption, and such like Diseases, follow. So, on the contrary, if they be unseasonably suppressed, Madness, Pleurisy, Coughing of blood, pain in the Kidney, Apoplexies, etc. do follow. The Hernia varicosa or Cirsocele is difficult to cure, as the rest are.  
The Varices aught not to be cured, unless they be painful, 
Cure.  or that they be extended into a large Tumour, or ulcerate and bleed much: for, as I have said, they preserve health. But if there be a necessity of curing them, it aught to begin with Purging and Bleeding, not once or twice, but often repeated; and if the Viscera be in fault, they aught to be strengthened and amended; after which the Cure may be endeavoured by astringent and exsiccant Medicaments, and those to be applied with convenient Bandage, to press back the blood coagulating in the Vessel, and moderately resist the Current. If these suffice not, than, according to the ancient practice, you are to proceed by Section, dividing the Skin and separating the Teguments; and having raised the varicous Vein, you are to pass a Ligature above and another beneath it, making a deligation of them; than slit the Vein, cast out the gross Blood, and afterwards digest and heal it, as is after said in an Aneurisma. With what success this hath been done, you may read in the Works of Fabricius Hildanus: and whether the pain be little or much worth the while, you may see Marius his Argument thereof in his Life set down by Plutarch. In my Practice I have met many diseased with varicous Swell in the Thighs, Legs, Belly, etc. some of them very large, and as unsightly as troublesome: but I never met with one Patient that cared to hear of the Cure by Ligature, nor indeed have I seen any great reason for it. For if the unsightliness and pain be in the Legs, it may be helped by the wearing a laced Stocking, placing a Card, piece of velum or beaten Lead between them. A laced Trowze will do as much for the Thigh. When they affect the Belly, they may be restrained by a Bracer, without much trouble to the Patient, or inconvenience to his health. But if you suspect it, you may in great Varices both purge and bleed them. The Medicaments externally applied are ballast. cortices granat. ros. rubr. nuc. cupress. Empl. Caesaris, unguent. sumach. etc.  
The Cure of the Hernia varicosa is by good Bandage, viz. a Bag-Truss, and the same Medicaments above mentioned: but if they be distended with Wind, treat them as flatulent tumors. How the Varices when ulcerated aught to be dressed and cured, you may see in the Treatise of Ulcers.   

CHAP. XV. Of an Ecchymosis.  
ANother sort of Tumour arising from mere Blood is the Ecchymosis, called by the Latins Suffusio or Sugillatio: which two latter are more proper to the Eye than other Parts.  
Ecchymosis may be defined, 
Definition.  an Extravasation of the Blood in or under the Skin or any other Part, the Skin remaining whole.  
It is an eruption of Blood from the lesser Vessels in the Skin or near it, 
Cause.  whether from Blow, Bruise, Fall, or Prick of a Lancet in Chirurgery, when the Orifice of the Vein lieth not directly under the Orifice made in the Skin, so as that the whole stream may discharge there, and after bleeding both be closed together. For if when you close the outermost the inner lieth open, it will make a Sugillation.  
These external Effusions are the Subject of this Chapter.  
To the better understanding of the nature of these, it will be necessary to divide the Blood into two parts, Serum and Grumus.  
The Serum is that fluid substance which floweth about the Coagulum or Grumus in the Surgeon's Porringer. It is not only the nutritious juice that nourisheth all the parts of the Body, but also the Balsam that heal it; and is that thing that is capable of digestion, discussion, and many other alterations. This is the Vehiculum of the Grumus, and whilst it circulates doth keep it fluid, and causeth its perpetual motion through all the Vessels and Pores, as long as they continued incorporate together. And in Extravasation, if the effusion be not great, it will by degrees swallow up the Grumus, dissolving it and returning it into the Veins again: but if the effusion be great, so that the Grumus separates from the Serum in the Contusion, there it difficultly re-uniteth with the Serum again, much lesle digests, but either putrefieth in the Part, making Inflammation, and sometimes Gangrenes; or else, which is more seldom, hardens there and dries, making only a morbus in numeris partium. Such a one Doctor Walter Needham and myself saw in the Foot of a young Gentlewoman, who was our Patient upon another account.  
Signs of a Contusion are the black and blue colour with or without Tumour. 
Signs.  The Causes, 
Causes.  as Blow, Fall, etc. are learned from the Bystanders.  
The danger is small, if the Contusion be such: 
Prognostic.  also whilst the Humours are thin and fluid, there is hopes of returning them back, or they may be afterwards discussed.  
But when any great Contusion happens, there the case altars, and danger is often great: of which, to omit many others, that of Ingrassius is a remarkable instance; where a Nobleman's Leg being bruised by the armed Knee of one that encountered him on horseback, it killed him in three days.  
When the Part, in stead of being black, blue or green, groweth read, hard and painful, the danger is eminent. Such was the case of a fat Gentleman, who, by a Fall upon his Buttocks going down stairs, bruised those Parts, and neglecting the Cure, it tended toward a Gangrene, but was got of by Scarification and Discutients.  
Since the discovery of the Circulation of the Blood, 
Cure.  some people have proposed to themselves the Cure of this Disease by returning the Blood back into its Vessels by warm Applications, as spir. vini, etc. Which possibly may have seemed to effect it where the Ecchymosis hath been small: but in great effusions of blood, accompanied with much pain, it is not reasonable to hope a return of the Blood by such Applications; for thereby the Tumour would be made bigger, and the lest that can be expected therefrom is a Suppuration; whereas those which shall be treated according to the method of the Ancients, by Repellents, and afterwards by Discutients, shall be secured from Apostemations, and soon recovered, if the Habit of the body be any whit good.  
If the Effusion of great, we begin the Cure by opening a Vein, and drawing blood proportionably. If it be small, the common Remedy of brown Paper soaked in cold water or Oxycrate may serve for the first Applications; and afterwards the Sugillation may be breathed forth by fomenting it with Discutients, or warm water, or with spir. vini, ol. anisi, etc. But if we suspect great Extravasation, we than embrocate with ol. ros. myrtill. cum aceto & album. ovor. and renew the Applications often: or if more astringent be required, there may be added of the pulv. bol. Armen. sang. dracon. flor. ros. rub. ballast. myrtill. gallar. nuc. cupress. And after the Fluxion is restrained, we apply Discutients with Repellents. ℞ ung. aregon ℥ iij. ol. lumbric. cham. rutae, an. ℥ j terebinth. ℥ ij. pulv. sem. foenug. ʒuj. flor. ros. rubr. ballast. an. ʒij. croci ℈ ij. cerae q. s. fiat Ceratum. If the skin be whole, a mixture of the tops of green Wormwood, Bay-salt and Vinegar may be applied. In great effusions of blood this Discutient may be applied after the Fluxion is checked: ℞ rad. bryoniae, sigil. Solomonis, an. ℥ iij. flor. cham. sambuci, an. P. j far. hordei, fabar. sem. foenug. an. ℥ j summit. absinthii M.j. sem. cuminiʒiij. coq. in vino, & fiat Cataplasma S. A. addendo in fine Oxymel. scillit. q. s. and foment the Part with a decoct, absinth. in lixivio come. If after such Applications the Blood remain extravasated, you shall than open the Tumour, jest it corrupt the Bone or Parts underneath: but if it inflame, and turn to Suppuration, hasten it by Suppuratives, and give vent to the Matter, and deterge with mundif. ex apio, etc. as the putrefaction requireth. If it tend to Mortification, treat it as such; but with Caution to leave of these Applications when you have restored the native heat to the Part, jest thereby you make new Fluxion, and the Part gangrene indeed.  
In case the body be bruised by a Fall from on high, or any other way, the Patient is to be immediately let blood, and the bruised Parts to be embrocated with some of the abovesaid Repellents; or, if it may be had, lap him in a Sheepskin flayed quick of: and than you may prescribe the common Remedies, as a draught of Spruce Beer, or ʒj. sperm. ceti, Irish Slate, or such like Powders; ℞ rhabarbari tosti, terrae sigil. mumiae, an. p. aeq. The Dose may be a dram in some proper Vehicle: and afterwards you may by Discutients in the form of Unguents or Cerots breath forth the remaining bruised Blood.  
I shall now give you some Observations of an Ecchymosis, and should begin with the lesser, as those in the Face, which are so commonly known by the black and blue marks which they leave behind: but the Cure being as common, makes it not worth my labour. Something of them you may meet with in the Treatise of Wounds. Of the Cure of the greater Contusions I shall give you some Instances.  
A Person of about thirty years old, 
1. Observat.  of a full Body, stepping into his Coach, his foot slipped, and he bruised his Shin upon the Foot-board. He returned to his Lodging, and purposed to sand for a Chirurgeon: but in the while looking upon it, and seeing no skin broken, he was advised to bathe it with spir. vini, to rarefie the blood and keep it circulating; a new way to make work for a Chirurgeon. He did so, and lapped it about with a cloth dipped in the same, continuing this way of Dressing some days. It growing daily lesle painful, but the Swelling not going away, I was sent for, and perceived indeed the black and blue colours to be in a great measure gone, but by their relation the Tumour was bigger: by which it was easy to judge of the great virtue of spir. vini so used. Whereas by Repellents at first with the expulsive Bandage the Blood might have been restrained, and afterwards what was extravasated might have been easily discussed. We see it daily in our Practice, and censure those of our Profession who suffer such Extravasation in every little Tumour to corrupt.  
In this Patient there was a Tumour of about a week's continuance: the question was, whether what was contained in the Tumour was Blood or Matter. If Matter, than a painful Fluxion should have preceded with Inflammation and hardness, and have terminated by Discussion or by Suppuration: whereas this swelled and was painful upon the blow, but was never hard nor inflamed, or much painful, after the sense of the stroke was over, but soft from the first night; and must consequently be Blood. But whether it were Blood putrefied, or concocted Matter, there remained no hopes of discussing it; nor was it safe permitting it to lodge so near the Bone in expectation thereof. Therefore, without farther dispute, I laid it open by Incision, and discharged about two spoonfuls of a corrupt black blood and Serum; than dressed it up with a Digestive ex terebinth. and embrocated the Tumour with ol. chamaem. and applying an Emplast. stict. Paracels. with Compress and Bandage rolled it up. The third day after I dressed it again, fomenting it with the Decoction set down in the method of Cure, and deterged with mundif. Paracelsi; and by the help of the Vitriol-stone and the common Sarcotick, unguent. diapompholyg. etc. incarned and cicatrized it, but continued the Bandage a few days after, to strengthen the Part.  
A decayed old Gentleman walking in the streets one evening was crushed up to a wall by a Cart: 
2. Observat.  the Wheel passing too near him bruised the outside of his left Leg, but did not break the skin: it was suddenly swelled, and very painful. His Friends chafed it with Brandywine, and, dipping a cloth in the same, bond it about the Part. By this way of dressing that side of his Leg swelled and inflamed very much. Others advised him L●●●●●●'s Balsam: by which improper Application the Fluxion was increased, and the Patient confined to his bed. Here was an object of Charity, upon which account I was sent to him. I found the outside of his Leg swelled and apostemated from the Gartering to the Small. I laid it open by Caustick an inch or two, according to the length of the Member. In dividing the Escar, there was discharged a large quantity of Matter with clotted blood in it. I dressed the Escar with Lenients, and embrocated the Parts affected cum. ol. ros. & vino austero, and applied Empl. è bolo over the Tumour with Compress and Bandage. The next day I brought a Decoction of absinth. flor. cham. ros. rubr. bacc. myrtill. fomented the Leg, and dressed the Escar with Lenients to hasten Suppuration; than by good Bandage thrust out the Matter, and endeavoured to agglutinate the hollow Parts; but could not do it without laying it more open by a snip made with a Probe-scissors. After which I deterged the Ulcer with the Vitriol-stone and with unguent. basilic. cum Merc. praecipitat. Than I incarned and cicatrized it, as hath been said in the former Observation. If in stead of spir. vin. etc. they had dressed this man's Leg cum bol. Armen. aceto, album. ovor. & ol. ros. they might have haply prevented the pain and trouble that followed.  
And old Gentleman was sorely bruised by a Fall in several parts, 
3. Observat.  but especially on the inside of his left Arm. After the space of two months I was consulted, and saw an Ecchymosis very hard and big lying along the Vessels that reach on the inside of the Arm to the Elbow-joynt. I embrocated cum oleo lumbricor. vulpin. & guttis aliquot olei origani & lavendulae, and applied cerat. agripp. over all. The next day I fomented with Discutients to which was added spir. vini. Than, having embrocated it as abovesaid, I applied a Cataplasm ex farinis hordei, orobi, lentium, sem. foenugraeci, cum flor. chamaemeli, sambuci, etc. decocted in some of the former Fotus, with an addition of some of the abovesaid Oils and Oxymel scillitic. By which method the Swelling and Ecchymosis were scattered.  
A Man of about sixty years of age scorbutically affected, 
4. Observat.  by a Fall upon a paved Floor, bruised his left Thigh. It was embrocated cum oleo ros. & aceto, and an Empl. è bolo applied over the grieved Part. Venaesection was proposed, but not permitted, by reason of his age, not would he purge. The third day he complained of extremity of pain, and suspected his Hip luxated. I took of the Dress, and felt the Joint well, but all that side of the Thigh overspread with an Ecchymosis. I embrocated with ol. chamaemel. & lumbricor. with an addition of ol. terebinth. and applied Empl. stict. Paracels. with a third part of Empl. diachalciteos; and the next day fomented the diseased Thigh with decoct. absinth. etc. in vino & aqua, to which was added spir. vini. Thus the extravasated Serum was resolved: but the Emplaster was continued by reason of his pain which remained notwithstanding. Some weeks after he complained of a nummedness of the whole Leg: upon which account Embrocations were repeated, also Purging and decoct. sarsaes, etc. with Antiscorbutics: but he took little of them. During this the Leg began to emaciate, and a Species of a Paralysis increased. Vesicatories were applied, and afterwards a Caustick below the Gartering. The next day I divided the Escar, and dressed it with Lenients, but left the attending of it to my Servant. Some days after, being informed that the Escar did not separate, but grew painful, I visited him, and saw it dry, not likely to separate: the Leg was also swelled with pituitous Humours. Since his Fall he had been below stairs walking with Crutches, but of late did sit up most part of the night, by reason of his pain. This and the weakness of the Member had occasioned the Swelling, and enfeebled the native heat in the designed fontanel. I cut into the Escar, dapt it cum oleo terebinth. hot, and filled it with Merc. praecipitat. than dressed it with Pledgits applied warm out of a mixture of unguent. basilic. with some of the said Oil; after fomented the Leg with a Lixivium wherein had been decocted some of the warm Plants, and applied a Cataplasm over the Ulcer. Thus the Escar was digested, and fitted with a Pea, and the Swelling restrained: but some months after he sunk under a Diarrhoea.  
A Man of about thirty six years of age, 
5. Observat.  of a lean Constitution, by accident of a Fall near two stories high into the Street was sorely bruised, especially on his left Side, Hippolito and Arm. I immediately let him blood largely, and embrocated the Parts bruised cum ol. ros. myrt. & aceto, and applied astringent Emplasters as above mentioned. A Clyster was also prescribed, and Irish Slate, etc. was given him, whereby he was disposed to a breathing Sweat: and at the hour of Sleep an Anodyne draught was prescribed, to incline him to rest. By this method the Fluxion was checked, during which the Parts diseased were fomented with a decoct. summitat. absinth. anethi, majoranae, flor. cham. sambuci, sem. anisi & cumini; to which was added spir. vini. Embrocations were also made ex oleis aneth. rutae, & terebinth. and the Cerote above proposed was applied over them: and in progress of time he was cured.   

CHAP. XVI. Of an Aneurisma.  
AN Aneurisma, according to my Description, is an Ecchymosis, and indeed the highest Species of it. But since Authors have given another account of that Tumour, and have allowed it a peculiar Chapter, I have done so too; the rather, because the nature of the Vessel through which the Effusion is made doth require a different method of Cure.  
It is a Tumour soft, 
Description.  white, and yielding to the touch, but riseth again upon the removal of your finger; and is for the most part accompanied with pulsation of the Artery.  
It is raised, 
Opinion of the Ancients.  according to the Opinion of Authors, by dilatation or relaxation of the Artery; they supposing the Blood to have burst its passage through the first Coat, and dilated the second, thereby raising the Tumour. And this some of them have delivered to us so positively, as if they had in opening them found the exterior Coat so dilated. This I myself was taught, and some while believed: but not having been able by my Practice to discover one Aneurisma made by dilatation or relaxation of the outward Coat, I am apt to believe that there is no such thing, but that it takes its rise from Blood bursting quite through the Artery into the interstices of the Muscles, where it raiseth a Tumour suitable to the Cavity it findeth, growing bigger or lesle, of this or that shape, as the Muscles give way. But this Tumour consists of Blood extravasated, the Artery lying undilated the while. I do therefore suspect the possibility of an Aneurisma by the dilatation of the outward or softer Coat of the Artery, because it seems improbable that a force big enough to burst the inward Coat, which is so tough and firm, should leave the exterior, being softer and weaker, whole, and go out so leisurely into it as to give it time for dilatation. Those which I have met with did all come from downright eruption through both the Coats; and those that come from external Punctures must of necessity begin with a breach of the external Coat first, it being next the Lancet, or other Weapon that made the division. Sennertus would have it to heal again, though contrary to my experience, who have always found it open as well as the internal: and indeed reason must tell us, that the constant eruptions of blood out of the Artery in every Pulse must needs keep it open; nay, the Blood keeps not within the bounds of any one Membrane, but I have seen it extravasated through all the interstices of the Muscles of the whole Arm.  
The Causes of Aneurisma's are diverss, internal, or external. 
Causes.  1. The internal Cause is, the impetuosity of the Blood, which moving with greater violence in its Channels than the Artery can sustain, doth force its way through the side of the Vessel, and, bursting a hole in it, doth issue into the space that lieth between it and the neighbouring Muscles, there incrassating the Membranes of the Muscles, and framing itself a nest.  
This Impetus may rise first from the quantity of the Blood. Either when it is more than the Vessel can contain, a case that seldom happens to produce an Aneurisma in any conspicuous Vessel; but if any such thing be, it opens at the Nose, or Lungs, or in the Brain, (there causing an Apoplexy;) or in the Stomach, Guts, Anus, etc. Or else when this Blood is not really more than the whole Body naturally should contain, but by violent Passion, or motion in stirring, is too forcibly driven forwards from the Heart towards some peculiar Artery; when the farther progress being (it may be) intercepted by some violent contraction of the Muscles through which it must pass, it of necessity breaks the Vessel: and thus in violent Vomiting and other Straining Aneurisma's are often made in the Neck, Arms, Legs, etc.  
Secondly, from the quality of the Blood, which, being too sharp or thin, crodes the Vessel; or, being highly fermented by other causes, bursts through all.  
This Blood, though extravasated, doth usually pulse: partly, because the body of the Artery from which it breaks doth pass through it, and by its Pulse doth agitate that; and partly, because in every such Pulse some addition of Blood is made to the Tumour. Yet this Pulse is chief in small Aneurisma's or superficial ones; for in the greater the motion of the Artery is not always felt.  
2. The external Causes are puncture by Lancet or Weapon, cutting, bruising, erosion, or whatever else may divide the Coats of the Arteries.  
The Differences of an Aneurisma are either from its magnitude, situation, 
Differences.  or shape. From the Magnitude it is denominated great or little, possessing the whole member or a part. From its Situation, it is superficial near the Skin, or deep in the Muscles. From its Shape: either it keeps the shape of the Part; which usually happens when the Orifice in the Artery is small, so that the Blood comes out leisurely, and finds the neighbour-Membranes so well united as to keep it within a certain channel, which Membranes are also fortified by an addition of a Serum coagulated from the extravasated Blood: or else it altars its form, when it groweth suddenly and irregularly, the Eruption being so great that it cannot be kept within bounds; or when it is by an ignorant Chirurgeon treated with Lenients and Discutients, being mistaken for some other Disease; for in this case the Membrances are relaxed, and give way to the Tumour.  
From these Differences the Signs of an Aneurisma may be taken. 
Signs.  If the Tumour be small and superficial, a Pulsation may easily be felt in every part of it. If it be great and rise suddenly, and was white and soft from its first appearance, though there be no Pulsation to be felt, yet you may conclude it an Aneurisma, there being not any Humour save that of Blood which can so suddenly raise such a Tumour. The often increase and diminution of the Tumour is also a Sign of an Aneurisma; the diminution of it being the return of the Blood into the Artery, whence it as often cometh out again.  
If it happened from a Puncture of a Lancet, the manner of the spurting out of the Blood will show it: and if it do not bleed, yet a sudden Tumour thrusts up under your Finger, with Pulsation, the blood breaking out into the interstices of the Muscles, though not quite into the Skin.  
The Tumour is more compact or scattered according as there was care taken at first to restrain it within compass. In some of these there is redness and Inflammation, by reason of the expansion of the Parts beyond their capacity, or from the putrefaction of the Blood: in which latter case Fever and Fainting for the most part accompany it.  
All Aneurisma's are difficult of Cure. 
Prognostic.  Those which are large, and arise from Arteries deep in the Muscles, to which you cannot make your Applications, are incurable: and if they be unadvisedly opened, the Patient is in great danger of his life. But if the Aneurisma be in such a Part as is capable of Bandage and application of Medicaments, the Cure is feasible; or the Disease may be palliated to the ease of the Patient.  
The Cure of an Aneurisma consists in the timely application of proper Medicaments, 
Cure.  and Bandage to restrain the Blood and keep it within its Channel: or by Escaroticks or the actual Cautery you may destroy it. But if it lie where you may take it up, the Cure is than best performed by dividing it. The Medicaments proper to restrain it in its motion, and agglutinate the Vessel, are, bol. Armen. sang. dracon. thus, aloe, far. volat. gypsum; also the juices of plantag. burrs. pastoris, millefol. vincae pervincae, pilosellae, lamii, and such like. The Compounds may be made of some of the foregoing Powders with some of the aforesaid Juices, or mixed cum aceto & albumin. ovorum.  
In the first appearance of the Tumour, if it arose from an internal Cause, you shall endeavour by the application of some of the aforesaid Astringents and Bandage to restrain the growth of it: but if it be in a place incapable of Bandage, you must content yourself with the application of Empl. Caesaris, or such like. If it be near the trachea Arteria, the Patient may wear beaten Lead or Gold upon it covered with Sarsenet or the like. You are to be well advised before you attempt the Cure by opening it. If by putrefaction the Blood burst forth suddenly upon you, the life of your Patient is than in danger, and it will become you to be quick in the application of good Restrictives and Bandage, till you have time to consider what to do: and be sure to provide against the next Eruption; for till it break of itself you are not to open it; and than you may attempt the stopping of the Flux by such means as have been or hereafter shall be proposed.  
If the Aneurisma hap by Puncture in letting blood, the Chirurgeon aught to permit the Vessel opened to bleed freely: but if it doth not bleed well, let him immediately loosen the Bandage, and apply a Compress dipped in his MAJESTY's Styptic, or, for want of it, in Oxyerate. Let it be held firmly upon the Apertion by a Servant, whilst the Chirurgeon openeth a Vein in the other Arm, and maketh Revulsion by a large evacuation to fainting, if it may be permitted. The while let your astringent Powders be applied to the Wound, with good restrictive Emplasters over them. The upper part of the Arm to the Axilla is to be defended by  wrung out of Oxycrate. Than with a Rowler with two heads take two or three turns upon the diseased Part, and roll upward, (his Arm being bowed the while:) and, for more security, take a turn about the Neck, and return back with your Bandage gradually to the Part affected, fastening it on the outside; than make the expulsive Bandage from the Hand upward. These aught to be made to the ease of the Patient, who, being thus dressed, must be put into his bed, and his Hand placed upon his Breast. Contemperating Juleps, Emulsions, Opiates, etc. aught to be prescribed him, and his Diet, etc. to be regulated as is proposed in the Chapt. of the Wounds of the Veins and Arteries. Having made this Bandage well, you are not to be overhasty in opening it again; for this first Dressing haply secures your Patient. For the great mischief happening in these Aneurisma's proceedeth from the ignorance of the Bloud-letter, who, not considering the error by him committed in letting blood, binds up the Arm carelessly, and the next day, upon the Patient's complaint, not discovering the cause of the Tumour, foments and embrocates it, thereby making way for the Blood to empty itself into the interstices of the Muscles; whereupon the whole Arm swelleth. In which case a laced Sleeve and Glove may be of great use. When this method fails, it may be necessary that you prepare for Deligation of the Artery. The manner of doing it you may see in the Chapter of the Wounds of the Veins and Arteries. I shall also show it in one of the following Observations.  
I Have had many brought to me with swollen Necks, 
1. Observat. of Aneurisma's lying near the trachea Arteria.  upon suspicion that they were troubled with a species of King's Evil, called Bronchocele: but the Pulsation of those tumors shown them to be Aneurisma's, and the most difficult to treat, they, by reason of their situation, not being capable of Bandage. In which cases I commonly proposed the wearing of a Cap of beaten Lead made of many sheets laid upon one another, and covered with Silk or Sarsenet, which with Ribbons were made to fasten about the Neck with much ease: or, if they would have Emplasters, I applied some of a mixture of unguent. sumach with Empl. Caesaris, or such like.  
Where Aneurisma's have affected Parts capable of Bandage, I have sometime palliated them: but when they would not be so quieted, I prosecuted the Cure as followeth.  
A Man of about 40 years of age, 
2. Observat. of an Aneurisma.  having some time been troubled with a large soft Tumour on the inside of his right Leg about his Gartering, desired my advice. It was without Pain, Inflammation or Pulsation, but soft from its first appearance, and was bigger or lesser according as he walked much or little; which gave me suspicion it might be an Aneurisma. I applied Empl. Caesaris over it, caused a laced Stocking to be put on, let him blood, and advised to Purging, regulation of Diet and Exercise, etc. by which it was kept quiet some time. But he, growing more secure, neglected the Rules prescribed him; whereupon the Tumour increased, and burst forth one night in a flux of Blood. I was sent for, and found much extravasated; but the Opening itself was stopped with a clot of grumous blood. I dressed it up with Restrictives and Compress wrung out of Oxycrate. Than I made Revulsion by Venaesection and Deligation of other Parts. I also prescribed Opiates, etc. to calm the ferment in the Blood. By this and my way of dressing the Blood was for some days tolerably restrained: but as the Opening grew bigger, the effusion was greater. Upon which consideration I had provided some trochisci de minio of several sizes, also some pulv. sine pari Jo. Arden. I put in some of the former, and applied my Restrictives and Bandage over the Tumour; and, as often as the Blood burst forth, I continued that way of dressing, hoping by those Escaroticks to destroy the Artery. Afterwards the Orifice growing larger, I filled up the Abscess with the pulv. sine pari upon Dossills', and applied Restrictives and Bandage as before. The Patient grew daily weaker; but from this latter Dressing the Bleeding was restrained till the fifth day, when I was necessitated to open it, by reason of the Excoriations made in many places about it by the Escaroticks: nor was it than much. The Opening being large, I applied the Escaroticks to more advantage, and dressed the Excoriations with unguent. album camphorat. continuing my Empl. è bolo and Bandage. From that time the Bleeding was stopped, I suppose by consuming the Artery; yet for some while there came away much stinking clotted Blood. While I endeavoured to keep the Blood within the Abscess, it insinuated between the Muscles, making the Calf of the leg hollow to the very Tendon: therefore, after I was secured of the Bleeding, I made way for the easy discharge of Matter, and deterged the Abscess with mundif. Paracels. To the Excoriations I continued the use of Epuloticks, and nourished my Patient with good Broths, Caudles, etc. by which he recovered strength apace. The sharp Humours being evacuated with his Blood, the Abscess incarned by the application of the common sarcotics, and he was cured in lesle than a month, recovering also the perfect use of his Leg.  
Some years since I was desired to give a visit to a man lying in my way to Whitehall. 
3. Observat.  He had a large white Tumour possessing the forepart of his right Thigh of few month's growth: it was soft from the first appearance, and observed by the Patient to be bigger and lesser one time than another. I considered the Swelling, and concluded it an Aneurisma. That there was no Pulsation to be felt in it, was because it lay deep amongst the Muscles, in which case the Pulse is frequently intercepted. There lay a gummy Emplaster upon it, and an attempt had been made to open it by Caustick; but it not penetrating deep enough, the Escar separated without reaching near the Cavity. I declared to the Patiented my thoughts, viz. that the Swelling proceeded from Blood poured forth of its Vessels, either by Erosion from within, or by some outward cause, as by Riding, etc. and advised him not to permit the Tumour to be opened, desiring that, if his Chirurgeon should persist in the suppurating or opening of it, he would sand to me to meet him. Some few days after the Patient sent me notice that his Chirurgeon had been with him, and resolved to open it: whereupon I took the next opportunity to speak with the Chirurgeon, and went along with him to his Patient; where I endeavoured to persuade him that the Swelling arose from Blood, and withal proposed a palliative Cure by a laced Trowze and some good Restrictive. But the Chirurgeon declared himself positively for the opening of it. I, seeing his resolution, replied, Since you are so opinionated, you may (if you think good) make a trial of the Tumour by thrusting a small Lancet directly into the middle of it; and if upon pulling out of the Lancet it appear mattery, you may lay it more open; if it appear bloody, you may more easily cure it than one made by a Caustick. He readily assented to the trial, and the Patient rejoicing in the proposal, he attempted it with a Lancet: but not thrusting it deep enough to reach the Cavity, I took the Lancet, and, passing it into the same Opening he had made, thrust it directly down into the Cavity, and pulled it out bloody, but not one drop followed it. The Chirurgeon not being therewith satisfied, I wished him to pass a small Probe down into the Opening. He did so: and I also made a search with the same Probe, and felt the Cavity large and full of Liquids', which was certainly Blood, the Probe coming out bloody. I persuaded the Patient to keep his bed till that Puncture should be agglutinated, and advised the Chirurgeon to be careful in the Cure of it. We dressed it with a Pledgit of lineament. Arcaei, with Emplaster and Bandage: to the use of which Medicine I left them, not doubting of their care in healing up so small a Puncture. About ten days after, walking near the door in a dark evening weary, and desirous to rest myself, the thoughts of this poor man inclined me to go into the house. I enquired of the Landlady if he was within. She replied, He is dying: That upon his rising out of his bed the Blood had burst forth excessively: That the Chirurgeon had for some days endeavoured to stop it, but had since left the Patient, and a Neighbour-woman had applied a Pultice to it; and that the Chamber stunk so extremely as it would poison me to go into it. I went up, and found the room scattered with stinking bloody , and the poor man languishing in his bed, which was not cleanlier. I sent presently away for the Chirurgeon, and in the while made Rulers and Compresses, and sent for some Yeast and Wheat-flower. The Chirurgeon being come, we spread a mixture of them upon , and armed several Tents with the same. Having thus prepared our Dress as the time would permit, we took of the bloody ones, and held the Orifice close while we cleansed the Thigh from the Pultice and Blood, than stopped the Orifice with a Tent proportionably, and applied our Agglutinatives over, with Compress and Bandage wrung out of Oxycrate. We rolled the Member moderately strait, than laid him clean, and caused a mess of Caudle to be given him, and encouraged him with hopes of recovery. The Chirurgeon pleaded for himself, that he thought the Patient had been dead.  
Three or four days after we dressed him again, and found him much recruited in his Spirits, he not having bled one drop: and indeed the Emplasters adhered as close to the Skin as we could desire. After we had taken out the Tent, abundance of grumous Blood issued forth: we cleansed it away, and shaked into the Abscess about a dram of Merc. praecipitat. and though we had than choice of Medicaments, yet we applied the same as before, and continued that method of Dress, till the Blood was converted to Matter. Than we slit open the Orifice, and dressed it as a sinuous Ulcer. After some days, observing that the Matter could not discharge while he kept his bed till the Abscess was full to run over, we caused him to rise out of it: but that little while he was up he swooned; wherefore we put him to bed again, and allowed him stronger nourishment, and by a Seton-needle made way for the discharge of Matter to more advantage. The Abscess being well disposed to cure, I left him again to his Chirurgeon, who cured him.  
This Experiment of opening Aneurisma's by Puncture is not to be imitated, unless it be in such cases as this, where both Patient and Chirurgeon are so incredulous.  
Some years since, while I dwelled in the Old-Baily, 
4. Observat.  I was consulted in the case of a man who in his letting blood was pricked in the Artery. The Artery did not bleed outwardly, but discharged itself between the Muscles. The Tumour, being mistaken for a puncture of a Nerve or Tendon, was fomented with Discutients, whereby I found it much enlarged, and not only the inside but the outside of the Arm swollen above and beneath the Elbow, with a Pulsation in those remote Parts. I caused an Emplaster to be made of some of the Restrictives set down in the method of Cure, cum ol. ros. myrtill. & aceto, and applied it over the Arm to the Axilla with Compress and Bandage. I than let him blood, and disposed him to rest with an Anodyne draught, and prescribed him Emulsions and cooling Juleps, with such a Diet as might incrassate his Blood. A day or two after I strengthened the former Bandage by a laced Sleeve and Glove, by which for some time much of the Blood was returned back into the Artery, and the Arm seemed in a hopeful way of recovery: but through irregularity the Arm swollen again, and the Patient grew weary of us, and gave ear to every prattle; and so it happened that an Empirick was commended to them, as having an excellent Medicament to stop Bleeding. He was fetched, and undertook the Cure, and removed the Patient nearer his Lodging, where he treated him: but he being ignorant in making the Bandage, or possibly not thinking it so necessary, the Arm swelled; and the Tumour on the inside of the Arm being soft and prominent, he concluded it a bag of Matter, (as he called it) and applied a few bruised Herbs to it, which eat into the Skin, and made way for the Blood to burst forth abundantly; insomuch as a neighbouring Chirurgeon was sent for, and he called others, who together made a shift to stop it at that time. But his Arm gangrened, so that within few days after they prepared for the cutting it of. The Patient's Relations, being acquainted with the accident, sent me to them. I saw it amputated, and the Patient put into his bed. We slit up the Arm, and laid the Artery bore. It retained its natural shape and smallness, not one jot dilated; nor was the Apertion considerable which had been made by that accident, but by reason of its constitution continued open, as I have seen a hole punched in Leather, whereby it was capable of receiving the Blood, if it had been timely returned: but that being omitted, the extravasated Blood forced amongst the interstices of the Muscles up to the Axilla, and on the outside of the Arm down beneath the Elbow, in which places we found a quantity of stinking grumous Blood.  
A Man being much afflicted with a Tumour in his right Arm, 
5. Observat.  occasioned by the pricking of an Artery in letting blood, having tried the endeavours of several of our Profession unsuccessfully, some whereof had purposed the taking of this Arm, at the last I was sent for, and met Mr. Arris and Mr. Holier there. Mr. Gardner was his Chirurgeon. The Tumour was large, much inflamed, and painful, with little or no Pulsation: but the Accident which gave rise to the Tumour enough confirmed it an Aneurisma. My opinion was, that a Tumour so inflamed was not capable of such Bandage whereby they might hope to return the Blood back into the Artery. Nor indeed was it reasonable to suppose that such a putrefactive heat as seemed to be enclosed in that Swelling was capable of being thrust back or retained long there, without making its own way by a Gangrene: and of what danger such an Eruption might be to the Patient, if a Chirurgeon were not at hand, I left to their consideration. Than in order to the removal of the Tumour there were but two ways, viz. Amputation of the Arm, or cutting into the Tumour, and making Deligation of the Artery; which latter I commended to them. They assented to the Deligation: only the Patient desired a day or two to prepare himself. We applied Empl. è bolo, with a moderate Bandage to restrain the increase of the Tumour the while. The fourth day after we met again, and, having all things ready, the Patient was placed in a Chair towards the light. I took of the Dress, and made a Ligature four fingers breadth above the Tumour, on which Mr. Holier made a gripe. Some other held the Hand and lower part of the Arm, whilst I made Incision down the length of the Tumour. That done, I threw out the grumous Blood with my fingers, and cleansed the Wound with a Sponge. Than desiring Mr. Holier too slacken his hand, upon which the Artery discovered itself by the blood spurting out, I passed my Needle under the upper part of the Artery, and tied that, and cut of the end of the Ligature. Near the Wound made in the Artery by letting blood there was a cartilaginous body form, which hindered my coming to the Artery; I cut it away, than passed my Needle, and made a second Ligature. We dressed it up with Pledgits spread with the common Digestive ex terebinth. dipped in pulv. Galeni, and applied Empl. diachalcit. malaxed with ol. ros. and rolled it up to the ease of the Patient; than put him into his bed, and prescribed him an Anodyne draught to take that night. The next day I visited him, and found him in much ease: he had slept well with half the draught was designed him, and was not troubled with those fainting fits which he had been subject to before the Operation. The third day we took him out of his bed to dress his Arm. In taking of the Dressing we found all safe, and the Lips of the wound tending to digestion. Mr. Holier, who held the Arm above, seeing no Blood flow from the Wound, for experience sake gripped it harder: upon which the Blood of a sudden dropped from the fleshy parts and Capillaries in great drops, as if it had been pressed out of a Sponge. I wondered at the manner of its bleeding, not minding what he had done: but he slackening his hand, it ceased as soon. 
Caution.  Which may show the ill consequence of overhard binding in the dressing of Wounds, Ulcers, etc. We dressed the Wound with the Digestive as before, and so continued it till the Wound was well digested. From that time we dressed it with sarcotics, rubbed the lose flesh with the Vitriol-stone, and hastened the cicatrizing of it with aq. medicamentoes. etc. I saw the Ligatures fall of, and the Wound cicatrizing, than left it to his Chirurgeon, it being at that time indeed almost cicatrized. The Patient made me a visit a while after, and shown me that he could use that Arm as well as the other.  
What more concerns an Aneurisma you may see in the Chapter of the Wounds of the Veins and Arteries.   

CHAP. XVII. Of an Herpes'.  
Herpes' hath its name à serpendo, from its creeping quality: 
Names.  it is also called Formica ambulativa & corrosiva; and, by Celsus, Ignis sacer. It proceedeth from pure Choler (as it is yet thought) separated from the other Humours, and cast out into the Superficies of the Skin.  
There are three Species of them, 
3. Species.  differing from each other according to the Humour of which they are generated. The first is the Simple Herpes', proceeding from pure Choler. The second is the Herpes' miliaris, wherein there is an admixture of a salt waterish Humour. The third Species is Herpes' exedens, where the Humour added to the Bilis partaketh of much acrimony, and proves exceeding corrosive.  
The Simple Herpes' is a Pustule of a yellowish inflamed colour with a sharp head: it cometh soon to maturity, 
Simple Herpes'.  and the Matter is visible in the upper part of it whilst its basis is inflamed; but in the eruption of the Matter the Inflammation goeth of, and it healeth. In the Face they frequently appear single, and so they will in other parts of the body, and are generally taken notice of as choleric Pustules: but they do often appear overspreading the Back, Sides, or Breast, and are accompanied with an Erysipelas, and have a Fever joined with them; being in this case known by the name of Shingles.  
The Herpes' miliaris riseth in a cluster of small Wheals little differing from the colour of the Skin. 
Herpes' miliaris.  They are first discovered by their itching, and being rubbed or scratched they weep a thin waterish Humour: from that time a Scab appeareth in the head of each of them of the form of a Millet-seed, from whence the Tumour hath its name. As the Pustules heal in one place, they usually break out in another.  
Herpes' exedens is said to be rather an Ulcer than a Tumour, 
Herpes' exedens.  but is indeed an Ulcer with Tumour, it rising in the Skin in a small Tubercle, on the top whereof there appeareth an Ulcer like a pin-hole. It is for the most part without Inflammation or pain. When it ariseth alone it is scarce taken notice of, it mattering but little unless it be picked, and than it scabs soon after with a thin Scurf. But in progress of time it showeth its ill condition, by eating away the Skin, and indurates the Flesh underneath and Parts about. Sometime I have seen these Ulcers arise in the Skin somewhat distant one from another, making an unequal furrow; as from the upper Lip by the Nostril creeping to that side of the Nose, so to the ridge of it, and down again to that corner of the Eye; healing in some places while it eat deep into the flesh in others.  
This Herpes' in Lues venerea frequently ariseth from a Simple Herpes', while the Matter is shut in by the Scab, it corroding underneath, and making an Ulcer; when it breaketh out, appearing like a Hony-comb, bigger or lesle, and of a round or long figure, accordingly as the Disease hath more or lesle malignity.  
The Simple Herpes' is neither dangerous, 
Prognostic.  nor difficult of cure; but in the Face it may be exasperated by picking or scratching, and grow corrosive; otherwise it will heal of itself. When it first overspreads a Part, the Patient is indisposed with Fever; but as it cometh to Matter, that indisposition goeth of.  
As an Erysipelas doth sometime terminate in a Herpes', so an Herpes' is frequently accompanied by an Erysipelas.  
The Herpes' miliaris is without Fever, but is difficult of Cure, especially if it affect the Face, Nose or Ears. If the Cure be neglected, it eateth deep into the Flesh; and than, in what Part so ever it is, the Cure is hard to accomplish.  
The Herpes' exedens is most difficult of cure, and if it be not timely treated, it certainly terminates in a Phagedaena of Cancer: but when it ariseth from Lues venerea, the very worst is curable.  
As to Internal Remedies; 
Cure internal.  a Simple Herpes' is cured much like an Erysipelas, by evacuation and contemperation of choler. Herpes' miliaris cometh near to the nature of an Itch, and is to be treated with Purgatives and Alteratives much of the same kind with what is proposed for that. For the Cure of the exedens I refer you to the Treatise of Ulcers.  
External Applications also in the Simple Herpes' do imitate those of Erysipelas, 
Cure external.  but aught to be more drying; as polygonum, equisetum, millefolium, plantag. solanum, etc. whose Juices may either be applied upon  wet therein, or else be mixed with lithargyrum auri & argenti, cerussa, tutia, bolus armen. so as by addition of ol. ros. myrtill. and Wax to make Cerots or Ointments: as, ℞ succ. plantag. summit. vitis, polygoni, an. ℥ iij. tutiae praep. cerussae, an. ℥ ss. litharg. auri ℥ j antimoniiʒiij. cerae q. s. ol. ros. & myrtill. fiat Cerat. Our Dispensatories abound with Compositions fit for your purpose, as unguent. album camphor. diapompholyg. tutiae, desiccativ. rubr. nutrit. mixed with populeon.  
Herpes' miliaris requireth a more powerful exsiccation: viz. ℞ pingued. porcin. vitulin. vaccin. an. lb ss. fol. alleluiae, chelidonii, sedi minoris, plantag. ling. canis, an. M.j. calcis ter extinctae lb ss. chalcanthi pulver. ℥ j flor, aerisʒiv. omnia ad invicem conquassentur, & simul dimittantur marcescere per hebdomadam; postmodum addantur aq. plantag. & succ. granator, an. ℥ iv. deinde bulliant lento igne usque ad consumptionem aquae & succi, & colentur; colaturae adde lethargy aur. & argent. an. ℥ iv. boli armen. minii, an. ℥ j pulv. court. granat. ℥ ss. terebinth. clarissimae ℥ iij. iterum bulliant, & cum cera alb. fiat Vnguentum. Or, ℞ axung. porcin. ol. laurin. an. ℥ ss. unguent. rosat. ʒiij. auripigment. ʒij. Merc. sublimat. ʒss. argenti vivi saliva jejuni extincti ℥ ss. lithargyr. auri, argenti, & cerussae, an. ʒiij. Misce in mortario marmoreo pro usu. Merc. dulcis, Merc. praecipitat. arcanum corallinum mixed with unguent. rosatum, have sometime served me to good purpose in the curing of this Disease in Children and tender Bodies; but in the more rebellious sort we foment them with good Lixivium or an Ablution of Turbith. Spirit of Vitriol and the Caustick-stone itself may be also necessary. And this is it which makes an Herpes' in the Face so hard of cure, we not daring to apply such Corrosives there, especially not on the Nose, where the Cartilages and Bones lie so near the Skin.  
A Girl of about six years of age was brought to me with many small angry Wheals rising behind her left Ear and down that side of her Neck towards that Clavicle, with an Inflammation about them. 
1. Observat. of an Herpes' behind the Ear.  I applied an Empl. de cerat. ad herpetem, to assuage the heat, and defend her  from sticking to them, and advised her Mother to keep her warm. A few days after they brought her to me again. The Inflammation was than going of, and the Pustulae on the lower parts burst; but those behind her Ear were white and full of Matter. I opened them all, and discharged the Matter, than dressed them with unguent. tutiae upon Pledgits of Lint; by which in three or four days after they were dried up and cured.  
A Gentleman of about fifty years old, through some disorder in Diet, 
2. Observat. of an Herpes'.  heated his Blood, and was indisposed with a Cough and Shortness of breath: he had also many Pustules risen upon his Breast, Back, and Sides, with an Inflammation partaking of an Erysipelas. I let him blood about ten ounces, and prescribed him a Clyster, also a pectoral Ptisan, and advised him to forbear strong drinks, and to make his diet of Water-gruel, Panado, and the like. I sent him some of my lenient Cerote to apply, in case any of the Pustules should matter and stick to his linen. Three or four days after they came to maturity, and broke, and dried as the former: while they dried he was purged with Whey and Manna, and a few days after was well and abroad.  
A young Gentlewoman of about eighteen years of age, 
3. Observat. of an Herpes'.  upon a suppression of the Menstrua, was afflicted with many angry Pustulae on her right Hand from her Wrist to her Finger's ends, which by ill treating ulcerated into one another, and excoriated all over. I dressed them with unguent. album camphorat. beaten up with album. ovi, than let her blood in the Arm, and advised her a Clyster of Milk and Sugar. The next day I purged her with an opening Apozem, such as is proposed in the Chapter of the Itch; which she repeated often. The day after her first Purge I looked upon her Hand, and, finding it all mattery, bathed it with a Decoction of polygonum, summitat. equiseti, rubi, etc. than dipped  in some of the same, and rolled up each Finger by itself, leaving a space here and there between, on which I applied Pledgits spread with unguent. de lithargyro. I dressed up the Hand after the same method, and advised her to renew the Dress thrice aday. By this and other drying waters it cicatrized here and there; but than an Inflammation arose above the Wrist with many Wheals. Upon the sight of which I gave her ℈ j calomel. over night, and a draught of her purging Apozeme in the morning. By the repeating it three or four times, with intermission of some days, I took of the Fermentation in her blood; and by the bathing that Hand and Arm with lac butyriatum, and dressing it with unguent. de lithargyro and such like, I cured her. It being than the season to drink the Waters, I recommended her to Epsom, and from thence to Tunbridge: they passed well, and she recovered her perfect health.  
A Person of Honour, 
4. Observat. of an Herpes'.  of a full Body abounding with sharp Humours, was seized with an Herpes' on his right Leg. I dressed it with a mixture of unguent. nutritum and populeon, and proposed Bleeding and Purging: but we being upon a march, our lying in the fields the nights and marching all day was inconsistent with such Rules; whereupon it inflamed and swelled very much, many Wheals arose, and fretted one into another, with great Excoriation. I fomented the Leg in the mornings, and sometime in the evening, (as we had time) with a Decoction of polygonum, plantag. equiset. flor, ros. rubr. and dressed it with unguent. album camphorat. cum albumine ovi, with an addition of unguent. tutiae spread upon little pieces of Linen, and laid on at such distance as the Matter might get out between, than rolled on a Compress pressed out of the Fomentation. But the Fluxion was so great, and the Matter so very sharp, that for a while it would yield to no Applications. But after he had the conveniency of a Coach to rest his Leg, I made a shift to cicatrize the Ulcerations by applying bits of Linen dipped in the aforesaid Decoction, and laying Pledgits spread with unguent. tutiae, etc. upon the edges of the Ulcerations over the Linen, with Compresses and Bandage. The Matter was well discharged between Dress, by which means the Ulcer was digested and healed.  
Of the Cure of these Ulcerations with Intemperies humida you may read more particularly in their proper Chapter in the Treatise of Ulcers.  
One came to me having an extreme itching in the Palm of one of his hands. 
5. Observat. of Herpes' miliaris.  I looked upon it, and saw many small white Wheals scarce discernible: those which he had scratched had small Scabs on the heads of each one of them like Millet-seed: they seemed dry, but were encompassed also with Wheals, and did all itch very much. He had also somewhat of the same Herpes' on his Thumb and Forefinger of the other hand. I purged him with pulv. cornach. and sent him a pot of the unguent. calcis prescribed in the method of Cure to dress them with. I afterwards purged him with pulv. cornach. and Merc. dulcis: by which, and the addition of a few grains of Merc. sublimat. to the aforesaid Unguent, the Herpes' was dried up in the several Parts.  
A Woman came to me with an Ulcer in the Sole of one of her feet. 
6. Observat. of Herpes' miliaris.  It was an unequal dry Ulcer, eating into the Skin to the Flesh of the compass of Half a crown: it was not much painful or inflamed, otherwise than as she heat it by walking on it. I caused it to be washed with an Ablution of Turbith, and applied unguent. calcis upon it, and afterwards purged her with Catharticks and Calomel. Thus the Ulcers dried, but afterwards risen again in the ragged Lips. Upon sight whereof I rubbed those Lips all of with the Caustick-stone so far as I could judge any of that Humour lurked; than applied unguent. basilicon hot upon Pledgits, with some of the abovesaid Cerote over all. The third day after, when I thought to have seen a deep Ulcer, I found it flat and dry, and, scraping of the Ointment, I also brought of the Slough, and saw the Skin smooth and even perfectly well: by which it was evident that the Disease was only in the Skin.  
A Gentlewoman about fifty years of age, 
7. Observat. of Herpes' miliaris and a simple Herpes'.  upon the ceasing of the Menstrua, was afflicted with an itching on the right side of her Head above her Ear. It growing vexatious, and not yielding to common Remedies, she came to me. It was an Herpes' miliaris about the breadth of an Half-crown-piece amongst her Hair. Her often scratching it had exasperated it, and the sharp Humour which issued from it had fretted the Skin behind her Ear downward, and in progress of time that became serpiginous, and was, when I saw it, covered with white branny Scales. The Humour dropping down from these had than inflamed the Parts beneath, and many fiery Pustulae were there risen, which spread down to that Clavicle. I dressed these latter with cerat. Galeni, let her blood that evening, and the next morning purged her with Whey, Manna and crem. tartar. and that afternoon, when her Physic had done working, I dressed the simple Herpes' with the Cerote as before; than clipped of the Hair from the Herpes' miliaris and parts about, and with a strong lixivium bathed that Herpes', and washed of the branny Scales; than applied that Unguent with the auripigmentum mentioned in the method of Cure. It was very painful, but by twice applying the malice of the Disease was extinguished; and afterwards by anointing it with unguent. rosatum the pain was removed, and the Herpes' miliaris and Serpigo appeared well cured. The Herpes' beneath mattered, and were dried up with the common Epuloticks. I than made her fontanelles in her Legs; since which time she enjoys good health.  
A Man long vexed with an Herpes' miliaris on the inside of his Thigh was cured by the same method.   

CHAP. XVIII. Of an Oedema.  
HAving showed you how Blood and Choler become offensive when disturbed and thrown out of their proper Sphere, I shall now proceed to speak of that Tumour which hath its rise from the Pituita or Phlegm, and is known by the name of Oedema.  
It is a soft cold Tumour without change of colour, pulsation, heat or pain, 
Definition.  unless it be from the distension of the Part it affects.  
The Cause of Oedema is, as in other preternatural tumors, Antecedent, 
Causes.  and Conjunct.  
The Antecedent 'Cause are either remote, as default in Diet, Air, Exercise, etc. also old Contusions, Luxations, Fractures, etc. or more immediate, as the pituitous Humour abounding in the Body.  
The Conjunct Cause is the same Humour collected into a Tumour, which is done for the most part by Congestion, these cold tumors being rarely made by Fluxion.  
Oedema in itself is not dangerous; 
Prognostic.  people of gross bodies and good fellows are frequently subject to them, yet live to old age. But in Consumptive and Hydropical bodies it is of ill consequence, not as it is a Disease, but as it foreshews a decay of native heat. Those Oedemata that attend accidents of Wounds, Fracture, etc. are not dangerous, nor difficult to cure: but if an Oedema grow hard and painful, there is fear of a Scirrhus; or if it suppurate, of a long and tedious Cure.  
In the Cure of an Oedema three things are required: first, 
Cure.  preventing the generation of the pituitous Matter; secondly, evacuating the gross Humours that abound in the body, which is the immediate Cause of the Disease; thirdly, the Cure of the Tumour itself, which is effected by external Remedies.  
The first of these is performed by regulating the Patient in his manner of living; as in Diet, Air, Exercise, Sleeping, Watching, Passions of the mind, etc. As, that his Bread be of pure Wheat, well baked with Correctives, as Carraway, Fenell, or Aniseeds: that his Meat be Flesh of good nourishment and easy digestion, Mutton, Veal, Pullet, Rabbit, Chicken, etc. that his Drink be Ale well boiled and medicated. Wine is also commended; but moderation in drinking is desired. The Air aught to be dry and heating, the very removal into hotter Countries being often the Cure of this Disease. Exercise is required, to stir up the native heat, and to waste the Crudities. Sleep in the daytime is forbidden, and aught to be moderated in the night. Melancholy is to be avoided, and Venery if the Body be weak.  
The second consists in prescribing such Remedies as may attenuate, open Obstructions, and evacuate the pituitous Humour. Bleeding is not always proper, yet may be admitted if there be Plethora. Purging is necessary, and in order thereto you may begin thus; ℞ rad. apii, petroselini, an. ℥ ss. flor. persic. genistae, an. P. j senaeʒ ij. salis tartari ℈ ij. agarici inclusi in noduloʒ jss. zinzib. ℈ j coquantur in aqua font. ad ℥ viij. colat. add syr. de spina cervinaʒ x. pro dnabus vicibus. Or, ℞ sem. carthami contusiʒ iij. senaeʒ ij. flor. sambuci, persic. an. P.j. fiat Decoct. in aq. font. & vin. alb. ad ℥ iiij. colaturae add aq. cinnamomi hordeat. cochl. iij. syr. ros. cum agarico ℥ j Misce. Or you may purge him with this following Apozeme; ℞ rad. ireos ℥ j court. inter. sambuci, ebuli, an. ℥ ss. rad. faeniculi, petroselini, an. ʒ vj. summitat. centaur. min. agrimoniae, marrubii alb. an M. j flor. genistae, sambuci, an. Mss. sem. foenic. carui, an. ʒ jss. fol. senaeʒ x. turbith, sem. carthami, an. ʒ iij. fiat Decoctio s. q. vini & aquae ad 3. part. stint in infusione per noctem, mane colentur ℥ xij. ℞ colaturae ℥ iv. syr. de spina cervina ℥ j Misce; fiat haustus; reiteretur per aliquot dies. The stronger Catharticks are, pill. è duobus, extract. rudii, pill. cochiae minor. pulv. diaturbith cum rhabarbaro, diasen. cornachin. etc. Six drams of Electuar. caryocostin. is a good Purge for the poorer sort. Vomiting is of great use: and, if the Tumour be in the inferlour or remote Parts, it may be as useful for making of Revulsion, if the Patient labour not under a Phthisis. Your Vomit may be oxymel scillit. or the emetic Wine, sal vitrioli, etc.  
You are also to have regard to the weakness of the Stomach, and endeavour the strengthening it, not only by outward Applications, as Fomentations of absinth. card. benedict. scored. cassiae lign. calam. aromat. etc. but also with stomachical Unguents and Emplasters, of which you may find sufficient set down in the London Dispensatory. Cordial Electuaries and digestive Powders are also useful, whereof I shall give you some. ℞ cons. anth. ℥ ij. court. citri conduit. ℥ ss. nuc. moscat. conduit. ʒ vj. spec. diarrhod. ℈ ij. cum syr. de court. citri & syr. garyophyll. fiat Electuarium: of which the Patient may take the quantity of a Nutmeg often in a day. Or this; ℞ sem. anisi & foenic. cond. an. ℥ j coriand. & carui conduit. an. ℥ jss. cinnam. pulv. ℈ iiij. spec. aromat. rosat. ʒ ij. fiat pulivis. A spoonful of this may be taken after Dinner, or at any other time. Also Decoctions of sarsaparilla, lign. guaiaci, sassafras, with Antiscorbutics, etc. adding Wine, aq. mirabilis, or the like cordial water to it, to make it more grateful and hearty in the Stomach.  
The third concerneth the handling of the Tumour itself: and that varies, according as it is in its beginning, state, or declination.  
In the beginning, the Medicaments may be such as do moderately repel, not violently, jest the Humour of which the Tumour proceedeth, being for the most part gross, be thereby made more tough: besides, Repellents are not so proper in congested tumors. When we use them, it is rather to strengthen the Part, than to repel; therefore we mix with them such as have an attenuating and discutient faculty. One of the milder is Bay-salt with Oil of Olives. In small Swell proceeding from the weakness of the Part Brandywine, or a Solution of Bay-salt in Spanish Wine, or the party's own Urine, may serve sufficiently to attenuate and dry up the humidity, and strengthen the Part.  
In the state, when the tumors are large, they require Medicaments more resolvent and discutient: and the better to dispose them to rarefaction, you may begin with such a Fomentation as this: ℞ summitat. absinthii, abrotoni, origani, calaminthae, pulegii, sambuci, chamaemeli, rutae, salviae, an. M. j bacc. lauri, juniperi, an. ℥ j sem foeniculi, dauci, carui, cymini, an. ℥ ss. contundantur crasso medo, & in aq. q. s. bulliant ad dimid. partis consumptionem; colaturae add spir. vini q. s. fiat Fotus. After which you may embrocate with this; ℞ ol. laurini, rutacei, de castoreo, an. ℥ ij. salis marini, ʒ ij. Misce: and apply this Cataplasm; ℞ farinae fabar. hordei, an. ℥ vj. summitat. absinth. rutae, origani, abrotoni pulv. an. ℥ ss. flor. sambuci, chamaemeli, ros. rub. pulver. an. ʒ iij. coquantur in praedict. fotu ad cataplasmatis consistentiam, addendo in fine aluminis & sulphuris vivi an. ℥ j olei rutacei & mellis come. q. s. If these be not enough discutient, you may make the former Decoction in a Lixivium, and the Cataplasm in the same, and embrocate with such like: ℞ ciner. brassicae ℥ ij. unguent. dialthaeae ℥ iij. ol. cham. chymic. ʒ j Misce. Emplast. de minio cum sapone, Emplast. diasulphur. are also proper to discuss these tumors.  
In the declining of the Tumour foment with such things as may be discutient, and corroborative to strengthen the Part: ℞ summit. origani, majoranae, flor. anethi, cham. ros. rubr. an. M.j. balanst. nuc. cupress. calic. gland. an. ℥ jss. calam. aromat. ligni aloes, an. ℥ ij. coquantur in vino rubro, & fiat Fomentum.  
Bandage is of great help in the Cure of these pituitous Swell: indeed we can do nothing considerable without them. Those I especially recommend to you are the laced Stocking, Trowze, Sleeve and Glove. They, as sitting most firmly, may be worn with the greatest advantage, and with the lest trouble or prejudice to the health of the Patient; yet do they require your consideration and care how they be laced: for by the unequal hard lacing of them you may raise a Tumour, and by an equal over-streight lacing you may emaciate the most fleshy Leg. Many instances may be given of the former, and I shall give you one of the latter.  
A person of a sedentary life, who had been vexed with an Ulcer in one of his Legs, was advised by his Chirurgeon to wear a laced Stocking; and having thereby cured the Ulcer, he thought fit to continued the use of the Stocking some while, which he did: but, minding more his Study than his Leg, he laced the Stocking every morning straighter, till his Leg became so weak that it could scarce support his body. I was fetched, and surprised to see his Leg so dwindled away, wondering how he could lace it so small without causing Inflammation, or indeed suffer it to be so extenuated without taking more timely notice of it. I presently caused the Stocking to be unlaced, and his Leg to be bathed with warm water, and embrocated with ol. lumbricor. by which it plumped again in few days, and recovered its former strength.  
A Gentleman of about thirty years of age, 
1. Observat. of a swollen Hand.  having laboured long of a Quartan Ague, was afflicted with a phlegmatic Swelling in his right Hand from the Finger's ends to the Arm, as full as the Skin could hold, both back and palm, the Joints stiff and useless. The Tumour was painful by reason of the great distension of Parts, and was thereby rendered hard, yet yielded to the impression of my Fingers. Doctor Lenthall had purged him frequently; but the Tumour not yielding thereto, he put him into my hands. I began my work with the milder Fomentation prescribed in the method of Cure, and embrocated it with ol. cham. & rutac. cum sale comm. applied over the whole Swelling Emplastr. diasulphuris, rolled it up, and placed it high up to his Breast. I continued this method some days without much advantage, than left of the use of the Emplaster, and applied a Cataplasm ex fair. hordei, etc. as it is set down in the method of Cure, and continued the Fomentation and Embrocation; by the use of which the Tumour did somewhat discuss. But, according to my long Observance, these crude tumors cannot throughly discuss without the help of a more strict Bandage; therefore, having thus disposed them for Bandage, I caused a Glove to be made of strong Leather, slitting the back and fingers, and making Eylet-holes to draw it close. Than having applied the Cerote above prescribed, with a Compress of cloth over it, and a piece of velum to defend the Hand from the Lace, I laced the Glove on moderately straight to the ease of the Patient, and straightened it still daily. But from that time I did not dress the Hand more than once in four or five days, and than I fomented and dressed it as I had done before, laying Compresses upon the Palm of the hand and elsewhere as I saw occasion. As the Swelling diminished the Glove became too big; we therefore put on another lesle, and began again to purge him, and prescribed him decoct. sarsaes, lign. guaiaci, etc. and from that time we purged him once a week with extract. rudii & calomel. By this method I discussed this Tumour in the midst of Winter, he not keeping his Chamber but when he took Physic: yet there remained a stifness in the Joints of the Wrist and Fingers, and the Arm was extremely emaciated. For the nourishing of it I made a Fontanel in that Arm; and in order to the relaxation of the stifness of the Joints of his Hand, I fomented them with emollient Herbs boiled in Flesh-broth, and embrocated them daily with ol. lumbricor. applying a Cerote of unguent. dialthaeae and Wax over all. His Hand was also sometimes put into Grains or a Beast's Belly. After which we dressed his Hand, and laced on the Glove, as before we were accustomed to do, and directed him to wear a furred Glove to keep it warm. By this method his Arm grew fat, and his Hand flexible and strong before March.  
A Widow-woman aged fifty six years, 
2. Observat. of swollen Legs.  of a gross Body, having been long subject to Swell in her Legs and Feet, was at last thereby confined to her Bed. They were pituitous, and yielded to the impression of my fingers; yet were hard, and somewhat inflamed, and painful: which latter was occasioned, I suppose, from the extraordinary influx of Humour. I purposed to have begun my Cure with Purgatives: but she, having no use of her Legs, would not be persuaded to Physic. I fomented her Legs and Feet one after another with the milder Fotus prescribed in the method of Cure, embrocated them with ol. cham. lilior. cum aceto, and applied a Cerote of unguent. dialth. with an addition of Wax, and ʒ j of ol. cham. chymic. with good Bandage from the Toes to the Knee. I repeated this way of Dressing twice aday, till I had mollified and resolved somewhat of the Tumour and hardness; than made the Fomentation more discutient by the addition of Salt and Sulphur viv. and some days after caused a pair of laced Stockings to be put on, and laced them daily straighter. But from that time I dressed her Legs but once in three or four days, unless it were that the Skin were fretted by the Salts or her scratching them. In which case I took them of, and bathed her Legs with warm water, and applied cerat. Galeni on them. Thus her Feet and Legs were made lesle, and her Stockings taken in accordingly, till the Swell were quite discussed, and her Legs and Feet restored to their true shape, which was in lesle than eight weeks; during which I purged her with that Apozem prescribed in the method of Cure, and made her Fontanels in her Legs, and continued the use of the laced Stockings. I thought this Widow had been dead, till the last Summer she sent to me for an Emplaster for a pain in her Shoulder; it being the year 59 in which I cured her.  
A Person of Honour about fifty years of age, of a corpulent full Body, 
3. Observat. of swollen Legs. etc.  whom I had seen many years before in France afflicted with pituitous Swell in his Legs and Feet, came over into England, and put himself into the hands of Sir Fr. Prujean, he than labouring under a complication of Diseases, of which those Swell in his Legs and Feet were only a Symptom. By Chalybiats and Antiscorbutics he was relieved, and restored to a tolerable good health; but those Swell in his Legs did not lessen. Upon which consideration I was sent for, and proposed the laced Stockings as the only remedy. It being allowed of by the Physician, I fomented his Legs with the milder Fomentation above prescribed, embrocated them as above faid in the preceding Observation, and rolled them up from the Feet above the Knees. After three or four days I put him on laced Stockings with Knee-pieces, and by a moderate lacing of them restored the Legs and Feet to a better shape than they had been in many years before, and he enjoyed a better health. After the wearing them some months longer, his Legs grew so well, that he frequently discontinued the use of them many months: yet when he perceived any fullness in them, he did put them on again, without advising us about it. Nine years after this Person was diseased with a Carbuncle: after the Curing whereof his Legs, Thighs and Belly swollen extraordinarily. By Purging and Antiscorbutics his Belly sunk; and by laced Stockings and Trowzers the Swell in his Legs and Thighs went of, and they continued well without farther use of the laced Stockings, he enjoying a good health some years afterwards.  
In the time of the last great Plague, while I was in the Country, 
4. Observat. of a swollen Thigh.  I was fetched to a Person of worth, of about seventy years of age, lying in bed diseased with a cold phlegmatic Tumour in his right Thigh, soft and yielding to the impression of my fingers. Doctor Bowles had been with him, and prescribed a Fomentation with Embrocations to be daily applied. I approved of what had been done: but the weather being than extreme cold, the ground covered with Frost and Snow, I thought he might get cold in the time of Dressing; and besides, without a strict Bandage it was not likely to remove that Tumour. Therefore I offered to their consideration, whether a Flannel Trowze might not be made to lace straight upon that Thigh, to cherish the native heat of the Part, and defer the Cure of the Tumour till the Spring. The Patient approved of it, and declared that he would return to London about that time, and consult us there in order to his Cure. This being his resolution, I directed his Servants to make a Trowze of a fine Dimity, lined with a soft Flannel, with Eylet-holes, to lace on the outside, with a Waist-band fitted to the upper part of it. The Trowze being made, I saw it laced on, a piece of Spanish Leather being placed under the Lacing, to defend his Thigh from being hurt by it. The lower part of the Trowze was tacked to a Cotton Stocking he put on that Leg. I desired (in case that Leg should swell) they would put on a laced Stocking with a Knee-piece. After I was gone, there were some Objections made against this Bandage: but the Patient, finding ease by it, continued the use of it, and came to London in the Spring of the year, and sent for Sir Fr. Prujean, Doctor Bowles, and myself, to meet Sir Ed. Alston and Mr. L. a Chirurgeon at his house, to consult his health. We met, and found the Patient walking in a large Dining-room. He gave us an account of the Swelling in his Thigh, and how it was cured by the Bandage I had directed in the Country. He also related to us how he had been over-persuaded to have the Calf of that Leg blistered, and of the pain it gave him, and that a Fontanel had been made in the same Leg; which he was also forced to heal up by reason of the pain. (These were made after I had been with him.) He farther declared the Objections had been made against the Bandage, and said, he had therefore sent for us together, to have our Opinions how to regulate himself for the future. The Physicians did all approve of the Bandage, and allowed his wearing laced Stockings on his Legs in case they should swell, and prescribed him a stomachical Pill and some pectoral Syrups to take for a Cough he was subject to. Some while after the Patient's Legs swelling again, I put him on laced Stockings, which he did wear till they recovered their tone. Afterwards, as occasion offered, he wore them, or left them of. During the time he wore them, he commonly bathed his Legs with warm water at night (by my direction) once a week to refresh them, and put fresh Stockings on the next morning. Thus he lived happily some years, and died of Old age.  
A Youth aged about 15 years was diseased with the Smallpox, 
5. Observat. of an oedematous Swelling with Apostemation, etc.  and soon afterwards with a Rheumatismus, which especially afflicted the Scapulae and right Ischion. During these Distempers the Physicians endeavoured by frequent Bleeding, Sudorificks, etc. to take of the Ferment in the blood: but the pain increased, and that Leg swelled from the Hip to the very Toes exceedingly, and seemed oedematous. On each of the Scapulae there also appeared a large Tumour without Inflammation. These latter we judged to be full of Matter, and accordingly I opened them by Incision, and discharged a great quantity of purulent Matter. We dressed them with unguent. basilicon upon Pledgits. The Swelling in the Leg we stuped with a Decoction of warm Plants in a common Lixivie, adding to it some Brandywine. After we had well fomented it, we embrocated the whole Member with ol. olivae and a Solution of common Salt; than rolled it from the Toes up to the Hip, and placed the Foot and lower part of the Leg so high upon Pillows as might hinder the descent of the Humours. We also laid him upon his left Side, to give ease to a large Ulceration upon the Os coxendicis, which was occasioned by his long lying upon that Part. After we had thus dressed him, my Kinsman Jaques Wiseman took the care of him, and in four or five days removed the Swelling out of the Foot, Leg, Knee, and lower part of the Thigh, to the great ease of the Patient: but the while the upper part of the Thigh and Hip swollen the more; also an Anasarcous Tumour stretched the Scrotum to such a bulk as hindered his lying longer upon his Side. At the fight of which I scarified it with a Lancet, gave vent to that serous Humour, applied a warm Stupe on it wrung out of the forementioned Decoction, and thereby freed the Scrotum so perfectly well as it became not more difeased. The Abscess in Scapulis continued to matter much, and the Bones were felt bore in both of them: but upon making new Apertions in the Parts more declining, the Matter discharged easily, and they cured within three weeks after. But in the mean time the Tumour in the upper part of the Thigh became painful daily more and more. Feeling Matter fluctuate in it, we opened it by Incision, and discharged a large quantity of Matter indifferently concocted: yet we could not by search of Probe discover any Sinus considerable; but, by pressure with our hands upon the Os sacrum and backside of the Ilium, we saw the Matter flow fresh out of the Abscess: upon which account care was taken to make Compressure by Bandage upon that Part. Whilst this Abscess became the care of the Surgeons, there was consideration had of Internals, to dispose the Humours to a healing condition. But, alas! he was so emaciated, weak and restless by reason of new Ulcerations which were risen upon the Os coccygis and both Hips, that we only prescribed him good Broths and such Meat as might nourish him; and at last, for his more ease, we placed him directly upon his Belly; and thereby the Ulcers which had been made by lying on the places aforesaid were disposed to cure, and the Matter which lodged deep in the upper part of the Thigh and Ischion, etc. by this pofition made its way down by the Os ilion, and flowed more plentifully. Upon fight whereof that Opening was enlarged about two or three inches, for the more free discharge. From that time the Matter daily lessened, and accordingly the Tumour diminished, the Abscess and external Ulcerations healed, and the Patient visibly recovered his strength, insomuch that we hoped our work had been well-nigh at an end. But he not being able to lie so long upon his Belly, the Ulcerations on his Back and Hips increased, and proved exceedingly vexatious, also the Swelling upon the Ischion grew big, and so painful, that it contracted that Leg. Fomentations and Cataplasms powerfully discutient and resolvent were for some time applied: they proving ineffectual, we applied a strong Caustick on the middle of that Tumour, and cut into it: but it appearing dry and callous, we filled up the Apertion with Praecipitate. While we were digesting out that Callus, Embrocations were used to the contracted Tendons, and the Ulcerations, etc. were daily dressed, whereby in the space of six weeks they were all cured, and the Patient restored to the use of that Leg, but as yet he makes use of Crutches to support his weak body.  
I was sent for to an Infant of about a year old, 
6. Observat. of an Oedema in the Thigh.  diseased with a soft white Tumour in the midst of her right Thigh yielding to the impression of my fingers: it was of a very large size, without much complaint of pain. I embrocated the Swelling with ol. ros. and Bay-salt, and applied an Emplaster of diachyl. ireat. cum aceto, with Bandage over it. After a few days continuance of these Dress, finding the Tumour not to lessen, I fomented it with the milder Discutients set down in the method of Cure, and applied Emplast. diasulph. by the use of which it seemed to dissolve; but afterwards it increased again, and became hard, of a dusky colour, and as it were fixed to the Bone. Than I applied a Cataplasm ex mucilag. rad. althaeae, lilior. sem lini & foenugraeci, etc. endeavouring Resolution: but it inflamed, and suppurated deep amongst the Muscles. I continued Suppuratives, and after a few days, the Matter being more concocted, opened it, and gave vent to a foetid Matter; than dressing up the Abscess with unguent. basilicon upon a Tent, I embrocated it with ol. ros. applied the same Cataplasm, and afterwards deterged it with mundif. Paracels. and incarned and cicatrized it as hath been said in large Phlegmons.  
A poor Woman brought a Child to me diseased, as she was told, 
7. Observat. of the Thigh.  of the King's Evil; as indeed now-adays every Disease that appears dangerous or difficult of cure is sent to us as the Evil. He was about six years of age, and had a large Tumour on the inside of his right Thigh. It was not the Evil, but, the Child seeming an object of Charity, I offered her the Cure of it; and at the same time, while the Child lay upon the Table, I made Incision into it without ask leave, and discharged, I believe, near a Chamber-pot full of a crude Matter; than dressed it up with Pledgits of unguent. basilicon and Emplastr. diachalcit. with Compress and Bandage. The second day she brought him again to me, and than the Skin seemed much contracted; yet it bagged, and had near a Porrenger-full of Matter in it. I laid it open that way with a pair of Probe-scissors, and dressed it afterwards once more. My Servants from that time continued to do it, till she thought she could cure it herself.  
A Child of about four years of age, 
8. Observat. of phlegmatic tumors in the Thigh and Ischion.  having been seized with a Fever in the Autumn, languished the Winter following under various Diseases, and was lame by reason of some Swell about the right Hip and Thigh. Dr. Denton was his Physician, who, having recovered the Child to a tolerable measure of health, took me along with him to consider those Swell. There was one round Tumour near the Hip, the other was on the forepart of the Thigh, very large: they had all the signs of flatulent tumors (except the Sound.) We applied Emplastr. diasulph. and put on a laced Trowze with a Compress upon the tumors, and deferred the farther prosecution of the Cure till the weather grew warmer; and than, finding the tumors unresolved, we fomented them with Discutients boiled in a common Lixivium, and repeated the use of the former Emplaster, by which the Tumour on the outside discussed, (if it did not pass its Matter into the other:) which soon after I opened in the most declining part four fingers breadth above the Knee, and, instead of Wind, discharged a large Porrenger-full of a clay-coloured foetid Matter. The Opening was made by Caustick: it served for the easy discharge of the Matter, which after a few days lessened, and by Compression the Part agglutinated above, and cured without farther enlarging or putting in a Tent.  
A Gentleman of about thirty years of age having from his youth been vexed with a fistulous Ulcer in his right Testicle, 
9 Observat. of an Oedema in the Belly.  in progress of time a Tumour arose in the lower Belly over the Pubes, stretching to the right Groin. He consulted Mr. Jenman and myself. The Swelling was hard and painful, but without Inflammation. We supposed it to arise from an effusion of Serum through all the hypogastrick Arteries. That of the Testicle we believed to come from Juices cast in by the spermatick Vessels, which, meeting with a check in their progress, made the whole Testicle scirrhous, and the Ulcer, as I said, fistulous. We begun our Applications to the Tumour with a discutient Cataplasm ex far. fabar. hordei, sem. lini, foenugraeci, flor. sambuci, cham. pulver. in oxymel. hoping to scatter the Humour: we also endeavoured Revulsion by Venaesection, Clysters, and lenient Purgatives. Doctor Short was consulted, and assisted all along in the Cure. While we were endeavouring to discuss the Tumour, it began to inflame and tend to Suppuration. Upon sight whereof we suppurated it, and opened it by Caustick about two inches long near the Os ilion, and discharged a large quantity of Matter. As the Escar separated, we endeavoured Digestion, and cherished the Parts by good Fomentations, adding Compress and Bandage to press out the Matter; the Physician having the while prescribed a decoct. sarsaes, chinae, etc. with proper vulnerary Plants and Balsamicks, purging by intervals. Yet notwithstanding these endeavours, the Abscess became more sinuous, and put us upon a necessity of laying it open the whole length as it lay transverse the Belly. The Matter was thereby more easily discharged; but, by reason of its virulency, it corroded under the Lips of the Ulcer, rendering them sinuous and jagged, and the Peritonaeum bore in some places. The lest application of a Cathaeretick exasperated it, etc. The rubbing of a callous Lip with the Caustick-stone gave him a fit of the Colic. Upon which considerations we exhibited a few grains of Turbith mineral, which gave him three or four Vomits. By the repeating of that some times he salivated, and the Ulcer afterwards became well disposed and cured. The Testicle was grown to the Scrotum, and passed its Matter through it in two several places: there was also another Sinus which passed through the body of the Testicle downwards. We had been some while endeavouring to consume the Callosities of these by Emollients outwardly applied, as also by Cathaereticks inwardly upon Tents into the Ulcer: but failing in the latter, we laid open the Sinus on the side of the Testicle from one Orifice to the other, and digested and healed it; than passed a Seton-needle through the other Sinus, and made way beneath for discharge of the Matter. When that lower Orifice was digested, 
10. Observat. of a Tumour in the Belly.  we pulled out the Ligature, and kept it open with a Tent, and thereby drained the Matter from the uppermost parts, and cured the Testicle.  
A Man came out of Ireland diseased with a large Tumour in the lower Belly deep under the Muscles, without Inflammation, hardness or Pulsation: it was most prominent towards the left Inguen, and somewhat heated. The Tumour had been long growing, and of late very painful. I applied an Empl. Caesaris over the whole Tumour, and fitted him with a Bracer to bear part of the weight of it, designing that way to palliate it. By these he was somewhat relieved, and made a Journey with some of his Friends into the North, purposing to drink the Waters at Knaresbrook: but by reason of his pain he stopped at York; and, meeting wlth no hopes of Cure there, he returned hither, and sent for me. I went, and found him in his bed full of pain, and that part of the Tumour in the Groin swollen and inflamed, and full of Matter, as I thought: but, doubting the success, I desired he would consult some eminent men of my Profession. He made choice of Mr. Tho. Holier. We considered the situation of the Tumour, the time and manner of its growth, with the Symptoms all along attending it, and concluded it originally a Tumour by Congestion; supposing the pain to proceed from some acrimony in the Serum, which falling into this declining Part putrefied. Upon this supposition we complied with the Patient and his Friends desires, opened the Tumour in that Groin by Incision, and discharged about half a large Porringer of a bloody Serum. We than laid it more open, and, observing nothing more to come forth, made a search with our fingers, and, feeling nothing but Fat, dressed it up with Digestives' ex terebinth. etc. with Emplaster and Bandage. The Patient was eased of his pain, and rested well that night, The third day we met again, and found him as well as might reasonably be expected: but from the time we opened the Tumour he had not been out of his Bed. Taking of the Dress, we found the Tumour sunk, and a little Matter from the Lips of the Wound; but from the Abscess there was only a Gleet discharged. We fomented the whole Belly with decoct. absinth. flor. cham. sambuci, etc. made in Wine, and dressed up the Abscess with Digestives as before. We were not satisfied with our work, yet had no Symptoms of its penetration: he breathed well, and his Urine and stools were good. At our next Dressing we saw the Ulcer had gleeted much, and the Opening appeared full of a greasy Fat soiled, as the Omentum will be after it hath been some time corrupted by the air. We pulled some of it out, and, having made a Ligature under it, cut it of, and dressed up the Patient as before. We were inclinable to think that what we had cut of was part of the Omentum: but than why should not the Intestines thrust out? To clear this Doubt, I brought the next day an Injection made of a Decoction of some Vulneraries, ex rad, ireos, aristoloch. rot. myrrh. aloe, sarcocol. mell. ros. and a little spir. vini, and cast some of it up with a Syringe. It came out again. We repeated the Experiment, till we had well satisfied ourselves that it came all out again: which confirmed to us that the Abscess was not within the cavity of the Belly amongst the Bowels. But the casting up of this Injection gave the Patiented a Colic, upon which we used it not more. The Lips of the Abscess digested well, but from within it only gleeted, and thrust out Fat, which we daily cut of without the loss of a drop of blood, and dressed up the Abscess with mundif. ex apio, continuing the use of discutient Fomentations and Cataplasms. We very much desired to see our Patient up out of his Bed: but he apprehended that his Guts would tumble out; and the more Fat we pulled away, the more he desponded, and in the space of two months languished and died. I resolved to open his Body, and to that purpose made my Incision down from the Cartilag. ensiformis to the Pubes, and from the Navel cross over. Than it appeared plainly that the Tumour was made by abundance of a soft white greasy Fat lying between the Peritonaeum and Muscles of the lower Belly. The Peritonaeum was sound, not the lest tainted, yet lay so bore, that the most curious Anatomist could not by Dissection more expose it.  
If this person had but risen out of his Bed to the Close-stool, nay, if he had but rose upon his Knees to urine, the Fat had slipped out at the same time; for it lay lose floating upon the Peritonaeum. After I had removed the Fat, I divided the Peritonaeum, and there I saw all the Viscera sound and sweet as ever I beheld in any dead body in my life.   

CHAP. XIX. Of a Scirrhus.  
SCirrhus hath hitherto amongst Authors been reputed to have its Original from Melancholy and tough Phlegm: 
What among the Ancients.  the truth of which I dare not deny before I know what is meant by those words. For in progress of discourse the Writers upon this Subject do divide Melancholy into natural, and preternatural: a Distinction by whom begun I do not at present remember, but continued and used by all Writers of the latter Ages. Men that make this Distinction do suppose the natural Melancholy to be the terrestrious part of the Blood, but not yet to have exceeded the bounds of a sanguineous element: preternatural to be such as hath contracted a more than ordinarily fixed or terrestrious quality by a fault in Concoction, which if it be only a Humour so fixed, may be called preternatural Melancholy. If the Blood was very hot and acrimonious, it hath been presumed to be burnt, and hath gone by the name of Choler adust: but than it is not of the same kind or family. Of these more in the Treatise of Cancers.  
I desire not to wade into Controversies of this nature, fit for the Schools than a practical Discourse: it may suffice to give such a notion of Melancholy as may be agreeable to the common conceptions of men versed in the Faculty.  
If we so derive our Notion, we may consider the Blood to be bred out of Chyle, 
What truly it is, with its Causes.  which in the lacteous Vessels is white, but when it enters the Veins it by degrees groweth to be pellucid, and than is called Serum, and in some cases Pituita; and at last, when it is read, we call it Blood. Which Blood consists of much Salt and Sulphur, without which neither the animal Spirits nor the solid Parts themselves could be made. According to the degrees of fixedness and volatility that these Salts and Sulphurs' do acquire, the Blood is more or lesle florid, and the whole Habit of body of a better or worse Constitution. If these Parts arrive to their due volatility, the whole Habit is Sanguine: if they be too fixed, it is Melancholic, according to the old phrase; which is indeed so far from being Adustion, that it is rather a Crudity, and the body in this case differs from a Sanguine condition as a green Apple doth from a ripe one. It being the fault of the Blood that the Chyle, having met with too great acidity in the first Concoction, doth not ever acquire a genuine ripeness, but is apt upon occasion to concrete itself upon the Fibres of the Tendons or Muscles outwardly, and upon the Viscera inwardly: which Concretion, where it happens, is that Tumour which we call Scirrhus.  
The Differences of Scirrhus must be taken from the various mixture that happens in the Juices of the Blood. 
Differences.  For Blood, being made at several times, may partake of many several qualities; some of which may be produced in the Mass of Blood, and some in the Part itself, either by the peculiar Ferment thereof, or else by the alteration it may receive from applications of Medicaments. If a false Ferment in the Ventricle vitiate the Digestion, instead of good and laudable Chyle, we often found the product to be peccant, either in acidity, or acrimony, or some other quality. If it be Acrimony, when it comes into the Blood it produceth many hot Diseases, and often Cancers: of which more hereafter. If a mere crude Acidity, than the body is liable to a Scirrhus: but that Scirrhus, according to the various mixtures it may meet with of Blood that went before, may be so compounded as to make those several Species which we call Scirrhus' phlegmonoïdes, erysipelatodes, aedematodes, etc. Nay, though the whole Blood may be troubled with one uniform Distemper, which may dispose it to the raising of a Phlegmon, Erysipelas, Oedema, etc. yet the applications of Medicines to a Part so affected may be such as, exhaling too suddenly the thinner Juices, may make the cruder portion that remains, instead of ripening into a due Digestion, harden into a Scirrhus: or else by Medicines that cool too much the whole Mass may be kept in its crudity, and so fixed in the Part as to become hard.  
The exquisite or true Scirrhus hath no sense; 
Signs.  the imperfect Scirrhus hath some sense, if it be pressed upon. The Tumour is hard, immovable, and of a dark read colour; if Pituita be mixed with it, than it is of a livid colour. If a Scirrhus be the original Disease of the Part, and not the effect of some other that hath been ill handled, it gins usually small like a Vetch or Pea, and by degrees increaseth, without shifting or changing of place. If it be the effect of some other Tumour that terminated in it, as a Phlegmon, etc. than the Accidents proper to that Tumour did suddenly change into those of a Scirrhus: of which you may see more in their proper place.  
The true or exquisite Scirrhus, being altogether without sense, 
Prognostic.  admits of no Cure. The reason is, because the induration of the Part is so great, that it will not open to receive the free afflux of Blood into it, but keeps its own hardness in despite of all Applications, and thereby the use of Medicaments is rendered ineffectual.  
The imperfect Scirrhus, which hath some sense, is not incurable, but yields by Resolution; though very often it terminates in a Cancer.  
The Scirrhus which ariseth from Pituita, without change of colour in the Skin, if it be very big and hard, and have hair grown upon it, is neither curable, nor yet doth terminate in a Cancer.  
In the Cure of the Scirrhus three Intentions are required. 
Cure.  The first is, in the regulation of Diet and manner of living: the second is, in the preparing and evacuating of the antecedent or peccant Humour: and the third is, in the application of external Medicaments.  
In order to the first, the Air aught to be clear, and temperately hot and moist. Their Aliment such as may breed good Blood; as newlaid Eggs, Chickens, Pullet's, Mutton, Veal, Lamb, Kid: and these boiled with spinach, borage, Endive, Succory, Lettuce, Sorrel, etc. are better than roasted. Their Bread aught to be of good Wheat and well baked; their Drink a well-boiled small Ale, or small White-wine, Rhenish, etc. Their Exercise moderate, and also their Sleep: their Mind cheerful, free from care: and the Body soluble, by Clysters or otherwise.  
The second Intention is, the evacuation of the Humour which aboundeth in the Body: whether, to use the vulgar phrase, it be Pituita or Melancholy that caused the Scirrhus; or that it proceeded from Obstructions of the Menstrua, or Suppression of the Haemorrhoids. If from any of these Causes Blood abounds and be feculent, Phlebotomy is allowed, a Clyster preceding: but if Blood do not abound, forbear Bleeding, and proceed in preparing and evacuating the Humours.  
The Preparatives thereto, according to the Ancients, were with syr. de succo borrag. bugloss. fumariae, lupul. de duabus radicibus, de pomis, Byzantinus, etc. in the distilled water of the same Plants, or in Whey. But our Patients would think that time lost: therefore, instead of those Digestives, we purge with Minoratives; viz. decoct. senae Gereonis, decoct. epithymi, also Decoctions of cassia, tamarind. etc. cum syrupis de pomis purge. etc. elect. diacathol. diaprun. solut. diacassiae; and also pill. de lapide lazuli, de agarico, aggregativ. etc. These tough Humours require frequent Purging, but not by strong Catharticks: confect. hamech and elect. diaphoenic. are of the strongest sort. If Phlegm abound, proceed as hath been proposed in Oedema, and forbear Bleeding.  
The Plethora evacuated, you may endeavour Revulsion to the contrary Parts by Friction, Cupping, Fontanels, etc. In Obstructions of the Haemorrhoids Leeches may be applied; and in Suppression of the Menstrua a Vein may be opened in the Arm or Leg.  
The third Intention is performed in treating the Tumour itself: in which these Directions are to be followed. First, that you do not use Repellents; for cold and tough Humours, of which these Swell are created, are not capable of returning back as hot Humours, but do increase the more thereby. In the next place, you aught to be cautious in the use of Emollients alone; for thereby they are frequently exasperated, and terminate in Cancers. You aught also to avoid the use of the stronger Discutients, jest thereby you resolve the serous thin Humours, and convert the grosser part into a more solid substance. Therefore you are to consider well the Habit of the Body, and whether the Scirrhus be recent or old, and what the Parts are that be affected, and proportion your Medicaments accordingly.  
As to the Habit of the Body: young people, and such as live effeminately, require to be treated with milder Resolvents than those who live a labouring life. So also a Scirrhus in its recency, whilst it is in its augment, requireth milder Applications than the confirmed or inveterate one. And those Scirrhi arising in the Fleshy parts will more easily resolve than those on the Ligaments and Tendons.  
The milder Resolvents are butyrum rec. adeps gallinac. ol. amygdal. dulc. lilior. adeps anser. anatis, sevum vitulin. hircinum, vaccinum, axung. porcin. vet. rad. althaeae, lilior. etc. The stronger are radices cucumeris agrest. bryoniae, sigil. Solomonis, ireos, pix navalis, liquida, terebinth. gum. galban. ammoniac. bdellium, opopanax, etc. Acetum by virtue of its penetrative quality is properly mixed with other Medicaments in the resolving gross Humours.  
Some Writers do not approve of Fomentations: but I have always found them necessary to dispose the Tumour to Resolution, and have ever begun my Applications with them, and do propose them to you. ℞ rad. althaeae, lilior. an. ℥ iiij. rad. cucumeris agrest. ℥ ij. summitat. cicutae, M. ij. summitat. majoran. M. j flor. meliloti, sambuci, an. P.j. sem. lini, foenugraeci, althaeae, an. ℥ j coquantur in ss. q. aq. font. colaturae adde aceti modicum.  
In soft Bodies, where the Scirrhus is recent, ℞ rad. althaeae lb ss. rad. lilior. ℥ iij. sem. lini & foenug. an. ℥ j coquantur in broad. ex capite & pedibus vervecinis, deinde pistentur, & trajiciantur per setaceum, addendo olei chamaemel. lilior. an. ℥ ij. oesypi ℥ jss. Empl. diachyl. simple. cum oleo lilior. solut. ℥ iij. cerae alb. q. s. fiat Ceratum. Ceratum hyssopi is also proper to resolve these tumors.  
In dry Bodies, where the Scirrhus is more confirmed and fixed amongst the Ligaments and Tendons, the Fume of acetum, yea sp. vini sprinkled upon a hot Stone, are of special virtue in resolving those tumors: afterwards you must chafe the Part, and apply this or such like. ℞ gum. galban. ammoniac. bdellii in aceto dissolute. styraecis liquidae, an. ℥ j diachyl. magn. ℥ ij. ol. lilior. axungiae anseris, an. ℥ j cerat. aesypat. ℥ ij. liquescant omnia simul, & cum cera alba fiat Ceratum molle. If by the use of these Medicaments it tend to Suppuration, treat it accordingly: but beware that you be not deceived, and the Suppuration prove false, and terminate in a Cancer.  
A Person of Honour near 40 years of age, of a full Body, 
1. Observat.  had been long subject to oedematous Swell in both her Legs from the Knees downwards: for the remedying of which many Applications had been made abroad during the time she was in France; but, by reason of her constant attendance there, they continued swelling, and in progress of time the Matter indurated and became Scirrhous, not only along her Shins, but the musculous Flesh on the Calves of her Legs and Ankles. The Cure was difficult; but she promising to keep her Chamber, I undertook it. She consulted Sir Alex. Fras. who prepared her body by Purging, etc. after which I began my work with the Fomentation set down in the method of Cure, her Servants bathing her Legs with a Sponge morning and evening; after which they were embrocated cum oleo ex ped. bovinis & ol. lumbric. Than I applied a Cerote on them of unguent. dialthaeae and Wax, and rolled them moderately on to retain the Dress: after which she rested herself upon a Bed or Pallet daily. Whilst this Person was under Cure, there happened a private Dissection of a sound Body at our Hall, whence I collected a good quantity of Fat, which I clarified, and, after the fomenting of her Legs, I embrocated them with it twice aday; to which I imputed very much the Recovery; for from that time the hardness visibly resolved, and in a month's space they were restored. During this method of Dressing she was frequently purged, and a Fontanel made in each Leg. Suspecting her Legs might swell upon her first going abroad, I caused a pair of laced Stockings to be put on, which she did wear some few days: but observing they did not swell, she not only left them of, but healed up the Fontanels.  
A Gentleman of about fifty years of age by a Fall broke his lower Jaw, 
2. Observat.  the Cure whereof you may see in the Treatise of Fractures. About half a year after the same Patient complained of a hard Tumour fixed under that Ear and Maxilla, of a dark read colour, not so much painful, as uneasy from the hard binding of the Parts together. It was an imperfect Scirrhus, and not unlike to end in a Cancer. Sir Charles Scarburgh, Physician to his Royal Highness the Duke of York, and one of His majesty's Physicians, was consulted, and by his prescription the Patient was let blood, and several times purged. I fomented the Tumour with the Fotus above mentioned, and embrocated it with ol. lilior. sambuci, and unguent. dialthaeae, applying Empl. diachyl. cum gummi, and afterwards a Cataplasm ex fol. cicutae, rad. lilior. sem. lini, foenugraeci, etc. During these Applications little hard Tubercles' rose in the body of the Tumour, (as I have sometime seen rise about the Lips of inveterate cancerated Ulcers,) and after some days broke and gleeted, but would not digest. In the presence of the Physician I cut into them, filled them with Praecipitate, applied unguentum basilicon on them, and continued the use of Fomentations, etc. The Praecipitate not digesting them, I rubbed into them with a Caustick-stone, divided the Escars, and filled them with Praecipitate, from that time hastening separation of the Sloughs. Than by the Vitriol-stone and Praecipitate I deterged them. As these digested, the hardness resolved, and I cured them with unguent. tutiae. The Patient being cured, we sent for Mr. Gosling, to inform himself whether any carious Tooth or Stump affected that Jaw. He pulled out one; but whether that was the cause I much doubt.  
One of about fifty years of age, 
3. Observat.  of a full Body, came to me with a hard Tumour of about four inches in length lying on the outside of his right Thigh, close to the Musculus vastus externus, of a livid colour mixed with a dark read. It was occasioned by a Fall upon a Threshold of a door, which bruised the Part, and I suppose made a large extravasation, which, for want of timely discussing, dried and hardened. The Tumour was sensible, but not otherwise painful than as it numbed that side of the Leg, and so caused a Lameness. I began with Venaesection, and purged him frequently with decoct. epithymi, etc. during which I fomented the Tumour with the Fotus proposed in the method of Cure, and beaten and pulped the faeces of it, and with farin. lentium & hordei cum axung anseris & ol. lilior. made up a Cataplasm and applied it. I embrocated the benumbed Parts with ol. lumbricor. and made him a Fontanel on that side of the Leg. After I had continued these Applications some days, I added more Cicuta to the Cataplasm, and boiled it in Wine and Water. By the frequent application of the Cicuta the Skin was fretted; in which case I omitted the use of it, and applied the milder resolvent Emplaster set down in the method of Cure, and embrocated the Tumour with axung. humana. By this method I resolved the Tumour, and dismissed him cured.  
I could give you some other Instances of these imperfect Scirrhi; but they not differing in their Cure, I shall forbear, and conclude this Chapter with one Instance of a Scirrhus which may serve to show what the Disease is when heightened by acrimony or evil quality.  
A Gentle woman aged forty eight years, 
4. Observat.  of a full Body, having been long diseased by immoderate fluxes of the Menstrua, and subject to Cough with Shortness of breath, etc. at length recovered her health by the prescriptions of Doctor Denton, and enjoyed it the space of a year; but was than seized with a straightness and pain in her right Breast, which increasing much with Inflammation, she came again to her Physician, who sent for me. At the first sight it seemed to me a confirmed Cancer fixed to the Ribs: but upon more mature deliberation and handling of it, I found the Disease was in the Skin, and that the Glands' and musculous flesh underneath it were not hard, or otherwise affected than as they were bound in by the intense hardness of the Skin, which kept them immovable. From that uneasiness an Erysipelas was raised, which overspred the Skin of the Breast and Parts about with great heat. We supposed the hardness proceeded from a concretion of the nutritious Juices: but how to relieve her was the difficulty. We applied over the Parts affected cerat. Galeni to repress the heat, and supplied her with Medicaments to dress herself, that she might, according to her desire, retire to her house in the Country, where she was let blood, and purged with manna and cremor tartar. dissolved in Whey; and her house being near Epsom, she was afterwards purged with those Waters. But, after all, growing more indisposed, she returned to London: at which time I saw her Breast inflamed and excoriated, also several hard Tubercles' risen in the Skin which gleeted much. The Scirrhus was also spread up that side of the Neck by the Muscul. mastoïdes to the Os bumeri and Scapula, and so under that Axilla, and down that side. We dressed some of the Excoriations with unguent. tutiae Vigonis, and others with Pledgits dipped in this following Lotion; ℞ aq. spermat. ranar. lb j. sem. cydon. ʒ ij. sem. plantag. ʒ j infund. calide per quatuor horas: colaturae add troch. alb. Rhas'. pulv. ʒ j sacchar. Saturni ℈ ss. And over all we applied some of this following Cerote: ℞ mucilag. sem. cydon. psyllii extract. cum aqua solani, an. ℥ iv. unguenti nutriti ℥ iij. unguent. popul. ℥ vj. cerae albae q. s. fiat Ceratum. Thus the Inflammation was remitted, and the Excoriations healed in some places, and checked in others. Many internal Remedies were also prescribed, Emulsions, Cordials, etc. according to the Accidents which happened. During the while I was in the Country other Surgeons were consulted, but without success; the Scirrhus, still spreading, over-ran the other Breast and side of the Neck, and in few weeks rendered her Neck stiff and immovable: and, by reason of the Compression which was made in the Axilla and about the Shoulder, there was a restagnation of the Humours, and the Arm swelled to the Finger's ends. We fomented the Arm with a decoct. fol. & rad. althaeae, fol. violar. plantag. solani, salicis, lenticulae palustris, flor. cham. meliloti, sem. lini, foenug. and endeavoured by Embrocations and Cerots, Emollients and Resolvents, to secure these Parts: but all this while she was either afflicted with Colicks, or Diarrhoea, or Vomiting. We endeavoured to carry of the Matter by Calomel, inwardly, and by Mercurial Unguents outwardly, and would have salivated her, if she would have permitted. The weather growing hot, and her Lodgings being too straight, she removed again to her house in the Country, where she was visited by us. I saw the Scirrhus affecting both sides of her Neck, her Shoulders, Arms, Breasts and Sides, and beginning to invade the Skin of her Loins and Hips; yet she was not at that time sick or pained, but eat her Dinner well. She at length grew weary of Medicine, and with patience endured the remaining Accidents of her Disease till it killed her. She was seized with this Scirrhus in May, and died in August following.   

CHAP. XX. Of Warts and Corns.  
HAving run through the Discourse of Scirrhus, I shall make bold to add to it something concerning Warts and Corns, as being more reducible to that Head than to any other that I know: they being for the most part indurated tumors; and though sometimes we found them soft, yet that is upon some admixture of an extraneous Humour that makes the Tumour compound.  
Warts and Corns are both of them cutaneous tumors, but do differ from each other by this most essential Difference: A Wart beginneth in the Cutis, 
'Cause of Warts.  and seemeth to be either an efflorescence of the Serum of the Blood, which, hardening in the surface of the Skin, maketh a dry Tumour; or else some small luxuriancy of the little Arteries of the Cutis, which do thrust out themselves, making a petty Sarcoma which we call a soft Wart. 
Differences.  According to the variety of the Tumour, it is sometimes whole with a smooth surface, sometimes chapped and uneven. According to the manner of their production, sometimes they arise by a general exsudation out of the Cutis, with a broad basis, and are called Verrucae sessiles; sometimes a few Capillaries putting out together do, after they have grown to a small length, enlarge themselves into a greater compass, and make the pensile Tumour we call Acrochordon.  
The Corn, on the other side, beginneth in the Cuticula with its basis outward, 
'Cause of Corns.  owing its origin to an outward Compression, and thence derives itself inward into the Skin, nay, often through it to the Membranes, Tendons, and Cartilages, to which it frequently unites itself, to the no small disturbance of the Patient. It groweth in any part that is liable to great Pressure; the Toes and Feet, the Lips of Trumpeters, the Ears of Ladies, etc. The hardest part of the Corn is usually in the middle, thrusting itself in like a Nail; whence it hath its Latin appellation of Clavus. That hard part doth often turn black, making a speck in the middle, which in some Countries gives it the name of a Bird's eye. The outsides are softer, not so horny as the former, but still scirrhous, and do either prohibit access into the hole whence the Corn grew, if it have been cut out; or else suffer themselves to be crowded into the place that was voided by excision, there hardening into a new Corn of the like solidity with the former.  
But it is not always that Corns are hard, 
Differences.  they often are soft between the Toes, where the Compression is not great, and sometimes have Inflammation joined with them: which variety is ordinarily observed, and easily reduced to the common heads.  
There need no Signs be given of Warts, 
Signs of both.  they being so apparent. And for Corns, whether they be hard or soft, the pain will discover them: yet in the soft Corns the Skin is for the most part whiter than the rest.  
Warts do often fall away of themselves; 
Prognostic.  whereas Corns are scarce ever so cured that they return not again.  
The Medicaments commended in the Cure of Warts are many. 
Cure of Warts.  Those which are most easy to be had in the Country are, the green Rinds of Willows beaten, the juice of Marigolds, Celandine, all the Spurges, a Garden-snail sprinkled with Salt. If you rub them with any of these, they will fall of. Ol. vitrioli or ol. sulphuris will certainly destroy them. I have seen some burn them out by running a hot Needle into the roots of them. There are other ways, as by rubbing them with raw Beef, and burying it. But when any great one falls into my hands, I make a speedier riddance of it by Ligature or Caustick. Where it is capable of being tied, I make a Ligature: in others, where it is not, the Caustick-stone alone will do it.  
The Cure of Corns is in paring them of, 
Cure of Corns.  and applying read soft Wax: or, ℞ picis navalis ℥ j Empl. diachyl. magn. ʒ iij. gum. galban, dissolute, in aceto ℥ ss. salis ammoniaci ℈ j Misce; or, ℞ aluminis, vitrioli Vngarici, auripigment. ana part. equal. pulveriz. & misceantur cum aceto. All which are proper as well in the soft as in the hard Corns.  
A Young Lady, 
1. Observat. of Warts.  having been long vexed with an unseemly overgrown Wart upon one of her Fore-fingers, desired my help. I rubbed the chapped head of it with a Caustick-stone till it was soft and black, than scraped it of, and rubbed the remaining root with some of the same till I judged it was eradicated, than washed out the Salts, and dressed it come unguent. basilic. with a few drops of ol. terebinth. which made separation of the Escar, and cured it.  
In another young person, 
2. Observat.  where they were small in the basis, I tied some of them close by the roots with a Silk, others I snipt of with a pair of Scissors, not regarding the dropping of the blood upon the neighbouring Parts, which is thought to infect them, and beget others. Than I rubbed the roots of them all with a Caustick-stone, and digested the Sloughs out as above said, and they cicatrized of themselves the while.  
Yet you aught to be cautious how you meddle with those growing upon the Knuckles: 
Caution.  for Warts there, being for the most part near the Tendons, cannot well be extirpated without offending them, and so are consequently subject to Fluxion, and corrupt the Cartilages or Bone.  
This was the case of a Person of quality aged about fifty years, 
3. Observat.  of a plethoric Body, who had a Wart upon the first Joint of one of her Fore-fingers. It was imprudently undertaken by some pretender to Chirurgery, and treated as ill; so that after many months' endeavours he was dismissed, and a more knowing Chirurgeon entertained, who found much difficulty in the Cure, yet made a shift to cicatrize it: but it swollen again, and discharged part of its Matter by the side of that Nail. Upon sight whereof I was consulted, and saw a thin Ichor weeping through the old Cicatrix at an Opening not bigger than a small Pin-hole. The Lady importuning me to undertake the Cure, I sprinkled the Orifice with Praecipitate, whereby I crusted in the Matter to thin the Skin, which the next day I opened, and by search of a Probe felt the Cartilages rotten. I informed the Patient of the necessity of making an Incision proportionably large in order to the Exfoliation, and withal represented the difficulty; and offered to her consideration the more certain and speedy way by cutting of that Joint. She with little demur consented to it. All things being immediately prepared, I chopped of that Joint, dressed it up with pulver. Galeni, and afterwards digested it, and cured it, as hath been showed in such like Extirpations.  
A Citizen came to me complaining of a pain between the two little Toes of one of his Feet, 
1. Observat. of a soft Corn.  which he had of a long time supposed to arise from a Corn on the outside of his little Toe, and pared that often, causing his Shoes to be made wider, yet without any manner of ease: but of late he had discovered the pain to be on the inside of the little Toe. I looked on it, and, seeing the Skin whiter there than on the other parts, concluded it a soft Corn, and sent for one to cut it out. He pared out that white Skin, and filled up the Fovea with soft read Wax. From that instant he wore the straightest Shoes with much ease.  
Many such like Corns I have been consulted in making the discovery, and by my advice they have after the aforesaid manner relieved themselves.  
A Person of quality complained to me of a pain in the Joint of her great Toe and Sole of the Foot: 
2. Observat.  underneath the Toes she said her pain was so much, that she could neither go in the day upon it, nor sleep in the night. I looked upon them, and, supposing they might be soft Corns, sent for a Corn-cutter. He cut away the thick Skin to the quick, as we thought; but she continued in much pain, and, sending for me the next morning, told me she had not been in bed that night by reason of her exceeding pain. I suspected they had been cut too close, and were festering; but in looking upon them I saw no heat or disturbance; yet upon pressing my fingers on them she complained much. I, concluding there was some fault under the Skin, resolved to found it out: to which purpose I rubbed one of these places with a Caustick-stone, and scraped away the Skin as it softened, and, penetrating more deep, gave vent to an extravasated Blood. I served the rest so, and found the like Blood in every one of them: the quantity did not exceed the kernel of a Cherry-stone. I dressed them all with unguent. basilicon and an Empl. diapalm. over them, and thereby they cicatrized in twice or thrice dressing; but from the first dressing her pain ceased, and she continueth since without complaint.  
In the Cure of the hard Corns of the Feet or Toes I do not busy myself, if such Emplasters as have been proposed fail, they may sand for the Corn-cutter. But if through pain a Fluxion be occasioned, and the Part apostemate, it may than be worth the consulting a Chirurgeon; for generally they penetrate to the Periosteum: and if the Apostemation doth not foul the Bone immediately, yet the Lips of the Ulcer grow callous, and do not easily unite.  
An clderly Gentlewoman was much afflicted with Corns, 
1. Observat. of Apostemations from a Corn.  especially one on one of her little Toes, which apostemated, and discharged its Matter forth at a small Pin-hole. The speedy Cure was, by eating that Skin of with a Caustick, or cutting it away, that the Matter being at once let out it might heal. But she not admitting of either, I was put upon the necessity of paring away the Callosity, and dressing it with Lenients. Thus the Skin was kept suppling, and the Matter discharging freely the while, it healed underneath, and the Callosity peeled of: and from that time the Toe hath continued free from Corns.  
A young Lady about fifteen years of age had an Apostemation on the outside of one of her Toes. 
2. Observat.  It was occasioned by the hard pressure of a Corn upon the Joint of it, and had continued some months discharging its Matter through the middle of the Corn, in spite of the endeavours that had been tried by Corn-cutters and others. Upon sight of it, the Skin which covered the Ulcer appeared (to my judgement) callous within, and not capable of uniting with the parts underneath. Upon which consideration I stopped the Orifice with Lint, and, rubbing the Skin with a Caustick-stone, removed that false cover; than dressed it with unguent. basilicon warmth; by which it was digested, and afterwards cicatrized.  
Another having an Apostemation on the outside of her little Toe by reason of its hard Pressure, 
3. Observat.  I opened it by Incision, and discharged the Matter; and afterwards perceiving the Matter retained under the callous lose Skin, I snipt it of with my Scissors, whereby she was freed of her Corn, and the Ulcer was soon cured by the abovesaid Unguent.  
A young Gentlewoman came to London with an Ulcer in one of her Toes, 
4. Observat.  that next to the little one. It was on the middle Joint, occasioned by the pressure of a Corn. Doctor Walter Needham commended her to my hands. We dilated the Ulcer, and discovered the Bone carious. We advised her to keep her Chamber in order to the Exfoliation of it, and withal put her in mind that it was the work of nature, and required time for the perfecting of it. Upon which she demanded how long the Wound might be curing if the Toe were cut of: and being told fourteen days; she replied, Cut it of. We did so, and cured it accordingly by the method usual in such Extirpations.   

CHAP. XXI. Of a Cancer.  
CAncer is the name of a Tumour arising (as it is thought) from an adust or atrabilious Humour. 
Description.  It is round, unequally hard, and (if not inflamed) of a livid or brown colour, with exquisite pricking pain: the Veins appear turgid in the Skin upon the surface of the Tumour.  
The Cause of a Cancer is usually said to be adustion of Humours, 
Cause.  which upon an over-concoction or rather broiling grow retorrid and sharp.  
I cannot imagine what heat these Authors suppose to be in the Body which is capable of making such an Adustion as is here spoken of. I rather impute the corrosive venom that attends this Tumour to the materials of which it is made, than to any extraordinary heat; and that because we see the highest Fever not attended with a Cancer, and on the contrary a Cancer not often attended with any extremity of heat: so that it cannot be Adustion that is the cause of the Malady. But I rather think the matter of the Humour to be in fault, which by some error in Concoction became sharp and corrosive, (it may be arsenical, as appears by the Sloughs we sometimes find made in a night.) This Humour, being of itself sharp and corrosive, is apt to convert whatever comes to it of Blood into the same acrimony with itself: which is easy to be done by mixing such an acrimonious Ferment with a Liquor that abounds with acid Salts, as the Blood of such men usually doth. Being such, it doth increase apace while the Skin is yet whole; but much more when, upon breach of Skin, the accession of air adds to the vigour of the Ferment, upon which it grows fierce, and thrusts itself out into Fungus and Tubercles', etc.  
The remote Cause of this Tumour is, either a fault in the original Constitution of the Body; or an acquired one, as by Bruise, tumors, ill handling, etc. Or it may be an error in Diet, viz. a great acrimony in the meats and drinks meeting with a fault in the first Concoction, which, not being afterwards corrected in the Guts, suffers this acrimonious matter to ascend into the Blood; where if it found vent in the Menstrua in Women, or by the Haemorrhoids, or by Haemorrhagia, or Urine, or the like, the mischief may be prevented: but if upon any defect in those the Humours divert to some other peculiar Part, than the foundation of this Disease is laid, whether it be in the Breasts, or other glandulous and spongy Parts, or indeed any other Part of the Body.  
The Differences of Cancers are many; some whereof are with Ulceration, 
Difference.  others not. The Cancer not ulcerated is of two sorts. The one is visible and evident to the sight in the exterior Parts of the Body, and beareth the name of a Cancerous Tumour: the other is within the Body, and is called a Latent or Occult Cancer, and possesses the Vterus, Anus, Palate, etc. Others call all those Cancers occult which are not ulcerated, amongst which may be reckoned those which are felt in the Glands' of the Breasts, etc. Of these some are lose and movable, and sometimes so hard that they have knocked against one another like Pebbles; if it be not more fit to call them Scirrhi: others again are hard and fixed to the Bones. Some lie superficially under the Skin; whereas others are deeper in the Flesh. Other Differences may be taken from the Humour to which they own their Original. If the Matter be not very corrosive, their growth is slow, and they are not very painful. These are called the milder sort, of which I have had many under my care; and some of those affecting the Breast I have palliated a long time with easy Remedies. If any man will, instead of mild or occult Cancers, call them scirrhous Cancers, I shall not gainsay him.  
Such was the case of a Lady that laboured many years of an ulcerated Cancer. It had eat deep into her left Breast, and was fixed to the Ribs, 
1. Observat. of Varieties Cancers.  but not with much pain. In progress of time the Lips inverted, and united as it were, and lay covered with a crusty Scab: the Humour in the mean while spent itself upon the Nerves, and caused a Species of a Paralysis in some parts of her Body, and the Gout in others. She lived long, and in her latter age tolerably healthful.  
Another person of great age hath laboured long of such another Cancer in her right Breast. It lieth large and deep about the middle of it: 
2. Observat.  the whole Breast is hard and immovable. She enjoys a good health, and is like to live long for any thing of disturbance she at present suffereth by it.  
It is not long since that Doctor Walter Needham and myself were desired to look upon a Gentlewoman's Breast in the City. 
3. Observat.  We found a Tumour hard and fixed, which had been some years ulcerated, and was judged a Cancer by those who had before seen it; but it was not painful. We judged it a scirrhous Cancer, as indeed all the forementioned are, or at lest seem to partake much of a Scirrhus: yet by ill handling or increase of Acrimony they frequently terminate in raging Cancers, and torment the Patient with exquisite darting pains. Some Instances whereof I shall set down, to make the young Chirurgeon more cautious in undertaking the Cure of them.  
An old Gentlewoman came to me with a Swelling behind the right Ear, 
4. Observat.  supposing it the King's Evil. The Tumour was of the bigness of a Pigeon's egg, but lay more flat: it was hard and fixed, of a dark read colour, with a pricking pain. I assured her Friends that the Swelling was cancerous, and gave them caution in applying Suppuratives. But there wanted not one who undertook the Cure by breaking of it; upon which it became more painful. I was sent for, and saw it ulcerated deep, with stinking Sloughs, and thick Lips standing up. It was spread under her Ear, and so horribly painful that she seemed distracted therewith.  
So a Girl of ten years old had a hard round Tumour in her left Cheek; 
5. Observat.  by the use of Discutients it heated and became painful, that Eye inflamed, and the Temporal Muscle swelled: it reached downward, and afflicted that Jaw and Tonsil, rotting the Bones underneath, without breaking the Skin. She lost her Eye, and died soon after Lethargic.  
A Lady coming to Town with a Swelling in her left Breast consulted some of our Profession, 
6. Observat.  and at last me. She said she had some years since Kernels in her Breast, which were judged the King's Evil; upon consideration of which she was presented to His MAJESTY, and touched. In progress of time they swollen, and, her Breast being extremely painful, she desired my Judgement of it. The Swelling was large and round, and greatly inflamed, under which it was soft, and seemed to have Matter in it. The Parts more distant were hard, and several Tubercles' lying under the Skin made it unequal: yet the Breast was not fixed. She urged me instantly to deliver my thoughts of it: which to decline, I turned from her, and told her Friend it was a Cancer, and that I saw no hopes to save her life but by cutting it of. He wished me to consider how I delivered such Judgement of it, two Surgeons having lately assured her the contrary, they taking it for a Phlegmon. But I, not being used to guide my Judgement by what others delivered, confirmed to him what I had before said by a sad prediction, which befell her within few weeks after. And indeed there was no way than to deal with it but by cutting of her Breast.  
In another, 
7. Observat.  who consulted me about a pain in her Breast, I felt one of the Glands' swelled. I advised her to refrain the handling it, and to avoid the lacing herself too straight. It lay some years quiet; but than the death of her Husband happening, and one affliction following another, and the Menstrua stopping, the Humours fermented in this Gland, and afterwards the Breast swollen, and seemed to apostemate. Some were so wise as to assure her it was a simple Apostemation, and required Digestives: whose advice she was persuaded to follow, till she became extremely pained, and than she sent for me. It was without Inflammation, but swollen very big, and seemed to be full of Matter; yet was not without hard Tubercles' and other Symptoms to show it would terminate in a Cancer whensoever it should break. Therefore I refused to open it, but advised the best I could to give her ease, and promised to come to her, if after it broke she would sand to me. Some months after she sent for me, and shown me a great quantity of curdled Matter newly burst forth. The Breast was lank, but very hard Glands' lay within, and in the circumference of the Tumour there were some Tubercles' that required to be eradicated. To which purpose I designed to have slit open the Abscess, and to have pulled away the cancerated Glands: but she would not permit me so much as to enlarge the Orifice: upon which consideration I left her. She sent for another, who chose rather to treat her the way she desired, than to leave her to other hands. She died within half a year after.  
Some years since a Clergyman dwelling in the City brought his Wife to me with a painful hard Swelling in one of the Glands' of her left Breast. 
8. Observat.  I advised them to forbear the use of all Cataplasms or Emplasters that might heat her Breast, and to dress it with valentia strammonii: but she was otherwise persuaded, and thereby increased her misery. About half a year after she came to me again with a stinking sordid Ulcer, with Lips turned out, and the Breast fixed to the Ribs, with a hard unequal Swelling reaching to that Clavicle and side of the Neck, apostemated in some parts, and ulcerated in others. From the Pectoral Muscle it crept up to the Shoulder, and affected the Axilla underneath; and by the Compression of the Vessels the upper part of the Arm swollen, and became scirrhous. From the Elbow downwards it was oedematous to the Finger's ends. She passed under the endeavours of many eminent Physicians and Surgeons of the City, but died miserably.  
There is also a sort of bleeding Cancers, which become such either from an eruption of some Vessel, which makes a vent often at the Nipple or some other Pin-hole, the Breast remaining whole; or else from the spreading of infinite capillary Vessels in a Fungus, which in ulcerated Cancers is not unfrequent. These do very much spend the strength of the Patient, so that they soon die exhausted and tabid.  
Cancers may also be said to differ as they affect several Parts of the Body, as the Head, Face, Eyes, Nose, the Palate, Tonsils, Throat, Tongue, Jaws, or Lips: in some of which they take their Original from small hard Tubercles', or little Excrescences, and in progress of time penetrate deep into them, or spread and invade the neighbouring Parts with a Fungus or lose Flesh, rotting the Bones under them.  
Cancers affecting the Vterus and Podex may also be distinguished as they are in the interior or exterior parts; or as they take their beginning from a Swelling, or Excrescence: in both which cases and places they are extremely painful, and communicate their malignity both from within outward, and also from the external to the internal parts. Those that possess the body of the Vterus, or the upper part of the Rectum intestinum, are not discovered till they have made some progress; in which cases there is a bearing down, with suppression of Urine.  
And this was the case of a Country-Gentlewoman who came to London last Summer with great suppression and difficulty of Urine, 
9 Observat.  (she supposed from the Stone.) Upon search I felt two hard Glands' in Vagina uteri: these pressed upon the neck of the Bladder, and suppressed the Urine. The pains from hence were so like those of the Stone in the Bladder, that Mr. Holier at first would not be dissuaded from that opinion; but upon search he found it cancerous. She, poor woman, rejoiced that it was not the Stone, and soon after returned homewards, but died by the way.  
If they be ulcerated, a filthy Sanies will discover it. If it be in the Intestinum rectum, the difficulty and pain in going to Stool will be exceeding great. If the Vterus be cancerated, there will be Fever; nauseousness, anxiety of mind. In some of those who died so diseased I have opened the Body, and found the Vterus preternaturally big and hard: in cutting into it, I have seen it all rotten. Those in the more exterior parts, whether it be of the Womb or Podex, are sooner discovered, and the Patients are in a greater possibility of being eased of their pains.  
The Signs of a Cancer may be taken from what I have already delivered of them. Whether they begin in a Tumour or Excrescence, 
Signs.  their first appearance is very small: and according as the Humour is of which they are generated, so is their increase quick or slow, from the smallness of a Vetch to the bigness of a Pompion. If the Matter be very corrosive, the pain is sharp, (to use their own expressions) as if they were struck with a dart. And these painful tumors have frequently a Phlegmon joined with them, or are overspred with an Erysipelas. And while they are thus inflamed, they will be soft underneath the Inflammation, so may be thought full of Matter; but if you than open them, they will only gleet. If you assuage that heat, the same place indurates again. Yet I have frequently seen a Phlegmon suppurate in some part of the Cancer: and after the cutting of a Cancer I have found an Apostemation of well-concocted Matter in the body of it. And so it was in that Cancer my Friend Mr. Nurse cut of in the presence of Doctor Walter Needham and several of us. If pituitous Humours abound in the Body, an oedematous Tumour many be found affecting some exterior part of the cancerous Tumour: in which case the Swelling somewhat resembles a Tumour made by Congestion. These are they that grow to such a great bulk, and are pale or livid, with a mixture of a brown colour, and have those turgid Veins stretching over the Skin: whence Authors have likened them to Crabs, and these Veins to their Claws, and from thence imposed upon them the name of Cancer. The many Tubercles' lying under the Skin make the Tumour round and unequal: at last they break; and from that time, be the Matter much or little, they ulcerate, thrust out hard painful Lips, discharge a stinking Gleet, and fix to the Ribs, as if they were nailed to them, and in progress are of a horrible aspect.  
Of all the Diseases which afflict mankind the Cancer is the most grievous and rebellious, 
Prognostic.  and is generally incurable, by reason of its corrosive and malign venom fermenting in the Humours, which, so far as we can yet found, yields neither to Purging, Bleeding, Repellents, Discutients, Suppuratives, nor any other Medicine inward or outward.  
Those which lie superficially under the Skin may be attempted by the Surgeon's hand: or if they rise from an external cause, as Bruise, etc. though they lie deeper, they may be cut of, or otherwise extirpated. But those that arise from a corrosive quality in the Humours, though they may be cut of or otherwise extirpated, yet the success is most doubtful. Nor do Cancers in the Mouth or other internal Parts cicatrize well, though they be extirpated by Knife or Fire.  
The Cure of a Cancer in general consisteth in these three Intentions: 
Cure.  first, in the generation of good Blood; secondly, in correcting and evacuating of the atrabilious Humours in the Body; thirdly, in preventing the growth of the Tumour, and disposing it to Discussion.  
We endeavour to perform the first Intention by an exact regulation in Diet and way of living, advising to abstain from such salt, sharp and gross Meats as may dispose the Blood to acrimony, and make choice of the contrary, such as are cooling and moistening, of easy digestion and good nourishment, as hath been proposed in the Chapter of a Scirrhus.  
The second Intention is, in preparing and purging of the acrimonious Humours. If there be Plethora, or a suppression of the Haemorrhoids or Menses, a Vein may be opened, and a Clyster given. The Humours may also be evacuated by lenient Purgatives, as decoct. epithymi, sennae Gereonis: or this; ℞ flor. trium cordialium M. j senaeʒ iij. epithymiʒ ij. infund. in sero lactis; colaturae add syr. de pomis purge. ℥ j mannaeʒ vj. Misce. Clarified Whey and what else hath been prescribed in the Chapter of Scirrhus are here proper. Traumatick Decoctions of this sort are also usually prescribed. ℞ rad. & fol. caryophyll. chelidon. maj. pimpinellae, senecionis, gentianae, plantag. an. M. j These are to be boiled in two parts Water and one of Wine to the quantity of three pints, and sweetened with Sugar, to drink thrice aday. Or, ℞ rad. scrofular, maj. tapsi barb. an. ℥ ij. filipend. ceterach, herb. Roberti, agrimon. tormentillae, scabiosae, linariae, an. M. j flor. sambuci, anthos, an. P. j sem. urticar. ʒ ij. fiat Decoct. colaturae add syr. de pomis alterant. & de succo citr. an. q. s. This following Electuary is also reckoned among the Specificks: ℞ pulver. ranarum, limac. praeparat. an. ℥ ss. pulv. cancror. fluviatil. ℥ j ossis de cord cerviʒ j court. citr. conduit. ℥ j cons. borrag. lujulae, an. ℥ ij. syr. de succ. citr. garyophyll. q. s. fiat Electuar. sumatur q. nuc. castaneae mane & vesperi, superbibend. hanst. Decoct. superscript. Emulsions, distilled Milks and Opiates are of great use to contemperate the acrimony, and alleviate the pains.  
The third Intention is, to restrain the growth of the Tumour, and moderately discuss it. Whilst the Humours are evacuating, we apply Repellents, and afterwards we add Discutients. The Repellents aught to be of the milder sort, jest they tender the Humours too gross and unfit for Resolution; as, Lactuc. portulac. plantag. umbilic. Ven. solanum, sempervivum, Lentils boiled in Vinegar, also Clay tempered with Vinegar.  
The Medicaments ready compounded are, unguent. album, nutritum, populeon, tutiae, de plumb. usto, Led itself. And all the Unguents prescribed aught to be wrought in a leaden Mortar. Led beaten into thin laminae is usually worn in these cases; so is Gold after the same manner.  
The Oil of Frogs is commended in this case, and is made by baking them with butter in their mouths. Frog-spawn-water is of good use in the Summer, if  be dipped in it and applied: but they aught to be shifted as they dry, and fresh ones applied. The often changing them in the Winter may 'cause the Patient to take cold, therefore you may apply than this or such like Cerote: ℞ ranar. virid. ʒ iij. pulv. cancror. fluviatil. combust. ℥ ss. lethargy aur. ℥ ij. plumbi usti, tutiae praeparat. an. ʒ ij. cerussaeʒ vj. succour. solan. plantag. an. ℥ vj. aceti ℥ ij. olei ranar. & unguent. popul. an. ℥ iij. sevi vitul. ℥ iiij. cerae q. s. fiat Ceratum. Or, ℞ sem. papaveris albi ℥ j sem. hyoscyami ℥ ss. opiiʒ j gum. Arabic. ℥ ss. pulverizentur, & cum ol. ros. & myrtill. an. ℥ iij. cerae q. s. fiat Ceratum. This is proper in case of pain, in the extremity whereof you may double the quantity of Opium; or in such cases you may foment the Tumour with a Decoction of Poppy-heads, flowers of Roses, and tops of Melilot, and apply the following Unguent: ℞ theriacae vet. ℥ j succ. cancr. fluviatil. ℥ ss. succ. lactucae & ol. ros. an. ℥ jss; s. vitell. ovor. sub cinerib. coct. num. ij. camphoraeʒ ss. agitentur in mortario plumbeo.  
The Discutients are Ceterach, Agrimony, lens palustris, scabios. stramonium, succ. coriandri, ranar. limac. cancror. fluviat. Raisins of the Sun stoned and beaten with Rue and Garden-Nightshade into a Pultice are proper to resolve them. Many such like Medicaments are designed to this purpose; Cancers requiring variety of Applications.  
If notwithstanding all your endeavours the Tumour increase, and be like to ulcerate, you may do well to forewarn the Patient of the danger: and if it be lose, and in a place where it may be safely extirpated, propose it to them, jest afterwards they desire it when it is too late.  
That you may be the more successful in the Operation, I shall offer to your consideration these few Oualifications. First, that the Patient be of a strong Constitution, and of a tolerable good Habit of body, and not in a declining age, when the Menstrua are ceased. Secondly, that the Cancer be lose, and the Axilla free from painful Glands'. It were also to be wished that the Cancer took its Original from some Accident, as a Bruise, etc. Thirdly, that the Operation be performed in the Spring or Autumn of the year: jest through the great heat of the Summer the Spirits be resolved; or by reason of the extreme cold in the Winter the native Heat should be choked.  
In order to the Operation you aught to have good Rulers, Compresses, restrictive Powders and Defensatives, as in other Amputations. The use of Chalcanthum or other Escaroticks I do not approve: for you cannot apply them so to the mouths of the Arteries but they will corrode the adjacent Parts, and cause pain, which aught not to be, especially in a Cancer. Besides, they require a strict Bandage, which is very troublesome on the Breasts. To avoid which inconveniences, I propose the stopping of the Blood by a small Buttoncauterie; which I acknowledge is not done without some pain, but that is momentary, and serves to correct the indisposition of the Part: whereas the other lieth gnawing so long as it is upon the Part, and rendereth it crude and ill-disposed. There aught to be actual Cauteries of different sorts ready heated in some corner of the Chamber, jest in the Extirpation there hap to be left some relics of a cancerous Gland behind. All things being ready, the Patient must be placed in a Chair to the light, and held steady. It is than at the Operatour's choice, whether he will make a Ligature about the basis of the cancerous Tumour, or pull it to him with one hand while he cuts it of with the other. For the cutting into the Breast, and pulling out the cancerated Knot, rarely succeeds well: nor indeed is every Breast so capable of being freed of the Cancer when it is cut of by making a Ligature. If the Cancer be cut of clear, your business is than to stop the blood as you please: but if any Scirrhosity remain, you shall do well to consume it by actual Cautery. The Ancients used in these Operations to permit them to bleed freely, nay provoked them to it by crushing the blood out; after which the actual Cautery was applied all over, than they dressed the Wound as a Burn: but according to my method pulv. Galeni is most proper. Than place the Patient in bed, and give her an Anodyne draught that night, to quiet the Ferment. The second or third day after you may dress her with some Digestive, as that ex terebinth. cum vitello ovi; or, ℞ terebinth. lotae ℥ iij. syr. de ros. siccis ℥ jss. succ. plantag. solani, an. ℥ ij. succ. apii ℥ j coquantur ad dimid. succour. consumptionem; dein add far. hoard. & ciceris an. ℥ ss. croci ℈ ij. vitell. unius ovi: Misc. If there be pain, you may apply this Anodyne over it; ℞ mucilag. rad. & fol. althaeae, malvae, violar. lb. j far. tritic. ℥ ij. ol. ros. ℥ iij. coq. ad consistentiam Catapl. addendo in fine coctionis vitell. ovor. num. ij. crociʒ j Misc. But if there be no pain, dress it with Empl. è bolo. After Digestion proceed with Detergents, and incarn and cicatrize as in Wounds is showed; remembering to keep the Body soluble the while by Clysters, and purge or bleed as you see occasion. And if they had no Fontanels before, make them some now: for though the Cure may seem successful, yet if there be any evil quality in the Humours remaining the Ulcer will scarce cicatrize.  
If in cicatrizing it the Lips do grow callous, attempt the eradicating it timely by actual Cautery, whilst it is within a narrow compass, and lieth in the superficies: for if you defer it till it hath seized the musculous Flesh, it will be too late, it being than scarce capable of Palliation. Yet some Authors have left us Prescriptions whereby they give us hopes to cure them, or extirpate them. Those they have offered to us for the Cure are much the same with what I have already set down: viz. ℞ ol. ros. cerae alb. an. ℥ ijss. succ. granat. & solani an. ℥ ij. cerussae lotae ℥ ij. plumbi usti loti & tutiae praep. an. ℥ ss. thuris, mastic. an. ʒ ij. fiat Vnguentum S.A. Or, ℞ unguentum tutiae Vigonis ℥ iiij. theriacae Venetae ℥ j sacchar. Saturniʒ j succ. geranii q. s. ducantur in mortario plumbeo, etc. Others commend the Juice of Mullen boiled with Honey. Riverius tells you in one of his Observations, that he cured one by the often dressing it with aq. ros. plantag. & rhoead. with a mixture of mel rosat. Aetius proposeth extract. sumach: but that is more proper in Cancers of the Vterus.  
Empirics amongst us brag much of their skill in curing of them; and, by the giving of Matthews' Pill, or Opium mixed with some Purgative, they do now and than alleviate the pain, and thereby encourage diseased people to commit themselves into their hands, whom if they can persuade to an Amputation, they get some money in hand: but their frequent miscarriages in that work have taught the more prudent people to avoid them.  
Some eminent Surgeons, I suppose, after a fruitless endeavour to cure them, have attempted the extirpating of them by Escaroticks. Guido hath commended to us Arsenic powdered and sprinkled daily upon them, the Escar being first pulled of. Riverius in his Observations tells of a Cancer that was extirpated by this Application: ℞ aq. fortis ℥ j sublimati crudi ℥ viij. salis Armeniaci ℥ ij. arseniciʒ j These are to be distilled ad siccitatem, than the eaput mortuum powdered, and the like weight of Vinegar to be put thereto, and distilled again to the consistence of a soft Paste for use. Ol. arsenici, aq. regia, ol. vitrioli, lap. caustic. etc. have been proposed. When such are applied, there will be need of good Defensatives. By the authority of some of these Authors young Surgeons have been sometimes engaged to their prejudice: and some years since an eminent Chirurgeon, since deceased, undertook the eradicating of an ulcerated Cancer in the Breast of a Woman that had strength and courage to endure it. He applied the strongest of the forementioned Escaroticks: they penetrated deep, and made great Sloughs, which he pulled of, and by repeating the Escaroticks raised new; but the use of them was not long continued: for the Gleet partaking of the Corrosives ulcerated the adjacent Parts; and the Cancer was so enraged by the Escaroticks, as shown there was no good to be done by them. Indeed if they had contrived Medicaments that could have penetrated deep with little pain, there might have been some hopes of success. So cancerous Excrescences and Ulcers in the Mouth are increased by the touching them with ol. vitriol. sulphur. etc. Upon which consideration there remain but two ways, either the actual Cautery, or palliative Medicines. If the Cancer be in such a place as you may hope to eradicate it, the actual Cautery is than a sure help: but not by applying it lightly upon the upper parts; but by thrusting at the root with a Scoop or Chisel-like Cautery, carrying it away before you. If there remain any rags of it, with a proportionable Button-cautery burn it down to a crust: but if this cannot be effected, than endeavour Palliation by such Medicaments as above have been proposed; and in case the Menstrua or Haemorrhoids be stopped, bleed by Venaesection or by Leeches, and make Fontanels: for by such means many people live tolerably well who have Cancers ulcerated; when others, who ailed lesle, by their impatience are dead. As you may see amongst the following Observations.  
A Maid of about twenty years of age, of a healthful Complexion, 
1. Observat. of a cancerous Gland in the Breast.  came to me complaining of a pain in her Breast. I looked upon it, and felt a hard Gland of an oval figure movable. I advised her to keep her hands of of it, and to give her Breast what liberty she could by cutting the Stiffning out of her Bodies, there being little more to be done in such tumors. I prescribed her a Solution of sacchar. Saturni in aq. spermat. ranar. to dip  in, and apply to her Breast, in case of pain; advised her to bleed Spring and Autumn, to purge with Whey, Manna, cremor tartar. and to contemperate the Humours with clarified Whey, wherein borage, Bugloss, chicory, fumitory, etc. had been boiled. Some time after, upon a new complaint, I added troch. alb. Rhas'. cum opio to the former Water. By such like Remedies she lived with more quiet of mind many years, and with much ease, and hath lately recommended others to me upon the same account.  
To another, 
2. Observat. of a cancerous Gland in the left Breast.  very much pained with a Gland in her left Breast of the bigness of a Chestnut, I prescribed the dressing of her Breast with  dipped in the forementioned Solution, and some days after let her blood, and prescribed an Electuary of cassia, manna, pulp. tamarind. cum resina jalapii & sal. tartari, to take the quantity of a Nutmeg at any time to keep her Body soluble. Her pain continuing, I prescribed an Infusion to be made of sem. cydon. psyllii, papaver. alb. hyoscyam. in aq. solani & plantag. She was purged with decoct. epithymi cum syr. de pomis purge. Barly-creams, Emulsions, with Crayfish, etc. were prescribed. After all she removed into the fresh air, and drank the Waters of Barnes and Tunbridge; by which she was somewhat relieved: and by the repetition of the abovesaid Prescriptions the Gland continues quiet, and may to her death.  
A Gentlewoman came out of the Country with a cancerous Gland in her right Breast, 
3. Observat. of a cancerous Gland in the right Breast.  she supposing it was the Evil: but being informed what it was, she desired my advice. I prescribed her such like Medicaments to palliate it. She was after some while advised to consult others. Some of them applied an Emplastr. galbani to it: from which time the pain increased, and the Breast swelled. She than returned to me. I anointed it with valentia stramonii, let her blood, and purged her with Whey, Manna, etc. by which I calmed the Ferment, and she returned into the Country well contented to palliate it, and by that Unguent it is quieted.  
A Gentlewoman, 
4. Observat. of a cancerous Gland behind the Ear. 5. Observat. of a cancerous Gland in the left Breast.  pained with a cancerous Tumour behind her left Ear, was by the said Ointment palliated many years; and, for aught I know, is yet alive.  
A Gentlewoman aged about fifty years, of a Scorbutical and very ill Habit of body, had also a painful Gland in her left Breast. Sir Fra. Pr. was her Physician, and commended the Cure of that swollen Gland to me. She was in a Scorbutical course of Physic, and had been let blood by Leeches, Fontanels were made, and several Medicaments had been applied unsuccessfully to her Breast. I applied this: ℞ sevi vitulini ℥ vj. unguent. rosatis, popul. an. ℥ ij. ol. myrtillor. ℥ iij. succ. plantag. solani, geranii, an. ℥ ij. succ. rutae murariae, summit. rubi, an. ℥ j lithargyr. aur. ℥ iij. tutiae praeparatae, cancror. fluviatil. an. ʒ vj. plumbi usti & cerussae an. ℥ j mucilag. sem. psyllii, papaver. alb. hyoscyami extract. in aq. spermat. ranar. ℥ iij. cerae q. s. fiat Unguent. in mortario plumb. S. A. By the use of this her pain was eased; yet, being a melancholic person, she was not without suspicion of ill from it, and in the Country sometimes consulted me in it. But of late years the Gland lessened and resolved. Some while after she complained of a pain in her Back, and made bloody water, which growing more foul, she came to London. Her Physician being dead, she consulted others. They all suspected an Ulcer in her Kidneys, treated her accordingly, and sent her to Tunbridge; from whence she returned little the better. She retired into the Country, and enjoys there a tolerable Health. I suppose this of her Kidneys is a Translation of some of those sharp Humours which affected her Breast.  
A Gentlewoman of about forty years of age, 
6. Observat. of a cancerous Gland in the Breast, the extirpation attempted by Caustick.  subject to the Gout and Scorbute, consulted me about a small painful Gland lying superficially under the Skin of her right Breast two fingers breadth above the Nipple, not bigger than a small Hazelnut. It was a Cancer incipiens, and like to be of ill quality, beginning with so much pain. I proposed the palliating of it, or the taking of it out by Incision. To the former I rather inclined: she replied, she would have it broke, and cured by digestion. Some days after she met with one that applied a Caustick upon it, and treated it that way; and, being confident of the success, she sent to me to see her dressed. I went, and saw the Ulcer in a seeming good condition; but, in handling of it, I perceived part of the Gland remaining hard, which confirmed to me the unsuccessfulness of the undertaking. He dressed the Ulcer with Praecipitat, alb. upon Lint, and applied over it a piece of a boiled Tripe scraped thin, (as I was afterwards informed.) About ten weeks after the patiented sent for me. She was much emaciated, and her Breast ulcerated, and fixed to the Ribs, with inverted Lips, and a foetid Gleet issuing from it. I dressed her Breast with unguent. diapompholyg. and applied on the Parts about it unguent. nutritum, prescribing a Pearl-Julep to refresh her fainting spirits, and an Anodyne draught that night to dispose her to rest. The next day Sir Fr. Pr. appointed her this distilled Milk: ℞ rad. garyophyll. chelidon. symphyt. tormentil. gentianae, an lb ss. fol. plantag. sedi vulg. hederae terrest. vinc. pervinc. agrimoniae, an. M. vj. fol. veronicae utriusque an. M. iv. glycyrrhiz: Anglic. sang. porcin. an. lbij. lbij. lactis vaccini cong. ij. distillentur in organis rosaceis; sumat. ad q. ℥ iv. tribus horis medicinalibus, addendo singulis vicibus aq. cinnamomi hordeat. cochlear. ij. vel iij. & table. magist. Perlar. ex duplic. vel triplic. caudar. cancror. q. s. in saporis gratiam. And in extremity of pain, ℞ syr. è court. citric. & de pomis alterant. an. ʒ iij. theriac. solani gr. iij. sumat. horâ somni.  
I fomented her Breast with a Decoction of some of the abovesaid Plants, and with some of the Unguents prescribed in the method of Cure of Cancers ulcerated dressed her up, by which she was restored to such a condition as to return to her house in the Country. About half a year after her Physician writ to me, and by her order offered me a sufficient Reward with convenience answerable to come to her. To which I returned for answer, That if he could propose how I might extirpate the Cancer or palliate it otherwise than I had directed her from hence, I would gladly make a Journey to her; otherwise I desired to be excused. How long she lived afterwards, I have not heard.  
A Person of Honour aged about thirty eight years was taken with a pain in her right Breast, she thought from some Bruise. 
7. Observat.  A while after she felt a hardness two fingers breadth above the Nipple, which growing more painful, she put herself into the hands of some who pretended to cure it: but the blood burst out at the Nipple the while, which eased her of the pain. During this the Nipple contracted inward, and by the large and frequent bleeding the Humours became sharp, affecting her Kidneys, and at other times her Hands and Arms, with a Rheumatismus: meanwhile her Breast was easier. Thus she suffered some years under the Fermentation of sharp Humours in one part or other, but for the most part in her Breast, which in progress of time raised it into a great unequal Tumour of a brown and livid colour, with turgid Veins overspreading it. Doctor Whistler had been often consulted by her, and relieved her as often by Purging, Venaesection, Leeches, Traumatick Decoctions, etc.  
The Cancer growing great, and the Tubercles' ready to disburden themselves of the corrupt Serum which distended them, I was consulted, and, observing the danger the Patient was in, desired a Consultation, and that Dr. Whistler, who had discontinued his Visits, might be present, with Sir Al. Fras. Dr. Walter Needham, and Mr. Holier Chirurgeon, to join in the Consultation. Accordingly we met, and considered the Cancer. It was of a very ill aspect, ready to burst, and not fixed. But I, apprehending that after its eruption it would fix, and rage, as is usual at such times, offered to their consideration the taking of the Breast while it was capable of it, jest afterwards it should be objected as a fault. It arising from an outward cause, gave me the more encouragement: but the Patient not admitting of it, we consulted how to treat it. Cordials, Emulsions and Anodyne draughts were prescribed; external Medicaments were also considered to calm the heat of the Cancer. Some few days after a stinking Gleet burst its way out in great quantity by a small Opening, to the great ease of the Patient; upon which the Tubercles' and Breast sunk, and, after the casting forth of some corrupt Sloughs, the Matter became well scented, the Breast also contracting into an uniform shape, grew lesle than thè other, and the Patient recovered strength to rise out of her Bed. Doctor Whistler attended the Cure, and by good Balsamicks, Traumatick Decoctions, etc. disposed the Humours to better temper, insomuch as the Lady appeared abroad, to the wonder of those that had seen her some weeks before. She being so recovered, it became a question whether it had ever been cancerated. But since that there have happened new Eruptions, and there yet remaineth such hardness and inequality in it as will demonstrate what it was.  
The year before the Sickness a young Woman came to me complaining of a grievous pain in her right Breast. 
8. Observat.  She was of a healthy Complexion, and her Breast seemed to look as well: but in handling of it I did feel a couple of hard Glands'. She had consulted others, and came to me to cut them out. I dissuaded her at that time from such thoughts, by telling her the inward Cause was first to be removed, and the Humours better disposed. To which purpose she was let blood, purged with Infusions of Sena, etc. and advised to drink the Waters of Epsom and Tunbridge. I also directed her some of the Medicaments set down in the method of Cure, to alleviate her pain. Some weeks after she came again, and told me she was informed that she should not be eased of her pain till those Knots were taken out. I told her those Glands' lay deep, and the musculous Flesh and Parts about were infected with the same Juices, and consequently the Operation could not be successful unless the Breast were cut of. Upon which she departed from me unsatisfied, and some days after put herself into the hands of another, who cut out those Glands', and endeavoured to cure. But it grew cancerous; and than he cut of the whole Breast. Some months after, when it was near cured, she came and shown it me with much joy. I felt it hard round about, and suspected it would not cure; as indeed it did not: for some months after she came again to me with it ulcerated deep and wide into the pectoral Muscle and Parts about, and fixed to the Ribs. She grievously bemoaned her misfortune, in permitting it to be cut of. By this and such like work I have been taught not to cut of Breasts that cancerate from an internal Cause. I did what I could to ease her pain by palliating the Ulcer, but it was too late.  
In the time of my waiting at the public Healings there came to me a Country-maid, 
9 Observat. of a Cancerous Breast cut of.  aged about twenty six years, of a sickly Complexion, diseased with a Cancer in her right Breast arising from some accidental Bruise. It first swollen, than grew hard, and in progress of time ulcerated, and had frequently bled to the quantity of a quart at a time, and sometime to two quarts, as her Friends told me. I considered the Breast as incurable, and judged the bleeding to arise from a Fungus which lay too deep to be reached by any Medicament: therefore thought it reasonable to propose to them the extirpation of the Breast before it should be fixed to the Ribs. They had tried many things unsuccessfully in the Country: and, being now informed that it was not the King's Evil, they were not unwilling that it should be cut of, but took time to consider of it; and about a month after came to me again resolved for the work.  
The taking of of this Breast happened to be seasonable for the experimenting of the Royal Styptic liquor which was given me the morning before by His MAJESTY's command: upon which consideration I provided no other Astringent than a couple of Buttons made of Lint which lay wet in a spoonful of that Water. But, in order to the bringing the Lips of the Wound together, I had prepared a couple of Needles with a strong twisted Thread cered, also a Digestive ex terebinth. cum vitello ovi, etc. spread upon Pledgits, with Compress and Bandage. Being thus provided, I attended some Friends who desired to see the efficacy of the Water. But Doctor Walter Needham being come, and it growing late in the evening, we proceeded in the work. He pulled up the Breast while I made a Ligature upon the basis of it, and cut it of. The two Arteries bled forcibly out, till Doctor Needham applied a wet Button on the one, and my Kinsman Jaques Wiseman applied the other. That of the Doctour's stopped the Bleeding at that very instant, and the Compress adhered to it; but the blood dribbled from under the other: which we supposed happened by reason of the blood streaming upon it in the putting it on. But by the application of a fresh Button the Bleeding there also stopped. During this the Lips of the wound were brought nearer to each other by a cross stitch. We than applied our Digestive with convenient Bandage over it, and laid the Patient in her Bed. In our absence she fainted, and upon the drinking a draught of cold water vomited, and her Breast bled through the Dress. Upon sight thereof I took of the Dress, and seeing one of the Arteries seepe, I applied a fresh Dossil, and stopped it: but it being night, and dreading mischief might hap if it should bleed again, I sent for a small Button-cautery, and that way secured it. The third day we took of Dress, and found it well digested; and from that time it cured daily. But she complained of a soarness of that side of her Throat, which she had done ever since her Breast was cut of, and within a week after of a shortness of breath; upon which she was let blood; and by my Friend's prescriptions she was also purged with infus. sennae, rhabarb. etc. and afterwards with pill. foetidae, etc. Her Breast being near cicatrized, she was supplied with Dress, and returned to the Country the sixth week after the cutting it of. But she continued there indisposed, and the Cicatrix, by reason of the sharpness of Humours, fretted of, and enlarged the Ulcer very much: whereupon she returned to me again. I dressed the Ulcer with unguent. tutiae, etc. and let her blood; than purged her as abovesaid, made her a Fontanel in her left Arm, and in few weeks cicatrized her Breast. Since which time I have seen her often in Town in very good health, and her Breast firmly cicatrized, without pain or hardness.  
A person of about fifty years of age, 
10. Observat.  having some scirrhous Glands' in her left Breast, was impatient to have them discussed or suppurated: to which purposed she consulted several of our Profession, and afterwards myself. She was under the hands of some Empirics, that were endeavouring by Pultices to break it: there was also a Fontanel made in the lower part of the Breast under the Tumour, she hoping that way to spend it. I advised her to forbear the use of such applications as might heat her Breast, telling her the ill consequence in breaking those Swell. She did not approve of what I said, but pursued her design. Some time after a false Suppuration was made in her Breast, and an effusion of blood followed; and by the continued use of Pultices the Ulcer enlarged, and by frequent Bleeding her Body emaciated. She being very near wasted by a new Eruption sent for me. I stopped the Bleeding by the application of pulv. sang. dracon. with Pledgits of unguent. desiccativum rubrum, with a soft cap of Tow pressed out of Oxycrate. The next day I took of the Dressing, and found it had not bled. I also observed the Tumour to be a mere Fungus, and the Ulcer an Excoriation of the Skin which encompassed it round, and the frequent Bleeding occasioned by Escaroticks and hot Cataplasms. I dressed the Breast with Epuloticks, as unguent. tutiae Vigonis, and such like, and with  dipped in aq. spermat. ranar. with sacchar. Saturni; and in some parts I applied Pledgits dipped in the same, with a Solution of troch. alb. Rhas'. cum opio, by which the heat was contemperated, and the Excoriation cicatrized. Sir Fra. Pruj. was in the while consulted, and prescribed her this; ℞ antimonii diaphoretici gr. 15. magist. perlar. gr. 6. fol. auri num. j Misc. pro una dosi, & sic pro aliis; detur horis matutin. & quartis pomeridianis, superbibendo sequent. Julep. ℥ iv. singulis vicibus: ℞ aq. stillat. borraginis, buglossi, cardui benedict. scordii, dracont. an. lb ss. syr. è succ. citr. & de pom. alterant. an. ℥ iv. ocul. cancror. ℥ ss. aq. cardiacae ℥ iv. Misc. in usum prescript. And to dispose her to rest, ℞ syr. è succo citr. garyophyll. an. ʒiij. theriac. solani gr. iij. sumat. horâ somni. Distilled Milk, Emulsions, etc. were prescribed; her Body was kept open by Clysters; and, after she recovered her strength, she was purged with Whey, Manna, etc. Thus in a few weeks she was cured: but the Tumour remained, and retained the colour of the Blood lying underneath it. In the time of the Bleeding, by the application of Escaroticks and hard Bandage a Gland was raised under the right Axilla: but by forbearing the use of Bandage, and my dressing her Breast with Lenients, the pain therein ceased, and she enjoyed a good measure of health, and was my good Friend, till about a year after it was told her that one Mistress R. who laboured of a Cancer in her Breast, had caused a Mountebank to cut it of, and that she was thereby cured. Upon this she sent for me, and would have her Breast cut of. I declined it, and shown her, as I thought, such reasons as might have dissuaded her from such an Enterprise: but she was resolved, and, after I was gone, sent for the Empirick, who undertook to extirpate it by Escaroticks: and she bled to death in few days. I was sent for; but, being out of Town, she was dead before I came to her. If she had not been in such haste, she might have outlived that Gentlewoman: for her Breast cancerated, and she died within a few months after.  
A person of about forty years of age, 
11. Observat.  of a very ill Habit of body, from her very youth had a hard Gland on her right Side near her Breast: it had some pricking pain in it, but was movable: it seemed to me a Cancer incipiens. I was willing to apply somewhat to it, but, suspecting that the increase of the Gland might be imputed to it, advised her to keep her hands of it, and to lace her Bodies more slack; telling her, that upon her return to London the Autumn following, if she were not better, she might consult those of our Profession. She did so, and accordingly as she had proposed came to Town again, and sent for me. The Gland was than grown bigger and more painful, but was movable: there was also a small painful Gland under that Axilla, which much discouraged my undertaking. I acquainted her Physician of the danger she was in, and wished him to propose to her the consulting some others. The next day Doctor Wharton met the Lady's Physician, Doctor Windebanck, and myself. At the Consultation I declared my thoughts of that Gland, viz. that it was a Cancer, and by the progress it had made in three months it was like to be a difficult work, and wished the Patient might be acquainted with the danger; for by her discourse to me she expected I should speedily cure her, and that by suppurating the Gland: which way was destructive. For, according to Galen, and our daily experience, ab emollientibus exasperantur: and to proceed by Repellents and Discutients were only to palliate; which I doubted we should not be long able to do. The only hope than remaining was, cutting into the Skin, and taking the Gland out while it was movable. This was not approved of. We than considered what to dress it with. Doctor Wharton would needs leave that to my care: but I, having no inclination to be engaged in it, desired it might be prescribed by us, and made by the Apothecary; which was as followeth. ℞ aq. spermatis ranar. lb j. sem. psyllii, papaver. albi, cydon. an. ℈ ij. extrahatur mucilag. cui add. troch. alb. Rhas'. cum opioʒj. sacchar. Saturni ℈ i Misc. fiat mixtura parti affectae tepide linteis in illa madefactis applicanda: than a distilled Milk; ℞ fol. agrimoniae, veronicae utriusque, garyophyll. plantag. borrag. fumariae, heder. terrest. an. M. iij. limac. cum testis lbij. lbij. passul. maj. lb j. astacor. fluviat. num. 24. glycyrrhiz. rec. lb ss. sem. foenic. dulc. coriand. an. ℥ iv. fiat omnium distillatio in congiis ij. lactis vaccini recentis; dulcoretur cum sacchar. perlar. q. s. capiat lb ss. 3 horis medicinalibus; in haustu ultimo, horâ somni, capiat alternis nociibus ℥ j syrup. de papaver. erratic. ℞ asellor. recent. num. xx. pistentur & macerentur in haustu aq. lactis prescript. capiat horis matutinis tres dies continuos. Many things were prescribed, both internal and external: but she was no way relieved. When the Glands' were not painful, she was sick of some Diarrhoea, Catarrh, etc. and if she was well in health, than the Glands' were painful: and while this bigger was treated, it would feel soft in some part, and be protuberant, and after a while harden again. Thus every new Fluxion increased this Gland, and gradually made it unequal; yet it continued movable: which gave me one time an occasion to tell her, that the cutting the Skin, and taking that Gland out whole, was the best way to free her of it. She, perceiving that I had no inclination to suppurate it, as she hoped I would, was contented that I should draw of, to make way for some other. About two months after I met with one that attended the Cure; who told me they had suppurated it, and were in hopes to cure. I replied, You will only have a Gleet; as indeed it proved: and afterwards it thrust out a large Fungus. She was than desirous to have it cut of, but it was too late.  
A Woman of about thirty six years of age was supposed to have a Cancer in her left Breast, and had been palliated many years by Sir Fra. Pr. One day, 
12. Observat. of a cancerous Wen gangrened and cured.  she being at her house in the Country, it did break, with very exceeding pain. She writ to her Physician, who sent me to take of the Breast. When I came, I saw it gangrened, and was somewhat surprised at the novelty. The Tumour was round, of a very great bulk, and movable; it was gangrened by reason of the overstretching of the Skin. The Mortification had eaten through the Skin the compass of the palm of a hand. I cut into the body of the Tumour, and found it a cancerous Flesh, and lying within a Cystis. I, supposing it a cancerous Wen, (how properly I know not, it being the only one I ever saw,) fomented it with Wine, dressed it up hot with unguent. basilicon, and gave her an ounce of syr. de meconio in a draught of Mace-ale, to quiet her pain. The next morning I found her much afflicted, and saw many  wet with the Gleet, the Mortification was much spread in the Skin, and the cancerous body cracked as a Pomegranate over-ripe. I considered the Gangrene, and supposed it would save me the labour of cutting of the Breast, and that it would cease upon the pulling away of the cancerous body. Upon which consideration I pulled out that part which was outermost, I believe the fourth part of it; and would than have pulled it all out by dividing the Skin; but she would not permit it. I continued my way of dressing as before, stayed at the house with her three days, and dressed it twice a day, pulling out some part of the Wen each time. The Gangrene in the Skin stopped, and she became very easy. But perceiving she would not permit me to thrust out the remaining Wen, I desired a neighbouring Chirurgeon might be sent for: who being come, we dressed the Patient. I shown him that by Digestion the remaining fleshy body with the Cystis would come away, and by that time the Lips with the Skin would be ready to unite with the whole: which accordingly came to pass, and she was perfectly cured in lesle than six weeks, and is yet well.  
A Man of about fifty years of age came to me out of the Country with a hard unequal Tumour, of the bigness of a large Walnut, 
13. Observat. of a cancerous Tumour on the Head.  between the Coronal and Sagittal Suture: it had been ulcerated, but was at that time crusted over with a Scab, and seemed to be a milder sort of Cancer. He supposed it the King's Evil; but being assured by me otherwise, he desired my help. I, considering its basis resting upon the Cranium, made no difficulty in the undertaking it. Therefore providing Dress ready, I made an Incision round it to the Scull; than raised it of with a Spatula, and permitting the blood to flow a while, dressed it up with Astringents. The third day after I took of Dress, and saw the Lips of the Wound well disposed, and the Cranium uncorrupted. I rasped it till the blood appeared under it, than dressed up the Wound with Digestives' ex terebinthina, etc. and after Digestion incarned and cicatrized it with as little difficulty, and dismissed him cured.  
A Man about twenty eight years of age came out of the Country recommended to me with a Cancer on his left Cheek, 
14. Observat. of a Cancer on the left Cheek.  stretching itself from that side of his Nose close under the lower Eylid to the external Canthus, so making a compass downwards. It was broad in its basis, and risen copped like a Sugar-loaf. It gleeted, and was accompanied with Inflammation and much pain. He had also some scirrhous Glands' under that Jaw. The extirpation of this Cancer had been attempted in the Country; but it growing afterwards bigger, and threatening his Eye lately with Inflammation, he hastened up, and importuned me to undertake it. I complied with his desire, and four or five days after, having prepared all things ready, viz. actual Cauteries, Digestives, Defensatives, Bandage, etc. Doctor Walter Needham and my Kinsman Jaques Wiseman being assisting, I pulled the Tumour towards me with the one hand, during which I made my Incision close by the Eyelid, and cut it smooth of, as close to the Os jugale as I could do it, avoiding the Periosteum. The blood at first spurt out forcibly from many Capillaries besides two considerable Arteries: we permitted them to bleed a while. The lesser Vessels stopped of themselves, and we cauterised the greater afterwards. Than viewing our work, and observing some relic of the Cancer remaining above the external Canthus, we consumed it by actual Cautery, and dressed up the Wound with our Digestive, with Embrocations, Defensatives, and moderate Bandage to retain them. The third day we took of Dress, saw it well disposed to digest, and dressed it as before. The second day after, dressing it again, the Cancer appeared rising from the side of the Nose and Eyelid; it also overspread the Cheekbone. I dressed it as I had done the time before; and the next time came prepared with actual Cauteries, and consumed it all, than dressed it up with Lenients. From that time the Ulcer healed daily, and contracted in ten days space to the half: yet since that it gins to bud again here and there, which will put me upon a necessity of using the actual Cautery: and what account to give of it I yet know not.  
A Gentlewoman aged about forty years, 
15. Observat. of a cancerous Excrescence of the lower right Jaw.  of a strong healthy Constitution, came out of the Country diseased with a large fleshy Excrescence, painful, and of a livid colour, thrusting out from the Gums of the lower right Jaw. It had rotten the Teeth nearest to it, and weakened the rest, by the Ulceration and Relaxation it had made in the Gums. It had been viewed by some of our Profession, who declined the meddling with it as cancerous; for which reason I undertook it: for, supposing it a Cancer, it aught the rather to be extirpated whilst it affected some particular Part that was capable of it. The ill consequence of such omissions may be judged by the following Observations. I readily undertook the freeing her of the Excrescence by actual Cautery: which she consenting to, I caused a Scoop-like Cautery to be made proportionably big, to thrust of the Excrescence at once with its root: than sent for La Roche, who punched out the stumps of the Teeth that were in my way. Than, one of my Servants holding her Head steady whilst another held her lower Lip down and her Tongue on one side, I pressed with the Cautery well heated into the lower part of the Gum, and extirpated it quite; than with a Bolt-cautery consumed and dried the lax and rotten basis: which being done, she held in her mouth a decoct. hordei cum sem. cydonior. and used it daily till the Escar separated. I than made her a decoct. plantag. equiset. summitat. rubi, flor. ros. rub. ballast. cum syr. de ros. siccis, with which and the Vitriol-stone I cicatrized the Ulcer firmly. I neither purged her, nor let her blood; supposing the latter would be more seasonable after in case of Inflammation: but there happening none, that was omitted. And so was the Purging, I supposing it might put the Humours rather upon a Ferment. She was cured in lesle than three weeks, and continueth well.  
A person of about fifty years of age, of a strong Constitution, 
16. Observat.  by cracking of an Apricock-stone caused a pain amongst the great Teeth of his upper Jaw on the left side. From that time that part of the Gum swollen, and one Tooth grew lose, and after some time a Fungus thrust the Tooth out. A Frenchman, Chirurgeon to his Regiment, endeavoured to consume the Fungus with oleum vitrioli and such like: but it increasing spread farther, and affected the whole Jaw, insomuch as all his Teeth dropped out to the Septum. The Fungus greatly increasing thrust out two distinct Lips, the one whereof stretched out the Cheek, and the other overspred that side of the Roof of his mouth. The Patient being in this condition came up to London, and called to a Consultation Sir Fra. Pr. and Doctor Bate Physicians: of Surgeons there were Mr. Arris, Mr. Edward Molin (deceased,) Mr. Shunbub, a Germane, Chirurgeon to his Grace the Duke of Albemarl, Mr. Troutbeck, and myself. We, being met, saw the Patient dressed; his Chirurgeon pulling out a Tent very big and long from between the two Fungi in that place where the Disease began. After we had severally considered the Malady, we withdrew to consult, and, unanimously concluding it an ulcerated Cancer, proposed various Remedies in order to Palliation; as shaving the Hair of his head, applying Cephalicks, a Seton in the Neck, Fontanels, Blistering, Bleeding, Purging, etc. Coming to the Patient with the Prescriptions, he asked what way we had designed to cure him. After some pause, (for we, having no hopes of curing him, had not discoursed of that,) Sir Fra. Pr. answered, the attempt of Cure in such Ulcers had been always unsuccessful and extreme painful, viz. by Burning, and thereby the Disease hath been for the most part exasperated, and the Life of the Patient shortened. The same was affirmed by us all. The Patient replied, God's will be done. I pray go and consider of the way: for I had rather die than live thus. We withdrew, and resolved to comply with his desire, returning suddenly again to him with that Answer, and commended to him Mr. Edward Molin, that excellent Operator. But he refused it, as being preingaged to go out of Town. It was than put upon me: and at their desire I undertook it, and gave directions for the making actual Cauteries of various sorts, some Bolt-like, others like Chisels, others of other fashions. There were Instruments also made to defend his Tongue and Lips. While these were making, the Patient was let blood, purged, and prepared for the work. That done, we met again, and had the Instrument-maker attending to heat the Cauteries, and mend or altar them as occasion should offer. One of the Assistants held his Head and upper Lip, whilst I with a Speculum oris held down the Tongue with the one hand, and with the other passed a plain Chisel-cautery just under the upper Lip into the body of that part of the Cancer which stretched itself along the Roof of the mouth to the Palate, and repeated the use of that-fashioned Cautery till I had made a separation of so much. The carrying the Cautery thus in the middle of that cancerous Lip was the way to preserve the sound parts from being scorched with the reflection of the glowing Iron. It was also a great encouragement to the Patient to see such gobbets burnt of with so little pain. After I had scooped of what I could of that Lip, than with Olive and Bolt-like Cauteries by burning I dried up the remainder to a crust. That done, I went to work with the other cancerous Lip which lay stretched along that part of the Jaw to the Cheek, and raised it up as a Trumpeter's in the time of sounding. I passed a Chisel-cautery into the body of that, and made a riddance of a great part of it, cutting and burning through the Alveoli, which were as rotten as dirt, till the Patient grew weary, and the Physicians thought it was enough for that time. We than gave him of this Lotion to hold in his Mouth to cool it: ℞ sem. cydonior. ℥ j sem. psyllii & papaver. albi an. ʒij. extrahantur mucores in aq. plantag. solan. & ranar. an. part. aeq. That night he was laid to rest with this; ℞ aq. paralyseos ℥ ij. aq. theriaoalisʒiij. syr. de meconioʒuj. Misc.  
The next day in the afternoon the two Physicians and some of the Surgeons met me at tha Patient's Chamber. He had slept well, and was for the work, he said, placing himself very cheerfully in the Light. Renewing my work, and feeling with my Finger the length of that Lip stretching by the Roof of the mouth, I felt a moisture in a chink, which I searched with a Probe, and found a hollowness over the Roof, from whence there issued Matter. On the other side, which I burned last, the Flesh was high. I began with that over the Roof, and burned all that part dry, and left it lying hollow like an Arch: than burned the other side with Olive and Bolt-cauteries down towards the basis of the Alveoli, and found the remaining Sockets full of the same lose Flesh. I burned into each of them, and at the same time dried them what I could; and wherever I saw any Excrescence, I consumed it, and thereby smoothed my work. It was not easy to distinguish the sound from the unsound by reason of the swelling in the neighbouring Parts. It was also much more painful to the Patient, as the sense of the Nerves and Membranes were more exquisite than that of the hard Lips which I consumed the day before. Yet he sat cheerfully, till I declared that I had not left a cranny uncauterized: them he risen, and washed his Mouth with some of the forementioned Mucilage, to which there were some beaten whites of newlaid Eggs added. His constant Drink was this: ℞ rad. sarsaparillae ℥ vj. infund. in aq. font. lbix lbix. per horas xij. tum add. rad. scorzonerae ℥ iij. summitat. majoranae, melissae, an. M. j flor. cordial. an. Mss. pom. redolent. num. vj. coq. ad tertiae partis consumption. ℞ decocti prescript. lb jss. cancr. fluviat. coct. num. xuj. amygdal. dulc. num. vj. nuc. pin. ʒiij. manus Christi perlatae ℥ j fiat Emulsio. Of which latter he took thrice a day. About 12 of the clock that night he sent for me, and told me I had changed his pain: It was before, said he, a gnawing pricking pain, but now it is burning hot; yet, said he, I did not sand for you so much to ease my pain, as to rejoice with me in my recovery. I embrocated the Cheek cum oleo & aceto rosac. and afterwards applied soft  dipped in the same, advising him to hold some of his formerly-prescribed Lotion in his Mouth, and gave him a draught of his Anodyne, which laid him to sleep. In the morning, when he wakened, he called his pain a comfortable heat. His Physicians prescribed him a Clyster, and this cordial Electuary and Julep: ℞ pulpae cons. lujulae, garyophyll. an. ℥ jss. confect. de hyacinthoʒjss. marg. praeparat. ʒj. magist. è coralliis ℈ ij. syr. garyohyll. q. s. fiat Opiatum; capiat q. nuc. moschat. 3 horis medicinalibus, superbibend. Julep. sequens; ℞ aqu. cerasor. nigror. flor. tiliae, an. ℥ vj. aq. theriacalis ℥ ij. syr. garyophyll. ℥ jss. Misc. I visited him daily, and where I saw lose flesh arise, I burned it down with one Cautery or other moderately heated. A learned person visiting him often, and for the most part finding me there drying and smoothing my work with the actual Cautery, suspected the event, and went out from us mumbling that Aphorism of Hypocrates, Quibus sunt Cancri in Palato, Sede, Vtero, etc. si urantur ulcera, cicatrice induci non possunt. It much disturbed me, but I prosecuted my Cure more industriously; and by drying the lose Flesh wheresoever it appeared, as also the Bones, I disposed them to cast of, and the Flesh to a hard Callus, which cicatrized with the adjacent Parts. In the time of the cicatrizing I prescribed him this Water to wash his Mouth before and after meat: ℞ aq. plantag. equiseti, fragor. an. lb j. flor. ros. rub. ballast. an. M. jss. coq. ad 3. partis consumptionem; colaturae add. syr. diamoron, de ros. siccis, an. ℥ jss. acet. rosac. ʒuj. Misc. By this method he was cured in the space of six weeks with a firm and smooth Cicatrix. Doctor Bate whispered Sir Fra. Pr. that it would not hold a month: but it held seven years, or thereabouts. Others of our Profession, who at our first Consultation had declared it an incurable Cancer, did afterwards, when they saw it cured, declare amongst their Companions that it was no Cancer. Such an irresistible Disease is a Cancer.  
In the year sixty eight the same person, being at his house in the Country, was taken with a Fever, which after some days terminated by a Crisis in the outside of the same Cheek from which the cancerated Jaw had been extirpated. They dressed it with Pultices of Chick weed and the like, by which it suppurated, and discharged its thin Matter by small Eruptions; the grosser remaining rendered the Ulcer sordid and callous. Upon which they sent for a Chirurgeon, and afterwards for a Physician of that Country. They dressed it about half a year. It not yielding to their Applications, they consulted me by a Letter: to which I returned Answer, that I suspected it cancerous. Upon the receipt of it, he came to London, believing at the worst I could burn it out. He here consulted divers eminent Physicians and Surgeons. It was now a Cancer, and indeed not capable of extirpation, having seized that side of his Throat. I attempted some part of it within by the actual Cautery: but it not succeeding, and I being soon after fetched into the Country, others were employed: but after all he languished and died.  
A Captain of a Company in one of His MAJESTY's Regiments of Foot quartering in the North of England was troubled with a small Excrescence under his Tongue. 
17. Observat. of a Cancer under the Tongue.  He consulted the Physicians and Surgeons in his neighbourhood: but it increasing with pain, he was persuaded by his Friends to come to London to me. But after he came to Town, he met with some who told him that such a small thing was not worth the troubling me. Upon which he went to some other, and, having got somewhat to dress it, he returned to his Command in some of the neighbouring Counties, and there fell into the Surgeons hands, where it increasing and spreading much infected the internal salivary Glandules on both sides the Tongue, all the lower left Maxilla, and part of the right. 'Twas fixing upon the lower Lip, the Teeth all lose, and some of them fallen out: there were also some Glands' without under the Jaws. In this condition he came to me. I acquainted his Friends that it was a Cancer, and incurable. If an attempt was to be made in hopes of Cure, it was to be by burning it out. They consulted their Friends: and aftwards Doctor Tho. Cox, Doctor Walter-Needham and myself met. It was concluded by them, that there was no other way or hopes to cure him: how that might succeed we doubted. If he would have it attempted, it should be at his desire, and not upon any assurance from us to cure him thereby: for indeed it was doubtful. The next day he sent for us to meet at his Chamber in order to the extirpation. Accordingly we met, and, having Mr. Gosling with us, and our actual Cauteries and all things ready, we placed the Patient in a clear light, than pulled out the Teeth that lay lose, and as it were buried in the Fungus. Than having his Head held firm, and his lower Lip defended, I passed in a plain Chisel-cautery under the Fungus, as low as I could, to avoid scorching of the Lip, and thrust it forward towards the Tongue, by which I brought of that Fungus and the rotten Alveoli at twice or thrice repeating the Cautery; than with Bolt-cauteries dried the basis to a crust. After with a Scoop-cautery I made a thrust at the Fungus overspreading the left Jaw, and made separation of that, and what was rotten of the Alveoli: than with Olive and Bolt-cauteries I dried that as well as he would permit, and left the rest for the next day's work, giving him some decoct. hordei cum sem. cydon. psyllii, & alb. ovor. beaten in it, to cool the heat in his Mouth, and applied on the outside under his Chaps this Defensative: ℞ boli armen. pulv. ℥ j pulv. flor. rosar. rubr. ballast. sumach, an. ℥ ss. gallar. pulv. ʒiij. coq. in acet. acer. lb ss. ol. ros. & myrtill. an. ℥ ij. empl. de minio q. s. The Physicians prescribed this: ℞ laudani gr. iij. solv. in aqu. epidemic. cinnamon. hordeat. an. ℥ jss. syr. kermesʒiij. capiat tertiam partem statim, repetátque altern. horis donec placide dormierit. This following Cordial was also prepared: ℞ aq. epidemic. ℥ viij. syr. caryophyll. è succo citr. cardiac. an. ℥ ss. sumat cochlear. iv. ad libitum in languoribus.  
The next day we met again, and found our Patient much relieved with the good night's rest he had got: he was cheerful, and resolved for the work. I began with Bolt and Olive-cauteries to make an end of drying that Fungus on the left Jaw; which having done, I burned the salivary Glands' on both sides of the Tongue: than I placed a Tin-instrument between the Tongue and the Excrescence which was rooted on the Ranula, of the shape of a Crista, thick and hard, bearing the Tip of the Tongue backward. The Tongue thus defended, I thrust at the root of it with a Bolt-cautery, by which I eradicated and burnt it of. Having thus cleared the Mouth of the Fungi, I desired the Physicians Judgement of it: they looked, and liked what was done: the Patient washed and cooled his Mouth with the same Lotion as before, and had liberty to repeat the use of the Opiate and Cordial.  
The next day we met again, and found our Patient well satisfied with what had been done, it being only stiff and hot, otherwise not painful, and he could take his sustenance with more ease and Gusto. The Physicians prescribed him this Clyster to make his Body soluble: ℞ decoct. come. ℥ x. elect. lenitiv. ʒuj. mell. violac. & sacchar. rub. an. ℥ jss. ol. amygdal. dulc. ℥ j Misc. fiat Clyster. The second day they purged with the following Apozeme: ℞ fol. senae ℥ j turbith & hermodact. an. ʒij. ligni sassafras, sem. coriand. an.ʒj. nuc. moschat. ʒss. salis tartari ℈ ij. infund. & bull. in aq. beton. s. q. fiat colatura ad ℥ xij. cui add syr. de pom. magist. ℥ jss. syr. ros. solut. mannae, an. ℥ j clarificentur ovi albumine, & fiat Apozema pro tribus dosibus matutinis, sumend. horis duabus ante jusculum cum custodia. There was also prescribed this following Traumatick Decoction: ℞ sarsaparill. ℥ ij. chinae ℥ j ras. eboris, corn. cerv. an. ℥ j infund. & bulliant in aq. font. lbuj lbuj. addendo debito tempore summitat. elatin. hyperici, millefoliis, herb. Robert. an. M. j sem. coriandriʒij. cinnamomiʒjss. passul. enucleat. ℥ ij. colat. ad lbiv lbiv. bibat lb jss. in die quotidie. By the extirpation of the Fungus within, the hard Glands' under the Chaps wihtout dissolved: but the Patient not permitting me to keep down the Fungus afterwards as it arose, it quickly over-ran all his Mouth, and those Glands' swelled again and apostemated, and afterwards indurated amongst the internal Muscles of the Larynx, and hastened his death. Yet long before that he admitted me to use the actual Cautery, but so sparingly as it signified nothing. Indeed some Empirics promised him great hopes of Cure by their Specificks: but he languished and died notwithstanding all our endeavours.  
Thus another person of about sixty years of age, 
18. Observat. of a Cancer on the Tongue.  having been long diseased with a Cancer on the left side of his Tongue, stayed in the Country till it had corrupted one half from the Root to the Tip of it, as also the Ranula and Salivals of that side, as well the external as internal parts. Than being at a loss what to do, he came up to London recommended to Doctor Walter Needham for Cure; who, seeing his case so deplorable, advised him to consult others. He assenting to it, Doctor Micklethwait, Mr. Arris, Mr. Holier and myself met Doctor Needham. At a Consultation we proposed to palliate the Disease. But he declared to us that he came to Town with resolution to have the Cure attempted, though he died under it. We endeavoured to dissuade him from it; but he persisted earnestly in the having it attempted: to which we at last complied, and agreed to cut of that part of his Tongue, and to cauterize the sordid Ulcer that lay on that side of his Mouth between that Jaw and his Tongue. To which purpose we presently sent for some actual Cautery, and in the presence of that Company I put into his Mouth a Raspatory, and, fixing it between the Root of his Tongue and edge of that Tonsil, pulled away the corrupt Flesh; and than with Olive-cauteries burnt that to a crust. Having, as we supposed, consumed the Cancer there, I passed a Probe with a Ligature into the Ulcer under the Tongue, and brought it out above through a Tubercle; than, pulling his Tongue forward, I cut of the cancerated part as it lay, according to its length, from the Tip to the Root of the Tongue: and after I had permitted it a while to bleed, I cauterised it. We than gave him of a decoct. hordei, cydon. etc. to cool his Mouth, and treated him as hath been said in the preceding Observation. In this Patient the Escars separated, and the Ulcers digested, and that part of the Tongue near the Tonsil cicatrized; but the while a hard Swelling arose in his right Thigh, and became so painful, that he was forced to keep his Bed: the Matter fermented also in the salival Glands', and made Apostemations on the outside under the Jaws: of which together he languished and died.  
These unsuccessful attempts may tender us extreme cruel to those who feel not the misery those poor creatures suffer with Cancers in their Mouths.  
If the Cancer be but in some particular part, as the Tongue, Gum, etc. though the Patients have no certain hopes of being cured by knife or Fire, yet they generally put it to trial sooner or later. How much more than shall these poor creatures, who have Cancers overspreading their Mouth, eating and gnawing the Flesh, Nerves and Bones? who, besides the danger they are in every minute of being choked with a fierce Catarrh, do suffer hunger and thirst; and if they can swallow Broth, Caudle or Drink, yet is it with an unsavoury taste, by reason of its passing through such sore corrupt Parts, form which putrefaction their stomach nauseates its sustenance, and their Spirits are infected with the stink, whence Fainting frequently happens; Sleep is a stranger to their eyes, their Slumber very troublesome, and Death is only their desire. At such a time as this it is not to be wondered if they try a doubtful Remedy, though painful. What I have attempted of this kind hath been at the earnest request of the Patients and their Friends, and by the authority of a Consultation of eminent Physicians and Surgeons. That the Cure succeeded not, must be imputed to the greatness of the Disease, and may teach others how dangerous it is to neglect the consulting the experienced Chirurgeon while the Disease is recent, and easy to be eradicated.   

CHAP. XXII. Of Noli me tangere.  
Authors in their Chapter of Cancer do usually mention Noli me tangere and Lupus. These two most men esteem to be but particular names of a Cancer when it is fixed in some peculiar place: as in the Face, Nose or Lip it is called Noli me tangere; in the Legs and Shins, Lupus. Whence it is plain that our vulgar language useth the name of Wolf in a large sense, applying it very often to the Breasts, and indeed any other place, where the Cancer groweth highly corrosive. I shall think it more instructive to the young Chirurgeon, if I appropriate this word Noli me gangere to a small round acuminated Tubercle, 
Description.  which hath not much pain, unless it be touched or rubbed, or otherwise exasperated by Topics. Concerning which Rogerus saith, that Cancer plus corrodit uno die quàm Noli me tangere in uno mense. But if so exasperated, it is immediately enraged, and becomes a true Cancer. Such as these are sometimes found in the Face and Lips; but do likewise hap in all other parts of the Body. I have seen them in the Arm. Particularly a person of about sixty years of age, of a healthy Constitution, hath one in the outside of his right Arm, a little above the Elbow. He weareth a Cup upon it of a light wood, with Straps fastened to it, which brace it on, and defend the Part from the pressure of his Sleeve. He sent for me one morning to see it when he was in bed, his Arm lying out covered with a light mantle. He turned up his Sleeve, took of the Cup, and shown it me. The Tubercle was small, of a bluish colour, and looked as if it had been a Varix: it was without Inflammation, hardness, or change of colour in the Parts about it. He did not permit me to look long upon it: the while I did, I saw it rise into a Tumour as big as a Kernel of a Hazelnut. Such another I saw in the Arm of a Woman of about forty years of age, of a blue colour, on the outside of her Arm: but it was not defended from the pressure of her Sleeve. I offered to undertake the Cure of them both; but they had been dissuaded by most of those that had seen them. I should not have doubted of good Success, having before seen a person so diseased and cured by an Eminent Chirurgeon in his time, who by the application of an actual Cautery burned it to the Flesh, supposing it had lain no deeper; but after the separation of the Escar it rising again, he burned it deeper, and from that time it returned not more.  
WHile I was attending a Noble Family in the Country, 
Observat.  a Person of quality in the neighbourhood sent his only Daughter of about eleven years of age to me. She was diseased with an unequal Tubercle upon her left Cheek, of the compass of a half Guinny when undisturbed; but if any thing were applied to it, it heated the whole Cheek. It was a great blemish to her Beauty, upon which very account her Parents had much endeavoured to have it cured, or at lest to be disposed to such a calm temper, as it might bear a black Patch. Some weeks after the Lady her Mother brought her to London, and put her into the care of the late deceased Doctor Stanley and myself. He purged her with this: ℞ fol. senaeʒijss. rhabarb. ℈ j sem. foenic. dulc. ʒss. salis tartari ℈ j infund. in aq. cichorei cum succo aurantior. colat. ℥ ij. add syr. de pomis purge. ℥ j Misc. This was repeated often. Merc. dulc. & ceruse. antimonii were also given her at distinct times, and distilled Milks, such as have been set down in the Cure of Cancers. I begun my Application with this; ℞ litharg. vuri ℥ ij. sem. cucurbit. excorticat. ℥ ss. aceti vini q. s. nutriatur in mortario in formam unguenti, addendo camph. dissolute. in aq. ros. gr. vj. This was applied spread thin upon Sarsenet: but it immediately swelled and heated all the Cheek. I than took it of, and anointed the inflamed parts about the Tubercle: but it did not agreed with it. We wiped it of again, and by exposing it to the air it cooled, and returned in a day or two to its former temper. After I had tried several Medicaments unsuccessfully, a Friend gave me a black concreted Juice to work into a Paste to cover the Disease, it being all the Mother than desired from me: and this being laid upon it, adhered to it as if it had been Pitch, and seemed to agreed well with it. But after four or five days it heated her Cheek, and was taken of. Upon which the Mother grew impatient, and had some thoughts of going with her Daughter into Gloucester-shire to a man there who pretends to the Cure of Cancers. Which coming to my knowledge, I made an offer to Doctor Stanley to undertake the Cure by extirpating that Tubercle by the actual Cautery. But he replying, that the very mention of it would fright them out of Town; I than proposed it by Caustick to the Lady-mother: which she accepted, upon a promise not to do it whilst she was in Town, nor than till I heard from her in the Country. Some while after she went into the Country, and wrote to some of her Friends to see the work done. Upon the receipt of which I met Doctor Stanley and them; and, having placed the Patient in a clear light, I drew a Line with ink how far I intended to burn, and they took the compass exactly in a piece of paper, which they kept. I began with a Caustick-stone pointed, and pressed upon the middle of the Tubercle, burning deep into it; and, to quicken the work, I touched it with ol. vitrioli upon a Stick, and than with the Caustick-stone interchangeably, till I had consumed the Tubercle and the parts within the marked Line. The while I was thus working, I dried up the Salts which mixed with the Ichor with armed Probes. Having thus finished the work as I designed, to the satisfaction of the Physician and Relations, I washed out the Salts of the Caustick with Wine warmed, than divided the Escar, and washed it again with Milk, till I had freed the Escar and the Part from pain: than I dressed it with unguent. basilic. cum oleo ros. on a Pledgit, and applied an Empl. è bolo overall. By these Lenients the Escar separated, and left a deep round Ulcer: which in few days I digested with unguent. basilic. mag. & Merc. praecip. and incarned and cicatrized with unguent. tutiae, etc. but within ten days after it broke out again. We repeated Purging with calomel. Bezoard. miner. etc. and healed it up with a firm Cicatrix by the aforesaid method, adding a few drops of tinct. vitrioli dulc. in aqua rubi. From which time it hath continued well, she not having worn any Mouch upon it of late years. I have now under cure one of this kind; but, it not being perfected, I shall insert it in the Treatise of Strumae.   

CHAP. XXIII. Of Waterish tumors.  
WAterish or Hydropical tumors are the effects of an extravasated Serum, which according to the place on which it lights doth denominate the Disease.  
If it fall inwardly into the Cavities of the Belly, it is Hydrops ascites; of the Thorax, Hydrops pecioris; of the Scull, Hydrocephalus: which name it also retains if it affect the outward parts of the Head. When it is lodged between the Skin and the Flesh, or in the Interstices of the Muscles, it is Anasarca; in the Scrotum, Hydrocele, or Hernia aquosa, etc.  
Waterish tumors that are external differ from the phlegmatic by their shining and the manner of their pitying. 
Differences.  Hydropical Swell, if they be pure, do glister and are pellucid, they take impression easily, and do as soon loose it. Oedemata receive the impression easily also, but they keep it longer. The transparency in the surface or change from the natural colour in the Skin is lesle than in the other. But these Humours are very apt to mix both in the Anasarca and other Swell; which where they do, the Symptoms are confounded.  
Ascites differs from Tympanites by its weight, and the swagging of the water in the Belly; whereas the Tumour in a Tympanites is more light, equal, hard, and, say Authors, sounds like a Drum.  
Causes of Waterish tumors are whatever may either increase the Serum of the Blood beyond its proportion, 
Causes.  or restrain it in any part of the Body preternaturally, so that, wanting its natural course, it stagnates in some one or more places. Of the former sort are ill Digestion in the Stomach; defect of Sanguification, which is frequent in intemperate persons; also great Hemorrhages, where the Blood, being weakened by much diminution of its quantity, is not able to digest the Aliments assumed, but lets them run into Serum, from which Cause alone several waterish tumors arise; so also any defect in the Ferments of the Viscera, as when the Kidneys do not separate the Serum from the Blood, or the conglobate Glands' do not their office; likewise too great acrimony in the Blood, which, though hot in itself, yet melts down the Blood into a thin Serum, as in hot Catarrhs. Of the latter sort are, 1. a check of transpiration through the Pores of the Skin, which keeps in a greater part of the thinner Serum, and forceth it to stop in the body: 2. retention of Urine: 3. the forming of some Cystis in which it is contained: 4. its extravasation in any part of the body, external or internal.  
Waterish tumors are, as we have reckoned, internal, or external.  
The internal ones are described in Physik-books; 
Signs.  and their Signs shall be given particularly by me as I have occasion.  
The external, if they be pure indeed and very much external, do by a visible resplendency betray themselves to the eye; those especially that lie near the Cuticula and Cutis making a very thin pellucid Tumour. Those that lie deeper under the Skin do shine lesle: yet in some of them, if in a dark room you shade them, as women do an Egg with their hands, and hold a Candle to the other side, you will found at lest a faint transparency. Those that lie yet deeper, or are contained in a Cystis, do not discolour the Skin at all, nor 'cause any considerable pain: but if the Swelling be large, you may by shaking it perceive an undulation.  
Watery tumors as such portend no danger to the life of the Patient, 
Prognostic.  unless the Viscera be obstructed or otherwise tainted. If such Obstructions or Corruptions hap, the measure of the danger is to be taken from the degree of the Corruption. Those inward tumors are more dangerous than the outward; and the more noble the Part affected, the more important the danger.  
In the Cure of these tumors there are four Intentions required. 
Cure.   
The first consists in a requlation of Diet and manner of living: the second, in evacuation of those serous Humours by Stool, Urine, or Transpiration: the third, in rectifying the Concoction, and restoring the Viscera to their natural state: the fourth, concerning the Tumour itself, is performed by Discutients and Exsiccants, or by Apertion.  
1. The Diet aught to be with great moderation, excess in eating or drinking being prejudicial to their Cure. As to the quality of it, Physicians generally prescribe it drying and attenuating, such as hath been proposed in the Chapter of Oedema; and after that manner they aught to regulate their way of living: yet it is not unfrequent to see these tumors arise from a hot Cause, in which case cooling Diets are requisite.  
2. The second Intention is usually performed by Purging with such things as are prescribed in Oedematous cases. Only here there aught to be a more particular regard had to the Hydragoga, as elaterium, camboya, sambucus, ebulus, rad. bryoniae, syr. de spina cervina, etc. If the Cause be hot, Bleeding and Barnet Waters may be necessary, of which you may found some Instances.  
3. The third Intention of restoring or rectifying the Viscera, aught to be the work of the Physician.  
4. The fourth Intention is, of removing the conjunct matter by drying and discutient Medicaments; for which all those set down in Oedematous and Flatulent tumors are suitable. ℞ summitat. abrotoni, absinth. origani, calaminth. majoranae, an. M. ij. flor. sambuci, chamaem. anthos, ros. rub. an. M. j baccar. lauri, juniperi, an. ℥ ij. coquantur in ss. q. aquaefont. to which may be added Wine, Vinegar, Salt, Sulphur, or Alum. Or you may make the Decoction in the common Lixivie, if the Tumour require it. You may also embrocate with such like; ℞ salis nitriʒx. piperis albiʒuj. euphorb. ʒij. ol. laurin. ℥ vj. Misc. and apply this over the Part affected; ℞ sem. anisi, cumini, bacc. myrtil. lauri, an. ℥ ss. succi ebuli ℥ iiij. ol. rutac. & cerae q. s. fiat Ceratum. If by application of these or the like Medicaments the Cure succeed not, it may be reasonable to make Apertion, and give vent to the Water, and proceed in the Cure as shall be showed in the following Observations. Where the Hydrops hath affected the Breast, I have not seen any operation attempted by letting out the Water, the Disease itself being rarely discovered till after the death of the Patient. In some such I have taken out about a gallon. Nor is there often found better success where the Water affects the Belly, as in the Ascites: it being for the most part the product of long chronic Diseases, which either took their original from or ended in Obstructions of the Viscera; in which cases the Cure usually depends upon the Physician; the best assistence of the Chirurgeon being that of Bandage, which, if applied even to the whole Belly by a strong Dimitee or Holland Bracer, made to encompass the Abdomen, and tied or laced behind, may conduce much to the prevention of a sudden increase of the Swelling.  
The like or greater success we may hope for in Anasarcous Swell, where the Legs, Arms, Hands, etc. are affected, to which a straight Stocking, Sleeve, etc. being accommodated doth usually repress the Humour, and dispose it to be carried of another way by Medicine.  
Where the Ascites follows Haemorrhagiae, Fever, or any acute Disease, it admits more often of Cure: but those of our Profession are rarely consulted while there is any hopes thereof by internal Remedies, which is so long as the Patient hath strength to bear them. At last, when the Viscera are tainted, the evacuation of the Water hastens their deaths, and the Operation is scandalised: whereas if the Paracentesis were made in time, better success might be expected.  
The way of making a Paracentesis or Tapping hath been variously set down, according to the several fancies of Surgeons. Some have made the Apertion in the Navel by Bodkin, Needle, etc. others three fingers below it on either Side, choosing that on which the Patient did least lie; for the Orifice aught to lie uppermost, to prevent too great an effusion. Those that open below the Navel have likewise devised several ways. Some take up the Skin, and perforate that first; than make a Perforation in the Peritonaeum. A method not practicable where the Belly is very hard and stiff with much Fat between the Skin and Muscles. Therefore it is that we generally strike through all at once. The worst way is by Caustick, and Incision after that.  
But the downright Puncture, being the best of Cures, is to be so managed as that the Serum may not fly out all at once, but be retained according to the desire of the Chirurgeon; nothing being so pernicious to the Patient as great Evacuations, though of an excrementitious Humour. Hence it is that much Art hath been used in this affair as to designation of quantity and contrivance of Instrument. Barbett hath lately published the use of an hollow Needle, which, being thrust in, will let out what quantity you please, but being pulled out leaves little or no passage in the Skin. The repeated intrusion of this into the same or into fresh holes (say he and Silvius) will evacuate Water at your pleasure. Truly, the whilst the Belly is distended with abundance of Water, it may succeed well: but they themselves dare not pretend farther than the Evacuation of half the Liquor, for by that time you will be in danger of wounding the Intestines. Several Experiments I have made of that Instrument, and one lately, rather to satisfy the Patient and his Relations that the Swelling was an Ascites, than that we could propose any Cure by it. I made the Apertion in the presence of Mr. Holier: we discharged about a pint of Water, and part of that by a Catheter; for, feeling some opposition in the cavity within the Abdomen which obstructed the flowing of the Water, I pulled the pointed Cannula out: and it was well I did, for afterwards in opening the dead body I found the Intestines floating above the Water, though there were above two gallons in the Belly. Upon which Observations I do conclude it a very unfit Instrument to discharge a Dropsy: besides, our people will not admit of so many Openings as would be necessary to empty an Hydropical Belly. This very person, as earnest as he was at first for the Operation, chose rather to die with the Water in his Belly than suffer a second Apertion.  
I therefore do conclude the good old way of a Cannula made taper-wise with holes in the side, whose description you may find in Pareus, to be the best; which being conveyed through a hole made by puncture may be kept in by Bandage till the Water be evacuated, the hole of it being stopped by a Screw or otherwise, as you will found in the aforesaid Author. I shall now give you some Observations of this Work, though it be for the most part unsuccessful: as indeed what can be expected from rotten Viscera?  
A Woman near fifty years of age, of a gross body and strong Constitution, 
1. Observat. of Ascites.  laboured of an Ascites a long time: after much Physic ineffectually taken, the Water burst its way through the Skin by a small Opening on her right Side, near the place where we usually make the Paracentesis; and after some days, the Aperture wearing larger, the Water flowed more abundantly. I was fetched, and stopped up the Orifice with a Tent of Lint, applying a Pitch-plaister, and over that another of Yeast and Wheat-flower, with Compress and Bandage. Than I advised her to lie on the contrary Side, by which that part was kept dry. The fourth day I opened it, and gave vent by a Cannula to three pints of Water; than bond it up again. As the Belly emptied, the Opening contracted: Therefore I put in a Cannula, retaining it in with Compress and Bracer, and thereby discharged the Water at pleasure, and afterwards left it to her own and her Servants ordering. I visited her some while after; and, finding most part of the Water discharged, I took out the Cannula, and permitted it to cure. The Water seeped out sometime upon rising or lying on that Side; but she was a strong Woman, and recovered.  
A young Man of about eighteen years of age fell from a Fever into a Quartane Ague, 
2. Observat. of Ascites.  which held him long, and ended in an Ascites: his Belly swollen exceedingly, and he became extenuated. While he languished in this deplorable condition, one undertook the Cure of him, by letting out the Water with a Thorn thrust into his Navel, (though it were not at all swelled up.) The Water was let out gradually, and a sticking Plaster only applied over it. Thus in a month's space it was evacuated, and the Belly contracted proportionably. During this Evacuation he took opening Broths and Apozemes. After the Water was discharged, and the Puncture cured, he continued extremely emaciated, and the Skin of his body and limbs was withered; yet he was ordered to be let blood about six ounces: at which time he was so very a Skeleton, and his Skin hung so lose, that I doubted how I could hold it over the Vein to open it. Yet after this I saw him fat, and perfectly cured.  
A Gentlewoman of about thirty eight years old laboured of an Ascites with Anasarcous Swell on her Belly, 
3. Observat. of Ascites.  Thighs and Legs; and, having taken much Physic unsuccessfully in the Town, was removed to her house in the Country to die: but after some while being tired with the weight and stretching pain of her Belly, she sent for me to give vent to the Water. I went provided for the work, and found the Patient resolved to undergo the Opening. Other Symptoms to encourage me I had none. The next morning, she having prepared herself, and being placed on that side she could best lie upon during the Evacuation, her Bracer being well fitted, I made the Perforation according to custom three fingers below the Navel on the upper side. The Water spurted out forcibly whilst I passed in my taper-pointed Cannula, which fitting exactly, I let out about three pints of Water, than applied an Emplastr. ad herniam over it, with a Stupe wrung out of a carminative Decoction and Bandage. She seemed somewhat relieved at the present, but rested ill that night, and was much indisposed in the morning, yet would have more Water let out. I discharged two quarts of Water, and dressed it as before.  
After I had continued there three or four days, and shown the Servants the manner of letting out the Water and dressing, I returned to London. After a few days, going back, and finding her Belly very much sunk, and the Water not over-ready to flow, I took out the Cannula, applied a Pledgit of unguent. basilicon, and an Emplastr. ad herniam over it, with a warm Stupe and Bracer as before. I left her weak and not like to recover; and indeed she died a few days after.  
A Gentlewoman of about thirty years of age, big with Child, 
4. Observat. of Anasarca in the Legs, etc.  was much diseased with Anasarcous Swell in her Legs and Feet. Sr. Fr. Pr. was sent for; who, seeing her in such a condition, and unfit to take Physic, desired my Opinion concerning them. I saw the Swell pale and shining, yielding to the impression of my fingers, and returning slowly. She was very uneasy in her bed, and not in a condition to sit up. I proposed Fomenting with good discutient and exsiccant Medicaments, to dispose them for Bandage, and than to put on laced Stockings and Trouzes. After he had a while considered of it, he wished me to writ a form of the Fomentation; which I did thus: ℞ summitat. absinthii, majoranae, origani, rorismarin. an. M. iiij. flor. chamaemeli, sambuci, ros. rub. an. M. ij. baccar. lauri, juniperi, an. ℥ iiij. sulph. vivi, aluminis rup. an. lb ss. salis come. M. iij. coq. in ss. q. aquae pro usu. He gave way to the use of it and the Bandage. I began the next morning with the Fomentation, causing her Legs to be bathed, than rolled them up from the Feet above the Knees equally straight. After I had repeated this method three or four days, and disposed her Legs by Bandage for the laced Stockings, I saw them laced on with Knee-pieces and Trouzes: these were daily straightened to such proportion as the Patient could easily bear. By the wearing of these she recovered the use of her Legs, to the great advantage of her health. She went her full time, and was delivered of a healthful Child, which is yet alive.  
A Gentleman having long laboured under a complication of Diseases, particularly a Dropsy, 
5. Observat. of Anasarca of the Legs.  sent for me. I found his Body much extenuated, his Legs Anasarcous, and his Back and Hips excoriated with lying in bed. I proposed to him to use of a Fomentation and equal Bandage, viz. a pair of laced Stockings. After some reasoning with me about the use of them, he complied, and I caused a pair to be made, and laced them on. They were easy, and did all I designed by them. He was able to walk to his Closet, and take the air in his Coach, and was well pleased with them. But afterwards, being informed by some body of great inconveniences that might hap to him from the wearing of them, he caused them to be pulled of; upon which his Legs swollen again, and he was confined to his bed, whereby his Hips and Back galled: also by reason of the great increase of those waterish Swell the native heat was overcome, and a preternatural one arising inflamed and blistered them. I was fetched, and by Fomentations, etc. got of the Mortification, and in six weeks healed the Ulcer and Ulcerations. I made him a fontanel by Incision in his right Leg, and put him on the laced Stockings again, by the use of which he recovered.  
A young Woman of about twenty five years of age, 
6. Observat. of a watery Tumour in the Back.  of a healthful Constitution, came to me out of the Country, supposed to have the King's Evil. Upon enquiry I found none of that Evil, but a large Tumour lying upon the Muscles of the Back: the Skin of the Tumour was thick, without inflammation or discolouring.  
I was than in quest of windy tumors, and thought this might be one, having Symptoms not unlike it, the Sound excepted. I had a great desire to see what it was which made that bulk, and offered her the Cure of it gratis; which she gladly accepting, I ordered my Servants to make ready Astringents and Bandage. Than I made an Apertion into it with a Knife, upon which a Water forced out: we received it in a Chamber-pot. Whilst it was discharging, I slit up the Tumour, and gave way to the Dregss, which were like Honey, but not contained in a Cystis. I cut of as much of the Skin as was superfluent, and brought the rest together, dressing it up with the common Digestive ex Terebinth. etc. with a restrictive Emplaster, Compress and Bandage. Being thus dressed she walked with her She-friend, more briskly than she came, to her lodging in Shoe-lane; from whence she came to my house the third day after, to be dressed, and so daily till the Wound was cured; which healed by Agglutination in lesle than three weeks.  
OF Waterish tumors Hydrocele is one very remarkable Species, 
Hydrocele.  which subdivides itself into many others.  
It may be generally defined, 
Definition. Differences.  a waterish Swelling of the Scrotum.  
This may be either part of another more general Tumour, or else an original Disease of that place. When it is part of another Tumour, the Body is Hydropical, viz. either Anasarcous or Asciticall: in both which cases it is frequent to see the Cod swollen up after the manner of an Anasarca. And indeed, when in Asciticall cases we found a Swelling of the Testicle, there is for the most part an Anasarca of the lower parts of the Belly joined with it. When it is an original Tumour of the Part, it either lieth without the Tunica vaginalis, affecting the whole Scrotum; or else is contained within the said Tunicle, or at lest in a Cystis of its own: in which case you will found one side swelled whilst the other remains in its natural state; or if both Testicles are concerned, the tumors are distinct.  
The Causes of Hydrocele are the same with those of a Dropsy, 
Causes.  at lest when it is part of a Dropsy. But when it cometh alone, it is generated as all other waterish tumors are, viz. by a separation of Serum out of the Arteries, which never returneth into the Veins, but lodgeth in the Skin or other parts of the Body. This Extravasation may be caused from some Bruise by Blow, Fall, etc.  
Signs of an Hydrocele may be taken from the distemper of them. Viz. 
Signs.   
1. The Anasarcous Hydrocele may be known by the splendour, softness and thickness of the Scrotum. It taketh impression from the fingers easily, and may be wrought like soft Wax. The Prepuce is usually swelled, if it attend the Dropsy of that name.  
2. The simple Hernia aquosa, as it affects the whole Scrotum, fills it like a Bladder, and discovers itself by its shining.  
3. When the Hydrocele lieth within the Tunica vaginalis, between it and the Testicles, or in a peculiar Cystis, the Scrotum is proportionably stretched, and somewhat wrinkled; and indeed at first sight it is not unlike an Hernia intestinalis or zirbalis: but you may distinguish them by pressing with your fingers upon the Production, which when you do, bid the Patiented cough; if nothing press upon your hand like wind, it is an Hydrocele. If the Water be lodged in the Tunica vaginalis of both Testicles, the Swelling appears double.  
This Disease is more or lesle dangerous according as it is complicated 
Prognostic.  That which is joined with Dropsy cannot be cured, unless that be first cured: yet it sometimes serves to discharge anasarcous Swell in the Parts lying above it. Those which arise from an external Cause are more easily cured. If the Habit of body be tolerably good, the Hydrocele may be cured; and if it be bad, the Water may be let out as often as it fills, without danger. 
Cure.   
In the Cure of these tumors there is required a regulation in Diet and manner of living, as hath been set down in the preceding Discourse of Waterish tumors in general: only here they are to be proportioned according to the greatness of the Malady and the Accidents that attend them. They also require to be treated with such Discutients and Exsiccants as have been there proposed, and you must retain your Applications close to the Part to which they are applied. A Bag-truss is necessary, it serving also to sustain the Part, jest by the weight of the Humour the Tumour be increased: also after the discharge of the Water it furthers the corrugation of the Scrotum.  
While the Swell are small, they may haply yield to Discutients. An accidental Bruise, by stirring up an Inflammation, hath sometime disposed them to Discussion. If they tend to Suppuration, further it by Suppuratives, as in a Phlegmon hath been showed, and treat them as such. But if the Tumour have any quantity of Water in it, your speediest way of Cure is by giving vent. if it be an Anasarca that possesseth the whole Scrotum, the way to discharge it is either by Scarification, or by a Seton.  
Scarification is proper when only the Scrotum is Anasarcous. If it be made by puncture with a Lancet, the Water will discharge in few hours, and the Wounds agglutinate soon after without other Application than a warm Stupe. An Instance whereof you may see in the Observations of Oedema.  
If there be an Anarsaca of the Belly, the Seton is most proper, in consideration of the time which is required for such an Evacuation. It aught to be made transverse the Scrotum in the depending part. It is to be kept open till the Serosity be discharged; and the while you are to preserve the native heat of the Part by the application of warm Stupes wrung out of Wine wherein have been boiled summitat. absinthii, majoranae, flor. chamaem. ros. rub. ballast. bacc. myrtill. nuc. cupress. etc. And take care jest the Scrotum excoriate from the sharpness of the Humour and inflame: for in Hydropical bodies it is apt to gangrene. If you apprehended such mischief, pull out the Seton.  
In the Opening the other Species of Hydrocele, you are to consider the quantity of Water, and the place it is lodged in. If it have not a pint of Water in it, forbear opening it till it be bigger, jest you hurt the Testicle: besides, it is not worth the while. But if it be a Child that labours of it, you may open it though there be scarce half a pint of Water. In order to the Opening them, you are to place the Patient in a clear light: than with the one hand to press upon the Production, that the Tumour may be more tense: and if the Hydrocele be in a Man, your Servant aught to press with his hand upon the other side, that the Scrotum may be the more steady. You are to make the Puncture in the depending Part, and avoid the cutting of the greater Veins lying upon the Scrotum, jest thereby the Water be made bloody, and you be thought to have hurt some Part within. You are to make the Apertion big enough to receive a small Cannula, which you are immediately to put in, and keep it there till you have drawn out all the Water. That done, apply a Pledgit of unguent. basilicon, and an Emplaster to retain it on, with a Flannel Stupe wrung out of an astringent Decoction, and put such a Bag-truss on as may keep your Dress close. By this method you will in two or three days found the Puncture cured, and the Scrotum contracted. Yet it may be reasonable to apply an Emplastr. Caesaris, or some other astringent Emplaster, over the Scrotum, and to put on a lesle Truss, which the Patient may wear for more security. For they are apt to fill again with Water once in a year or two, if the Habit of body abound with serous Humours.  
If the Water be lodged in a Cystis, or within the proper Coats of the Testicle or Testicles, they require accordingly to be opened distinctly. And in these Hydrocele's you are to be careful to pass in your Cannula, and keep it in till the last drop of Water be discharged: for if by any accident it slip out, you will scarce get it in again; the inner Tunicle hanging lose, the holes may not answer each other; nor is the Tumour capable of being opened so well again as at first: and if you leave any Water behind, the Operation will be thought ill done. The Water discharged, you are to proceed in the Cure as above said. What hath been hitherto delivered of these Hydrocele's doth only concern the palliative Cure.  
If you purpose the perfect Cure, you aught than to make the Apertion large on one side of the Scrotum reaching towards the Production, in such manner as it may lie according to the length of the Testicle, that you may open it after the Water is discharged, and thereby the better apply your Medicaments to it in case it be affected. In these Operations the Patient should be of a tolerable good Habit of body, and not in his declining age: for whether they be made by Incision or Caustick, they are generally subject to Inflammation, Colic and Fever, till Suppuration be made. In which case Bleeding and Clysters are necessary, and outwardly Lenients and Anodynes are to be applied, also good Fomentations to keep up the natural heat: of which you will found some Instances amongst the following Observations.  
A Boy of about six or seven years old was brought to me labouring of an Ascites, 
1. Observat. of Hernia aquosa with an Anasarca and Ascites.  with an Hernia aquosa in Scroto, and Anasarcous Swell possessing the outside of the Scrotum and Prepuce. I made an Apertion on the left side of the Scrotum in a depending Part, and, passing in a Cannula, discharged near a pint of Water; than fomented it with warm Stupes wrung out of read Wine. While I was fomenting it, suspecting the Anasarcous Humour would soon fill up the Scrotum again, if the Apertion were not kept open, I therefore without delay thrust a Seton-needle with a small twist of Silk through the Aperture before made, and passed it out transverse the Scrotum, about an inch distant from the first opening; than cut of the Seton from the Needle, and tied the ends together, fastening them with an Emplaster above upon the Scrotum, and trussed it close with a warm Flannel Stupe, covering also the Penis, and dismissed them with directions to stupe it at lest thrice a day with a Decoct. absinth. flor. ros. rub. etc. as it is proposed in the method of Cure. If in this case the Stupes be not often shifted, the serous Humour, which so continually drops into it, will excoriate the Scrotum, and stir up a painful Inflammation. Some few days after I visited the Patient, and saw the Swelling in the Prepuce and Scrotum discussed, the Seton having well discharged its part. I cut out the Seton, and dressed the Ulcers with unguent. tutiae, by which they healed; and by the continued use of the Fomentation in a few days the Scrotum contracted.  
A Gentleman of about sixty years old came to London diseased with a Hernia aquosa. 
2. Observat. of Hernia aquosa with Anasarca.  The lower parts of his Belly and upper parts of his Thighs were Anasarcous: the Prepuce and Scrotum were not free of it. Sr. Fr. Pr. being his Physician advised the opening of the Tumour, and was present the next day: where, having all things ready, I placed the Patient in a Chair to the light, the Physician laying his hand upon one side of the Scrotum, while mine was on the other side. I made a Puncture in a declining Part, than passed in a Cannula, and let out about three pints of Water in a Basin. I was much of the colour of Urine in healthful people. The Water discharged, I pulled out the Cannula, and applied a warm Stupe, and trussed it up close. In the space of two or three days the Anasarca discussed, and the Scrotum contracted and cured. I applied an Emplastr. Caesaris over the Scrotum, and fitted him with a Truss accordingly. Two years after I opened this Tumour again.  
A Man of about forty years of age, 
3. Observat. of an Ascites with Anasarcous Swell in Scroto, etc.  of a strong Constitution and sanguine Complexion, being of late years Asthmatick, was about two months since swelled with an Ascites and an Anasarca of his Belly, Scrotum, Thighs and Legs. Dr. Denton and Dr. Brook were his Physicians, and consulted me in the Chirurgery, especially in that of the Scrotum, which was very much distended (as we supposed) with Water, the external parts being (as I have said) Anasarcous.  
I proposed Scarification in order to the present discharge of the Anasarca: but, in consideration of the necessity that appeared of continuing a vent to the serous Humours, which would most certainly affect the Scrotum whilst any thing of the Hydrops remained in the parts above, we resolved upon the use of a Seton. To which purpose the Patient was seated upon the side of his Bed, and a Basin placed under the Scrotum. I raised up the Anasarcous Skin, and, whilst Dr. Brook held part of it, passed through the Needle with a twisted Silk. Immediately upon the Apertion there discharged a bloody Serum, (as it seemed to us by the candlelight,) which we permitted to flow to the quantity of at lest a pint and a half: during which the colour not changing, we stepped to the window with the Basin, and saw it a pure florid blood; so also was that which flowed the while into a Porringer. Upon sight whereof I pulled out the Seton, and placed a Servant's fingers upon the two Apertions, till I hastily made Dress ready of farin. tritic. cum albumine ovor. spread upon a couple of Pledgits and upon linen cloth in the form of a Plaster, which I applied upon that part of the Scrotum with Compress and Bandage, whereby the bleeding was stopped. We did not perceive that he was the lest discomposed by the Evacuation. The second day after we met again, and saw the Patient walking in his Chamber marvellously relieved both in his breath and strength. He formerly took his rest by leaning upon his Knees and Elbows; but that night he slept lying down in his Bed, and had discharged in our absence above a gallon of Urine well coloured, and made more than a quart during our being in the house. In the taking of Dress the Apertions were seemingly healed, and had not bled one drop after the application of those Emplasters. We fomented the Scrotum, and trussed it up. His Physicians prescribed antiscorbutical Juices, cordial Juleps, etc. The second day after we met again, and, seeing the Scrotum big, made Scarification by puncture of a Lancet. The blood trickled down apace; but after a while it stopped, and a Serum flowed forth. A warm Stupe was applied, and renewed often, and continued the most part of that night; during which the Serum was plentifully discharged, and he urined well. At our next meeting, which was within two or three days, we found our Cure succeed well; but the Scrotum was big, and likely to be so whilst there remained any Water in the Abdomen or Parts about. Upon which consideration we were inclined to make a Seton again: but, suspecting a new effusion of blood, we contented ourselves at that time in making an Apertion with that Spear-pointed Cannula described by Barbett. It bled at first opening about two ounces, than gleeted a serous Humour. We dressed it as before, and thereby the Serum was discharged for the space of three or four days; during which the Patient removed from his Lodging at Limehouse into the Town, nearer his Physicians. Than we again pierced the Scrotum with a round Needle and twisted Silk, whereby the bleeding was restrained and the Serosity discharged: but the Scrotum from that time began to indurate, and thereby straightened the Seton, and stopped the Water in its passage. Upon sight whereof we fomented the Scrotum with Emollients and Discutients, viz. ex foliis & radic. althaeae, bryoniae, cucumeris sylvest. summitat. ebuli, flor. sambuci, sem. foenugraeci, etc. and of the Faeces made a Cataplasm, with an addition of farin. hoard, lentium, axung. porcin. etc. During these Applications the Patient was purged with Hydragoga once in two days, whereby great quantities of waterish Humours were each time evacuated. The Juices were also repeated those days he intermitted Purging. Thus the Patient was daily relieved, the heardness in Scroto resolving as the Seton digested, and indeed the Scrotum was well-nigh restored to its natural bigness. We than designed Scarification of his Legs, to evacuate that Serum: but he not permitting it, we fomented them with Discutients, and embrocating afterwards cum oleo olivar. aceto & sale, we rolled them from the Toes upwards; and having that way disposed the Parts for straight Stockings, we laced them on, and fitted laced Trouzes to the Thighs. During which the Patient was frequently purged to much advantage; yet the swollen Thighs and Legs did not yield to our Bandage, but continued hard and painful. He was also straightened in breathing, and often delirious, and too much debilitated to bear so frequent Purging as was requisite to evacuate the daily increase of Water. Upon which consideration we scarified his Legs and Feet, and by the application of Cupping-glasses discharged a quantity of bloody Serum: from which time the evacuation of Serum was continued by the application of warm Stupes and Emplasters. About ten days after, having notice that his Legs and Feet were exceeding painful, I made him a visit, and found him upon his Feet: his Stockings being pulled of, I saw his Legs inflamed, and in one place livid, and the very Toes inflamed, also blistered, and in some parts livid. I scarified them, and fomented them with decoct. summit. absinth. flor. ros. ballast. in vino rubro; than dressed the Scarification with unguent. basilic. hot, and applied cerat. Galeni with moderate expulsive Bandage from the Feet to the Knees; than put him into Bed, placing his Legs upon Pillows, to prevent the descent of Humours. The next day the Patient was let blood about ten ounces; from which time he began again to urine plentifully, and thereby was freed of the Delirium and difficulty of breathing, the Inflammations of his Legs and Feet went of, and those Ulcerations healed: yet there afterwards appeared a small collection of Matter upon one of his Legs; which being discharged, and disposed to cure, the Patient was again purged, and is at this present in a hopeful way of Recovery, his Belly, Thighs and Legs being soft, and in a manner restored to their natural state, and his Physicians are sending him into the fresh Air to perfect his health.  
A Gentleman of about twenty seven years of age came to London diseased with a Swelling in Scroto. Dr. Walter Needham was his Physician. 
4. Observat. of Hydrocele.  It was soft, and possessed the Tunicles of the right Testicle, making a Swelling only in that Testicle. It did not shine, as the simple Hernia aquosa is want to do. We made Compression upon the Production of that Testicle, and concluded the Tumour water, and lodged within the proper Coats of that Testicle, the other lying unconcerned. We made an Apertion in the declining Part, and, passing in a Cannula, discharged about a quart of Water, all that was in the Scrotum: than pulled out the Cannula, and applied a Pledgit of unguent. basilicon, and an Emplaster to retain it on, with a hot Stupe wrung out of Wine, and trussed it up close. By which method of dressing the Puncture cured, the Scrotum contracted, and he returned cured.  
A person aged fifty eight years, 
5. Observat. of Hydrocele.  having been long troubled with a large Tumour in Scroto, desired my advice. The Production of the Peritonaeum on the right side was much dilated. I pressed upon it with my hand, and upon his Coughing felt nothing of Wind. That Testicle was lodged within the Tumour, so as I could not feel it. The Tumour was soft and without pain. I concluded the Disease to be Water lodged within the Tunica vaginalis, or some particular Cystis encompassing the Testicle; the other Testicle and Production being unconcerned, and the Scrotum thick, as is usually in such cases.  
I proposed the letting out of the Water; but he desired time to consider of it. After two or three days I was sent for again, where I met Sir Charles Scarburgh, Physician to his Royal Highness the Duke of York, and one of his Majesty's Physicians, and Doctor Denton. We together considered the Tumour; and they, being satisfied that it was Water, encouraged the Patient to admit of the Opening of it. I, having all things ready, made a Puncture in a declining Part, and, passing in a Cannula, discharged near two quarts of Water, dressing it up as above said. I opened this Tumour afterwards twice in the space of four years.  
A Gentleman of about sixty years of age, labouring of an Hydrocele, was commended to me by Doctor Morison, his Majesty's Botanic. 
6. Observat. of Hydrocele.  The Swelling was within the Tunicles of the right Testicle, the Scrotum thick. I let out the Water by Puncture and Cannula; it was about a quart; than dressed it as above said, and the third day applied a restrictive Emplaster over it, with Compress and Bag-truss, and within a few days after dismissed him cured of his Disease.  
A year after or thereabouts the aforesaid person came to me again, the Scrotum being replete with Water. I opened it, discharged the Water, and dressed it as above said, and thought him well, and gone out of Town. But after some days, accidentally hearing he was sick and kept his bed, I hastened to him, and found him afflicted with a Colic and Fever: the Scrotum was also swelled and inflamed. I ordered him a Clyster, let him bold, and applied an anodyne Cataplasm. By these means the pain was mitigated, and the accidents of Fever, etc. ceased: but the Scrotum remained relaxed and big. In consideration of which I applied Cataplasms powerfully discutient, ex rad. bryoniae, fol. cicutae, flor. cham. sambuci, sem. foenugraec. etc. by which the Swelling lessened. He being in haste to go out of Town, I supplied him with Medicaments to dress himself, by which the Tumour was discussed. He hath not been troubled with that watery Swelling since.  
A person having a Swelling in the left Testicle desired my Opinion of it. The Tumour was soft, 
7. Observat. of Hydrocele.  and of the bigness of a Goose-egge, without Inflammation or pain, the Scrotum itself not much concerned. I, supposing it an Hydrocele, and within some of the proper Coats of that Testicle, advised him to truss it up close, and in case it grew bigger, I would open it; for at that time there was not half a pint of Water in it. After a year or more, this person in riding bruised the same Part against the Pummel of his Saddle; it immediately became painful and hard. He came to London, and sent for me. It seemed to me than to be in a capacity of discussion by reason of the access of heat: to which purpose I prescribed this Fomentation: ℞ fol. hyoscyami, cicutae, an. M. ij. fol. malu. bismalv. an. M. j flor. cham. sambuci, an. M. ss. rad. bryon. & lilior. an. ℥ iiij. sem. lini & foenugraeci an. ℥ ij. these to be decocted in brodio ex capite & pedibus ovinis, and the Faeces made into a Cataplasm, with the addition of medulla panis tritic. mel comm. & axung. porcin. By the application of these emollient and resolvent Medicaments the hardness and Swelling were removed, and the Testicle reduced to its natural state.  
One between forty and fifty years of age, 
8. Observat. of an Hydrocele returned.  of a full Body, came with his Chirurgeon to consult me concerning some kind of Hernia which of late began in Scroto, and was since by accident of Bruise much increased. At sight of the Tumour it appeared to be overspred with an Ecchymosis, and I supposed the Humour within it to be an extravasated Serum. I advised a discutient and exsiccant Fomentation and Emplaster, also a Bag-truss. Some little while after, seeing the Extravasation discussed, and the Tumour inconsiderable, I advised the continuance of the Truss. About a month after we visited the Patient, and saw the Tumour very large and tense, and by holding a lighted Candle on one side it appeared splendent. We concluded it an Hydrocele, and proposed the Opening of it: but the Patient at that time declined it; and some while after his Chirurgeon assured me that it went of of itself, without any manner of Application.  
Whilst I attended the KING at St. Johnstone in Scotland, 
9 Observat. of an Hydrocele with Sarcomata of both Testicles.  a Man of about forty years of age desired my advice, he having been some years troubled with a Swelling in Scroto, which through length of time was grown so big, that he was not capable of following his affairs without much pain. It was soft, and seemed to make a double Tumour. I concluded it an Hydrocele distinctly lodged within some Cystis, or the proper Tunicles of the Testicles, for I could feel neither of them. The Scrotum itself was not concerned, otherwise than by its giving way to the Humours within. The Patient desired to be cured: to which purpose I began my work on the right Testicle, it being the most swelled. I applied a Caustick according to the length of the Part on the outside, so as after the discharge of the Water the Opening might fall upon the side of the Testicle, that, in case it should be corrupted by the long lying of the Humour, I might the better apply Medicaments to it. The next day I divided the Escar, and gave vent to a quantity of Water, than to a rotten Matter, with some rags of corrupt Flesh; and at last a bloody Serum discharged; upon which this side sunk, but the other remained full as before. I dressed it up with unguent. basilicon hot, and applied over all Empl. è bolo with Compress and Bag-truss. The Patient was that night seized with a Colic, and rested ill; and in the morning, finding him distempered with a Fever, I prescribed him a carminative Clyster, and some hours after let him blood. That evening, taking of the Dress, I found the Escar dry, and the Parts about it swollen, and beginning to inflame. I fomented it with decoct. absinth. flor. cham. sambuci, ros. rub. etc. in vino rubro, and applied unguent. basilicon as before, and a Cataplasm ex far. hoard. fabar. etc. decocted in Oxymel over the diseased Part. In the next Dress I added ol. terebinth. to the aforesaid Unguent, and continued the use of the Fomentation and Cataplasm. By these Applications the Ulcer tended to digestion, and the Escar separated; but the Swelling continued big. I than applied the Cataplasm mentioned in the former Observation, doubling the quantity of cicuta, and dressed the Ulcer with mundif. Paeracels. cum praecipitat. After a few days I observed in dressing of the Ulcer a rotten Slough to lie within, which I took hold of with my Forceps, and feeling it lose pulled it out. It was the corrupt Cystis. Upon the coming away of which the Tumour sunk. I dressed it up with Dossills' spread with the Mundificative, and upon the Ulcer without applied unguent. diapompholygos, as also where the cicuta had blistered the Scrotum. From this dressing the Ulcer digested well. My endeavour was than to dry up the humidity, and contract that part of the Scrotum: which I did by adding flor. ballast. nuc. cupress. sumach, etc. to the former Fomentation of read Wine, and by a Cataplasm of far. hordei & fabar. boiled up in some of the said Fomentation. Whilst I was healing the Ulcer within, a hard Swelling arose near the Production, and a Fungus thrust out from that Part of the Testicle. Upon search I found that occasioned the hard Swelling; whereupon I laid that part open by a Snip with a pair of Scissors, and covered the Fungus with Praecipitate and Dossills' of Lint; and by the use of that and the Vitriol-stone I consumed it, and cured the Ulcer.  
After the Patient had a little recovered his strength, I began with the other by Incision, making it about an inch in length, supposing it would sooner digest, and thereby escape those accidents. It discharged the like Matter as the other did. He suffered also Colic and Fever, till the corrupt Cystis digested out, which was the space of ten or twelve days. After which the Ulcer digested, and by the same method it healed, and the Scrotum contracted, so as it was not easy to judge that it had ever been diseased. The Patient is yet alive, and hath never been disturbed in those Parts since.  
A Citizen aged about forty six years laboured of such an Hydrocele in both Testicles. 
10. Observat. of the same.  I opened and treated them after the same method as in the former Observation hath been said. He was subject to the same Accidents of Colic, Fever, etc. After Digestion the Cystis cast forth, as in such like cases is usual, and by the blessing of God I cured him. Doctor du Molin saw him dressed once or twice, and prescribed him some cordial Julep, etc. as he thought fit.  
These Hydrocele's do not differ in the way of Cure, therefore I forbear a more particular discourse or giving you more Instances of them; but wish you to consider the Age and Habit of body before you begin this way of Cure; for they are generally subject to Colicks, Fevers, Singultus, etc. and, if the native heat be weak, they are apt to gangrene.  
HYdrocephalus is a watery Swelling of the Head, 
Hydrocephalus.  having the same Original with other Hydropical tumors. It is most usually the Disease of Children. The Part affected is (as I said) the Head, either within or without the Cranium.  
The Causes of it are an effusion of the Serum, 
Causes.  either outwardly between the Cranium and the Scalp, or inwardly between it and the Membranes.  
Those that hap on the outside are too often the effect of ill handling by Midwives and Nurses, whereby the capillary Vessels are bruised, and the serous part of the Blood extravasated. From this Bruising it is that Corruption often followeth, and the Humour is apt to stink.  
The other more internal Hydrocephalus, affecting the Parts within, is an effusion of Serum within the Scull, either between it and the Dura mater, or between that and the Pia mater. It is not lesle frequent to found this Serum so extravasated to coagulate into a stiff gelatinous substance all about the Vessels under the basis of the Brain, and thence to involve all the Roots and the Caudex of the Spinall marrow, quite over the Nates and Testes and Glandula pinealis, reaching into the Ventricles of the Brain. Many instances of this kind I could give you in Ricket children: but these things are not to be discovered till the Patient be dead.  
The Signs are suitable to the Part affected, 
Signs.  and the quality of the Humour. If it lie immediately under the hairy Scalp, and possess it, all the whole Head must be swelled. If the Matter within be oedematous, it will pit under your finger: if it be a pure Serum, it will return to its seat when your finger is taken of. The Face is pale and swelled, so also are the Eyelids, sometimes bloody and shining. In the increase of it, it sometimes thrusts out a Tumour like a Wen, but the Fluctuation of it showeth it to be Water. If it be between the Cranium and Pericranium, you may feel the Cranium bore, and a Fluctuation between it and the Pericranium. If it lie between the Cranium and Dura matter, the Sutures are lose, so that you may often bury your finger between them. When it lieth under the Dura mater, it maketh that swell, and frequently thrusts itself through between some of the Sutures of the Scull; as particularly it did in a young Child, of which anon. What is within the Ventricles of the Brain is not easily discovered whilst the Patient is alive; only it may be guessed at by great Stupidity and Insensibility, if any such thing be.  
Doctor Walter Needham did tell me of one that in Bedlam was observed to sit upright with his back to a wall without speaking or opening his Eyes for many months, only some odd mimical gestures he used. Upon his death he was opened by order of Doctor Thomas Allen, Physician of the place. An oedematous Tumour was found to occupy all the upper part of the Cerebrum between it and the Pia mater, which descending by the posteriour parts of it did possess the entrance into the two Ventricles, the Glandula pinealis itself being turned into a Bladder of water.  
But the Story cited out of Vesalius by Sennertus is yet more wonderful, of a young Girl, that kept her Senses well enough, yet her Head swollen so great as to hold nine pints of Water. The like Observations we found in Hildanus, Kerkringius, and others, where the Brain hath been so little, and so oddly placed, that the whole hath been judged to be Water. By which we may judge that Stupidity, though, when we found it, it may give us cause of suspicion that such a Tumour is there lodged, yet it is not the necessary concomitant of the Disease.  
Children labouring of this Disease are for the most part very unhealthful, 
Prognostic.  and in their infancy subject to Convulsions. If they scape that, they fall into Rachitis, which for the most part terminateth in the King's Evil.  
Those that thrust out from within the Scull are deadly. Those next the Cranium are not without great danger. If the Tumour be large, and possess all the Head, the Cure is not without difficulty: but if it possesss only some particular external Part, it is more easy.  
The Cure of this Disease is much the same with that which hath been delivered in the general Discourse of Watery tumors, 
Cure.  viz. by powerful discutient and drying Medicaments; as summitat. thymi, absinth. majoranae, fol. beton. salviae, flor. sambuci, chamaem. ros. rub. ballast. sumach, bacc. myrtill. nuc. cupress. gland. querc. gallae. These may be boiled in Wine, or in a Lixivium. And if stronger Medicaments be required, you may add to them sulph. vivum, alum. and the various Salts, with which you may foment the Parts. You may also embrocate with such like; ℞ ol. laurin. anethi, an. ℥ ij. ol. de spica, de lateribus, an. ℥ j sulph. vivi, salis come. aluminis usti, an. ℥ ss. ciner. siliquar. fabar. ʒij. terebinth. styracis calamitae, an. ℥ j Or with the addition of Wax make it into a Cerote. Or, ℞ pulver. summitat. absinth. origani, flor. ros. rub. ballast. an. ℥ j salis come. ʒuj. mellis come. q. s. fiat Cataplasma. Empl. de baccis lauri, cephalicum, empl. diasulphuris, de sinapi, are proper. In order to the applying of these the Hair aught to be shaved. fontanelles are also of use in the Neck and behind the Ears, etc.  
If the Humour doth not discuss by the aforementioned Remedies, you may let the Water out by small Apertions, that it may as it were insensibly discharge; and the while continued the use of the milder Discutients and Exsiccants, to restore the Scalp to its natural tone. But if, through length of time, the Humour hath united itself into a Tumour of some particular Part, if you be satisfied that it doth not arise from within the Scull, you may cut into it, and let out the Water; or, if it hath a small basis, make a Ligature on it, and cut it of. But if you suppose it ariseth from within the Scull, forbear the extirpating it.  
A Child of about four years of age was brought to me, 
1. Observat. of Hydrocephalus.  supposed to have the King's Evil. The Head was extraordinary big, the Face full and pale, the Eyebrows and Eyelids swelled. I laid my hand upon the Head, and, feeling it soft, I advised them to purge the Child with resina jalapii or diagridium and Calomel. in the form of a bolus, cum syr. de spina cervina, and to make fontanelles in the Neck and behind the Ears, and afterwards, if there were occasion, to shave the Head, applying such Medicaments as have been set down in the method of Cure. Sometime after the Parents told me the Child was cured only by the fontanelles behind the Ears.  
In a Child of half a year old, 
2. Observat. of Hydrocephalus.  labouring under a watery Swelling of the upper part of the Head between the hairy Scalp and Pericranium, I made Issues behind the Ears and in the Neck, and fomented the Head with a Decoction of the milder Discutients and Exsiccants boiled in read Wine. But, it being cold weather, they rather desired an Emplaster. In compliance with their desires a cephalick Emplaster was applied. After some time it made such an itching and soarness, as put us upon the necessity of taking it of; which was not done without difficulty, the Scalp being much excoriated underneath. We fomented it again as abovesaid, and applied Colewort-leaves on the Parts affected. It healed up in few days, and the Disease was not much lessened: the Issues behind the Ears also healed as the Escars cast of. Having applied several Medicaments unsuccessfully, I made two or three Punctures into the Scalp, and let the Water out; than applied a Cataplasm ex far. fabar. flor. ros. rub. ballast. nuc. cupress. bacc. myrtill. & summit. hyssop. pulver. decocted in read Wine. By the use of this and the foresaid Fomentation the Child was cured.  
A Gentleman of about forty years of age, 
3. Observat. of Hydrocephalus.  having a large Tumour on the Os lambdoides bigger than a Goose-egge, was commended to me by Sir Fra. Pr. I shaved the Hair from about it, brought the basis in by a Ligature, and cut it of; than made a cross Stitch, taking up the Artery with the same Stitch, and brought the Lips as close as conveniently I could; than dressed up the Wound with pulv. Galeni cum albumine ovi, and applied an Emplastr. è bolo over all, with Compress and Bandage. The Humour was a crude Serum, as in Hydrocele; only in the bottom of it there were dregss that seemed to be a melicereous Matter. The third day after, finding the Wound tending to digestion, I dressed it with the common Digestive ex terebinthina: after Digestion I cut the Stitches, and incarned and cicatrized it in few days by the usual Medicaments set down in Wounds of the Head. Many as big I have taken of the same way, and cured accordingly.  
Some years since I was fetched to a little Infant not ten days old that was born with two of the  tumors. 
4. Observat. of Hydrocephalus.  They were of the shape of Cupping-glasses of the middle size, seated upon the Suturae lambdoïdes and sagittalis: they had their Original within the Scull. I felt the Holes they thrust out at; each Hole was round, I suppose of the compass of an Half-crown, and, as I afterwards found, had their Cystis from the Dura mater. The Infant seemed to be dying when I came; it died that night. The next day I opened it, and found it as I have said. There was also great quantity of Water floating within the meanings, and in the Ventricles of the Brain, and a gelatinous substance all about the Vessels on the upper part, as also under the basis of the Brain, etc. as I have before related.   

CHAP. XXIV. Of Scabs and Itch.  
AFter Waterish tumors I found Authors frequently treating of the Scab or Itch; 
Causes.  a Disease which seems to have its Original either from abundance of vicious Salt in the Blood, or possibly from a local Ferment in the Skin.  
A Scab catched by Infection seems pretty manifestly to own its Origine to a local Ferment, there being no other fault in the Body than what lieth in the Skin itself, and converteth the nutritious Juices thither conveyed into the Disease here mentioned. And its probable that most other Itches do begin in the same place, there being in the Skin a vicious Ferment which makes a Concoction accordingly, and consequently causeth all the other Degenerations that hap. These Degenerations do increase to a farther infection, if the Blood abound with a salt Serum; in which case the Fermentation becometh exorbitant, the Disease groweth more vigorous, spreads farther inward, and infects the whole mass.  
This way, I say, the Itch is very often generated, pressing from without inward: nay, I believe that most commonly it so happens. But I do not deny that it may likewise rise from within, as some of the greater sorts of Scabs certainly do.  
The Differences may be taken from the Cause, 
Differences.  and accordingly as it affects the whole Body, or some particular Part, as the Hands, etc.  
The Disease needs not much description; it's known by its nastiness and trouble, and upon that account is more important than it would otherwise be thought.  
The Scab or Itch is not esteemed dangerous to Life when it proceedeth from an outward Infection. 
Prognostic.  But if it own its Original to an inward indisposition of the Blood, it may prove dangerous; either when it is accidentally stopped by external Applications and causes, upon which occasion Fevers, Epilepsies, Consumptions, and many other like Accidents, have arisen: nay, when the Scab hath not been hindered in its untoward progress, the Blood hath nowithstanding been wholly corrupted, and the Patient brought to the grave. Another mischief it hath, viz. Infection, especially if the Scab be moist and full of subtle Humours. Upon all these accounts, both of the Turpitude, Danger, and Infection, it is convenient to propound a Cure.  
Whether this Disease arise from an outward Infection, 
Cure.  or inward indisposition of the Blood, the Cure is much one; only this latter requireth more your consideration, to take the indication from the Cause, and to make Evacuation accordingly before you apply your external Remedies.  
In the first place, a good Diet aught to be prescribed, of Mutton, Veal, Pullet, Chicken, etc. and those rather boiled than roasted. All sharp, salt and spiced Meats are forbidden: so are all Fish, Milk, and Herbage, as being corrupters of the Blood. Their Drink may be a small Wine diluted with Water, or a well-boiled small Ale, which may also be medicated with Dock-roots, Succory, and Grass-roots, the tops of Agrimony, Pimpernell, Harts-tongue, Fumitory, Hop-buds, etc. Or, ℞ fol. agrimoniae, origani, veronicae utriusque, an. M. ss. rad. enulae camp. scorzonerae, hirundinariae, an. ʒiij. macis, cinnamomi, an.ʒj. coq. in cervisiae tenuis lbuj lbuj. ad dimid.  
The Evacuation aught to begin by Bleeding; and if Blood abound, the Venaesection may be repeated, after the Body hath been somewhat emptied by Purging.  
The Purgatives may be Whey and Manna, with crem. tartar. or a Decoction of some of the opening Roots, with sena, rhabarb. etc. ℞ summit. fumariae, M. j rad. cichorii, polypod. lapathi acut. an. ℥ j flor. trium cordial. M. ss. epithymiʒij. senaeʒiij. rhabarb. incisi & in nodulo inclus. ʒj. liquiritiaeʒij. sem. foenic. dulc. ʒiij. coq. in aq. font. ad lb j. colatur. add syr. ros. cum agarico ℥ j ss. mannae ℥ ij. vel q. s. dividatur pro tribus dosibus. Decoct. senae Gereonis, Decoct. epithymi, in the Pharmacopoeia Londinensis, are proper in this Disease.  
If the Body be strong, and the Humours contumacious, you may purge with pulv. diaturbith, pulv. cornachin. pill. cochiae, de agarico; or with this: ℞ tartari vitriolati, diagridii, an. ℥ ss. turbith albi gummosi, hermodact. an. ʒij. pulverizentur, & cum oleis caryophyll. & cinnam. an. ℈ ss. Misc. Dosis à ℈ ij. adʒj. Merc. dulc. aethiops mineralis, Bezoard. mineral. ceruse. antimonii, are also of use in the Cure of this Disease. If the season of the year be proper, Barnet or Epsom Waters may be also good. Amongst the common people Brimstone and Milk is a usual Remedy.  
The outward Applications prescribed in the Cure of this Disease are numerous, and may be proportioned to the quality of the person, viz. as he is poor or rich, and the greatness of the Disease.  
If it affect but some one part, as the Hands, the Cure may be performed by Fomentations, Unguents, or Cerots: but where the whole Body is infected, there I propose Bathing as most necessary. A Fomentation may be made of such like; ℞ rad. enulae camp. lapath. an. ℥ ij. rad. bryoniae ℥ j summit. fumariae, abrotoni, an. M. ij. flor. ros. rub. M. j court. granat. sumach, an. ℥ ss. vitrioli albiʒiij. salis petraeʒij. aluminis, sulph. vivi, an. ℥ ss. coq. in aq. font. lbiiij lbiiij. colatur pro usu. After which the diseased Parts may be anointed with some of these following: ℞ unguent. rosat. ℥ iij. balsam. Peruvian. ℥ ss. arcan. corallin. ʒij. Misc. Or, ℞ sevi agnini ℥ iiij. ol. amygd. dulc. papaveris, an. ℥ j ol. hyoscyami per express. ℥ ij. unguent. tutiae Vigonis ℥ jss. aluminis usti, zinziberis pulv. an. ʒij. olibaniʒj. croci ℈ ij. cerae alb. q. s. Or, ℞ unguent. nutrit. ℥ ij. unguent. populn. ℥ j styracis liquidae ℥ j cinnabarisʒiij. Misc. Or, ℞ unguent. popul. ℥ j unguent. rosati ℥ ij. opii ℈ ss. Misc. In Chaps of the Hands or Fingers, ℞ unguent. rosati in succo aurantior. lot. ℥ iij. cerae alb. ʒuj. misceantur super ignem; addatur piperis albi, zinziberis pulv. an. q. s. fiat Ceratum.  
Where the Disease hath overspred the whole Body, there (as I have said) Bathing is necessary; and if the season of the year be proper, the River of Thames or other Rivers may serve: but in the colder seasons Bathing in warm water is effectual, the party sitting the while on a Bag of Wheat-bran. Persons of quality may have sweet Powders, as those of lign. cassia, Rhodium, calamus aromaticus, etc. If the Disease require it, they may have such Ingredients boiled in the Bath as have been prescribed in the Fomentation above: they may also have a mixture cinerum sarment. fraxini, alum. rup. sulphur. viv. etc. cap. pulverizatorum an. p. aeq. It may be quilted in bags, or made into balls with Wheat-bran and Soap, with which they may rub their diseased Bodies.  
In the time of the late Civil Wars our Soldiers in the Western parts of the Kingdom were much annoyed with this Disease, which being gotten amongst them, they infected one another. I commonly let them blood which fell under my care, and advised them to drink for their Morning's draughts Brimstone and Milk, and to anoint themselves with Brimstone and Butter. But in warm weather frequent bathing in the Rivers was their Cure.  
CHange of Diet and manner of living is frequently the cause of the Itch. 
1. Observat.  So a Youth of about seventeen years of age, newly entertained into a Gentleman's service, raised from a slender mean Diet to a more plentiful fare, broke out with Itch and Scabs all over his Body. Several Ointments were applied, and after all a Quick-silver-Girdle was put on him: but the Disease enraged, and under the Girdle the Skin was heated and excoriated much. I caused the Girdle to be thrown of, and advised the raw Parts to be dressed with a mixture of unguent. nutrit. and populeon; than caused him to be let blood, and purged with a Decoction of radic. lapath. sena, sem. carthami, etc. and directed him to bathe in warm water for some few days: by which he was cured. Such like Youths so diseased, in the hotter seasons, after Purging and Bleeding, I have commended to bathing in the River of Thames, and thereby cured them.  
A Girl of about twelve years of age was infected by her Playfellows at School in the Country, 
2. Observat.  and broke out in mattery Scabs and Itch all over her Body, insomuch as her Shift was frequently bloody with scratching herself. I let her blood also, purged her often with Infusions of Sena, Rhubarb, etc. I endeavoured to contemperate the Humours by calomel. and aethiops mineralis, but without success, it itching so intolerably, that, do what we could, she would rub and scratch, so as it not sooner healed in one place, but it broke out in the same or in another. So difficult a work it is to extinguish this Disease where it hath been of any long continuance. The weather growing warmer, she bathed in warm water, rubbed her Body with some of the  Bags the first three or four Bathe, and in about three week's space was freed of her Itch, and perfectly cured thereby. The Scars and discolouring of her Skin on her Hands and Arms were removed by anointing them with a mixture of sacch. Saturni with unguent. rosac.  
A Gentleman of about thirty six years of age was infected with the Itch all over his Body. 
3. Observat.  I let him blood and purged him, as hath been set down in the method of Cure; and, having so evacuated the Plethora, I prescribed him the taking of aethiops mineralis, and sent him some unguent. popul. etc. and cured him. By the same means I have cured some others since.  
A Gentlewoman of about fifty years of age was very much disturbed by an Itch. 
4. Observat.  After the taking divers Medicaments unsuccessfully she sent to me. I made her some Pills of aethiops mineralis, which she took morning and evening, without any observance of keeping her house; by which she was cured in eight or ten days, and hath not been troubled with it since, as she herself told me three years after, which was last Summer.  
A person of about forty years old, 
5. Observat.  of a melancholic and scorbutical Habit of body, was sorely afflicted with the Itch all over her Body. Her Physician at the same time being indisposed could not visit her, but, according to the relation her Servants gave him of her Disease, prescribed her Clysters, and purged her with such opening Apozemes as were proper in her case, advising blood to be drawn from the haemorrhoidal Veins by Leeches, and afterwards prescribed her a Bath, in which she bathed often, but without success. Upon which consideration I was desired by the Physician to give her a visit, to inform him of her condition. I did so, and saw her Hands, Arms and Breast overspred with brawny Scales, under which were mattery Wheals. She was very hot, and her Tongue parched; her Pulse seemed to be oppressed. I told her she had a Fever. She replied, it was for want of sleep occasioned by the intolerable Itch and soarness. I gave an account of her condition to the Physician, who thereupon prescribed her to be let blood about eight or nine ounces, and that night after a Clyster and a cordial Julep; by which she was relieved. About three or four days after she complained of a pain on her left Side, and had a Fever, with great heat and thirst. The Physician prescribed more blood to be taken away; which was done to the quantity of nine ounces or thereabouts, by which she was relieved of her pain and Fever, and daily recovered strength. And upon farther information of her Recovery, her Physician advised her to remove to Epsom, and there to drink the Waters. She did so, and by his Prescriptions was also cured there of her Itch.  
A Girl of about four years of age was brought to me in a poor woman's arms in the very midst of Winter, the ground being covered with snow. 
6. Observat.  She was broken out all over the Body with an Itch and mattery Scabs. The woman desired my Opinion of it, whether I could cure it. I told her the Cure was difficult; but when the weather should be more seasonable I would readily undertake it. The following Spring I was fetched to this Child, saw the Body so diseased as I before represented it, and was persuaded to undertake the Cure. I, considering that they were but few things I could give such a Child, and those required to be well tasted, therefore began with a small Ale medicated with sarsaparilla, lign. lentisc. China, and some of the Herbs and Roots proposed in the method of Cure for such Drinks. In some of this Ale I mixed a purging Syrup, by which the Child was frequently purged: than I gave her Merc. dulc. in cons. ros. damasc. once in three days, and continued medicated Ale for her ordinary drink, with which they also sometimes made a Posset-drink. By this method the Itch lessened, and the Scabs dried: but by the prosecution of it the Child's Chaps became somewhat soar. I cured the Child and finished my course by bathing it in Milk and Water, and some few Diaphoretcks. The Parents were well pleased with the Cure: but afterwards consulting a Physician (since deceased) in some case concerning their own healths, and discoursing of the Child's Cure, he persuaded them I had effected it with Mercury, and put them upon such a prejudice to the Medicament, as they from that declined the advising with me, suspecting I might again repeat the use of it.   

CHAP. XXV. Of Lepra, or Elephantiasis.  
LEpra and Elephantiasis have so many acceptions in Writers, 
Description, and Differences.  that it is fit to distinguish them in the first place. I shall therefore understand by Lepra the highest degree of the Itch, where the Scabs grow dry, and break out in the form of white Scales, sticking hard to one another, not easily to be pulled of; but if they are, they leave the place read, and soon return again. The Leprosy of the Arabians was a quite other Disease, which by the Greeks is called Elephantiasis, and is nothing else but an universal Cancer of the whole Body, black, and indeed a most miserable Disease, but I think scarce known in England. The Arabians also have an Elephantiasis differing from that of the Greeks, which is a kind of Varix, of which Authors may be consulted.  
The Disease I purpose to give you an Instance of is the Lepra Graecorum, supposed to be Celsus his Impetigo, and by others Psora, the white Scurf, proceeding from a vicious Salt in the Blood, that doth diminish the Serum of it, which when the Skin should separate by a just Transpiration, in stead thereof it converts it into a dry, salt, itching, white Scab, very troublesome to the Patient, and difficult of Cure.  
The immediate Cause of this Disease is, 
Cause.  as I have said, a vicious Salt in the Serum. Authors will have it to be generated of a mixture of Atra bilis, to be of a more gross matter, and to arise from evil Diet, a dry Intemperies of the Skin, a Suppression of the Haemorrhoids or Menses, also from a Quartan Fever; and to proceed by the way of Infection, as Scabs do, it being an excess thereof.  
It is known by the Description I have given of it, 
Prognostic.  and from thence a Judgement may be given of the difficulty and contumaciousness of Cure. If salt Humours abound very much in the body, it proves often incurable.  
The Cure of this Disease consists in the prosecution of the same method with that of the Scab; 
Cure.  only this, as it exceeds that, requires to be treated more strictly, and with Medicaments more powerful. I shall not trouble you with the particularising them, but refer you to the Observation following.  
A Young Woman about 20 years of age had been long afflicted with a Species of an Elephantiasis upon her left Brow. 
1. Observat. of Elephantiasis.  Many endeavours had been used by Prescriptions internal and external, viz. frequent Venaesections, application of Leeches, etc. The Disease increasing, I was consulted, and advised her to purge once in four days with Merc. dulc. and diagrid. and the intermitting days to take Bezoard. mineral. and to drink for her ordinary drink decoct. sarsaes, lign. lentiscin. with some of the alterative Plants prescribed in the method of Cure. The Part affected we fomented daily with the Fotus proposed in the method of Cure: and after the Scabs and Scurf were removed, it was anointed with some of that Unguent of Vigo's prescribed in the Cure of Herpes' miliaris. I began this Cure in Winter, presently after Christmas, and cured her before the Spring; yet advised the continuance of the internalls, purging her weekly, and when the weather should grow seasonable, bathing in fresh water temperately warm. I saw her half a year after perfectly well.  
A Maid of about thirty years of age, 
2. Observat. of Elephantiasis.  having been a long time diseased with an Impetigo, or Species of Elephantiasis Graecorum, in her Arms, Thighs and Legs, came commended to my care. It began with a Serpigo, making many round spots, such as are generally called Ringworms, with extreme itching, which by frequent scratching heated and mattered, and afterwards scabbed, and in progress overspred her Limbs with a dry white Scurf, under which the serpiginous circles lay covered. She had passed through the milder Remedies frequently without success: upon which account I designed Mercurialls; and beginning with Venaesection, afterwards purged her with decoct. epithymi, as it is prescribed in the method of Cure. After the second Dose I gave her twenty grains of Calomel. over night, and purged it of in the morning with the said Apozem: during which I caused her Limbs to be bathed and rubbed often with the Decoction to that purpose prescribed in the method of Cure, by which the Scurf was moistened and brought of; than it was anointed with one of the foresaid Unguents. After I had thus evacuated the Plethora, and disposed her body for Mercurialls more operative, I gave her each morning and evening a few grains of Mercur. diaphoret. in a bolus with cons. lujulae and Mithridate, disposing her thereby to a breathing sweat, and caused her Limbs to be daily anointed with unguent. enulat. cum Mercurio. These Medicaments proving unsuccessful, and her Chaps not growing soar, I caused her Limbs to be anointed with Sir Alex. Fras. his Unction prescribed in Lues venerea, and vomited her once in four or five days with Turbith mineral. By this course she emaciated, and her Skin became clean of the Impetigo, etc. but she did not salivate, nor indeed were her Chaps very soar. I concluded her course of Physic with Bathing, and Sweeting with Diaphoreticks, purging her between while, for the space of a fortnight, and dismissed her, with advice to drink a Decoction of rad. lapath. summit. fumariae dulc. amarae, etc. About two months after she shown herself to me cured and well complexioned, and is well at the Printing of this.  
A Maid of about fourteen years of age, 
3. Observat.  of a sallow Complexion and lean dry Body, having been diseased from her infancy with a white dry Scab from the crown of her Head to her Feet, her Skin of a Moorish tanned colour, after taking divers Remedies without success, was at last put into my hands for Cure. I purged her with a draught of the Decoctum epithymi, and the day after let her blood about eight ounces or more. She bore it well, and the blood was of good colour and consistence. The day after I purged her with some of the same Decoction, with the addition of syr. de pomis purge. and in the while caused a medicated Ale to be made according to the prescription hath been set down in the preceding Chapter of the method of Cure, which was her ordinary Drink, and served to make Possets those days she purged. Than I prepared a Bath wherein had been boiled fol. & radic. althaeae, lapath. enulae camp. bryoniae, fol. scabiosae, majoranae, fumariae, saponariae, bacc. laur. juniper. sem. staphisagriae, sem. sinapis, alumen, sulph. vitriol. Hungaric. and a Bag of Wheat-bran to sit upon. I prescribed her likewise the Mixture afore mentioned made into a Ball, with common Soap, for her to rub herself with while she sat in the Bath. She had also a Pearl-Julep ready to take upon occasion. After she had thus bathed according to her strength half or three quarters of an hour, she was leapt in a warm Sheet, put into bed, and took a morsel of a cordial bolus ex theriaca, cons. borrag. lujulae, Bezoard. occident. ocul. caner. troch. de viper. made up cum syr. è court. citr. & pom. alterant. Upon which she sweat an hour or more, than dried, and anointed with one of the  Unguents. A waistcoat, etc. was put on, and she arose and was dressed. Her Diet was of good nourishment and easy digestion, such as hath been already proposed. I continued this method of Bathing some while, and purged her every third day with calomel. ℈ j at night, and a draught of decoct. epithymi next morning. Her Head was full of white dry Scabs; for which reason her Hair was clipped close of, and her Head bathed with a Lixivium wherein had been boiled some of the same materials which were prescribed for the Bath, and than anointed with  Butter cum fuligine & sale, an. p. aequ. In the time of Bathing I caused her Head to be rubbed with common Soap, and bathed, to loosen the Scurf and dry Scales. Sometime during her Bathing I rubbed some of the largest Scales and such as stuck firmest with a Caustick-stone, which did not only hasten their fall of, but scoured the Skin notably well. Where the bigger Scabs separated, there remained for the most part an ugly discolouring of the place, and little Excrescences of flesh, by which those Scabs had been held on so close as if they had been thereby nailed fast. These Excrescences I rubbed of with the Caustick-stone, and where there was occasion I dressed the Parts with unguent. tutiae or lithargyr. yet notwithstanding the Disease risen in one part as it dried in others. Upon which consideration I vomited her with a few grains of turbith mineral. and repeating it twice or thrice, intermitting a day or two between, her Chaps swelled. Upon which I forbore the use of the Bath, and kept her warm, than salivated her seventeen or eighteen days: in which time the Scurf fell of quite, and her Skin became clean. I than purged her with Sr. Alex. Fras. his Potus amarus, and put her into a decoct, sarsae, Chinae, etc. with some of the hepatick Plants; I sweat her for some days with Diaphoreticks, purging her once in three or four days; than bathed her in warm water, washing her Body with Balls of Wheat-bran and Soap for some few days. Thus we concluded the course, she being to all appearance perfectly well, and her Complexion fresh. She should than have returned into the Country, but that I desired she might stay the Spring of the year for a farther trial of her Cure, it being than February. She did stay, and in April the Disease began to appear in her right Arm, and rise scattering about her Body; which increasing, I let her blood again, purged her with Whey and Manna, and bathed her in warm water, wherein I put a Solution of Sublimate, designing that way to flux her. But it not rising to my mind, I anointed her Legs and Arms with Sir Alex. Fras. his unguent. Neapolit. by which I salivated her near thirty days; in which time the Scabs fell of again. As the Salivation declined, I put her into a decoct. sarsaes as formerly, sweat her and purged her, and, having finished the course with Bathing as I had done before, delivered her once more cured. Her Friends, seeing her thus recovered, put her to School, to give her that Breeding which her diseased Body had hindered her so long from. Since that she is married, and, as I have been lately informed, continues well: yet is not so freed of that Disease, but that she hath sometimes little Remarks of it.   

CHAP. XXVI. Of Gutta Rosacea.  
THe Face is also subject to these irksome Diseases, which have been anciently distinguished by the names of Impetigo or Lichen, Mentagra, and Gutta Rosacea. The former of which raged in Italy, and was taken notice of by Pliny in his days as a malign Disease; but it is not known in our times, unless it be in the Lues venerea, where are sometimes found all the Species of Impetigo and Pustulae that ever were mentioned by any of the Ancients. But in this place I shall only take notice of the Gutta Rosacea, a Disease which, when heightened by acrimony, is not inferior to the most malicious of other Diseases, and as difficult of Cure.  
Gutta Rosacea ariseth in little hard Tubercles' like so many Hordeola, 
Description.  affecting the Brows and Face all over with great itching, which being scratched look read, and rise in great Welks, rendering the Visage fiery, and in progress of time make those toting Copper-noses, as we generally express them.  
The immediate Cause is gross hot Blood affecting the Face with such a flushing heat as is commonly seen in Blushing, 
Cause.  and by reason of its gross consistence can neither return back, nor suddenly discuss, but remaineth in the Part, and after some time riseth in read Pimples, which so vitiate the tone of the Fibres, that though the Patient do get afterwards a better Habit of body, yet doth he for the most part suffer under the Disease. Ill Diet is a Cause, hot Spices, Onions, Garlic, and the like; so are strong Wines: yet it's thought more commonly to befall those that drink strong Beer. A suppression of the Menses or Haemorrhoids is often a Cause of this Disease.  
The Signs of the Disease are, a flushing heat, with read Pimples and Tubercles', 
Signs.  which in progress of time become bluish, and of a more dark read colour.  
The Gutta Rosacea is difficult of Cure in its recency: and if it be of long continuance, 
Prognostic.  the Tubercles' grow big, and Excrescences arise out of them, and they accompany the Patients to their graves.  
The Cure is begun with regulation of Diet, 
Cure.  removing of the Obstructions in the Viscera, and contemperating of the evil quality of the Blood. The Diet aught to be of good nourishment and of easy digestion, as hath been above said. The Evacuation consists in Bleeding, and Purging with opening Apozemes: as, ℞ fol. cichor, acetosae, an. M.j. senaeʒiij. tamarind. ℥ ss. flor. trium cordial. an. P.j. liquiritiaeʒij. sem. foenic. dulc. ʒj. coq. ad ℥ iiij. in colat. dissolve. Rhei in aq. cich. infus. ʒj. syr. ros. solut. ℥ jss. aq. cinnam. cochl. j Misc. Or, ℞ rad. oxylapath. acetosae, cichor. gramin. an. ℥ j fol. endiviae, fumariae, dent. leon. capill. Ven. an. M.j. sem. quat. frig. maj. an. ʒiij. liquiritiae ℥ ss. senae ℥ ij. tamarind. ℥ j galang. ʒij. santal. citr. ʒj. coq. ad lb j. colat. add expressionem ℥ ss. rhab. in praedict. decoct. syr. de pomis purge. & diasereos an. q. s. fiat Apozem. With which you may purge your Patient. After which Chalybeats may be of use, etc.  
In the use of externalls, if the Disease be recent, only with a flushing heat in the Skin with some small Pimples, a decoct. malvae, bismalvae, viol. sem. verbasci, psyllii, or the like, may give a breathing to the Humour; and a Posset made with juice of Lemons or the like may restore the Face to its former good Complexion. But if the Disease be of longer standing, and the Tubercles' many and hard, you must than bathe them with more powerful Emollients: as, rad. sigil. Solomon. cucumber. agrest. rad. lilior. sem. lini, foenug. etc. and cerat. dialthaeae may be afterwards applied on them, and such Medicaments as may dispose them to Suppuration: than they may be opened with a Lancet, and the Matter discharged. You shall afterwards deterge and cicatrize them with as small a Scar as may be, and smooth the Skin with such like; ℞ camphoraeʒj. ol. amygd. dulc. ʒiij. mix them in a mortar, than add ol. Tartari per deliquiumʒij. vitell. ovor. num. ij. sacch. Saturniʒss. aq. flor. fabar. sigil. Solomon. & aq. ros. an. ℥ iij. Or a lac virgins thus made; ℞ lithargyr. aur. ℥ iij. aceti optimi lb j. coq. ad dimidium, & colatur. add salis come. in aq. font. soluti ℥ iiij. aq. ros. ℥ vj. sal. armoniac. ʒj. Misceantur omnia simul pro usu.  
A Gentleman of about forty years old was very much vexed with a flushing heat all over his Face, 
Observat.  with some read Pimples not considerable. Many Medicaments he applied, but in progress of time they terminated in Tubercles', some whereof were round, others of an oval figure; some were hard, others soft. They all itched extremely, and put him upon a pinching of them, upon which they grew the bigger. One of them he opened with a Penknife, and gave vent to a viscous white Matter, but the Tubercle filled again. Upon which consideration he advised with me, and desired my help. I caused a Fomentation to be made of some of the Emollients above mentioned, and to the Faeces beat and pulped I added axung. gallin. anatis, ol. ex ped. bovinis, and with a little terebinthina and Wax made a Cerote, which after the use of the Fomentation was daily applied. In the while he was purged, as hath been above proposed, and let blood, and after wards drunk Epsom Waters. By this method much of the Matter was evacuated, the heat contemperated, and the Tubercles' in part breathed forth. Those that suppurated I opened, and discharged the Matter: and those that would neither suppurate nor discuss, I cut into, and permitted them to bleed. By the continuance of Emollients they resolved, and in the space of six weeks he was in a manner freed of these Hillocks, and his Countenance became smooth and clear.  
Some others I have cured by the same method, and of the female Sex, where it was more discernible. I shall forbear the instancing them, because it was a work of time, and performed after the same method.   

CHAP. XXVII. Of Flatuous tumors.  
WE have already treated of tumors coming from Humours, which was our first general Head: we shall now say somewhat of those that own their Origine to Wind, called by the Latins Inflationes, by the Greeks Emphysemata.  
They are by Authors usually ranked next to Oedema, as partaking much of the nature of those tumors, having generally a watery Phlegm joined with them.  
Emphysema is a light puffy Tumour easily yielding to the pressure of your fingers, and ariseth again in the instant you take them of. 
Description.  It is of an uncertain bigness, some times very large, other times small, without any weight to the Part that contains it.  
As to the Differences, they are either pure, or mixed. 
Differences.  A pure Emphysema is found rarely, unless it be in cases of Wounds in the Breast, where the air getting in between the Muscles and Membranes doth puff them up like to the inside of a Shoulder of veal. Most usually they are mixed with Humour, which is always Phlegmatic. They differ also as to their place, some being inward, others outward. The inward belong to the Physicians. Outwardly we found them upon the Eyelids, on the great Joints, and in other membranaceous Parts. The Belly is very subject to them, both in the Scrotum and Navel, which are the usual seats of the Hernia ventosa; and indeed in other parts of it wheresoever of the Guts, etc. the Peritonaeum is relaxed. In which places we do first found a soft windy Tumour, and at length, if it be not prevented, an Extuberance of the Gut itself.  
The Cause of the pure Emphysema is evident, viz. the ingress of air. 
Cause.  But that of the mixed ones is not so be assigned. And possibly he that reads what the learnedest Authors have said on this Subject will departed unsatisfied.  
In the inward Parts, as in the Ventricle and Guts, we found manifest acidities, which meeting some fermentaceous Matter do huff and puff, and, being contained within the bounds of these Cavities do blow them up into a Tumour, which is usually dissolved by Evacuation upward and downward; which notwithstanding doth not prevent the successions of new Inflations, unless the fermenting principle be destroyed.  
In the outward Parts, as the Knees, etc. we do imagine some proportionable degeneration of the local Ferment, which doth make the like Ebullition with the extravasated Humour. The Vapour so generated being confined within the Skin, so as not to be suffered to pass out, remains there in a windy or flatuous Swelling.  
Those tumors are without alteration of colour in the Skin, or pain, 
Signs.  unless they lie deep amongst the sensible Parts near the Periosteum. One Sign is given us of them, viz. the sudden increase and diminution. The Ancients distinguish an Emphysema from other tumors by the Sound it giveth when struck upon. But that Sign I have not met with, not not in the Tympanites. Indeed a crackling is often felt, if the Tumour be in the Knee or other outward Part; and in the Belly Wind is heard to rumble: but what concerneth inward Diseases is not within compass of my discourse.  
Flatuous tumors affecting the great Joints are of most difficult Cure, 
Prognostic.  and not to be opened without mature consideration. All tumors of this nature are more easily cured in Summer than Winter. But those of from the Joints may be opened at any time, and are of easy Cure.  
In the Cure of those tumors you may proceed by internalls, as hath been showed in Oedema, 
Cure.  the Causes differing but little, both being from a Phlegmatic constitution of the Blood. Phlebotomy may be admitted, if Blood; but generally the Pituitous Humours are here in fault, and they are to be prepared and purged as aforesaid.  
The external Applications aught to be such as may by their heating and attenuating quality discuss the Flatulencies. Such are summitates majoranae, abrotoni, hyssopi, origani, rutae, rorismarin. bacc. lauri, juniperi, sem. anisi. foeniculi, carui, cymini, etc. Of which Fomentations may be made in Lixivies or Wine. Sacculi likewise may be made ex sem. milii, cymin. & sale. Embrocations may also be as followeth. ℞ ol. rutacei, sambucini, chamaemeli, anethi, an. ℥ j majoranae, carui, an.ʒj. Misc. ol. sulphuris, terebinth. balls. sulphuris Rulandii, Empl. de baccis lauri, è cymino. Or, ℞ faecis betae novae lb jss. micae panis furfuracei lb ss. flor. ros. rub. ℥ j coquantur in vino albo; deinde contunde, & add piperis, caryophyl. nucis myristicae, zinziberis, an. ʒijss. sem. cymini, anis. foenic. ammeos, an. ℥ ss. ol. chamaemeli, anethi, rutae, an. ℥ ij. Misc. S. A. & fiat Cataplasma. Searification, Blistering and Cupping are also commended. If by none of these it yield to Discussion, but inflame and grow painful, treat it with Anodynes; of which cerat. oesypi and lana succida hath the preeminence. But if the Tumour be in such place where it may be safely opened, the speediest way of Cure is by cutting into it. Some Writers have advised the binding of the Part above and below, and opening the Tumour between. If you think there be reason for it, do so; but there is no fear of its flying away from the vent you shall give it. The Cure of the Abscess is afterwards effected as in other crude Abscesses hath been showed.  
In penetrating Wounds of the Thorax, and where the external Orifice is small, there flatulent tumors may be frequently seen greatly blowing up that and the adjacent Parts. The Cure is performed by enlarging the external Orifice in the Skin. You may see an Observation of it amongst those of the Breast in the Treatise of Wounds.  
Of the many that have come to me supposed to have the King's Evil, there were not a few diseased with crude tumors of other kinds. Some of those which seemed most like Flatulent tumors I opened, but they proved all to be phlegmatic and waterish tumors. Those in the very Knees which are so generally esteemed flatulent, I opened by puncture with a Lancet, some to the very Bone: in the most prominent parts there issued forth only a few drops of serous blood, and that without any diminution of the Swelling. In some of those in which I made the Puncture lesle deep I passed in a Probe, where feeling a Tumour under the Periosteum, I penetrated it with my Lancet, and discharged an Ichor in small quantity: the Bone was there carious. Upon which consideration I am apt to think that all these painful Swell in the Knees (which are not strumous) do arise from an over-moisture of the Membranes and Ligaments, which in progress of time doth corrupt the Bone underneath, so that they apostemate and terminate in carious Ulcers. Those which are lesle painful are generally superficial, proceeding, as I suppose, from an over-moisture of the Membrana carnosa and Parts above it. It being so, our best endeavours aught to be in the applying moderate attenuating and exsiccant Remedies with good Bandage.  
A Young Gentleman of about eighteen years of age was commended to my care by Doctor Denton. 
1. Observat.  He had a round soft Tumour upon the forepart of his right Thigh, without Inflammation or Pulsation. I applied a Caustick upon it, and the next day divided the Escar: there came nothing of Matter forth. I thrust my Knife deeper into it: there followed only a few drops of blood, but the Tumour sunk. I dressed up the Escar with unguent. basilicon to digest of the Slough. During the separation of it there appeared no more Matter than might reasonably be expected from such an Escar. After separation thereof the Ulcer incarned and cicatrized in few days. This we judged a flatulent Tumour, yet it was not discovered by its Noise or Sound.  
A Citizen's wife aged about thirty six years, of an ill Habit of body, had, 
2. Observat. of a flatulent Tumour on the outside of the Thigh near the Knee.  amongst other Diseases, a soft white Swelling a little above her Knee on the outside of her right Thigh. Many Applications having been ineffectually applied, Doctor Walter Needham and myself were consulted. We concluded it a Flatulent Tumour, and proposed the opening of it; to which purpose she was purged. Her Body being so prepared, I applied a Caustick on the most prominent part, and the next day divided the Escar, and passed my Knife deep into it: there came out nothing of Matter or Blood. I made a search with a Probe, and passed it almost to the Bone, meeting no other opposition by the way than a soft puffy membranous Flesh, such as is usually seen in a Shoulder of Veal. I dressed it with Lenients, Emplasters and Bandage.  
The fourth day, the Physician being present, I took of the Dress; on which there appeared little more Matter than what is usual from such Escars. The Tumour continued, and was somewhat inflamed: it required Digestion. To which purpose I sprinkled in about ℈ j of Merc. praecipitat. and dressed it up with Lenients as before. The third day after I dressed it again, and saw the Escar separating, and the Abscess digested. I dressed the Abscess again with Praecipitate, and the external parts with unguent. tutiae. By this method the Abscess digested, and the Tumour sunk, and was cured as hath been above showed. Many of these tumors we meet with which are certainly raised by a Flatus, yet give no Sound, nor yet doth there appear any Wind to puff out upon opening.  
In the time of the Wars a Soldier was brought to me much wounded. 
3. Observat.  During his Cure we took notice of a large white Swelling on the outside of one of his Thighs, which we supposed Matter: and after the Digestion of his Wounds I opened that Tumour. There issued out only a little waterish Humour, part whereof was tinctured with the blood dropping from the incised Lips. There was neither crackling of Wind nor hollow Sound, yet the Tumour sunk from that Dressing; and by Discutients and Exsiccants with good Bandage it was soon cured. Some other such like tumors I have met with, and cured accordingly.  
A Gentlewoman of about thirty years of age had a Swelling on her right Knee encompassing the Rotula: it had been growing about a year or two. 
4. Observat.  I supposed it flatulent, and treated it as hath been set down in the method of Cure, by Fomentations, Embrocations and Emplasters: but it heating thereby and increasing, I applied an Empl. è bolo, and caused a Knee-piece to be laced on: by the continued use of which the Swelling was restrained, and the Knee recovered its former strength.  
Another about forty years of age, of a full Body, had a round soft Swelling lying on each side of the Rotula without alteration of colour in the Skin. 
5. Observat.  It had some time disabled her from going up or down a pair of stairs, and often hazarded her falling in other motions. In this case I applied an Emplaster ad herniam, with an addition of cerat. hyssopi over each Tumour, and a Compress of brown Paper soaked in aqua fabrorum, over which a laced Knee-piece was put on, and straightened proportionably. By the renewing these Dress once in a week or ten days the Swelling discussed, and her Knee recovered its former strength: yet she continued the wearing of the Bandage some years.  
A young person having been some years afflicted with a Swelling in one of her Knees, 
6. Observat.  after various Applications it increasing, I was sent for, and saw it overspreading the Joint and Parts about, retaining the natural colour of the Skin. It yielded to the impression of my fingers as a Bladder half blown up; by which I judged it flatulent. The Bone on the inside of the Knee was also protuberant, which at their first discovery of the Tumour gave the Parents a suspicion it was luxated. I began with a Fomentation made of a Decoction of some of those Plants proposed in the method of Cure, and embrocated it with unguent. nervinum, and with Wax made up a Cerote of the same, which I applied with good Bandage till I got a Knee-piece made. Being made I laced it on, and from that time repeated the Dress once in a week or ten days. By this method the pain and Swelling diminished, and she walked on it with more strength. Indeed the Cure of these chief depends on the well-lacing of them; for accordingly as it was straightened, so the Swelling lessened. The weather growing seasonable, she went to the Spa, and afterwards to the Bath: from whence returning not better, she was again recommended to my care. I than attempted the discussing it by Medicaments more powerful: they heated the Tumour, and blistered it here and there, but did not lessen it. After I had assuaged the heat by Lenients, and healed the Excoriations, I applied over the Tumour Empl. diasulphuris Rulandii, laced on the Knee-piece again, and renewed the Application once in ten days. In their overhard lacing of this Bandage the Leg swollen: to prevent which, I caused a laced Stocking to be put on it. By the wearing thereof the Knee-piece was laced with more advantage, and she recovered strength of it daily, to walk, dance, and visit her Friends abroad. During this, Doctor Micklethwait being in the house visited my Patient, prescribed such Internalls as were proper for her, and proposed the embrocating of the Tumour cum oleo sulph. terebinth. which was used daily for some time. Afterwards a Pultice was advised of the tops of green Wormwood, Rue, Sage and Feverfew, with Hog's grease: this was applied till it became offensive to her. After these several Applications, it appearing to them more visibly that her Cure consisted in the well lacing of her Knee-piece, there was taken more care therein by her Servants, and a warm Cerote applied under it. The Tumour lessened, and is since very much diminished. I have lately taken of the Plaster and laced Stocking, and hope in few weeks she may leave of the Knee-piece, the Swelling being now inconsiderable.  
A young Gentlewoman came to London with a puffy Swelling on her left Foot near her Toes; 
7. Observat.  part of the Swelling stretched over the Toe next the little one, on which the Tumour was near two finger's breadth. It was without Inflammation or considerable pain. I supposed it to be Wind, and would have given vent to it; but, not being permitted, I endeavoured than by Discutients to scatter it: it inflamed, and would not yield thereto. I than applied Emplastr. è bolo, and put on a laced Sock with a Bracer tacked to it for that Toe, and by Compress and careful Lacing suppressed the Swelling, and gave her so much ease, that after some time it hindered her not form taking those Divertisements others her Schoolfellows did. After she had worn this Sock some months, she left of the use of Emplasters, but continued the Bandage some years. The Swelling on her Foot is since discussed, but the Toe continues still big, yet inconsiderably to what it was.   

CHAP. XXVIII. Of Hernia.  
HAving thus far treated of tumors by Humour and Wind; it remaineth now that I say somewhat of a Tumour made by the interposition of a solid Body. Examples of this nature are frequently to be found in some sorts of Hernia, viz. the zirbalis and intestinalis, the falling out of the Kell or Guts, which, being both of them solid Bodies, are often interposed preternaturally between several Coats of the Peritonaeum, Scrotum, or other adjacent places, and do denominate the Tumour an Hernia of that Part where it is raised.  
If is burst out at or near the Navel, extending there the Peritonaeum, together with the several Tendons of the obliqne and transverse Muscles of the Abdomen, 
The Kind's. Exomphalos.  it is called Exomphalos. If either of these break down into the Cod, that Tumour is most strictly called a Hernia. 
Hernia.  And though only these which I have here mentioned be strictly that Disease, yet other tumors of those Parts, for their likeness to these, obtain the same name: viz. the Hernia aquosa, which is an Hydropical Tumour; the Hernia carnosa, which is a Sarcoma, or sometimes Scirrhus, of that Part; the Hernia ventosa, which also belongs to another Head, as also doth varicosa: of the former notwithstanding of these two I do add something in this place, by reason of the affinity of the Cure.  
I shall first begin with the Hernia Scroti, intestinalis and zirbalis: 
Hernia Scroti.  both which are manifestly the falling down of the Gut or Kell, either quite into the Scrotum, which is a perfect Rupture; or else part of the way only, which is usually termed a Relaxation.  
That this Disease may be throughly understood, it will be necessary to give you an exact account of the Parts concerned. The principal is the Peritonaeum, or strong Membrane that lines all the insdie of the Abdominall Muscles, and than passing to the Back, doth there some way or other involve and give Coats to all the Viscera. It is a strong Membrane,  double; in the duplications of which all the Viscera of the Abdomen are hid, and through which all the Vessels do pass. It's thickness and thinness is very different in several Parts, according to the several necessities of Nature. The lower part of it is strongest, to enable the Belly the better to bear the weight of the Intestines; and is usually presumed by inadvertent men to be perforated in the Navel, for passing of the umbilical Vessels, and in the Groin, for the transmission of the Seminalls. But he that will consider the case will found it otherwise. For the Membrane, being  double, doth so receive these Vessels between its Coats, as that they passing behind the first Coat leave it  entire, both at the Navel and Inguen. But in the latter place, the Seminalls do take the outward Lamina, of the Peritonaeum along with them, which, containing them in itself, doth at length make that Tunicle which involveth the Testicle, by the name of Tunica vaginalis or Elytroides.  
This, I say, is the most natural structure of the Peritonaeum, in which if the inward Lamina be strong, it keeps within the hollow of the Belly the Guts and Humours, if there, so that though the Cavity be full of water, yet it transmits' nothing into the Scrotum; and the tumors that hap to the Scrotum of Hydropical persons are usually anasarcous, coming outwardly into the Membranes of the Scrotum, not passing from one Cavity to the other.  
But if this inward Lamina, either through its own weakness, or the force put upon it in straining, etc. do relax, the Entrails thrust forwards to the Scrotum, and in the top of the Process (usually so called) suffer an Angle to be excavated wherein part of the Guts is contained, and the Membrane extended, but not broken. In which case the membranous partition that intercedes between the Guts and the Scrotum is visible. But if the Membrane break, than the Entrails rush down without control into the Scrotum.  
In Women also Ruptures are apt to hap in the Groin in the same place by reason of the transition of the Ligamenta uteri teretia, which pass between the Laminae of the Peritonaeum after the same manner as the Seminal Vessels do in men. These tumors usually end in the Groin, and are known by the name of Bubonocele, which is a common name to all the Herniae in that place, whether they be in men or women.  
The Causes of Hernia intestinalis and zirbalis are divers. 
Causes.  In Children it proceeds from abundance of crudity or moisture, vehement crying, and holding their breath too forcibly. In those of more age, from violent Exercise, hard riding, jumping, vaulting, hallowing, carrying great burdens, a Blow or Fall, or any thing that many over-stretch the Peritonaeum. The very weight of the Bowels and Kell in fat people is often the occasion of a Rupture. In such bodies Vomiting may be a cause; yea the very straining upon the Close-stool (if they be costive) is enough to make a Relaxation in some part, and a Rupture frequently followeth.  
In Women hard labour in Childbed hath often been the Cause of a Rupture in the Groin, as also in the Navel.  
The Sign of a Hernia by Relaxation is, a certain Eminence or soft Tumour appearing under the Skin in either of the Groins, or other part of the Belly, without Inflammation or pain, 
Signs.  which disappeareth after the Patient hath lain some time on his back in bed, and appeareth again when he is up: and by laying your hand than upon it, if he cough or sneeze, you will feel the impulse of the Bowels, which is not to be felt on the sound part. According as this Swelling is greater or lesle, so it is more or lesle accompanied with an uneasiness or Colic. In Infants this Disease is scarce taken notice of by their Nurses, till it hath made its way into or near the Scrotum, to which place these through neglect do fall.  
The Sign of a Hernia intestinalis made by Eruption is, the sudden rise of the Tumour, whether it be made by Blow, Fall, or the like; in which case the Intestines or Omentum, or both, slide down into the Scrotum, or lie in a great Tumour in Inguine. If it were caused by a Blow or Fall, there is sometimes blood extravasated, and the Swelling is painful, whether it be in Inguine or Scroto; and it soon descendeth from the Inguen to the Scrotum, where you may distinguish it from a Sarcoma by laying your hand upon the Production of the Peritonaeum just at its Exit from the Abdomen, than putting the Patient upon coughing or sneezing: upon either of these you will perceive the motion of the Gut, if it be there. If this Hernia be neglected in the Female sex, it will make a round Tumour near the Pudenda.  
The Hernia omentalis is an unequal soft slippery Tumour, of a continued bigness, whether the Patient be full or empty: whereas that of the Intestine is round, and hath a certain murmuring, if it be empty; and if it be full of Excrements, they may be felt in it. The Tumour is also greater or lesle according as the Patient is full or empty: a painful Colic attends it; and, if it be not timely reduced, a Fever and Vomiting followeth.  
The Hernia umbilicalis is discerned by the Prominence in the Navel. Whether it be of the Omentum or Intestines, may be judged by what I have already said of the other.  
The Pneumatocele or Hernia ventosa, affecting the Belly in divers parts, is distinguished by its quick growth and roundness. Infants are frequently subject to it, sometimes in one Groin and Testicle, and other times in both. It lodgeth between the Testicle and Tunica vaginalis, making a Tumour like the Bladders which are found in some Fish: it is long or round, according as it possesseth only the cavity of the Testicle, or that and the whole Production.  
No Hernia intestinalis is without danger: 
Prognostic  those made by Relaxation are least dangerous. Those by Ruption in Children and Youth under twenty years of age, or while they are growing, are curable if they be timely reduced, though the Intestine be fallen down into the Scrotum: but in people of full growth they are for the most part capable only of being kept up by good Bandage. If the Intestine be not speedily reduced, there followeth grievous pain, with Colic and Fever, because the excretion of Excrements is prohibited; from whence Inflammation, vomiting of Excrements, yea sometimes Gangrene and Death, ensue. But if the Rupture in the Peritonaeum be very large, the Intestines frequently perform their office as safely in the Scrotum as if they were in their natural place within the Abdomen.  
The Hernia umbilicalis is subject to the like Accidents as that of the Scrotum, if not timely reduced.  
In other cases the Skin is sometimes worn so thin that it breaks, and the Cure is most difficult, by reason of continual pressure of the Bowels.  
The Hernia omentalis is not dangerous, yet by reason of its softness and slipperiness it is difficultly reduced, and retained within after it is reduced, but in Children it is of easy Cure: and those people who are of a sanguine and humid Temper are of more hopes of Cure than those of a dry Habit. Yet if the Tumour be small and recent, and only in Inguine, the Cure is feasible, be the Habit of body what it william.  
Hernia arising from Wind is of more easy Cure, especially in Children, whom it generally afflicts.  
In order to the Cure, you are to consider the Hernia, 
Cure  whether it be intestinalis or omentalis, recent or of long continuance, made by Relaxation or Ruption. You are in the first place to endeavour the reduction of it; to which purpose, you aught to advice the Patient to lie upon his Back, with his Head declining, and his Hips raised high, with his Heels retracted towards his Hips. Than with warm  you are to try how you can reduce it, pressing moderately and gradually, taking care that you do not bruise it or the Testicle. If it yields not to such endeavours, you are than to consider whether the repletion of Excrements or Crudity were the Cause; in which cases you may prescribe a Clyster: ℞ rad. & fol. althaeae, fol. malvae, viol. betae, parietariae, an. M.j. flor. cham. melilot. sambuci, an. Mss. sem. lini, foenugraec. an. ʒuj. sem. anisi, foenicul. an. ℥ j coq. ad tertias; colat. sum ℥ viij. in quibus dissolve. sacchar. rubr. ℥ ij. mellis rosat. colati, diacathol. an. ℥ j hierae picraeʒuj. ol. cham. lilior. an. ℥ ij. salis come. ʒij. fiat Enema. Or else Clysters of fat Broth with a little Salt. These may be repeated till you have emptied the Bowels, and the while the remaining Decoction may be applied hot with Stupes: and if the Excrements by hardened in the prolapsed Intestines, you may make a Cataplasm of the Faeces, by beating them up with axung. porcin. unguent. dialthaeae, ol. lilior. etc. and apply it hot to the Scrotum. Thus the Excrements may be softened and evacuated. If Flatulency be the cause of its not reducing, foment and embrocate with such Discutients as have been proposed in Flatulent tumors, (if what is prescribed be not sufficient;) than reduce the Hernia: which being done, your next work will be to shut up the Foramen by which the Omentum and Intestines passed forth; and that we shall propose with Medicaments that have a binding and agglutinative quality. Such is Emplastr. contra rupturam in the London Pharmacopoeia, and Emplastr. de pelle arietin. Or, ℞ mastic. thuris, aloes, sang. dracon. sarcocollae, bol. Armen. gypsi, gallar. an. ʒij. ichthyocollae & taurocollae in aceto dissolute. an ℥ ij. malaxentur, & fiat Emplastr. Spread some one of these upon Leather, and apply it with some convenient Truss; of which some are made of Dimity or course Holland, others of Whale-bone, Steel, etc. Those made of Dimity have Bolsters stuffed with Cotton for one or both Groins, with two Straps to come betwixt the Legs, and fastened behind or to the Bolsters by Clasps or Points. Those that are designed for the Bubonocele have a couple of Straps tacked to the end of the Bolster, and, passing betwixt, are fastened with Points behind. These Trusses are proper for Infants and tender bodies, where the Rupture is recent, and for the most part made by Relaxation. They are necessary in the Cure of Ruptures in people of years, and have always served my prupose in the Cure of Children. There is great care required in the putting them on and wearing them. In Children it is the work of Nurses or Maidservants, who frequently tie them too slack about the Loins, and too straight betwixt the Legs; by which negligence they bring the Truss over the Buttock, or else permit the Rupture to slide down under the Bolster into the Scrotum: all which Errors, though they be forewarned, yet they do often commit, and thereby the Cure is delayed, and imputed to the Ignorance or Neglect of the Chirurgeon. To avoid which, we are sometimes necessitated to put them on Straps over the Shoulders, such as Labourers commonly wear to keep up their Breeches. Nor indeed are Children only sufferers in this case, for people of full age, by reason of carelessness in putting on and wearing their Trusses, permit small Herniae by Relaxation in Bubonocele to increase and slide down in Scrotum. To prevent which in Men, I commonly order a Bag-truss to be fastened near the Bolster, by which the Scrotum is tucked up, and rendered the lesle capable of receiving the prolapsed Omentum or Intestine. In Women, through ignorance and shyness in consulting, small Herniae in Inguine do also increase to a great bulk: in which case a hollow Boulster-truss may be fitted proportionably to the Rupture, or a Bag-truss, to retain it up. In Men, through the often descent of the Bowels, the Eruption is made some times so large, that the Intestines do their office in the Scrotum with as little disturbance as if they were in the Belly: in which case a Bag-truss is to be proportioned, with a hole for the Penis to pass through; which being put on whilst the Patient is in bed, and in a declining posture, will much hinder the prolapse of the Bowels, and ease the Patient much in his going abroad about his affairs; and by the continuance of the Chirurgeon and his endeavours the Rupture may be restored to good condition. These sorts of Trusses are well made by Mr. Syms in Bell-alley near Temple-Bar.  
There are other sorts of Trusses made of Whale-bone. The stuffing of the Bolster is placed upon Cork, which will sit firm upon Children and Youth. There are others made of thin Laminae of Tin and Steel, with and without Joints, which do sit easily about the Loins: they have also Bolsters, that, by virtue of Worms and Screws fixed in them, do sit closer or more distant, and retain the Rupture up without pressing upon the Spermatick Vessels or Os pubis. They are useful in old Herniae. These are made by Mr. Smith, a Scotchman, who lives near Fleet-bridge. He is the most ingenious man in that work, and maketh the best Trusses for the retaining the Hernia umbilicalis within its bounds. But in great fat Bellies we found it often necessary to put them on a Bracer to encompass the Belly, which may be laced behind or on one side, to bear part of its weight.  
Having thus far provided for the retaining the Hernia within its bounds, you aught to have the Hair shaved, if there be any, and apply Agglutinatives with good Bandage. If the Bolster sit uneasy, a Quilt may be made to lie under it, or a Compress of brown Paper soaked in aqua fabrorum wherein some Astringents have been boiled; by which your Truss will sit the easier, and retain the relaxed or torn Parts, and thereby they may be the sooner agglutinated.  
Our next consideration will be matter of Diet and manner of living. Their Diet aught to be sparing, but of good nourishment. as Mutton, Veal, Lamb, Pullet, Chicken and the like; avoiding all Herbage, Fruit, Fish, and White-meats, such as may engender Crudities. Their Bread aught to be of Wheat, with carminative Seeds in it. The confected semina carui, coriandri, foeniculi, and the like, are commended after Dinner and at other times to further Digestion. Their Drink a read Wine with a little Water wherein god's of Steel have been quenched; or Ale wherein some of the specific Plants have been infused.  
Rest is of great advantage in the Cure of these Herniae. Fabritius Hildanus and others who have writ of this Disease will tell you, that some have been cured of great Ruptures by keeping their bed upon some accident of a Fracture, or fit of the Gout, when before their best endeavours in the Cure signified nothing. In consideration of which they forbidden all manner of Exercise; and advice them that, whilst they keep their beds, they should often feel with their hands about the Part affected, principally in case of any sudden Sneezing or violent Coughing, and especially in easing nature by Stool, that, if any Relapse hap, it may be helped. But that you may the better avoid such Accidents, you aught to keep their Bodies soluble by Clysters, Suppositories, or lenient Electuaries. Where the pituitous Humours abound, they require sometime also to be purged; for which I refer you to the Chapter of Oedema. After it may be proper to prescribe some Agglutinatives; and they are either simple, or compound.  
The simple are reckoned among the Vulnerary Plants; not all of them, but such as have a moderate Astringency, and are without remarkable heat or acrimony, and have specifical virtue. Such are consolid. maj. & minor, quinquefolium, equisetum, sanicula, auricula ursi, pilosella, jacea utraque, sigil. Solomonis, tormentilla, osmunda regalis, hippoglossum, lunaria min. perfoliata, herniaria, herba trinitatis, court. cypress. granat. etc. The distilled water of osmunda regalis is commended in the Cure, so are also pilosella, hippoglossum, lunaria, and severally given in a Powder in a Decoction of Comfry-roots. Perfoliata and herniaria are delivered to us to be of so great virtue as to cure this Disease in few days, conditionally the Rupture be kept in by a good Bandage. They may be given as Tea; or they may be juiced or powdered, and mixed with read Wine.  
The more compounded are these: ℞ cons. ros. rub. vet. symphyti, an. ℥ j florum salviae, acori, an. ℥ ss trochisc. de carab. vel de spodio, vel è bolo, ʒiij. cum syr. cotoneorum, fiat Electuarium: of which the Patient may take twice or thrice a day, drinking thereupon six ounces of this medicated Wine, ℞ herba alchimillae, ophioglossi, nummular. fragar. auricul. muris, veronic. artemisiae, scolopendr. perfoliat. an. M.j. virgae aur. M.ij rad. cichor. tormentil. bistort. vincetoxici, id est, hirundinariae, an. ℥ j perfoliat. ℥ ss. court. citr. ʒjss. sem. anisi. foeniculi, an. ʒiij. coriandri praeparat. cinnamom. an.ʒj. flor. borraginis, buglossi, an. ʒij. prunell. sylvestr. ʒjss. galang. ʒij. passul. enucleat. ℥ jss. Misc. infund. in ss. q. vini optimi; colatura reservetur pro usu.  
If after the forementioned endeavours to reduce the Hernia, (whether it were by reason it had been too long relapsed, and the Excrements grown hard and dried in the Intestine, or that they were stuffed with Crudities, or inflamed by the constriction in the Production, etc.) you do not succeed, you aught to consider what the impediment is, and proceed accordingly to let blood, purge or vomit, or put him into a Semicupium, keeping on his Bag-truss the while: after which he may if occasion require, be carried to and so from upon the back of a strong man with his Head downward, by which the prolapsed Bowels are often reduced. Mr. Smith the Truss-maker told me he had made such an Engine by which he set them on their Heads, and thereby had reduced many, which could not otherwise be relieved.  
But the aforesaid ways, I bless God, have served the most deplorable Patient labouring of these Diseases under my hands. Yet if it should so hap, that all endeavours of this kind prove ineffectual, and the Patient's life be threatened by frequent vomiting and inflation of the Abdomen, and nothing pass through him by Stool, I would ask whether in such a case it be not more reasonable to offer in Consultation the laying open the Production while there is strength, than to suffer the Patient miserably to perish under the Disease. I refer it to the judicious Artist, there seeming nothing of difficulty or danger in the work; yet would not have it attempted whilst there is hope of otherwise reducing it.  
To perform this Operation, the Patient aught to be laid flat on his Back upon a Table or Form, and bound thereon; than an Incision must be made upon the upper part of the Scrotum to the Production, which requireth also to be divided, without touching the Intestines or Omentum: than you are to pass in a Cannula (like our common Director, but as big as a large Goose-quill) into the Cavity under the Process of the Peritonaeum upwards, avoiding the Intestines; than make your Incision of such a length as may serve to put your fingers into the Scrotum, and raise the Intestines and Omentum, which you are to reduce into their natural place within the Belly. They being thus reduced, you must stitch up the Wound, as is said in the Wounds of the Abdomen, taking up with your Needle so much of the Production as may shut up the Cavity, and prohibit the relapse of the Intestines. That done, cure the Wound, as is showed in the Treatise of those Wounds; it not being so large or dangerous as many of those we have cured in the Wars.  
In the farther Cure of these, various ways have been proposed by Surgeons; viz. the actual and potential Cautery, also Puncture and Deligation of the Process of the Peritonaeum, also Incision, with or without extraction of the Testicle. These ways are not practised amongst our people, they esteeming such Operations full of hazard and cruelty: yet they having been delivered to us by good Authority, I shall show you how they are performed, and begin with that of the actual Cautery. In the effecting of which work there are required various sorts of Buttons, some bigger and lesle than other. Whilst these are in the fire, the Patient must stand, and hold in his breath, by which doing the Tumour in Inguine will be more apparent. Than it is to be circumscribed within a triangular figure: after which the Patient being placed on his Back, press with your hot Cautery on the middle of that Triangle, and repeat it often, making the form of the Greek Letter Γ so deep till you reach to the Membrana adiposa, taking care you do not scorch the Peritonaeum: than dress the burned parts with a little Salt and an Onion beaten together, and afterwards digest and heal the Ulcer as you found proposed in the Chapter of Burns, he keeping his bed till he be cured. By this method the Author proposeth a contraction of the Skin by reason of the Cicatrix. How this will do without the wearing of a Truss, I much suspect.  
Another proposeth the reducing of the Hernia, and the thrusting up of the Testicle to the Os pubis; than marketh the Compress of the Prominence made by the Testicle, and, shoving it and its Vessels out of the Scrotum, he burneth in the middle of that Mark (with a pointed Cautery a little curved) to the very Bone, than dresseth it cum albumine ovor. and cureth it as a bourn: by which if he burneth the Bone, it must necessarily exsoliate, and unite with the Skin and fleshy Parts over it, and hinder the prolapse in Scrotum. But yet there must remain a Bubonocele, which will require a Boulster-Truss to prevent its swagging down, as is frequently incident to Women.  
The way by Caustick is propounded by others as more easy. The mildest of them is Soap-lees boiled to a stone, with the addition of sevum vitulin. and a fourth part of opium added to it at the last. The other are as followeth. ℞ vitrioli usti ℥ iij. salis ammoniaci ℥ j calcis vivae, ciner. è vini faece, an. ℥ iij. these must be bruised and mixed with a lixivium è cineribus sicuum & tithymal. than strained out and boiled to a stone. Or, ℞ salis nitri, chalcitidis, an. ℥ x. distil them, and cast away the first water, it being black and unfit for use. The second Distillation is clear, and must be put into a Glass bottle, in which dissolve arsenici albi ℥ ij. tartari albi usti, merc. sublimati, an. ℥ j than put it into a copper Vessel, and by a moderate heat consume the humidity; the remaining faeces is the Caustick.  
In order to the applying of any of these Caustics, the Part must be marked, and the Patient afterwards laid upon a Table, as hath been said in the preceding Operations; than the Caustick is to be applied , an inch long and as much transverse, near the Os pubis; which having operated to the Bone, it's supposed that Bone shall exfoliate, and the Callus arising from it will unite with the Ulcer in the fleshy Pannicles and Skin, and stop the descent of the Viscera: which notwithstanding cannot prevent a Bubonocele. Another way is by the application of a Caustick in Inguine, than to raise of the Escar, and, taking up the Membrana adiposa with a Hook, to divide it, and free the Seminal Vessels from the Process of the Peritonaeum. Than pass a Needle with crude Silk under it, tie it close, and leaving it hanging out digest the Ulcer, incarn and cicatrize it; during which the Silk will have cut through, and fall of: and the Production uniting with the Wound absolutely confirms the Cure. The Cure by Puncture is the invention of some of the Moderns, and is set down by Ambrose Pareus.  
There yet remain two ways of Cure by Incision: in order to which the Patient must stand upright, as hath already been said, that the Rupture by falling down may plainly discover its bigness, and that the Part so swelled may be encompassed with a circle: after which the Patient must be laid flat on a Table, with his Heels raised up, as in the forementioned cases: than one of the Assistants shall press with his hand upon the bottom of his Belly, whilst the Chirurgeon with his left hand raiseth up the marked Skin as much as he can, than divideth it with his Knife long-ways down the length of the Process or Tunica vaginalis, so as to open that Coat, and lay the Seminal Vessels bore; which he is to avoid the hurting whilst he takes up the divided Tunicle, and stitcheth it with the Skin so close that the Hernia may be retained within the Belly from starting out. Than by Agglutinatives, as bol. Armen. sang. dracon. thus, aloe, cum albumine ovi, dress it up, and place him in his bed. If afterwards there be occasion to apply Digestives, ℞ vitell. ovor. num. ij. far. tritic. thuris pulv. q. s. After which you may deterge with mundif. apii, and incarn with some such like Sarcotick: ℞ terebinth. siccat. ℥ iij. thuris, mastic. sem. foenugraec. an. ℥ ss. cerae ℥ j ol. hypericiʒx. Misc. S. A. Than cicatrize it as in other like Wounds.  
The Empirical way is by extraction of the Testicle: in the doing of which the Patient must be laid on his Back, as afore mentioned, and bound fast upon the place: than the Intestines being reduced, the Assistant shall retain them up with his hands, whilst the Operator maketh an obliqne Mark in the Groin, to which place he thrusteth up the Testicle; than makes an Incision so deep and large upon it, as to take it out with the spermatick Vessels, which he holdeth with the one hand, while with the other he separates it from the Membranes. (In all which cases he must be careful not to lacerate them, for thereby he shall 'cause Convulsions, and hasten the death of the Patient.) That done, he maketh a Ligature above the Testicle upon the Vessels, and cuts it of. If there be fear of a flux of blood, he cauterizeth the ends so tied: than, replacing them within the Belly, leaving the ends of the Ligature hanging out, he stitcheth up the Wound, dressing as above said: and during the time of Cicatrizing the Ligature falls of.  
In order to these Operations the Patient aught to be of a strong Constitution and well habited, his Bowels emptied by Purging and Clysters, and to be very sparing in his Diet, at lest three or four days preceding the Work. But I never yet met one that would submit to any of these ways.  
The Cure of the Bubonocele in Women requireth its being reduced and cured as those in Men, by Emplasters and good Bandage, etc. as hath been already showed in those.  
In the Hernia umbilicalis the Cure also consists in the well reducing of it, and in the retaining it so by Agglutinatives and good Bandage. If through neglect of treating it timely, as aforesaid, the Skin do wear thin and mortify, you must dress it as such: and after the separation of the Escars, you must than endeavour to take up the Peritonaeum, stitch it close together, and incarn it with the rest of the Ulcer, as hath been showed: and after it is cicatrized, endeavour by good Bandage to retain it more easily within its bounds.  
There is scarce any Disease little Infants are more subject unto than Ruptures. They are not difficult of Cure, if their Nurses would be careful to keep their Trusses well on: but, through their negligence therein, the Cure is frequently rendered vexatious. Therefore I shall begin my Observations with them.  
AN Infant of about four months' old was discovered to have a Swelling in the left Inguen, 
1. Observat.  another in the Navel, and another three fingers breadth higher. That in the Groin, which we generally call Bubonocele, was made by Relaxation of the Intestine, as appeared by the noise it made in the time of Reduction. The other two proceeded from Wind. I took the compass of his Hips with a Ribbon, and the next day brought a soft Boulster-Truss of Holland linen, with two Straps fastened to the Bolster: and, having applied an Empl. ad berniam spread upon Lambskin on the Tumour in the Groin, I fitted the Bolster to it, and reduced it, than tied it on; than passing the Straps between his Legs, I fastened them with Points on each side behind; by which the Rupture was retained within the Bolster, not pressing upon the Thigh or God. On the Rupture of the Navel, or Hernia umbilicalis, I applied a mixture pulver. thuris, mastic. aloes, etc. sang. draconis, cum albumine ovi, and made a Compression with an Emplastr. è bolo by a small Button sticking in the middle thereof, made of some snips of the same Emplaster, by which the Emplaster under it was retained the closer. On the other above the Navel I applied a Compress made by some pieces of Emplastr. ad herniam, and retained them close by applying over them Emplastr. è bolo. By this method these Herniae were cured in few weeks. For that in the Groin they had half a dozen Trusses sent them, for shifted as occasion offered; and it was cured thereby in few months.  
A Child about two months' old laboured of some Indisposition of body, 
2. Observat. of Hernia intestinalis.  and was observed to have a Swelling in the right God. In pressing upon it with my fingers, it seemed to me not to lie lose in the Scrotum: it yielded to a moderate pressure; and being somewhat reduced, the residue of it jerked suddenly up with a noise, which confirmed it a Hernia intestinalis by Relaxation. I took the compass of his Loins to the Groin, and the next day brought him an Emplastr. ad herniam with some Boulster-Trusses. I reduced the Rupture as easily as I had done the day before, than applied the Emplaster, fitted the Bolster over it, and tied it moderately straight. These Trusses had the Straps stitched on behind; they were brought between his Thighs, and fastened to the upper part of the Bolster cross each other by Points. I shown the Nurse how they were to be put, and gave her caution jest the Bolster should at any time gall the Thigh or Scrotum, or that by too strict a Bandage the Hip should be hurt, or by too slack a Bandage the Hernia should slide down under the Bolster, or whilst it was lose tied those Straps between the Legs should be tied so straight as to bring the Bandage over his Haunches and slip down. Having thus forewarned her, I made my visits the seldomer, as not desiring to appear too officious; and indeed was fetched the next day to a Patiented some miles of, where I stayed three weeks. At my return I made a visit to this little one, and felt the Rupture slipped down into the Scrotum by reason of the slackness of the Bracer; and the Nurse had pulled the Straps between the Thighs so over-streight as to bring the Bracer down, and would not believe it could be kept up without a Bandage from the Shoulders. But I reduced the Rupture, tied it straighter, slackened the Straps between the Thighs, and shown her it could not fall over the Buttocks whilst it was so tied. The next Error she committed was in bracing it too straight about the Hips, whereby she had gauled it on the right Hip; and than she complained to her Lady, that it was not possible to cure the Child without giving it some healing Drinks: such and such had been cured so in few days. To this I replied, That the Cure consisted in the keeping up the Rupture; that done, it would cure without Drinks: That there was but little to be given to such an Infant. Yet I wished them to consult their Physician therein. I applied an Emplastr. diachalciteos upon the Excoriation, with two or three folds of soft linen over it, and braced the Bandage slacker: by which Dress the Excoriation cured, the Nurse became more experienced, and the Child was happily recovered in few weeks; but left not of the wearing the Truss till the Summer following.  
I was fetched to a Child half a year old having a Swelling in Scroto on the left side. It was a Hernia intestinalis by Relaxation. I reduced it easily, 
3. Observat. of Hernia intestinalis.  and the next day fitted it with a soft Boulster-Truss; and, having reduced it, applied Emplastr. ad herniam, put on the Bandage, and supplied them with more Trusses for change, (they being apt to bepiss them daily, so that, if they be not carefully attended, they are subject to Excoriation.) Once in four or five days I called in to see how the Nurse ordered her affair; and by her diligence the Child was cured in few weeks, but continued the use of the Truss till it was grown stronger, and had bred his Teeth.  
A Youth aged eleven years had been some months diseased with a Rupture before his Friends discovered it: 
4. Observat. of Hernia intestinalis.  through which neglect it fell into the Scrotum, and indisposed him with Colicks. I was sent for, and saw it an Hernia intestinalis on the left side. I endeavoured to reduce it, but could not. I than took measure of his Loins, and the next morning found him in bed, and placed him on his Back, with his Hips high, etc. and with warm  reduced the Rupture: than put him on a Boulster-Truss made of strong Holland, with a couple of Straps fastened to the lower part of the Bolster; and having fastened the Truss about his Loins with Points, I brought the Straps between his Legs, and tied them behind. Thus I retained the Rupture. The next day I made him a visit, and seeing the Rupture well retained, I loosened the Bandage, applied an Emplastr. ad herniam, and braced it on again, leaving Directions with his Servant to take care in the bracing the Truss close every morning. This Patient was very active in running and playing daily; yet by the use of these Emplasters and careful Bandage, he was cured in few months, I scarce making him six visits the while.  
A Child of about six years of age was brought out of the Country, 
5. Observat. of Hernia intestinalis.  having somewhile suffered under a Hernia in Scroto. He had a Truss, but it was not well made. I laid him upon his Back, with his Heels retracted to his Hips. It did not presently yield to a Reduction; whereupon I caused some warm  to be applied, and than pressed it moderately upward: it returned up with a murmuring noise. I than applied my Emplaster and Bandage, and, having advised them concerning the use of the Truss, I left them to prosecute the Cure, supplying them with Emplasters and Bandage. About half a year after I saw him cured.  
A Youth of about nine years of age was brought to me out of the Country with a Swelling in his right Groin: 
6. Observat.  it was supposed to be a Bubonocele, and to that purpose Emplasters and Trusses had been put on, and the Part thereby inflamed. I felt the Swelling, and, as I thought, the Testicle which was wanting in the Scrotum. Upon which consideration I forbade the use of the Truss, and applied an Emplastr. oxelaei: by which the heat was removed, the Child freed of his Bandage, and the Testicle left to fall down by degrees; which accordingly it did, and his Parents were well pleased.  
The Pneumatocele, 
7. Observat. of Hernia ventosa.  or Hernia ventosa, appeareth often in Inguine in the Tunica vaginalis, and maketh a Tumour not unlike that of the Testicle. Such a one was brought to me in the Groin of a Child of about seven years of age. It was as big as a Pullet's egg, soft, but withal so tense that it yielded little to pressure. It had been treated by Bandage, but yielded not thereto, but became more painful. I prescribed a Fomentation and Emplasters, as hath been set down in Flatulent tumors, and caused a soft Boulster-Truss to be put on, rather to keep it warm and retain the Dress on, than to make any straight Compression. I treated him by internalls proper in such tumors, by which he was some time after cured.  
A Gentlewoman brought a Son to London with a Swelling in his left Testicle. 
8. Observat. of Hernia ventosa.  Several of our Profession had seen it, but delivered no certain Judgement of it, nor prescribed aught in order to the Cure. The Swelling was Wind gotten into the Tunica vaginalis, which encompassed the Testicle round, so as I could not feel it. By reason of the Tumour, which was so tense that it would not yield to the pressure of my fingers, I proposed Discutients and a Bag-Truss. They were dissuaded from my Opinion by some who had rather their Friend should fail of his Cure than receive it from me. Which hath somewhat appeared in this case: for two years after the Father of this Child told me he continued as I had formerly seen him.  
A Child about two years old had one of these tumors lying the whole length of the Production the Testicle, 
9 Observat. of Hernia ventosa.  like unto the uppermost of those Bladders which we found in Carp: and the same Wind, having raised up the Tunica vaginalis, made the Testicle not unlike to the lower round Bladders that are united with the forementioned upper Bladders in the same Fish. The Cure was performed by Discutients and a Bag-Truss.  
I was fetched to see a Child who was (as I suppose) not two months old: 
10. Observat. of Hernia ventosa.  it was a very small Infant, much emaciated. A Swelling had been newly discovered in Scroto, and supposed a Rupture: it affected the right Inguen down into the Tunica vaginalis. The Tunicle of the other Testicle was likewise distended. And the next day, when I brought a Bag-Truss, I found that Inguen also affected with the same Disease. Whilst the Infant cried, the Tumour was much; but by an easy pressure with warm  it lessened. I designed a Fomentation: but the weakness of the Child, together with its frowardness, deterred me. Whereupon I applied Emplastr. è cymino over the Scrotum and Inguina, and put on the Bag-Truss. The next day I met the Physicians, took of the Truss and Emplasters, and shown them that it was a Hernia ventosa, not capable of Reduction nor of other Bandage. There was also a Hernia umbilicalis, which was likewise from Wind, which I treated as hath been showed in the first Observation. The Physicians resolved the Milk should be changed: upon doing of which the Child began to thrive. But this Nurse not keeping the Child very dry, the Piss fretted the Thighs and Cod: upon which account I put on a Diachalciteos Emplaster, and renewed it daily. It not only cured the Excoriations, but also supplied the place of the other Plaster. During the Cure, I observed that upon good Bandage the Tumour appeared very inconsiderable, and some times would be quite discussed: but than through neglect in bracing the Truss close, it would appear very big. The last time I saw the Child it was grown fat, and the Flatulency seemingly discussed: but a Rupture appeared in both Groins. Upon which account a double Boulster-Truss was put on, whereby it is kept up, and in a hopeful way of Cure.  
A Man of about thirty years of age, of a full Body, 
11. Observat. of Bubonocele.  having some time a Swelling in his left Groin, consulted me. I declared it a Hernia inguinalis, and advised the use of a Boulster-Truss, which accordingly I brought the next day, with an Emplastr. ad herniam; which, after I had shaved the Hair, I put on, and left him Directions how to wear it. He carefully observing the Direction, it was in some months happily cured.  
A Man of a full Body, by a Fall in riding, 
12. Observat. of Bubonocele.  bruised his left Inguen and that side of the Scrotum against the Pommel of his Saddle, by reason whereof a Rupture was made in his Groin, and much blood was extravasated in the Inguen and Scrotum to the very Praepuce. It was too late to apply Repellents, therefore I prescribed this following Fomentation: ℞ summit. majoranae, absinth. flor. cham. sambuci, an. ʒuj. flor. ros. rub. ballast. an Mss. nuc. cupress. bacc. myrtill. sumach, an. ℥ jss. coq. in vino austero, addendo in fine sp. vini ℥ iiij. fiat Fotus. A Cataplasm was also made thus: ℞ farinae fabar. lb ss. furfuris tritici M.j. flor. cham. sambuci pulv. an ℥ j sem. anis. foenic. pulv. an ℥ ij. These were boiled with some of the Fomentation, and towards the latter end some Spirit of Wine, mel commun. ol. rutac. which was applied upon the diseased Parts with a Bag-Truss. We let the Patiented blood, prescribed him Clysters, and keeping of his bed during the Cure. This method of Dressing continued till the Swell were discussed: than I shaved the Hair, and applied to the Groin a mixture of Emplastr. Paracels. & diachalciteos, with a soft Boulster-Truss, to which a Bag was fitted for the Scrotum, to retain the Dress on. Some few days after, observing that the Scrotum was overmoistned as in an Anasarca, which hindered the corrugation of it, I applied Emplastr. diasulphur. by which the Humour was dried up. After the tenderness of the Groin was removed, I applied Emplastr. ad herniam, with a Quilt under the Bolster, and braced it straighter; than, having caused a lesle Bag to be stitched on to retain the Scrotum, I gave him leave to sit up. His Rupture having been reduced from the first night I saw it, there was little doubt but his lying in bed had disposed it to Cure. Indeed from that time I heard no more of it; but he continued the wearing his Truss longer.  
I was sent for to one of about thirty six years old, 
13. Observat. of Bubonocele.  of a full Body: he complained of a Swelling in his left Groin. It was a Bubonocele, and, by the manner of reducing it, seemed to be of the Omentum. I applied an Emplastr. ad herniam with a Boulster-Truss, and advised him how to govern it. I heard not from him again in five or six years; about which time being sent for I found him in bed, bemoaning himself that his Rupture was fallen into the Scrotum, and he could not reduce it. I felt it lie unequally in the Scrotum. He had, it seemed, neglected the bracing of the Truss while it lay in Inguine, and so it happened that in progress of time it slipped down under the Truss; upon which he consulted some, who put him on a Steel-Truss: but that pinching and galling, he caused others to be made, of which he shown me at lest half a dozen; but they all hurt him, and did not keep his Rupture from falling down. But now it was so great, that he could not reduce it but with warm : which being done, I fitted to it a Boulster-Truss with a Quilt and Bag. To those Excoriations occasioned by his Steel-Truss I applied Emplastr. oxelaei spread upon course linen, which soon cured them; and if his occasions would have permitted him to have kept his bed, he might have been restored to a better condition: but this served his turn as a palliative Cure.  
A Man of about 30 years of age, 
14. Observat. of Bubonocele.  of a healthy Constitution, came to me with a Bubonocele. I advised him the wearing a Boulster-Truss with an Emplaster under it: which for some time he did with much ease; but afterwards became more secure and careless in the bracing it, upon which the Omentum slid down half way into the Scrotum. It being yet within the Process, I easily reduced it, and applied a fresh Emplaster, and supplied him with more and new Trusses. His affairs would not permit him to stay within doors, yet by his well ordering it he was cured in a few months, and for a trial he left of wearing the Truss three or four days: but, having been used to it, he could not be without it; so that he continued the use of it, but without the Bag or Quilt.  
Another of that age, 
15. Observat. of Bubonocele.  but not of so good a Habit of body, being diseased with a Bubonocele, had for some time worn a Steel-Truss: but the Hernia slid down in Scrotum notwithstanding, though often reduced, and the Truss braced more close. Upon an extraordinary relapse, when endeavours of his own failed, I was sent for, and upon examination found the Intestine and Omentum both in Scroto. I could not reduce them by warm , therefore prescribed him a Clyster, and after it a Fomentation, Cataplasm, and Bag-Truss. The next morning I fomented the Part again, and, placing him in a convenient posture, reduced the Rupture; than shaved the Hair, and applied an Emplastr. ad herniam, with a Compress made of brown Paper which had been all night soaked in an astringent Decoction, and fastened thereon a Boulster-Truss, with a Bag fitted to it, for to bear up the Scrotum, that, in case the Rupture should slip downwards, yet it should meet with a check. Having thus by Bandage trussed it up, I advised him to keep his bed some days, at lest till the Excoriations which the Steel-Truss had made in his Hips were cured. During which his Diet was slender, and his body kept soluble by lenient Bolus', and consolidating Drinks were prescribed him. He was one that had no great employment abroad, so was persuaded to keep his bed the longer; during which the lacerated Parts did unite, and he was cured.  
One Summer, whilst I attended the King at Hampton-Court, 
16. Observat. of Hernia intestinalis.  an Officer belonging to the Larder, a man of above sixty years of age, having been long afflicted with a Hernia intestinalis, which frequently slipped into the Scrotum, had it than fallen down passed his skill of Reduction. I, finding him vomiting and in a Fever, endeavoured by warm  to reduce it, but could not. I therefore presently caused a Clyster to be given him of fat Broth with a little Salt in it, and applied a Fomentation made of the same Broth, and at length, putting him in a declining posture, I reduced the Rupture, and put on his Truss with a Compress under the Bolster; by which I retained the Rupture up. I would have prescribed him other helps, but he was satisfied that it was reduced. After two or three days he went abroad again, and, for aught I know, is yet alive.  
A person having been long afflicted with a Hernia in France, 
17. Observat. of Hernia.  through ill fitting of Trusses had it much increased, till at length he threw them of, as not only useless, but painful to him. The Rupture was so large, that the Intestines did their office in the Scrotum without Reduction. But the weight of them was uneasy, and often accompanied with Colicks, and would by degrees have proceeded to worse inconvenience. I helped it by the palliative way of a Bag-Truss, with a perforation for his Penis. This sustained the weight, and enabled him to follow his occasions without farther trouble.  
In some people I have seen the Ruptures so great that they have not been able to go; yet not any of them would admit of the most probable of the forementioned Operations, but contented themselves with such accommodation as a Bag-Truss would afford them.  
A young Woman, after hard Labour, had a Rupture in her left Groin. 
18. Observat.  I supplied her with a Boulster-Truss with one Strap and Emplaster, by which she was cured, or at lest palliated. In others, where they have not timely consulted, whether through ignorance or shame, they have increased to a greater bigness, and have made in progress of time such a swagging Tumour as became extremely troublesome to truss up.  
One of about thirty years of age, of a gross fat Body, 
19 Observat. of Hernia umbilicalis.  laboured of a Hernia umbilicalis about the breadth of the palm of a hand. He had worn the common Navell-Trusses; but they, not sitting steady upon the diseased Part, pinched him sometimes in one place, sometimes in another, and did not retain the Rupture. I being advised with, and considering his Belly very great, and likely to suffer greater Ruptions, if the weight of it were not timely born up, persuaded him to permit a Bracer to be made to lace in his whole Belly, under which a Bolster might be placed on the Navel. I took measure of it, and fitted him with such a one as reached from the Pubes to the Cartilago ensiformis, and laced behind. Under this I applied an Emplastr. ad herniam with a quilted Bolster, which was worked upon Sole-leather: this was tacked to the Bracer. In some others I have made a Bandage over that Bracer; but here it was needless.  
One had three Herniae besides that of the Navel, viz. one in each Groin, 
20. Observat. of Hernia.  whereof the one descended in Scrotum, and the other not; the third lay on the left side of his Belly, raising up a Tumour under the Skin like half an Apple. The Herniae in Inguinibus were kept up by a Steel-Truss with a double Bolster; to which a Bag was tucked to retain the Scrotum. To that on the side of the Belly was applied an Emplastr. ad herniam, with a Compress in the middle of it, made of some folds of the same Emplaster, and a quilted Bolster over it. To the Navel there was an Emplastr. ad herniam applied, and such a like Bolster as was used in the like case in the former Observation of a Hernia umbilicalis: and, to retain these close, a Bracer was fitted to the Belly with Straps, which went from the lower part of it between the Legs, and fastened behind, where the Bracer was laced. This person being fat was also gauled between the wrinkles of his Belly, which was for some time dressed daily with Epuloticks.  
A Person of quality, 
21. Observat. of Hernia umbilicalis.  of a full Body, having been sometime subject to a Hernia umbilicalis, which through defect in Bandage increased much, so that the Skin was excoriated by the unequal sitting of the quilted Bolster, I was consulted. The Rupture in the Peritonaeum was great, and the Omentum and Intestines had made their way out to the external Skin of the Abdomen, so that between them and the Bolster it was worn very thin. The Excoriation was dressed with Epuloticks, as unguent. tutiae, etc. and a soft Compress applied between the Quilt and Emplaster. A Belly-piece was made to bear the weight, and retain the Compression. After this was cured, Mr. Smith was advised with. He made a Bolster with a Bracer to sit under the Belly-piece, which retained the Rupture, and the Patient went abroad daily. But one day, whilst he was about his affairs, the Bolster slipped of, and the Intestines started out between the Muscle and external Skin, so that he was brought to his Lodgings very ill. Physicians were consulted, and I was sent for, and reduced it with a warm cloth in their presence, and an Emplaster and Bracer were put on. From which time he hath not been so subject to a Relapse.    

A TREATISE OF ULCERS.   

OF ULCERS. The Second Book.  

CHAP. I. Of Ulcers in general.  
AN ULCER is a Solution of continuity in a soft Part made by Erosion with loss of substance, 
Definition.  which loss is in this Description presumed to be the effect of the Erosion: for if it be the effect of the Wound, as a piece of flesh being cut out, etc. it is not immediately an Ulcer, nor doth it deserve that name properly, till by ill handling there do fall upon it corrosive Humours, which cause a farther diminution of the substance: for till than the Digestion and Matter there produced do not altar the name, but continued the appellation of a Wound; but having once lost part of its natural flesh by such Erosion, though preternatural do arise in the room of it much more in quantity than what was lost, as Fungus, etc. yet the name of Ulcer remains.  
To this Ulcer many Accidents may hap, and especially tumors of all sorts: but these are not parts of the Ulcer, being separable from it; for they may be taken away, and the Ulcer remain. The subject of an Ulcer is chief Flesh, especially in the larger sense of the word, as it signifies Membranes, Tendons, Guts, Bladder, etc. When an Erosion happens in a Bone, it is commonly called Caries.  
For the Differences of Ulcers, some are more proper, 
Differences.  by some Writers called essential; others accidental. The more proper, or, as some call them, essential, are taken from the form of the Ulcer and efficient Cause; as from the figure, magnitude, equality and inequality, and Part affected. From the Figure; they are strait, obliqne, round, or crooked. From the Magnitude; some are great, others small, superficial, deep, long, short, broad, and narrow. From the Equality and inequality: those are equal in which the Flesh is alike plain; unequal, when it is corroded more in one place than another. From the Part affected; some Ulcers are in the Flesh, others in the Membranes; or in this or that Part, internal, or external. Differences from the Causes will be best understood by viewing the Causes themselves.  
The accidental Differences are taken from those things which are not intrinsecall to the nature or constitution of an Ulcer; as, to have Inflammation, Tumour or Putrefaction joined with them, as Phlegmon, Erysipelas, Cancer, Gangraena, Callus, Varix, or Caries: Also from the Symptoms; some Ulcers are painful with Pulsation, and pricking burning heat, others with itching and Excoriation: From the quality; Ulcers are malign, benign, contagious, or not; rebellious, or easy of Cure: Also from the age of the Ulcer; some are recent, others annual; also some in their state, others in their declination, only requiring Desiccation.  
From these fountains the Differences and Distinctions of Ulcers do arise; the methodizing of which hath already pozed able Writers: we shall endeavour to put them into such order as shall be most plain to the young Chirurgeon.  
Therefore first we shall speak of Ulcers in general: 2. of a Simple Ulcer: 3. of Ulcers with Intemperies: 4. of Ulcers with Pain: 5. of Fluxion: 6. of Ulcers with Hypersarcosis or superfluous Flesh: 7. of Ulcers with Caries: 8. of Sordid Ulcers: 9 of Callous Ulcers: 10. of Ulcers called Phagedaena and Dysepulota: 11. of Ulcers with Varix: and, lastly, of Sinuous Ulcers. I should also treat of Fistulous Ulcers from Gangraena and Sphacelus; but they have been heretofore occasionally put into the Treatise of Wounds, to which I refer you.  
We shall begin with Ulcers in general, 
Causes of Ulcers in general.  and treat first of their Causes; of which some are internal, others external: both are (if we speak of immediate Causes) corroding Humours, which eat away the Flesh, Membrane, etc.  
If this corrosive quality arrive from Internal Causes, it oweth its Original to the excess of an acrid Serum: which Serum if it mixeth with any other Humour, whether Choler, Phegm, Blood, Melancholy, etc. gets a denomination from that.  
These Humours, when they abound so far in the Body as to exceed that Temperament ad justitiam which is always necessary to health, (to which Temperament a latitude must be allowed,) are apt to separate from the whole Mass, and flow either quite out of the Body by natural Excretions, or else upon some Members of it; whether they be carried thither by their own source, or drawn by some attractive cause.  
Being so cast out from the Mass of blood, they are not longer subject to the Balsam of that, but become acrimonious and corrosive: and by how much the longer the Humour hath been extravasated, by so much the more acrid it becomes, and is the more corroding; acquiring in its degeneration a quality suitable to the Humour out of which it is engendered.  
The External Causes are Poisons, corrosive and causticall Medicaments. Nor do we exclude actual Fire, Hot water, scalding Oil: to which may be referred the Contagions of Scabby, Leprous and Pocky persons, which are communicated to the Skin, and exulcerate it, and beget the like Disease.  
From these diversities of Causes different sorts of Excrements flow: three forts whereof give name to Ulcers.  
1. The one is a thin serous Humour, called Sanies, by the Greeks Ichor; by others Virus, from whence they are called virulent. Celsus reckoneth two sorts of Sanies; the one he calleth Ichor, and the other Meliceria. They are taken notice of by Fabricius Hildanus. The Ichor is a thin whitish Gleet incident to ill-disposed Ulcers, especially amongst the Nerves and Tendons. The Meliceria is a thick glutinous Humour of a pale colour, and it may be yellowish, not unlike Honey, from whence it taketh its name. This also affects Ulcers of ill condition near and in the Joints, where the Membranes and Tendons are eroded. But that which we generally in our common Chirurgery call Sanies is, a thin excrementitious Humour begotten from abundance of serosity in Ulcers, and rendering them humid. Of which Humours some are hot and reddish-coloured, others cold and pale-coloured. These are called Sanious Ulcers.  
2. There is a second sort of Matter affecting Ulcers that is thick, generated of abundance of gross tough Humours, and rendering the Ulcer foul; whence it is called a Sordid Ulcer. This kind of Sordes differeth as it is white or grayish, though unequally coagulated, or else as it is blackish and foetid.  
3. The third sort of Matter is of a middle consistence between thick and thin; sometimes of a greenish or yellowish colour, and than it hath a rank smell; but for the most part it is of a white colour, and is called Pus or Matter. And this is supposed to proceed from a benign Serum flowing to the Part affected for its nutriment; which, by reason of the weakness of the Part, is not assimilated, but converted into a whitish substance, and giveth the name of a Purulent Ulcer.  
These Differences of Excrement in a Sore are best understood by considering the Causes of their generation. For if the nutritious Serum be well conditioned, and the Part not affected with Wound, Tumour, or other preternatural weakness, it is by Nature converted into nourishment: but if there be a Solution of continuity, than she, failing of her first intention, acteth according to her ability, and according to the quality of the Serum. If the Constitution be good, and the Serum well-conditioned, than we found a laudable Pus to arise, which is white, smooth, and easy to the Part, and every day approacheth nearer and nearer to the true nutritious Juice, till by degrees the Ulcer fills up with Flesh and heals. But if it degenerate towards a sharp virulent Serum, than the Ulcer appeareth full of a thin Ichor or Sanies, Nature's Balsam being weak, and her heat insufficient for a due concoction of the Matter. If the Blood grow phlegmatic, its Serum is so too, and groweth gross and slimy, and wanting heat, doth corrupt into a thick glutinous Matter, which we call Sordes; and sometimes a stinking Matter, which makes a Putrid Ulcer.  
An Ulcer, if it be in the outward Parts, is discoverable by the sight. 
Signs.  If it be inward, viz. in the Ventricle, Guts, Vterus, Kidneys, etc. it must be guessed at by the Excrements that come from it, and other Symptoms. The greatness and littleness is likewise distinguishable by the eye, if it be in the Superficies. But Ulcers that are deep require farther search of Probes, etc. and, if inward, must be presumed proportionable to the quantity of the Matter that floweth from them. Equality and Inequality are also judged by the view; so Sinuosity and Caries by Probing.  
Sanious Ulcers are known by the undigested Serum that gleets from them: and if the Gleet be corrosive, we found the flesh waste apace. If that Erosion be with jagged and callous Lips, it is Phagedaena, or at lest virulent. If the Matter issuing out be slimy and gross, it is a sordid; if foetid and corrupt, it is a putrid Ulcer. If it be only superficially corrosive and spreading, it is a Herpes' exedens.  
The nearness of a Nerve, Tendon or Ligament, is best understood by the pain, which is commonly acute. If a Nerve lie near, and cause pain, it is apt to contract the Limb, or cause Convulsion. An Artery if near, is discovered by Pulsation.  
To make a right Prognostic in the Cure of Ulcers, 
Prognostic.  we aught first to observe well the greatness of the Disease, and what strength the Patient hath to overcome it: for if that be deficient, our endeavours to cure them will prove vain.  
The greatness of the Disease is known, either by the quality of the Part affected, or by the depth or other conditions of the Ulcer.  
As to the quality of the Part: Those in the Skin are not dangerous, nor difficult of Cure, but as they are accompanied with Intemperies. Ulcers in the Emunctories, by reason of the great Vessels, may be dangerous, and through moisture of the place are difficult of Cure. Those near any principal Part are not without danger, for that by their penetration the neighbouring Viscera may suffer. Ulcers in the Muscles of the Spine of the back and in great Joints are of great danger and hard Cure: amongst the Tendons and Bones of the Hands and Feet they are painful, by reason of their exquisite sense, and of difficult Cure.  
The depth and largeness of the Ulcer makes the Cure hazardous: for in great and wide Ulcers the native heat is much weakened; and if they penetrate under any great Artery, Nerve or Tendon, that you cannot safely lay them open, the Cure must needs be slow, and the great discharge of Matter may exhausted the Spirits of the Patient.  
The Condition of the Ulcer is of great moment in Prognostic: where we are to consider both the quantity and the quality of the Humour flowing to it. If it be in a depending Part, and the Body plethoric, the very multitude of Humours (though otherwise not bad) is a sufficient impediment of a Cure: so also if the quality be amiss, though the quantity be not great. For when the Ulcer is accompanied with a dry Intemperies, it frequently eludes your Medicines. The case is as bad when Ulcers have continued so long as to bring an habitual Dyscrasy upon the Part: as we see in the Nomae and annual Ulcers, which are either not cured at all, or with danger to the life of the Patient. A degree beyond these are the Phagedaenicall Ulcers, and worst of all the Cancerous and Sphacelous: of all which in their due places.  
In the Cure of Ulcers in general, 
Cure.  we shall consider the Ulcer first as it is simple, with Solution of continuity and Erosion; than as it is compounded, and hath other Symptoms or Indisposition joined with it.  
The Simple Ulcer, as it consisteth in a Solution of continuity, requireth Union; and as it hath lost of substance, Restauration: and this is effected by Exsiccation; for so long as the Ulcer continueth sanious or sordid, it cannot heal: therefore in such cases Digestion or Detersion are required.  
The loss of substance is either of Skin or Flesh. If only the Skin be wanting, the Flesh is so to be dried with Medicaments, as the Juices coming thither may be hardened into a callous substance resembling Skin; for that it is a spermatick Part, and cannot be regenerated. If the Flesh be wanting, it must be renewed: which work is performed by the benefit of Nature out of a part of that blood which was designed for the nourishment of that Member. But forasmuch as in the generation of Flesh in an Ulcer there is a twofold Excrement separated, the one thin, the other thick; the thin, as I said, requireth to be dried up, and the thick to be deterged.  
But in the Cure of Compound Ulcers many Indications are requisite, according to the variety of Causes and Symptoms which attend them. In the application of Medicaments to those Ulcers you aught to consider their beginning, augment, state, and declination. In the beginning the Sanies is crude and waterish, and requireth the benefit of Concoction, whereby it may be made thicker, and turned into good Matter; in which case Suppuratives are of use: which is not allowable in putrid Ulcers, for in that case they increase Putrefaction; and in purulent ones also they tender the Ulcer more lax, and at length sordid. If the indisposition of the Ulcer be caused merely by the pain, Suppuratives are convenient; for by their digestive and lenient quality they mitigate the pain, and thereby remove the Cause: which Suppuratives are to be continued till the Matter be well concocted. And for this reason it is we use them in the beginning, jest the extravasated Humours should corrupt, and stir up pain and Inflammation. In the Augment, when the Matter is lesle in quantity and thicker, we use Detergents to cleanse it. In the State, when the Ulcer is well cleansed, it may be reasonble to use sarcotics: and in the Declination, as the Ulcer fills with Flesh, we do our endeavours by Epuloticks to cicatrize it.  
But if the Ulcer labour under any Distemper of Symptom, whether it be internal or external, as Influx of sharp corrosive Humours, whether they abound in the whole Habit of body, or affect only the Part itself; they are all to be removed before you can hope for Cure. The consideration of which indicateth many Intentions: we shall reduce them to four heads. The first shall be of a regulation in Diet and the other Non-naturalls: the second of Evacuation, Revulsion, and Derivation of the antecedent Matter: the third shall have a regard to the Part in which the Ulcer is seated, to strengthen it against the Influx: and the fourth and last treateth of a due application of Medicines to the Ulcer itself.  
1. To satisfy the First Intention, their Diet shall be proportioned to the strength of the Patient, according as the Humours are peccant in quantity or quality, and abound in the whole Body, or in some particular Part; that their heat and acrimony may be contemperated. To which purpose there is regard to be had that the Air be good, and their Exercise, Passions of the mind, etc. be moderated, according as hath been said, in the former Treatise, of tumors in general.  
2. The Second Intention consisteth of Evacuation, Revulsion, and Derivation of the Humours. If they abound in quantity, or offend through their evil quality, it may be made either by Bleeding, if their strength permit, and other things be consentaneous, which also makes Revulsion; or by Purging or Vomiting.  
Derivation is always made in the remote Parts, and according to the rectitude of the Vessels, either by opening a Vein by Lancet, or by the application of Leeches, Cupping-glasses, Blistering-plaisters, Friction, Binding &c. for which I refer you to the Treatise of tumors.  
3. The Third Intention hath regard to the weakness and Intemperies of the Part affected: to which purpose the Humours may be intercepted in their course by the application of astringent and repellent Medicaments on the sound Parts above the Ulcer, in the nature of Defensatives. If the Member be dependant, the raising of it up, and placing it equal with or higher than the rest of the Body, may be of great advantage: the Influx may also be restrained, and the Part strengthened by expulsive Bandage. We may also by Alteratives correct their acrimony, and, if the Humours be too serous, incrassate them, or, if otherwise they offend, rectify them by their contraries. How farther to resist the various Symptoms attending Ulcers shall be set down in the particular Cure of each several Species.  
4. The Fourth Intention is in curing the Ulcer itself; which is, as I have already said, by drying up the excrementitious serous Humour, and deterging the more gross. The Medicaments proper thereto, with the method in applying them, shall be treated of in the particular Cure of each Ulcer, to which I hasten.   

CHAP. II. Of a Simple Ulcer.  
A Simple Ulcer is a Solution of Continuity with Erosion, 
Description.  having no other Symptom or remarkable Affection joined with it. Of these Authors make two kinds; 
Kind's.  the one only with Skin of, and the other with the loss of Skin and some part of the Flesh. As they call the first planum or equal, so they call this latter cavum. The former is inconsiderable: the Cure of the latter I shall here deliver.  
In the doing of which two things offer themselves: 
Cure.  the one is the generation of Flesh, to fill up that Cavity; and the other is the making a Cicatrix, to unite the separated Lips of the Ulcer.  
To the prosecution of the first Intention, in restoring the lost Flesh, it is necessary that the Part affected be free from distemper: for the generation of Flesh is the work of Nature, and her strength consists in the just temperament of the Part; which being so, our endeavour aught to be, that the Succus nutritius, whereof the Flesh is generated, be good, and that it flow moderately into the Part affected. To which purpose a good Diet must here also be observed, with a regulation of the Non-naturalls; that the Air be temperate, Exercise moderate, and in some cases none at all. In Sleeping and watching a mediocrity aught to be observed; natural Evacuations are to be continued, and the Quiet of the mind to be preserved. If these things be duly observed, and the tone of the ulcerated Part preserved by the moderate inflowing of good Juices, and the Matter in the Ulcer well digested, it is than capable of being healed: but if the Ulcer be too dry, moist, or crude and undigested, it cannot incarn. Therefore it behoves that we consider the temper of the Part ulcerated, and the Excrements flowing thereout, and thence take indication whether to use Suppuratives or Detergents, and when sarcotics are convenient, or one more than another. Suppuratives aught to be of a lenient quality, temperately hot and moist, proportioned to the Habit of body, as it is weak or strong, and to the temper of the Part they are to be applied unto. The common Digestive is terebinthina in tender bodies, with far. tritici, a little crocus pulv. cum vitell. ovi. In drier bodies we add far. hordei, fabar. colophon. thus, pulv. sem. foenugraeci: to which we sometimes add mel rosat. & syr. de ros. sicc. Unguent. basilicon is not inferior to any. These Medicaments aught to be of a moderate consistence: not too liquid, jest they make the Flesh too lax, or run of the Pledgits, and leave them uneasy to the Soar. For the same reason your Medicaments are not to be of too hard a consistence. The deeper Ulcers may admit of the more liquid, that they may reach to the bottom. They are to be used upon Lint in the form of Pledgits, Dossills', or Tents; and over them may be applied Refrigerants, to contemperate the heat of the Part, and resist the Fluxion.  
Suppuratives are of no longer use than till the Matter be well digested; for through the too long use of them the Ulcer may be made sordid: therefore when the Matter appears well digested, we mix Detergents with them, to cleanse the Ulcer. Of the milder sort is this: ℞ terebinth. lot. in aq. acetoes. ℥ iiij. succ. apii ℥ vj. coq. ad consumpt. succi, deinde add vitell. unius ovi. Such is mundif. Paracelsi. In these kind of Ulcers I have frequently digested, deterged and incarned by the use of Merc. praecipit. mixed with unguent. basilicon more or lesle. The Ulcer deterged, (which you may know by the good condition of the Matter, together with the ruddy colour and firmness of Flesh,) you may than proceed by sarcotics. In the use of which you are to remember, that in the generating of Flesh two sorts of Excrements arise, the one thin, called Sanies, the other thick, distinguished by the name of Sordes. How they disturb the Ulcer in its healing, I have elsewhere told you, and now advice you that you consider the temper of the Part, and what Sense it hath, and fit Sarcoticks accordingly, moderately to dry and cleanse; jest through error therein by overdrying you consume the Flesh you designed to raise, or by too moist Applications tender it corrupt. The season of the year is herein to be observed: for in the hotter season Medicaments more cooling are required, and in cold weather more heating. Therefore at such times we put thicker Compress, and take more turns with our Rowls, than in hot weather. The Habit of body is also to be regarded. For in lax and tender Bodies Sarcoticks require to be moderately drying, such as are olibanum, thus, aloe, court. thuris, far. foenugraeci, orobi, etc. The Compounds are, unguent. matrisylv. or basilicon magn. diapompholyg. unguent. tutiae, calaminaris: or this, ℞ myrrhae, aloes, an. ℥ ss. thuris ℥ j mastic. ℥ ss. gum. elemiʒ iij. terebinth. Venet. ℥ iiij. ol. hyperici q. s. fiat Vnguentum. The more drying are, rad. ireos, aristoloch. rot. far. lupinor. sarcocol. asa foetida made up with mel despumat.  
If these Medicaments be well proportioned to the nature of the Ulcer, the Matter will appear of good colour and consistence, and in lesle quantity, and the Flesh of a natural colour, firm, and drawing into a healing condition. But if the Medicaments were too drying, the Flesh in the Ulcer will be pale, the Matter thin, and the Parts about heated with the disturbance.  
The Ulcer incarned, you are to endeavour to cicatrize it by drying the Flesh into Callus: and forasmuch as Callus is drier and harder than Flesh, therefore your Medicaments aught to be more drying than those you incarned with, and to be endued with an astringent Quality.  
The making of this Callus is the work of Nature, yet is furthered by the application of Medicaments, (as I have said.) If the temperament of the Part be well disposed, you may observe the Ulcer to skin from the edges while it is filling with Flesh within, and without the help of Epuloticks: but where the Part hath been long affected with Ulceration, it is usually weak and out of temper, and is very difficult to cicatrize; therefore it requires Epuloticks accordingly more drying and astringent.  
The milder cicatrizing Simples are, bolus Armen. sang. dracon. creta, pulv. ostreorum combust. ros. rub. ballast. sumach, calx lota, cerussa, plumb. ustum, tutia. A mixture of some of these may be sprinkled upon the Ulcer, or a Decoction of them applied upon Lint. The stronger are, sacchar. Saturni, vitriol. Rom. aes ust. squamae aeris, ferri, croc. Martis astringens. These Powders may be mixed with Unguents. Or, ℞ unguent. calaminaris, Emplastr. grisei, an. ℥ j lineament. Arcaei ℥ ss. sacchar. Saturn. ℈ j cerae q. s. fiat Emplastrum. Or some of the abovesaid Powders may be decocted or dissolved in proper Waters, and applied upon Lint, taking care that you do not by the use of them consume the Flesh, in stead of condensing it into Skin.  
The time of applying Epuloticks is, when the Flesh is rising up near the Lips of the Ulcer, (before it grow too high) that it may be dried to cicatrize even with it; for Nature is not wanting the while to incarn. Therefore if you defer the use of Epuloticks till the Flesh be grown equal with the Skin, you will be forced to use Escaroticks, or make an unseemly Cicatrix: to avoid which we generally apply Epuloticks to the edges while we are incarning the middle. For by the way you must take notice, that none but ill-conditioned Ulcers begin to cicatrize from the middle. If the Lips of the Ulcer lie not level with the Ulcer, it will not easily cicatrize: therefore in such case you must make a more strict Compression by Bandage.  
AMongst the various and sundry sorts of Ulcers that hap daily under my Cure, I found it difficult to make out one Simple Ulcer, as Authors have described it to us, without other Symptom or Affects joined to it; every Ulcer having somewhat of distemper till it be digested and brought into a healing condition. In which regard we shall call that a Simple Ulcer which hath fewest Accidents attending it, and shall give you an Instance of one in a Gentleman, 
1. Observat. of a Simple Ulcer.  who having a small incomsiderable Push risen upon one of his Legs on the outside, he not taking notice of its mattering, it adhered to his Stocking, and became ulcerated in the Skin, with a small Inflammation and Swelling. I dressed the Ulcer with unguent. basilicon upon a Pledgit of Lint, applying Emplastr. oxelaei with a soft Compress lf linen over it, and rolled it up from the Small of the leg to the Gartering, advising him to favour his Leg what he could, by laying it sometimes upon a Stool. Thus in two or three days it was digested, and freed of the Inflammation and Swelling. From that time I dressed it with unguent. tutiae Vigon. by which I cicatrized the Ulcer to the compass of a silver Halfpenny. The Patient supposing himself cured left of the use of the Bandage, and gave himself the liberty to walk abroad: upon which the Lips of the Ulcer grew high, and became incapable of cicatrizing that way. I therefore made a Paste of Ceruse with unguent. rosat. which with Compress and Bandage pressed the Lips even with the Ulcer, and cicatrized it in three or four days, whilst he was attending his affairs at home.  
Such another was commended to my hands by Doctor Weatherly. 
2. Observat. of a Simple Ulcer.  The Ulcer was in the Leg, and had been very vexatious to the Patient: it was accompanied with some little Fluxion, enough to relax the Parts, and keep the Ulcer from digesting, and consequently from healing. I dressed it as in the former Observation hath been said; only in stead of a Rowler I put on a laced Stocking: by the wearing of which the Humours were restrained, and the Patient cured himself in few days by the Unguents forememtioned.   

CHAP. III. Of Ulcers with Intemperies.  
IT frequently happens that Ulcers are subject to various complicated Affects: Therefore the Cure must necessarily vary accordingly. For which cause we shall now treat of Ulcers as they have Symptoms or Diseases joined with them; and begin with those that labour under Intemperies, whether from corrupt Juices in the whole Body, or Imbecility in some particular Part. Whatever it is, that Cause must be first removed, before you can hope to make good Digestion in order to the incarning or cicatrizing of the Ulcer.  
Intemperies is simple, or compound. The Simple are four, hot, cold, moist, 
Kind's.  and dry: the Compound are, hot and moist, hot and dry, cold and moist, cold and dry. We shall begin our Discourse with the Hot Intemperies.  
A hot Intemperies may arise from a Fermentation of the Serum in the blood, 
Hot Intemperies.  and that from ill Habit of body, ill Diet, or the like; also from heat of the Air, or keeping the Part affected too hot, by lapping too many  or Rulers upon it, or by reason of too strict Bandage, or by the application of too sharp Medicaments.  
A cold Intemperies is caused by abundance of pituitous Humours, 
Cold Intemperies.  or by exposing the Ulcer too much to the air in the time of dressing, or by the not enough defending it in cold weather by good Compresses and Bandage, or through the application of Medicaments too cooling.  
A dry Intemperies may be occasioned by the exhausting of the natural heat, 
Dry Intemperies.  as in long chronic Diseases, hectical indispositions, or by too slender Diet, or the like; also through defect of Aliment in the Part itself for want of use, as it frequently happens where Ulcers have long affected the Member.  
A moist Intemperies may proceed from abundance of Humours in the body, 
Moist Intemperies.  and Imbecility of the Part affected from hard Bandage or too slabby Applications, or possibly want of Bandage. Wet and foggy weather is frequently a cause of it.  
If the Intemperies be hot, the Ulcer and Parts about it are read, 
Signs of hot.  and the Patient complains of heat in the Ulcer. Also the Matter is sharp, whence a pricking and burning is frequently felt, and sometimes an itching in the Part. The Cause preceding will show the nature of the Intemperies.  
These sorts of Ulcers are relieved with cooling Medicaments, and exasperated by those that heat.  
The cold Intemperies may be distinguished by the livid or pale colour of the Ulcer and Parts about it; the Flesh in the Ulcer is whitish and lose; 
Signs of cold  the Patient also complains of cold. It finds relief by Medicaments that are heating.  
A moist Intemperies may be judged by the too much humidity in the Ulcer: 
Signs of moist.  and if that Humour be not acrimonious, the Flesh will be luxurious and flaccid. The great discharge of excrementitious Humours and the Habit of body will evidently discover the Cause.  
A dry Intemperies is for the most part judged by the Habit of the body, 
Signs of dry.  it being lean and dry; the Member or Part diseased is also dry and squalid, the Lips thin and lank, and with little moisture.  
By the Signs of these Simple Intemperies the Compound may be judged of.  
As all Ulcers complicated with great Diseases are of difficult Cure, 
Prognostic.  and therefore called Cacoethe: so these Ulcers labouring under Intemperies, though they be well handled, are hard of Cure, and may be truly reckoned among the Cacoethe, malign and rebellious Ulcers. But those accompanied with Siccity are the worst; for that we are necessitated to neglect the Cure of the Ulcer, to secure the Part affected. The Cure is also long in effecting, by reason that the whole Habit of body requires by Humectation to be altered, which is a work of time: whereas the Ulcer distempered with heat, cold, or moisture, may be cured while you are removing the Intemperies.  
THE Cure of these Ulcers consists in the removing of the Intemperies. 
Cure of a hot Intemperies.  Therefore in the first place you are to consider whether it be hot, cold, moist, or dry, and endeavour to restore the diseased Part to its natural temper by its contraries; as if it be hot, treat it with Refrigerants, to the moist apply Desiccants, and so the rest: having care the while that you do not neglect the Cure of the Ulcer. But if it be so that both may not be relieved at one and the same time, than you are to regard that which most requires your help. If the Ulcer be accompanied with a hot Intemperies, that must be first removed by Refrigerants of an astringent and repellent quality, milder or stronger according to the greatness or smallness of the Distemper. Also a cooling and moistening Diet is to be observed, with regulation of the Non-naturalls. If there be Plethora, Purging and Bleeding are necessary, as well for Evacuation as Revulsion. The Ulcer itself requires detergent and exsiccant Remedies: But in consideration that the hot Intemperies consumes the humidity in the Ulcer, and renders it lesle moist, therefore these Ulcers are to be treated with the milder Driers, yet with regard to the greatness of the Intemperies, and the quantity of Matter the Ulcer discharges. The Topics are unguent. diapomphol. tutiae, album, unguent. è plumbo, è calce, basilicon, with Praecipitate.  
The external Remedies to be applied over the Part affected, to abate the heat of the Intemperies, may be unguent. album camphorat. Emplastr. diapalm. cum succis, Emplastr. oxelaeum, etc. unguent. refrig. Galeni, nutritum, & populeon. The Unguents may be applied simply, or made into a Cerote with white Wax. Over them may be applied  dipped in Oxycrate, or read Wine, or Juices of fol. plantag. polygon. lactuo. burs●●pastoris, with acetum, or read Wine, wherein have been infused flor. ros. rub. bacc. myrtill. ballast. sumach, etc.  
A Reverend Divine of a good age, 
Observat. of an Ulcer with hot Intemperies.  having laboured some months under an Ulcer on the inside of his right Leg along the Shinbone with much pain, sent for me. The Part affected was distempered with great heat, and the Ulcer discharging a Sanies, endeavours had been used to digest it cum terebinth. & vitell. ovi, and such like, unsuccessfully. I fomented the Ulcer and Parts about with Claret-wine, and dressed it with two parts of unguent. diapompholyg. and one part of unguent. basilicon maj. with Praecipitate. Upon the Lips of it I applied Pledgits spread with unguent. diapomphol. and an Emplaster of some of the same diapomphol. over all, with Compress wrung out of the Wine, and rolled it up lightly, placing his Leg in bed as before. The next day I brought a Decoction of fol. plantag. summitat. rubi, equiseti, flor. ros. rubr. ballast. to which I added some Wine; and while it was heating I took of the Dress, and found the heat somewhat allayed, and the Ulcer well disposed to Digestion. I stuped the Ulcer, dressing the Parts about with unguent. tutiae. mag. Vig. and rolled it up as before. By this method the hot Intemperies removed, and the Ulcer digested: after which by the help of unguent. desiccativum and the Alume-stone I cicatrized it firm, to the satisfaction of the Patient and his Relations, leaving him again to the care of his Physicians Sir. Alex. F. and Sir Fr. P. by whose order I made him a fontanel, and some while after put him on a laced Stocking.  
IN the Cure of an Ulcer with a cold Intemperies there is required an observance in Diet and other Non-naturalls, 
Cure of a cold Intemperies.  as hath been prescribed in cold tumors, with Purgations to evacuate the Cacochymia, and alterative Decoctions to attenuate and dry the Humours. Outwardly are required Medicaments heating; and, forasmuch as it is the nature of cold to straighten the Pores and harden the flesh in Ulcers, they aught also to be attenuating and rarefying. The Medicaments proper to dress the Ulcer aught to be drying and detergent. The degrees of these qualities must be taken from the distemper of the Ulcer and Part affected, as it is much or little; also from the Age of the Patient, and Season of the year; and from the greatness or smallness of the Ulcer.  
The Intemperies of the Part we correct by Decoctions of absinth. scabios. agrimon. salv. betonic. flor. cham. bacc. lauri, juniperi, with the addition of Wine or spirit. vini, and all those Medicaments proposed in the Cure of Oedematous tumors, applied hot with Stupes. Those proper to deterge the Ulcer are, mundif. ex apio, mundif. Paracels. unguent. apostolor. The Emplasters are, diachyl. ireat. de betonica, barbarum magn. diasulphuris, flos unguentorum. After which you may proceed with sarcotics and Epuloticks, as shall be said.  
A person of about twenty five years of age, of a gross fat Body, 
Observat. of an Ulcer with cold Intemperies.  was vexed with an Ulcer in his right Leg. The Ulcer was large, crude and undigested, and the Lips thick, the Parts about the Ulcer pale, and yielding to impression. I fomented the Ulcer and Parts about with Wine, filled up the Ulcer with Praecipitate, and applied unguent. Nicotianae over it, with Emplastr. de sandyce, Compress and Bandage, and dressed it not again till the third day. In the while I purged him with an Apozeme made with a Decoct. polypodii, sennae, rhabarb. agaric. sem. carthami, to which was added syr. de spin. cerv. and put him into a Decoction of sarsa, lign. guaiaci, sassafras, etc. than provided a laced Stocking, and a Fomentation made of absinth. hyperic. centaur. flor. cham. bacc. myrtill. ros. rubr. and ballast. boiled in Wine and Water, with an addition of spirit. vini: after that I took of Dress, fomented the Part affected, and dressed the Ulcer cum unguent. Nicotianae, with a mixture of pulv. praecipitat. and Emplastr. didehyl. ireat. and laced on the Stocking with a good Compress under it. By which I brought the Ulcer to Digestion, flatted the Lips even, disposed it to incarn, and afterwards cicatrized the Ulcer with Pledgits pressed out of a spir. vini wherein was dissolved a few grains of sacchar. Saturni.  
IN the Cure of an Ulcer with a moist Intemperies slabby and greasy Medicaments are to be forborn, and drying to be used: and, 
Cure of a moist Intemperies.  in consideration that the Part is weakened by the too much humidity, you are to mix Corroboratives of an astringent faculty; the Ulcer also requireth to be dried. The Medicaments aught to be proportioned according as the Intemperies affects the whole Body, or some particular Part, and as the Ulcer is great or small. Diet, Air, Contemperatives are also here to be considered. The simple drying Medicaments in these Ulcers are, Litharg. auri & argenti, minium, cerussa, plumb. ust. and the like, of which Medicaments may be made up. Or you may make choice of some of these Compounds. ℞ plumbi usti, pompholyg. lot. an. ℥ j ol. myrtill. & cerae q. s. or, unguent. diapompholyg. tutiae mag. unguent. è calce lot. unguent. nutritum, album camphorat. desiccativum rubr. or, ℞ cadmiaeʒ jss. aernginis, aeris combusti, an. ʒ ij. alum. scissilisʒ ss. cerae novae ℥ v. sevi arietin. q. s. Misc. fiat Vnguentum.  
If the Ulcer requires to be fomented, a Fomentation may be made of summitat. absinth. fol. beton. flor. ros. rubr. summitat. rubi, bacc. myrtill. nuc. cupress. ballast. sumach, etc. boiled in Wine or Oxycrate. Also aq. calcis and aluminosa are useful in the drying up of the humidity in the Ulcer and Parts about it.  
A Gentleman of a full Body, 
Observat. of an Ulcer with moist Intemperies.  between fifty and fixty years of age, abounding with Cacochymia, and subject to Swell in his Legs by reason of the Gout, which he was frequently afflicted with, by some accident rubbed the skin of his left Leg. He endeavoured the curing it by healing Medicaments, but it was thereby the more exasperated, and spread larger. I, observing the too moist Intemperies of the Part, and the Matter crusted about upon the sound edges, bathed it with aq. calcis, dressed the Ulcerations with unguent. de lithargyr. and applied a Compress wrung out of the said aq. calcis over that with good Bandage. After I had thus dressed him, I let him blood in the Arm about ten ounces, and the next day purged him with half an ounce of Elect. caryocostin. But notwithstanding these endeavours, I found in the taking of Dress a great discharge of a hot serous Humour, which increased the Ulcerations much. I therefore caused a Fomentation to be made of some of the forementioned Ingredients, to fortify the weak Part against the Influx, and to dry up the Ulcer, and applied my Pledgits, spread with Epuloticks, somewhat more distant one from another, that the thin Humour might get out between them; than applied a Compress spread with unguent. nutritum over all, rolled it up equally, repeated the Purgation, and ordered him each other night ʒ vj. syr. de meconio in aq. papaveris rhoead. with a little aq. cinnamom. hordeat. Observing in taking of my Dress, that the Matter would in spite of my endeavours be here and there shut in by the Pledgits which lay upon the edges of the Ulcerations, I sprinkled them with pulv. lap. tutiae praeparat. and forbore the use of Pledgits there, supposing that way to give vent to the Matter, and at the same time to cicatrize them, and the while dressed the Ulcer with Pledgits pressed out of a styptic Decoction in some places, and in other with unguent. è plumbo. But I found on the next Dress that the Powder crusted upon the edges, and by retention of the Humour caused Erosion underneath. I than made a Solution of pulv. lap. tutiae corn. cerv. ust calx lot. etc. in a Decoction of fol plantag. salicis, summitat. rubi & equiseti, dipping little bits of fine Lawn in it, and appled Desiccatives upon that; on the edges, unguent. desiccativum rubr. mixed with unguent. è calce lot. in the middle I sprinkled some Powders, as boli Armen. corn. cerv. ust. Various endeavours were used; but by this last way the Ulceration was cured. Than a laced Stocking was put on, which restored the Part to its natural tone. Of this Intemperies you will found an Observation in Herpes', and another in the Treatise of Wounds, particularly that in the outside of a young Nobleman's Leg, which puzzled two eminent Surgeons as well as myself. And wherever you meet it, you shall found difficulty.  
IN the Cure of an Ulcer with dry Intemperies, 
Cure of a dry Intemperies.  you are to apply your endeavours more immediately to the removing the Intemperies, and content yourself the while in digesting the Ulcer, and keeping it clean. You are here to consider the Cause of the Drought; whether it were from defect of Nourishment in the whole Body, or in some particular Part, or in both. If the first, than a good Diet must be directed of such meats as are of easy and good nutriment. In this case Wine is allowed to be moderately drank. In the second and third cases, you are to endeavour that the aliment be attracted into the affected Part by putting it upon action, if it may consist with the Cure of the Ulcer. Otherwise Friction, Pitch Emplasters, Fomentations, Embrocations, fontanelles, and the like, are to be used, to stir up heat in the Part affected. The Fomentations are to be applied moderately warm, and the Member to be bathed till it looks read and gins to swell: than you are to desist; for if the Member be longer fomented or chafed, you may dissipate what you attracted. The Medicaments afterwards to be applied aught to be humecting, as a mixture of Water and Oil; also such like Cerote may be applied: ℞ succ. bismalvae & parietariae an. ℥ ij. ol. amygdal. dulc. ℥ vj. cerae albae q. s. fiat Ceratum.  
The while the Intemperies is removing, the Ulcer may be dressed with the milder Digestives, or with unguent. basilicon and Praecipitate; which is also a good Detergent and Sarcotick: or this; ℞ thuris, mastic. sarcocollae, an. ʒ j ol. hyperici ℥ ij. terebinth. Ven. ℥ iss. cerae albae q. s. fiat Vnguentum. In the treating of these Ulcers, you are to be careful that your Applications to the Ulcer be not too drying, jest you thereby bring the Intemperies again upon the Part. The Ulcer incarned, you may proceed with Epuloticks, as hath been all along delivered.  
A Youth of about thirteen years of age was brought out of the Country, 
Observat. of an Ulcer with dry Intemperies.  and lodged near me. He laboured under several Ulcers in his right Leg, one especially upon an Exostosis on the Os tibiae on the inside near the Ankle. The Ulcer was large, and of an oval figure, the Lips pale, dry and thin, the Matter little and sanious, the Leg itself emaciated and squalid; which I supposed was by the weakness of the native heat from not using of the Lim. I caused his Leg to be bathed with warm water, and dressed the Ulcers with unguent. basilicon and Praecipitate, applying a Cerote over all of a mixture of unguent. dialthaeae, ol. expedibus bovinis, and Wax; than rolled a soft Compress on it, to retain the Dress on and keep it warm, and ordered his Diet as above said. The lesser Ulcers digested and cured by the ordinary Epuloticks; but the larger upon the Exostosis would not digest for three days together with any Medicaments: which gave me cause to suspect the Bone under it to be carious, and that I should be necessitated to lay it bore: but I could not by search of my Probe feel it. I continued to nourish the Part by bathing it with emollient Decoctions and Embrocations, with ol. ex ped. bovinis, and gave the Patiented liberty to use his Leg by setting his Foot on the ground; by which it swollen, and became more humid. After some while, when I saw the temper of the Member altar, I ordered a laced Stocking to be put on, for that I could not with a Rowler make such a Compression so near the Ankle as I would, without causing a swelling in his Foot. I dressed it with Pledgits of Lint dipped in a Solution of Tincture of Vitriol in aq. rubi, and made the Compression over it; by which method the Ulcer cured with a firm Cicatrix upon that Exostosis. He went well cured out of my hands, and I suppose is well to this day. These kind of Ulcers are frequently seen in hectical and emaciated Bodies and withered Limbs.   

CHAP. IU. Of Ulcers with Pain.  
PAin is also one of the Symptoms which interrupts the Cure of Ulcers, and affects the Part sometime after the Ulcer is cured, whence various Accidents are stirred up, as Fever, Watching, and a Prosternation of spirits. Therefore it requireth our utmost endeavours speedily to remove or mitigate it.  
The Causes of Pain are acrid sharp Humours corroding the Ulcer, 
Causes.  and heating the Parts about; proceeding either from a repletion of evil Juices abounding in the Body, or through misapplication of Medicaments in Chirurgery, as not timely digesting the Ulcer, or from too long use of Abstersives.  
The Complaint of the Patient will demonstrate the Pain, and the Symptoms will show the Cause; 
Signs.  whether it arise from want of Digestion or Detersion, the Matter will testify.  
The removing of the Pain requireth a right distinguishing of its original Cause. 
Cure.  The Habit of body is also to be considered, how it is fault: and accordingly as there is Plethora or Cacochymia, you aught to make Evacuation by Purging, or Bleeding, or both, and use contemperating Juleps, Opiates, and the like. Also the Patient's eating and drinking aught to be regulated proportionately.  
These things premised, you are to apply your speedy endeavours to remove the Pain by proper Anodynes. If the Ulcer be sanious, it wants Digestion; and that is furthered by such Medicaments as have a temperate heat, as we have already showed. The heat in the Parts about may be mitigated by Lenients, as is before said in tumors, and after in Wounds, or by such like; as the Mucilages of sem. cydon. psyllii, althaea, extracted in decoct. malvar. and far. hordei, croc. & vitell. ovi, axung. gallin. porcin. made into the form of a Cataplasm, or with Wax into a Cerote, or ceratum Galeni, or that with populeon: if more cooling be required, unguent. nutritum, alb. camphorat. Emplastr. è bolo, etc.  
If the Pain arise from hot acrid Humours fretting the Ulcer, it may be dressed with unguent. diapompholygos, or unguent. è plumbo, unguent. tutiae simply, or mixed with basilicon, with a little Praecipitate, with Compress wrung out of Oxycrate, or read Wine, whereby the heat may be contemperated, and the Part strengthened to resist the Influx, by which the Cure of the Ulcer may happily be effected.  
If the Pain be caused by a sordid Matter sticking to the bottom of the Ulcer, and hindering transpiration, you cannot remove the Pain without Detersives; of which Merc. praecipitat. is the best and mildest.  
Pain is so familiar an attendant of Ulcers, as it is not easy to represent you any one without it: but in complicated Ulcers it may not possibly be so easy to distinguish its Cause, nor yet so directly to demonstrate the way of relieving it, as in a Simple Ulcer, where there is no other Symptom joined with it. Amongst which I suppose it may appear most conspicuous in fontanelles, I therefore have chose to give you a few Instances of such, but shall begin with one arising from an Accident.  
A Person of about forty years of age, of a full and scorbutical Body, 
1. Observat.  by some accident broke her Shin, and endeavoured the curing of it: but it daily growing more painful, and not to be endured, I was sent for, and, observing the Ulcer sanious, proposed Digestion as the only way to remove the Pain. I dressed the Ulcer with two parts of the common Digestive ex terebinth. and one part of unguent. tutiae mag. spread upon a Pledgit. The Ulcer was of so exquisite sense, that it would scarce bear the Pledgit. I applied unguent. alb. camphorat. spread Emplasterwise, with a Compress of soft Linen over it, and rolled it up from the Foot to the Gartering lightly, a little to restrain the Influx. This method I continued three days, by which the Ulcer was pretty well digested, and lesle painful; but the Leg was subject to Fluxion: and I doubted how it would cure so suddenly as was expected without the help of a more steady Bandage, meaning a laced Stocking. But she replied, they had always made her sick. I than proposed Purging. To which she objected the want of convenience. I continued the dressing of the Ulcer as before, till it was digested well; than I dressed it with Pledgits dipped in aq. calcis overthwart the ends of the Ulcer, with a Pledgit of unguent tutiae in the middle, to cicatrize if from the end, and applied unguent desiceativ. rub. over them as an Emplaster, than rolled it up; by which it cicatrized in a few days. After the Patient saw herself so suddenly cured, she became well inclined to have a laced Stocking put upon that Leg, and, finding no inconvenience by it, bespoke another for the other, and returned well satisfied to her house in the Country.  
Some months after this person being again in the Town was grievously pained with a fontanel in her left Arm, 
2. Observat. of Pain from Sordes.  which she had kept for the space of eight years; but now, not being able to ease herself by the usual method, she threw out the two Pease, and endeavoured to cure it: but it became more painful, and would not heal. I, being sent for, observed the Ulcer to retain the form the Pease had given it, by reason of a grayish viscid sordid Matter that covered the bottom and sides thereof. This hindered the Transpiration, and stirred up a great heat about and in the Ulcer: the Lips grew turgid with the anguish, and so painful that she could not endure the wiping the thin Ichor from it with a soft Rugin with her own hands.  
This Ulcer required Detersion, and the best Anodyne had been to have filled it with Praecipitate, and to have applied Lenients over it. But her complaints put me upon the dressing it with such Medicaments as she had lest apprehension of, which were unguent. basilicon with Praecipitate upon a Dossill, which I laid in the Ulcer lightly with Pledgits of unguent. diapomphol. over the Lips, and unguent. album over all; she fastening a Cloth over it, according as it would bear. She than complained grievously of the pain she felt by the Dossill in the Ulcer, and was, as she told me next morning, in a Fever all that night. I continued the same Dress, only applied Emplastr. è bolo over all that Part near the Ulcer, which remitted the heat and pain thereabout; but the Ulcer was excessive painful for the space of two hours after dressing: yet the Lips of the Ulcer had cast of part of the Sordes, and the Ulcer itself looked better after three or four days Dress. The Parts without were so well tempered, that she could bear a Compress and Bandage: but the Pain in the Ulcer continued for some hours after dressing, and returning again in the evening, lasted a great part of the night. Upon which consideration I desired her to give me leave to dress it with Praecipitate, assuring her ease from it. She permitting me, I dipped my Dossill in the Praecipitate, and sprinkled some of it where the Sordes was thickest. I than applied my Dossill over it, and a Pledgit with unguent. diapomphol. over that, with Emplaster and Bandage, as before, and resolved not to open it again till the third day after; but was called the next morning and informed by herself, that she had been much easier since the dressing: and indeed at the next dressing I found a Slough come away with the Dress, which was the Sordes. I dressed it with unguent. basilicon and Praecipitate mixed as at first, with the other Applications and Bandage; and the second day after dressing it again, and finding it well digested, and free from Pain, I put an Orange-Pea in the Ulcer, and continued it as a fontanel with much ease.  
Thus in scorbutically-habited ill Bodies, abounding with Cacochymia, we frequently see these simple Ulcers afflicted with sharp Humours, which corrode them, and tender them painful fordid Ulcers; which, if not timely relieved by Detersives and Lenients, do terminate in putrefactive Ulcers.  
A Person of Honour of about thirty six years of age, 
3. Observat. of Pain from Putrefaction.  labouring under sharp Humours, was ordered a fontanel in her Thigh, which a Chirurgeon made, and fitted with an Orange-Pea. It grew very painful; but the Patient, supposing it should be so, endured it so long till she could not stand with it. I was sent for, and saw the Thigh much swelled and heated with the excessive Pain, and the Ulcer covered with a brown Sordes, and a quantity of a thin Gleet issuing from it. I threw out the Pea, fomented the affected Part and Ulcer with Wine, filled the Ulcer with Merc. praecipitat. and applied unguent. tutiae with Pledgits over it, with Emplastr. è bolo over all, rolling they up, and advising her to keep her Chamber and Pallet. The third day after I dressed her again: the Slough came in part away. I dressed it up again as before; and the third day after found the Ulcer digested. The Pain mitigated the first night, and the heat went of the next dressing. I healed this fontanel in few days, and made her one in her Arm.  
But in such indisposed Bodies Pain doth not affect the Ulcers only, but the Parts also where they have been, after they are cured.  
A Maid of about thirty five years of age, 
4. Observat.  of a scorbutic Habit of body, had an Issue made in her left Arm, which was continued running many years; but at length, whether through negligence, or from some other reason, she suffered it to dry up. The Winter following she grew very much out of order by reason of a great complication of ill Symptoms, of which the most important was an intolerable pain in that Arm and place where her Issue had formerly been. After various courses of Physic and external applications, she was in some measure relieved, and was pretty free all the following Summer: but in the Winter, viz. 1672. her pain returned with such violence, as to afflict not only the place of the Issue with such pains, that she likened it to the cutting of of the Arm, but it stretched itself in a while after to the whole Arm, Shoulder, yea the very Side itself; so that many Attempts being made, the Surgeons in the Country opened two Issues on each side of the seat of the old one. Many other things were done, till at last she came into my hands. Doctor Walter Needham was her Physician, and upon examination found her afflicted with a Rheumatismus, for which he instituted a convenient course, and judged withal that the Pain of the Part was from the usual way Nature had taken to the old Issue, whither the sharp Humours making their passage, and finding no vent, did disperse themselves through all the branches of the Axillary Artery on that side, viz. to the Scapulary and Thoracick branches, etc. the Pain being everywhere found according to the places of their distribution.  
To the Cure of this, besides what was inwardly administered, it was thought requisite to eat down deep by a Caustick into the place where the old Issue had been, and thereby to divide the Fibres of the Membrane of the Biceps, which lay just under it, and seemed to be the place of the principal Pain. When this was done, we divided the Esoar, and cut it out, than filled the Opening with Praecipitate, and applied a Pledgit of unguent. basilicon. with ol. liliorum upon it, and dressed it up. We dressed it every other day, till the remaining Escar and Slough separated; than we incarned and cicatrized the Ulcer even. From the time of the Opening this her Pain ceased, and she was well of that, but laboured under a Rheumatismus in great measure, it swelling her Thighs, Legs, Hips, and lower Belly: but by frequent Phlebotomy, Purging, and other Prescriptions, she was by my said Friend happily cured.   

CHAP. V Of Ulcers with Fluxion.  
BUT it rarely happens that Pain afflicts an Ulcer without Afflux of Humours: we shall therefore say somewhat of that, it being a great cause of the difficulty we meet with in the Cure of Ulcers.  
What the Causes of Fluxion are, 
Cause.  hath been delivered when I treated of tumors in general, viz. the Part mittent, and Part recipient: That vicious Humours peccant in quantity or quality are either thrust forth by the Part mittent, through the strength of nature; or attracted by the Part recipient, by reason of heat or pain; or are moved to it by reason of its weakness, or low situation, which rendereth the descent of the Humours more easy.  
An Ulcer with Afflux of Humours is discerned by the tumefaction of the Lips and Parts about it; 
Signs.  and from the abundance of excrementitious Humours flowing from the Ulcer. It is also accompanied with Inflammation proportionably to the quality of the Humours.  
All Ulcers with Fluxion are of difficult Cure, 
Prognostics.  the Ulcers being thereby rendered lax and indisposed with Pain, Tumour, etc. and by how much the greater the Influx of Humour is, so much the more difficult is the Cure.  
In the Cure of this Ulcer, the Cause of the Fluxion is to be enquired into; 
Cure.  whether it proceedeth from Humours peccant in quantity or quality, thrust forth by the Part mittent upon the inferior weak Parts, or that it was attracted to it by reason of heat or pain. If Heat was the Cause, that must be removed as hath been said in the Chapter of a Hot Intemperies. If Pain was the Cause, you must endeavour to mitigate that by Lenients, as hath been showed in the preceding Chapter. If Plenitude be the Cause, a slender Diet aught to be prescribed, and Venaesection if nothing hinders, and the Body kept soluble by Clysters and the like.  
If the Humours offend by reason of their evil quality, Purgatives are proper, according to the quality of the Humour: and if they be too fluid, they must be incrassated and contemperated by Alteratives, as Endive, Succory, Sorrell, Purslane, Lettuce, in Broths; also Barly-cream, Emulsions, Violets, Citron, Rasburies', and the like: and the Humour flowing to the weak Part may be averted by Revulsion, Interception, and Repulsion. What they are, and where they aught to be applied, you may see more particularly in the Treatise of tumors in general.  
The Medicaments proper to strengthen the weak Part, and resist the Influx, aught to be of a cold and astringent quality; as fol. plantag. polygon. summit. rubi, equiseti, court. ulmi, flor. ros. rub. bacc. myrtill, ballast. nuc. gland. querc. cypress. gallor. Some of these may be juiced, others powdered and mixed with Unguents, or boiled in Oxycrate, or read Wine, and applied with Stupes to the Part. In great Fluxion and in strong Bodies aq. aluminis and aq. calcis may be of use; to the latter of which may be added a few grains of Sublimate.  
The Unguents may be unguent. nutritum, alb. camphorat. unguent. desiccativ. rub. cerat. Galeni, Emplastr. de minio, è bolo, etc. But forasmuch as these Ulcers are frequently disturbed by sharp Humours impacted in the Pores, which cannot be repelled, and by their acrimony may stir up pain and Inflammation; you shall therefore have regard to the Ulcer, to digest and deterge it, while you outwardly resist the Influx upon the Parts about it: and let your Detergents be such as are more drying than in simple Ulcers, but with little acrimony: of which sort you may found choice set down in the Chapter of the Moist Intemperies, to which I refer you. The Ulcer deterged, you may incarn with such like: ℞ terebinth. Venet. ℥ ij. sevi vaccini ℥ j plumb. ustiʒuj. tutiae praepar. corn. cerv. usti, an. ʒij. Misc. To which may be added thus, sarcocolla, resina pin. etc. For in the dressing of Ulcers the proportioning of Medicaments aught to be left to the discretion of the Chirurgeon, avoiding greasy Applications in these Ulcers as much as may be. The Ulcer incarned, you may proceed by Epuloticks, as hath been all along showed.  
A Maidservant living in a Noble Family had cut the inside of her right Leg by a Fall upon a hot Grate-iron, 
1. Observat. of an Ulcer with Fluxion  and, having suffered about eight weeks under ill Chirurgery, was commended to my care. The Ulcer was with loss of substance and sanious, with some pituitous Swelling in the Lips and Parts about. I dressed it with unguent. basilicon mixed with Praecipitate, as it is usually in my Salvatory, ʒj. of it to one ounce of the Unguent. I applied over it an Emplastr. diachalcit. sprinkled with a little acetum, and a Compress wrung out of Oxycrate, than rolled it up with the expulsive Bandage; the Cure indeed consisting mainly in the well rolling, the want of that causing frequently Crudity in the Ulcer. By the use of it both the Influx was restrained, and the Member strengthened, and with the help of the Unguent aforesaid it was digested: as the Lips flatted by virtue of Compression it, incarned, and by unguent. tutiae and Pledgits dipped in aq. calcis cicatrized in few days, without Purging or Bleeding.  
A Man about fifty years old, 
2 Observat.  of a gross Body, frequently afflicted with the Gout, and labouring than under it in his left Leg, (as I remember) was commended to an Empirick, who pretended extraordinary skill in the Cure of that Disease, but understood no more than what he had learned by Books. The Patient's Leg was much swelled with pituitous Humours, as most fat Bodies are that have long laboured under the Gout, and no Medicaments or Bandage were used to fortify the weak Member. He began the Cure by Purging, and than proceeded by bathing his Leg in a Tub with some Decoction of Herbs, etc. The Bath might possibly be good; but the putting his Leg into it, as it seemed, served but to lead the Humours more powerfully down to it, and increased the Swelling. Whereupon he was again purged by strong Catharticks, it was supposed Lockyer's Pills: he was also frequently vomited as roughly; but without success, the Gout continuing, and the Leg growing more weak and swelled. Endeavours were used by Emplasters of various sorts, and Purgatives repeated, till the Patient's spirits and strength were near exhausted, the Empirick confidently promising a Cure thereby. But the Patient not able longer to endure his Applications, I was sent for, and found him extremely weak, and complaining much of Pain. I took an Emplaster of his Leg, I suppose Emplastr. de ranis cum Mercurio, or some Solution of Mercury with Gums; it was spread thick upon Leather, and lay in great wrinkles about the whole Leg: under it was great Excoriation, with Tumour and Inflammation. I caused some water to be warmed, and while it was held over a Vessel my Servant bathed it with a Sponge, to cleanse it, and give a breathing to the Humour. I than dressed the Ulceration with unguent. tutiae, and applied ceratum refrigerans Galeni, cut into pieces, to give way for the discharge of the Humour, and rolled the Leg from the Foot to the Knee. After I had continued this method of dressing a few days, mitigated the pain, and digested the Ulceration, I left of the use of the Cerote, dressed the Ulcer with unguent. desiccativ. rubr. applied unguent. nutritum over all, than rolled the Member more strictly, and thereby cicatrized the Ulceration, and he was free from the Gout. I ordered him a laced Stocking, and by moderate and equal lacing it restored the Leg to a better shape than it had been in many years before, and left him well recruited in his strength; forewarning him again to trust such Bragger's.  
A Servant to a Nobleman in the Country, by a Fall upon a sharp piece of Timber, 
3. Observat.  bruised and cut his left Leg from the Shinbone transverse the outside of the Calf of his leg. Through neglect in the Country it inflamed and swelled very much, and the Ulcer became undigested. He was sent up to Town, and lodged near me. I fomented the Part affected with Wine, dressed the Ulcer cum terebinth. vitell. ovi & far. hordei, applied Emplastr. è bolo, with a Compress wrung out of the said Fomentation, and rolled it up; than let him blood. The next day I fomented his Leg with a Decoction of some of the Simples above mentioned, dressed his Ulcer as before, and applied an Emplaster of farina fabarum, pulv. ros. rubr. ballast. bacc. myrtill. sumacb, decocted in Wine, adding some mel common to it. Thus in few days the Ulcer digested, and the Tumour wasted. Than I deterged with the same Digestive, adding pulv. rad. aristoloch. ireos, sarcocol. & mel ros. touching the Ulcer with the Vitriol-stone daily more or lesle, and applied Emplastr. è bolo as at first; than by a more strict Bandage disposed the Lips of the Ulcer to incarn; and by unguent, è plumbo & desiccativ. rubr. I cicatrized it, and directed him a laced Stocking to be put on, and returned him to his Lord.   

CHAP. VI Of Ulcers with Hypersarcosis.  
THE arising of luxurious Flesh in Ulcers sometimes createth a difficulty in their Cure.  
The Cause is either from abundance of serous Humours flowing into them; 
Cause.  or the ignorance of the Chirurgeon, in not distinguishing the superfluous Flesh from the good, who thereupon continueth the use of mild Detergents or drying Medicaments.  
The Signs are so evident that they need no Remarks.  
The Indication of Cure is taken from the Cause. 
Cure.  If Fluxion were the Cause, Purging and Bleeding may do good, and a regulation of Diet, with the use of such Remedies as may resist the Fluxion; as you may see in the preceding Chapter. But if too mild Detergents or sarcotics caused the Flesh to grow lax and spongy, than more powerful Driers are required, yea cathaeretick or caustick Medicaments, as you see cause.  
The milder are spong. ust. court. granat. nuc. gallar. lapis tutiae, alumen ustum; and amongst them Merc. praecipitat. may well be reckoned, if used alone. Compounds are these: ℞ nuc. gallar. court. granat. an. ʒij. ballast. ʒj. aluminis ust. ʒj. pulver. subtle. Misc. It may be sprinkled on the Ulcer thick, and dry Pledgits with Compress bound over it; or it may be boiled in read Wine, and Pledgits dipped in it and applied. Aq. calcis is also moderately drying without pain: if you add a few grains of Sublimate, it is more powerful. Aq. lapidis medicamentoes. aq. viridis, & Fallopii, are more strong; but by the addition of aq. plantag. or the like they may be made milder. The Vitriol and Alume-stone serve well to this purpose, to keep down lose Flesh, and to cicatrize those Ulcers which are most luxurious; and if they be discreetly used, will perform the work with little pain, and cicatrize these kind of Ulcers most firmly.  
A Gentleman of about twenty years old, 
Observat. of an Ulcer with lose Flesh.  of a good Habit of body, put himself into my hands for the Cure of an Ulcer on his right Side the breadth of the Palm of a hand. It was occasioned by a Burn, and had been bigger. The cause why this remaining part of the Ulcer did not cicatrize was most evident, it being overgrown with lose Flesh. I applied Pledgits of a mixture of unguent. basilicon with two parts Aegyptiac. upon it, with Bandage: but observing it not to yield to that so soon as I designed, I leveled it with the Caustick-stone, and after separation of the Escar digested the Ulcer with unguent. basilicon and Merc. praecipitat. and afterwards cicatrized it with some of the Waters above mentioned.   

CHAP. VII. Of Ulcers with Caries in the Bones.  
A Caries or Rottenness in the Bone is frequently found in Ulcers, and sometimes giveth rise to them: but however it is, it always prolongeth and rendereth the Cure of them difficult.  
The Causes of Caries in the Bones are either internal, 
Causes.  as through retention or acrimony of the Matter, or some occult quality, as in Lues Venerea, where the Bone is carious, and the Skin is whole; or in strumous Ulcers near the Bones, where the Erosion gins in the Bone itself; or they are corrupted externally by the Air. Bruises, Wounds in the Head, through ill Chirurgery, may corrupt both Tables, etc. But this I never met with in any Patient of my own, or where I had power to govern. The Bone may also be fouled by oversharp Medicaments.  
If the Bone be bore, its Corruption is easily discerned, 
Sign.  though sometimes it be covered with a grumous or viscous Matter, which rubbed of, the Bone appeareth white, brown, or black. If the white be pory, the Caries may be deeper and more dangerous than if it were black and hard. If the Bone lie so hid as that you cannot feel it with your Probe, yet you may judge it carious from the quantity or quality of the Matter. If the Bone lie near, and the Flesh lax and white, it is shrewdly suspicious that the Bone is carious: but if the Matter stink or be oily, it is a more certain sign of a Rottenness. Ulcers of long continuance near a Bone do also foreshow a Caries, according to Hypocrates, Si Vlcera annua aut etiam diuturniora fiant, ossa corrumpi necesse est. Also the difficulty in cicatrizing them, and the frequent and sudden Eruption of them after they are cured, giveth a suspicion of a foul Bone. But if the Bone be much corrupted, the Matter is foetid, and the Probe will penetrate into it.  
Ulcers with Caries or Rottenness in the Bones are of difficult Cure, 
Prognostic.  and reckoned amongst the Cacoethe and malign Ulcers; but are more or lesle dangerous where the great Joints or heads of the Bones are affected, where the Chirurgeon cannot safely apply such Remedies as are proper for Exfoliation.  
In the Cure of Ulcers with Caries a good Diet is to be observed, 
Cure.  and the peccant Humours to be evacuated and averted by Bleeding, Purging, etc. left they cause Fluxion. And forasmuch as in the Cure of these Ulcers the corrupt Bones must be first removed, and a Callus generated, before you can hope for Sanation; therefore you must in the first place make way to the Bone, that, if it be possible, you may have it in your sight. To which purpose, if the outward Orifice be small, you must enlarge it proportionably according as the Caries is greater or lesser, and scrape the rotten Flesh away, or consume it by Escaroticks. But if by reason of the nervous and great Vessels, as in the Hands, Feet, and in the great Joints or Spine, you cannot safely do it; you shall than by prepared Sponge, Gentian roots, or the like, dilate the Ulcer till the Caries be bared. But if the Caries lie just under some comsiderable Nerve, Tendon or Artery, so that you cannot well come to apply your Medicaments to the Bone; you are than to consider whether the Caries can be removed without laying the Bone more bore: and if that be not feasible, you are than to consider the prejudice may hap to the Patient in the cutting of those Vessels, and, comparing the Worthiness of them with the Inconveniences which may behappen the Patient from the Caries, proceed accordingly.  
The Bone laid bore, you are than to consider the Caries, whether great or small, deep or superficial, hard or soft; and proceed by Medicaments or manual Operation accordingly. The Bones of the Head do not admit of the hot Iron, nor need it. The Vertebrae of the Back will neither admit of Cauteries, Rugin, or sharp Medicaments, the Spine of them excepted: nor will the Sternon or Rib admit of the Cautery. The Heel-bone requires also great caution, for that it is soft, and rarely exfoliates by rough handling. In the rest you may proceed by Cautery, actual or potential, Rugin, or otherwise.  
If the Caries be superficial, and the Bone firm, you may by Medicaments of a moderate drying quality consume the moisture in the Caries, and thereby dry the Bone, and dispose it by virtue of its ossifick faculty to thrust out a Callus, and make separation of its Caries.  
The milder sort are, rad. ireos, peucedanum, rad. aristoloch. myrrha, aloe, court. pin. and spir. vini.  
The stronger are, euphorbium, unguent. Aegyptiac. ol. garyophyll. spir. vitriol. sulphur, pastill. Andronis, Musae, polyid. But these require to be used with caution, and the sound Parts to be well defended from their acrimony.  
The Powders above mentioned may be applied upon the Bone with Dossills' of Lint over them, to keep the Lips of the Ulcer distended; or may be mixed with syr. de ros. sicc. aut mel rosat. vel common. or used in a spirit of Wine, or with unguent. Aegyptiac. or thus in the form of Injections: ℞ symphyt. maj. gentian. aristoloch. rot. & long. rad. ireos, an. ℥ j flor. ros. rub. sumach, ballast. an. ℥ ss. coq. in vin. alb. ad lbij. lbij. colaturae add spir. vini ℥ ij. mell. ros. aut Aegyptiac. q. s. Where you can safely dilate the Ulcer, you aught to do it, and keep the Bone bore and dry, by filling it up with Dossills', that the Lips of the Ulcer encroach not upon your work, jest the Matter dropping from thence corrupt the sound Bone under them: for to exfoliate well, it should begin to rise from the sound edges.  
The spongy Bones in the Hands or Feet are to be kept bore by Dossills', according to the length of the Caries: and if the whole Bone be corrupt, it will dry and separate from the Joints in time, and the Ulcer happily cure; yet, to hasten it, you may dry it with an actual Cautery. But if the Bone be only carious in one part, as in the middle or at the end, to hasten the Cure you may nip it there in pieces with a pair of Pincers, pull away the broken bits, and dress it lightly with some of the above milder Driers; whereby in few days the Caries will cast forth, a Callus thrust out, and unite the two ends, as in fractured Bones, if the native heat of the Part be preserved the while.  
But if the Caries be in the great Bones, and lie deep, and be subject to the inflowing of Matter; your speediest way will be by manual Operation, viz. either by Rugines or actual Cautery. If you can come easily to the Bone to scrape it, as in the Cranium, that way will be most proper. You are to scrape till you found it firm, or that you discern a ruddiness in the Bone; and not only till it look white, for that is the natural colour of the outer Shell of the Bone: yet in some it is frequently found pory and carious while it retains that colour; and if you do not rugine that away, the Callus will be slow in thrusting out; and if you do rugine it, the deeper you enter into it, the browner and softer the Bone will be. Therefore you must be cautious in this Work, jest you penetrate to the Marrow of the Bone, when possibly you needed not have taken away more than the external Shell of it.  
The Bone rugined, dress it up with the milder sarcotics: or, if you had rather use an Unguent, ℞ terebinth. clarae ℥ iiij. gum. elemi ℥ ij. resin. pineae, mastic. an. ʒuj. thuris, sarcocolae, an. ʒiij. Misc. super ignem. Apply this warm upon Lint, and in few days you may see the Flesh thrust forth in small grains, which is Callus, and in a few days more thrust of small Speels from the Bone you scraped.  
But if the Caries be so deep that you cannot rugine it, than with a Terebellum make penetration into it to the found part, or by an actual Cautery consume the Rottenness. In order to this work, if the Ulcer be narrow, you are to pass it through a Cannula fitted to go down through the Ulcer to the Bone: which Cannula or Pipe aught to be covered with an Emplaster or Linen starched on, and oiled, to pass in more easily. Than having a Basin of Water ready to cool the Pipe, you shall place the Cannula upon the carious Bone, having first cleansed the Matter from it with armed Probes: than pass the actual Cautery down through the Cannula to the Bone so often till you have dried it, pulling out the Cannula after each heat. So you may perform the work without scorching the Lips of the Ulcer.  
According as the Bone is rotten, so the Humour will spurt out from it upon the first application of the Cautery: but upon repeating it, that Bone will be so dry that you shall not hear it hiss; besides, you may feel the Bone firm. Than dress it with the white of Eggs beaten with the Mucilage of Quince-seeds extracted in aq. germ. querc. or the like, and dress the scorched Ulcer and Lips with unguent. refriger. Galeni, and a Cerote of the same over that and the neighbouring Parts. Continued this way of dressing till the heat of the Ulcer be mitigated: than, if the Lips be vesicated, dress them with unguent. album, tutiae, or the like, and the Bone with the milder Exfoliatives, and keep the Ulcer open till the  Bone cast of; than throw out the Dossills', and you shall see the Ulcer incarn and cicatrize by the most familiar Epuloticks.  
IN the year 1652. passing from Cheshire into the County of Rutland, 
1. Observat.  taking North-Luffenham in my way to London, I was desired there to visit a Freeholder, who had laboured under a Fever, and had been long Bedrid by reason of a grievous pain in his right Thigh, which was supposed the Crisis of that Fever. I saw him much emaciated, and his pained Thigh was somewhat the bigger of the two, but it retained its shape without any visible Tumour, Inflammation or hardness; nor was the Fluctuation so distinguishable as that I could positively say there was Matter, it lying so deep and equally in the outside of it: but, suspecting Matter, I opened it on the outside according to the length of the Member, and feeling my Knife in the Cavity, I made the Apertion large, and discharged a putrid Matter like the Leeses of Beer. After I had discharged a Porringer-full, I dressed the Opening cum unguent. basilic. upon a Tent, with an Emplaster de minio over it, and with Compress and Bandage rolled it up. The next day, finding the Patient relieved, and the Matter plentifully discharged, I fomented the Tumour with a Decoction of absinth. flor. cham. ros. rubr. and such like, and making a search with my Probe, found the Bone bore a great length. I enlarged the Opening, to make more way for the Matter, and the better to apply my Medicines to the Bone; than dressed it up as before, and against the next day made an Injection summitat. hyperici, centaurii, rad. consolid. maj. bistort. tormentil. gentian. ireos: to which strained liquor I added syr. de ros. siccis, and cast some of it daily in warm to deterge the Ulcer. His body was kept soluble by Clysters of Milk and Sugar, and his Spirits relieved by a morsel of theriac. Lond. with cous. lujulae. I also ordered him a Julep made with a few Strawberry-leaves and roots, a little Ivory, and a crust of Bread, infused a stick of Cinnamon in the strained Decoction, put in a few drops of spir. sulphur. and sweetened it with Sugar. His Diet was Oatmeal-Caudle, Broth, Grewells, and Eggs; and as his Appetite increased, we allowed him a more liberal Diet. Although the Opening was large, and the Thigh very bore of Flesh; yet, by reason of the distance the Bone lay from the Opening, and the hollowness of the Ulcer, it was not possible to make any Applications to the Bone by Medicaments to exfoliate it, that should not be offensive to the Ulcer, if they were so powerfully drying as the Bone required. Therefore I caused an actual Cautery to be made at the next Smith's, and dried the Bone that way, and the while continued the abovesaid method of dressing, keeping the Orifice moderately dilated with Dossills' pressed out of the Injection; than by good Compress and Bandage squeezed out the Matter, insomuch as it lessened daily, the more remote Cavities agglutinated, and the Ulcer was like to cure, if the Caries in the Bone did not obstruct it. That it might not, I got the Cautery made in the form of a Wedge, but thicker, to retain heat; and having fitted it with a Cannula, I placed it upon the Bone according to the length of the Caries, passed the Cautery through it to the Bone, and repeated it again and again, cooling the Cannula each time in a dish of water near me: than I covered the Bone, and dressed the Opening with Dossills' dipped in a Mucilage of Barley and Comfrey-roots, fastening a Thread to those Dossills' which I conveyed first in towards the Bone, the better to bring them out again, and applied unguent. refrigerans Galeni outward upon the Ulcer, with an Emplaster of cerat. Galeni over all. This way of dressing I continued daily till the Excoriation was healed without: than I repeated the use of the former Injection, adding flor. ros. rubr. ballast. sumach, with a little alumen, and by Compress and Bandage hastened the unition of it within, leaving the Exfoliation of the Bone to nature. While I stayed in that Country, the Cavity filled up, and by the well-digested and little Matter the Ulcer seemed near cured; and I was afterwards informed that the Patient followed his Husbandry some one or two months after. The Exfoliation was here insensible, as it most frequently happens, the Scales mouldering away, and discharging with the Matter.  
A Gentleman of about forty years of age, 
2. Observat. of an Ulcer with Caries in the Tibia and Fibula of the right Leg.  having been long afflicted in the Country with Ulcers on his right Leg and Foot, came to London, and put himself into my hands. There wa● one large Ulcer upon the Fibula near the Ankle here and there superficially cicatrized. Upon search with a Probe I found the Bone carious in several places, but covered with the Tendons of the Peroneïs'. On the inside of the Leg upon the Tibia near the Ankle there were also Ulcers with Caries: the Foot was also ulcerated, and the Leg and Foot swelled. I began with the laying open of that Ulcer on the outside upon the Fibula by the application of a Caustick, and dividing the Escar took out some small pieces of Bones which lay lose in the Ulcer. The Fibula itself was covered with the Tendons of the Muscle Peroneïs', so as there was no possibility of applying Medicaments to exfoliate the Bone, nor indeed of curing the Ulcer, whilst those Tendons lay in the way. Wherhfore I cut them transversly; upon which division the upper part of them contracted, and than the Fibula appeared bore and black. I applied dry Lint upon the Bone, and dressed the Ulcer with unguent. basilicon hot, to hasten Digestion and separation of the Sloughs. The other Ulcers and Excoriations I dressed, some with Detersives, and others with Epuloticks, according as they required; and with Compress and Bandage endeavoured to press out the pituitous Humours affecting those Parts. As the Escars began to separate, I deterged by the use of the Vitriol-stone and Praecipitate, and dressed the Bone with Dossills' pressed out of tinctura vitrioli dulc. of Felix Wurtz. The upper ends of the Tendons suffered Convulsion with great tremor upon the application or taking of Dress; but it was without pain: yet, suspecting the worst, I cut as much of of the Tendons (with a pair of Scissors) as lay bore, than dipped them cum oleo terebinth. hot, and dressed them with Praecipitate. By this way of dressing the remaining ends of the Tendons digested and incarned with the fleshy Parts, and by the application of Epuloticks cicatrized: so also the main Ulcer cicatrized round from the edges to the carious Bone, thrusting of the rotten edges of them before it. During this I healed the Ulcers and Excoriations on his Foot, and by the help of a laced Stocking pressed back the pituitous Humours, and reduced the Member to its true shape. Having thus happily succeeded, I began with the laying open the Ulcer upon the Os tibiae by Caustick, and in dividing the Sloughs took out several fragments of Bones which lay entangled in the Flesh. After separation of the Escar, i deterged that Ulcer after the same manner as the former; and indeed by rubbing the carious Bones with the Vitriol-stone I hastened the Exfoliation of them. They came away in bits at several times, but that of the Fibula was thrust of by the Callus underneath in one piece. After the Exfoliation of the Bones I purged the Patient with a cathartick Apozeme, and prescribed him a Decoction of Sarsa, etc. and soon after cicatrized the Ulcers; but advised him to continued the wearing of the laced Stocking.  
A Young man by some accident bruised the Back of his hand: 
3. Observat. of an Ulcer with rotten Bones in the Hand.  it inflamed and apostemated, and after some while terminating in a sinuous Ulcer, and underneath corrupting the Bone, I was consulted, and advised the way of dressing it: but that method not being observed, other Bones of the Hand became carious, and the Hand in great hazard of being lost. Upon which he was commended to my care. Sir Alex. Fras. being present, I took of the Dress, made a search with a Probe, and felt the Bones leading to the two middle fingers bore, rough, and, as I suspected, rotten. The Orifice being small, I applied a Caustick large enough to make way for the taking out those Bones; than divided the Escar, and dressed up his Hand with Digestives, Emplaster and Bandage. Sir Alex. Fras. prescribed him a vulnerary Decoction, and left the prosecution of the Cure to me. As the Escar separated, I saw the Bones leading to the two middle fingers black, and softened with Putrefaction. I laid hold on the one with my Forceps, and pinched it into pieces with much ease, bringing part of it away. I fomented the Hand with decoct. absinth. etc. in Wine, dissolved a little Aegyptiac. in some of it, washed the Ulcer, and applied a Dossill dipped hot in it upon the Bone, and unguent. basilicon over the Escar. I than pinched out what was most rotten, dressed the remaining ends of them with a mixture of unguent. Aegyptiac. spirit. vini and extract. scordii actually hot with an armed Probe, applied Pledgits of the same upon the Bones, rubbed the lose Flesh in the Ulcer with a Vitriol-stone, and laid unguent. diapomphol. upon Pledgits over the tender edges of the Ulcer. By this way of dressing I deterged the Ulcer, and at several times pinching out those rotten Bones that led to the two middle Fingers, disposed the rest to cast of. During which I laid the Ulcer higher open to the Joint of the middle Finger: which Knuckle I also found rotten to pieces, and took out what would come easily away; than dressed the remaining Caries as the other in the Hand, and after some time made a separation of the Caries there. Having the while digested and healed the Ulcer I first laid open, I also cicatrized this Part, and dismissed the Patient well cured, as I thought. But some while after he came to me again with a Tumour upon that Knuckle of the middle Finger, from some remaining Splinter of a Bone. I laid it open, and took that out. While I was curing this, I observed a small Opening, with a Tumour near it as big as a small Hazell-nut, upon that part of the Bone which led to the Forefinger. I opened this by Caustick, and, discovering part of the Bone black, pinched it of, and dressed the remaining end with Aegyptiac. scalding hot upon an armed Probe. I kept the Ulcer open with Dossills' pressed out with spirit. vini till I made separation of it, than cured this Ucler also. And from that time, which is more than five years, he hath continued well, and his Hand is firm and strong; Nature having supplied that loss of Bones with Callus. But he beareth the Marks of the Disease, which will assert the truth of what is here delivered. You may see more of this work in the Treatise of Struma.  
An Officer of the King's Regiment of Foot, 
4. Observat.  of a Sanguine and healthful Constitution, marching at the head of his Company in a hot Summer's day, heated his Blood, and was seized with a pain in one of his Teeth of the lower right Jaw. He sent for a Tooth-drawer, who pulling out the Tooth broke the Alveoli of from the Jaw according to the length of it. The pain made great Fluxion, and required Evacuation and Revulsion by Bleeding and the like. But this being omitted, and the Part affected not treated as it aught, the pain increased, the neighbouring Parts swelled and apostemated, and all his Teeth and part of the Alveoli cast of. After some week's continuance in the Country, finding his Disease increase upon him, he came to Town, and sent for me. That side of his Head, Face and Neck were extremely swelled outwardly, so was the Cheek and Tonsill within, and the fractured Bones hidden within the Tumour. Upon a pressure with my hand on the outside of his Cheek, seeing the Matter flow into his Mouth out of a small Opening near the farther part of that Jaw, I made a search with a Probe, and felt the Jaw bore. There was a necessity of laying that Orifice open, for the more easy discharging of the Matter: which being done, I employed my endeavours to take of the Fluxion and Fever he laboured under, let him blood from that Arm ten ounces, prescribed Fomentations and Cataplasms to be applied outwardly to discuss the Tumour, and inwardly an Injection to deterge the Ulcer of rad. ireos, tormentil. bistort. aristoloch. with syr. è rosis siccis, and a little spirit. vini; also a Gargoyle to wash his mouth of flor. ros. rubr. plantag. summitat. rubi, etc. with diamoron and spirit. vitrioli dulcificat. Doctor Warner being consulted, he directed Anodyne draughts, Cordials, Juleps, Emulsions, and purging Apozems. The Cacochymia thus evacuated, and the Humours contemperated, we hoped the outward and inward Swell and discharge of Matter would have lessened: but they not yielding one jot to our endeavours, I laid open the Cheek from the Orifice I had enlarged forward alongst the Bone, with intention to take it out; but it was so shut in that I could by no means get it out, till with Watch-makers Files I cut through that Bone; than the ends thrust out into his mouth. These I pulled out: they proved to be pieces of the Alveoli. Than I felt the Jaw itself arise; and, considering that if it were lose it must out, I passed the end of my Probe under it, whereupon it risen up, having been some while lose, and was only held down by the foresaid Alveoli; which being removed, the Jaw came away without the lest pain or one drop of blood, he only crying out of his Ear, as if it had made a hole through there.  
The Jaw being extracted, the side was ready to fall in: to prevent which I caused the Patient to hold it stretched out with his fingers in his mouth, and a Looking-glass held before him, that he might the better see to keep it more exactly even, whilst I by agglutinative Powders cum albumine ovi made a Crust upon the outside; which with Pasteboard wet in aceto applied over it sat close to it, and after it was dried kept that side of the Cheek firm, and by Bandage it continued so, he helping it as hath been above said. It also was somewhat stiffened by the hard Swelling which was in the Cheek.  
To hasten the Callus, I gave him daily osteocoll. as I had read in Fabr. Hildanus his Works. Whilst his Chaps were thus bound up, I continued to wash his Mouth with the Decoction abovesaid injected often in a day with a Syringe; by which means the Ulcer was cleansed and cured, and disposed to a Callus, which grew and hardened in lesle than twenty days so equal with the other, as without looking in his Mouth it could not be discerned.   

CHAP. VIII. Of Ulcers with Callous Lips, etc.  
IT also frequently happens that Ulcers become callous, hard and livid, and are thereby rendered difficult of Cure.  
These Ulcers are generally annual, 
Cause.  and through length of time contract this Callosity and hardness with a livid colour. The Causes of these are the frequent defluxion of a hot Serum, which hath been condensed by the Air, or by overcooling or drying Medicaments.  
The Signs are evident from what hath been said of them.  
The Prognostic of them is, 
Prognostic.  that the Ulcer cannot cure till the Callosity be removed: and if the Ulcer be of a round figure, that aught also to be changed.  
In the Cure of this Ulcer you are to consider the hardness of the Lips; 
Cure.  for from what cause soever it ariseth, that must be removed, or depressed to cicatrize with the Ulcer; for no Ulcer skinneth well but from the edges. Therefore if the Lips be hard and callous in the Superficies, you shall endeavour by emollient and discutient Medicaments to soften them, and by good Compress and Bandage dispose them to cure first, by a Fomentation of rad. & fol. althaeae, lilior. malvae, sem. lini & foenugraeci, flor. cham. melilot. sambuci. By this you may also rarefy the condensed blood, which maketh the lividity in the Parts about the Ulcer, and preventeth the generation of good Flesh. Than you may embrocate the indurated Lips with unguent. dialthaeae, ol. amygdal. dulc. ol. lilior. lumbricor. and apply cerat. oesypi, cerat. Galeni, Emplastr. è mucilag. diachyl. ireat. or, if stronger be required, Empl. de ranis cum Mercurio, or a plate of Lead rubbed with Mercury, or a Past of Ceruse or calx lot. made up with axung. porcin. and over this a good Compress and Bandage; of which sort the laced Stocking is best for the Leg, which being well made preserveth the other Parts from Fluxion better than a Rowler doth. But if the edges of the Lips be inverted and callous, or the Ulcer be in such a place where you cannot make good Bandage, your best way than will be by Caustick or Knife to remove it, and than digest and heal the Lips even with the Ulcer.  
A Young man of about eighteen years old, of an ill Habit of body, 
1. Observat.  having laboured long under an Ulcer on the inside of the Ankle of a round figure, with the Lips thick and callous, and the Parts about livid, put himself into my hands for Cure. There was in this case no hopes by Emollients or Bandage to flat the Lips so as to dispose them to cicatrize; therefore I rubbed them with a Caustick-stone round, dressed the Ulcer with unguent. basilicon and Praecipitate, and applied Emplastr. diachyl. ireat. over all, with Compress and Bandage, designing to dispose the Lips to unite with the Ulcer. But the Escar separating slowly, the Lips skinned underneath, and disappointed me. Notwithstanding, the inverted parts being removed with the Callus underneath, I made a Paste with calx lota and axung. porcin. and with good Compress forced the Lips even with the Ulcer, than united it with a smooth and firm Cicatrix.  
A Maid in Fanchurch-street labouring under such an Ulcer with livid callous Lips, 
2. Observat. of Callous Lips.  but not inverted, I digested with unguent. basilicon and Praecipitate, and fomented with a Decoction as above mentioned, than applied Emplastr. diachyl. ireat. over the Parts about, and put on a laced Stocking with a Compress under it, thereby digesting the Ulcer, and flatting the Lips; incarning and cicatrizing it with unguent. diapompholyg. in lesle than three weeks, which had been more than three years the work of some Barber-chirurgeon. The speedy Cure of this I imputed to the laced Stocking, it performing all the Intentions necessary to the curing of many such like Ulcers.   

CHAP. IX. Of Putrid Ulcers.  
ULcers labouring under Fluxion of sharp acrid Humours are (as I have elsewhere said) for the most part sordid. The Sordes as it increaseth in the Ulcer rots the Flesh, renders the Ulcer putrid, and the Matter foetid.  
The immediate Cause of these Ulcers are gross viscid Humours heated in them by the Intemperies of the Part, 
Causes.  whence they contract a malign quality, and corrupt. They also hap through the unseasonable application of lenient or greasy Medicaments, or by too-powerfull Detergents, which resolve the sound Flesh, and stir up a putrefactive heat in the Ulcer, whereby the Humours become so sharp that they corrode the Parts about: whence they are sometime deservedly called Vlcera serpentia & depascentia.  
The preceding Causes are excrementitious gross Juices abounding in the body from ill Diet, 
Causes preceding.  Air, etc. Malign Fevers are also the Cause, by transmitting their malignity outward.  
The Sign of a sordid Ulcer is a viscous tough Excrement sticking in it with great heat and pain. 
Sign.  As the Sordes increaseth, it changeth its colour, by reason of the suffocation of the natural heat, and the Ulcer corrupts, and the Matter stinks.  
If from abundance of Sordes Transpiration be hindered, 
Prognostic.  a corruption of the Part follows, and it terminates in a corrosive or putrid Ulcer: and if that Putrefaction be not checked, a Gangrene and Sphacelus follows.  
In the Cure of these Ulcers a good Diet is to be observed, 
Cure.  with a regulation of the Non-naturalls: the viscous Humours require to be purged, and Revulsion is to be made by Bleeding and otherways. Vulnerary Decoctions are also to be prescribed, to waste the excrementitious Humours. The Topics or outward Medicaments are to be proportioned according to the quality of the Ulcer. In sordid Ulcers made by too strong Detergents unguent. basilicon cum Merc. praecipitat. unguent. diapompholyg. mag. be proper to dress the Ulcer with; and some cooling Unguent or Cerote, as refrigerans Galeni, may be applied over it, with a Compress wrung out of Oxycrate.  
If the Ulcer became sordid by the use of Lenients, and be lined thick with the Sordes, doubt not to fill the Ulcer with Praecipitate, and apply some mild Detergent on Pledgits of Lint over it, with a Compress wrung out as is prescribed in humid Ulcers, and dress it not till the third day after: thereby the pain will lessen, and the Sordes come away in a Slough. After which digest the Ulcer till it look more fleshy and natural; than proceed with milder Medicaments, and incarn.  
In the common sordid Ulcers unguent. basilicon and Praecipitate, ʒiij. to an ounce, mundif. Paracels. with alumen ust. and unguent. apostolor. are proper Detergents.  
If the Ulcer be putrid, wash it with a good Lixivium wherein absinth. scordium, etc. have been boiled, or with spirit. vini and unguent. Aegyptiac. or sprinkle the Ulcer with pulv. sine pari Joan. Ard. or pulv. troch. Andronis, etc. and outwardly defend the Parts from Fluxion.  
If the Ulcer be corrosive, and undermine the Lips, and tender the Flesh soft and unfit for healing, dress it as shall be showed in a Phagedaena.  
But if the putrefaction increase, and the Ulcer tend to Mortification, treat it as is said in Gangraena and Sphacelus.  
A Woman of about forty years of age, scorbutically and hydropically affected, 
1. Observat. of Putrid Ulcers.  having long laboured under a sordid Ulcer in the Country on the inside of her Leg, with great pain, came at last to Town, and put herself into my hands. The Ulcer was large and deep, with great putrefaction; the Leg was much swelled, inflamed, and had been excoriated in the Parts about by the acrimony of the Matter; and by the application of Nutritum or such like the Matter was crusted in, and also a Hypersarcosis was risen underneath very large. I fomented the Parts affected with wine, and washed the Ulcer with spirit. vini and unguent. Aegyptiac. than with a Spatula thrust out the putrid Flesh, and strewed the Ulcer with Praecipitate, dressing it with Pledgits pressed out of the same Solution, and applying an Emplastr. diachalcit. over it with Compress and Bandage. The next morning I took of the Bandage and Emplaster, fomented the Ulcer with a Luxivium as above mentioned, applied mundif. Paracels. cum oleo terebinth. on the Ulcer, and a Cataplasm ex far. fabar. with oxymel, and rolled it up as before, causing her to keep her bed. The day after I purged her with an Infusion of Sena, etc. cum syr. de spina cervin. & de ros. sol. and prescribed her a Decoct. sarsaes, lign. guaiaci, with Antiscorbutics. Having by the Dress abovesaid removed the Putrefaction, I endeavoured to incarn with the sarcotick Unguent, and applied cerat. oxelaei over it with good Bandage: but it would neither deterge nor incarn nor yet digest for two days, till I put on a laced Stocking; by the use whereof the Influx was restrained, and the Lips pressed down. Having disposed the Ulcer to a healing condition, I incarned it with the foresaid Unguent of mel despumat. mixed with sarcotick Powders. While I was doing that, I rubbed part of the Lips which were callous with a Caustick-stone, and also rubbed the Hypersarcosis of by some of the same Caustick. After separation of the Escars I cicatrized the Ulcer and neighbouring Ulcerations with Epuloticks, than made her a fontanel in the other Leg, and returned her into the Country cured.  
A Maid of a gross full Body, aged about twenty three years, 
2. Observat.  wanting her natural Evacuations, an Abscess thrust out on the inside of the Calf of her left leg, and terminated in a callous sordid Ulcer. After some endeavours ineffectual in the Country, she was sent up to London, and commended into my hands by Sir Fr. Prujean. The Ulcer was large and deep. I dressed it with unguent. Aegyptiacum, basilicon, and Emplastr. diachalcit. with a Compress dipped in read Wine, rolling they up from the Foot to the Knee. The Physician began with the direction of a Purging draught, and the second day after I let her blood. She was also prescribed the Decoct. traumat. Londinens. and once a week purged with pulv. cornachin. I furthered the Detersion of the Ulcer by rubbing it with the Vitriol-stone, and afterwards digested it, and endeavoured to incarn with sarcotics, as in the former Observation: but on a sudden, without any cause, the Matter became sanious and flowed in great quantity. I than dressed the Ulcer with pulv. Andronis mixed with unguent. basilicon, fomented the Part with summitat. absinth. centaurii, hyperici, flor. ros. rubr. bacc. myrtillor. ballast. decocted in Wine, and by Intercipients upon the Knee and good Bandage endeavoured to resist the Influx. Upon my complaint to the Patient and her Relations of the difficulty I met with in the Cure, I perceived by them that the Ulcer had been frequently subject to such discharge. The Physician was again consulted, who concluded they were the Menstrua that thus periodically affected the Ulcer. She was again let blood and purged, and put into a chalybeate course, a fontanel was also made in her other Leg: during which I proceeded again by Detersives, viz. the Vitriol-stone, Merc. praecipitat. alone, and with mundificat. Paracelsi, etc. and applied Defensatives, with Compress and a laced Stocking. By which method the Ulcer seemed a while well disposed to incarn: but the Menstrua being still obstructed, the Ulcer became again distempered, and rendered all my endeavours fruitless.  
I having spent some months in this work to little purpose, they grew weary of me, and were desirous to make use of an Empirick, who had been it in my absence, and promised a speedier Cure. I gave way to the entertaining him; he also dressed the Ulcer after his way: but his endeavours proving also unsuccessful, they came to me again. I, finding the Leg much inflamed and swelled, and more sordid, dressed the Ulcer with Detergents as above said, applying ceratum Galeni over the diseased Parts with Compress and Bandage as heretofore, and by Sir Fran. Prujean's leave gave her a few grains of Turbith mineral. The next day it gave her four or five Vomits and a Stool or two. The next day after I fomented the Ulcer as at first, continued the use of the former Dress, put her on a laced Stocking, and repeated the use of the Turbith three or four times, avoiding Salivation. We also put her into a Decoct. sarsaes, lign. guaiaci, etc. and by this method incarned the Ulcer, and by a malagma of calx lot. beaten up with axungia cicatrized it. By the continuing of the laced Stocking she remained well, and after some months those Evacuations came naturally down of themselves, which by no Art would be persuaded, and she remained well.   

CHAP. X. Of Phagedaena, Nomae, Dysepulota.  
BEsides all the difficulties we found in curing of Ulcers upon the forementioned Accidents, there yet remain divers others which are not easily described, nor easily reconciled to the ancient Nomenclature of Ulcers: I mean those called Annua, Phagedaenica, Depascentia, Nomae. Out of which words that I may pick some sense, I shall refer them to two Heads.  
One, of the corrosive Ulcers, which from their corroding the neighbouring Parts have obtained several names in the Greek and Latin; as Phagedaenica, Depascentia, and Nomae: all which depend upon an acrimony of the Humour.  
The other are rather the effect of some continuance of an Ulcer, which after long Intemperies doth by degrees so weaken the tone of the Fibres, destroy the natural Balsam of the Part, and by frequent Fluxion induce Callosity, that the Disease groweth very hard of Cure, and when cured is apt to break out again. These, from their continuance, are called Annua; from the evil disposition of the Part, Cacoethe; from the hardness of cicatrizing, Dysepulota; from the reputation Chiron the Centaur had in Chirurgery, Chironia; and Telephia, from the hard fate of Telephus, whose Wound could not be cured but by the Spear that wounded him. These latter being insignificant names, not describing the nature of any Ulcer, I shall content myself only to have explained them in few words: but the former, namely Phagedaena, or Vlcus depascens, Nomae and Dysepulota, deserve farther consideration, and are our present task.  
Phagedaena strictly so called is an Ulcer with swollen Lips, 
Description.  that eats the Flesh and neighbouring Parts in the bottom and edges of the Ulcer. It differs from Herpes', because that always gins in the Skin, with little moisture, this always affects the Flesh, and abounds with Matter.  
Noma is a deep Ulcer that eats and spreads without Tumour, but hath a Rottenness and Putrefaction joined with it.  
Both these are venomous malignant Ulcers, and both spread: 
Difference.  but they differ, in that one hath Tumour, and no Putrefaction; and the other Putrefaction, and no Tumour.  
These Ulcers do all take their Original from vicious Humours abounding in the Body. Whether they be simple Choler, or a salt Phlegm mixed with it, 
Cause.  or that the Humours are made sharp and corrosive from a hot and dry Intemperies of the Part affected, I leave others to judge: but in Bodies abounding with Cacochymia it is frequently seen, that an Herpes' exedens ariseth in the Nose and Face from a small Wart or fiery Pustule, which being heated by scratching or picking with their Nails will terminate corrosive, and from an Herpes' exedens become Phagedaenicall, and by a farther exasperating cancerate; they differing but as the Humour becomes more or lesle fierce.  
The Signs are evident from what hath been delivered of them. 
Signs.  Some take their Original from Abscesses deep in the Flesh, others begin more shallow, and in time spread and eat, not only the Skin to the Flesh, but the Parts about, and dissolve the Flesh in the bottom of the Ulcer very sensibly.  
All these kinds of corrosive eating Ulcers are accounted malign: 
Prognostic.  but some are lesle malign than other. Those which arise in veneral Diseases are in themselves difficult of Cure; but by reason of the Specificks that Disease hath for its help, they become easy. The other are extreme difficult, and do frequently terminate cancerous. 
Cure.   
In the Cure of these Ulcers a good Diet aught to be prescribed, to prohibit the increase of sharp Humours. The Body is also to be purged, the Humours contemperated, and the Matter to be diverted by Revulsion, Dervication and Interception, if it be possible. The virulent Humour affecting the Ulcer requires to be dried up, and the Intemperies to be corrected. But forasmuch as these Ulcers differ one from another in their corrosive quality, the Medicaments must accordingly vary. If the Intemperies be hot, and the Ulcer corrosive, your Applications are to be cold and dry, with some little astringency; as unguent. tutiae, è plumbo, de calce, & de lithargyro. If these answer not expectation, you must proceed with more strong Medicaments. But by the authority of the Ancients you must scarify these Ulcers, or some way provoke them to bleed, that the sharp Humours may thereby be discharged. Than wash them with some drying Medicaments, which may also restrain the Influx of the Humours; as aq. calcis, aeruginosa, or aluminosa, or a Decoct. plantag. equiseti, rubi, flor. ros. rubr. ballast. nuc. cupress. gallar. in a Chalybeate water. After which the Ulcer may be sprinkled with any of these, pulv. tutiae praeparatae, corn. cervi usti, pulv. ostreor. combust. court. granat. Or they may be made into Unguents, as thus; ℞ unguent. diapomphol. ℥ ij. bol. Armen. sang. dracon. ballast. an. ℥ ss. ol. ros. q. s. Misc. a Compress being applied wet over all, wrung out of some astringent Decoction. The Ulcer thus dressed is not to be opened again in three or four days: for in these Ulcers the temperament of the Part is weak, and the frequent exposing it to the Air rendereth it more weak, and the Medicaments lesle effectual.  
But if this Ulcer be with Rottenness and Putrefaction, you are to proceed with Detergents, as unguent. Aegyptiac. Merc. praecipitat. pulv. Andronis, Musae, also Caustick and actual Cautery. To these Applications Objections have been made; and, but a little above, Medicaments are by myself proposed drying without Erosion: but when those take no place, we proceed to stronger; and where there is Putrefaction, you will found use for the strongest sort of Medicaments, as the actual Cautery, it not only serving to remove the corrosive Flesh, but to check the malignity, and strengthen the weak Part. But in case that will not be admitted of, you must proceed with the other, and the while defend the parts about with refrigerants, and after separation of the corrupt Flesh, treat it by sarcotics and Epuloticks, as hath been elsewhere said.  
A Man aged sixty odd years, of a lean dry Habit of body, 
1. Observat. of an Ulcer hard of Cure.  had a long time been troubled with an Ulcer on the inside of the Ankle on his right Leg: it had been often cured, but it broke out again soon after. I found the Ulcer sanious, the Parts about it swollen and livid, and endeavoured to cure it by the common method set down in the general Cure of Ulcers; but it would not digest two days together. I than proposed a laced Stocking: but he replied there was no need, his Rowler kept of the Swelling. Observing him to be so very wise, I omitted my accustomed attendance, upon which he employed another, who found much difficulty in it. Whether he cured it or not, I do not know; but about half a year to more after, the Patient sent for me again. The Ulcer was undigested, and the Flesh in it soft and rotten, of a florid colour, and the Parts about it as it were bruised; which proceeded from the frequent Fluxion and unequal strict Bandage. I proposed a laced Stocking which he willingly permitted. Mean time I deterged the Ulcer with Merc. praecipitat. applied Pledgits of unguent. basilicon mag. over it, with an Emplaster of cerat. Galeni, Compress and Bandage. The second day after I fomented the Ulcer and Parts affected with a discutient and astringent Decoction, and digested it with unguent. basilicon and Merc. praecipitat. After I had thus digested and deterged the Ulcer, and rarefied the impacted Humours in the adjacent Parts, I fomented it with aq. calcis, applied Pledgits dipped in the same over the ends of the Ulcer, and dressed the middle with Compress, and laced on a straight Stocking; by which the Fluxion was moderately restrained, and the Ulcer disposed to cicatrize: yet through the acrimony of the Humour, and the indisposition of the Lips and adjacent Parts, the work was not without some difficulty, the Matter being apt to shut in and bring part of the Cicatrix with it. But it was cured in lesle than two months' space; whereas without that Stocking it would scarce have cured in six months. It was usually painful after it had been cured by former methods, but was now free.  
A person of about fifty years of age, much subject to the Gout, 
2. Observat. of an Ulcer of hard cure.  having long laboured of a soar Leg, sent for me. There was one large Ulcer with callous Lips on the inside of the Small of his leg, with an Ulceration down below the Ankle. This Leg had been formerly subject to pituitous Swell, wherein the endeavouring to resist the Influx had impacted the Matter, and made the Tumour scirrhous. The Ancle-joynt was stiff, and the Knee as bad, by reason of a contraction in the Ham. Upon these considerations the Soars were of difficult Cure. I dressed the larger Ulcer, which was sordid, with Praecipitate and unguent. basilicon, the lesser with unguent, è plumbo, with Compress and Bandage, and against the next Dressing provided a Fomentation of read Wine with Stipticks, hoping that way to cicatrize the lesser Ulcers at lest: but they would not cure so, for the indurated Parts required to be made soft, and the Matter to be discussed first: but this was a hard task, while the Patient laboured under the Gout, or pain from the weakness and indisposition of the Parts. Therefore, having designed a Fomentation ex rad. & fol. althaeae, malvae, parietariae, sem. lini, etc. I bathed the Leg as it was held over the Liquor, continued my Applications to the Ulcers, and applied cerat. dialthaeae over the scirrhous Parts; continuing this method till I had relaxed the hardness. Than I put on a laced Stocking, by which I strengthened the Part against the Influx, and used all my endeavours to cicatrize the Ulcers, by Pledgits pressed out of astringent Liquors applied upon Lawns, also by epulotick Unguents, Powders, and Malagma: but as fast as I healed them in one place, they broke out in another, so that with much difficulty I cicatrized them at last by the help of a laced Stocking.  
A Maid of about seventeen or eighteen years of age, 
3. Observat. of an Ulcer difficult of cure.  with an Ulcer in her right Leg about a hand's breadth on the inside near the Ankle, despairing of Cure, sent for a Woman who had some credit in the curing such Ulcers. She came, and seeing a foul Ulcer with thick hard Lips, applied a Caustick to it, I suppose Merc. sublimat. It put the Patient to grievous pain for the space of a day and night, causing great Inflammation and Tumour. Upon which consideration the Woman was sent for again. She saw the effects of her Medicine, and would have applied somewhat to ease the pain: but the Patient's Friends seeing the disturbance in the Ulcer, and doubting whither it might tend, resolved now to put her into the hands of a Chirurgeon, and sent for me. I came, and found the Leg swollen, and the Escar large covering the Ulcer, and taking in the callous Lips round. It was so thick and deep, that I much feared it would leave the Bone bore under it. My work was to hasten the separation of the Escar, and mitigate the Accidents of pain, etc. To which purpose I fomented the Part affected with Milk, dressed the Escar with unguent. basilicon cum ol. liliorum, and applied cerat. Galeni, with Compress and Bandage to retain it. Thus in few days the pain ceased, and the Escar separated, leaving a Flesh of a colour as it were bruised. I dressed the Ulcer with a Digestive ex terebinth. far. hoard. etc. and fomented the Tumour and Ulcer with Decoci. absinth. flor. ros. rubr. ballast. etc. than applied unguent. tutiae as an Emplaster with Bandage. After Digestion, I incarned with mel despumat. etc. and continued the use of the Fomentation, hoping thereby to give a breathing, and dry up the bruised Parts with made that lividity about the Ulcer, and were the cause of its difficult curing. As the Ulcer incarned, I endeavoured by Bandage to keep the Lips flat to cicatrize with the Ulcer, and to that purpose dressed them and the Ulcer with unguent. è calce, touching the lax Flesh with the Vitriol-stone, to dry it, and fit it to cicatrize, and with much pleasure cicatrized it to the compass of a Silver penny, and thought the work very easy. But, when I least suspected it, the Skin cracked in the sound edges, and the Flesh in the Ulcer looked of a dark read colour. I dressed it with Epuloticks, hoping it would yet cicatrize: but the Cuticula afterwards cracked in three places more, and the Patient suspected the cause to be from a fault in the Bone; as in truth I should myself have doubted it, if I had not seen the separation of that Escar; for the Flesh appeared rotten under the broken Cuticula, and as the Ulcer healed in one corner, it broke out again there, or in another place. But this was from the Intemperies of the Part, and required again to be digested before I could hope to cicatrize it. To which purpose I dressed it with unguent. basilicon and Praecipitate, let her blood, purged and vomited her, prescribed her a decoct. sarsaes, put on a laced Stocking, and used my utmost endeavours to cicatrize it, as in such Ulcers I was accustomed to do; but all to no purpose, the Cicatrix would not hold two days. I than left of the use of the laced Stocking, and desired the Patient once more to give me leave to try whether it would cure without it; and to that purpose persuaded her to keep her Leg upon a Stool level with her Body a few days, I hoping thereby to keep of Fluxion, and supposing, if I could once more breath out that gross Blood impacted in the Part, I should be able to cicatrize the Ulcer; and if the Ulcer were cicatrized without Bandage, it would be the more lasting. I repeated the Fomentation, digested the Ulcer, and with a Solution of the Tincture of Vitriol in a Decoct. equiseti, etc. applied Pledgits over bits of fine Lawn, and smeared the edges of the Ulcer with unguent. tutiae, that it might not adhere to them. With such like endeavours I cicatrized it firm, than put on a laced Stocking again, with a Compress under it spread with unguent. tutiae, moderately to dry the Cicatrix, and dressed it once it two or three days for fear of the worst. A dry Scale arose upon it do what I could. I anointed it with Pomatum to suppling it; than raised it lightly up, and took it of: and so I did two or three times, and at last left it firm and natural as the rest, and so it continueth to this day.  
This Ulcer from its continuation might be Annuum; from its difficulty of cure, Chironium, or Telephium; from its rottenness of the Flesh, Noma; from its callous Lips, Callosum; from its frequent cracking of the Skin after cicatrizing, Dysepulotum.  
As I was passing one day through Brainford to London, 
4. Observat. of a Phagedaenous corrosive Ulcer.  I was desired to see a poor Servant lying under an Abscess in his left Leg, the Crisis of a malign Fever. The Abscess possessed the outside of his Leg, from the head of the Fibula to the Ankle, the Orifice being three fingers breadth below the said Fibula. The Matter could not discharge itself till it overflowed; therefore I applied a Caustick upon the lower part of the Tumour to give vent to it, and left him Dress till he should be able to follow me. Some days after he came to Town: I visited him, and found the lower Opening discharged the Matter well, as I had designed; but it was sanious, and abounded in quantity more than was reasonably to be expected from the Abscess. I endeavoured to deterge it with mundif. Paracelsi mixed with Praecipitate, and fomented the Part affected with a Decoct. absinth, salviae, betonicae, flor. ros. rubr. bacc. myrtill. ballast. in read Wine; than applied Emplastr. è bolo, with a Compress wrung out of the Fomentation, rolled it up, and applied a Defensative over the Knee to restrain the Fluxion: I also let him blood, and purged him with an infus. senae, rhabarb. etc. cum syr. de spin. cervina. But finding the Ulcer would not deterge, I laid it open the whole length, and seeing it sordid, filled it with pulv. Andronis, applying the Mundificative upon Dossills' between the Lips, with an Emplastr. è bolo over all, and rolled it up. The third day after I dressed it again with the Mundificative as before, only adding some Merc. praecipitat. to it. This method I continued some days, rubbing the lose Flesh with a Vitriol-stone, dipping some of the Pledgits in Praecripitate, and applying it under some of the Lips of the Ulcer which was undigested; than cut of some part of the Lips where they were very hollow and troublesome, and put on a laced Stocking. Thus I deterged and disposed the Ulcer to incarn under the Lips and elsewhere; and that it might do so, I put the Patient into a Traumatick Decoction, and vomited and purged him as occasion offered. But after some days, observing the Lips of the Ulcer did not unite with the neighbouring Flesh, nor the Ulcer contract as I expected, I made a search with my Probe, and found the Flesh, which was seemingly good, to be soft, and the Lips hollow and thin, and in some part callous. I dressed them with that unguent. aeruginis, Cadmiae, etc. as it is set down in Ulcers with moist Intemperies, rubbed the callous Lips with the Caustick-stone, and applied unguent. basilicon to hasten the separation of the Escar; supposing by these drying Medicaments to dispose the Ulcer to Incarnation. But as they incarned and cicatrized in one end or part, the Flesh became soft and rotten in another, and here and there the Lips were hollow, which I cut of, and thereby freed the Ulcer of them; and by the help of the former sarcotics I incarned it again: but frequently in the cicatrizing some part of the Ulcer would be corroded from the acrimony of the Humour, insomuch that I was necessitated to dress this Ulcer with various Medicaments. In some parts of it I applied Pledgits in drying Waters, as aq. calcis, lapidis medicamentosi, and Epulotick Unguents, to cicatrize it; while in some others I applied Detergents, yea and Digestives in others; and was not wanting the while by Mercurial Remedies and good Diet to contemperate the acrimony in the blood: yet was it a most hard and difficult work. My Kinsman Jaques Wiseman was my Assistant in the dressing of him, and saw this Ulcer with much ado cured: but he continued the use of a laced Stocking for some while after.  
Such an ill-conditioned Ulcer affected the Thigh of a Gentleman of about fifty years of age, of a full Body: 
5. Observat.  it was the Crisis of a malign Fever. Doctor Wederbourn was the Physician. The Ulcer was of the compass of a Five-shilling-piece, but lay only in the Skin, extremely corrosive, with Lips standing stiff up round the Ulcer: and although I took them down with Caustick, yet they arose again in the same form; and, being in a place difficultly managed by Bandage, would not cicatrize, but thrust out in the middle little hard Excrescences of read Flesh like pins heads, which increasing grew bigger, first one, then another. While I was endeavouring to deterge these Excrescences, they became callous, united with one another, and made an unequal Cicatrix, notwithstanding my endeavours by the Caustick-stone to rub down those that risen higher than their fellows. At last it joined itself to the Lips round, making a firm and hard Cicatrix, which after some while cast of a dry Scurf, and became soft as the natural Skin.  
In the year after the great Plague I was sent by Sir Fran. Prujean to a Gentleman of about fifty years of age, 
6. Observat.  of a lean dry Habit of body, labouring under a corrosive Ulcer, running from the left side of the upper Lip near that Nostril, close along by the Nose, to the great Canthus or Corner of the Eye, penetrating the Skin here and there deeper than elsewhere: it spread also without the edges of the Ulcer, making as it were a double furrow alongst the ridge and side of the Nose superficially in the Skin. These latter did not matter much, nor were they very painful. His Physician had purged him with an infussenae, rhabarb. and the like, in which were dissolved Manna and syr. de pomis purge. and put him into a Decoct. sarsaes, Chinae, corn. cervi, eboris, santal. with vulnerary Herbs, also purged him once in four or five days with calomel. and resina jalap. cum Elect. lenitiv. And those days he did not purge, he took ceruse. antimonii in confect. Alkermes, with pulv. corallii & perlar. etc. I began my Dress come unguent. tutiae Vig. with Merc. praecipitat. upon Pledgits in some parts where there wanted Digestion, and in others with unguent. tutiae simple, and applied unguent. Comitiss. over all. The next day I took of the Dress, fomented the affected Parts with a Decoct. fol. plantag. ros. rubr. ballast. sumach & aluminis in Wine, and continued to dress the deeper Ulcers with the unguent. tutiae and Merc. praecipitat. The other, which were more superficial, I sprinkled cum pulv. è corn. cerv. ust. ballast. & croc. Martis astring. and applied unguent. Comitissae over all. By this method I dried up the upper Ulcer on the side of the Nose, but the Cicatrices were unseemly, as in most such rebellious Ulcers they are, we being glad to dry them on any fashion as we may. The other Ulcers also filled up with Flesh, and afterwards cicatrized in some parts. The deepest Ulcers were also well disposed to it. The season of the year being hot, the Patient retired into the Country, taking the foresaid Medicaments with him, they agreeing well with the Ulcer. His Wife, having often dressed him in Town, knew how to apply them, and dressed him in the Country, where he continued all the Summer. He not giving us the lest account of his Ailment, I concluded him cured: but in the Fall of the leaf he returned, and than I found the Ulcer much exasperated, and discharging a virulent Matter, it having corroded deep the whole length from his upper Lip along the Cheek into the great Canthus dividing the lower Lid of the Eye, and was passing between the Glandula lacrymalis and the Eye: it had also spread beneath into that Nostril, and had passed its Matter through; and in truth the case was most deplorable; for whatever these Ulcers may bear of sharp Medicaments in another Part, here they would not: and possibly this was exasperated by such in the Country amongst those busy-bodies. I endeavoured to recover it by Lenients powerfully drying without acrimony, such as I had formerly used in the like case, and washed the Ulcer with a Solution of a Salt drawn of from the flowers of Antimony in aq. veronicae. Doctor Prujean was again consulted, and Doctor Bate, also Mr. Holier and other Surgeons. The Physicians repeated the former course, with some additions, and sweated him, and after that prescribed him a Diet of Milk, which he lived strictly upon a long time. Many Topics were proposed by us, but they were only drying Medicaments without acrimony, which agreed well with the Ulcer, and those served only to palliate it. Whilst I attended it, the Ucler spread itself under that Eye, fretting of the Muscles so that the Eye was drawn by the contrary Muscles to the external Canthus, and distorted so as it was easy to see the Optic Nerve. I was not able to serve him. He lived under Palliation till within this twelvemonth. The Humour afterwards affected the other side: what progress it made there I cannot tell.  
A Gentleman of about forty years of age, 
7. Observat. of an Herpes' exedens.  of a sanguine Complexion and Plethoric, came to me with an Herpes' exedens affecting the Eyelids. It had been of some years' growth: it began on the middle of the upper Eyelid near the Cilia or edge in a small Pustule, (as it is described in the Chapter of those tumors,) and in continuance spread along the edge to the external Canthus, where it eat deeper into the Skin, and by erosion caused an Ulcer of a round figure the breadth of a Silver-peny, eating into the corner of the Membrana conjunctiva, and thence the length of the lower Eyelid, consuming it downwards, leaving the neighbouring Parts scirrhous. It's Erosion in these Parts was increased by the continual Fluxion from the inflamed Eye: for the upper Lid where the Herpes' first arose was not so much concerned, the original Herpes' lying there not unlike a hordeolum. Upon view of this Ulcer I desired a Consultation, and to that purpose Doctor Tho. Cox and Mr. Holier met me. Collyria of a refrigerant and exsiccant quality were prescribed, Venaesection in the Arm, Purging with decoct. epithymi, etc. and the second day after the external Jugular was opened, and about ten ounces of blood was taken: fontanelles were also made inter Scapulas, etc. a Seton was also advised. The Patient thus fitted took a Journey upon extraordinary occasions into the Country. About a month after he returned, and put himself again into my hands. I treated the Ulcer with Epuloticks of various sorts and forms, applied frontals to intercept the descent of Humours, purged him with Calomel. cum rhabarbaro, prescribed Vulneraries in a decoct. sarsaes, lign. lentiscin. etc. with Balsamicks to contemperate the acrimony of the Humours. This method not succeeding, we consulted a Physician, who prescribed cooling Juleps of distilled Milks, etc. But he growing hereby indisposed in his Stomach, and the Ulcer raging, he returned to his former Prescriptions; and by the taking Bezoard. mineral. those days he intermitted Purging, and by the application of unguent. calaminar. he was restored to better health, and the Ulcer more sedate: upon which he supplied himself with some of the same internal and external Remedies, and retired into the neighbouring Country. About six weeks after he shown himself to me. The Ulcer in and near the external Canthus was almost cicatrized, and the other Parts well disposed. He than recruited himself with more of the same Medicaments, since when I have not seen him; but hear it increased in the Country, and he hath almost lost the fight of that Eye.   

CHAP. XI. Of Ulcers with Varices.  
WE have already treated of Varix as it affects the Thigh, Leg, etc. and have there shown you that it is a Dilatation of the Veins with gross Blood: we also have there delivered the Cause and Signs, and how it differs, as dilating some one Vein, or all the branches of that Vein to the very Capillaries; and so the Varix may lie deep between the Muscles and Skin, or more superficially. I have also there shown the advantage and disadvantage that may hap in repressing them. It remaineth now that I say somewhat of them as they are ulcerated by the acrimony of the Humour, or by some accident of Bruise, Wound, etc. whereby they become painful, inflame, and swell the Member.  
The Cure of these Ulcers with Varix are real, or palliative. 
Cure.  The Real or perfect Cure proposed by the Ancients I have delivered to you in the Chapter of a Simple Varix: it is by making an Incision in the Skin, and taking up the Vein and tying it, etc. But this way hath not been admitted (to my knowledge) amongst us; nor have I often seen that a Varicous Ulcer could be cured by cutting of the branch leading to the Ulcer, there being commonly more Veins concerned in it.  
The Palliative Cure consists in dressing the Ulcer with Digestives and Detersives, according as the Ulcer is sanious or sordid, and the while by good Bandage or a laced Stocking to repress the Humours impacted in the Part; by which Bandage the Lips of the Ulcer are disposed to cicatrize with the Ulcer. I call this method Palliative, for that it commonly lasts not longer than the laced Stocking is worn. In the Cure of these Ulcers, if there be Plethora, it may be necessary that the Body be purged, and a Vein opened.  
A Woman of a full Body, aged 54 years, was grievously pained with an Ulceration on her right Leg. 
1. Observat.  Several Medicaments had been ineffectually applied. I being consulted saw the Ulceration large, and the Capillary Veins lie dilated superficially in the Skin; from whence I judged the Ulceration to arise. The Leg was much swelled, and somewhat inflamed. I dressed the Ulceration with unguent. tutiae Vigon. applied over it a mixture of unguent. nutritum and populeon, rolled it up with Compress and Bandage, and bespoke a laced Stocking against the next day; which being than laced on, and the former method of Dressing repeated, the pain ceased from that day, and, the Humours being repressed by virtue of the Bandage, the Ulceration cicatrized in ten or twelve days.  
In the year 1654. 
2. Observat.  I was sent for to an Inhabitant of this City, who complained of his soar Legs, and that his Chirurgeon who used daily to dress them was lately dead: he desired me I would supply his place, and accordingly he would allow me the same Salary. I unrowled his Legs, and saw the Ulcers lying in the Skin in several places amongst the Varices without Inflammation or SWelling: but towards night they swollen, and were painful. I acquainted him with the nature of his Disease, and proposed the Cure by laced Stockings. I dressed the Ulcers with unguent. diapomphol. and rolled them up. Within a day or two his Stockings were brought him, and after I had dressed his Legs they were put on, with Compress under them upon the Ulcers. There were also pieces of velum laid between to defend them from the wrinkles of the Stockings. By the wearing of these the Humours were restrained, and the Ulcers disposed well to cure. I made him a fontanel in each Leg, and left him some Epuloticks to finish it, which they effected in few days. The Issues he continued to good purpose, for he is alive to this day.  
A Nobleman of Scotland, of more than seventy years of age, 
3. Observat. of a varicous Ulcer.  being diseased here in Town with a large varicous Ulcer in the inside of his left Leg, was commended to my hands by Sir. Fr. Prujean. The Ulcer reached from the Gartering to the Small of the leg deep amongst the Fleshy parts; it was crude and undigested. I dressed it with unguent. basilicon and Praecipitate, applied unguent. tutiae spread as an Emplaster with a Compress wrung out of Oxycrate, and with good Bandage rolled it up from the Foot to the Knee. The next day I fomented it with a Decoction of flor. ros. rubr. baec. myrtill. ballast. nuc. cupress. in Wine and Water; than dipped the Pledgits spread with basilicon in Praecipitate, and applied unguent. tutiae as before, with Compress and Bandage. The third day I opened it again, and dressed it as before. The fourth day after, finding the Ulcer well deterged, I dressed it with unguent. basilicon mixed with Praecipitate; and after I had digested it, put on a laced Stocking; than incarned with this, ℞ aloes & thuris an. ℥ j assae foetid. ℥ jss. mellis despumati ℥ vj. Misc. & fiat Vnguentum. I afterwards added a third part of unguent, è plumbo to one part of this Sarcotick, and by the help of the Vitriol-stone, and Pledgits dipped in a styptic Wine, cicatrized the Ulcer. Mr. Pearce was his Lordship's Apothecary.  
One having been troubled with a soar Breast about a year after Childbed, 
4. Observat. of a Varix in the right Breast.  it growing more swelled and ulcerated, she sent for me. It was hard, without Inflammation or discolouring in the Skin, and discharged a well-concocted Matter out of the Nipple and some small Openings near it. I wondered what should be the reason it did not cure. At last, in handling the Breast, I felt a Varix lying under the Skin: it felt like Network. I dressed the Ulcer sometimes with unguent. basilicon, and others with unguent. tutiae, applied Emplastr. è bolo over the Breast, with Bandage to support it, and advised the wearing of fine Tow sprinkled with Ceruse under that Axilla: by which method it was afterwards cured in a month's space or thereabouts.  
The last year, while I was putting these Observations of Ulcers with Varices together, 
5. Observat. of a varicous Ulcer with great tumefaction.  a poor Woman was brought to me out of the Country, suspected to have the King's Evil in one of her Legs. The Swelling was great, and the Ulcer large and sordid. In handling of it, I felt the Veins dilated under the Skin in the Fleshy parts of the Leg from the Gartering to the Ankle, by which it was evident that the Ulcer was varicous; upon which account I undertook it gratis, and commended her to own of my Servants to cure, with directions to keep her Chamber, and that he should the while foment and dress her Leg after the same method set down in the former Observations, and by Bandage dispose it for a laced Stocking. Accordingly he fomented the Leg, dressed the Ulcers with Detersives, and with Compress and Bandage rolled it moderately straight from the Foot to the Gartering. After he had thus rarefied the pituitous Humours which were impacted in the Part, and deterged the Ulcer, he laced on a straight Stocking with a Compress upon the Ulcer, by which the blood was straightened in its passage, and the Humours repressed, also the Lips of the Ulcer were brought even and cicatrized in few weeks without Purging or Bleeding, and this prodigious swollen Leg was reduced to its natural state. Thus may the greatest Swelling accompanying varicous Ulcers be removed, and the Ulcers palliated, if not cured: for it is confessed that they return again for the most part upon the discontinuing the laced Stocking.   

CHAP. XII. Of Sinuous Ulcers.  
HItherto I have treated of Ulcers which take their names from the Humours which affect them: I shall now discourse of that Ulcer which derives its name from its hollowness, and is called a Sinuous Ulcer.  
Sennertus' places the Chapter of Sinus next to that of a Phlegmon: 
Causes.  and indeed they frequently arise from such, especially where the Orifice hath not been sufficiently large to discharge the Matter: nay, in some great Abscesses, where the Cavity hath been very large, there, though the Aperture be great, yet for want of good Compression, and disposition in the Humours, the Skin unites so unequally with the Flesh underneath, that it maketh several Sinus', and doth as it were cuniculos agere, make Coney-burrows. Sometimes Abscesses do arise from within, viz. from the Lungs, etc. and pass their Matter externally under the Armpits, or through the Back, Breast, or Sides; or from other Viscera in the lower Venture, and raise Abscesses amongst the external Muscles of the Abomen, etc. Of which I shall give you some Instances, having already occasionally treated of the other sort in a Treatise of Gun-shot.  
The Antecedent 'Cause may be ill Diet, etc. whereby the Humours exceed in quantity, or evil quality, and being too long retained in the Abscess, get a corrosive disposition, and tender the Ulcer sinuous.  
These Ulcers differ from one another, as they are either strait, or crooked; deep, 
Difference.  or lying only under the Skin; or have one or more Sinus'. They may be distinguished from a Fistula, in that the latter is callous, which these are not, unless it be in the very Orifice.  
The Signs of Sinuous Ulcers may be taken from the preceding Causes, 
Signs.  whether it be a translation of Matter from within outward, or from Phlegmon, or other Abscess, Wound, etc. The Sinus may also be judged by the search of a Probe or Wax-candle. The quantity of Matter will also show the largeness of it.  
Sinuous Ulcers of long continuance are of difficult Cure, 
Prognostic.  by reason of the weakness of the native Heart in the Part, which rendereth it incapable of assimilating its proper aliment, and subject to the receiving superfluous Humours. Also if the Sinus run under the Joint, Nerves or Tendons, where it may not be safely laid open, the Cure is more hard to obtain.  
If the Sinus proceed from a translation of Matter from within the body, you cannot hope to cure it till the diseased Viscera be healed, during which the Patient is in great danger of a Marasmus; but if the sinuous Ulcer discharge little Matter, and that well digested, and be in a place where it may safely be kept open, the Cure is hopeful.  
In the Cure of these Ulcers Authors have proposed four Intentions. 
Cure.  The first consists in a regulation of Diet and the other Non-naturalls, accordingly as it hath been set down in the general Discourse in this Treatise.  
Secondly, that the Humours be evacuated and contemperated. If there be Plethora, the Evacuation will be necessary by Purging and Venaesection. The contemperating of the Humours may be by Traumatick decoctions and other balsamics, as all along hath been proposed.  
The third is effected in prohibiting the Humours to flow into the Ulcer, and that by Revulsion, Interception and Repulsion: which hath been sufficiently spoken of in the Discourse of tumors in general.  
The fourth Intention concerns more immediately the Cure of the Ulcers, viz. by the removing of those accidents of pain, inflammation, tumour, etc. without which there is no hope of Cure. In order to this work, you must consider the Sinus, how the Matter may be best discharged. If the Orifice be in the declining part, enlarge that: but if the Sinus run beneath downward, your best way will be to open that in the declining and lowest part by Knife or Caustick; so shall the Sinuous Ulcer above be disposed to cure. But if the Sinus do run under considerable Vessels, or be in such a place where you cannot safely lay it open, you aught than to enlarge the Orifice, and put the Member in such a position as may dispose the Matter to flow forth, and by Compress and Bandage contribute your endeavours thereto. Having thus made way for the discharge of Matter, you are than to deterge the Ulcer with Medicaments proportioned to the impurity of it. The most usual are, unguent. Apostolor. mund. Paracels. & ex apio: to which may be added Merc. praecipitat. etc. If there be a necessity of Injections, you may with a Syringe cast in some of these following Liquors; but do not stop the Orifice the while, for thereby you will dilate the Sinus. The milder may be, a decoct. bordei, cum syr. de ros. since. mell. magist. nost. Or, ℞ summitat. centaur. min. agrimon. equiseti, pimpinellae, an. Mj. rad. aristoloch. rot. rad. iridis, an. ℥ ij. myrrhae, sarcocollae, an. ʒiij. coq. in aq. font. lbij. lbij. colat. add spir. vini ℥ iiij. mell. rosar. q. s. Other of this sort you may see in the Chapter of Sinuous Ulcers in Gun-shot Wounds. If the Ulcer arise from some Abscess within the body, it will not be safe to use Injections, till you can satisfy yourself how they will come out again. Therefore in such cases you must consider, as above said, how you may give a vent to the Matter: for while that is retained, there is no hope of detersion. But that being conveniently made, you may keep it open by Cannula, or with a Pea threaded, as a fontanel, till Nature shall be disposed by the Physician's help to heal the internal Viscera, and than the external Ulcer will heal of itself under the Pea, if you leave it not timely out.  
During the Cure of all these Ulcers, you aught to use Fomentations discutient and drying proportionably as the case requireth; viz. of summitat. absinth. majoranae, hyperici, betonicae, flor. cham. ros. rubr. ballast. bacc. myrtill. nuc. cupress. etc. in Wine and Water, with the addition of Brandie.  
A Married Woman aged thirty four years, 
1. Observat. of a Sinuous Ulcer in the Leg.  having lain a great while lame with a pain in her right Leg, supposed a Rheumatismus, after frequent bleeding, purging, etc. it swollen on the outside from the Gartering to the Heel, and discharged its Matter near the Ankle. Some neighbouring Chirurgeon and Apothecary were employed, who dressed it and prescribed her Physic accordingly, and after some time permitted the Ulcer to close, endeavouring to persuade her she was cured. But it swelling soon after with Inflammation, I was sent for, and saw the Ulcer near closed: but the quantity and ill quality of the Matter shown it sinuous; and upon search I discovered it so to the very Gartering, also a Sinus running down towards the Heel. I dilated the Orifice with Gentian roots, applied a Caustick about an inch and a half in length upon the Sinus above, and gave vent to the Matter, dressing it up with Lenients, as unguent. basilicon cum. ol. ros. and after the fomenting it, applied cerat. Galeni with Compress and Bandage, supposing the Matter would be intercepted, and the Sinus' beneath thereby disposed to cure. But after separation of this Escar, the Ulcer appeared hollow under the lips; and the Matter flowing from the remaining Sinus above, put me upon a necessity of laying that open by a Snip with a pair of Scissors: and after all my endeavours, I was glad to lay open the lowermost Sinus, from the Ankle downwards, before I could dispose it to cure. The several Cavities being laid open, I dressed them with Digestives, Detersives and Epuloticks, accordingly as they required, than cherished the native Heat in the Member by good Fomentations, as above in the method of Cure is set down; and by Intercipients and Bandage restrained the influx of Humours.  
To add to this poor Woman's misery, 
Caution in making fontanelles.  she had a fontanel formerly made upon the Tendon of the Biceps, which had caused a contraction of her Arm, and a hard Tumour on the inside of the Radius, with great pain and convulsion in her Hand and Fingers. This very pain kept her watching day and night, exceedingly exhausted her spirits, and put such a Ferment in her blood, as it seemed to me difficult to cure her Leg whilst this disturbance continued on her. Wherhfore I began with the Embrocation of the Arm, and so downwards, with this; ℞ unguent. nervin. ℥ iij. ol. lumbric. ℥ ij. ol. vulpin. ℥ j ol. origani, lavend. ana q. s. Misc. and applied over the Tumour on her Wrist a mixture of Emplast. diachyl. cum gummi & de mucilag. I also prescribed her an Infusion of Sena, etc. with Manna and syr. de pomis purgant. and that night one grain of laud. in cons. anthos, & syr. de garyophyll. and a cordial Julep of aq. cerasor. nigror. tiliae, lil. convall. cinnamomi, confect. Alkerm. & syr. è suce. citr. of which she drank frequently. She was also purged once a week with Calomel. and at other times took Antimon. diaphoret. etc. Thus I resolved the Tumour in her Wrist, and the contraction of her Arm, and restored the use of her Hand: during which the Ulcers in her Leg digested, incarned and cicatrized, according to the method prescribed in the general Chapter of Ulcers. Her Leg being extremely emaciated and weak, I advised the bathing it with Flesh-broth wherein had been decocted emollient Herbs; by which it afterwards grew so full, that I was necessitated to put her on a laced Stocking; and thereby the swelling was restrained, and she recovered strength to walk on it very well.  
A Maidservant, 
2. Observat. of a Sinuous Ulcer penetrating the right Breast.  aged twenty six years, had a small Phlegmon on a part of her right Breast tending to Suppuration. I, supposing it simply such, confidently undertook the Cure; and having suppurated it by the application of unguent. basilicon, opened it by Caustick, and discharged a purulent Matter; which increasing daily with diminution of the Inflammation and Tumour, I made a search with a Probe, and penetrated into the cavity of the Thorax. I than discoursing with her, informed myself that she had been long diseased with a Cough and frequent Shortness of breath. I was much ashamed of my confident undertaking it. The rarity of the case deceived me, and as many as afterwards saw it, every one judging the Ulcer simple. But its penetrating (as I said) shown the Cure difficult, and the work of time. Therefore I fitted it with a Cannula, which I retained with a snip of Plaster, and applied a thin piece of Sponge pressed out of Wine upon it, with Compress and Bandage over it, directing the dressing it twice aday. After I had thus healed up the rest of the Ulcer, I left out the Cannula, put in a Pea, and kept it as a fontanel, till Nature should dispose the Viscera within to a better condition. But she, growing hectical, removed into the Country with internal Prescriptions and directions to dress herself; where I suppose she is since recovered of her Fever.  
Some while since I was accidentally consulted in the Country by a Chirurgeon there about an apostemated Breast, 
3. Observat. of an Ulcer penetrating the Breast.  the biggest I ever saw. The Patient was a Woman of about forty years old: she had a Cough, and was oppressed with Difficulty of breathing. The Chirurgeon opened her Breast in the declining part, and discharged a proportionable quantity of foetid Matter. She was somewhat relieved by it; but it penetrated into the Thorax, and the large discharge of Matter soon wasted her.  
A Child of about four years of age was brought to London, 
4. Observat. of Sinuous Ulcers on the left Sid penetrating.  supposed to have the King's-evil. It had three Ulcers lying near one another on his left Side, between the two lowermost of the true Ribs: they were accompanied with Inflammation and Excoriation. He was much emaciated, and afflicted with a Cough and Shortness of breath. Upon search with a small Wax-candle into the upper Orifice, I penetrated between the Ribs, and felt the edge of the uppermost foul. The other Ulcers were made by the insinuation of the Matter for want of timely enlarging the first Orifice. I dressed the Excoriation with unguent. album camph. & cerat. Galeni, and applied some of the mild Caustick, by which I enlarged those Orifices. After the separation of the Escars, I dressed the lowermost with unguent. tutiae, and cured them. The uppermost I kept open as a Fontanel with a Pea, for discharge of the Matter from within, not concerning myself in the exfoliation of the Bone, but leaving that to Nature, which seldom fails where the Ulcer is kept well digested. During my proceeding thus with the Ulcers, the Child was prescribed a Decoction of Sarsa with Pectoralls, and his body kept open with syr. de rhab. in aq. germ. querc. somewhat of Calomel. was also prescribed, cerussa Antimonii, etc. and the Child recovered. But while the Attendants grew secure and careless in dressing the Ulcer, the Pea slipped out, and the Orifice closing in the Matter, he was seized with a Cough, Difficulty of breath, and Fever. Upon which account I opened that Ulcer again, and relieved him. He went soon after into the Country, and by the foresaid method recovered.  
A Man of about forty years of age labouring under a Fever in the Country, 
5. Observat. of a Sinuous Ulcer in the Breast.  it terminated in some Abscess within the Breast, and passed its Matter at last into the right Axilla, raising a large Abscess there, which, being left to Nature, made its way through the Skin; but not having Opening sufficient nor timely, the Matter invaded the interstitia of the Muscles, and spread itself over all the Breast and Side, and did not discharge itself outwardly otherwise than as it overflowed: by which means the Abscess became very large, and the quantity of Matter had well-nigh exhausted the Patient. It was my chance to come into that Country, and being desired to give him a visit, and seeing the cause of it, I presently made a long Incision in the lower part of his Breast, and gave vent to the Matter; and afterwards made another Opening from the Ulcer in the Axilla downwards, where the Matter was straightened by a hard Callus. In other parts, where the Matter was also contained, and could not be discharged by the former Openings, I applied Caustics, and the next day divided the Escars, thereby giving way to the remaining Cavities to empty themselves. This being done, I left Medicaments and directions for the dressing them: viz. unguent. basilicon for Digestion; mundificat. Paracelsi, Merc. praecipitat. and Vitriol-stone for Detersion; unguent. sarcotic. to incarn; and unguent. tutiae & desiccativum rubr. for the cicatrizing the Ulcer. For whatever people pretend of Cure by Injections, the way is slow and hazardous, they often rendering these Ulcers more sinuous, and being of use only where the Ulcer may not be opened by reason of the considerableness of the place. Here in this case, after the Matter had free vent, the Ulcer cured most easily.  
A Daughter of a substantial Citizen laboured under an Abscess in the Region of her left Kidney, and was long treated by a bold Empirick, 
6. Observat. of a Sinuous Ulcer penenetrating the left Kidney.  who promised Cure: but after all his endeavours, the Child languishing under the Ulcer, sometimes by reason of the great discharge of Matter by Urine, and othertimes through the suppression of it, great pains were stirred up within the Body, and outwardly in the Abscess. I being consulted, observed that the external Abscess took its original from the Ulcer within the Kidney, and required other manner of dressing, its Cure being the work of time. I proposed the laying it open to the very Part where the Matter passed forth from the Kidney. To which purpose I applied a Caustick upon the Sinus below, divided the Escar, and dressed it up with Lenients. Than after separation and digestion of the Ulcer, searching the same with my Probe, I found the Sinus run up above the Orifice; which being also laid open, I discovered the passage into the Kidney, and felt the side of the last short Rib bared by the Matter in its passing out. I dressed the Ulcer with mundif. ex apio, and healed up the remaining Sinus' above and below to the very Aperture. While I was doing this work, Dr. Barwick was consulted to help us in the Cure by Internalls, who prescribed a Traumatick decoction of Sarsa, etc. with the more temperate Plants, and Balfamick pills to contemperate the Humours. During my disposing of this Ulcer to retain a Cannula, the Matter discharged by Urine in great quantity, and the Patient was as soarly afflicted, and had the same Symptom that others have who are diseased with Ulcers or Stones in the Kidney; but after vent was given by a short Cannula of Lead, she recovered. Having continued the use of the Cannula some months, I removed it, and kept a Pea just in the Opening, and by read Sparadrope and Compress retained it on; than left her to her Mother to dress, and only called some times when they gave me notice of their wants. After a year or thereabout that she had kept this fontanel open, the internal pains and discharge of Impurities ceased, and she grew more fleshy and strong. She went also daily to a neighbouring School, where she was exercised in Dancing, etc. After the space of two years or thereabout, the Ulcer seeming not to matter more than might be expected from a small fontanel, the Mother cast out the Pea, and permitted it to heal up. But being soon alarmed by the old Accidents which returned upon the Child, she sent for me. I opened it again, and left them to keep it so. Dr. Barwick was also again consulted, who repeated the former method with some little alteration. The Ulcer was afterwards kept open near three years, during which she repeated her course of Physic Spring and Fall, and was frequently brought to me. At length I seeing her well grown and of a fleshy and healthy Complexion, and the fontanel in a manner dried up, I advised them to throw out the Pea, it being of no use. They did so: from which time the Patient hath continued strong and well, and is since married.  
A young Gentleman of about ten or eleven years of age was afflicted with a Sinuous Ulcer on his right side of the Spine. 
7. Observat. of a Sinuous Ulcer penetrating the right Side.  It had taken its original from a translation of Matter arising from within his body whilst he lay sick of a Fever in the Country. It came at length to maturation, and was let out by a neighbouring Chirurgeon: but it proving difficult of Cure, he was brought to Town. He was hectic, and diseased with a Cough and Shortness of breath, the Abscess mattering much, but especially when he bowed his body downward, or lay in his bed upon the contrary Side; also in lying upon his Belly the Matter ran forth some spoonfuls, and upon holding his breath it blubbered forth, which shown it came from within. Yet, for that sometimes upon pressing with our hands upon the Muscles of that side the Spine, there discharged Matter, we were apt to think it lay originally between the Muscles of that place. Doctor Micklethwait was consulted, and entertained their Physician, and was often present at the dressing the Patient. The Apertion was small, and obstructed by a Callus and luxurious flesh within the Ulcer, whereby neither the Probe nor Wax-candle could make any considerable way. We were satisfied that there were more Sinus' than that transverse the Back, yet by the search of a Probe we could make no discovery: but about three days after a redness in the Skin shown us a Sinus lying near the Os ilion of about two inches long, the Skin seeming thin. I opened it with a mild Caustick, and having divided the Escar, I passed in a Probe from thence towards the Spine: but that not satisfying me, I applied a Caustick upon the old Orifice, and another lower, whence I had pressed out Matter. Than dividing them, I filled them with Praecipitate; and by rubbing into those Escars afterwards with the Caustick-stone I penetrated into the Sinus'. One of these discharged the Matter which flowed that way; and the other served our purpose to discover the Sinus penetrating under the uppermost false Rib towards the Breast; which I dilated, and by detersion enlarged the passage, than fitted the Ulcer with a Cannula of Lead, with an Emplaster, Compress and Bandage over it, by which the Matter discharged very well, and the Patient was relieved in his Cough, and recovered his appetite. The other Apertures, having emptied the external Sinus', were deterged and cured. After the use of the Cannula some days, perceiving lose Flesh to arise in the Ulcer, which hindered the discharge of Matter, and that the activeness of our Patient caused the Cannula frequently to start out of the Sinus, and sometimes fit uneasy, I left it out altogether, and put in a large Pea, with a Thread in it to pull it out at pleasure. By this, with application of the common Sparadrope for Issues, this Ulcer was as a fontanel kept open, and the Matter plentifully discharged thereby; his Habit of body was also by the Physician's prescription of Vulnerary decoctions and Balsamicks, with lenient Purgatives, so well restored, that he returned into the Country with his Parents. Some while after coming again to London with them, I gave him a visit, and found him fat and well recovered. I did not see the Ulcer, but was assured from himself and his Servants, that it was kept open with much ease, and that it mattered but little. I advised than the keeping it so while any Matter flowed to the Part: which they did, and thereby cured him.    

A TREATISE OF THE DISEASES OF THE ANUS.   

OF THE DISEASES OF THE ANUS. The Third Book.  

CHAP. I. Of Haemorrhoids.  
VARIX in general hath been handled in one of the foregoing Treatises. But because there is one sort of Varices more important than the rest, I mean the varicous Swell of the venae haemorrhoïdales, I thought it convenient to discourse of them particularly by themselves. These hap very often both in men and women, so as sometimes to break and voided blood; other times only to swell and distend. But the consequences of these are very great, both as to the duration and intenseness of the pain, and also as to the tumors and Ulcers that arise from them. These tumors are sometimes phlegmonous, sometimes scirrhous, sometimes cancerous; many times they are ulcerous and fistulous.  
I shall therefore take occasion from that Chapter of Varix, to add in this place an entire Discourse of the Haemorrhoids, together with all the Diseases that are of the same kindred and family with them: in which if I swarve from that accuracy of method which Learned men may expect in the disposition of the Parts of this Book, I hope the young Chirurgeon will at lest think that fault sufficiently recompensed by having all the troublesome Diseases of that Part brought at once into one view.  
The perspicuity of this Discourse will depend much upon a true notion of the constitution of the Anus, or uttermost Exit of the Intestinum rectum. In which place it is bound about with a Sphincter-Muscle, the contraction of which shuts it so, as to detain within the Guts whatever Excrements fall down thither, till such time as Nature, being stimulated either by the fullness or provocation of matter, doth voluntarily relax it, and by the help of several pairs of Muscles dilate it, to make way for the discharge. All these things put together make up that organical Part which we call the Anus in a compound sense; though in a strict signification it denote only the extremity of the Intestinum rectum, to which all these things belong, and for the motion of which they are all designed. These Muscles, and especially the Intestinum rectum itself, are fed by several Arteries. As, first, the Arteria mesenterica inferior, which, being almost wholly designed for the Intestinum rectum, doth spread branches all over it copiously, and very particularly to that end which we call the Anus: and, secondly, the Arteria hypogastrica doth sand branches to the Anus, but chief to the Muscles belonging to it. These Arteries bringing Blood hither, have proportionable Veins destined for its return; one of which is the haemorrhoïdalis externa, usually so called, which is a branch of the Hypogastrick vein, and corresponds with its cognominall Artery. The other indeed most important Vessel is the haemorrhoïdalis interna, which receiving the Blood from all the parts of the rectum, and especially about the Anus, unites into a slender Trunk, which passing along the Gut by degrees creeps into the Mesentery, and usually inserts itself up between the mesenterical branches of the Porta, sometimes into the right, sometimes into the left, and sometimes into the Trunk of the Porta. Moore rarely it forsakes this course, and is inserted into the Splenick branch, sometimes without, and sometimes within the Spleen. This last case happens but seldom: yet surely it happened to those that first conjectured this Vein to be the Evacuatour of the melancholic Humours of the Spleen. How else should they guests that a Vessel so visibly inserted either into the Trunk of Porta, or at lest into the Mesenterick branches, should derive Humours rather from the Spleen than the Liver?  
But since the doctrine of the Circulation hath quite taken away the foundations of this Hypothesis, we are of late taught clear a new Lesson, viz. That the Blood descends hither only by the Arteries, chief by the mesenterica inferior, by which being cast into the middle and inward Coats of the Gut, it is carried back by the Vein aforesaid. Now if any man ask me the reason of the frequent tumors and Apertions of this Vein, I shall give him this account. First, that it is set in a depending Part; which reason is common to it and the Legs, both of which are more subject to Varices than other parts of the Body. Secondly, that the Legs and all musculous parts of the Body, when they receive Blood into them, do contract themselves more vigorously for the expulsion thereof, and promoting of its ascent, than the Gut, which is a more lax part, and contracts with lesle force at all times, save when Nature aims at an expulsion; in which case the tendency of Nature is downwards, quite contrary to that of the motion of the Blood, and rather hinders the return than furthers it, binding up the Blood in its own Vessels. Thirdly, the Veins hereabout are in themselves so very small that they have no Valves, so that Blood being detained in them, is not so easily carried up or hindered from restagnation, as where Valves are frequent. Fourthly, the place is so often moistened by the frequent afflux of Humours, that it is very forward to increase the natural Laxity of the Part, to dilate the Vessels, and to provoke an afflux of Humours; by virtue of which sometimes spongy Flesh is thrust out, and sometimes tumors of other natures generated. Fifthly, that these Vessels being here not only depending, but also cutaneous, scattered in a very thin tender Skin, are apt upon the impulse of Blood to fly open, than where they are bound in by a thick strong cover: and for this reason the Nose also (if it be seasonable to speak of it in this place) is apt to bleed than other parts.  
The natural construction of the Anus being such as I have described, the preternatural may easily be inquired into. For if by any Fermentation or Ebullition of the Blood any sharpness so affect it as to 'cause a stagnation in this place, presently the Veins, being not sufficient for the discharge, grow varicous: and if the Humour by its sharpness or thinness, or both, stimulates Nature, by this means the rectum is always offering to squeeze and contract itself, and binds up the Vein so that the Blood cannot ascend, but is by the violence of the motion thrust back again, to the bursting open of the mouths of the Vessel. If the Coats be thick or apt to sponginess, than the Parts swell, and either the Vessels themselves appear blue and in clusters like Grapes, or else Flesh groweth about them, and makes Ficus, Condylomata, and Crista's. If the Humour be of a saline nature, it dries and parches the Skin, and chaps it; from whence comes Rhagades and Fissurae, things frequent in the Nose and Lips as well as here.  
This Humour is most frequently lodged within the verge of the Anus, and so appears to the eye: but it likewise very often is lodged on the Muscles near it, where the Varices are hidden, and seldom discover themselves, but only an outward Tumour appears which in progress often times apostemates, and at last ends in a fistulous Ulcer; which Ulcer, according to the dust of the Vessels that feed it, sometimes penetrates the Gut, and sometimes not.  
I shall first treat of the Varices themselves, and the tumors that are consequent to them; and than shall beg leave of my Reader to translate hither a Discourse concerning the Ulcers of these Parts: which I should have placed elsewhere.  
The Varices haemorrhoïdales themselves will admit of these following Differences; which are either essential, or accidental.  
I. Essential are those that are taken from the Parts themselves that are tumefied: viz. either the Vein only swells, or some adjacent Bodies swell with it, 
Differences.  or some new Body is generated that adheres to it.  
1. When the Vein only swells, than either it swells without bleeding, which we call Haemorrhoïdes caecas or blind Haemorrhoids; or, 2. upon swelling it opens and bleeds, which we call Haemorrhoïdes apertas.  
2. When other Parts swell with the Vein, other tumors arise, as Phlegmons, Scirrhi, Cancers, etc. all which are seated in the Muscles of the Anus, or of the adjacent Parts.  
3. When new Bodies are generated, they, according to their figure and substance, are called by several names, as Ficus, Condylamata, Warts, etc. which are all of them Excretions upon the Veins so swelled.  
II. Accidental Differences are many: viz. 1. From the place; so they are internal, or external. 2. From the bigness; great, or small. 3. Number; one, or more. 4. Figure; round, as the Haemorrhoïdes caecae, or long, as the Ficus, and Warts, or triangular, as the Crista. 5. Superficies; equal, or unequal. 6. The basis; broad, or narrow, etc. 7. The Times; periodical, or uncertain. Many other may be reckoned, as men's fancy leads them.  
The Internal Causes of Haemorrhoids must be either a mere Plethora, 
Causes.  or a Cacochymia. A mere Plethora is a rare case, and if ever it happens, sooner affects other Parts than this. But a Cacochymia doth produce them sometimes when it is plethoric, and than is commonly periodical and breaks: or else when 'tis without a Plethora, the sharpness of the Humour, or weakness of the Part, or both, do concur to the production. So according to the variety of the degeneration of the Humour variety of tumors do arise: concerning which we have severally treated already in their particular Chapters.  
But they are not Internal Causes only to which these tumors own their Original, they have often Externall Causes; as biting of Leeches, pain any way caused by Blow, Bruise, Friction, or Puncture. So a man living near Piccadilly in eating of Plaice swallowed a Bone, which in passing stuck in the Intestinum rectum, and stirred up pain. He advised with some, who applied Leeches, whereby the Fluxion was increased, and made an Abscess, which terminated in a sinuous Ulcer. The Patient pulled out the Bone, and I was called in to the sight of the Ulcer by the Chirurgeon, who was of my name and relation. So likewise there are many instances that demonstrate the Piles to arise from chirurgical Operations and Applications. Likewise sharp Humours passing near that place from the Guts do by their acrimony provoke the Piles. This Humour may be from internal Causes in the Blood, and yet effects externally, viz. whilst passing out at the Anus, it makes the same affections there that a sharp Clyster would: or it may be excited by Aloeticall, Scammoniate, or other acrimonious Medicines.  
After all this Discourse it will be needless to say much of the Signs. 
Signs.  Your eye will tell you whether it be a Vein or some other Tumour that you see; also whether the Part bleed or not. In other tumors the Figure will tell you which is the Ficus, Morus, Crista, Condyloma: the last of which is like a round pensile Wart with a narrow neck; if it be flat, it is Ficus; if it have a broad basis, it is Crista; and so forward; their names being given from their resemblances. Cancer, Phlegmon, Scirrhus, have their Signs taught in their proper Chapters.  
If the Haemorrhoids flow seasonably and moderately, 
Prognostic.  they purge the Body of feculent gross Blood, and thereby free it of many dangerous Diseases, as Pleurisy, Inflammation of the Lungs and Kidneys, Quartane Fevers, etc. and restore health.  
If they flow immoderately, the Patient groweth weak and faint, is subject to Cachexia, Dropsies, etc. So also by the inordinate suppression of them the Patient is rendered subject to all the forementioned Diseases.  
From all which it may be concluded, that there is not lesle danger in unseasonable suppression of the Haemorrhoids, than there is from their too great Evacuation; and that they are not unadvisedly to be provoked, nor yet too suddenly to be checked.  
If the Haemorrhoids called caecae, or blind Piles, be extreme painful, and not timely succoured, there is danger jest, through the great concourse of Humours, Inflammation, Apostemation, etc. do follow.  
Those Haemorrhoids which affect that part next the Neck of the bladder are more vexatious, by reason of the consent they have with it; whence Inflammation and Strangury may hap.  
Those Haemorrhoids called verrucales are the worst sort; the uvales are the milder, and the morales have a mediocrity between both.  
In the Cure of the Haemorrhoids we shall begin with the caecae, 
Cure of the Haemorrhoids; and first of the caecae, or blind Piles.  as well the external as internal: in both which the Patient's Diet aught to be such as hath virtue to keep the Body soluble; because in these Diseases they are generally costive, and by straining to ease nature do only excrete a Mucus; and if by such excretions they do avoid Excrements, it is with much pain. Therefore Pannadoes, Barly-grewells, Oat-meal-caudle's and Broths of Veal, Chicken, etc. with Beets, spinach, Borage, Bugloss, Endive, Succory, etc. are proper. Their Drink may be a small Ale, Beer, or Wine diluted with Water, or Ptisans. Strong Drinks and Salt or sharp Meats are hurtful. The Body may also be kept soluble by Clysters of fat Broths, emollient Decoctions, or of new Milk. They may be cast up with Syringes which have a short thick Pipe Tapershion. Lenient Purgatives are also of use, viz. Elect. diacathol. lenitiv. diaprun. etc.  
If there be Plethora, or the Haemorrhoids be inflamed, Bleeding in the Arm is necessary, and in the Leg is you repeat it. If the Patient hath been accustomed to a Flux of the Haemorrhoids, and they are suppressed, than Leeches may be applied, that the Blood may have its discharge that way: but unless in the cases aforesaid Leeches aught not to be used, and than also cautiously, 
Caution.  they rather drawing the Humours to the Part, than carrying them of, and so are frequently the cause of Piles and all the mischief that attends them. Therefore we take of the Plethora, and make revulsion by Bleeding in the Arm, before we apply them.  
The external Medicaments proper in the Cure of this Disease are of divers kinds, and aught to be proportioned according as they are internal or external, recent or of long continuance, or according to the pain and cause whereof they arise.  
We shall begin with the external ones, which, whether they be one or more, do always thrust forth with great pain, and are subject to Inflammation. In which case, if you propose to restrain the Flux, and dry them up, ℞ fol. plantag. polygon. summit. rubi, equiseti, an. M. ss. flor. verbasci, M. ij. sem. lini, ℥ ij. flor. ros. rub. court. granat. ballast. baccar. myrtill. an. ʒuj. coq. in sufficienti quantitate aquae font. & vini rubri, fiat Fotus. After you have fomented them, apply a mixture of unguent. popul. cum subere ust. Upon a Pledgit of soft Tow morning and evening.  
If the Disease be in its state, and the pain exceeding great, ℞ fol. malu. verbasci, an. M.j. flor. hyperic. M. ss. rad. cynoglos. ℥ ij. sem. lini, foenug. an. ʒuj. sem. althaeae, ℥ ss. coquantur in brodio pro fotu. Or this; ℞ farinae hoard. ℥ ij. succi intybi, lactucae, an. ℥ iij. sem. psyllii, ℥ ss. ol. nymph. ℥ ij. vitell. ovor. num. ij. croci ℈ ij. In extremity of pain, ℞ olei vitellor. ℥ j opii gr. seven. Misce.  
In the Cure of the internal Piles the same emollient Decoctions and Anodynes which have been proposed in the external ones may be injected with a Syringe to good purpose.  
If the pain proceed from a gross viscid Matter distending them, such Medicaments aught to be applied as are moderately heating, and resolving: viz. radic. chelidonimas, rad. gladioli, caepae, allium, squillae, etc. Also Balsam. sulph. Rulandii.  
In the Declination of this Disease you may treat them with Medicaments that are powerfully drying: for the Parts distempered are lax, and, having been much distended with that Humour, cannot easily recover their former tone. Therefore we use bolus Armen. calx lota, crocus Martis astring. squam. ferri, aerugo, etc. alone, or mixed with mel common, axung. porciin. etc. aqua calcis, aluminosa, sulphurat. lap. medicamentoes. etc. When they do not yield to such applications but are pendent as uvae, etc. they will be apt to swell upon every little disturbance, therefore in such cases I frequently cut them of.  
The Apertae or bleeding Haemorrhoids aught not to be stopped while they discharge a gross vicious Blood, 
Cure of the Haemorrhoides apertae, or bleeding Piles.  or while the Patient beareth the evacuation well, and laboureth of some Disease, whereof he may hope to be freed by the bleeding of them. In these cases the Haemorrhoids aught to be permitted to flow freely forth. If they do not, you are to endeavour to make them bleed with such Medicaments as have a quality thereto. The internalls are all those which have Aloes, Scammony, Colocynthis, etc. Doctor Read in his chirurgical Lectures commends pill. Ruffi; and a Physician in the Country once told me, he had experimented them with good success, and freed himself of a Haemoptoe and Phthisis he was falling into.  
The Ancients have offered unto us divers Medicaments to the same purpose: viz. the rubbing of the Podex with Fig-leaves; also the Roots of wild Cucumber, Showbread, etc. made in the form of a Suppository, and put up. Or, ℞ fellis bovini ℥ j aloesʒij. aceti acer. ℥ ij. Misce, & injiciatur. Or, ℞ pulv. colocynth. ʒiij. amygd. amar. ℥ j mellis despumati ℥ ij. Misce, fiat Suppositorium. Or, Take two small Onions, Garlic four heads, flower of Lupins two ounces, Wine-vinegar as much as will make them into a Paste in the form of Suppositories. It would be of great use in the preventing as well as curing of many Diseases, if such evacuations could be made when we would: but so far as I could yet ever see, outward Medicaments have rather disturbed the Parts, than moved them to bleed to any purpose: yet I suppose they may provoke them in such Bodies as have been heretofore subject to them, and so may be of good use.  
In others who are extraordinarily subject to the bleeding of the Haemorrhoids, your care will be required in the moderating of them by regulation of Diet and manner of living: in which cases I refer you to the Chapter of the Wounds of Veins and Arteries. If the Flux of blood be great, you may make Revulsion by Venaesection, Cupping, and binding the remote Parts, also by the application of astringent Medicaments; or by such internalls as may incrassate and contemperate the Ferment in the Blood. Such are syrup. cydonior. portulac. de succo citr. acetoes. plantag. de rosis siccis, de rib. myrtillor. etc. mixed with some of the distilled Waters or Decoctions, ex radic. consolidae: So also pulv. bistortae, tormentillae, fruct. mespilor. malicor. acatiae, cornu cerv. usti, bol. Armen. lap. haematit. sang. dracon. Troch. de terra Lemnia, de spodio, de carab. etc. may be mixed with Syrups: viz. ℞ boli veri ℈ j lap. haematit. ʒss. poscae ℥ iij. syr. myrtillor. ℥ j Misc. Or, ℞ croc. Martis astringent. ℈ j cons. ros. rub. ℈ j Misc. Opiates are also useful in great Fluxes of Blood, viz. theriaca Veneta, diascord. laudanum, etc.  
The external Applications are court. granat. ballast. thus, mastic. nuc. cupress. gallae, hyporistis, etc. made into Suppositories with gum. tragacanth. Ising-glass, or cum album. ovor. Hares-furre with which Pledgits of Tow may be spread and applied externally. The Royal Styptic cast with a Syringe is also proper in these cases.  
A Man of about forty years of age, 
1. Observat. of the caecae-or blind Haemorrhoids.  of a lean and dry Habit of body, was subject to the Haemorrhoids called caecae affecting the verge of the Anus. I let him blood about seven ounces in the Arm, and, in consideration of his costiveness, advised a Clyster of Milk and Sugar. The same night I fomented the Piles with the Decoction of plantag. polygon. etc. and applied a Pledgit of Tow spread with unguent. populeon, as is prescribed in the method of Cure: by the application whereof he was eased, and in few days cured.  
Another aged fifty years of a full Body, 
2. Observat.  diseased with the same kind of Piles, with great pain. They lay varicous in a great cluster, so as it was not easy to found the way into the Anus: but in pressing some of them on one side, I saw a lose read Flesh thrusting from within outwards. It was the inner Spongy Coat of the Recium intestinum relaxed by the Fluxion, and hence a serous Humour discharged with some Mucus. I let him blood in the Arm about twelve ounces at that instant, and stuped the inflamed Piles with  wrung out of Claret-wine. An hour or two after a Clyster was exhibited of Milk with the Yolk of an Egg, some Sugar, and two ounces of ol. hyperic. which brought away hard Excrements, and mitigated the bearing down which he had complained so much of. The same night I visited him again, and fomented with a Decoction of malu. verbas. sem. lini, etc. as it is described, and applied a Cataplasm of the faeces beat and pulped. I advised him to a slender Diet, and prescribed him a Barley-cream cum sem. melon. papaver. alb. a few Almonds, a little juice of Lemons, aq. ros. & cinnam. hordeat. He rested tolerably well that night, and was easier in the morning. I continued the same method of dressing till the pain was assuaged, repeating Clysters as occasion offered; and afterwards fomented them with a Decoction of summit. anethi, hyperici, salviae, ros. rub. nuc. cupress. in Wine, by which I discussed and dried up the humidity, and thereby cured him.  
A Man of about forty six years of age, abounding with sharp Humours, 
3. Observat. of external Haemorrhoids.  frequently diseased with the Haemorrhoids, being one time sorely afflicted with them, consulted me. I saw them lying in a great Cluster round the verge of the Anus, which was also relaxed and turned out. The Varices were of different sizes and colours: some were inflamed read, others pale, others livid, and some black. At first sight I supposed them Gangrened: but after a farther search I observed the different colour of them proceeded from the great Influx of Humours which dilated them, and caused the Compression they made upon one another. We commonly see the same in making a Ligature on any of the Varices; in which case generally they inflame, or if tied very strait, grow pale and become livid; than, as the heat extinguisheth they grow black: Yet sometime, upon tying, the Blood bursts forth, and they recover their native heat. Thus in our case, through want of timely relief, they inflamed and swelled, and straightened themselves; till by corrupting they withered, and made room for their fellows. Whether these would have gangrened if not than succoured, I shall not conclude; but in bodies ill-habited they do so sometimes. These were exceeding painful, and, by reason of the Relaxation of the Anus, caused a vexatious Tenesmus, and discharged much Gleet and Mucus. I fomented them at the instant with read Wine, and injected up a spoonful or more of ol. hyperici, to abate the acrimony causing the Tenesmus; than let the Patiented blood. The next morning I fomented the diseased Parts with the foresaid discutient and drying Decoction, and applied that old Remedy of fried Leeks with Butter, beaten to a Cataplasm: by which the pain was mitigated and the varicous Swell relaxed. The Ulcerations were afterwards dried up by the sprinkling them with pulv. nuc. cupress. & ballast. and the continued use of the foresaid discutient Fomentation; in which, towards the declination of the Disease, was dissolved extract. sumach, whereby the humidity was dried up, and the Anus reduced; during which his Body was kept soluble by Clysters, and Lenient Bolus' of cassiae extract. etc.  
A Woman of about forty years of age came to London upon some affairs, 
4. Observat. of external Haemorrhoids.  and, having been formerly subject to the Haemorrhoids, was here again afflicted with them. She being a stranger, and shy in discovering her Malady, it increased with much pain, which afterwards put her upon a necessity of complaining. I was consulted, and saw them thrust out in a great cluster with Inflammation to putrefaction, the Anus turned out with great Tumour. She was also diseased with a Tenesmus,, which put her bowels upon a continual excretion of much Gleet and Mucus. I fomented them with Wine, cut of some of the varices, scarified others, and permitted them to bleed; than washed them with a Solution of unguent. Aegyptiac. in some of the Wine, and injected some ol. lini. Afterwards I applied a Cataplasm of fried Leeks over all. Cordials were prescribed her, and an Anodyne draught that night, to dispose her to rest. A discutient and resolvent Fomentation and Cataplasm were also applied by her Nursekeeper, as occasion offered. By these Applications the pain mitigated, and the Tumour relaxed. The Ulceration being great required Medicaments drying and detersive; to which purpose I left of those slabby ones, and fomented with aqua lapidis Medicamentoes. applying balls. sulphuris Rulandii upon Pledgits of Tow, with warm Stupes over it. By the use of these the Ulcerations were healed, and the overmoistned Parts dried, also the Anus contracted. During her Cure Lenients were injected, to mitigate the heat and disturbance in the Intestinum rectum, and her body was kept soluble by Clysters. Also to prevent future Costiveness, I prescribed her a Lenitive Electuary of extract. cassiae, pulp. tamarind. maciae, pulv. jalap. salis tartari, to take the quantity of a dram more or lesle at night going to bed. I purposed the making her a fontanel, but she being well went out of Town.  
A Gentleman aged about forty years, 
5. Observat. of external Piles.  of a healthful Constitution, was often vexed with Haemorrh. uval. on one side of the Podex, one whereof, being overstretched, was uncapable of being so discussed, but that it swollen and inflamed upon every little disorder or Costiveness. He at last, wearied with the disturbance, consulted me: it was than swelled, and somewhat inflamed. I, observing its basis capable of tying, made a Ligature upon it, and cut it of; than permitting it to bleed some while, I dressed it come pulv. Galeni, with a Pledgit of unguent. basilicon, and a Plaster of unguentum nutritum over it, and cured it by the touch of a Vitriol-stone and unguent. desicat. rub. Since when he hath enjoyed good health, and been lesle troubled with the Piles.  
What more concerneth the Cure of these kind of Haemorrhoids, we shall be obliged to take notice of in the following Observations of the Haemorrhoides apertae, they being for the most part accompanied with them, and are also attended with Tenesmus & Procidentia Ani.  
A man aged about fifty years, 
1. Observat. of the apertae, or bleeding Haemorrhoids.  of a gross Body, subject to a bleeding of the Haemorrhoids, presuming upon that benefit of nature, heated his Blood by disorder so, that it flowed violently forth by Stool, and in few days it brought him to be very faint and weak. I injected two or three spoonful of succ. urticar. and applied a Pledgit of Tow on the Podex dipped in a Solution of extract. sumach in read Wine; than prescribed him an Emulsion, ex sem. hyoscyam. & papaver. alb. By this method the Bleeding was stopped, but thereupon he grew feverish, and the Haemorrhoids swelled externally. To them I applied unguent. populeon cum subere ust. and took away a few ounces of Blood from his Arm: by which an contemperating Julips, etc. his heat remitted, and he recovered.  
A Woman of about forty years of age, 
2. Observat.  having been long afflicted with the Haemorrhoids of both kinds, whereby she was much emaciated and grown cachectick, in extremity of a Fit of both kinds joined together sent for me. I caused this Leniment to be injected, and applied upon a Pledgit of Tow: ℞ mucilag. sem. psyllii extract. in decoct. malvar. ℥ iiij. myrrhae, thuris, croci pulveriz. an. ℥ ss. vitell. unius ovi, ol. ros. ℥ ss. opii gr. viij. This gave the Patiented present ease; but the next day she was seized with a pain in her Head, and her Wula and right Tonsill grew inflamed. I supposed it was a translation of that Matter which had been checked by the Anodyne; yet could scarce believe that a Body so emaciated, and so lately emptied by the bleeding of them, could be subject to such an Accident. I let her blood in the Arm four ounces, and by the application of Discutients externally to the Fauces, and a Gargarism of a few distilled Waters with sal prunellae & syr. diamoron, the Inflammation remitted, and she recovered.  
A man aged about forty years, 
3. Observat.  extremely subject to the Haemorrhoids many years, came to Town, and being sorely diseased with them, he consulted me. I saw him newly come of the Close-stool, sitting upon the corner of a Trunk, with a Pillow and Napkin under him, his breeches hanging about his Legs: his Visage was pale and dejected, a cold sweat dropping from his Brows. He had been twice upon the Close-stool straining with great uneasiness, avoiding only a Mucus with a bloody serum. He than went again to it, and after some while straining returned discontented to his bed, where (he said) he was want after an hour or two to be easier. I viewed the diseased Part, and saw the Podex relaxed so much as I believe I might have put up my four fingers. It was varicous round the verge, and had bled some two or three ounces. From the internal Piles he frequently bled very much, yet was not the lesle pained. I called for soft Napkins well warmed, and applied one after another hot, whereby I soon quieted and reduced the relaxed Anus. I commended to his use an Infusion of Astringents in read Wine, to be applied hot with Scarlet-cloaths immediately upon his coming from the Close-stool, and to wear a Pledgit of Tow sprinkled with pulv. nuc. cupress. ballast. etc. by the use of which he was frequently much eased. Some years after he died suddenly of an Apoplexy, as was supposed.   

CHAP. II. Of Procidentia Ani.  
HAving in the preceding Discourse made often mention of a Relaxation of the Anus, we shall now treat more particularly of it. 
N●mes.  It is called by the Latins Procidentia Any, also Prolapsus and Exitus Ani. By those names it is also known amongst us. It is a Relaxation of the Sphincter to such a degree, 
Description.  that the internal rugous' Coat of the Intestine turneth out, and bearet down, making a Swelling proportionably.  
The Causes of this Disease are Costiveness, at which time, 
Causes.  straining to ease nature it frequently falls down; also Fluxes of the Bowels in Diarrhaea, Dysenteria, and especially Tenesmus. The Piles are for the most part a Cause, so is hard Labour in Childbed, and the Stone in the Bladder. In Infants it commonly falleth down through Crudity or over-moisture of the Levatores Ani. In those of Age the Cause will be more certainly discovered by the complaint of the Patient.  
The Signs are evident to the sight: the inside is turned outward, 
Signs.  and the Tumour is of a fleshy colour and rugous, by reason of the folds and wrinkles of the Coat; and it is accompanied with an uneasiness, and desire to go to Stool.  
The Cure of this Disease is difficult, 
Prognostic.  but much worse in old people than young; and if it succeeded a dysentery or Haemorrhoids, it is the most difficult. In the latter case it is scarce ever curable. If it happened through Costiveness, the Cure is hopeful; so it is if it was caused from the Stone in the Bladder, or Childbed Labour, if in that work the Muscles or Membranes were not torn.  
In order to the Cure, 
Cure.  the prolapsed Intestine aught to be put up with an easy hand. The usual method is, to apply a Stupe of Flannel or Scarlet-cloath, wrung out of some Decoction of read Wine hot; and after the Part hath been a while fomented, you are to thrust up the relaxed Anus with your fingers till you have reduced it. If the Tumour be great and hard, you aught than to foment it with Emollients and Discutients, viz. fol. mal. viol. taps. barbat. flor. sambuci, cham. meliloti, sem. lini, foenugraeci, etc. The Tumefaction removed, reduce it as abovesaid, binding on a Button of soft Tow pressed out of an Astringent Decoction made thus; ℞ baccar. myrtillor. flor. ros. rubr. ballast. an. ℥ ss. nuc. cupress. gland. querc. an. ℥ j sumach, acatiae, hyporist. an. ʒijss. corn. cervi usti, thuris, an. ʒij. infundantur in vin. rubr. lb ij. & coquantur ad tertiae partis consumptionem. Your next endeavours should be how to prevent the descent of it in the time of easing nature; for upon the lest straining it for the most part thrusts down again. Therefore it is that we desire the Patient should be so well disposed in his Bowels, that, if it be possible, he may go seldom to Stool, and when he doth, that it may be with the lest straining. He should also have a couple of Sticks whittled and fitted for him to place close on each side the Podex, so as in straining the Excrements may pass out, yet the Prolapse of the Intestine be hindered. For the like purpose I have frequently commended a small Tin-hoop to be fastened in a quilted Bolster, which being fitted with Bandage may be retained at that time to pass the Excrements through, and prevent the Relapse. What you can invent to this purpose will much facilitate the Cure.  
An Infant about a month old was diseased with a Procidentia Any, 
1. Observat. of Procidentia Ani.  which being not reduceable by the Women, I fomented it with read Wine three or four times, than with my fingers upon the Stupe pressed equally upon it, and reduced it. I continued the fomenting it a while longer, than applied a Pledgit of dry Tow upon the Anus, directing them how to relieve it in case of its Relapse. I afterwards sent them papers of Astringents to infuse in read Wine, to apply as above said. By which method it was strengthened and cured in few days by the care of the Nurse.  
A sickly Child about four years old had been some months diseased with a Procidentia Any, 
2. Observat. of Procidentia Ani.  by reason of a preceding Flux of the Bowels with Tenesmus. It had been neglected by the Servant that attended it, and was too much swelled to yield to a Reduction. I fomented it with the discutient and emollient Decoction prescribed in the method of Cure, than bound on warm Stupes wrung out of the same, and kept him in bed. The Swelling being thereby somewhat relaxed, I endeavoured again Reduction; but it not yielding thereto, I fomented it with Discutients with somewhat of Astringency, and sprinkled the inner Tunicle with pulv. nuc. cupress. corn. cervi usti, an. part. equal. than applied warm Stupes thereon. After I had thus dried up the superfluous Humidity, I attempted it again: but as I pressed upon it on one side, it risen on the other. I repeated the warm Stupes, and with my fingers upon the Stupe I pressed close upon it, and twiddled it in first one side, than the other. It being reduced, a Compress of Tow made in the form of a great Button, dipped in an astringent Decoction, was placed thereon, and retained by good Bandage. His Diet was boiled Rice and suchlike, which might prevent a Looseness. At his next going to Stool I was fetched. After he had eased nature, I fomented the relaxed Anus, and having cleansed and dried it, reduced it easily, than dressed it as before, and continued my attendance at such times; whereby I facilitated the work and cured the Child, by the assistance of the Servant that attended it. Many suchlike in Children to twelve years of age I have happily recovered by the like method.  
A Man of about twenty eight years of age, 
3. Observat. of Procidentia Ani.  afflicted with a Procidentia Any, consulted me. It was neither inflamed nor hard; but, having been long out, was not easy to reduce. I returned that evening with a Decoction of summitat. anethi, hyperici, flor. cham. ros. rub. ballast. sumach, nuc. cupress. made in Wine; and after I had fomented the relaxed Parts, I endeavoured again to reduce it: but it not yielding, I sprinkled the inner Coat of the relaxed Anus with pulv. nuc. cupress. and applied a warm Stupe over it with retentive Bandage. The next morning I returned thither, and repeated the Fomentation, and having thereby reduced it, I dressed it up with a Compress of Tow made in the form of a Button dipped in a Solution of extract. sumach in read Wine, with Bandage to retain it close. I afterwards made him several visits, and assisted him in the reducing it, directing him according to the way proposed in the method of Cure for preventing the Relapse: by which method the Relapse was lessened, and the easier reduced when it slipped out.  
I was fetched to a Woman of about forty years of age, 
4. Observat. of Procidentia Ani.  who had been long afflicted with the Haemorhoids both internal and external, through the continuance of which the Sphincter relaxed, and, for want of timely reduction, in process of time swollen big, and was accompanied with great Fluxion, Ulceration, and various sorts of Excrescences, which rendered it uncapable of being reduced. I advised a discutient and astringent Fotus, as hath been proposed in the method of Cure; and the next day cut of the Excrescences with a pair of Scissors, and applied warm Stupes, to continued the bleeding till I thought I had sufficiently given a breathing to the Part. Than sprinkling them with a mixture of pulv. court. granat. nuc. cupress. with a third part of Merc. praecipitat. I applied a warm Stupe over all, with retentive Bandage. The next day I repeated the same Applications, with this Emplaster under the Stupe: ℞ pulv. summitat. millefoliis, flor. chamaem●l. an. ʒuj. cortic. granat. ʒij. ciner. ligni fraxini ℥ ij. aluminis ustiʒij. rad. squill. coct. sub cineribus ℥ iiij. pistentur in mortario cum axung. porcin. & mel. communis an. q. s. fiat Emplastrum. By the continued application of these Medicaments, I discussed part of the Swelling, and dried up the Ulcerations, and by rubbing of many roots of the Excrescences with the Vitrioll-stone consumed them. But the circumference of the Podex after all being too turgid to turn inward, I fomented it with Emollients, and applied Cataplasms of the same; by which it was after a while rendered reduceable, and by Compression retained: but by reason of the laxity and over-moisture of the Part, she was subject to the Haemorrhoids afterwards, and the Anus frequently relapsed. She languished long under that Disease, and died hydropical.  
A person aged about sixty years, 
5. Observat. of Procidentia Ani.  having laboured a long time under various Chronic Diseases, and of late years a supposed Fistula in Ano, which grew daily more vexatious; I was consulted. Upon view of the Part, I judged it a Procidentia Ani. It being questioned, I called for warm Napkins, and applying them hot one after another, I reduced it whilst I pressed one of the warm  close to it, and thereby eased the Patient, and confirmed the Judgement I had delivered of it. This Procidentia Any, by reason of its long continuance, and the continual discharge of serous Humours by it, rendered the Part so lax, that it relapsed upon the lest walking. Wherhfore I provided accordingly a Compress dipped in astringent Liquors, with Bandage to retain it close, and some days attended him in reducing it, and in showing his Servants how to reduce and dress it. The work of Reduction being grown more easy to his Servants, the Patient contented himself with having it reduced so often as occasion offered, and declined the trouble (as he called it) of Bandage. During the time of my attendance on this Patient, I observed the folded Sheet which lay all night under him to be wet through, as if so much water had sieped into it. Upon enquiry whence it proceeded, and feeling his Belly, I concluded the Patiented hydropical, and that the discharge per Anum was from thence. I was not much credited; but it appeared so about three quarters of a year after, when he dying of an Apoplexy, his Servants taking him out of Bed, the Sheet under him was found wet as aforesaid. In order to the Embalming of him, I pierced his Belly, and discharged twenty two pints and a half of Water. Towards the latter part of his life he was subject to Vomiting, with dejection of Appetite: the Procidentia Any was also continually attended with a Tenesmus, which was no small disturbance to his Bowels. In the opening of the lower Venture, I found the Viscera much obstructed; and in the left Kidney there was one stone filled up the same.   

CHAP. III. Of Condyloma, Ficus, Thymi, etc.  
THe Anus is also subject to various sorts of Excrescences besides those arising from the Haemorrhoids, and have names from the things they most resemble, being called Condylomata, Ficus, Cristae, Thymi, etc. Authors do not agreed about the Names of the three former: some making Crista and Ficus all one, only differing as they are greater or lesser; and take no notice of Condyloma at all. Others also have given very different Descriptions of them, such as seem to me insufficient to distinguish them. I shall therefore take the liberty to represent them to you as I have seen them grow.  
The Condyloma and Ficus I suppose to be both one, 
Description of Condyloma.  differing only in their manner of growth, they both arising from a peculiar kind of soft round Tubercle distending the internal rugous' Tunicle of the Anus, without pain or alteration of colour in the Skin; and as that increaseth, it groweth fleshy. If it continueth that figure, it is Condyloma: but if it shoot out with a long neck, 
Ficus.  as frequently it happens, resembling a Fig, it may deservedly be called Ficus.  
Cristae are a sort of hard Excrescences arising somewhat distant from the verge of the Anus, 
Cristae.  in the form of a Cock's Comb, and are usually a symptom of the Pox.  
Thymi are hard Excrescences not unlike the tops of the Herb they borrow their name from. 
Thymi.  They partake of the nature of Warts, and differ only in their manner of growth. There are other sort of Excrescences of a softer substance, called Papulae, etc. Of the former some are benign, others are malign and of a Cancerous quality.  
Rhagades are Chaps or Fissures about the verge of the Anus proceeding from the acrimony of the Humour fretting and cracking those Parts. 
Rhagades.  This happeneth in those who have been infected with any of the abovementioned Excrescences: it may also proceed from a Diarrhaea, etc. They are deep or shallow, dry or moist, malign or benign, according to the quality of the Humour to which they own their original.  
The abovementioned Excrescences are enough distinguished by the sight from one another. 
Difference.  They differ from the Piles, as affecting only the Skin, and that without Tumefaction of the Podex: nor have they any likeness to a Varix.  
The material Cause of all these sorts of Excrescences is pituitous or gross viscous Blood thrust forth by the strength of the Expulsive faculty out of the Pores of the Skin, and dried up into these forms in which we see them. 
Causes.  The Condyloma and Ficus arise from a viscous Humour flowing preternaturally into some part of the rugous' Coat of the Anus, raising it into a small Tumour, as I have already said. The Cristae and other Species of Excrescences are reputed to arise from the Lues Venerea, and from that filthy sin of Sodomy, and have the Rhagades for their companions: which I believe is frequently so seen in the hot Countries; but amongst us is a Symptom of the Pox. Yet I have met with it in a little Infant; and all the other Species in people whom I suppose never had the Lues Venerea.  
The Thymi are the worst sort of Excrescences, they being more often malign, 
Prognostic.  and are than painful; also if their extirpation be unsuccessfully attempted, they grow cancerous. The Condyloma, Ficus, Cristae, etc. are not difficult to extirpate or cure, if the Disease be rightly considered from which they arise.  
The Cure of these Excrescences at their first budding forth may be attempted by Medicaments that are astringent and drying; as summit. rubi, equiseti, 
Cure.  fol. & baccar. myrtillor. sumach, court. granat. ballast. squamae aeris, ferrugo, calx lota, ●●umen, etc. made into Fomentations, or powdered and mixed with Ointments, and applied upon Tow. If these do not check their growth, you may cut them of with a Knife or Scissors, and consume the remaining roots by escarotick or actual Cautery, and than proceed in the Cure by Digestion and Epuloticks accordingly. To prevent their growing again, Authors commend the Ashes of Vine and Bean-stalks mixed with Vinegar, to apply upon the Part.  
The Cure of Rhagades consists in removing the Callosity, and cicatrizing them smooth, as abovesaid. If Humidity abound, it requireth Exsiccants: to which purpose, ℞ flor. ros. rub. bacc. myrtill. summit. rub. an. M.j. rad. tormentil. bistortae, an. ℥ j aluminisʒj. coquantur in aq. chalybeat. ad. lb jss. in fine decoctionis adde vini rub. ℥ iiij. with which foment the part. Than apply suchlike: ℞ lethargy, cerussae, an. ʒiij. sarcocollae, mastic. thuris, an. ℈ j terrae sigillatae, ℈ ij. ol. ros. ℥ iiij. cerae q. s. Misce super ignem, deinde pistentur in mortario. plumbeo pro usu. If siccity be the fault, you must dress them with Medicaments that are humecting; as, ℞ pingued. vitulin. anatis, gallinae, an. ʒij. lithargyr. aur. ʒj. Misce in mortario plumbeo S. A.  
ALL these Species of Excrescences are for the most part symptoms, 
1. Observat. of Rhagades, Ficus, Thymi.  as I have said, of the Lues Venerea, to which Treatise I shall refer you for a more particular information, and shall here, for brevity sake, give you only one Observation of a person who suffered under various Species of them the most I ever saw, yet was not venereal. He was a man of about fifty six years of age of a healthy Constitution; he complained that he had been long obstructed in easing of nature by reason (as he thought) of the Piles, which of late was much more grievous to him, they in a manner stopping up the Anus. I viewed the Part, and saw a numerous company of Excrescences, great and small, overspreading the Anus, insomuch that it was very difficult to find their insertion. There were five very large, of the form of green Figs, the lest of them about an inch and a half long, inserted within the Anus. There were other lesser growing more externally, upon the verge of them some hung like so many Leeches. There were also about the Anus many Thymi growing right up of different size; under which were Rhagades, Chaps and Fissures, with small Excrescences or Papulae thrusting here and there out of them. These being all washed and cleansed from the Excrements, retained the natural colour of the Skin, and were not painful. He had concealed his Disease so long as he could, and was encouraged to sand for me, upon a report he had heard from a Neighbour of his, whom I had freed from an Excrescence in the same Part. I readily undertook the Extirpation of them, but desired to have some witness of the work: to which purpose one was consulted; but he, discouraging us with a prediction of their malign quality, left us. Yet the Patient urging me to proceed in the operation, and I considering the necessity of it: I came the next day with my Servant, furnished with Knife, Scissors, Needles and strong Thread, actual and potential Cauteries, astringent Powders, etc. Than having placed the Patient in a clear light, with his Knees drawn up towards his Body, he with my Servant assisting with their hands, I again considered the Part affected; and finding it difficult to get to the roots of those inserted within the Anus, thought to begin with those more remote. But suspecting how his courage might hold out, I began with those nearest the verge of the Anus, clipping them of close from their roots one after another, as fast as I could, not minding their bleeding, till I had freed my way to those within the Anus. Than with a Sponge dipped in Oxycrate I washed of the Blood, and with small actual Cauteries dried the roots of them. That done I oiled my Finger, and passed it into the Anus, to make way to the next: and whilst I held my Finger beyond it close to the root, my Servant the mean time pulling the Ficus to him, I passed the Scissors under it towards the end of my Finger; than tied them, and passing on cut them of, my Finger within directing me in the work. I tried the Speculum Any: and by the help of my Finger within, and a Speculum at the entrance upon the verge, I cleared the Anus of them, cauterised their roots, and put up a bit of a Rag dipped in unguent. refrig. Galeni. Than I fell to work with the rest, snipping and cutting them of, and consumed their roots with actual Cauteries. Some of those that had very small roots I burnt with the Button-end of my Probe, others with the point of my Forceps. The Lips of some of the Rhagades which were callous I burned with the Spatula, some others I rubbed of with the Caustick-stone. Thus in lesle than an hour and a half I consumed them all, and left the Anus free, and the Parts about smooth. I dressed them up with a Pledgit of Two spread with unguent. refrig. Galeni, and in the space of fourteen days or thereabouts cured him: for indeed most of them cicatrized as the Escars cast of. This Patient lived many years after, and publicly acknowledged the Cure to persons of great Quality. If these had risen from the Pox, they would have soon returned, and rendered my operation unsuccessful; which they did not.  
A young married Wife having been long diseased with an Excrescence growing out from the Os coccyx between three and four inches in length, 
2. Observat. A preternatural Body growing from the Os coccyx extirpated.  not unlike the tail of a Turkish Sheep, retaining the natural colour of the Skin, without pain, except in time of Childbed. She being again with Child, and dreading the pain thereof, consulted me. I undertook the extirpating of it, and in the presence of some eminent Physicians made a Ligature upon the basis of it, and cut it of. It scarce bled; yet having astringent Dress ready prepared, I applied them. We slit the preternatural Body open, and judged it to be a soft white Fat, like that of a Rump of Mutton. At the next Dressing I perceived the remaining part was Fat, and had for its root long slips of the same kind of Fat, running up from the Coccyx on each side to the back of the Os sacrum about two inches in length. I laid it open, and digested it out with Merc. praecipitat. than cured it according to the usual method in such cases, since which time she hath been delivered of two Children without any disturbance from that Part.   

CHAP. IU. of Phyma.  
IN the lower part of the Intestinum rectum, where the Musculi Any are inserted, there frequently ariseth a hot Tumour called Phyma. You may found it described amongst the tumors arising from Blood; therefore I shall not trouble you here with a farther Description of it; but give you three instances of it as it affected the Anus, the better to show you the original of Fistulae in Ano: they for the most part proceeding from these Abscesses, whether they break within and ulcerate there, or the matter descend lower, and raise a Tumour without the verge of the Anus.  
Those within the Anus produce the most dangerous Fistulae. The matter of which penetrating through the coats into the neighbouring Muscles, 
Prognostic.  is rarely discovered till it hath made its way more outward amongst the Muscles of the buttock; but if it chance to be discovered sooner, yet the cure is most difficult: nay those Phymata which appear outwardly upon the verge of the Anus, though they are of easier cure; yet if they be ill handled, the defluxion is continued, and the Sinus within groweth callous, and requireth the same method that Fistulae in Ano do, it being directly such as you may see in the following Chapter.  
The way to prevent these mischiefs, is by timely laying open the external Phyma by Caustick, that the Matter may have free discharge; 
Cure.  for if you open that by incision it must be kept so with a Tent, which cannot be easily retained in: and whether the Matter be choked in by that, or it slide out and the Orifice close up, is alike inconvenient and prolongs the cure. The internal Phymata are easily cured if they be timely discovered and opened by incision.  
I Shall begin with an instance of an external Phyma, in a Child of about four years of age, the only Son of his Parents; 
1. Observat. of an external Phyma.  he had been grievously pained in Ano four or five days, they not discovering his malady: but the Tumour appearing externally, I was fetched; it lay juxta. Anum, of the bigness of a Pheasant's egg, perfectly suppurated. I applied the milder Caustick upon the declining part, with Plaster and Bandage. The next morning I heard the Patient had rested tolerably well. I took of the Dress, and found the Matter discharged through the Escar, which was, as I had designed it, the breadth of a twopences. I dressed it with a Pledgit of Tow spread with unguent. basilicon cum ol. ros. by this method the Matter discharged freely without disturbance in going to Stool, and it cured by the Maids dressing, I not visiting it thrice. Many such I could give you of these so easily cured.  
A Countryman aged about thirty years, of a Sanguine full body, 
2. Observat. of external Phyma.  coming to London, was taken with a pain in Ano, and desired my advice. I viewed the Part and made a search with my finger dipped in a little oil, but discovered nothing whereby I might suspect Ulcer or Piles. I injected a spoonful or two of ol. liliorum warm, and directed him the use of it; but after three or four days the Pain increasing, I made a search, and felt a Swelling on that Part which lieth next to the neck of the Bladder; I took a crooked incision-Knife, and defending the edge of it almost to the point, with a bit of Plaster conveyed it in by my Finger to the Swelling, and made incision into the Tumour; he presently discharged a spoonful or two of Matter. From that time he complained no more of pain. I cast up a little ol. Hyperici warm as before, and henceforward dressed him not more, he being perfectly cured.  
A Planter which came from Virginia, 
3. Observat. of a Phyma.  lodging in the Old-baily, being extremely pained in Ano, consulted his overthwart Neighbour Physician, who prescribed Fomentations, Embrocations, etc. but his Pain increasing, and the Physician not coming to him so often as he desired, the Patient went to the Physician, where renewing his complaint, I was sent for and viewed the Podex; but seeing no outward disturbance, I anointed my Finger with a little Butter, and in passing it up in Ano felt a Tumour, which with their leave I opened as in the former Observation hath been said. The Patient cried out he must ease himself; I finding nothing for him to do it in, and seeing by my Finger and Knife it was Matter, I bid him ease himself there; he did so, and discharged only a quantity of Matter well concocted. From that time he complained no more of Pain, and was cured within a day or two by the benefit of Nature; I declining to cast in any injections jest they should get into the Abscess and make it sinuous.   

CHAP. V Sinuous Ulcers and Fistulae in Ano.  
FROM the afore-recited Haemorrhoïdes & Phymata Sinuous Ulcers are made.  
Those proceeding from the internal Piles are made gradually, and pass their Matter (which is generally a thing gleet) between the Tunicles of the Intestinum rectum, making their way out near the verge of the Anus through a small pin-hole. They are rather discovered by the discharge of a thin Humour staining the Shirt, than by any pain they have; which discharge is often thought to be rather a Sweeting of the Part than otherwise: but in progress it is accompanied with itching, and is subject to excoriation; from whence it is that various sorts of Papulae, etc. do arise, and sometimes Rhagades. At last these sorts of Sinuous Ulcers spread outward or grow callous, and the Orifice groweth hard and so contracted that you cannot pass in the smallest Probe.  
Those Ulcers which proceed from Phyma, do pass their Matter deep amongst the Interstitia of the Muscles, as other Abscesses in fleshy parts do according as they can make their way. These sometime penetrate through the Intestinum rectum, to the very neck of the Bladder; yea into the Pelvis, or at best do insinuate their Matter in amongst the Musculi Glutei, etc. This happeneth according as the Apostemation at first lay deep or shallow, or was great or small, or in a body Plethorique or ill-habited. They are very painful, and discharge a purulent Matter proportionably as they are hollow, and are they which do cuniculos agere; yet they do grow callous, and are reckoned amongst the worst sorts of Fistulae Ani.  
The Causes I have already declared with the manner of their growth, by which I suppose they may be sufficiently discovered. If you make a search with a Probe into the sinuous Ulcer arising from the Piles, and the while pass your Finger into the Anus, you shall feel the Probe run all along between the Tunicles of the Intestine, and it may be pass out through the Pile which gave it its original: whereas, the other sinuous Ulcers have in their beginning no external Orifice, but discharge their Matter by Stool; but at length possibly they pass their Matter externally through one or more Orifices, more or lesle distant from the Podex, or according as the Abscess lay in the Intestine.  
Sinuous Ulcers arising from the Piles are heathfull, 
Prognostic.  and aught not to be cured while they may be continued without pain or disturbance to the Patient.  
Sinuous Ulcers arising from Phymata are dangerous and difficult of cure, if they have been of long continuance. The Ulcer in Ano is also of difficult cure, if it discharge great quantity of Matter by an opening so remote that you cannot lay it open with safety; but if the Sinus lie near the Anus, the cure will be more easy.  
Sinuous Ulcers in progress of time grow callous, and are than deservedly called Fistulae. What a Fistula is I have declared in its proper Chapter: How these Sinuous Ulcers become fistulous, I have showed you in this foregoing Discourse with the Causes, etc. You may also make a Prognostic of them from what hath been said of sinuous Ulcers, they differing only from them as they are callous; for if Fistulae do run superficially upwards by the Rectum intestinum, whether it penetrate the Anus or not, the cure is without dnager or difficulty performed. Those Fistulae which run higher up than you can reach with your Finger are difficult to cure, because you cannot lay them open the whole length, for the Humour will flow from the remaining Sinus upon the part opened, and hinders its cicatrizing.  
Those Fistulae which penetrate deep beyond the Musculi Any, if they be cured by laying open, the Patient will afterwards retain his Excrements with much difficulty; and if they reach quite beyond the Sphincter, the retention is impossible.  
If the Fistula be the effect of a Cacochymical Habit of body, especially if the Lungs be weak, or any other of the Viscera, it will be reasonable to keep it open as a fontanel for discharge of that peccant Matter; but if it cannot be kept open with ease to the Patient, it will be requisite that a good Diet be prescribed, and the Humours carried of some other way before you cure the Fistula, and Issues elsewhere opened.  
Fistulae therefore in Ano are not always curable, nor safe to be cured; they frequently serving nature for the discharge of superfluous Humours, 
Cure. palliative.  brought down by the Haemorrhodiall vessels: so that unless they be painful and vexatious in keeping open, you aught not to cure them, especially if they be small and terminate in the circumference of the Anus.  
In which case if you apprehended that the Orifices of them will swell and not keep open, or that by reason of the contraction of the Callus the Matter may be straightened, and insinuate itself lower or deeper, and tender the evacuation troublesome; you may than apply a small Caustick upon the Orifice to remove the Callus, after which separation of the Slough, the Orifice may be kept open with more ease as a fontanel; and for the receiving the Matter, and preventing of excoriation, the Patient may wear a Pledgit of fine Tow which will sit close without Bandage; or it may be spread thin with any lenient Unguent, as the exigency requires, and be kept clean without pain or considerable trouble, till time shall cure it, or indicate what to do more in it.  
But if you design the Cure, and the Sinus lie more distant from the Anus, 
Curative.  you shall begin with laying it open first to the Anus, and curing that Apertion before you divide that in Ano. Which being done you shall than consider the Habit of body, and according as the Humours are peccant in quantity or quality, so you may let Blood or purge: but if there be no necessity of either, you shall prescribe your Patient a good Diet to prevent Fluxion, and especially a Diarrhaea, for a looseness much disturbs the Cure; therefore in such cases you are to forbear the dividing the Sinus till that be stopped.  
The way of laying open the Fistula in Ano is either by Incision or Ligature; the latter was the way of the Ancients, and aught to be proportioned so as it may divide the Sinus with the lest pain: it is made of twisted brown Thread, or stitching Silk, some put a Horsehair to them, whereby they are made to do their work the quicker; a twist of three Threads or of stitching Silk may be sufficient, for if you make the Ligature big, it will too much bruise the Flesh in cutting it. In the next place you are to consider the Needle you pass the Ligature with. If the Fistula hath penetrated the Intestine, than a Leaden Probe with an Eye, or of any thing else that is pliant, will serve to carry the Ligature through; it aught to be pliant, that it may perform its work with more ease: a piece of a searching-Candle may serve in some, in others a Probe of small Wire of Silver or Gold; for a present supply I have made use of a small Probe out of my Plaister-box, cutting of part of it, and smoothing the end. Where the Fistula hath not penetrated, I have for need made use of the like Probe making the point sharp to pass through the Intestine; but you aught to have Needles more pliant, fit for that work. In some cases where the Fistula lies high, and the Sinus crooked, I make use of a fit Cannula for the conveying of the Needle up, and to strengthen it in its work, that it do not bend in the perforating the Intestine.  
The way by Incision is with a pair of Scissors to divide the Sinus, a way approved by some who have observed the speedy division it makes; and in truth, if the Sinus be short it is the best. In doing thereof they aught to be careful the while, jest the folds of the rugous' Coat fall between, for so you make two Wounds for one. But if the Fistula penetrate the Intestine deep, the work will be more hazardous, not only in the cutting as I said before, but in progress of the Cure; for the recent divided Lips will be apt to fall upon one another again, and than what can hinder their uniting? which if they do the Fistula is renewed, a Doffill or Tent put up the Sinus will not continued in it, but lie as a Suppository stimulating the Intestine to excrete it: whereas the Ligature contuses the Lips in cutting them, so that they require to be digested before they can unite, in which time the Sinus fills up and heals within; insomuch as the Fistula may be judged to cure above, as the Ligature divides it below. I shall anon give you some instances of both ways, and leave it to your own Judgements to proceed as you like best. The manner of operation by Ligature is this.  
You shall make a search with a Probe into the Fistula, running up by the Intestinum rectum, and the while anoint your Finger with a little Oil or Butter and pass it up; and according as you feel the Probe more or lesle distant, or penetrating, proceed in the Cure. If the Fistula be straight and much callous, dilate it first with a Gentian-root or the like, and remove the Callus by such cathareticks as have been proposed in the Chapter of Fistula in general. But if that side be only callous which is next the Intestine, you may divide that in laying open the Fistula; therefore pass your Ligature with a Needle blunt or sharp, according as the Fistula penetrated or not; and as you pass the Needle up with one hand, turn the point with your Finger which is in Ano, and bring it out under that Finger as you thrust it up with the other: and if you pass the Needle through a Cannula, you must first pass up the Cannula, and place the end of it against your Finger, which is in the Intestinum rectum, than another holding the Cannula, pass your Needle through it into the Gut; and as it is brought out by your Finger there slip of the Cannula, and hasten the Needle forward on its way, till you have brought it out with the Ligature: than cut of the Needle, and make a knot upon a fold of Linen or bit of Plaster, to prevent, the Ligatures cutting the outside, tie it as straight as the Patient can bear, and let the second knot be with a bow: than place the ends of the Ligature on one side, jest it be fouled in going to Stool, and apply a Stupe of Tow dipped in vino austero, & ol. ros. to calm the heat of the part. Some make the knot upon a bit of Stick and twist it daily; but that is more painful, and cuts from without inward, which is to be avoided. I use to drss them daily after easement of Nature, and if there be cause, inject Decoct. hordei cum sem. cydon. and apply some Lenient as abovesaid, or unguent. rosat. popul. etc. and the fourth day loosen the Ligature by drawing the bow-knot, and tie it straighter: so in twice or thrice tying the Ligature will cut its way out, or when it is almost through with a pair of Probe-scissors you may free the residue; or if the Sinus run deep under the verge of the Anus, that the Lips be like to lie high, so as to make a guttur, it will be better to take them down by the application of a Caustick, for it will much hasten the Cure, and make the Cicatrix smooth.  
If there be any shriveld Piles, Condylomata, etc. about the verge of the Anus, cut them of at the same time or before you make the Ligature, to prevent the inflation they would be subject to from the pain caused by the Ligature or Incision. The Sinus laid open, whether it were by Incision or Ligature, the Ulcer requires to be digested, incarned and cicatrized, as hath been showed in other Ulcers, and shall be more particularly demonstrated in the following Observations.  
A Young married Wife being diseased in Ano, 
1. Observat. of a Sinuous Ulcer.  with great Pain and discharge of Matter, advised Midwives and others, who though they could not discover the cause of her Pain, yet prescribed Medicaments and kept her long in their hands, to the great increase of her Malady. At length I was consulted, and discovering nothing outward about the Anus, I passed my Finger up into the Rectum intestinum; about an inch within on the left side I felt a Perforation, I pulled back my Finger and saw it Mattery; I concluded that was the Orifice of the Ulcer, and supposed its Sinus lay amongst the Muscles, and that it took its Original from a Phyma, which she concealing, as in that modest Sex it frequently happens, the Matter had corroded and penetrated the Intestinum rectum, and the adjacent fleshy parts: I pressed with my Fingers on the outside where I conjected the Abscess to lie, and thought I felt the Sinus; I marked the place, and purposed the opening it when it should be desired. At that time my business was to satisfy the Relations concerning her Disease, which I declared to be an Ulcer in Ano, and for further proof offered to open it in that place I had marked; which they consenting to, I came about ten days after, and applied a Caustick upon that very place in the presence of some of her Kniswomen, and the next day divided the Escar, and passing the Knife down into it I met with the Sinus, and drawing my Incision towards the Anus, under the coccix gave vent to the Matter; than passed a Ligature with a blunt-pointed Needle, through the Sinus into the Gut, and with my Finger in Ano bowed the end of the Probe, and as I thrust it in with one hand, brought it out with my Finger of the other; than cut of the Needle, and tied the Ligature on a fast knot, and dressed the Ulcer with unguent. basilicon dipped in a little ol. ros. warm to hasten the separation of the Escar. They continued this way of dressing it daily, till the Escar separated, than I tied the Ligature straighter, and in few days cut it through, and digested the Ulcer with the common digestive; and deterged, incarned with mundif. Paracels. with the addition of Merc. praecipitat. and afterwards cicatrized it by the help of the Vitriol and Allum-stone firm: since that she enjoys her health well.  
A Gentleman of a full Body, 
2. Observat. of a Sinuous Ulcer.  aged about thirty six years, came to London labouring under various Diseases, as the Gout, Colic and Stone in the Kidney, and a sinuous Ulcer in Ano. Sir Fra. Prujean was his Physician and sent for me. The Sinus did stretch itself down from the verge of the Anus near the coccix, towards the perineum, about two inches, discharging much Matter. I laid open the Sinus with a pair of Probe-scissors to the Anus, and dressed it up with the Digestive ex terebinth. spread upon Dossills' dipped in pulv. Galeni, with Emplastr. è bolo over it, and Compress and Bandage to retain it on. I afterwards deterged come mundif. Parcels. & Merc. praecipitat. with the help of the Vitriol-stone, and with Epuloticks, Unguents, aq. calcis, etc. cicatrized that Sinus to the verge of the Anus: than consulting the Physician in the prosecuting of the Cure, we considered the Patients ill Habit of Body, and the advantage he might receive in keeping the Ulcer open as a fontanel for the discharge of peccant Humours. This being resolved upon, I advised the Patient to apply upon it a Pledgit of fine soft Tow morning and evening, or so often as occasion required; it kept on without Bandage, and received the Matter which discharged, and served as a fontanel without any disturbance to him in riding or sitting. Thus it was continued some years with great ease and advantage to his health; but since that Physician's death, the Patient was persuaded by others to have it cured. I was sent for and made a search, and found it had perforated the Anus about half an inch within the Rectum: I passed a Ligature with a piece of a Wax searching-Candle, and tied the Ligature straight upon a fold of Plaster to prevent the cutting outwardly; than cut of the overplus of the Ligature, applied a Pledgit spread with unguent. alb. camph. over all. The Servants renewed the dress so often as he went to Stool, and the fourth day I loosened the Bow-knot; and finding the Ligature near passed through, divided it with a pair of Probe-scissors, and dressed it up with the common Digestive: after it was digested I dressed it with unguent. diapomp. upon a Pledgit of Tow, and cleansed the Ulcer daily with aq. lap. med. Crollii, and in a few days cicatrized it; he returned to his house into the Country, but being a diseased person he lived not a year after.  
A Person aged about thirty years, 
3. Observat. of a Sinuous Ulcer.  of a sickly Constitution, subject to Cough and Rheums, being one day costive, and straining to ease nature, felt somewhat slip down as it were between the Tunicles of the Intestinum rectum, to the verge of the Anus, which lay uneasy; he put up his Finger and felt a small Tubercle of the bigness of a large Pea, which increasing settled somewhat lower, and made a hard Swelling without the verge of the Anus on the right side, and in few days raised itself into a Tumour as big as a Pidgeons-Egg, and inflamed and suppurated. I was than consulted, and opened it by Caustick, and discharged about two or three spoonfuls of a digested white Matter: after separation of the Escar, I finding much Matter discharged out of it, I made a search, and found it run up close along the Rectum; I laid it open to the Anus by a snip with a pair of Probe-scissors, and dressed it with a Dossill spread with unguent. basilicon, and a Pledgit of soft fine Tow spread with unguent. album over it, and in few days cured it to the verge of the Anus. Than considering the Patient labouring under a Cough with other obstructions, I proposed to him the continuing this Ulcer open as a fontanel, till he should reover his health better, and that if he found any inconveniency by it, I would readily cure it. I advised only a Pledgit of Tow to be applied to it, with directions to renew it as he should see cause. I took leave of him, he followed my directions, and finding no inconveniency in riding, walking, or the like, continued it as a fontanel to his much advantage; he recovering his health very well afterwards, and is yet alive.  
A Gentleman of about forty years old came out of the Country, 
4. Observat. of a Fistula in Ano.  labouring of a Fistula in Ano, breaking out on the left side: it arose from a Phyma, (I suppose;) the Sinus was large and painful, the Matter having spread under it. If I had laid this open by incision, the Lips would have lain hollow, and have rendered the Ulcer slow in curing; therefore I removed them by Caustick, laying the Ulcer open to the Anus, and after separation of the Escar, digested, incarned and cicatrized it: than made a search with a Probe, putting my Finger in Ano the while, and feeling the Probe pass into the Gut about an inch high, I prepared a Ligature, and with a Probe-needle passed it up into the Gut; than turned the end of the Needle downward under my Finger, and made a deligation, as in the like case hath been showed, and applied a Stupe spread with unguent. nutritum over all. The next day dressing it again I found the part alittle heated, and a Pile that was before the making of the Ligature (lank and withered) swollen and beginning to inflame; wherefore doubting it might be troublesome, I cut it of close by the root, and rubbed it with a Caustick-stone to stop the bleeding, and consume the remainder of it. Than I dress up the Escars with a Pledgit spread with unguent. basilicon and the nutritum over all. The fifth day I straightened the Ligature again, and dressed it up with a Stupe spread with unguent. nutritum as before; and as occasion offered I syringed the part affected with a Decoct. hordei, with a little Syrup de ros. siccis. About the tenth day of the Ligature, I observed it cut so near through as it was easy for me to divide the rest by a snip of a pair of Scissors; yet in consideration that the Ulcer was deep, and consequently the Lips so cut, would lie high and be apt to receive Excrements, which might make it painful and very troublesome, I chose rather to free myself of them by rubbing through them with a Caustick-stone: which having done and flatted them as I designed, I pulled the Ligature to me, and the while passed my Probe-scissors under, and divided the Sinus; and pulling away the Ligature uncut, dressed up the Ulcer with a Pledgit dipped in basilicon warm, and applied a Stupe wrung out of read Wine over it. After separation of the Escar, I incarned and cicatrized with unguent. tutiae, etc. as aforesaid.  
A Gentleman of about forty years of age, 
5. Observat. of an Ulcer in Ano.  having laboured long under Chronic Diseases, with great irregularity in Diet, etc. during which, Nature to ease herself, discharged some part of the Disease in an Abscess in his left Inguen, and another in Ano. This latter discharged a great quantity of Matter daily, and was exasperated by a Diarrhaea. The former in Inguine, (he not permitting it to be opened by his Chirurgeon) had made its way through the Skin in many little openings, and lay ulcerated under it about three inches in length, and in no condition to cure. Doctor Tern was his Physician, and by his prescriptions had opposed the various Symptoms that threatened the life of the Patient; but the Patient being ungovernable, I was called in, and seeing him much emaciated and cachectick, not likely to be cured till he should attain a better Habit of body, purposed to palliate these Ulcers awhile: that in Inguine by dressing it with Pledgits of unguent. diapomp. and cerat. dialtheae over it, whereby the Matter might be moderately discharged, and the Tumour mollefied, and rendered lesle subject to Fluxion. The Sinuous Ulcer in Ano was not capable of healing, while he laboured under such a Diarrhaea; but that it might be the better disposed thereto, I laid the Sinus open by Ligature, and thereby freed the tender Lips from the Excoriations they were before subject to; it was dressed with Lenients, and thereby the Matter was discharged with more ease, and the Ulcer disposed to cure, when Nature should be that way inclined: which, that it might the sooner be so, his Physician prescribed this Traumatick decoction, ℞ fol. millefoliis M.ij veronic. bugul. sanic. alchimil. flor. hyper. an. P.j. glycyrrhiz. ʒij. coq. in aq. font. ad lbij. lbij. in colat. dissolve. syr. è symphyt. Fernel. ℥ ij. bibat ℥ iiij. ter in die horis Medicinalibus. Also these Balsamic Pills, ℞ terebinth. chiaeʒij. bezoard. mineral. ʒj. balsam. solut. ℈ iiij. glicirrhiz. pulv. ℈ j fiant pilul. sumatʒss. quotidie manè & vesperi. In the time of his Diarrhaea his Physician prescribed this, ℞ rhei elect. parum torrefact. & aq. cinam. irrorat. ℈ ss. salis tartari gr. iij. cons. ros. rub. gr. xxv. M. fiat bolus quem sumat manè per triduum. This Julep was also prescribed him, ℞ aq. cinamomi hordeat. menthae crisp. an. ℥ iiij. spir. menth. ʒij. syr. è corallis camp. ʒx. M. de quo bibat coach. iij. pro re nata. Also this Antiscorbutic, ℞ aq. cinam. tenuior. succ. cochlear. hortens. an. ℥ vj. sacchar. christ. ℥ viij. digeratur in balneo, sumat cochlear in sing. haust. potûs ordinarii. At other times he took calomel. gr. xx. in cons. ros. rub. ʒss. The Patient thus supplied with different prescriptions, according to the exigency; the Spring coming on he retired to Chelsey, where following the method prescribed he recovered strength, and the discharge of Matter lessened; and consequently his Ulcers became so well-conditioned, as his Friends and Servants about him were capable of dressing him, and in few months he grew more healthful and fat. That Abscess in his Groin healed up by the Medicaments aforementioned, but that Fistula in Ano we thought fit to continued as a fontanel for his health-sake; which he kept easy by wearing a Pledgit of fine Tow on it, till at length it healed up of itself: he is no grown fat.  
A Woman aged about thirty four years, 
6. Observat. of a Fistula in Ano.  diseased with a Fistula in Ano, having tried unsuccessfully the endeavours of such Medicaments as those of her own Sex could advice her; at the last sent for me, it took its original from a Phyma in Ano, which had passed its Matter in a Sinus down to the Perineum. I laid open the Ulcer to the verge of the Anus, and cut of a withered Pile that was swelled (from the anguish of the Ulcer) to prevent its further inflaming; than applied a Pledgit dipped in album. ovi, & cum pulv. Galeni, and a Stupe of Tow spread with an Astringent over it with Bandage. The next day I dressed her with a Digestive of basilicon, and a Pledgit of unguent. nutritum over it; and left her Dress, and visited here myself once in three or four days. That Ulcer being cured, to the Fistula I made a search with a Probe, and passed my Finger up in Ano, and felt the Probe about three quarters of an inch within, but not penetrating: The Sinus was small, wherefore I put up a Gentian-tent, with a string fastened to it, and left them some of the same sort to put up daily to dilate it. The third day after they sent for me again, they had thrust the tent too far, so that in pulling it out the string came away, leaving the tent betestine higher than the Sinus, than drawing my Finger back over the Sinus, I thrust the tent out; than laid open this Fistula by Incision with a pair of Probe-scissors, passing one shaft into the Sinus and the other with my Finger in Anum, guiding it up the height, and with one snip laid the Fistula open, than applied a Dossill spread with amixture of pulv. Galeni cum albumine ovi, and bound it up with a Stupe spread with unguent. nutritum, and left her Dress with directions how to apply them. I presumed by this way of Incision the Cure would be the sooner effected, and with lesser visits from me; but the Sinus filled up with lose Flesh, and the Dossills' I left them to cicatrize it with commonly slipped out of the Sinus, and lay uneasy not unlike a Suppository, putting her upon a Tenesinus, and if the Injections were any thing abstersive they did the same; so that to hasten the Cure I was obliged to dress it myself, and dry the lose Flesh by rubbing the Sinus with the Vitrioll-stone; by which, and the Alum-stone, I at last cicatrized it.  
A Gentleman aged about forty four years, 
7. Observat. of a Fistula in Ano.  having long laboured with a Fistula in Ano, and a Tumour in Perineo, growing at last extremely diseased with it, was brought up to London, and sent for me. The Tumour was in Perineo big, and seemed to me callous, it reached from the Anus to the Scrotum; and by the Matter I saw discharged from the Anus, I concluded the Tumour was made by its insinuating itself downward, and that through length of time it was grown callous. The compression it made upon the Ductus urinarius, caused a difficulty in Urine, upon which account my speedy help was required. I began the Cure by laying this Sinus open by Incision, from the Scrotum towards the Anus: in cutting it I found the Sinus small, and the Matter in it little and thin, rather an Ichor; but the Lips were hard and thick, and did not much separate one from another: wherefore having applied to a Dossill spread with unguent. basilicon in the bottom of the Sinus to defend it, I applied a Caustick-stone on each Lip, from the Scrotum upwards, and some hours after took it of; and finding it had penetrated the Callus, as I designed, I bathed it with Decoct. malvae, etc. and dressed it up with Lenients, after the separation of the Escars I found that part freed of the Callus. I digested it with basilicon and praecipitat. and with unguent. diapompholig. healed that Part. Than applied a Caustick upon the remainder reaching to the verge of the Anus, and freed that also of its Callus, and disposed it to cicatrize; which while I was I doing, made a search with a Probe, passing it into the Anus, where I quickly discovered that about half an inch high the Sinus opened into the Intestine. It had run deep all the way, and here it lay deeper and more callous. Upon which consideration I passed up a Speculum ani, and during the dilatation, laid it open with a Caustick-stone in my hand by rubbing it, than washed out the Salts, and cut through the upper part of the Fistula with a pair of Probe-scissors; that done, I injected some ol. lini to hasten the fall of the Escars: which being separated, I digested it with unguent. basilicon and praecipitat. and dried the Ulcer with the Vitrioll-stone and Pledgits dipped in aq. aluminis, and cicatrized at firm, and returned him cured in few weeks.  
I was fetched to a Gentleman aged about fifty years, 
8. Observat. of a Fistula in Ano.  who had been long diseased with the Haemorrohoïdes, and several Apostemations the space of twenty two years; the Matter had passed through the Intestinum rectum into the Musculi glutei making various fistulous Ulcers, but one in Perineo, which through length of time was increased to a great bigness, and reached to the Scrotum. I began with that, by the application of a Caustick from the Scrotum upward, and divided the Escar; there issued out only a little foul Gleet, which had flowed into it from within the Intestinum rectum. I dressed this Escar with Lenients, as in the former Observation hath been showed: and as it separated with the Callus, the Sinus appeared dry and hardened with thick Lips, lying not unlike a trough: therein appeared many Excrescences, which put me upon the use of Escaroticks, viz. the Caustick-stone, Praecipitate, Alum, etc. Also by the use of the Vitrioll-stone I rubbed them of, and disposed the Ulcer to cicatrize: than I applied a Caustick to the remaining Callus, which run up from thence to the Anus, the pain whereof stirred up a Swelling in some withered Piles. To prevent their inflaming, and to put them out of my way, I snipt them of close by the roots, and after they had bled awhile, I rubbed them with a Caustick-stone, and dressed them up with a Stupe of fine Tow, spread with unguent. basilicon: having digested these, and disposed this part of the Sinus to Cure, and the lower part (which I first began with) being cured, I made a search into the remaining Sinus', which lay on each side the Anus; those I opened by Incision and Caustick, digested and cured them. Than I made a search into the great Fistula, which had penetrated the Rectum about three quarters of an inch within, and passed a Ligature through it, and tied it straight. The while it was dividing, I fomented the Anus with read Wine daily, and cast up Lenient injections, to ease the pain and cleanse it: and after I found the Ligature had made its way near out I loosened it, and with a Caustick-stone rubbed the remaining Callus off, for that by Incision it would have been long digesting, and the Sinus would have lain deep, and the Lips troublesome after the Cure. The Callus divided and the Ligature come away, the Escar separated by Lenients and the Ulcer cicatrized: in very few days the bottom of the Sinus having been hardened by the Callus, remained as a small guttur in spite of my endeavours to the contrary; but it proved no great inconvenience to the Patient, he being perfectly well. And from that time following his Employment daily abroad.  
A Gentleman of about forty years of age, 
9 Observat. of a Fistula in Ano.  a strong healthful Person, of a Plethorique body, after a hard riding in hunting, was seized with a pain in the Intestinum rectum; and a few days after with a Swelling and Inflammation about the Anus, which terminated in an Abscess, and was opened on the left side near the Perineum. After two years the Abscess remaining uncured, the Patient came to London, and put himself into the hands of Sir Fr. Prujean, who recommended him to me: Sir Charles Scarborough, since Physician to his Majesty, and to his Royal Highness the Duke of York, as also Doctor Warner were some time consulted. There were two Sinuous Ulcers, one on the left, and the other on the right side of the Perineum; they had both communication with one another near the Anus, and passed up between the Anus and Bladder as we supposed, for we could not make a search far up, till these were laid open: to which purpose I hastened the dilatation of them by Gentian-roots, etc. and afterwards with Caustick and Scissors laid them both open; than by Digestion disposed them to cure. That effected we met again, and I made a search with a Probe up the main Sinus, and discovered it running between the neck of the Bladder and Intestinum rectum above an inch high, but could not feel the Probe with my Finger in Ano: it was hoped the Sinus reached not further, but pulling out the Probe and bending it, I passed it up again by the rub I met with before, and discovered the Fistula at lest half an inch higher; and by pressing the end of the Probe towards the side of the Intestine, I did with my Finger there feel as I thought the end of the Probe, but at a great distance of, by which I well perceived it would be a difficult work to penetrate it, and bring the Needle out with my Finger, the Sinus being so high as I could scarce reach the end of the Probe with my Finger's end. It lay of such a distance from the Intestine, as I could not pass a small Needle without a Cannula, and a bigger which was proper for the penetration of the Gut, would not ply enough to be returned out with my Finger by the Anus; and to lay a Sinus open of that length and thickness by a pair of Probe-scissors, was very improbable; wherefore I resolved to dilate it, and try how I could digest of the Callus. To which purpose I dressed it daily with a Tent made of a Gentian-root, and afterwards endeavoured to consume the Callus by Tents made with Lint, and the white of an Egg crusted with a mixture of Merc. praecipitat. and alumen ust. over which I applied a Pledgit of unguent. basilicon, and a Stupe of fine Tow spread with a mixture of unguent. nutritum & popul. over that: from that time I fomented the pained part daily with an Emollient Decoction, and repeated the Lenient applications, but removed not the Tent till it separated with its sloughs. Having thus wasted the Callus, I left of the use of those Tents and dressed it with others armed with Digestives, and shortened these daily: during this work the Patient drank a vulnerary Decoction, and took such Balsamicks as the Physicians judged necessary. After I saw the Sinus well digested and but little Matter, I left of the use of the Tent (jest by keeping it longer open it should skin again within) and in few days cicatrized it, but some while after it broke out again; and upon search I found the Sinus open as at first. I attempted the wasting the Callus again; but seeing no good come of it, I tried by an Injection of aq. lap. Medicament. but that only shriveled up the Sinus and might have been of good use to palliate: but my work being to cure, I dilated the Fistula with rad. gentianae in order to the laying it open; and than calling in a Chirurgeon well experienced in this Art, who met the Physicians and myself, he made a search and concluded the way by Ligature proper. The Patient being prepared for the work, laid himself over a Chair: but when I came to pass up the Cannula, the Patient grew so unquiet as my brother Chirurgeon desired me to forbear, he supposing by the Patient's complaint that it was cancerous; and advised me to proceed in the cure by Injections, which I having no faith in, desired the Patient that my brother Chirurgeon might bring his Injection, and dress the Fistula for some time: which accordingly he did some days; but seeing it unsuccessful, he than advised the Patient to retire into the Country, and content himself with a palliative Cure. But the Patient being sensible enough that the Cure was feasable, if he could once resolve upon it; wherefore he dismissed the Chirurgeon, and sometime after took new resolutions and sent for another, who was not lesle eminent in this Cure than the other; he came and made a search, and approved of the dividing the Fistula by Ligature, and commended the way as both safe and easy: a day was prefixed, and the while I dilated again the Sinus with Gentian-roots. The day the operation was to be performed, the Patient dined abroad, and when we met and placed him in the light to proceed in our work, the Gentian-tent was fallen out, and the Sinus was closing; but we being resolved not to loose that opportunity, I dipped the Cannula in Oil, and passed it up about an inch, but than meeting with the old rub, the Patient began to be troublesome, and would have persuaded us to desist. The Chirurgeon supposing I was at the height, advised me to pass the Needle; but I knowing the Sinus reached further, and the inconvenience which might hap in the Cure by doing so, minded him not, but pushing the Cannula upward as I had designed, till I felt the end of it with my Finger, which was the while in Ano: that done I put the Cannula into my brother Surgeons hand to hold there, while I passed the Needle into it, and through the Intestine to my Finger within, with which I bended the point of the Needle, and drew it out of the Anus with the Ligature hanging at it. I than cut of the Needle with part of the Ligature, and having applied a fold of Plaster on the place, I tied the Ligature straight, and fastened it with a bow-knot, and applied a Stupe of fine Tow, spread with a mixture of unguent. popul. and nutritum over it. The Patient being dressed threw himself upon his Bed, my brother Chirurgeon told him the work was well done, and that he aught to accounted that day, as the day of his Birth, there being no hopes of Cure any other way; so took his leave. The Patient rested very ill that night, and was the next day feverish, and continued restless by reason of the pain, notwithstanding all my endeavours by Lenients. The third day after I was sent for in great haste, he being dying as they said; I found him shrewdly alarmed, he had newly voided three or four spoonfuls of Matter (as they called it) in his Urinal; upon which it was concluded by them that I had wounded his Bladder in passing the Needle, and that I had passed it farther than my brother Chirurgeon advised. I was somewhat surprised at their Language, and replied, there was a necessity of laying open the Fistula the whole length: looking in the Urinal I saw such a quantity of thick Mattery substance, but could not imagine how I should hurt the Bladder in passing the Needle; but there was no answering them. I carried the Urinal to Sir Fr. Pruj. he caused some of it to be heated in a spoon over a Candle, where it hardened, by which we were assured it was not Matter; he concluded it made in the Bladder, by the heat and disturbance it had received from the Neighbouring parts. I returned to my Patient with the Physicians answer, which somewhat quieted them; but that expression of my brother Chirurgeon had done me some prejudice, if the Patient had not recovered. Thus it usually happens amongst us in Operations, where they prove unsuccessful. From that time the Ligature made its way more easily, I taking more time in the cutting through the Callus, by which compliance it was above sixteen days cutting its way out; all which time Injections were cast up after his going to stool, and the Part affected was treated with Fomentations and Lenients, and at length the Ligature made its own way out: during which the Sinus above cured, so as I had nothing to do but to cicatrize the outmost part, which I did with Lotions and Pledgits dipped in aq. calcis, etc. in a few days after; and the Patient returned joyfully to his sports in the Country, and relapsed not more.  
I was sent for to a Gentleman of about thirty six years old, 
10. Observat. of a putrid and fistulous Ulcer in Ano.  much emaciated and of a very ill Habit of Body; he was diseased with a painful Tumour on the left side of the Anus, reaching from the Os coccix to the Perineum, of a dark read colour hard in the circumference, but along the verge of the Anus, it felt soft; it seemed to arise from under the Anus, and to be an ill-conditioned Tumour: I applied a Caustick upon the soft part according to the length of it near the Anus, and some hours after divided the Escar, and gave vent to a a faetid brown Matter. I dressed the Escar with unguent. basilicon cum oleo terebinth. and applied a Cataplasm over it of far. fabar. pulv. sem. faenug. lini, flor. chamomel. sambuci, ros. rub. decocted in oxymel; as the Escar separated the Ulcer shown itself putrid. I fomented it with a lixivium wherein good store of wormwood had been boiled, and dressed the Ulcer with mundif. Paracels. cum praecipitat. & alum. and the Escar with Lenients, etc. as before.  
This Patient had laboured some weeks of a Diarrhaea, which after the Escar was separated flowed into the Ulcer, and much disturbed our Cure; therefore I caused an Injection to be made of a Decoct. absinth. hyperici, scored. centaur, etc. to which I added spir. vini, mell. ros. and unguent. Aegyptiaci; and that the Excrements or sordes might not be retained, and tender the Ulcer more sinuous, I cut it open the whole length above and below, and filled it up with Merc. praecipitat. with the mundificative upon Dossills', and with Plaster and Bandage retained them on. Than prescribed him a Decoct. sarsap. etc. also an Electuary of cons. ros. rub. diascord. & rheitorrefact. etc. which he took once in four hours, and thereby stopped his looseness. The Ulcer not deterging with the former applications, I dressed it with pulv. Jo. Arden. and defended the Lips with unguent. basilicon, and an Emplastr. è bolo over all. Thus in two or three dress I consumed the sordes, than dressed it with mundif. Paracels. and praecipitate; and applied Stupes of Tow over it pressed out of read Wine, wherein had been infused flor. ros. rub. ballast. etc. and afterwards prescribed him the taking of calomel. ℈ j every other night. Thus the Ulcer deterged, I incarned it with pulv. aloes haepat. myrrhae, sarcocol. rad. aristoloch. rot. ireos florent. lap. calamin. made up into the form of an Unguent with mel ros. While this was incarning, and in some parts cicatrized, a Sinus appeared running under the verge of the Anus about half an inch; I applied a Tent armed with the mundif. Paracels. and after it was deterged, left out the Tent and it cured. But than a small Sinus discovered itself on the otherside of the Anus; upon sight thereof, jest more mischief should fall upon those weak parts, (whilst I attended the cure of that Sinuous Ulcer under the Anus) I dilated it, and snipt it open with a pair of Probe-scissors into that great Sinus, and from that time the Ulcer cured, and I thought my work had been done: but within a few days after another Sinus appeared near the verge of the Anus, on that side where the former was; it much discouraged the Patient, but it lying so convenient for discharge of the peccant Matter, I continued it to further consideration, it proceeding from the mere weakness of the part. I advised the keeping it clean, and to wear a dry Pledgit of Tow over it: It was kept with much ease, and the Patient enjoyed his health very well many years, and at length it cured of itself.  
A Person of Honour having some months laboured (as was supposed) under the Piles, being extremely wasted with the pain and accidents which attended it, 
11. Observat. of an Ulcer in intestino recto with stricture of the Anus.  sent for me to consult with his Chirurgeon; I went, and there I also met Dr. Tho. Cox his Physician. The Patient discharged a purulent Matter per Anum as he lay in his bed, and in each stool a great quantity came away with his Excrements; on the left side of the Anus lay an Abscess perfectly suppurated, to which we presently applied a Caustick, and gave vent to a digested Matter. I than made a search with a Probe, and the while passing my Finger in Ano, felt the Probe in the Intestinum rectum about an inch deep; I pulled it out and endeavoured by my Finger in Ano to found what Sinus or cavities there were, and felt one above the Sphincter in that part of the Gut lying next the Bladder: I supposed the Abscess was there, and that the Matter from thence had insinuated itself amongst the Muscles, and made that Tumour outwardly, which we had opened by Caustick. What it was that gave original to that Ulcer, was not easy for me to determine, whether it was a Phyma, or a translation of Matter from some other part: However it was, the Cure was difficult and depended upon a rectifying the Habit of body, it being by what I than felt out of our reach to lay more open; nor did I think it safe to be overhasty in injecting Liquors there, I always suspecting the seminal Vessels concerned in those Abscesses, in which cases Injections may dilate the Ulcer, and hasten its penetration into the Pelvis; therefore we dressed it up with Lenients to hasten separation of the Escar: after the Escar separated, we made a search with a bended Probe, and turning it upward, found a cavity amongst the Muscles on that side; by which it seemed to us, that the laying that Sinus open into the former would be of no great advantage, we thereby could only divide the upper part of the Abscess, and so make the first Orifice wider: yet it seeming somewhat advantageous to the discharge of Matter, we passed a Ligature through, and in few days divided that Sinus, and soon after cured it again; for the discharge of Matter continued very great per Anum. The Patient continuing weak and more indisposed, Sir Alex. Fraser was consulted, who seeing such a discharge of Matter per Anum, concluded that an opening aught there to be made in some external part; we had several times endeavoured to found some place amongst the external Muscles of the Anus and Glutei: and now again we raised the Patient upon his Knees in Bed to search, but we could not by Fluctuation or otherwise discover aught, whereby we might be encouraged to apply a Caustick; whilst he was in this posture, the Matter poured forth, as also when he lay down in his Bed it came involuntarily out. We having in a former search with a bended Probe, discovered a cavity amongst these Muscles beneath the former Abscess, it was resolved that an opening should be made there; but that cavity lay at such a distance within, that it was not easy to reach it by Caustick: wherefore I having at my house an Instrument proper to open Sinuous Ulcers so lodged, I sent for an Instrument-maker, who upon sight of that and the cavity we designed to pierce, fitted us with one somewhat like a crooked Forceps; one leg thereof we passed into the Anus, which being crooked turned up into the cavity, and being there, the other shaft having a sharp blade in the form of a great Lancet fixed in it, would at our pleasure cut in upon the other, which was the Director: thus we cut into the Buttock from without inward, and that we might not loose the opening we had made, we presently passed a Fistula-needle through it with a Ligature which we brought out per Anum; and having tied the ends together, we fastened it on one side with a snip of Plaster, and dressed up the wound with a proportionable Tent armed with a Digestive. From that time we dilated it daily towards the Buttock, to try whether the Matter would that way discharge. The Physicians prescribed vulnerary Drinks, Balsamicks; Cordial Bolus' and Juleps were also prescribed, Lenients to appease the Tenesmus, and somewhat of Injections we considered of to cast up in some little quantity to heal the Abscess which lay above the Sphincter. After we had somewhile continued that opening last made, and observed it painful, and not to empty the Matter, nor divert it from flowing its wont way, we cut it down to the Anus and cured it. From that time we applied our endeavours to cure the Ulcer within, whence (it was most certain) all the abundance of Matter issued. The method used was by detergent Injections, such as have been proposed in the Chapter of Sinuous Ulcers; but without acrimony to avoid a Tenesmus, and in small quantity at a time jest it should be retained and tender the Ulcer more Sinuous. After we had thus spent some time successfully, and by the Physicians help removed the severer accidents; it was resolved (the weather growing being warmer) that the Patient should remove to Kensington, and take the benefit of the fresh air, and observe a Milk-Diet, and prosecute his Cure there. Whilst the Patient was weak and kept his Bed, and was vexed with Diarrhaea's, &c. we could not observe any want he had of the retentive faculty; but being in the Country somewhat recovered, and walking daily abroad, he complained that he could not retain his Excrements, they pressing almost continually forth. We went on our method in curing the Ulcer, and accordingly it contracted daily narrower, and the discharge of Matter grew lesle; but as the Ulcer cicatrized, he found his Excrements did not come away, but with great straining, and those that came away, were small like Earthworms: he also complaining of frequent pain in his Hips and Os sacrum, sent for his Chirurgeon and myself; we went and prevailed with him, to let us put up our Fingers dipped in a little Oil, upon search we found a stop about an inch or more within the Rectum, the Gut pursed up so close, that I could not get in my Forefinger to the first joint. This was by reason of the cicatrix; we caused presently a Decoction to be made of rad. lilior. albor. altheae, sem. lini & hordei, to which was added some ol. ex ped. bovinis, and injected some of it: we directed the repeating of it often in a day, and to permit a Syringe full to be cast in at his going to sleep at night; we afterwards dilated it with Tents of Gentian-roots, and between while others of Deer-suet, some whereof were fitted with strings. A consultation was also resolved on for the Physicians to meet us at, which time we came provided with a spec. Any, etc. in order to the dilating of the stricture: but the Patient would not admit it, he being eased by the use of the Emollient Decoction; but replied, if it again contracted, he would come to Town and be governed by us. Some months after the Winter approaching, he returned to Town; his Excrements were suppressed, and his Belly swelling, his Urinal also high-coloured and near suppressed: his Physicians prescribed him a Clyster that Evening, and a Purging-draught of Decoct. cassiae, tamarind. etc. he omitted the taking of the Clyster, but took the Purge the next morning, which bearing down the Excrements, so over-distended the Colon, that the way between that and the Strictura being choked up by them, the Patient fell into a cold Sweat, and frequent fainting; but by laying him in his Bed, and Cordials, he was somewhat relieved, and at last the Physic worked through him, and he grew better; and from that time he was more governable, and admitted of Clysters before Purging, both which he often repeated. We together prosecuted the Cure by internal Medicaments, such as by their virtue restored the Patient to a better Habit of body: our work was the dividing the contracted Callus, which made the Strictura, which we did by an Instrument made for that purpose, with which without hurting the Intestine we cut through in several places, making the opening so large that the Excrements came away big; and by the injecting of ol. lumbricorum, cured the wounds in few days after, and left him at liberty, he not only expelling them well, but also retaining them: Yet within this twelvemonth twice, we have enlarged it, and by the Instrument we designed, it may at any time be helped without hazard of wounding the sound parts near it; but since the last Incision of it, February 1673. it hath continued open, and upon a late search with my Finger I could feel nothing of it.  
A young Fellow of about thirty six years old, 
12. Observat. of a Sinuous Ulcer near the Anus.  a Servant to a Person of Honour in the Country, was sent to Town; he had been long diseased with a supposed Fistula in Ano, it was on the right side near the Podex, the Ulcer was sordid and with round callous Lips. I made a search and found it run under the verge of the Anus, but not penetrating it. He had been long diseased of the King's-evil, there being many Scrophulae on both sides of his Neck. I rubbed the sordes and putrid flesh with the Vitriol-stone, and than filled it with Merc. praecipitat. with Pledgits of Lint close over it. Than applied some of my caustick Unguent upon a Pledgit round over the callous Lips, and with an Emplastr. è bolo, and Bandage bound it up. The next day I took of the Caustick and found it had worked as I designed: I dressed it with Lenients to hasten separation of the Escar. This poor man had heretofore been subject to the Haemorrhoids; from which disease some withered Piles remained hanging upon the verge of the Anus, which upon the application of the forementioned Escaroticks and Caustics, began to heat and swell: I presently cut them of with a pair of Scissors, and after they had bled awhile, dressed them with pulv. Galeni, and afterwards cicatrized them by the use of the Vitriol-stone and common Epuloticks. During which I cleansed the Ulcer of its sordes, and endeavoured to lay a basis with mundif. Paracels. etc. for incarnating the Ulcer; but while I was so doing, I observed a great quantity of corrupt Matter flowing again down upon the Ulcer: upon search I found a Sinus run towards the Os sacrum a great length, and so deep as gave me small hopes of laying it open. The next Dressing I was provided with vulnerary Injections, such as have been set down in Sinuous Ulcers, and dressed him up with Detersives, and prescribed him such Physic as might have regard to his Scrofulous Habit of body. While I was thus treating him, he began to be troubled with a cough, which he had been frequently subject to in the Country, upon which account Pectoralls were prescribed, and he was thereby relieved. The cure of the Ulcer not succeeding, I applied a Caustick upon the upper part of the Sinus between the Os sacrum and the coccix, and passed in my Director at the same time, and cut through the Escar into it, designing by this opening to intercept the Humour flowing downward to the Ulcer, but the while he was taken again with a shortness of breath: I let him Blood, and repeated the use of Lohocks and Cordials, with Spirit of Saffron, etc. but he took his Bed and died the third day after. I having leave to open him, desired Doctor Walter Needham his assistance in finding out the Cause of his death; we found all the Glandules within very Scrofulous, those that lay upon the Iliack-Vessells ulcerated, from whence flowed a great quantity of Matter down into the Pelvis, thence insinuating itself amongst the Muscles, and so to the place where I had applied my Caustick, and from thence to the Ulcer near the Anus: his Lungs were also stuffed with Strumae, and the Viscera all very bad.  
This Observation being indeed strumous, should have been placed in that Treatise; yet notwithstanding I thought it fit to insert it here, that the young Surgeons, when they meet with such sordid Ulcers, with extraordinary discharge of Matter, may learn to suspect some extraordinary cause within.  
A Lady of about sixty eight years of age, a lean withered Body subject many years to the Haemorrhoids, 
13. Observat. of an ill-conditioned Ulcer in Ano.  which in her declining years grew more painful, and at last afflicted her night and day, and being without hopes of relief from the several applications prescribed her, was persuaded to admit of a Chirurgeon: She sent for me, I heard her roaring before I came into her Chamber. On the lower part of the verge of the Anus, next the Perineum, was a Swelling as big as a Pheasant's egg, it seemed to be the inflation of the rugous' coat, but was hard and of a livid colour; but that which she most complained of was within, which I could not come to see nor yet feel: by pressing this downward, I saw a foul Matter, and as I thought a large Ulcer; I caused a Syringe to be fetched, and some mel ros. which I mixed with some Chicken-broth and cast it up, and brought away some Excrements, and foul mucus: I caused a Fomentation to be made of fol. verbasci, solani, plantag. an. M. j sem. lini ℥ j sem. cydon. ℥ ss. sem. psilliiʒij. flor. nymph. & ros. rub. an. P. j boiled in Wine and Water, by which it was often stuped in a day; also a mucilage with some of the cold Seeds, with sem. papaver. alb. hyosciam. psillii, were thrown up to quiet the pain within. Emollient Clysters were also sometimes injected with a Syringe, having a short thick taper-Pipe; lenient Cerots were outwardly applied, made of some of those abovesaid mucilages cum sevo cervin. vitulin. vitell. ovor. croco & opio, cum ol. lumbric. & cera alb. By these Medicaments I somewhat relieved the Patient, and got so much credit with her, as I hoped to have liberty to take of this Tumour by one way or other. Some while after I did apply a Caustick, and removed the upper part of it, as I designed: there came nothing out of it, but it was so levelled, that I could with the help of a Spatula look into the Anus, where at some distance I saw little hard Excrescences like Thymi standing stiff up; these were they which gave her so continual pain, especially in the easing of nature. There was also a fordid Ulcer between them and the external Tubercle, (to which I had applied the Caustick:) it was not easy for to me extirpate the Thymi till I had quite removed this Tumour without; whereupon I presently rubbed it with a Caustick-stone, and laid it flat, and washed it with the Emollient Decoction; than scarified the Escar, and filled it with Merc. praecipitat. and dressed it up with Lenients; afterwards I worked it down, and smoothed it with the Vitrioll-stone, and cicatrized it with Epuloticks, the Alum-stone, etc. This removed I began with those Thymi, which if I might have had my own way, should have been treated by the actual Cautery; but I did not mention it, nor did I acquaint them with what I intended to do, but placed her towards the light, and passed a Scoup-like Instrument up into the Anus, than having a Caustick-stone fixed in a convenient Instrument, I pressed upon the head of thencerest Thymus, and as the Salts melted, dried them up with an Armed-Probe, and continued the work till I had quite extirpated it; than cast up some of an Emollient Decoction with a little ol. Hyperic. by which the pain was assuaged; after the Escars cast of, I touched them with sp. vitriol. and afterwards with the Vitrioll-stone and cicatrized it, than dressed the sordid Ulcer with Detergents stronger or weaker as it would bear; by which I cleansed it well, and disposed it to Cure by injecting aq. calcis, etc. During which I attempted the extirpation of the other Thymi with Caustick-stones, and thought I had eradicated them; but some time after they risen again, and in truth did so often, and proved vexatious to the Patient, and troublesome to me: Yet at last after a years attendance they wore of, and the pain ceased. She lived many years afterwards as happily as any person of her age.  
A Freeholder about fifty four years old, much emaciated, 
9 Observat. of a Cancer in Ano.  having laboured many years under the Haemorrhoids, and Apostemations within the Anus; at last being tormented excessively with pain, and not able to ease nature, he came to London in a Litter. He sent for me supposing that he had a Fistula in Ano; I looked and saw the verge of the Anus callous, than searching with my Finger I felt a large cancerate Ulcer within the Rectum, lying under the Os coccix, and possessing the parts round with hard Lips; also a large Excrescence, growing upon the lower part of the said Intestine about an inch and a half within, so that there was but a small passage for discharge of Excrements.  
This was an inveterate Cancer, and not likely to yield any thing to Palliatives: I would gladly have been rid of him, but he would be my Patient, protesting that he could not live unless way were made for the more easy disburthening of nature; to which purpose he implored my speedy help. I perceiving his lamentable condition, and his resolution to have somewhat attempted, desired him to consult some eminent Physicians and Surgeons; he assented to it, and made choice of Doctor Tho. Cox, and Mr. Hollyer Chirurgeon. We met at his Chamber the next day and made a search, and concluded it an inveterate Cancer incapable of Cure: but the Patient declared, he came to Town with resolution to be cured or dye, and would have it attempted. We at his importunity complied, and resolved upon the use of the actual Cautery, as being the only way whereby we could hope to extirpate these Excrescences and callous Lips, he was well pleased with our proposals, and desired we would meet again with what expedition might be. The second day after we met, and came provided with an actual Cautery of the fashion of a bolt, with a Cannula having a hole cut in it to receive that great Excrescence near the Sphincter: a mucilaginous Decoction was also prepared ex summitat. malvae, viol. sem. cydon. psillii, etc. in aq. hordei. The Cautery being ready, and a basin of Water with Sponges to cooll it; the Patient risen out of his Bed, and placed himself towards the light, leaning upon the side of his Bed without any body to hold him. I anointed the Cannula with unguent. refrigerans Galeni, and passed it up, placing the opening in the Cannula upon the Excrescence; than passed in an actual Cautery glowing hot, and repeated the use of it so often, till the Physician and Mr. Hollyer judged the Excrescence and callous Lips consumed; Mr. Hollyer putting his Finger in after the passing each Cautery, the Cannula being the while taken out often and cooled in Water. The work done, Injections were cast in, and the  parts dressed with Lenients; the Patient returned briskly to his Bed, and from that time discharged his Excrements freely, but made little Urine, and that high-coloured: by the use of Emulsions, and the frequent casting in Emollient Clysters and Injections, his Urinal voided more easily, and in more quantity. After the separation of the Escars, we dressed the Ulceration with unguent, tutiae, and injected troch. alb. rhaz. dissolved with a Mucilage of the greater Cold Seeds, sem. plantag. papaver. albi, psillii, in aq. spermat. ranar. & germ. querci. These parts disposing to cicatrize, the Patient was seized with a Pleurisy, and not submitting to be let Blood as was prescribed, his pain increased so very much that he could scarce breathe; being afterwards let Blood about eight ounces, he was relieved: but than a Diarrhaea followed, and it being Midwinter, and the Patient not allowing himself Fire, nor observing good Diet, it terminated in a dysentery, and he languished and died.    

A TREATISE OF THE KING's-EVILL.   

OF THE KING'S-EVIL.  
The Fourth Book.  

CHAP. I. Of the Cure of the EVIL by the KING's Touch.  
WHAT great difficulty we meet with in the Cure of the KING's-Evill, the daily experience both of Physicians and Surgeons doth show. I thought it therefore worth my while to spend a whole Treatise upon the Subject, and very particularly to go through the description of it, informing thereby the young Chirurgeon whatever is requisite to the Cure, at lest as far as it cometh within the compass of our Art. But when upon trial he shall found the contumaciousness of the Disease, which frequently deludeth his best care and industry, he will found reason of acknowledging the goodness of God; who hath dealt so bountifully with this Nation, in giving the Kings of it, at lest from Edward the Confessor downwards, (if not for a longer time) an extraordinary power in the miraculous Cure thereof. This our Chronicles have all along testified, and the personal experience of many thousands now living can witness for his Majesty that now reigneth, and his Royal Father and Grandfather. His Majesty that now is having exercised that faculty with wonderful success, not only here, but beyond the Seas in Flanders, Holland and France itself. The King of this last pretends to a Gift of the same king, and hath often the good hap to be alone mentioned in chirurgical Books, as the sole possessor of it, when the French themselves are the Authors: yet even they when they are a little free, will not stick to own the Kings of England as partakers with him in that faculty; witness the Learned Tagaultius, who in his Institutions takes notice of King Edward's faculty of doing the same Cure, and the continuance of it in his Successors. Italy as well as France hath made the like acknowledgements in the Book of Polydore Virgil, who reciting the Gift given to Saint Edward the Confessor, doth subjoin these words: Quod quidem Immortale munus quasi haereditario jure ad posteriores Reges manavit: nam Reges Angliae etiam nunc tactu, ac quibusdam hymnis, non sine ceremoniis, priùs recitatis, strumosos sanant. Which Immortal gift hath been derived as it were by an hereditary right to the latter Kings; for the Kings of England even now also do Cure the Struma by Touch, etc.  
Indeed if Historians of our Nation be diligently compared with the French, we shall found that the French Kings had this Gift later than ours. Dupleix a most diligent Writer of that History, deriving it no further than Philip the first, and Lewis the gross; saying, that before their times no man had that power: whereas we on the contrary meet with the general acknowledgements of all our Writers of the same miraculous Power in Saint Edward's time, which were enough for this Controversy: and not only so, but with strong surmises, that this Miracle was ancienter; it being notorious in the days of Malmsburiensis, who lived not long after his Reign, that it was than disputed, whether the Cure of the Evil were a peculiar reward of the King's Holiness, or rather a Hereditary faculty attending the English Crown. Which Gift, that it was not taken away upon our departure from the Church of Rome, we have not only our daily experience to testify, but also the confession of Doctor Harpsfield, a great Divine of the Romish persuasion; who, after he hath in the Ecclesiastical History of England described at large the Miracle wrought by the Confessor, doth add, Quam strumosos sanandi admirabilem dotem in posteros suos Anglorum Reges, ad nostra usque tempora tranfudisse & perpetuâsse, meritò creditur. Which admirable faculty of Curing the Struma, he is justly believed to have transmitted to his Posterity, the Kings of England, and to have continued it amongst them to those times in which he wrote. And when Bishop Tooker would make use of this Argument to prove the Truth of our Church, Smitheus doth not thereupon go about to deny the Matter of fact; (nay indeed both he and Cope acknowledge it) but he rather chooseth first to retort upon him the Protestant argument against Miracles which they will not allow to be the necessary mark of a true Church, because they may also be performed by Infidels. But withal he himself, who is not willing to let go so specious an Argument from his own Church, finds another Solution of the difficulty, attributing it to the great Goodness of God, and the great Grace of Saint Edward, Quòd nec in indigna haerede defecerit, that the Gift did not fail in an unworthy Successor: Such as he calleth Queen Elizabeth, and adds, that She did perform that Cure, non virtute propriâ, sed virtute signi crucis; not by her own virtue, but by virtue of the Sign of the Cross, which she made at the time of Healing; as if the Sign of the Cross, by whomsoever made, were sufficient to work a Miracle. What would he now say were he living, and had seen it done by three Generations of Kings without the Sign of the Cross? But it is not my business to enter into Divinity-controversies: all that I pretend to, is first, the attestation of the Miracles; and secondly, a direction for such as have not opportunity of receiving the benefit of that stupendious Power. The former of these, one would think, should need no other proof than the great concourse of Strumous persons to Whitehall, and the success that they found in it. I myself have been a frequent Eye-witness of many hundreds of Cures performed by his Majesties Touch alone, without any assistance of Chirurgery; and those, many of them, such as had tired out the endeavours of able Surgeons before they came thither. It were endless to recite what I myself have seen, and what I have received acknowledgements of by Letter, not only from the several parts of this Nation, but also from Ireland, Scotland, Jersey and Garnsey. It is needless also to remember what Miracles of this nature were performed by the very Blood of his late Majesty of Blessed memory, after whose decollation by the inhuman Barbarity of the Regicides, the relics of that were gathered on Chips, and in Hankerchieffs, by the pious Devotees, who could not but think so great a suffering in so honourable and pious a Cause, would be attended by an extraordinary assistance of God, and some more than ordinary Miracle: nor did their Faith deceive them in this point, there being so many hundred that found the benefit of it. If his dead Blood were accompanied with so much of virtue, what shall we say of his living Image, the Inheritor of his Cause and Kingdom? whom though it hath pleased God to deliver out of those dangers that overwhelmed his Royal father; yet it was with so long an exercise of afflictions, that though (God be thanked) he be not now like to increase the catalogue of Martyrs, yet he may well be added to the number of Confessors. This we are sure, the Miracle is not ceased.  
But since matter of Fact itself is, in such difficult cases as these, liable to exception; I shall take notice of the Evasions, that obstinate and incredulous Men have used to avoid so great a notoriety of Experience. For since it cannot be denied that many go away cured, some will impute it only to the Journey they take, and the change of Air; others to the effects of Imagination; and others to the wearing of Gold.  
The first of these is easily confuted by the hundreds of instances that are to be given of Inhabitants of this City, who certainly could meet with little change of Air, or indeed of exercise, in a Journey to Whitehall. The second is as readily taken of by the Examples of Infants, who have been frequently healed, though they have not been old enough to imagine any thing of the Majesty, or other secret rays of Divinity, that do attend Kings, or do any other act that way to contribute to the Cure. The third hath more of colour in it, because many that have been touched, have upon loss of their God felt returns of their Malady, which upon recovery of that have vanished. But in this case also we have many Evidences of the contrary.  
For his Majesty's Royal father in his great extremity of Poverty had not Gold to bestow, but instead of it gave Silver, and sometimes nothing, yet in all those cases did cure; and those that were cured by his Blood wore not Gold.  
Now whereas upon the loss of the Gold some have found damage; I would know, whether any of them were relieved by the wearing any other Gold than what the King gave them. This is certain, that many that lost their Gold continued sound; and whereas others did not, it may rather be imputed to secret Providence, which would give the Persons concerned that obligation of being mindful of their Benefactor.  
But since the infidelity of many in this fantastical Age, and the want of opportunity of others, doth deprive them of this easy and short remedy; and, since it is not necessary that a Disease, which is cured by Miracle, should be remediable by no rules of Art; I think it will not be amiss, if I do here give an account of what Nature and Art have supplied towards the relief of Mankind, in one of the most obstinate Diseases that I know: in the doing of which, though I think I shall say as much as those have said that have preceded me in this Employment, (it may be something more;) yet I must needs profess that what I writ, will do little more than show the weakness of our ability, when compared with his majesty's, who cureth more in any one year, than all the Surgeons of London have done in an age. However that this Attempt may not seem to want precedent, give me leave to tell you, that it is no more than the French Kings Surgeons have done before me, or than old Mr. Clow's did in Queen Elizabeth's days, and all other general Writers in Chirurgery have done more or lesle. Withal, as feeble as our Art is, this Treatise willshew you that it is not altogether ineffectual; and though the difficulty of Cure will sufficiently appear, yet the possibility will also be made out in many remarkable instances.   

CHAP. II. Of the Definition of the Disease, and its Causes.  
THE Latins call this Disease Struma and Scrophula, we the King's-evil. Galen defines it thus, Struma caro estsicca quae aegrè solvitur: Paulus thus, Strumae sunt Glandulae induratae: Aetius, Strumae sunt carnes subcandidae facilè augescentes, in membrana contentae, & in summa glandula induratae, quae in collo & sub inguinibus oriuntur. Strumae are a hard Glandulous flesh, somewhat white, contained in cystis, etc. But none of these Definitions do seem to me sufficiently to express the Disease which we in England call the King's-evil. For I appeal to the practitioners of this Nation, Physicians and Surgeons, desiring them to say, whether there be not many tumors and Ulcers commonly judged to be the Evil, which are contained in no cystis at all; neither do they concrete into a Glandule. I instance in the thick upper Lips chopped, divers tumors by congestion in the musculous parts of the Body, other in the Bones, etc. so that either we must exclude all these from the King's Touch, or altar our Definition: yet I do confess withal that the specific Difference, whereby this Tumour is distinguished from divers others, is so hard to found out, that it will be difficult to put a new Definition in the room of those which I now reject. I shall endeavour to fix upon a peculiar Acidity in the serum sanguinis for my specific Difference; and shall describe the King's-evil to be, 
The Author's Description.  a Tumour arising from a peculiar Acidity of the serum of the Blood, which whensoever it lights upon Glandule, Muscle or Membrane, it coagulates and hardens; when it mixeth with Marrow always dissolves it, and rotteth the Bone.  
If this acid Humour be simple, the Disease is a simple Struma; if joined with a malignity, or any other Humour, it makes a mixed Tumour, as Struma maligna, Phlegmonodes, Schirrhodes, Oedematodes, etc.  
Now by a Coagulation I mean something distinct from Concretion, which is incident to all other Humours and tumors, and to the serum itself upon many other causes. The whole Blood being fibrous may admit of many concretions and thickning; but they differ from this Coagulation as much as the boiling of Milk up to a thickness, or their thickening it with Flower, etc. differs from making a curd with Rennet. I shall the rather assume this instance of Milk because of the near kindred between it and Blood, and also for the near resemblance that many Strumous tumors have with the curd of that. It is very common to see the lesser Glandules of the neck, which of late have obtained the name of Conglobate, to grow large, and fill with a white curd so exactly like that of Milk that it is hard to distinguish them. When they differ from this, it is from some other mixture in the Blood which makes some other alteration; which may be very various, whether in the nature of the coagulating Ferment, or of the matter coagulated: the former may be an Acidity of this or that sort, and sometimes so sharp as to approach near to the acrimony of aqua fortis; in which cases the Patient feels violent corrosions and hideous pains, the Tumour itself being apt to degenerate into a Cancer, or may have other mixture with it to make it of a Vitriolique or Aluminous nature: all which Acidities though they agreed in the common notion of Coagulating, yet they make Coagulations very unlike each other. The difference also may be in the Matter coagulated, the varieties of which being infinite are hard to be recited: only I must take notice, that from this latter Cause it is that I was forced to put as well the property of Dissolution as of Coagulation into the description of the Disease; for though the Acidity be the same which cometh into a Bone with that which goeth into the Flesh-glandule, etc. yet the Matter it works upon being different, viz. Marrow, (whole peculiar nature we do not understand, only found it much different from other Juices of the body) it doth there dissolve and rot it, and with it the fibres of the Bone itself. Let no man wonder at the contrary effects of the same Cause, who observeth the different operations of Fire itself upon wax and clay; where it is visible that the contrariety of Accidents happens from the Matter, and not the Efficient. The like instance may be made in Vinegar, which when it is mixed with Milk, etc. it coagulates it into a curd; if put upon an Egg, it not only dissolves the Shell, but also attenuates the White contained in it into a limpid water; which White we notwithstanding observe to be a body much apt to concrete and grow thick than Milk itself. The similitude will hold good of our Strumous Acidity, which when it lights upon the Serum of the Blood coagulates it, and when it enters into Marrow, though that be in a nearer disposition to Hardness than the Serum, yet the mixture of this Acidity is so far from promoting that Hardness that it rather dissolves the consistency it already hath.  
The immediate Cause of the King's-evil is delivered already, 
Causes.  viz. the Acidity of the Serum: but the remote Causes, viz. the causes of this Acidity (to which the Strumae own their original) are somewhat hard to be enumerated. The heads to which they be referred are these, Air, Diet, Exercise, natural Complexion, hereditary Affections, etc.  
Those who are born of Strumous Parents are usually subject to these Diseases, and derive it from them; so they will from a Nurse so diseased whose Milk they sucked.  
Those whose temper of Blood is acid and the Serum apt to coagulate, are very obnoxious: so are Rickety children, and indeed in all children the heat being little for concoction, the Serum is apt to coagulate.  
Those that live in an Air excessively thin and sharp, or very thick and foggy, are both liable to the same Disease. Diet of salt, sour and slimy meats are causes of this Disease, of which more elsewhere.  
Want of Exercise is a great cause of the blood's growing acid and slimy: external Accidents are often the occasional cause of the King's-evil, but they always suppose a predisposition of the Body to it; in which case we often see a blow, compression, bruise, etc. to produce it. So also by a wrench of the hip, knee, ankle, or other joint, we found crude tumors to arise which are soon followed by visible Symptoms of the King's-evil, viz. either glandulous tumors in the Neck, etc. or tumors of the Bones themselves, which arising in the body of them make the Spina ventosa; of which elsewhere. I shall give you one remarkable instance of a Cook's servant in the Old-Baily, who sleeping one Summer's night upon a form, his head slipping of the one side of his Neck pressed upon the end of it: when he wakened his Neck was full of Strumae on both sides, some as big as Walnuts, others lesle; they were of different figures, and distinct from one another. He was presently let blood and purged, all else was done that expert Physicians and Surgeons thought fit to relieve him; but the Strumae continued and after a few days apostemated and mattered, and became virulent Ulcers: he died tabid within half a year. A straight stay, as some Women and Children wear them, hath too often the same effect: pain in the Breast makes them under the Arms, and in ill Habits of body; a sore Leg hath often caused as much in the Groins.   

CHAP. III. The History of the Disease with the Diagnosticks and Prognostics.  
THE King's-evil is already described in short; but that will not serve the uses of a young Practitioner unless he may have the History of it more fully delivered, which cannot be well done unless we give an account of the Parts themselves which are concerned in it. 
Parts affected. Nerves and Brain.  Now the Parts usually affected are either Glandules, Muscles, Viscera, Membranes, Tendons or Bones. I do not remember ever to have seen the Nerves or Brain affected immediately with any Humour of this kind: or if they have, the Juices of those Parts are rather dissolved, and the Fibres corroded by this Acidity after the likeness of Marrow and Bones, than coagulated into a Tumour; which Corrosion when it happens, the Disease gets another name, and being indeed mortal needs not be insisted upon in this Treatise, it admitting of no other doctrine but that of a Prognostic.  
So a young Lady having overgrown tonsils, 
Observat.  which were judged Strumous, was cured by me by Extirpation, as you may see in the chap. of tonsils: but she some years after labouring under great pains of her Head, and being upon the way coming up to London for Cure, died suddenly; her Head being opened, her Brain was found corroded, and much wasted with great putrefaction, the inner Table of the Skull carious.  
The Veins and Arteries do indeed dilate themselves in all congestions of Matter, 
Veins and Arteries.  whether natural or preternatural; but have not any particular Affection in the Strumae distinct from what they have in other cases.  
Glandules are a very notorious seat of this Distemper, insomuch that Authors generally have confined it to them as its subject. 
Glandules.  Here we have a great deal to say, viz. that this Part is the most commonly affected  the Patient is Strumous; and if the outward and more visible Glands' remain whole, 
Mesentery.  yet generally speaking the inward ones, those especially of the Mesentery, are obstructed and swelled. Of these I have seen divers examples, especially in Children, and have passed my Judgement that they have been Strumous, when the outer Signs could not so far justify my conjecture as to make others of my mind: yet when the Patient hath been dead, the truth hath appeared upon dissection. In one of this sort Dr. Walter Needham hath lately been my witness. Nay whenever the outward Glands' do appear swelled, you may safely conclude the Mesentericks to be so too, they being usually the first Part that is attacked by this Malady. Nor is the Mesentery alone, but all the conglobated Glandules partake with it; which word Silvius hath appropriated to the reductive Glands' that serve the Lymphducts. 
Conglobate.  These are frequently liable to this Distemper, their offices being a percolation of the Serum; therefore whensoever that is amiss, these must needs suffer. This is outwardly visible in the Neck, on the sides of the musculus mastoïdeus quite down to the Clavicle, 
Neck.  whence they pass into the Thorax down along the Spine, and about the Lungs; which themselves also do frequently abound with Strumous coagulations. Laurentius adds the Bronchocele as a species of this Disease.  
It is as easy to be seen in the Groin, Axillae, 
Groins. Axillae Conglomerate more seldom.  etc. in both which places they do often appear; but nowhere more commonly and frequently than in the Neck, of which every day showeth examples. Nor are the conglomerate Glandules free of the like malady, under which name Silvius contains all the excretory ones, which I do reckon to be the Salivalls bigger and lesle, the tonsils, the Glandulae Lachrymales, the Thymus, the Pancreas, the Mammae, the Testicles, Prostates, etc.  
These are sometimes affected together with the Conglobates, sometimes separably. Many instances may be given thereof, in some we have found all the conglobate Glandules of the Neck swelled, and many of them to press hard upon and between the parts of the Salivalls; 
Salivalls.  yet they remained sound.  
The like hath been seen concerning the Pancreas and Thymus, which have been both surrounded with Strumae, yet themselves remained untouched; but very often the Conglomerates are affected by themselves, of which we have a great example in the Ranula, it being but the Tumour of the Glandula salivalis inferior, 
Ranula.  which in a man lieth immediately under the sides of the Tongue. The Parotis also, which is the external Salivall, is very often preternaturally affected; and in the Pancreas the learned Dr. Walter Needham saith, he hath, seen a Strumous Tumour suppurated, which held a pint of matter when the other Glands' of the Mesentery remained sound.  
The Breasts are evidently obnoxious to it, as common practice testifies. 
Breasts.   
In a late private Healing I presented a young Woman with one in the right Breast, and 3 near that lying between the 2 Breasts, as large as Pheasants eggs.  
The Testicles and Prostates may be liable, but I cannot instance in them; 
Testicles and Prostates.  and it may be that we do the lesle acknowledge their being affected with this Disease, because we are apt in all these cases to suspect another distemper.  
The overgrown Tonfills are so frequently Strumous, 
tonsils.  that they need not be insisted on.  
The Glandulae Lachrymales are often infected, and do according to the variety of their disorders produce several sorts of tumors about the eye; the most usual of which is a Lippitudo, an affection of the ends of the Lachrymall Vessels, which being derived from them do terminate near the cilia: so also the Hordeoli, etc. nay it is not rare to see the whole ball of the Eye thrust out by the Tumour of these Glandules.  
Ophthalmia itself is often a consequent of the Disease; 
Ophthalmia, Fistula Lachrymalis, Adventitious Glands', Face, Legs, Arms, Skin Muscles, Membranes.  so is also the Fistula Lachrymalis which often oweth its original to this cause.  
Besides all these Glandules which are naturally born with us, there are many more which do arise upon the occasion of this Disease in the several interstices of the Muscles, as I have seen in both the arms of one person now under my Cure near the musculus biceps. The like happens to others in the Legs and Feet, also the very Fingers and Toes.  
In a Child of six years of age I saw them scattering all over the Body, as in the balls of the Cheeks, and upon that part of the Os zygoma nearest the external canthus of the Eye, higher than the parotis reacheth: but whether that were part of the parotis or not, the others were certainly adventitious which appeared upon the sides, back, breast, belly, shoulders, arms, and things, scattering up and down, some superficial in the skin, other deep.  
The Viscera are often found with great Strumae growing in them, 
Viscera.  or from them. Nor are we to wonder at it if Malpighius' doctrine be true, who supposeth poseth most of the Viscera to be made up of Glandules. In them we frequently found Strumous Swell as in the Liver, Lungs, Spleen, and sometimes appendants to them. Dr. Walter Needham declared in one of his late Lectures of Anatomy at our Hall, that he saw a Strumous Swelling hung at the cone of the Heart that weighed 2 ounces.  
The Tendons are sometimes involved with a great gumminess and collection of Strumous matter, especially the fingers, hands, feet and toes; yea upon the musculus mastoïdeus itself we found them very distinguishable from glandulous tumors, and hard to be managed. Elbows, knees, ankles are very remarkable Seats of this species of the Disease.  
Bones are as frequently affected as any part of the Body, Glandules only excepted: 
Bones carious from within.  but there the manner of the Tumour differs; for though the Bone swell, and the outward shell thereof appear hard, yet the inward Juices are all putrid and rotten. This sort of Tumour is sometimes called Spina ventosa, how properly let others judge; but it is certain that not only the Bones of the fingers, carpus, metacarpus, tarsus, metatarsus, and Toes, are liable to this Evil, but also the Skull itself and the Jawbones, and all the other Bones of the body; the venomous nature of which will be seen by those who upon opening some of these tumors have found the Bone when laid bore at the first appearance sound, but when pierced into to be in the heart wholly rotten.  
Bones are likewise affected on the outside by any Strumous Tumour that toucheth them; 
Bones outwardly catious.  whether Membrane or Tendon, etc. which we often experience in opening of them when they lie near such parts; for when we do, we most commonly found the Bone itself bore, if not carious. There is a mixed case of Membranes and Bones which frequently is found Strumous, I mean the Ozaena, which requires your utmost diligence; the Bones and Cartilages there soon rotting, leave a blemish to the scandal of the Patient.  
As to the Differences of the Strumae, 
Differences.  they are sometimes more mild without Inflammation or pain, and moderately hard, but by access of heat inflame and suppurate; as well those of a round figure, which is esteemed the best and mildest sort, as those of any other. Some of the mildest and biggest Strumae I have seen perfectly suppurated without change of colour in the skin, but after some days they again became hard as before. When they suppurate with Inflammation than there is a mixture of Blood with them, and than are called Phlegmonoïdes; others are indurated and after a while Schirrous, yet sometime by a putrid heat do ferment, and grow painful and soft in the upper part; which softness hath by some been mistaken for a Suppuration, but at their Opening they only gleet, and at length too frequently show their malign quality by terminating in one of the species of a Cancer, as I have showed you in the Chapter of Cancers.  
Other Differences may be taken notice of, viz. that some are primigenial as when the Disease is original, 
Other Differences.  and secundary when they succeed some other Disease, as particularly a Fever, which often terminates in a congestion of matter. It also sometimes happens after Catarrhs and other Distempers. There are likewise some by sudden Fluxion, others by long Congestion. From the place of their situation Differences may be taken which every man's eye can show him.  
The Steatoma, Atheroma & Meliceris, as they are the frequent companions of so they are often not easily distinguishable from, 
Steatoma, etc.  these tumors. This makes Barbett, a late Author, to say, that Materia melli, sebo, aut pulti similis, circa articulos, Ganglion, circa colli glandulas, Scrophulam sive Strumam, in brachiis, pedibus, aut capite Tubercula, & si ex Lue venerea Tophum constituit. By which it appears that he makes them not to be distinct Species of themselves, but the accidents of other tumors.  
Signs of these tumors will be more difficultly given, by reason of the various shapes in which they do appear.  
When it affects a conglobate Glandule the Tumour is usually round, 
Diagnostics,  moderately hard, and movable without pain. Those of an oval figure which are hard, and accompanied with pain without Inflammation, are of an ill quality; and if they grow unequal they threaten a Cancer. When a Conglomerate is the seat of it, it usually observes the shape of that Glandule, especially if the whole Gland be diseased: but it is not unfrequent to see those Glandules (which are indeed but compositions of lesser Glandules clustered up together like a bunch of grapes) particularly affected; so that some of those lesser Glandulae, or Kernels, shall swell into oval, round, or flat, or other figures, leaving the remainder sound enough; as indeed having no other communication with them, but only by that small pedunculus which toeth them to, and dischargeth them by, the common great dust of the Glandule.  
In a Muscle the shape is uncertain, and always distinct from the Muscle; the Tumour harder or softer as it happeneth: but those of a round figure are the best-conditioned ones.  
The lip when infected is commonly thick and chopped.  
Bones when Strumous do swell, grow hard and big, but if you open them, they are found inwardly rotten, as hath already been hinted.  
These which we present to his Majesty are chief such as have this sort of Tumour about the musculus mastoïdeus, or Neck, with  other circumstances they are accompanied; nor are we difficult in admitting the thick-chapped upper Lips and Eyes affected with a Lippitudo: in other cases we give our Judgement more warily.  
In the Prognostic you are to consider, whether the tumors be many or few, grown together in clusters or more distinct, great or small, 
Prognostic.  deep or shallow, movable or , benign or malign, soft or hard: the place of them, whether near great Vessels, Joints, Nerves, Tendons or Bones, and the Habit of body, is to be considered; also the Age of the Patient.  
If the Habit of body be tolerable, the Patiented young, the Strumae recent and but moderately hard, the Resolution or Suppuration of them is feizable: but if they have been of long continuance, are hard and lie deep amongst the Vessels, the work is difficult; yet the Cure of both is very often furthered by accidental Ferments, which will resolve them to a wonder, and as often suppurate them. In case of the King's Touch the Resolution doth often hap where our endeavours have signified nothing; yea the very Gumata, insomuch that I am cautious of predicting concerning them (though they appear never so bad) till 14 days be over. If the Struma be movable, and free from remarkable Vessels, the extirpation is not difficult; but if the Habit of body be bad, the Strumae , they are not to be meddled with; if that they be movable, yet lie deep amongst the great Vessels, the extirpation is dangerous: besides, in the best Habits of body new Strumae are apt to arise while you are extirpating the old ones.  
If the Strumae have been long ulcerated, and are become sinuous and virulent, 
Strumae ulcerated.  and if they lie near one another, they do often found a communication to one another, though to your Eye they may seem distinct: in which case the Lips grow callous and the Ulcers corrosive, yea frequently sordid, and the Cure not to be hoped as long as any one cystis remains, or indeed the Vessels that feed them; and if they run under the great Vessels what will you do? but if the Ulcerations be simple the Cure is accordingly easy.  
Those that are seized of Strumae in the Neck after 40 years of age seldom recovery, those generally labouring under great obstructions, whence spring Scorbutical affections, Jaundice, fainting, vomiting, loss of appetite, sometimes Dropsy; otherwhile a Cough, in which case they die tabid.  
If Strumous tumors or Gumata arise from caries inthe Bones of the fingers or hands, 
Caries within the Bone.  it will require your care; if in the foot or toes, it will be more difficult; if in the Os calcis, Joint of the ankle, or Astragalus, or in the Knee-bones, or Ischia, etc. where you cannot lay open, or indeed where you cannot judge of the rottenness, the case is deplorable, the work is long; and the very discharge of matter exhausts the spirits of the Patients, so that they generally die of a Marasmus: but if by strength of Body and help of Medicines the Ulcers do digest, sometimes the rotten Bones do moulder and cast forth, and by virtue of a callus within, the member is supplied; as in some cases you may see, but the case always portendeth danger.  
If Strumous tumors or Gumata do outwardly foul the Bones, 
Caries from without.  if the Habit of body be tolerably good and the Ulcers well-handled, they may recover; but if the Habit of body be bad, new Ulcers arise so that the work is long and difficult.   

CHAP. IU. Of the Method of Cure.  
IN the Cure of the King's-evil you must consider the Habit of body, strength and age of the Patient, the affection of the Viscera, and particularly whether the Struma be simple or complicated.  
If all things appear benign according to the Diagnostic or Prognostic before delivered, you may hope well; if otherwise, than you are to defend yourself with a prediction, and work warily.  
In order to the Cure three Intentions are required. The first consists in the regiment of Diet and the other non-naturalls; the second, in Pharmacy or internal Prescriptions; the third, in the application of Externalls either to discuss, suppurate or extirpate the Glands'.  
In the first concerning a general regiment of Diet, amp; c. there aught to be special regard had of the Constitution of the Patient whether he be hot or cold, dry or moist, old or young, tough or tender and washy. If the Body be cold and moist, we generally suppose a crapula preceded, and crudity to abound; in which case the ready road is by Fasting from meat and drink, which was the method of the Ancients, or at lest great moderation: their Diet aught to be moderately heating and drying, Mutton, Kid, Rabbit, Pullet, Chicken, Partridge, Pheasant, Cock, etc. and these roasted; avoiding all meats which yield a gross nourishment, as water-foule, fish and herbage: their Bread aught to be of wheat well baked, and their Drink medicated ale or beer; wine is also allowed and water utterly forbidden.  
In hot and dry Bodies which are tending to a Hectic, we allow a more humecting Diet, their meat boiled with Lettuce, spinach, Purslane, Wood-forrel, etc. To some of these we dare scarce permit the eating of any Flesh, but rather a Milk-diet or Ass' milk; but where Milk doth not agreed we prescribe them medicated Broths.  
Air is a great help in our Cure: in the cold ones it aught to be moderately heating and attenuating, in the hot ones cooling; in neither overmuch piercing, as that of Hampsted is, in which sort of Air there is always something esurine and acid; but rather mild and gentle, as that of Kingsington, upon which supposition of gentleness, the farther removed from the smoke of the City the better. I shall mention one Observation which I leave to your Judgement, whether it aught to be attributed to the smoke or Northern blasts from Highgate. It was in a Patient of Dr. Tho. Cox and mine, diseased and wasted even to skin and bone: we removed him to Knightsbridge, where after in some weeks he had a little recruited his strength, and was eased of his Cough, which had been very grievous to him; we removed him (for more conveniency of curing an Ulcer with caries of the cranium which he had some time laboured under) to a Lodging near Kings-Gate in Holborn, which stood backwards and Airy enough, the windows opening to the Fields. Upon lying there but two nights he relapsed to such a degree, that if I had not removed him the third day I verily believe he could not have survived the fourth; but at Knightsbridge he again recovered, and some weeks after went well away to his Parents in the Country, and hath continued healthful since.  
Exercise of body aught to be enjoined, it being necessary to waste superfluities; Sleeping in the day is forbidden, unless it be in case of pain to which it is an Anodyne; Passions of the mind aught also to be moderated.  
The second Intention consisting in Pharmacy, must be qualified according to the Habit of body. If it be cold and phlegmatic, abounding with gross viscous Humours, your Prescriptions aught to be heating and attenuating: in Plethorique bodies you must purge with the stronger Catharticks, or repeat the milder often, otherwise the Disease will be apt to increase under your hand. The Purgatives are, species hierae cum agaric. diaturb. pull. cornachini, pill. cochiae, è duobus, rudii, hermodact. aloephang. imperial, è succino, trochis, albandal, diagrid. resinae jalapii, & merc. dulcis, and all those Medicaments prescribed in Lues venerea. ℞ pill. rudii ℈ j calomel. gr. 15. ol. sassafras gut. iij. Misce & fiant pilulae 5. auratae; sumat summo mane. Or, ℞ senae ℥ ss. agarici trochiscatiʒj. hermodact. ℈ iiij. sem. carthamiʒiij. salis tartariʒss. ligni sassafras ℈ ij. fiat infus. in aq. flor. genistae, scrophular. an. ℥ vj. colaturae add syr. de spina cervinaʒx. vel q. s. Or, ℞ turbith gummos. hermodactil. an. ℥ ij. rad. scrophulariae ultriusque, an. ℥ j rad. angelicaeʒiij. fol. senae ℥ ss. diagrid. ʒij. fiat pulv. & cum syr. ex infus. ros. pallidar. fiat Electuar. does. ʒj. ad ʒij. addendo calomel. gr. x. now and than. Or, ℞ sarsaparill. elect. ℥ ij. rad. chinae, court. lig. vitae, an. ℥ ss. sassafras, santali, citri, an. ʒiij. rad. jalapii, senae, an. ℥ iiss. hermodact. turpeti, an. ℥ iss. pulveriz. omnia, & fiat Electuar. cum ss. q. mellis despumati. Or, ℞ rad. aristoloch. rot. raphani, spatulae foetidae, an.ʒj. pimpinellae, rutae, pilosellae, an. ʒij. rad. scrophular. filipend. an. ℥ ss. sem. anisiʒij. zinziberisʒj. turbith gummosi, fol. senae, an. ʒiij. sacchar. alb. ℥ iiij. fiat pulv. of which the Patient may take daily a spoonful in White-wine. Or he may purge with this Wine, ℞ summitat. marjoranae, origani, calaminthae, tamarisci, an. Mj. flor. ros. damas. salviae, betonic. anthos. staechad. centau. min. veronic. utriusque, an. Mss. sem. papaver. alb. ʒiij. sem. fenic. dull. nigellae, Romi, cardomomi, cubebar. an.ʒj. rad. ireos florent. calam. aromat. pyrethri. an. ℥ ss. cortic. aurantii siccat. ʒiij. court. lig. sassafras, court. Winteran. an. ʒij. hermodactill. turbith gummosi, an. ℥ ij. hellebori nigri ℥ iij. macerentur in vino Hispan. lbiiij lbiiij. per quatriduum; does. cochl. iij. mane & horâ somni. ℞ spec. hierae picrae simple. ℥ iss. court. Winteran. contus. ℥ ss. maneat spatio trium dierum in frigido in aq. lumbric. lb ss. aq mirabilis & bryoniae composit. an. lb j. saepiùs agitentur, extrahatur Tinctura clara.  
℞ pull. sanctiʒij. sacchar. oped. in aq. mirabilidissoluti ℥ j spir. cinamomis, gut. ij. fiat tabella ad pondusʒj. capiat iij. pro does.  
Alteratives are also usefully taken those days they do not purge, of which sort this is very much commended. ℞ ciner. spongiae, pilae, or paleae, marinae, ossis saepiae, piperis longi nigri, cardomomi, zinziberis, salis gemmae, pyretbri, nuc. cupressi, gallar. an. ℥ ij. fiat pulvis: he is to chew some of it daily, and swallow it down as it were insensibly. Or, ℞ rad. gladioli conduit. ℥ j ciner. viperar. ʒuj. ciner. spong. ℥ ss. spec. de gemmisʒj. diarrhod. abbatisʒij. cum syr. de betonica fiat Elect. de quo capiat ad q. castaneae tribus horis medicine. any hour in ●●e day fasting. Or, ℞ rad. helen. gladioli, ircos, an. ℥ j cons. flor. anthos. betonic. an. ʒuj. theriac. Venetaeʒiij. spec. aromat. rosatis, diagalangae, an.ʒj. cum syr. de court. citri, fiat opiata; sumat q. ʒiij. horâ somni. After any of these may be drank a draught of the following Decoction; ℞ sarsaparillaes ℥ iij. ligni guajaci ℥ iss. sassafrasʒuj. rad. filipendulae, scrophulariae maj. an. ℥ j fol. agrimoniae, herb. Roberti, veronicae utriusque, an. Mss. flor. betonic. anthos. an. P. j liquiritiae ℥ ij. sem. coriand. ʒuj. coq. in ss. q. aq. font. ad lbuj lbuj. colaturae adde vini rhen. lbij. lbij. sumat ℥ vj. horis trib. medicinal. Or, ℞ rad. chinae ℥ ij. sarsaparillae ℥ vj. santal. omnium, an. ʒiij. sassafrasʒx. infund. in aq. font. lbviij lbviij, per horas 12. deinde, adjectis fol. agrimon. Mij. fol. veronic. Miij. seabiosae Mj. sem. fenic. dull. carvi, an. ʒiij. uvar. passular. enucleat. ℥ vj. coq ad consumpt. tertiae partis; fiat colat. pro potu ordinario. ℞ rad. sarsaparillae ℥ ss. rad. chinae ℥ j ligni sassafras ℥ j rad. scrophular. filipend. an. ℥ j ophyoglos. alchimillae, fol. agrimon. veronicae utriusque, an. Mj. milleped. no. 200. liquirit. ℥ ijss. coq. in aq. font. lbx lbx. ad lbuj lbuj. sumat ad ℥ iiij. tribus horis medicine. The Decoction of lig. vitae in phlegmatic Bodies alone frequently cures the simple Strumae. ℞ sarsaparillae incis. & contus. ℥ iij. rad. chinae ℥ j lig. lentis. ℥ ij. ras. ebor. ℥ j millep. recent. no. 1000 uvar. passular. enucleat. ℥ viij. rad. rusci ℥ iiij. M. fiat sacculus pro congiis tribus cerevisiae non lupulat. pro potu ordinario. In some cases aq. calcis hath been of good use, thus: ℞ aq. calcis lbuj lbuj. sarsaparillae incis. & contus. ℥ ij. chinae ℥ j sassafrasʒuj. uvar. passul. enulceat. ʒiiij. glycyrrhizae ℥ j fiat infus. & coletur pro usu; bibat ℥ iiij. tribus horis medic. in delicate Bodies you may leave out the Sassafras and make Emulsions of it with some of the 4 cold Seeds, Almonds, etc. sweeten it with fine Sugar. Chalybeats are frequently of use in these Diseases, and may be thus prescribed. ℞ margaritae pull. ʒuj. ocul. cancror. ℥ j cerus. antimon. ℥ ss. salis martis ʒiij. sacch. cand. alb. ℥ iiij. fol. Auri no. vj. M. fiat pull. Or, ℞ chalibis cum sulphur. praeparat. rhab. oped. an. ʒuj. court. Winteran. ʒij. sal. absinth. ʒj. sacchar. oped. ℥ iiij. fiat pull. the Dose of either may be a Dram. If the Patient be of a hot and dry Constitution the case is more difficult, because the Medicaments eminent in the Cure of this Disease are generally such as are like to injure the Body in one of those qualities, being most of them such as either heat, or at lest dry it; many of them do both, viz. Sarsa and the Woods as also the cineres Spongiae, sal Gemmae, and all the Species. In this case the Waters will have their place (though I cannot so particularly approve them as others do.) Ass' milk is of great efficacy in the most of these, of which I shall give you one instance in a case where thy worthy friend Sr. F. P. was concerned.  
A young Gentlewoman about 11 years of age, shrewdly diseased with Strumae in her Neck, with obstructions in the Mesentery, she being thereby exceedingly emaciated: Sir F. Pr. being sent for, and seeing her so diseased with loss of Appetite, advised her to be removed to the fresh Air at Kingsington; she was so, and there by Ass' milk recovered her strength, and returned to her friends, well recovered. Where Asses milk doth not agreed we prescribe Distilled milk, of which sort this may serve for an example. ℞ sarsaparillae elect. incis. & contus. lb j. ras. corn. cervi ℥ vj. fol. agrimon. veronicae utriusque, an. Miij. santal. alb. rubri, an. ℥ ij. liquiritiae Anglic. lb j. limac. horten. no. 100 vermium terrest. lb j. lactis vaccini recent. cong. two. distillentur in organo common. S. A. Liquoris distillat. sing. lb iij. add tabellas oculor. cancror. ℥ ij. sumat ad quantitatem ℥ iiij. singulis dosibus addend. aq. cinam. hordeat. Cij. To these diseased Patients we also generally prescribe Decoctions of sarsa, china, ligni lentiscini, santal. albi, ras. C. C. & eboris, with the more temperate Pectoralls and opening Roots; so also the testareous powders of oculor. cancror. coralli, margaritae, etc. of which this my serve for an instance. ℞ ohelar. cancror. cerus. antimonii, ccul. cancror. an. ʒiij. margaritae, coral. rub. an. ʒii. sacchar. purissimi ℥ iiij. fiat pull. de quo capiat adʒj. ter in die superbibendo haustum aq. lactis superscriptae. Or the foresaid powders may be made into Pills with balls peruvianam, etc. Merchant diaphoret. bezoard. miner. antimon. diaphoret. are also great Specificks in these Diseases; Emulsions, Pearl, Juleps, and Opiates are also of use. Purging in this case, if the Body require it, aught to be with Lenitives, viz. Elect. diacassiae cum manna, diacatholic. diaprun. syr. de pomis, purgantis diasereos, syr. de rhab. & de cichoreo cum rhabarbaro: and to Children the infusion of Rhubarb is sufficient. Our most experienced Physicians have generally purged these with pull. rhab. with an addition of the Elect. diascord. or, succ. chermes, with Merchant dulcis where they have been subject to Diarrhaea, and in other cases alone, or mixed with the milder Purgatives: for in truth whatsoever Disease it is complicated with, without some preparation of Mercury our hopes are vain; nay in some of the most deplorable cases where the Patient hath been extremely emaciated by reason of the Acidity in the serum, I have proceeded higher to salivate them, and thereby recovered them, as you may see in some of the Observations of Ulcers with caries in the Bones.  
The third Intention is performed by the application of Externalls, 1. to the tumors which we endeavour to resolve or suppurate or to extirpate, which latter may be performed either by manual Operation or by Escarotick or Causticall medicaments; 2. to the Ulcers, which are the effect either of Suppuration or Extirpation. In tumors we shall begin with Emollients and Discutients, though I must confess it is no easy work to resolve these Glands', if we consider two things: first, the stubbornness of the Matter, secondly, it's being contained within a cystis; yet in soft delicate Bodies the milder sort of Glands', which are not too much indurated, do frequently resolve. We shall therefore offer to you such as I have sometimes applied with tolerable good success: as ℞ empl. diachyl. ireat. ℥ ij. gum. galbanum, ammoniac. dissolute. in aceto, an. ℥ ss. pull. sem. nasturtii ℥ j sal. gemmaeʒij. sem. sinapis & urticae pull. an. ʒiij. axung. anseris, ol. irini, an. ʒuj. cerae ℥ ij. M. S. A. fiat cerat. Or, ℞ rad. bryoniae, cyclam. raphani, an. ℥ ij. cucumeris silvest. spatulae foetidae, an. ℥ j coquantur in lixivio communi ad mollitiem: cribraturae add sterc. columbini, caprini, an. ℥ j gum. ammoniaci dissol. in sp. vini ℥ ij. labdanis, styrac. calamitae, an. ℥ ss. picis naval. q. s. fiat cerat. Or, ℞ gum. galban. sulph. vivi, an. ℥ j salis armoniaci ℈ ij. terebinth. q. s. fiat ceratum. The softer Strumae may by these or some of Celsus' Malagma be resolved, or disposed to Maturation by the access of Heat and subtle quality of the Medicaments.  
Those which partake of a Phlegmon do frequently suppurate: the way to further Suppuration is by suchlike; ℞ cepar. capita allior. in furno coctor. no. ij. mucilag. radic. althaeae, lilior. an. ℥ j pull. sem. foenugraeci, lini, an. ℥ ss. fermenti veteris ℥ ij. cari tosti no. iiij. limac. no. vj. axungiae anseris & porcinae, an. ℥ iss. crociʒj. M. fiat cataplasma. ℞ tussilag. cum toto Mij. sem. lini pulver. ʒuj. axung. porcinae q. s. fiat cataplas. S. A. Or, ℞ folior. & rad. altheae, rad. lilior. an. Mj. sem. lini, foenugraeci, an. ℥ j far. triticeae. ℥ iss. axung. porcinae & gallinae, an. ℥ iss. vitel. ovor. no. ij. crociʒj. fiat cataplasma. In order to the suppurating of them it is common to pinch them hard: I have seen some people in the Country thrust a Thorn into them, and thereby stir up Inflammation which soon disposeth them to suppurate. You must endeavour a perfect Concoction; for if you open them while any part of the Gland is hard, it will increase and put you upon a necessity of eradicating it, or of leaving your Cure imperfect. I could give you many instances of Patients that have come to me for Cure after such Treatment. As to the way of opening them when suppurated that by Incision makes the lest Scar; but if the Struma be large, the way by Caustick may give you more Opening, and with lesle pain assure the Cure: the Matter being discharged you may deterge with mundif. Paracels. praecipitat. and the Vitrioll-stone, and afterwards incarn and cicatrize as in crude Abscesses hath been showed.  
But in the old and hard Strumae we do seldom obtain a complete Suppuration; sometimes during the application of the most subtle Discutients we raise a heat in the Skin, which affecting the cystis and part of the Gland next under it doth 'cause an imperfect Suppuration: by the continued use of the Discutients it at length frets its way through in small Apertures, in which case if you continued the Applications, they grow bigger and become so many painful Ulcers spreading one into another, the body of the Gland remaining hard without hopes of Suppuration. But if you dress them a day 2 or 3 with a Pledgit of unguent. basilic. you may qualify the Heat and moderate the Ulceration; and so by interchangeably applying the Discutient or Lenient, you may happily waste the whole Gland, if the Patient be treated the while by proper Internalls. In some of these who have come to me out of the Country with Strumae ulcerated about the Chaps, I have seen the Strumae thrust forth in a fungus; so that with my Spatula passing under them I have thrust them quite out, and healed the Ulcer in few days: in others where they are incapable of being so soon thrown out, I cut of the protuberant part, and consumed the remaining basis with Escaroticks.  
If the Struma be movable, and free from remarkable Vessels, the speediest way of Cure is by cutting the Skin, and taking them out whole with their cystis: those which have stalks and are pendent, or grow small near the basis, may be tied and cut of; of this sort we see many. The last I was consulted in was as big as the largest Catharine Pear and of that shape, growing on the outside of the thigh of a Woman: I made a Ligature about the basis of it, and and in compliance with the Patient left it on, and deferred the cutting it of till the next day; but when I came I found it rotten of by force of the Ligature and required no Dressing, I cut it in pieces and found it a white Glandulous body. In an Infant newly born there appeared one upon the outside of her little Finger, of the perfect shape and colour of an unripe Cherry, partly read and partly pale, with a stalk proportionably long; I cut it of with a Knife, it bled with a full stream, I stopped it by the application of pull. Galeni cum alhumine ovi; the third day after I took of Dress and saw it healed. About ten days after coming thither to make a fontanel, I saw that Cherry lying in a Box in the window: I cut into the soft part and discharged a bloody serum: the other side which gave the pale colour to it was a Glandulous flesh.  
In those which are so thick in the basis that you cannot make Deligation on them, you may pass a proportionable big Needle under the roots of them, and cut them of under the Needle.  
The common way of taking out all the species of Strumae, Atheromata, 
The way by Incision.  & Meliceris, by Incision, is in cutting the Skin the length of the Tumour: in these latter you must make the Incision more warily, jest you divide the cystis and the Matter flow forth. After you have separated them round to the basis, it may be sometimes necessary to make a Ligature upon the Vessels before you cut them of. Those which are of great bulk and have their basis proportionably big, as Steatoma, generally called Wenns, are sometimes taken out by making a cross Incision, other-while by an oval, one taking of so much of the Skin as may be judged superfluous; than separate it, proceed calmly in the Work, for in these the Skin commonly adheres so close to the cystis, that it will not part from it without the help of your Knife: having separated it turn it out, and make a Ligature underneath upon the Vessels, and cut it of; than bring the Lips of the Wound together with 2 or 3 stitches, and dress it up as you see cause. Some Empirics cut them of without more ado, scarce making a Ligature on them; but this way being always attended with a flux of Blood, others choose rather to pass a Seton-needle with a strong Ligature close under the basis, or as near it as may be, and that way make a Ligature strictly about it. Sometimes we make the like Ligature without Incision, and are content to eat of the Tumour by streightening it. Thus it falls of without effusion of Blood; but hereby there is hazard in mortifying the sound parts underneath, or of causing such disturbance as prolongeth the Cure: upon which consideration I do propose in great Steatoma's and complicated tumors, which are enclosed in cystis', rather to cut into the cystis, and with your hands to pull out that preternatural Body, and leave the cystis behind. So shall you be secured from a flux of Blood, and for the cystis, you need not doubt but by Digestion it will separate and cast of; the Wound will also heal smooth by Agglutination afterwards, if you cut of the superfluous Skin, and bring the remaining Lips together, as in such Operations is usual. An Instance of this I shall give you amongst the following Observations.  
After the same manner I usually treat all those Tubercles' in the Eyebrows and Face, where the cystis separates difficultly from the circumjacent parts, or where a great Scar may be unsightly.  
Where the Strumae are large or lie deep near considerable Vessels, there, 
Extirpation by Escaroticks.  if Extirpation be safe, the best way will be by causticall Medicines and Escaroticks. It is a Work requiring more time, yet it is sure; and indeed is the only way our Patients generally admit of. The very mention of a Knife frighting them from us.  
In preparation to this Work, the Body aught to be frequently purged, and if there be Plethora Venae-section may be necessary: also during the Extirpation they aught to be in an Antistrumaticall course of Physic with Alteratives, etc. as hath been already prescribed; otherwise new Glands' will arise whilst you are eradicating the old ones. Upon which consideration you are to furnish yourself with such Escaroticks as may penetrate deep into the Gland, and do their work with lest pain: for these Glands' have small sprigs of a Nerve branching through them, which maketh them sensible of Pain and subject to Fluxion; therefore it is that we endeavour to eradicate them with Corrosives lest painful. But such is our misfortune that all Medicaments fit for this Work are extremely painful, the stronger Caustics are most proper to begin with upon condition that they be kept within their bounds: of these some are made up of Sope-lees boiled to a Stone, but this Medicine will spread in spite of all our Defensives; so will all those made with Arsenic, Sublimate, Vitriol, etc. that of calx viva boiled up with lixivium saponis spreads the lest. The Medicaments proper afterwards to eradicate them are either Escarotick, as the Caustick-stone Merchant sublimate, Arsenic, ol. vitrioli. Auripigment, unslacked Lime, etc. or Catheretick, viz. all the sorts of Vitriol, viridis aeris, squamae aeris, chalcitis misii soris Cinnabar. Alumen, Merchant praecipitat. and so forth. The compositions of the Escaroticks are pull. sine pari ex equal. part. Merc. sublimat. Auripigmenti, Calcis vivae. A milder than this is that of Johan. Arden, Trochis de minio vigon. is a powerful Escarotick; it is compounded of Merchant sublimat. Minium, and Leven. In his Book you may found Prescriptions more escarotick, of which this is one. ℞ merc. sublimat. ℥ ss. arsenici pull. ʒiss. cerus. succi amyli an. ʒiiiss. succi asphodeli ʒx. aceti oped. ʒv. bulliant omnia ad consumptionem succi & aceti, deinde pulverizentur & incorporent. cum ℥ ij. panis crudii addend. auripigment. calcinatiʒiiiiss. & cum modica aqua ros. fiant Trochisci. You may make this stronger by leaving out the Ceruse and Starch, and adding a few drops of ol. Arsenici; but you will found the mildest of these preparations with Sublimate too painful to be applied in tender Bodies. The Cathereticks commonly used are Turbith minerale, merc. praecipitat. alone or mixed with Alum. ust. or applied with the use of the Vitrioll-stone; the mildest is the Precipitate, it is of a slow operation, but may serve in tender Bodies.  
In the eradicating of Strumae, we are sometimes necessitated upon an accidental erosion of an Artery to apply the strongest Escaroticks; but generally we qualify them according to the Habit of Body, Age and Strength of the Patient, and condition of the Glands', as they are hard or soft, have more or lesle sense, or are seated in or near an Emunctory. In my long Practice in eradicating these Glands', I have experimented all the several Escaroticks and Cathereticks aforementioned, and know that those Compositions which have Sublimate in them are exceeding painful, scarce to be endured in the strongest Bodies, although you do take them of in 5 or 6 hours after; yet the Salts having once penetrated the Glands', the Pain will continued vehement many hours after, and affect the neighbouring Parts with great Inflammation and Tumour, and so frequently raiseth new Glands': but when you apply these to the softer Sex, or tender Bodies, it affects their Head with grievous pain benumbing that side and parts about, depriving their very senses. Fainting, and palpitation of the Heart, are frequent effects of such Escaroticks, and not seldom a Fever; by which may be judged the ill consequence of applying strong Escaroticks of Sublimate indistinctly to all Complexions and Ages.  
The Method I usually begin this Work with is by the application of such a Caustick as will least spread, making it proportionably long, reaching from the lowest part of the Gland upward; for in the consuming it, the Strumae will sink downwards: you must defend the sides with Plasters that it do not spread; for the Lips being once divided they will give way, and accordingly as your Escaroticks penetrate into the body of the Gland, the sides of it will fall in and be eradicated out of the narrowest Opening you can make; and the narrower it is the lesle Blemish will arise from the cicatrix, and the sooner it will be cured. The Escar being made you may divide it the whole length, and with a Caustick-stone rub into it till it hath penetrated into the body of the Gland, which it will the sooner do if interchangeably you press into the same place with a stick dipped in ol. vitrioli. Having thus done, dress it up with unguent. basilic. cum oleo lini hot, embrocating the parts about cum ol. ros. & aceto, and apply an Emplaster è bolo over all. This way of Dressing is not without pain, but it seldom lasts above half an hour. The third day after you may dress it again, and if you found the Escar in the middle dried hard, I dress it with Lenients: but if it feel soft rub it again interchangeably with the Caustick-stone and ol. vitrioli, thrusting them every was into the body of the Glands', taking care that the Lips of the Ulcer be not enlarged thereby: by this way of proceeding a great part of the Struma will be eradicated before the first Escar in the Circumference cast of from the Skin. Having thus near eradicated the Struma, you may consume the Remainder with Merc praecipitat. and keep it open by Dossills' of Lint; permitting the Lips of the Ulcer to contract narrower the while, that it may heal with a cicatrix like an incised Wound. This I conclude the easiest and speediest way to eradicate the largest Struma: but in these complicated Strumae, and others which will not admit of such proceeding I apply an Escarotick or the strongest Catheretick powders as I see cause; of which proceeding you may see more particularly in the following Observations. The Steatoma being suet yields not to Escaroticks.  
All this while I have treated only of the King's-evil as it is contained in a cystis, being the Struma of the Ancients: but in my History of the Disease I have enlarged the bounds of it further, so as to take in several tumors and Ulcers upon Muscles, Tendons, Ligaments and Bones; also Ophthalmia, Aegylops, Fistula Lachrymalis, Tonsillae, etc. which cannot be reduced to this Method here proposed: yet that concerning Muscles, Tendons and Bones being more universal, and happening in several parts of the Body, especially the Joints, I shall say somewhat of in this place; the other I shall be forced to handle in distinct Chapters, and place them in the latter end of the Treatise.  
As to the Strumae, and other preternatural tumors included in a cystis, affecting the Muscles, Tendons, Ligaments and other parts of the Body, they differ not in the way of Cure from what hath been already delivered, save that they require more caution in the Extirpation of them as they affect the Joints or sensible Parts.  
The Ulcers arising from these are cured after the same manner that hath been showed in that Treatise; for whatever some Authors may have pretended of this or that peculiar Remedy, the Cure depends upon the general Method there proposed, to which if your fancy so lead you may add Specificks.  
The gumminess upon the Muscles and Tendons require emollient and discutient Dress, as in the Chapter of Sehirrus hath been demonstrated.  
The Swell affecting the Joints in this Disease are of 2 sorts: 
Swell of the Joints are of 2 sorts, Externall and Internal.  both of them are made by Congestion, and increase gradually; yet differ in that the one ariseth externally upon the Tendons, and between them and the Skin, or between them and the Bone; the other internally within the Bone itself.  
That which ariseth externally affecteth the Ligaments and Tendons first, and sometimes relaxeth them to such a degree that the heads of the Joints frequently separate from one another, and the Member emaciates and grows useless. But for the most part the Humour over-moistning the Ligaments and Tendons produceth a weakness and uneasiness in the Joint, raising a Tumour externally, and in progress the Membranes and Bones are corroded by reason of the acidity of the Humour; yet it is much hastened, if upon a Supposition of a dislocation they consult the Bone setters.  
In order to the Cure you aught in the beginning of the Fluxion to apply Emplasters of an astringent and drying faculty, empl. de minio, è bolo caesaris, etc. with moderate Bandage, and place the Member in such a position as may prevent the descent of Humours. If Blood abound Venaesection may be admitted, but this Humour requireth Purging with calomel. etc. and Alteration by specific Decoctions, antimon. diaphoret. bez. minerale, etc. In the declining of the Fluxion you must strengthen the Joints by Fomentations and Emplasters of a discutient and astringent quality, summitat. hyperici, centaur. absinth. majoranae, betonic. flor. salviae, anthos. ros. rub. ballast. nuc. cupressi, bacc. myrtill. juniperi, etc. in Wine with the addition of Brandy and Emplaster de sandicis, etc. But if through want of such a Treatment they grow excessively swelled, and the Humour incapable of being pressed back or discussed, you may shrewdly suspect the Bones corroded: for that Swelling is for the most part raised by an Hypersarcosis within, and aught not to be opened without a prediction of a caries; for however it may by a seeming Fluctuation be thought to have Matter, yet upon Opening it will only discharge a Gleet, and the Hypersarcosis will thrust out in a fungus. If in some particular part there do visibly appear Suppuration, and upon Aperture there do discharge an albugineous Matter, you may conclude the Bone under it is rotten, especially if it be hand or foot: and the longer you delay the Opening the more rotten the Bones will be.  
Therefore in such cases make your prediction of the danger, and give vent to the Matter proportionably large (according to the rectitude of the Vessels) to the Bone, and proceed in the Cure as in Ulcers with caries, being careful to keep the Member in a right position that the Joint above it do not contract, as it frequently happens in the Elbow, Knees and Hip. It sometimes happens that those diseased creatures fall into the hands of pretenders to Chirurgery, who by improper Applications raise great tumors, and unadvisedly open them; and not knowing how to dress them suffer the Aperture to be filled up, and overgrown with luxurious Flesh till the Bone rot underneath. It is also as usual in some others of our Profession, when consulted in such cases, (although they know the Bones to lie carious underneath that Hypersarcosis) to advice the leaving them to nature, persuading their Patients that it is the work of Time, and that the assistance by Chirurgery will but increase the Malady. But be assured one rotten Bone cannot cast of another, they may well rot in pieces; but until the Hypersarcosis be removed, and the Bones laid bore, you can expect nothing but Apostemations one after another, and your Patients at length will die Hectic. Therefore when you shall be called to such deplorable cases consume that Hypersarcosis by such Applications as their strength can bear, and make way to the Bone or Bones, and pull out such as are lose, and dispose the other to exfoliate; than by Compress and Bandage press out the Matter, and endeavour to restore the part to its natural smallness; which that you may do, the Ulcer must be well deterged, and the native Heat cherished by discutient and drying Fomentations as abovesaid. The Compresses under the Bandage aught also to be pressed out of a Solution of sal nitri, etc. in aceto. But this Method you may happily cure them, if Internalls be the while prescribed with regulation of Diet, etc.  
The other sort of Abscesses which take their beginning from an Ulcer in the Bone, I have already mentioned in the general Description of the Disease under the name of Spina ventosa: 
Spina vento. sa.  it hath been taken notice of by very few Authors, and I myself succeeded happily in the curing those in the lesser Bones, many years before I knew what to call the Disease. And in truth I do not now greatly approve of the Name, but shall acquiesce in it, and represent it to you as I have frequently seen it in my Practice in the King's-evil, it being a certain species of that Disease, and of no other that I ever saw.  
It taketh its beginning from a thin acid serum in the medullary Juice, 
It's Original.  which corroding the Fibres maketh a solution of continuity there, and at length corrupteth the interior part of the Bone, and at last (if not prevented) corrodes the Shell, and passeth it's subtle Humour through some porosity it had made.  
This Disease of the interior part by degrees usually so affecteth the external Shell of the Bone, as to raise it to a preternatural Tumour, which at the same time overstretching the Periosteum causeth an uneasiness; and this Pain if it grow so acute as to produce Inflammation, an Abscess consequently followeth.  
If the Bone be spongy and soft, it is wonderful to see how quickly the Fibres of it will be mollified by the influence of the serum of the Blood, and made apt for a sudden Distension, as if the part were rather musculare than Bone. So in childrens Fingers I have seen a Bone swelled in a night, and the like Tumour raised in the spongy Bones of elder persons in few days, and without much difficulty to yield again to exsiccant Remedies.  
Yet it sometimes happeneth that the interior part of the Bone is totally corrupted without any external Tumefaction or Pains, till the acid Humour maketh its way through the cortex, and eroding the Periosteum, causeth a Solution of continuity there; which by access of pain swelleth and inflameth the external Parts, and produceth Maturation in few days. Those in the protubeberant Bones do also frequently raise Abscesses after the same manner, and sometimes whilst the exterior Parts suffer under another Ulcer different from this: But of that hereafter.  
Somewhat of their Differences I have showed you in the preceding lines, 
Differences.  others may be taken from the Quality of the serum. In some there is a sudden Tumour raised in a night, in others it swelleth gradually and never corrupteth externally. In others the Humour pierceth through the cortex, and raiseth suddenly an Abscess. And these Differences may be said to arise somewhat from the Place or Bone they affect; for accordingly as the interior part of it is softer or harder, or the external cortex is solid or porous, so it suffers Solution sooner or later. Those of the cranium for the most part pass their way through the interior lamina, and affect the dura mater, etc. producing great Pains, Convulsions, Spasmus, Epilepsies, and they die before the Disease is discovered. In the great Bones of the Knees, Ankles, Elbows, etc. they pass their Matter slowly, and are more generally diseased with Apostemations, externally arising from the protuberance of them. In the Os tali or Heel-bone which is spongy within and full of external pores, they make their way through more suddenly, and so accordingly they do in the Jaws, Fingers and Toes.  
The cause of the Spina ventosa I have already delivered you in short to be the Acid quality of the serum sanguinis in the Bone. 
Signs.  The most visible Signs of it are a protuberance of the Bones without discolouring of the Skin, and often without Tumour or Pain.  
The Apostemations proceeding from the Spina ventosa do most certainly show them, they rising always between the Membranes and Tendons; and somewhat of Fluctuation may be felt there before the external Skin be considerably inflamed: also if upon Opening it you make search with a Probe, you will found it penetrate deep into the Bone, yet is the cortex of it white; whereas the other Abscesses do always begin externally, and if the Bone be bore, yet is it only superficially carious or stained by the Matter.  
The Cure of the Spina ventosa in the lesser Bones, as the Cranium, Jaws, 
Prognostic.  Fingers and Toes is feasable; but those in the bigger Bones are for the most part deplorable. Infants and Children are generally the subject of this Disease.  
In the Cure of these the same Method is required which hath been above proposed 
Cure.  in those Abscesses and Ulcers with caries; as also the same regulation in Diet and other non-naturalls.  
The Topics aught in the beginning to be such as are astringent and drying, as hath been set down in Abscesses, viz. empl. è bolo caesaris, comitissae, deminio simp. etc. cum sapone, de sandicis, & de ranis duplicat. mercurio, with good Bandage.  
If afterwards they pass their Matter externally they must be laid open by Incision according to the length of the protuberance. Those of the Cranium are not much protuberant for the reasons aforesaid, yet you aught to make inspection, and proceed accordingly by Rugine or Trepan as the Symptoms indicate. Those of the Jaws are visible, and require vent by extraction of the Teeth, after which the caries must be consumed by Medicaments of a drying quality, of which the actual Cautery is the most speedy and effectual. Those of the Fingers and Toes are to be laid open by Incision in case of Apostemation the length of the protuberance, and the Bone cut into, and the caries dried up. The Ulcers in the greater Bones aught also to be opened, that the Matter may be discharged, and the Bone laid bore in order to Exfoliation, (if it be possible;) but if the interior part be much corrupted, your best way will be to keep that part of the Ulcer dilated which lieth over the Aperture in the Bone by some Dossill dipped in sp. vini or the like, and heal the rest of the Ulcer, and prescribe such Internalls as may dispose the Body to a better Habit. For these only are the carious Bones which we may leave to time, it being in vain to attempt the Exfoliation of great Bones where the rottenness, as in a Pear, beginning at the core hath consumed the substance of them. How all these are particularly treated by me, you may see in the following Observations of Ulcers with caries.  
We shall begin our Observations with the resolving of Strumae, which generally is a work of Time, and in those which suffer under internal Obstructions of the Viscera it is not so advantageous to their healths: upon which consideration I for the most part endeavour to waste them by Maturation, and the while prescribe Internalls suitable to the Habit of body and complication of the Disease; for if in resolving them the Viscera grow more diseased, it will be imputed to that, and if new Strumae arise the Patient will grow weary and be easily persuaded to consult others, who sometime get the credit of the Cure when the foundation was laid to their hands; wherefore I do not readily engage in this Work till they have tried others, and can willingly submit to my endeavours.  
AN Infant about a month old, 
1. Observat. of Discussion.  the only surviving child of its Parents, being subject to Fermentations of sharp Humours breaking out in the head, face and body, and frequently affecting the internal Viscera, being recommended to my care, I made a fontanel in its Neck, and purged it with syr. de rhab. once in 4 or 5 days, and on the intermitting days gave him a few grains of bez. minerale in a spoonful of white Bread and Milk: his spoon-meat was made in a Decoction of sarsa, ras. eboris, etc. In case of Catarrh or Cough I prescribed him my anodyne Syrup; sometime the acid Humours affected his bowels with a Diarrhaea, (especially in breeding his Teeth:) to remedy which we prescribed diascord. cum pull. rhab. etc. Thus each disturbance was leviated, and the Child thrived. In his 2d. year he fell into the small Pox, and was helped through it by Dr. Tho. Cox; after that the King's-evil appeared in large Glands' on the left side of his Neck: I embrocated them cum ol. ex ped. bovinis, and removed his fontanel into his Arm, also purged him with Rhubarb infused in his Drink, and prescribed merc. diaphoret. his breaking out in his Head was anointed with Bacon-lard, and covered with a Cap made of a Bladder. It was easy for me to have cured all the Eruptions in the Skin with Externalls, but I thought it safer to cure them by sweetening his Blood. The last Symptom which appeared was a swelled upper Lip, at sight whereof I purged him again as aforesaid, and discussed the Swelling. This method of purging with infus. rhab. etc. he continueth to this day, and hath thereby recovered a strong healthy Habit of body.  
A Youth aged about 13 years, of a strong Habit of body, 
2. Observat. of Discussion.  was commended to me, having a Struma of an oval figure on the right side of his Neck; under his Ear he had also an Ozaena, with a thick chopped upper Lip. I purged him with the Infusion of Sena, etc. prescribed in the method of Cure; and afterwards with one of the specific purging Powders, to which I added Calomel, and enjoined him the drinking decoct. sarsaes, lign. guaiaci, etc. with a strict drying Diet, and made him a fontanel in his Arm. I embrocated the Gland cum ol. ex ped. bovinis & aceto, and applied emplastr. diachyl. ireatum malaxed with cerat. oesypi. By this method the Struma relaxed, and seemed to be divided into 3 small Glands, which also resolved soon after. The thick chopped Lip was cured by the anointing it with Merc. praecipitat. mixed with unguent. rosat. after it was cured, I perceived his Nose swelled and hard; I looked upon his Nostrils, and saw them contracted very small, and stuffed with a crusty Matter. I directed some ol. lilior. to be snuffed up into his Nostrils, and the next day caused them to be syringed with decoct. hordei, sem. lini & althaeae, and purged him the day following with extract. rudii and Calomel. repeating it every other day, and continued the drying Decoction, antimon. diaphoret. etc. His Nose being cleansed of its Mucus, I syringed it with one of the Errhina prescribed in the Cure of Ozaena in Lues Venerea, and thereby healed the Ulcers.  
A Child of about 4 years of age was diseased with a Vitiligo, thick upper Lip, 
3. Observat. of Discussion.  and a couple of Strumae on the left side of his Neck somewhat large. I purged him with an Infusion of Rhubarb once in 3 or 4 days, and prescribed him 6 grains of Merc. diaphoret. sometimes, and othertimes Bez. mineral. than removed his fontanel out of his Neck into his Arm. Thus at length the Vitiligo was dried up, and the Strumae totally resolved. His Lip was frequently relaxed upon his purging, but at length it ceased swelling.  
A Maid aged about 12 years, 
4. Observat. of Discussion.  who had formerly been extremely diseased with internal Obstructions of her Mesentery, etc. supposed the King's-evil, was cured by Sr. Fra. Pruj. but after 4 years relapsed, and came to me with several Strumae on both sides of her Neck. I directed the embrocating them with valentia digitalis morning and evening, purging her sometimes with a cathartick Apozem of sena, rhabarb. agaric. hermodact. turbith, polypod. etc. cum syrup. de spina cervi; and in the intermitting days kept her to the drinking of a decoct. sarsaes, lign. lentisc. with some of the antistrumatick Plants prescribed in the method of Cure; with which she took some of the Specificks. There was also prescribed cerussa antimonii, etc. The Glands' sensibly resolved, and she recovered her health.  
A Maid aged about 24 years, of a strong Constitution, 
5. Observat. of Discussion.  came out of the Country to me with many Strumae on both sides of her Neck. I purged her cum pulv. diaturbith magist. with the addition of Calomel. and prescribed her a decoct. sarsaes, Chinae, lign. vitae, etc. which being clarified was afterwards decocted with mel common, of which she drank thrice a day with antimon. diaphoret. etc. During her taking these Internalls, her Neck was for some time embrocated daily with valentia digitalis, and a Cerot was applied ex rad. bryoniae, cyclamin. etc. After she had some weeks experimented the foresaid method, and found relief thereby, she returned into the Country. About a year after she came up to London in a very good condition, and by my advice was again purged, and a Solution of crude Mercury dissolved in aq. regis was added to the said Emplastr. ad strumas: by which, as I have been since informed, those Strumae are near resolved.  
A Maidservant of about 24 years of age, 
6. Observat. of Discussion.  of a Phlegmatic Constitution, came to me with pituitous Swell in her Legs and Thighs. She had been frequently purged and treated rationally by others: but the Swell continuing, she came to me. I advised her to proceed on in the foresaid Course of Physic, and directed her to wear laced Stockings and Trowzes: the former whereof she did make use of with much advantage. But some weeks after she returned to me with many Strumae thrust out on both sides of her Neck, very big, and of different figure. I purged her with pill. cochiae min. calomel. etc. and prescribed her opening Decoctions, with Chalybeats and Antistrumaticks, according to the method of Cure, also directed the embrocating her Neck with valentia digitalis, etc. but had no great hopes to resolve those Glands' whilst pituitous Humours so abounded. The Cure being slow, she grew weary, put herself into other hands, and at length died, I suppose Hydropical.  
A Child aged about 7 years, 
7. Observat. of Discussion and Suppuration mixed.  having been some time diseased with Obstructions in her Mesentery, etc. and a hard Struma of an oval figure movable under her Chin, Dr. Dacre and myself were consulted. We made her a fontanel in her left Arm, and prescribed one of Celsus Malagmas, which we applied on the Gland, and set her down this following Course of Physic: ℞ resinae jalapii gr. 5. calomel. gr. 10. cons. ros. damasc. ℈ ij. cum syrup. violar. q. s. fiat Bolus sumend. mane crastin. cum regimine. ℞ lign. sancti, sarsae, an. ℥ ij. sassafras ℥ j fol. scrophul. filipend. cum toto, an. Miij. betonic. salviae, urticae, malvae, an. Mij. rorismarin. majoran. an. Mj. rad. lapathi acuti, rusci, polypod. an ℥ ij. rad. galangae ℥ j nuc. moschat. ℥ ss. uvar. passular. lb ss. milliped. 500 contund. aliquant. & praeparentur pro sacculo suspendendo in cerevisiae mediocr. cong. 3. & post debitam infusionem utatur pro potu ordinario. ℞ antimon. diaphoret. ℈ ss. sumat in cochl. 1. potus prescript. mane & vesperi. By the application of the Emplaster part of the Gland resolved, and part discharged itself in a thin Humour, fretting through small Pin-holes in the Skin. After it was thus totally wasted, I cicatrized the Frets with unguent. tutiae; during which she recovered her health. Mr. Barnard was her Apothecary.  
A young Gentlewoman about 13 years of age, 
8. Observat. of the effects of Merc dulc. in Children.  Sister to her in the preceding Observation, of a Plethoric body and strong Constitution, was diseased with an Ophthalmia, etc. I prescribed an Infusion of Rhubarb in small Ale to take 3 days, than to take Merc. dulc. gr. 10. sacchar. alb. gr. 6. in a spoonful of White-bread and Milk, and gave her half a dozen papers of the Powder, designing she should repeat the taking them once in 4 or 5 days. She went into the Country, and observed the Directions. She took Calomel. upon a Saturday in Christmass-week: it purged her 3 or 4 times. She slept well that night, and went to Church the next day modestly dressed. The night following she complained of some indisposition, and was gripped, she also vomited and purged often. She continued ill 3 days before I had notice of it. Than Dr. Dand and myself went to her, and found her in bed, subject to a Vomiting and a Tenesmus, with frequent excretion of a Mucus. We directed Clysters of Milk cum vitellis ovor. we also gave her a morsel of an Electuary of diascord. cerussa antimon. cons. ros. rub. confect. alchermes, as it is prescribed in the Treatise of Lues Vener. in such cases. We likewise prescribed her decoct. rad. scorzonerae, corn. cerv. ust. with aq. cinnam. hordeat. She did not complain of any soarness in her Chaps, nor was there any smell of the Mercury in her breath. She rested well that night, and was well in the morning. We returned to London, concluding that her Distemper was the effect of Cold she had taken at Church. Two or three days after I received a Letter, that she was seized again with a Vomiting and Griping in her Bowels. I carried the Letter to the Physician; who concluded her Distemper to arise from the corrosive quality of the Mercury. I replied, it would not than have ceased upon our Prescriptions: besides, her Chaps must than have been soar, which they were not. I concluded, that the Humours drawn inward by her Purging, being checked as aforesaid, still affected her Bowels, and required to be purged of. To which purpose I resolved to carry with me 2 quarts of Barnet-water to purge her. I accordingly went early the next morning, boiled it with Milk, and dissolved some Manna in the first draught. She vomited that presently. I gave her more of the same Water, and plied her with it till she had drank it all. She vomited much green Choler with viscous Phlegm, and her Stools were frequent and bilious. A Clyster was given her of Milk and Yolks of eggs; and that night I laid her to rest with an Anodyne draught. She slept well, had a good Stool in the night, and slept again. She eat a boiled Chicken in the morning, and from that time was no more gripped. I stayed 2 days, and, seeing no Relapse, came away. This was all the ill I ever met with in the giving Merc. dulc. and upon such ill regulation every Cathartick would have done as much.  
A Woman of about 36 years of age, 
1. Observat. of Suppuration.  who had formerly been afflicted with a Strumous Ulcer, came to me, with another of an oval figure, very hard, near the Muscle mastoides. I applied a Malagma of Celsus, with directions to continued it so long as it would stick. In the space of 3 weeks it suppurated it, and fretted a hole, by which the Matter burst forth. I dressed it with unguent. basilic. and empl. diachyl. ireat. as it is prescribed in the method of Cure. There remaining some hardness after the discharge of Matter, I applied again the Malagma, which caused a Suppuration of the remainder: which being permitted to flow forth, I dressed it with Lenients as aforesaid, and thereby cured the Abscess, without enlarging it by Knife or Caustick.  
A Child of about 4 years of age, being internally diseased with a Cough, etc. 
2. Observat. of Struma suppurated.  was put into my hands for Cure of a Struma on the right side of his Neck, near the bigness of a small Pullet's egg. I purged him with syr. diasereos dissolved in a pectoral Decoction, and prescribed Lohoches, also medicated Ale, Bezoard. mineral. etc. Externally I embrocated with unguent. magist. ad strumas, and applied cerat. Agrippin. by which method the Struma resolved, and the Child recovered that Summer in the Country, by repeating the Internalls above mentioned. But about a year after he returned to Town diseased with a large Struma on the same side of his Neck, and internally obstructed with the said Disease. Antistrumaticks were prescribed as formerly in order to the removing those Obstructions; the Struma was suppurated, the Matter let out, and the remaining body eradicated, the Ulcer also disposed to cicatrize. During which the Child not taking those Internalls designed, the Obstructions increased, and he died before the Ulcer cicatrized.  
A Man of about 25 years of age, much emaciated with the King's-evil, 
3. Observat. of Struma suppurated.  being internally obstructed, was commended into my hands. He had externally on the right side of his Neck a great Cluster of Strumae: some of them were inflamed, and inclinable to suppurate; others lying amongst them, and scattering about, were pale and hard. I applied over the whole Tumour some of the Suppuratives set down in the method of Cure; and having concocted the Matter, where I found it at first inflamed, I applied a Caustick the whole length of the Bunch, taking in such a breadth as might serve for the eradicating of the rest. Than dividing the Escar, I gave vent to the Matter, and dressed it up with Lenients. During the digesting of it, I purged him with an Infusion of Sena, Rhubarb, etc. and put him into a decoct. sarsaes, lign. lentisc. santal. etc. with milleped. and some of the antistrumatick Plants, and prescribed him Calomel. with some of the milder Purgatives to be taken once in 4 or 5 days. After separation of the Escar, I saw the Ulcer lying unequal, and by search of my Probe found Sinus' running under one another, some of them deep under the Muscles. They seemed to be made by the unequal Suppuration of the Glands'. Some of the deepest Sinus' I dressed with Dossills' spread with unguent. basilic. and Praecipitate, others I dipped in Praecipitate; some I rubbed with the Caustick-stone, others with the Vitriol-stone; than covered all the Ulcer with Praecipitate, and applied empl. è bolo over all. After I had thus eradicated those Strumae most conspicuous, I divided some of the uppermost Sinus' with a pair of Probe-scissors, and kept the Lips dilated with Dossills' dipped in Praecipitate, till I had wasted those Lips: than I made way to the Sinus', and laid them all open, with Escaroticks smoothing the Ulcer; and raising a basis of good Flesh, I cicatrized the Ulcer even. After I had cured him, I continued the prosecuting of the foresaid Course of Physic with some of the milder Specificks, and directed him to drink Ass' milk; which he did, and thereby recovered his strength, and appetite to stronger nourishment. About 2 months after, this person came to me, complaining of that side of his Neck. Dr. Walter Needham being present, we both looked upon the place where the Strumae had been lodged, and saw that Part and the Clavicle down to the head of the Os humeri much leaner than the other side. I made him a fontanel in that lame Arm, and advised the embrocating the extenuated Parts with axung. humana cum guttis aliquot ol. lavendulae: by the use whereof it plumped, and he enjoyeth a good health to this day.  
A Man of about 45 years of age came to me with a round Tubercle (without inflammation) between the Sagittal and Coronal Suture. 
1. Observat. of Incision of a Meliceris.  I opened it by Incision, and discharged first a yellow Serum, than a gritty Matter like Honey. I wiped away the blood, and pressed out the Matter; than dressed it with Dossills' spread with unguent. basilic. dipped in Praecipitate, and thereby digested out the Cystis; and cured it soon after by the common method.  
A Man of about 30 years of age came to me with an Atheroma on one side the left Temporal Muscle. 
2. Observat. of Incision.  I opened it by Incision, and digested it with mundif. Paracelsi. He had also one near the Coronal Suture, which had been formerly opened by Puncture, and remained sinuous and full of lose Flesh. I laid it open by a snip of a pair of Scissors, and deterged, incarned and cicatrized them both according to the usual method of curing such Ulcers.  
A Gentleman came to me one evening with a Steatoma a little above the Coronal Suture. 
3. Observat. of Incision.  I slit the Skin with a Lancet, and thrust it out with its Cystis, than applied a Pledgit of unguent. basilic. over which he put his Peruke on without farther concern, and cured it himself in few days.  
A Woman of about 40 years of age had 5 of these scattering about her Head, 
4. Observat. of Incision.  all which I cut out: some of them were small, others large. They digested with unguent. basilic. and were soon cured. Sometimes they lie so superficially, that the scratch of a Comb hath made way for their discharge.  
A Child of about 3 years of age was brought out of the Country to me with a Struma on the left Eyebrow, 
5. Observat. of Incision.  of an oval figure. I made Incision upon it according to its length, and, separating it from its Ligaments, thrust it out, than put a small Dossill in its place dipped in a Digestive, with a Pledgit of the same, cum emplastr. è bolo, and Bandage over it. The fourth day after I dressed it again, deterged it with unguent. basilic. and Praecipitate upon a lesle Dossill, and dressed it up as aforesaid. The second day after I left of the use of Dossills', and, bringing the Lips together, dressed them up with the common Sarcotick, thereby uniting them in a few days, and returned the Patient cured with a seemly Cicatrix.  
A Maid aged 18 years had a Struma on the left Brow of the bigness of a Pear-plum. I made Incision into the Skin according to the length of the Brow, 
6. Observat. of Incision.  and separating it, took it out. I dressed it with a Dossill dipped in albumine ovi & pulv. Galeni, and with empl. è bolo and Bandage bound it up. The next day the Eyelid being very much swelled, I embrocated the Parts about cum ol. ros. & aceto, than let her blood, prescribed a Clyster at night, and an Anodyne draught. The day after, finding the Inflammation and Swelling great, and the Wound sanious, I fomented them with decoct. flor. melilot. cham. ros. rub. ballast. etc. in vino rubr. and dressed the Wound with a Digestive ex terebinth. cum vitell. ovi: by which method the Wound digested, and was afterwards deterged with mundif. Paracelsi, and incarned. I afterwards cicatrized it with aq. calcis, etc.  
A Youth of about 12 years of age had a Struma lying under his right Jaw, 
7. Observat. of Incision.  of an oval figure. I made Incision into the Skin according to its length, than separating it, fastened a Ligature under it, and cut it out, leaving the Ligature to digest of. I dressed it with a Digestive ex terebinth. cum empl. è bolo. After Digestion I deterged, incarned and healed it as hath been showed in the former Observations.  
A Young man aged 24 years was brought to me, 
8. Observat. of Incision.  who had a large Struma on the Os frontis, of an oval figure, between his Eyebrows. I divided the Skin, made separation of the Gland, and thrust it out; than cut it of, and dressed the Wound with Pledgits and Dossills' spread with unguent. basilic. dipped in pulv. Galeni, and with Compress and Bandage bound it up. The third day I dressed it again with warm Digestives, and afterwards deterged with the addition of Praecipitate. By lessening the Dossills' it contracted, and I incarned and cicatrized the Lips close, according as is usual in such Wounds.  
A Child of about six years of age had a long white Swelling reaching down from the Os frontis between his Eyebrows to the Ridge of his Nose, 
9 Observat. of Incision.  swelling both sides of his Nose to both the Angles of his Eyes. After various endeavours by internal and external Remedies, he was commended into my hands by Sr. Fra. Prujean and Dr. Wolf. I designed the opening it by Incision according to the length of the Tumour: to which purpose I marked it with ink, and cut into the Tumour as low as might serve to discharge the Matter, with regard to the beauty of the Nose, where the lest Scar is a blemish. There discharged a Matter not unlike the White of an egg, upon which the Tumour sunk. I dressed the Wound with a Digestive ex terebinth. cum vitello ovi upon a Dossill with a Pledgit and an Emplaster over it; applying upon the sides and lower parts of the Nose Compresses of Lint dipped in Oxycrate, to press out the Matter, and retain them close, that they might unite the sooner. By this method the Abscess was digested, and afterwards cured in 10 or 12 days by the common method.  
A Woman of about 28 years of age had a large Struma on the left side of her Neck, of an oval figure and movable, under the Skin. 
10. Observat. of Incision.  I made an Incision the full length of it, and, separating it from the Skin on the sides, pulled it out, tied a Ligature on the Vessels under it, and cut it of, than dressed it up with a Dossill spread with a Digestive ex terebinth. dipped in pulv. Galeni, with Pledgits of the same Digestive over it, and a restrictive Plaster over all, with a retentive Bandage. After Digestion I incarned, and cicatrized the Lips together, according to the foresaid method. 
11. Observat. of Sarcoma cured by Excision.   
A Gentleman aged about 63 years, having been some years diseased with a Sarcoma on his lower Lip, consulted me with Dr. Fielding, an eminent Physician of the City of Gloucester. It had been formerly attempted by Escaroticks and by Exsiccants; but it returned, and thrust forth Excrescences, one whereof was not unlike a Strawberry. They were accompanied with Tumour and hardness, and would not cicatrize by any Application, but grew up, and spread under a crusty Scab, which frequently fell of of itself. We resolved upon the extirpation of it. To which purpose the Dr. prepared his body by Purging, etc. Than in order to the work, the Patient being placed in a Chair to the light, I marked out so much as I designed to cut of; than took hold of the Lip between my Thumb and Forefinger, and pressing the Sarcoma outward, I cut it of with a pair of Scissors: upon which I saw the remaining roots start up in a ridge of lose Flesh. I pressed them upward, and snipt them of. Than, after I had permitted the Arteries to empty themselves awhile, I stopped them by the application of Dossills' pressed out of tinctura vitriol. dulc. and with pulv. Galeni cum album. ovi dressed the Wound up. From that time it bled not more. The third day I took of Dress, and saw the Wound well disposed to digest. I dressed it with Digestives' ex terebinth. etc. and from that time deterged it with Merc. praecipitat. and the Vitriol-stone, cicatrizing it with unguent. tutiae and the Alume-stone, 
12. Observat. of Noli me tangere cured by Excision.  and so it continues to this day.  
A Woman about 30 years of age had a small Gland of the bigness of a Lupine upon her left Cheek a little above the lower Jaw. It had been a long time growing, and of late years was exceedingly painful, periodically pricking and shooting with Inflammation in that Cheek, and would endure no Application. Upon which account she came to London, where she consulted several of our Profession together. They all thought it necessary to be eradicated, but differed in the manner, most of them concluding the actual Cautery properest. I was afterwards consulted with Dr. Tho. Cox, and proposed the extirpating it by Incision, and a week after visited her again; when, in the presence of Dr. Cox, I passed a Needle under the Gland, and cut it of. I dressed it with a Digestive ex terebinth. etc. deterged with unguent. basilic. and Merc. praecipitat. and afterwards cicatrized it with unguent. tutiae, and dismissed her cured.  
A Youth about 12 years of age had a Struma of an oval figure on his right Cheek, 
13. Observat. of Incision.  lying movable between his Jaws, and most capable of being taken out on the inside within his Mouth. I made Incision upon it there, and with my fingers pulled it out, than washed his Mouth with Oxycrate: but it continuing to bleed, I filled the Wound with Dossills' of Lint, and placed a round Bolster dipped in the foresaid Oxycrate between his Teeth and Cheek: I also applied externally a Compress spread with a Defensative with Bandage; by which the bleeding was restrained. I took out the Bolster in the morning from between his Cheek and Teeth, and permitted him to wash his Mouth with a tincture of Roses with syrup. diamoron, and the second day after took the Dossills' out of the Wound: but suspecting that the way of dressing it with them might prolong the Cure, I clipped of the lower Lip with a pair of Scissors, and prescribed him a sanative Lotion of fol. plantag. virg. aur. alchimillae, pilosellae, rad. consolid. & liquiritiae, cum syr. de ros. siccis: by the use of which it cured in few days.  
A Man of about 30 years of age had an Atheroma on his left Cheek, 
14. Observat. of Incision.  which at length made its way externally through a small Orifice, and healed up again. It growing vexatious to him by its frequent eruptions, he put himself into my hands at a time when it was full of Matter. I, feeling the Tumour big within between his Jaws, made a large Incision into it, and discharged a foul Matter with dregss, which shown it a Meliceris. I put my finger into it, and with a Knife in my other hand cut of the nearest Lip as far as it was hollow, and prescribed him a decoct. summitat. equiseti, veronicae, bistortae, rad. iridis, consolidae, etc. to wash his Mouth: by which he was cured, and from that time relapsed not.  
A poor fellow of about 40 years of age came to me with a large white Tumour upon the right Cheek reaching close to the tip of his Ear, 
15 Observat. of Incision.  supposing it was the King's-evil. I put my finger into his Mouth, and feeling it big within, and the Matter fluctuating, I thought it Atheromatous; yet for more security opened it by Puncture. It discharged a bloody Serum. I permitted it to empty itself, (it being towards evening) and contented myself in stopping it up with a Tent of Lint dipped in albumine ovi, applying a restrictive Emplaster and Bandage on the external parts. The next morning, finding the external Tumour sunk, I took out the Tent from within, enlarged the Opening, and thrust out a foul Matter like dregss of Beer. I cured it in few days, after the same method that hath been showed in the former Observation.  
A Tradesman aged about 30 years came to Dr. Walter Needham and myself (while we were dressing a Patient in the City) with a large soft Tumour within his right Cheek near his Mouth, much distorting it, 
16. Observat. of Incision.  so that it hindered him in eating his Victuals: it was overspred with a Varix; which ill aspect, I suppose, had deterred the Surgeons whom he had consulted from meddling with it. But we concluding it a Species of an Atheroma, I opened it by Incision by the side of that Varix, and discharged a proportionable quantity of Serum, and crushed out a Cheesie substance. Than considering that the overstretched Lips of the Abscess would by falling between his Teeth be very troublesome, I cut them away, laying the Abscess open: after which I gave him Water and Vinegar mingled together, to wash his Mouth, and prescribed him decoct. veronicae utriusque, salviae, betonicae, flor. ros. rub. with a Solution of mel ros. to gargoyle it: and by the touching it sometimes with a Vitriol and Alume-stone, it was deterged and cicatrized in few days; his Cheek also contracted, and became natural as the other.  
A Man of about 24 years of age came to me with a very large soft Tumour under his upper Lip near his Nose, with very great deformity. 
17. Observat. of Incision.  He had tried the endeavours of the Physicians and Surgeons in the Country by internal and external Remedies, and earnestly desired my help. I, concluding it Atheromatous, proposed the opening it: which he submitting unto, I passed a Knife deep into it, and gave vent to at lest a Bloud-porrenger full of serous Humour. Upon consideration of the quantity, I made a search with a Probe, and felt a large Opening into the Cavity of the Maxilla superior; but supposed nature would dispose it to heal, if the Orifice were a while kept open. To which purpose I immediately enlarged the Orifice by Incision the whole length of the Abscess, and gave him of the Decoction prescribed in the former Observation to wash his Mouth. He stayed 3 or 4 days in Town, and shown himself to me. The Abscess being well disposed to cure, I permitted him to retire to his house in the Country, and prosecute that method. Whilst he was there, the Orifice closed, and the Part grew painful and swelled again; upon which he returned to me. I opened it, and discharged a well-concocted Matter, keeping it dilated with a Tent dipped in syr. de ros. siccis. By this way of dressing the agglutination of the Ulcer was prohibited, and the Abscess was drained. He returned back into the Country, and I suppose was thereby cured; for I heard no more of him. 
18. Observat. of a complicated Tumour taken out by Incision.   
In the time of the last great Sickness, whilst I was in the Country, a young Woman was brought to me who had a large unequal Tumour near her Neck, movable, and without Inflammation. I, designing to take it out by Incision, prepared Dress ready, and had 2 Women, and a Boy that I had taken to attend me that Journey, present to assist me. During the separation of the Skin from the Wound, it bleeding, my two Women left me, and the Boy dropped down in a Swoon: the Patient also growing froward, and the work of Separation being not very easy, I was put upon a necessity of cutting into the Cystis the whole length: in the doing of which there discharged about half a large Porrenger-full of materia purulenta: after which, putting in my hand, I pulled out a hard body of Suet. It was a Steatoma, and weighed 9 ounces and a half. Than I filled the Cystis with Stupes of Tow dipped in a mixture of unguent. basilicon and ol. terebinth. hot; and bringing the Lips of the Wound over it, applied an emplastr. è bolo, with convenient Bandage, to retain the Dress, there being no appearance of its bleeding. The fifth day after I returned thither again, and dressed it as before, the Wound digesting well. The fourth day after, dressing it again, and seeing the Cystis lie lose, I pulled it away with the Dress; and perceiving the Wound within fresh, I brought the Lips flat over it, and healed it in few days by Agglutination. I did not design the leaving this Cystis behind when I began the Operation; but am satisfied that it is the easiest and most safe way in great complicated tumors, where there is danger of a flux of Blood, and much to be preferred before that Mountebank-way of Abscision with Ligature in every respect.  
A person of above 60 years of age, 
19 Observat. of a preternatural Tumour taken out of the left Breast by Incision.  of a corpulent full Body, had a round movable Tumour on his left Breast of the bigness of a Chestnut. I divided the Skin by Incision, and, finding that Tubercle lying in its Cystis, I easily thrust it out by passing a Spatula under it; than dressed up the Wound with a round Dossill spread with the common Digestive ex terebinth. cum vitell. ovi, with empl. è bolo over it. The third day I dressed it again, lessening the Dossill. Thus the Wound digested, the Lips contracted and incarned, and healed in few days. In this Cystis was contained a Trash not unlike Hair or Wool. This person was subject to these preternatural tumors. He had one caused by the Waist-band of his Breeches, which I afterwards cut out: it contained the same kind of Trash.  
Whilst I was attending a Person of Honour in the Country, 
20. Observat. of a complicated Tumour in Inguine taken out by Incision.  I was desired by an Apothecary in the neighbourhood to look upon an elderly Woman, who had a very large unequal soft Tumour in her right Groin. I concluded it complicated, and at their desire opened it, and discharged about the quantity of a Pint of a brown trashy Humour: whereupon the greatest part of the Tumour was voided; but what remained of it lay as it had been a coverture to a cluster of Damascens. I enlarged the Orifice, and found these so many Bladders containing several sorts of Trash in them, some whereof was melicerous. I pulled them out, and tore a thick Membrane which had divided the Abscess into several partitions; than dressed it with Stupes of fine Tow spread with mundif. Paracelsi, which I dipped in Praecipitate, and bound it up. The fourth day I dressed it again; and, seeing it digested, I dressed it with some of the same Mundificative dipped in mel rosar. and embrocated the Parts about cum ol. ros. By this method the Abscess deterged, and the Tumour lessened: by which time having done my business in that Noble Family, I left the Cure of the Woman to the Apothecary, who finished it.  
A Maid aged 24 years came to London diseased with a large Struma, 
1. Observat. of Struma eradicated by Caustick.  of an oval figure, lying on the left side of her Neck deep amongst the Muscles and Tendons. After evacuation by Purging, designing the eradicating it by Caustick, I marked out the place with ink, drawing 2 lines down the length of it, about a finger's breadth from one another: than defending the outsides with Snips of Plasters, I applied Pledgits spread with my caustick Unguent in the voided space, with emplastr. diachalciteos, Compress and Bandage. The next day I divided the Escar, and rubbed into it with a Caustick-stone and Stick dipped in ol. vitrioli interchangeably, till I had penetrated deep into the body of the Struma. Than I cut through that Escar, and dressed it up with unguent. basilic. malaxed cum ol. terebinth. embrocating the Parts about cum oleo ros. & aceto. I than dressed it up with empl. è bolo. The third day I took of Dress, and fomented it with decoct. fol. althaeae, malvae, summitat. abrotoni, flor. sambuci, sem. lini, etc. and dressed it with Lenients as before, to hasten the separation of the Escar. After I saw the Escar digest, and somewhat separated in the bottom, I rubbed into the Struma again with the Caustics, penetrating deeper into each part of it, and dressed it up with Lenients, and so dismissed her. About an hour after, the Escaroticks penetrating some Artery in the Gland, it bled through the Dress very much, and continuing so to do, she was brought back to my house in a Coach: at which time I was in the next Street with Dr. Walter Needham, experimenting the Royal Stiptick-Water. We hastened to this Patient, and seeing her bleed, we took of the Dress, and applying Dossills' dipped in the Styptic, immediately stopped it. I dressed the Escar with Lenients, and a Restrictive over it. The fourth day after I took of Dress, and applied Lenients again. After the separation of the Escar, seeing the body of the Struma consumed, the sides only remaining, I filled with Praecipitate, and kept the Orifice dilated till they were totally wasted; than permitted the Ulcer to incarn, and afterwards brought the Lips of the Ulcer close together, and cicatrized them with unguent. desiccativ. rub. etc.  
A Gentleman aged 30 years, of a tolerable good Habit of body, 
2. Observat. of the like.  had been long diseased with a hard Struma, of an oval figure, seated under the lower Jaw on the right side. After he had vainly endeavoured by various Applications to resolve it, he put himself into the hands of Sr. Alex. Fras. and myself. We proposed to eradicate it by Escaroticks: to which purpose his Body being prepared by Purging, we began our Chirurgery with the application of a Caustick the length of the Struma, and the next day divided the Escar, fomenting the Tumour with a Decoction of absinth. flor. cham. ros. rub. ballast. etc. than filled up the divided Escar with pulv. sine pari of Sr. Alex. Fraser's prescription, applying Pledgits of unguent. basilic. cum ol. ros. over it. The second day after I fomented and dressed it up again with Lenients and continued that method till the Escar made by the Escarotick began to separate: than I thrust it of, and filled it again with pulv. sine pari. By this way of dressing, sometimes with Escaroticks, and othertimes with Digestives, we consumed the main body of the Struma, and afterwards digested out the Cystis with Merc. praecipitat. than permitted it to incarn by lessening the number of the Dossills', and at last cicatrized it with a small Seam by the help of the Vitriol-stone and common Epuloticks.  
A Man aged 20 years, of a Phlegmatic Constitution, 
3. Observat. of the like.  came to me with a large Struma, of an oval figure, lying under the lower right Jaw. There were also some little ones lying higher up nearer that Ear. The bigger of these had not appeared worth taking notice of till within six weeks of the time that he came to me. I began with the application of valentia digitalis, and purged him frequently with pulv. diaturbith, pill. cochiae min. calomel. etc. The Tumour increasing, I applied more powerful Resolvents, as emplastr. diachyl. ireatum cum gummi, etc. by which, after some time, it tended to maturation; and than I proceeded that way, purposing not to open it till the whole Struma should be suppurated. But he, impatient of the delay, shown it to some other, who opened it whilst the Suppuration was superficial; so that presently after the discharge of the Matter it hardened again, and grew difficult of Cure. The Patient returning to my hands, I took of the Dress, and seeing the Tumour large and hard, the Orifice small, and a Tent in it, I pulled it out, and filling the Orifice with Lint, applied a large Caustick according to the length of the Gland. The next day I divided the Escar, and filled the incised part with turbith mineral. and applying Pledgits of basilicon over the Escar, dressed it up with empl. è bolo. After the separation of the Sloughs, I dressed it every other day with Merc. praecipitat. Vigon. repeated Purgatives, and prescribed him decoct. sarsae & lign. guaiaci, with Antistrumatick Plants, for to drink thrice a day, also cerussa antimonii, and some of the testaceous Powders, to be taken as often. During the application of Praecipitate and the milder Escaroticks, I made but small progress: wherefore to hasten the extirpation of it, I applied a troch. de minio the whole length, with Dossills' spread with Lenients over it. At the next day's dressing I found the troch. de minio had made a great penetration into the Gland, but with excessive pain, inflammation and tumefaction of the Parts. I fomented it with Milk, dressed the Escar with Lenients, and applied an anodyne Cataplasm ex fol. malvae, bismalvae, panis triticei, etc. by which the Tumour relaxed, but those Strumae near the Ear appeared bigger; which foreshowed the danger of proceeding farther with Escaroticks of Sublimate. I embrocated them with valentia scrophulariae, and hastened the discussing and drying up of the inflowed Humour by a Fomentation of summitat. absinth. majoran. flor. ros. rub. ballast. etc. During the separation of the Escar there appeared daily an increase of a well-digested Matter, and after the Escar cast of, the Matter issued out above and below under the Gland. The way to remove these Sinus' was to extirpate the Struma; which I presently did, by rubbing it with the Caustick-stone and Oil of Vitriol interchangeably. After I had removed it, and wiped of the lose Sloughs, I dressed the Escar with a mixture of unguent. basilic. & ol. lilior. hot, and kept the Lips of the Ulcer dilated with Dossills', than embrocated the Parts about, applying over all empl. è bolo. After the separation of this last Escar, there appeared part of the Struma lying on one side, which I afterwards wasted by the application of Praecipitate and the Vitriol-stone, than lessened the number of my Dossills', and permitted the Ulcer to heal up; during which I repeated Purging, and advised Embrocation of the lesser Glands. He was hastened into the Country: but of late years I have seen him very well, and those lesser Strumae wasted.  
A young Gentlewoman, 
4. Observat. of the like.  Scrofulous and full of fancy, came out of the Country with a large Struma on the right side of her Neck, lying under that Maxilla, not unlike that in the former Observation. It had been attempted in the Country superficially, and healed up again, with the Skin adhering to it. She had consulted several of my Profession in the City, and was curious in the informing herself how I would proceed in the taking it out. I offered to her the several ways proposed in the method of Cure, but more particularly the way by Incision. She objected against that way, having (it seems) been told that it might prejudice that Eye. I, supposing she urged it out of fear of having it cut, did not farther insist upon it: for indeed the very proposal of cutting generally frights people from us. Some time after she took a Lodging near me. I began the work by the application of a Caustick the full length of the Struma, divided the Escar, and filled it up with Merc. praecipitat. Vigon. than embrocating the Parts about cum ol. ros. & aceto, I dressed the Escar with unguent. basilic. and applied empl. è bolo over all, repeating this way of dressing every third day, and fomenting it with decoct. absinth. flor. ros. rub. ballast. baccar. myrtill. nuc. cupress. After the Escar separated in the middle, I thrust in a troch. de minio, and dressed it up as aforesaid. The next day she complained of her ill night's rest, and shown me the Tumour and Parts about inflamed and swelled. I fomented them with Milk, dressed them up with Lenients, and let her blood in the Arm. The next day I purged her with an infus. senae, rhab. etc. and afterwards with a cathartick Apozem. Which method aught to have preceded, if she would have admitted it. As the Sloughs cast of, I strewed in Praecipitate, and touched it sometimes with a Vitriol-stone. Having thus penetrated under part of the Struma, I raised that part up, and thrust it out in pieces with a round-pointed Knife fitted to that purpose, than dressed up the remaining Struma with the milder Escaroticks. From the time I applied that troch. de minio, she complained that her right Eye was lesle than the other, and was so possessed with the thoughts of it, that I was glad to refer it to the judgement of what Physicians she pleased. Whereupon Dr. Glisson, Dr. Tho. Cox, Dr. Stains and Dr. Walter Needham were consulted. By this her Surmise I had the honour to have my work approved by so many knowing persons, and she was the more encouraged to admit of my proceeding. The Cure was effected afterwards in the space of 3 weeks to her satisfaction: yet she would not be dissuaded but that Eye was lesle than the other. About a year after I saw her again in the Town, and felt a small Gland of the bigness of a Lupin lying lower on that side of her Neck. I would have persuaded her to admit of a resolvent Emplaster, and to be touched: but she did not (as she said) believe it to be the King's-evil.  
A person of about 19 years of age had many Strumae on both sides of her Neck, one especially very large on the left side, 
5. Observat. of Strumae extirpated by Caustick.  reaching from her Ear downwards, of an oval figure. The extirpation whereof having been attempted in the Country by Knife and Escarotick unsuccessfully, she was brought to London, and put into the hands of Dr. Walter Needham and myself. The Physician began with the purging her by this: ℞ tamarind. ℥ ss. fol. senaeʒiij. rhab. ʒi. sem. coriand. ʒss. infund. in aq. font. q. s. ad ℥ iiiss. add. mannae oped. ʒuj. syr. de spin. cervin. ℥ ss. aq. menthaeʒss. Misc. & fiat potio mane sumend. cum regimine. She was afterwards frequently purged with this: ℞ rhab. senae, an. ℥ iij. hermodact. ℥ ss. zinziber. ʒiij. passular. exacinat. lb j. Misc. S.A. & fiat sacculus pro 3 congiis Alae recentis. There was also prescribed her as followeth: ℞ lign. guaiaci ℥ ij. court. ejusdem ℥ j sarsae, sassafr. an. ℥ ij. Chinae ℥ iij. infund. & coquant. in aq. font. q. s. ad lbix lbix. deinde rad. scrophular. maj. filipend. an. ℥ iij. passul. maj. ℥ ij. glycyrrhizae ℥ j coletur pro potu ordinario. ℞ olibani, matricariae pulv. subt. an. ℥ j sacchari alb. crystallin. ℥ ij. Misc. & fiat dosis una mane, & altera horâ quartâ pomerid. in cochlear. decoct. superscript. & superbibat haustum, quartâ quoque nocte capiat pill. stomach. è gum. ℈ ij. in 4 pilulis, pergat ad 20 dies. After her Body was thus prepared, we designed to have taken out the Struma by Incision: but it lying deep, and the upper part of it being grown to the Skin by reason of the former attempts, we applied a Caustick according to the length of it, defending it from spreading. The Escar being made as we designed, I divided it, and began to raise it of, with intention to take out the Struma: but she growing impatient of the smart, I rubbed deep into the body of it with a Caustick-stone, and filled that Escar with Merc. praecipitat. applying Pledgits of unguent. basilic. over it; than embrocating the Parts about cum ol. ros. & aceto, dressed it up with empl. è bolo, Compress and Bandage. The 4. day we opened it again, and repeated the use of the Caustick-stone and ol. vitrioli interchangeably, penetrating thereby deep every way into the Strumae; than dressed it up with Lenients as before. By this way of dressing we eradicated the Struma; and afterwards, by rubbing it with the Vitriol-stone here or there where any little relic of it appeared, and dressing it with Dossills' dipped in Merc. praecipitat. we digested it. I being than obliged to a journey into the Country, left the finishing the Cure to my Kinsman Jaques Wiseman, who, by lessening the Dossills' gradually, permitted the Ulcer to heal within, and by Epuloticks and Bandage brought the Lips to unit; so that at my return I saw it cicatrized smooth and narrow, and the Struma totally eradicated. The other Struma, which had been big, seemed also well-nigh resolved: yet upon the cicatrizing that Ulcer she was seized with an Erysipelas on her Head and Face, which swollen them extraordinarily; but by purging the Physician removed that.  
A young Gentlewoman about 18 years of age, 
6. Observat. of a Struma extirpated by Caustick.  having been long diseased with a Struma on the left side of her Neck, reaching from her Ear down under her Jaw, and frequently subject to Catarrhs, and sometime Coughing of blood; I began the extirpation of it by the application of a Caustick the whole length of the Gland. In dividing the Escar there discharged a small quantity of an albuginous Matter. After the separation of the Escar, a Cheesie substance came away, and the Gland lay hard underneath. I filled the Abscess with Praecipitate, and kept the Lips dilated with Dossills', repeating this method of dressing her every third day: during which Dr. Micklethwait was consulted, and prescribed Internalls accordingly as he saw her obstructed. He met with many difficulties in the removing those various Distempers arising from the acid quality in her Blood, it dissolving her Flesh, and threatening a Marasmus. By the continued use of the Praecipitate the strumous Flesh seemed to me consumed, and the Ulcer well disposed for incarning: when one day in dressing her I beheld a small white Bleb of flesh in the middle of the Ulcer, and pressing upon it with my Probe, penetrated deep into it. I pulled out the Probe again, and bending it passed it into the said Sinus, and thereby discovered it hollow both above and below: by which it appeared I had incarned upon a false foundation. I passed a Director into the said Sinus, and laid it large open the whole length. The work was neither painful nor bloody. I filled up the Sinus with Dossills', rubbed the spongy Lips with the Vitriol-stone, and covered the Ulcer with Praecipitate, keeping the external Lips dilated as at first I had done. By the repeating this method the strumous Flesh was consumed, and the Ulcer smoothly cicatrized. But about a month after there appeared a Swelling in the same Part, to the great disturbance of my Patient: but it was only a Flatulency, which I soon discussed by the application of Discutients. From that time she hath been free of that Malady. She continued longer under the Physician's care, and at length, by his endeavours and the fresh Air, she recovered her health and strength, and is since a happy Mother.  
A Man of about 30 years of age, 
7. Observat. of a strumous Tumour above the right Scapula.  of a tolerable good Habit of body, came to me with a strumous Tumour a little above the right Scapula. It had been of a long continuance, and some years before it had suppurated, and was opened by some neighbouring Chirurgeon: but he not throughly eradicating it, it grew again, and was very large, the Skin adhering to the upper part of it. I applied a strong Caustick on it; which having penetrated deep into it, I divided the Escar, and applied troch. de minio to it, than dressed it up with Lenients. After the separation of this latter Escar, I rubbed it with a Caustick-stone under the edges of the first Escar, and into the basis of it, and interchangeably pressed into the body of the Gland with ol. vitrioli; than wiping away the lose Sloughs and blood, I filled it up with Merc. praecipitat. Vigonis, and dressed it with Lenients. After the separation of these Sloughs, I thrust out pieces of the strumous Flesh with the end of a Spatula somewhat bended and sharpened to that purpose. Thus I extirpated this great body of the Gland, and by the use of the Vitriol-stone and Praecipitate I deterged and cicatrized it smooth; and so it remaineth to this day.  
A Maid aged about 18 years came recommended to me out of the Country with a cluster of Strumae lying behind her left Ear, 
8. Observat. of Strumae. and Sarcoma extirpated by Caustick.  along the Musculus mastoïdes, down to the Clavicle. She had also a Sarcoma on the inside of her left Ankle. Sr. Fra. Pruj. prescribed her a Course of Physic, by which her Body being prepared, I began with the extirpation of the Strumae by the application of a Caustick from the uppermost part near the Ear downward, making the Escar about half an inch broad, than dividing it filled the Ulcer with pulv. sine pari of Sr. Alex. Fras. and applied Lenients over the Escar with empl. è bolo. The next day I stuped the Tumour with decoct. malvae, violar. etc. and dressed it up with Lenients, continuing that way of dressing till the Slough which was made by the pulv. sine pari separated: than drawing the Lips wider open, and finding that I had penetrated into the body of the Strumae, and that some of them lay lose, I passed in my bended Spatula, and thrust part of the Cluster out, some in pieces, others whole in their Cystis. That done, I wiped away the blood, and filled the Cavity with Merc. praecipitat. applying Dossills' of Lint and Lenients over all. By this method of dressing I extirpated the Strumae, and disposed the Ulcer to cure. During this I began with the Tumour on the Ankle, and having applied a large Caustick upon it, I made an Incision into it, and discharged a bloody Serum in some quantity: yet the Tumour did not sink. I filled up the Incision with troch. de minio, and dressed the Escar with Lenients, empl. è bolo, and Bandage. The fourth day after I took of Dress, and, finding all well, repeated the application of Lenients, to hasten separation of the Escar; which in few days cast of, and the fleshy body within appeared to be a Sarcoma. I filled it with Sr. Alex. Fras. his pulv. sine pari, and dressed it again as before with Lenients, Compress, and good Bandage. These fleshy tumors were not of so acute sense as the most sorts of Strumae are, but more difficult to extirpate, by reason of the many Veins and Arteries which branched through the body thereof, and rendered it apt to bleed, and increase faster than I could take it down by Escarotick powders. Upon which consideration I proposed the actual Cautery: but that not being admitted, I made up some Trochisks de minio with a double quantity of Merc. sublimat. in the form of Tents; and as the Escars separated in any part thereof, I thrust in a Trochisk, which always caused the blood to burst forth: but by the application of the pulv. sine pari with Dossills' dipped in albumine ovi, with good Compress and Bandage, I stopped it. By this method I made way deep into the body of it: yet between the Trochisks and in the circumference it did rise upon me; which put me upon a necessity of using the Caustick-stone and ol. vitriol. The use of these several Escaroticks caused excoriation in the neighbouring Parts, which obliged me to dress them the oftener with Refrigerants, unguent. alb. camphorat. etc. Having thus extirpated the Sarcoma near its basis, I left of the use of the Trochisks, and for some days applied pulv. sine pari Jo. Ardern. it being more powerfully drying, and lesle corrosive; than applied a Malagma of Celsus in the form of a Cake round over it, with Compress, and laced on a straight Sock, to keep all fast. After I had thus wasted the Sarcoma, I dressed it with Merc. praecipitat. unguent. tutiae Vigonis, etc. and by the help of the Vitriol-stone, aq. calcis, and the like, I smoothed and cicatrized the Ulcer. That of her Neck curing some weeks sooner.  
One about 11 years of age, of a sickly Constitution, 
9 Observat. of Struma with a fungus of an Artery.  was brought by her Friends to Sr. Fra. Pruj. He consulted me in the extirpating a Strumous Tumour upon the Aspera arteria. It was composed of many several Glands, in the middle whereof one lay much more protuberant, of the bigness of a Hand-ball. It was to my judgement Atheromatous, but somewhat more tense; and I thought I felt Pulsation in it, but so small, that I doubted whether it were not rather in my fingers: however, I desired a Chirurgeon might be consulted; who accordingly was fetched, and concluded it an Atheroma. We agreed in the opening it by Caustick, and by eradicating that to make way for the remainder. After the application of the Caustick we met again, and seeing the Escar almost large enough to take out the Tumour whole in its Cystis, we divided it, and began with our Knives to separate it: but the Child feeling it smart, and the blood trickle down, it hindered our farther proceeding that way, so that we only cut of the lose Escars, and dressed it up with Lenients. The third day Sr. Fra. Pruj. met us there as we were taking of Dress. The Cystis appeared to me the thickest and strongest I had ever seen. I could not think it was made to contain an Atheromatous Matter. I felt it again, and was contented to believe the Pulsation I there felt might be in my finger's ends; however I resolved to proceed warily; and to that purpose made a Puncture into it with a French Lancet, upon which a florid blood trickled forth. The Apertion being small, it stopped by the application of pulv. Galeni cum album. ovi, and we left her. The next day the Chirurgeon and myself met, and, considering the Cystis being disrobed of her natural Tegument, the Skin was not like to be re-invested with it again, we proposed to proceed timely in the preventing an effusion of blood. The way we designed was by Escaroticks, viz. pulv. sine pari. The next day we took of Dress, and covered the Cystis with the foresaid Powder, applying Restrictives over all the Part, it being incapable of strict Bandage. Against the next eruption we provided all things ready, both actual and potential Cauteries; yet with consideration not to dress her till we were necessitated. The second morning after we were both called early out of our beds by a messenger, telling us she had bled the most part of the night. We dispatched our Servants away to prepare Dress, and hastened after, and taking her out of her Bed placed her in a Chair. I stood behind her to hold her steady, and had one Servant near me with a Dish wherein were several Escaroticks, some stronger than other, also of different sizes and shapes. My brother Chirurgeon had his Servant near him attending the actual Cauteries in the fire. In taking of the Dress, the blood burst forth with such a gush as gave no leisure to call for an actual Cautery, nor was there possibility of using it with any advantage. I presently thrust in a piece of Merc. sublimat. and pressed a Pastillus of Celsus close upon it, and held it so with my hands; which stopped the bleeding in a moment. I held my hands on it till we judged the Escarotick had secured the bleeding: than they cleansed the Parts about with a Sponge, and refreshed the Patient with a draught of a cordial Julep: after which the Restrictives were applied one over another over her Throat, up both sides of her Neck. I kept my hands upon them till they were dried fast on. Than we put her on a Crevat, and laid her again in bed. It did not bleed; but she complaining daily of pain more and more, we agreed to dress her the fourth day. I attended than with our Servants, preparing our Dress, to stop the blood and heal the Excoriations. My Copartner not coming, I took of Dress, with design only to dress the Excoriations: but they came all of together, bringing with them a very thick Escar. While I was looking upon the Fungus, I saw the blood rise out of it in many places, as if it had been pricked with a Lancet. Those drops immediately enlarged their way, and bled forcibly in so many Streams. At first sight of it I applied a piece of Merc. sublimat. The blood burst forth between my fingers a while; but upon the applying a proportionable Pastill over the Sublimate the bleeding stopped. Whilst I continued my hands upon it, my Servant wiped away the blood, and dressed the Excoriations with unguent. alb. camph. etc. and applied the Restrictives over all as before: which being dried on, a Crevat was put on, and she placed again in her Bed. From this Dressing I grew confident of success, the former Escar appearing extraordinarily thick and large, as well it might, considering the Caustick, (which was such as I would not advice to use in any case where there may be the lest hopes to save their lives without it.) Where the Opening is small, a Finger may stop the bleeding of an Artery: but in a Fungus so branched, in a place so incapable of Bandage, what could have resisted such a gushing forth of blood but Merc. sublimat. whose force is far more penetrating in such Fungi than a hot Iron? especially considering how the blood would have dulled it by the way. The use of the Sublimate this second time caused a Fainting and Palpitation of her heart: in which case Sr. Fra. Pruj. came again, and assisted us by his Prescriptions; yet it terminated in a Ptyelismus. The fourth day after this we met all together, and took of her Dress, whereupon was separated a thick white Escar; the remaining body appearing like a glandulous Flesh, somewhat hard, and of the bigness of a small Chesnut. It bleeding not more, we dressed it with some of the milder Escaroticks, and the Excoriations with refrigerant Epuloticks, with Emplasters of diachalcit. etc. we wasted that Fungus, and also healed the Excoriations in the space of 3 weeks. There was a fair opportunity of extirpating the remaining Glands': but the Relations suspecting perhaps that new mischiefs might hap from some branches of the same Artery, we cured this Ulcer, and left the extirpation of the other to farther consideration.  
A Maid aged about 30 years, of a tolerable strong Constitution, 
10. Observat. of Bronchocele.  came to me with a complicated Tumour lying on the left side of her Neck, from her Ear to the Aspera arteria, and so stretching over it upward to the other side of the Neck. It was soft, and seemed to be full of Matter, but without Inflammation. I made a Puncture into the body of it, and discharged a stinking Serum not unlike Horse-piss. That being let out, the Tumour sunk, and felt unequally hard. I dressed it up with a Pledgit of unguent. basilicon and empl. diachalcit. The next day, taking of Dress, and seeing the Swelling lank, I applied a Caustick the length of two inches, about 3 finger's breadth distant from the Ear: the Escar I divided, and discharged a foul Matter, and afterwards dressed it up with Dossills' dipped in Merc. praecip. with Lenients over the Escar; and from that time hastened the falling of of the Slough. After the separation of it, I thrust out a different sort of Matter, not unlike that of an Atheroma and Meliceris mixed together. I passed in my Probe-scissors, and laid it open downward to the Aspera arteria, and pulled out with my fingers several Vesiculae, some containing a foul Serum, others a gritty substance. There also came away gobbets of Flesh, with which the basis of the Abscess seemed to be covered. Having thus cleansed it, I filled it up with Dossills' dipped in Praecipitate, and kept the Lips dilated; repeating this method of dressing every other day, and rubbing the strumous Excrescences with the Vitriol-stone. The Sinus contracted narrower within; but the original of this Tumour being Strumous, it would not heal whilst there remained any hollowness, but filled with that sort of Flesh, and raised a Tumour. Upon sight whereof I applied a Caustick upon the upper part towards the Ear, and divided it with a pair of Scissors, than filled the Sinus with Merc. praecipitat. dressing the Lips of the Ulcer with Digestives. After the Escar separated, I applied my endeavours to eradicate the strumous Flesh with the Vitriol-stone and Praecipitate, and cicatrized it from the Ear downwards; yet not without some difficulty, the basis proving false more than once in one part or other. Some of this strumous Flesh rising amongst the Vessels, and uniting over them, made Sinus' so deep, that I much doubted how to divide those without danger of these Vessels: but there being no Cure to be expected whilst this remained, I passed a Ligature with a small Probe under the Fungus, and by Deligation of it, and application of Praecipitate, I consumed the Fungus, and laid the deepest of them open; and afterwards by the application of Epuloticks brought a Cicatrix upon them. Having thus well-near healed the Abscess to the Aspera arteria, I laid the other side open, and eradicated that part by the same method as the former, and cicatrized it smooth.  
One of about 14 years of age came out of the Country recommended to Sr. Alex. Fras. with a complicated Tumour of a great bulk on the left side of her Neck and Cheek, 
11. Observat. of Bronchocele.  arising under her Ear. It had been growing many years, and was without Inflammation. Her Body being prepared by a purging Apozeme, and Antistrumaticks prescribed by her Physician, he commended the extirpation of it to my care. Accordingly I met him at her Chamber. We designed the taking it out by Incision; and to that purpose, having all things ready, I made Incision into it. But the blood trickling fast down, we forbore the Operation that time, and dressed it up with Astringents. The second day after we met again, and in taking of the Dress saw it had not bled, nor was there any Pulsation to be felt in it whereby we might suspect any considerable flux of blood. What did flow proceeded, as we supposed, from some small Fungus. Upon which consideration we resolved to eradicate this preternatural Tumour by Escaroticks; and began with the application of a strong Caustick on the middle of it, according to the length of the Tumour. The next day we divided the Escar, and filling it full of his pulv. sine pari, I embrocated the Parts about, and dressed the Escar with unguent. basilic. etc. By the application of this Powder we penetrated into the body of the Tumour: and after separation of the Sloughs, seeing no danger of its bleeding, we repeated the use of the pulv. sine pari: and having thereby discovered the Tumour to consist of many several Species, viz. Strumae, Atheroma, Meliceris, and Steatoma, we laid it more open by Incision, and with a crooked Spatula and our fingers pulled out some of them in pieces, others whole in a Cluster, than filled it again with the said Powder, and dressed the divided Lips with Dossills' spread with Digestives. By this method we eradicated this great body: but in our approaching near that part of her Cheek which had bagged so long time between her Jaws, we found it penetrated, and the Liquor she took in her mouth diffusing itself into the Abscess, also the Matter made in the Abscess discharging itself into the Mouth. Whether this Opening was made by the Teeth, or fretted by the acrimony of the Humour within, I shall not dispute; but it contributed much to the forwarding of the Cure there: for by Injections detersive and drying we cleared that part of the Ulcer, and cicatrized it with the external part of the Cheek so close, that her Jaws were at liberty to chew her meat, which they had not been in a long time before. The last difficulty was, in eradicating that part which lay in a manner round under the root of the Ear, threatening the very Organ. We laid it open, and by the milder Escaroticks at length eradicated the Strumae there without offence to the Organ, cicatrizing it smooth the whole length of the Ulcer, by bringing the Lips together within a narrow Cicatrix, to the satisfaction of her Relations. During the application of some of these Escaroticks, she was subject to a Palpitatio cordis, and did somewhat salivate; but was therein relieved by Sr. Alex. Fraser's Prescriptions, and restored to perfect health, which I have lately heard she yet enjoyeth.  
A Youth of about 10 years of age was brought out of the Country to me with a strumous Ulcer on one side of the sagittal Suture. 
1. Observat. of an Ulcer on the Head.  It was hollow the compass of a Half-crown; and had discharged its Matter, and filled up again with strumous Flesh. I applied a Caustick on it, and after separation of the Escar consumed the Strumae with merc. praecipitat. than cicatrized it with unguent. è calce and the Vitriol-stone.  
A Lady brought her only Son to Town, who was about 7 years of age, 
2. Observat. of Ulcers about the Chaps.  of a sickly weak Constitution, obstructed internally with the King's-evil in his Mesentery and Lungs. He had externally many Strumae under his Jaws, from his left Ear down to his right Jaw. Some of them were bigger than others, and ulcerated: one whereof had made its own way out, was grown callous, and lay protuberant in the form of an overgrown Excrescence. I desired the assistence of a Physician: but the Mother would not, yet promised, if there were a necessity, she would at any time consult one. I began his Course of Physic with a Solution of syr. de rhab. in a Tincture of Sena, and prescribed him a medicated Ale of sarsa, lign. lentisc. Chinae, ras. eboris, rad. rusci, scrophul. etc. with millipeds. I dressed the ulcerated Glands' with unguent. basilic. and Praecipitate: and after Detersion with unguent. diapomphol. to the other Glands', which were hard and entire, I applied empl. diachyl. ireat. as it is set down in the method of Cure. During which application, I purged him again, and with a few grains of diagrid. and Merc. dulc. vomited him once: it worked churlishly with him. That night I sent him some of the anodyne Syrup to take in a draught of Mace-ale; which quieted the Ferment raised by the Physic. From that time I purged him with Infusion of Rhubarb in his medicated Ale once a week, giving him 7 or 8 grains of Calomel. the night before he drank his Rhubarb: the intermitting days he took one of the testaceous Powders prescribed in the method of Cure. The callous Struma I rubbed down with the Caustick-stone, and after separation of the Escar I deterged with the Vitriol-stone, and sometime Merc. praecipitat. rubr. The ulcerated Strumae digested well, and as the Glands' wasted, the Ulcers cured. To the other Glands not ulcerated I applied a Malagma of Corn. Celsus, by which they visibly resolved. Whilst I proceeded in this method, Dr. Micklethwait was consulted by the Mother, he being her Physician. He saw the Patient in this thriving condition, and, I think, prescribed him only a cordial Julep. The Winter approaching, I supplied the Patient with Dress and internal Remedies, showing his Maid how to apply them, and directed her how to regulate the Patient. The Cure of these Diseases is the work of time: for till the internal Viscera be freed of the Strumae which generally they are stuffed with, the external Cure of them signifieth little. They returned into the Country, and the Child enjoyed a good measure of health till about Christmas, and than the Matter fermented again internally and externally, that Air disagreeing with him: upon which account they returned back to London early in the Spring, and sent for me again, and, I think, for Dr. Micklethwait. The Child was put into much the same Course of Physic as before. I also digested the Ulcers, and proceeded as I had done the last year: the Child accordingly recovered, and enjoyed a good health. His Maid being grown skilful in dressing him, I visited him the seldomer, yet sent my Servant oftener: for, as I have said, his Cure did not consist in the healing these Strumae; yet they were in a good condition, and not at all painful, unless it were sometime when I used the Vitriol-stone and Praecipitate together, which was seldom. He being well recovered, returned into the Country towards Autumn, and came up the Spring following indisposed with a Catarrh and other Diseases in his Bowels; but soon recovered here, whereas the Northern Air was too sharp for his tender Body. During the time I attended him, he was as much grown and improved in his health as ever I saw any, and the Strumae that were remaining were few, and much diminished: the Malagma of Celsus put them upon a Suppuration whensoever it was applied; and I always permitted the Matter to make its own way out by small Eruptions: during which I ordered them to be dressed with Lenients, viz. unguent. diapompholyg. tutiae, or such like, till the Matter was discharged; after which I applied the Malagma again, to put the remainder upon Suppuration. This way I shown his Maid, and by these interchangeable Applications they did resolve. The Mother did not this last time consult Dr. Micklethwait nor myself in Physic, but employed some other secretly. Upon notice thereof I visited them lesle, and told the Mother, that where I did not prescribe the Physic, or was consulted with the Physician, I did not desire to be the Chirurgeon, the Cure depending most upon the internal Prescriptions. Some weeks after, visiting the Patient, I saw one of the Strumae thrusting out of the Skin in a Fungus. I would have thrust it more out, tied a Thread under it, and have snipt it of with a pair of Scissors: but he crying, I dressed it up with Praecipitate. At my next visit I met a Chirurgeon there, and presented the case of the Patient to him, with my way of proceeding. He saw me dress the Ulcers: they were but few and small. He declared the way had been rational, and that such Diseases did require time to perfect them.  
A young Gentleman, 
3. Observat. of Ulcers in the Neck, and an Atheroma in the Arm.  aged about ten years, was diseased with many Strumae: some whereof lay under his Jaws and the side of his Neck, stretching down from the one Ear to the other; some of them lay entire in their Cystis; others were ulcerated, and passed their Matter into one another: they were sordid in some parts, and overgrown with lose Flesh in others. He had also an Atheroma on the outside of one of his Arms about three inches in length, reaching to the Elbow-joint. Sir Alex. Fraser was his Physician, and put him into my hands. He purged him with an Infusion of Sena, Rhubarb, etc. and prescribed him a decoct. sarsaes, etc. with Antistrumaticks. I began with the application of a Caustick on the Atheroma, laying it open the whole length, and gave vent to an albuginous and cheesy Matter; than dressed it with Lenients, to hasten separation of the Escar. I also laid open the Sinuous Ulcers in his Neck, some by Caustick, others by Probe-scissors. Those Ulcers which were sordid I dressed with Mercur. praecipitat. rubbed the luxurious Flesh with the Vitriol-stone, and kept the incised Lips dilated with Dossills' spread with Digestives. Whilst I deterged those several Ulcers, I endeavoured resolution of the lesser Strumae by the application of some of the Discutients proposed in the method of Cure. During these proceed in Chirurgery, Purgations were repeated, with the addition of Calomel. and on the intermitting days cerussa antimonii, etc. were prescribed; and thereby the Ulcers were disposed to a healing condition. The Atheroma on his Arm I endeavoured to digest with various Medicaments: but whilst any part of it lay hollow, it would neither digest nor deterge: but after I removed its Coverture, it digested and incarned with mundif. Paracelsi, and cicatrized as the other did by the common Epuloticks.  
A person about 28 years old, 
4. Observat. of Ulcers on the Neck.  having been long diseased with the King's-evil in many Glands' on both sides of her Neck, frequently apostemating with great tumefaction and pain, came to London, and consulted me. Those on the left side were than swelled from the Nuke down that side of the Neck and Cheek to the other side of the Trachea arteria. Whilst she was in the Country, that Gland near the Nuke apostemated, and was opened by a Chirurgeon there: but from that time it grew corrosive, and passed its Matter downward into the body of the Tumour amongst the rest of the Glands', and could not empty itself but as it overflowed. Upon which account I proposed the making an Opening in the declining part of the Tumour: but she, having been extremely over-watched and tired with pain, took deliberation, and after a day or two sent to me to meet at a Consultation with one who pretends great matters in Chirurgery. I accordingly went: but he had been there before me, and, according to his custom, boldly undertook the Cure, promising to resolve it in ten days by the application of an incombustible Sulphur. I did not believe it possible to cure her without giving vent to the Matter below, but left the Patient at liberty to proceed with him, or any other. He began the next day with the anointing it with balls. sulphur. Rulandii, and every day daubed more of his said Balsam upon the Swelling, till the ten days were passed. During which applications, the Matter being thereby choked in, her pain increasing more and more, and she being not longer able to endure those applications, she sent for Sr. Alex. Fraser, Sr. George Wakeman, and myself. We saw the Tumour exceedingly increased, and crusted hard over with the Balsam. I fomented it with Milk, and embrocated it with fresh Butter: but it not yielding thereby, I applied a Cataplasm ex fol. malvar. violar. sem. lini, pane tritic. axung. porcina, etc. The next morning we met again, took of the Cataplasm, freed the Tumour of its crusted Coverture, and saw the same hard, dry, and much inflamed. We added to the former Cataplasm mucilag. rad. althaeae & lilior. and applied it, thereby suppurating it; than opened it by Caustick in the declining part near the Trachea arteria, discharged a large quantity of digested Matter, and dressed it with Lenients. Whilst the Matter plentifully emptied itself there, the Inflammation and Tumour daily diminished, and the Ulcer above, which had been daubed close up with the balls. sulphuris, appeared well inclined to heal, and cicatrized soon after by the applying of unguent. tutiae. The accidents of Pain, etc. thus removed, the Physicians were again consulted; and hearing her still complain of a Vertigo and great pain in her Head, as likewise of an Inflammation of her Eyes, they prescribed her a purging Apozeme of sena, polypod. hermodact. turbith decocted with sarsa, lign. guaiaci, santal. etc. She was also purged with Cephalick Pills. Calomel. was also prescribed, and a decoct. sarsae with the specific Plants was her ordinary Drink. By these and such like Prescriptions she was freed of those various Distempers, and restored to a better Habit of body. The Tumour the while emptied itself by the depending Orifice, and several of the Strumae which had been encompassed with in that Tumour appeared again movable, and were afterwards totally resolved by the application of Celsus' Malagma, and by the Apertion made by the Caustick cured perfectly. The Strumae on the other side of her Neck, which seemed suppurated when I first came to her, did all save one harden again, (during her Course of Physic.) That one lay upon her Cheek near her Ear. I opened it, and thrust out a Cheesy Matter; than dressed it as abovesaid with Detersives, and cured it. The Patient being thus happily recovered, I supplied her with a Rowl of Celsus' Malagma, by which the remaining Strumae were resolved or suppurated: and since that I have seen both sides of her Neck freed of that Disease. Yet she is still subject to some little Indisposition of body, enough to show that there yet remain some seeds of that Disease in her Viscera.  
A Gentlewoman aged 34 years, of a sickly weak Constitution, 
5. Observat. of Strumous Ulcers on both sides of the Neck.  subject to the King's-Evill many years on both sides of her Neck, ulcerating, and the Ulcers passing their Matter one into another down to the Clavicles, had gone through long Courses of Physic, and had permitted divers Applications to be made: but they proving unsuccessful, she put herself into the care of Sr. Fra. Pruj. and myself. The Ulcers seemed to have risen from so many distinct Glands, and that after Suppuration, the Matter, growing virulent, corroded under the Lips, and both rendered them Sinuous, and at length Callous, and consequently not capable of Cure but by laying open. Yet I began with Digestives, and discutient and drying Fomentations. The Physician prescribed lenient Purgatives, with the addition of Calomel. once in 4 or 5 days, and on the intermitting days decoct. sarsae with antimon. diaphoret. These not answering our expectations, I proceeded in the laying open the Ulcers, and removing the callous Lips, there being not one that would cure till that was done. Afterwards they digested, incarned, and cicatrized from the edges firm and smooth, by the common method of dressing Ulcers.  
A Citizen's Daughter, 
6. Observat. of Strumous Ulcers in the Axilla and Arm.  aged about 12 years, of a weak Constitution, had been long diseased with the King's-evil. She had one Strumous Swelling on the right side of her Neck close above the Clavicle, from whence to the Os humeri there seemed to be a more than usual fullness. Under that Axilla lay an Ulcer, and another on the outside of the same Shoulder, and others down all along to the Elbow, some of them sordid. By search of a Probe these Ulcers appeared to be so many Eruptions from the Sinuous Ulcer in the Axilla. I dressed them with Detersives, etc. and prescribed a decoct. sarsaes, Chinae, lign. lentisc. with some of the antistrumatick Plants, milleped. etc. with which she took antimon. diaphoret. and once in 4 days a few grains of Calomel. cum pulv. rhab. in the form of a Bolus. I embrocated the Gland near the Clavicle and the Swelling of the Shoulder daily with valentia digitalis, and endeavoured the Detersion of the Ulcers with mundif. Paracelsi, Praecipitate, and the Vitriol-stone: but the Ulcer being Sinuous, (as I said) it would not digest in any one part. The Fluxion increasing greatly, and seeming to flow from that Ulcer in the Axilla, I laid it open: but that not serving my purpose, I cut open the upper part of the Sinus on the outside of the Arm near the Shoulder, hoping that way to intercept the flux of Humour: but the Fluxion continuing, I began to suspect the Matter flowed from the Strumous Tumour near the Clavicle; wherefore I opened it, and upon search found the Matter did pass from thence into the Axilla, and to the outside of the Arm. I discharged the Matter, and eradicated that Struma: after which the Fluxion diminished in the other Ulcers. That of the Axilla dried up soon after: the other also cured more easily, accoridng to the method set down in Sinuous Ulcers, and she recovered her perfect health.  
A Woman came out of the Country with a diseased Child of 2 years old. She had brought many into the world, 
7. Observat. of Ulcers in the Head, Neck, Lips, etc.  but they had been all lamentably diseased, and died one after another. This was broken out all over the Head, and ulcerated in many places to the Pericranium. It had also a large white Tumour lying deep under the left Jaw to the Trachea arteria. I fomented the Head with a Decoction of Cephalick Herbs, cum flor. ros. rub. bacc. myrtill. ballast. in Wine and Water, and dressed the Ulcers accordingly as they required, some with Digestives, others with Detersives, and others with Epuloticks; and to the Tumour I applied Discutients. During these Applications I purged the Child once in 4 or 5 days, giving it 4 or 5 grains of Calomel. over night, and in the morning syr. de rhab. in medicated Ale of sarsa, lign. lentisc. etc. and the intermitting days Bezoard. mineral. Before I put her into this Course, the Humours were so acrimonious, that the lest scratch with a pin terminated in a corrosive Ulcer: but after she had proceeded in this method a while, they all healed. So that there remained only the Tumour under the Jaw, which seeming full of Matter, I thought reasonable to open: but she having privately consulted some person, who, in consideration of its situation, thinking it dangerous, dissuaded her from it, upon notice thereof I left them. But some weeks after, having tried other Endeavours unsuccessfully, she came to me again; the Child being broken out for want of prosecuting the former method of Calomel. etc. and also diseased with a Cough. I began with the opening of the Tumour, designing to do it by Caustick: but in consideration of the Prognostic which had been delivered of it, I made an Apertion with a Lancet, and passing in a Cannula, discharged a spoonful or two of a purulent Matter: which confirming my Judgement of the Tumour, I stopped it up with a Tent, applied a Caustick the whole length of it, and the next day divided the Escar, and gave vent first to a purulent Matter, than to an albuginous Humour. I dressed the Ulcer with Dossills' spread with mundif. Paracelsi, and the external Escar with unguent. basilic. cum ol. lumbricor. After Detersion the Ulcer filled up with an Hypersarcosis, as all Strumous Ulcers are apt, and so tender our labour vain. Therefore timely to prevent it, I dressed it with Merc. praecipitat. and kept the Orifice dilated with Dossills'. While I was thus eradicating the Struma, I repeated the former method of Physic, and healed the several Ulcerations about the Head, Face and Lips. All things thus succeeding well, the Mother returned into the Country with her Child, unknown to me, (supposing it cured:) but she not taking Specificks with her to prosecute that method there, it languished and died, as I was afterwards informed.  
A Child of about 3 years old had an Ulcer with Caries upon the right side of the Os frontis, close by the Temporal Muscle. 
8. Observat. of an Ulcer with Caries in Cranio.  It took its original from an Atheroma, as I suppose, (the Child having some Strumae on his Neck.) The Bone lay carious the compass of half a Guinny. I took of the Lips of the Ulcer by Caustick, and dressed the Bone with Dossills' pressed out of spir. vini, to keep it dry till Nature should be disposed to make Exfoliation of its rottenness. For in this tender Child there was no talk of rasping, nor was there always liberty to put in my Dossills' so close as I aught to have done. During this work the Child was afflicted with the Measils, and in the declination of them with a Cough, and such a discharge of Matter from his Lungs, that he grew thereby Hectic, and emaciated to skin and bone. The Lips of the Ulcer on his Head lay lank and dry, and the Bone as it were dead without moisture. He being thus weak, Dr. Bates was consulted, and declined the attending it, as coming too late to him. Dr. Tho. Cox was persuaded to take care of him, who prescribed Pectoralls of various sorts, and advised the removal of him to Knightsbridge, where he drank Asaph's milk. Having there somewhat recovered, he was removed to a house near Kings-Gate, into back Lodgings looking into the Fields, for benefit of the Air, and more conveniency of Dressing the Ulcer on his Head. But upon the change of the Air he so relapsed in 2 days, that it was believed, if he had lain one night more there, he had died there. Upon which consideration he was again removed back to Knightsbridge, and there he daily recruited his spirits. As his strength recovered, the Lips of the Ulcer recovered their heat, and digested, the Caries of the Bone cast of, and the Ulcer contracted narrower. He afterwards removed farther of into the Country to his Parents: my Kinsman Jaques Wiseman attended him, and finished the Cure there.  
A Child about 3 years old was brought by its Mother out of St. Martin's Lane to me with a large soft Swelling upon the left side of the Head without inflammation. I, suspecting the Bone carious, 
9 Observat. of Atheroma with Caries on the Cranium.  applied a proportionable Caustick on it, and gave vent to a Matter not unlike Batter, and by search of a Probe felt the Cranium bore, I dressed it with Lenients, and after separation of the Escar saw the Cranium bore the compass of a broad Shilling. I dressed it up with lineament. Arcei hot, and the Lips of the Ulcer with unguent. basilic. magist. The second day I fomented it with a Decoction of summitat. hyperici, origani, betonicae, flor. ros. rub. ballast. in Wine and Water, and dressed the Bone with Dossills' of Lint pressed out of spir. vini: the Lips I dressed with unguent. diapomph. touching them sometimes with a Vitriol or Alume-stone. By these Applications the Bone incarned, united with the Lips of the Ulcer, and cicatrized from the edges round. During which some small Speels of Bones cast of, and the Ulcer cicatrized without much difficulty.  
A sickly Child of about 7 years of age was brought to me by its Mother out of Drury-Lane, 
10. Observat. of an Atheroma with Caries in Cranio.  having a large Atheroma between the Sagittal and Coronal Sutures. I, supposing the Bone carious, applied a large Caustick on it, and dividing the Escar discharged a crude Serum, and afterwards a curdled Matter. I felt the Bone carious round under the Escar, and dressed it up with Lenients: after the Sloughs cast of, I dressed the Cranium with Dossills' pressed out of spir. vini, applying them close to the sound Edges; the Exfoliation beginning always from the circumference. By which may be judged the ignorance of that man, who applied Lint dipped in Read wine over the middle of the Bone, leaving the Lips hollow. By this way of dressing a Callus risen from the sound Edges, the thrusting of the Caries, united with the digested Lips of the Ulcer, and at length cast of all the rotten Shell, and incarned and cicatrized firm by the method observed in the former Observation. I have since seen this Girl diseased with many Strumae in her Neck, and purpose to undertake her Cure when the season shall be more proper.  
A Woman of about 40 years of age, 
11. Observat. of Spina ventosa in Cranio.  of a Plethoric Body, having been long diseased with a pain in her Head on the right side, between the Sagittal and Coronal Sutures, it at length apostemated, and she was put into my hands. I made a search with a Probe, and feeling the Bone carious, opened it by a circular Incision, taking away so much of the Hairy-scalp as I judged necessary; than filled it with Dossills' of Lint, and applied over them Pledgits cum albumine ovi & pulv. Galeni, empl. è bolo, etc. The third day, taking of the Dress, I saw the upper Lamina very white, dry and thin: it was corroded, and seemed chambered like unto that Fracture the Greeks call Camarosis, or like some piece of old wormeaten Timber. I dressed it with Dossills' pressed out of spir. vini, and the Lips of the Wound with a Digestive ex terebinthina cum vitell. ovi, etc. embrocating the Parts about cum oleo ros. After Digestion of the Wound I designed the rasping away that thin Shell: but her pain ceasing, it was deferred. About the tenth day she was taken with a Fever. The Physician visiting her, I dressed her Head, and offered to his consideration the setting on a Trepan. But he concluded the Fever scorbutical, and no way related to the Ulcer in Cranio. But the Fever increased, and she died. The Physician being indisposed with the Gout, another was fetched, who saw her opened. At the taking of the Cranium, the interior Lamina appeared sound, and the Dura matter unconcerned; nor was there any Blood or Matter extravasated between the Membranes or Ventricles of the Brain; but in the Lungs a great Stagnation. When this Matter affects only the interior Lamina, the Patient generally dies before the Malady is discovered.  
A little Girl was brought by her Mother to me with a soft Tumour, 
12. Observat. of a Struma with Caries in the Os Zygoma.  of the bigness of a Nutmeg, upon her left Cheek, on the Os Zygoma. She desired me to undertake the Cure. But I, being at that time much indisposed in my health, declined the meddling with it, concluding the Bone carious, and that it was not so slight a work as she thought. The Mother went from me to a Chirurgeon than in my Neighbourhood, who opened it, and took much pains in the exfoliating the Bone: but it growing more carious, he at length left the Parents at liberty to make choice of some other. They came to me again. I made search with a Probe, and felt the Sinus' running under the Bone towards the Eye. I dilated the Ulcer, and, seeing the Bone black, applied a Dossill pressed out of spir. vini on it, kept the Orifice open with a Dossill spread with a Digestive, and embrocating the Parts about cum ol. ros. & aceto, dressed it up with empl. è bolo. By his way of dressing the pain was mitigated, and the Ulcer digested. I continued the use of the Dossill with spir. vini to the Bone daily, and dressed the Ulcer with a Pledgit of diapomphol. By this very method the rottenness of the Bone soon shelled of: after which, by lessening of the Dossills', I permitted the Ulcer to incarn, and by gradually leaving of the use of the Dossills', and dressing it with Pledgits of diapompholyg. it cicatrized firm in the space of three weeks, and continueth so to this day.  
A person of about 26 years of age came to Town with an Ulcer in her Cheek penetrating high under the Os Zygoma: 
13. Observat. of strumous Ulcers with Caries in the Os Zygoma.  there was also an Ulcer near the external Canthus of that Eye. I supposed them to have coherence with one another, and by search of a Probe felt the Bones carious. Her Cheek had been much apostemated and blemished by their Chirurgery in the Country, and like to be made worse, if the Bones were that way to be exfoliated. Wherhfore I considered to do it otherwise. The Teeth in that Maxilla were all sound and fast; yet I persuaded her to the pulling out of one under these Ulcers. She seemed to receive some advantage by it, the Ulcer mattering lesle for the space of 4 or 5 days: but both the Ulcers growing afterwards worse, and our hopes of Cure that way failing, I enlarged the lower Orifice, and rubbed of the overgrown callous Lips with a Caustick-stone, and proceeded in the deterging and digesting the Ulcers. During which Dr. Willis was consulted: but upon supposition she might be with Child, she took little Physic. By dilating the inferior Ulcer the uppermost closed up, that Matter discharging itself by the Ulcer beneath, but not without much disturbance, it threatening a Sinus down her Cheek. To avoid which, I caused an Instrument to be made whereby I cut between her Cheek and Jaw into the Ulcer to the carious Bone, and gave vent to the Matter. After I had thus laid open the Sinus, and wiped away the blood, I dressed it with a Tent dipped in syr. de ros. siccis, and the external Ulcer on the Cheek with a Pledgit of unguent. tutiae, and by Compression cicatrized that smooth and firm. The Ulcer within her Mouth growing offensive to her by reason of the foetid smell of the Bone, put me upon the use of an Injection of aq. ros. damasc. syr. de ros. siccis, and a few drops of tincture. vitrioli Felix wortz: by which the Ulcer deterged, and grew daily lesle offensive. I continued the dressing it with a Tent whilst any thing of Matter discharged. That ceasing, I omitted the use of Tents, and healed up the Ulcer, and so it is like to continued.  
A Child between 3 and 4 years of age, 
14 Observat. of an Ulcer with Caries behind the Ear.  having been subject to soar Eyes and an Abscess in one of its Ears, was brought to London, and commended to my care. The Matter at length made its way forth behind that Ear, and flowed in great quantity. Upon search I found the Bone carious. I began my work with Dilatation of the Ulcer by Gentian-roots; and after I had made way to it, I dressed it with Dossills' pressed out of spir. vini and unguent. tutiae upon Pledgits, or such like, accordingly as I saw occasion. Having thus disposed the Bone to Exfoliation, I purged the Child with infus. rhab. and afterwards with Calomel. once in 4 or 5 days, and prescribed Bezoard. mineral. also a medicated Ale, to take the intermitting days.  
After some time, seeing the Bone continued firm, I dressed it with a mixture of mel Aegyptiac. pulv. myrrh. etc. and thereby hastened the Exfoliation of the Bone. That being cast of, I designed to cicatrize the Ulcer: but perceiving the Eyes grow soar, I put a Pea into that Ulcer, and continued it a fontanel; not thinking it safe to dry up the Ulcer behind the Ear, though the Child had before one proper for Derivation. The dressing this Ulcer was never very painful: but the Servant that attended the Child having accustomed herself to put it beside its Frowardness by threatening to sand for me, it so terrified the Child, that it always cried at the very sight of me; upon which account I left her in the condition I have represented. She was long after diseased with soar Eyes from the acidity in her Blood, but hath since outworn it.  
From a Caries in the Alveoli Apostemations are frequently made externally under the Jaws; which being not unlike strumous tumors, are by unexperienced people supposed to be such, and sent to us to be presented to his Majesty. Many Instances may be given you of this kind, if it were necessary: but they not being Strumous, I shall forbear, and present to you what is, viz. the protuberant Jaws. They are made hollow by an acid Humour, which fretteth and corrodeth the Alveoli and inner substance to the very external Shell; in which cases they thrust out with great deformity. I have made mention of this Disease under the name of Spina ventosa, and distinguished it from the Caries arising from an external Erosion by that name. When this affects the Jaws, the Teeth grow lose, and Excrescences do arise, which in progress of time thrust out the Teeth. They sometimes discharge their Matter externally. But by pulling out those Teeth these Apostemations cure, and the Jaw having thereby vent for its Matter, the Caries will cast of insensibly by the force of Nature, and at length, if the Habit of body grow better disposed a Callus fills up the voided space in the Bone. But where Nature is deficient, we consume the Caries in them by detersive and drying Medicaments, or by actual Cautery: after which, if the Patient be young, he groweth out the Deformity.  
A Child aged 9 years, 
15. Observat. of external Ulcers from a Spina ventosa.  having been formerly diseased with the Rachitis, and afterwards with the Kings'-Evill, the left Jaw grew preternaturally big, and her Teeth in it rotten and lose: an Apostemation also had discharged itself externally under that Jaw in 3 several places. I caused some of those Teeth to be pulled out, and dressed the Ulcer with a Tincture of Vitriol. I prescribed Internalls, according to the method of Cure; than rubbing of the callous Lips externally with a Caustick-stone, and digesting them, they cicatrized without laying open or trouble in dressing, the Matter spending itself within, where it was not taken notice so much of.  
A Gentlewoman about 40 years of age, 
16. Observat. of Spina ventosa in the left Jaw.  having been many years diseased with the King's-Evill and a Spina ventosa in her left Jaw, put herself into my hands. She had formerly Apostemations under that Jaw externally; but the Matter having made its way out by loosening some of her Teeth, (which afterwards dropped out,) those Ulcers were in a manner healed up. The place where her Teeth had fallen out was filled with a putrid Flesh, which was very offensive to her by reason of the rottenness of the Alveoli. In this case there remained nothing to do, but to consume and dry up the corrupt Flesh and Bones; which I did by actual Cautery to the very end of the Mandible, laying it hollow like a Trough. I was troubled in my thoughts to see it so, suspecting it would prove an unthankful work, to leave such a uselses Cavity: but it was done to save that Jaw. I dressed it up with Dossills' dipped in a mucilaginous Decoction, and after Digestion with Dossills' dipped in spir. vini, the sides of the Mandible were dried by the actual Cautery, and being thin, they cast of, and the Gum lay flat, and served her afterwards to chew softer food.  
A Youth about 15 years of age came to Town with a Spina ventosa in the inferior left Jaw, 
17. Observat. of Spina ventosa in the inferior Maxilla.  the two farthest Teeth being thrust out with a Fungus rising in and about the Alveolus. It had passed its Matter externally on that side of his Neck and under that Jaw; also an Apostemation had been raised on the upper part of that Jaw externally near the insertion of it, between the Ear and the Cheek, in which place the Bone was carious round. It had been laid open by a Chirurgeon in the Country, who designed the cutting it of. I rubbed that Bone with ol. myrrhae distillat. and kept the Ulcer dilated with Dossills' pressed out of spir. vini. The Fungus in the Jaw I consumed with the actual Cautery, pulled out pieces of the corrupt Alveolus, and disposed the rest to cast of soon after; than dried up the remaining Caries in the Jaw, and afterwards dressed it with Dossills' pressed out of tinctura vitrioli. Whilst this was doing, I rubbed of the callous Lips of the external Ulcers by Caustick, opened their Sinus', and disposed them to speedy cure. After the cicatrizing of the Ulcer in the Jaw, it lying hollow and subject to Excrements, I filled it with soft Wax. Having thus cured those Ulcers, and exfoliated the greatest part of the Caries on the external part of the Jaw near the Ear, I lessened the Dossills', permitted that Ulcer to contract proportionably, and supplied his Sister with Medicaments and Directions to finish the Cure, and dismissed him. It being the work of time, required a longer keeping open than consisted with their conveniency to attend it here.  
In the year 1672. I was consulted by Letter out of the Country concerning a young Gentleman, 
18. Observat. of a Spina ventosa in the right inferior Maxilla.  whose Case I have here inserted as it was sent me.  
Adolescens nobilis, 19 circiter annos natus, duobus abhinc annis correptus est gravi Dentium molarium dolore in Maxilla dextra, unde unius caries subsecuta est. Remittentibus doloribus, suborta est Glandula exigua (jam ferè evanida) in cuspide externa Maxillae ex adverso denti primo vel secundo molari; exinde tumor Maxillae indies auctus, qui videtur in ipsa substantia ossea radicatus, nullâ exsistente vel Cutis ipsius vel Glandularum circumquaque prominentiâ manifestaâ, cum dolore exiguo vel nullo Maxillae, nisi cùm asperiùs digitis tractata vel fricata fuerit. Ex adverso latere circa eandem partem Glandula est exigua & mobilis. Tractatus est ab aliis Medicis cum Pilulis purgant. Mercurialibus, Diaetis Scrophulus respicientibus, Antiscorbuticis, & externis etiam Emplastris de ranis & ex ammoniaco, Fomentationibus, etc. sine fructu. Veremur nè ex illo tumore pereat aliquid de venustate faciei Adolescentis.  
Quaerimus quibus modis vel curetur, vel saltem incrementum praecaveatur.  
In answer to this, I advised the extracting of the carious Teeth, to make way for the discharge of Matter, and proposed Remedies to consume the rottenness in the Maxilla.  
About half a year after the Patient was brought to me by his Uncle Mr. Tho. Chol. He had than a Spina ventosa or Exostosis very large upon the outside of the said Jaw, which threatened a total corruption of it. They demanded my judgement in the taking it of. I replied, If the Bone be thin, it may be cut of by passing an Incision-knife within his Mouth between the Cheek and his Jaw. If upon trial the Bone prove too hard or difficult to extirpate, the Wound will soon cure without Deformity. This was delivered by me with such hesitation as might have well shown the little inclination I had to operate in it. Three or four months after the Patient came to me with his Uncle Captain Middleton, and earnestly desired me to proceed in the cutting out that Exostosis the way I had discoursed of formerly to him. I advised them to consult Physicians and Surgeons in the undertaking. They consented to it, and sent to Dr. Charleton, (who had been one of his Physicians in the Country,) Dr. Water Needham, and Mr. Hollyer. We accordingly met, and together informed ourselves of the nature of the Tumour and its situation, than retired to consult. The first question proposed was, whether the Exostosis might be cut safely of: which was unanimously granted. The next consideration was, of the way to take it out. But we differing therein, concluded to defer the Operation till the Caries in the Jaw should by its eruption make its own way through. Somewhat to this purpose we all subscribed, and delivered to the Patient; which he threw into the fire, and departed much unsatisfied with such a dilatory Answer.  
The third day after we were consulted again, and concluded that Incision should be made between the Cheek and Jaw to the Exostosis, and that accordingly as the Bone should be discovered by the Knife to be hard or soft, so we should proceed in the sawing it of, or permitting the Wound to heal again. This we subscribed, and sent to the Patient; and I afterwards discoursed with him and his Uncle, and prevailed with them, that those who had been consulted might be present at the Operation. Accordingly they sent to them. In the mean time his Body was prepared by a purging Apozeme 4 or 5 days. Venaesection was deferred, in consideration that blood would be evacuated in the Operation.  
In order to the Operation, the Patient having seated himself in a clear light, I passed my Knife between the outside of his Jaw and his Cheek close to the basis of the Exostosis the length of it, and at that instant attempted the cutting of it: but it was too hard. I declared so, and asked them whether I should pull out the Knife. They all unanimously, with the Patient and his Uncle, declared that I should proceed with the Saw; of which there were two provided of equal size with the Knife. I pulled out the Knife, and passing in the Saw to the very basis, made a tract: than put the Handle of the Saw into one of the Physician's hands, desiring them they would severally help in the sawing of the Bone; so should they be more satisfied in the work, and ease me, who was too much indisposed in my health for such a business. They did severally take their turns, and had at that time sawed of the Bone, if we had not been interrupted by the weariness of the Patient, and the bleeding of a small capillary Artery in the Cheek. I dressed up the Wound with Dossills' of Lint, to keep it dilated, and thereby stopped the bleeding. We embrocated the external parts with ol. ros. cum aceto, and applied empl. è bolo over it. The third night the Wound bled afresh, whether it was caused by eating, or what other accident; but my Kinsman Jaques Wiseman stopped it with a Compress dipped in the Royal Styptic held close with his fingers, and was relieved by others. But the Patient not permitting them to hold the Compress so close on as Mr. Hollyer and myself advised, the Vessel was the longer in agglutinating, and raised an Aneurisma of the bigness of a Lupin, which lying in our way, we burned it down by a small Button-cautery. This difficulty over, we all met again, and proceeded in the sawing of the Bone, and did all of us suppose we had finished that work, (which Opinion was occasioned by the Caries within it, which admitted of our Probes, and made the whole Bone seem lose,) and purposed than to extract it. But he pleading his weariness, we complied with him, dressed up the Wound with a Tent dipped in vitello ovi, and fomenting the external Parts, dressed them with Lenients; by which the parts were eased, and the Wound discharged a well-digested white Matter. In this condition I left the Patient (with their leaves,) to make a Journey into the Country 4 or 5 days; during which I grew more indisposed, and returned home grievously diseased, yet made a shift to visit the Patient, and urged the extraction of the Bone. Whether it was that he heard the Wound was to be enlarged, and that he feared a Flux of blood, but he put them of from day to day, and during my confinement to my Chamber I had news of an approach of Convulsions; upon which I was carried to him, where we all met at a Consultatioon, and Dr. Lower with us. It being suspected that this Accident was occasioned by some Shivers of the Bones pricking the Membranes, we resolved to hasten the extraction of them: but his Teeth being set, there remained no possibility of doing it that way. Therefore we resolved to apply a Caustick on the lower part of the Jaw externally, and by cutting through it to draw out the Bone. My hands being weak, Dr. Lower marked it, and together they applied the Caustick, resolving to meet again that afternoon to divide the Escar, and take out the Bone. But within few hours after the Patient sent for us to take of the Caustick. I went, and found an Escar made as was designed, but I had not strength enough in my hands to make use of a Knife. Dr. Charleton and Mr. Hollyer were at a public Dissection in our Theatre, where Dr. Walter Needham was Reader: only Dr. Lower and Jaques Wiseman were to be found. They being come, my Kinsman divided the Escar, made separation of the Bone, and drew it out. I afterwards put in my finger, and feeling no Shiver, advised the dressing it up with unguent. basilic. hot. That evening they all met, and approved of what had been done, and hoped the cause being taken away, the effects would have ceased. Dr. Goddard's Drops were prescribed, and Venaesection had been proposed; but being disputable, it was deferred. The next morning Dr. Tho. Cox met us at a Consultation, and advised the Patient to be let blood, the Hair of his head to be shaved, blistering Plasters to be applied, and variety of internal Medicaments were prescribed; the Wound was opened and dressed: it was not without good hopes of Digestion, but the Patient died convulsive the third day after.  
The Patient's Cheek was laid open in the presence of all the Physicians and Surgeons. The Bone was found sawed of without the lest impairing of the Jaw; but it was very much eaten into by the Caries, and was spongy. The cause of the Convulsions seemed to be referrable to the Constitution of his body, and the Acrimony of the blood, which upon fluxion fermented, and produced that sad effect. We see frequently the same in little Maladies. The only drying up of a light Excoriation behind the Ears in Infants hath caused Convulsions. In the King's-Evill you may see many Instances of the fermenting of this kind of Matter most grievously upon the healing some one Ulcer.  
The Monument at Westminster of the young Lady holding up her Finger pricked with a Needle, of which she died, may serve to show you that in ill Habits of body small Wounds are mortal. As to this Operation, it was not dangerous, if you consider the great Fractures in the Jaws which we frequently cure; and that of late years I cut into the inside of a man's Cheek, sawed in pieces the Alveolus, and took out the whole Jaw, and cured him. That the Operation was necessary, appeared by the rottenness in the Jaw upon dissection, and may be determined by all those who know what a Spina ventosa is, and consider the progress this had made in so short a time.  
Having thus given you some Instances of the several Strumae with complicated tumors and Ulcers arising from them, I shall now show you how the Tendons and Joints are diseased with various sorts of tumors, some whereof are without Caries, others with it, and others take their original from Caries in the Bone, commonly called by the name of Spina ventosa.  
A Child aged 7 years was brought to me, 
1. Observat. of Gummi upon the Tendons.  which had a Gummy Swelling encompassing the Muscle mastoïdes on the right side of her Neck: the Tendons also of the Fingers of her right Hand were affected with the like Swell. She had also a frequent discharged of purulent Matter from her right Ear; also an Ozaena, and thick upper Lip chapped. I caused the crusted Matter in her Nostrils to be suppled by the frequent injecting of decoct. hordei. sem. althaeae, etc. and afterwards deterged the Ulcers with a Solution of mel magistral. in a Decoction rad. bistortae, tormentillae, ireos, etc. The Lip was dressed daily with a Pomatum of unguent. rosat. and Merc. praecipitat. Vigon. and the Gummi upon the Neck and Fingers were embrocated with unguent. magist. ad strumas, and an empl. ad tophos applied over all. During which Applications the Child was frequently purged with Calomel. and diagrid. and drank a decoct. sarsae. radic. bardanae, scrophul. maj. flor. salviae, beton. anthos, etc. But the Cure not succeeding with these, I gave her a few grains of theriac. metal. by which she salivated: during which the Gummy tumors resolved, and the several Ulcerations dried up: yet to confirm her Cure, she took Sudorificks, and purged frequently.  
A Child of about eight years of age was brought to me with a pituitous Swelling in his right Ankle and Foot. 
2. Obervat. of a strumous Swelling on the Ankle.  His Parents supposed it caused by some distension of that Joint, and had applied anodyne relaxing Medicaments. But upon observing the Bones of the Ankle to be preternaturally big, I concluded the original of the Disease in them, and that the Swelling in the Parts about proceeded from the dilatation of the Membranes and Ligaments of that Joint. I declared the Cure to be a work of time: we not having yet discovered any Medicaments of force to dry up that Humour in the Bone, and restore it to its former smallness. That which was offered by me was, to discuss and dry up the serous Humours affecting the softer Parts, by Bandage to compress them, and resist the Influx, and the while to evacuate and contemperate the serous Humours. This being accepted of, I began with the fomenting it with decoct. summitat. absinth. majoranae. Jacobeae, flor. hyperici, salviae, ros. rub. ballast. bacc. myrtill. etc. in Wine and Water, with the addition of spir. vini. I than applied an empl. è bolo with a laced Sock over it, advising that Leg to be laid levelly with the Body till the Fluxion should be remitted, and the Joint strengthened. During which the Patient was purged weekly with Calomel. in cons. ros. damasc. adding sometimes a few grains resinae jalapii, or diagrid. and the intermitting days he drank decoct. sarsaes, etc. and took those morning's Bezoard. mineral. cum syr. è court. citri. Thus at length the Humours were contemperated, and the Joint strengthened; and as the patiented grew more in years, the other Ankle increased proportionably to it, and lessened the deformity.  
I could give you many Instances of these tumors; but the Cure not differing from what hath been said of this, I though it unnecessary. What the consequences of these tumors are when such method is neglected, you may see in some of the latter Observations.  
An Infant scarce a year old, 
3. Observat. of astrumous Tumour by Congestion.  in the undressing of it, was discovered to have a round soft white Swelling on the head of the Shoulder. It was thought overstrained by the Nurse. A Physician was consulted, than a Bonesetter, who declared it luxated, and pretended he had set it: but his frequent coming to dress it, and the remaining Tumour, shown that he understood not what he did. I was fetched, and opened it by Incision, giving vent first to an albuginous, than to a white concocted Matter; upon which the Tumour sunk. I fomented it with Read wine, and dressed it with a Digestive ex terebinth. cum vitell. ovi, with empl. diachalcit. Compress and Bandage, and afterwards deterged it with an addition of mel ros. than left of the use of Tents, and in few days cured it with unguentum diapompholyg. This Infant was afterwards diseased 5 or 6 years with the Kings- Evil affecting other Parts.  
Such another like Tumour did rise in the top of the Shoulder of a little Infant, 
4. Observat. of the like; and of a strumous Tumour in the Thigh.  the only Daughter of its Parents. At the Nurse's first discovery of it, she ran with it to the Bone-setters. They all concluded it out of Joint, and every one pretended he had set it. But the Swelling continuing, I was fetched; and, opening it by Incision, discharged such a like Matter as in the former Observation, and cured it as soon, after the same manner as abovesaid. This Child was afterwards afflicted with a very large Tumour lying deep under the Muscles on the inside of one of its Thighs. After divers Applications to resolve it, it at last came to Suppuration, and discharged an impure Matter; but was deterged and cured by the ordinary method set down in Putrid Ulcers, without any seeming defect in the Member. But some months after, the Infant using its Legs, this appeared much shorter than the other, yet without any manner of contraction or stiffness of the Member. I designed an Instrument for distending of it; but the Child being extremely froward, I declined it. After she was grown of more years, I was consulted again: but it was than too late.  
One about 19 years of age, of a seeming healthful Constitution, 
5. Observat. of an Abscess on the Elbow.  was suddenly seized with a white Swelling in his right Elbow, rendering the Joint immovable. Though he could not remember any particular action of his that should dislocate it, yet he was persuaded to consult the Bone-setters. They all concluded it out, and endeavoured to reduce it; thereby hastening an Apostemation amongst the Ligaments and Tendons, which discharged its Matter through many Orifices on the inner and outer side of the Joint, making part of the Bone carious. Some of the declining Orifices I laid open, and deterged them; during which he was purged, and prescribed Antistrumaticks. Injections were cast in of that sort proposed in Sinuous Ulcers with Caries, also discutient and corroborative Fomentations were applied. By all which at length the Tumour resolved, the Ulcers cured, and by frequent Embrocations he recovered a tolerable use of that Joint.  
A Child of about 3 years old, healthful from its Cradle, 
6. Observat. of an Abscess on the Hip.  was on a sudden taken lame in its right Hip. The Lameness increasing, he was brought to me. I compared the Hips, and found that swelled, and the Leg beginning to emaciate. I embrocated the Tumour cum ol. ros. & aceto, applying emplast. è bolo, and his Leg cum ol. lumbricor. I prescribed him a medicated small Ale with Sarsa, etc. and purged him once aweek with Rhubarb infused in some of the said Drink, giving him the night before a few grains of Merc. dulcis, and the intermitting days Bezoard. mineral. By this method he was relieved; yet afterwards upon the omitting it he relapsed, but at length recovered. Others of this kind I have had under my care: but partly by reason of the progress the Disease had made before, and partly through the Impatiency of the Parents, the Cure hath failed.  
A Youth of about 12 years of age was seized with a pain in his right Hip. 
7. Observat. of the like.  It increasing with Tumefaction and great Lameness, the Parents, suspecting it might be out of joint, sent for Thurland the Bonesetter. He declared it luxated, and pretended to set it, and dressed it up his way. The Child continuing lame, they sent for him again. He assured them he had set it, and that in time the Child would recover strength in it, and be well. But the Child growing daily more pained, Surgeons were consulted, and at last myself. I saw the head of the Os femoris shot upward, and a large Tumour possessing the Hip and Parts about, under which there seemed to be lodged Matter. There was also a long white Swelling stretching down the forepart of the Thigh, from the Groin towards the Knee, within 4 fingers breadth of it. The Tumour seemed to be full of Matter, and to derive itself from the Hip, and that the Luxation had been made by Fluxion, and increased by the Extension. But however it was, the Bone was not capable of Reduction, nor could I promise' myself any credit from my Endeavours there; yet I complied with his Parents, resolving to serve them as well as I could; but desired that the Bonesetter might be first fetched to see his work: I not thinking it safe to meddle in the Cure, whilst he insisted that the Bone was reduced. They sent often for him, but he did not come, till I accidentally met him at a Person of Honour's Lodging, and by threatening brought him with me to the Child; where he acknowledged his fault, and declared the Bone incapable of reduction. Yet this Fellow went directly back to that Person of Honour, and upon demand where he had been, declared that he had been with me, to set my Patient's Hip, and that he had reduced it.  
This Fellow's scurvy using me almost discouraged me in the undertaking: but after making a presentation of it, I attempted the Cure, and began with discutient Fomentations, Embrocations, and Emplasters, according to the method of Cure, till I had discussed part of the external Tumour, and satisfied myself that there was Matter lying deep under the Muscles of that Joint. Than, to prevent farther corruption of those Parts, I applied three several Caustics on them at one time: after which I divided the Escars, and penetrated deeper into them with a Caustick-stone, and by Incision gave vent to the Matter (which was partly albuginous) in the several Parts; than fomented them, and dressed them up with Lenients, to hasten separation of the Escars. The next day I applied a Caustick upon the declining part of the Abscess on the forepart of the Thigh, and discharged much purulent Matter. By the opening this at first, I might have discharged the Matter above: but that being the Part immediately affected, it was not probable to cure it thereby, and afterwards the Opening would have been more difficult. And indeed, though by one single Apertion on the Hip the Matter might have been let out; yet such a large Abscess would not have cured so: and afterwards to have cut through so many Muscles, must needs have been hazardous. But their lying thus triangular served to good purpose not only in discharging the Matter, but for conveniency of deterging; which after separation of the Escars I did with mundif. Paracelsi and Merc. praecipitat. and kept those Orifices so open, that I could pass my Probe out of one into the other till they were deterged, and the Matter little in quantity and good. During which, the Matter in the other Abscess discharging daily in great quantity, and being of so virulent a quality as to retain its Cavities, and tender the Lips phagedaenous, I snipt the Abscess more open according to its length, and deterged it as the former, than purged him with resina jalapii, Calomel. etc. and gave him the intermitting days Bezoard. miner. His constant Drink was a medicated Ale with sarsa, lign. lentisc. etc. with millipeds. By this method the Humours were digested, and the several Ulcers incarned and cicatrized by the common method of Cure. During which his Leg was kept straight; and time hath since made the place callous which received the head of the Bone, so that he walks tolerably well on that Leg.  
A Youth of about 9 years of age was taken lame with a pain in his left Hip. 
8. Observat. of an Abscess on the Hip.  Bone-setters were advised with, also Physicians and Surgeons were confulted, and many Applications made; he was likewise carried to the Bath: yet notwithstanding all their Endeavours, the pain increased with great Tumefaction. I was at last consulted, and felt the head of the Os femoris luxated and raised upward, with a great Tumour about it, which I judged by its fluctuation to be full of Matter. It was expected I should open it, and give vent to the same: but this Child being emaciated and Hectic, and the Matter lying deep, as in all these Strumous Abscesses it doth, the Solution beginning in or near the Joint, I declined the present Opening of it, and proposed the drying up of that Matter by powerful Exsiccants and Discutients, viz. aq. calcis, and empl. diasulph. with convenient Bandage. During which the Physician prescribed lenient Purgatives, with Calomel. decoct. sarsaes, Bezoard. min. etc. by which method the Patient was more easy, and seemed relieved for a while. But the Tumour increasing upon the lest neglect in rolling, and appearing by its fluctuation to be full of Matter, I complied with their desire, and opened it by a large Caustick, giving vent to an albuginous Matter. I made search, and felt the Bone bore. I hastened separation of the Escar; and afterwards feeling the Skin thinner in the declining part of the Tumour, and judging that convenienter for discharge of the Matter, I opened that part by Caustick. Having now made way for the Matter, I cast in an Injection of Decoct. rad. irid. aristoloch. etc. with a Solution of unguent. fuscum. After separation of the Escar, I enlarged the Orifice towards the old one, and saw the Epiphysis of the Os femoris lying out of its Acetabulum, and black with its Rottenness. I dressed it with Dossills' dipped in spir. vini, and kept the Ulcer dilated, expecting what Nature would do: but in the while the Child languished, and died tabid.  
A Girl of about 9 years of age, born of a diseased Mother, 
9 Observat. of an Abscess on the Hip.  having been some months lame of a Swelling on the Hip, was brought to me. It seemed to me that the head of the Os femoris was luxated by a defluxion of sharp Matter, and that there was small hope of Cure. I applied empl. diasulph. with a laced Trowze, and prescribed Antistrumaticks. In progress of time the Tumour increasing, they brought her again to me. When I had considered the original of it, and that if there were Matter in it, it lay too deep to be reached with a Caustick, I proposed the application of a pointed actual Cautery about the head of the Joint, hoping I might that way at lest give timely vent to the Humour, and prevent the corruption of the Ligaments and Bones. To which purpose I applied three small Caustics triangular about the most tumefied part of the Joint, and the next day passed in an actual Cautery through each Escar, dressed them up with Lenients, and fomented the diseased Part daily with an Infusion of Discutients in aq. calcis and empl. opodel F. W. over all. As the Escars cast of, a thin Sanies discharged, and the Tumour seemingly discussed: but than on a sudden it swollen; which put me upon the use of a maturative Cataplasm, by which it suppurated, and discharged its Matter through the former Apertions. But afterwards observing these Openings would grow too little, I passed in a small Probe with a Ligature into one of these, brought it out at one of the other, and kept them open by that Seton, than proceeded again with Discutients and Internalls. Some months afterwards these two Openings were laid into one, and the Orifice kept dilated with Dossills' spread with Detersives, and the Abscess was again restored to a healing condition. But after all my Endeavours, new Apostemations arose, and the Child died tabid.  
A Young man of about 18 years of age, being lame of his left Knee, 
10. Observat. of a Protuberance in the Bone of the Knee.  sent for a Bonesetter, who declared the Bone luxated, and would have extended it. The next day I was sent for, and saw a Protuberance on the inside of the Bone, a pituitous Swelling on each side of the Rotula, and a painful Swelling on the other Parts about the Knee. These, with the Protuberance of the Bone, made the Joint seem somewhat luxated at first sight: but upon farther, search, that Prominence was in the Bone itself, and is usual in strumous tumors of the Knees, Ankles, etc. and hath been taken notice of by Aquapend. under the name of Spina ventosa. I have taken notice of it in several places of this Treatise, and shall have occasion to speak of it again in some of the following Observations.  
I concluded this Disease to have been originally in the Bone; and, upon farther enquiry, did discover that the Patient had been diseased of the Knee from his Childhood more or lesle. I directed an empl. è bolo to be applied on the Knee, to calm the heat in the Part, than let him blood, and afterwards purged him. The next day after I caused his Knee to be fomented with Discutients and Exsiccants infused in aq. calcis some days, and afterwards applied empl. diasulph. with a Knee-piece, and disposed him to walk with more ease. About a year after he came to me again complaining of it, and will be subject to pain in it at times whilst he lives. This was the case of a person Dr. Walter Needham and myself were lately consulted about: and such are frequently seen at our public Healings, they being generally accompanied with other marks of the King's-evil.  
A person of about 9 years of age, 
11. Observat. of a Tumour on the inside of the Knee.  of a tender Constitution, subject to a Cough and other effects from an acidity in her Blood, was afterwards discovered to be lame of her right Knee, supposed to hap by some accident of a Fall. I being sent for saw the Bone on the inside protuberant, and covered with a white Swelling. It was possible that such an accident of a Fall might contribute to the hastening of that Swelling: but it was certain that the Protuberance of the Bone was of a longer growth. She had a Species of an Ozaena, as also a Struma ulcerated in her left Arm. I did suspect this Tumour would prove difficult of Cure, and therefore desired they would consult their Physician. In the mean time I applied an empl. è bolo. The third day after I met Dr. Micklethwait. The Tumour was than spreading over all that side of the Knee. It was resolved by us to endeavour Discussion, by the application of empl. diasulphuris: which was accordingly done. The Physician prescribed as followeth. ℞ sarsaparillae incis. ℥ ij. Chinae nodosae ℥ i sassafras ℥ iij. rad. scorzoner. Hispan. ℥ ss. ras. eboris, corn. cervi, an. ʒiij. cretae purissimae, bol. armen. an. ʒij. coq. in aq. font. ad lb iij. sub finem add sem. anisiʒiij. glycyrrhizae ℥ ss. uvar. passul. ℥ iij. fiat Colatura; bibat quantum poterit. ℞ Merc. dulc. gr. x. cons. ros. damasc. ℈ ij. Misc. fiat Bolus hora somni sumend. 5. quaque nocte ℞ milleped. praep. gr. x. antimon. diaphoret. gr. vj. Misc. This latter she took twice aday, with a draught of her Diet-drink after it: those days she intermitted, the Purgative. 4 or 5 days after we met again; and seeing the Tumour increased, and feeling the Matter fluctuate in it, we concluded it necessary to open it; and to that purpose applied a Caustick on the declining part. We divided the Escar, and discharged about 3 sponfulls of a thin white Matter; than dressed it up with Lenients, and empl. diachyl. The Matter discharged between Dress very well, yet the Tumour did not lessen: but upon pressure with my hand above near the Thigh, the Matter gushed out. Upon which consideration we applied a Caustick there. It did not reach it: but upon keeping that part open as a fontanel with a Pea, the Matter made its way out there, but in the mean while it insinuated itself below the first Apertion; which put me upon the laying that Orifice open lower. Having thus made convenient discharge of the Matter, I applied Intercipients above about the Thigh, and endeavoured by Digestives and Detersives with Compress and Bandage to dispose the Ulcers to cure. But the Matter, originally rising amongst the Membranes and Tendons, lay deep, and affected the Joint with great virulency, corroding the very Lips of the Ulcer. Upon which consideration I would gladly have laid it open from one Orifice to the other: but the weak condition of the Patient obliged me to cherish the native heat of the Part by Fomentations ex summitat. absinth. hyperici, flor. rorismarin. beton. salviae, ros. rub. ballast. bacc. myrt. juniper. etc. in vino rub. and to alleviate the pain in the Ulcers, till the Habit of body should be better disposed by those internal Prescriptions, to which were added Emulsions, with aq. calcis, medicated Broths, Ass' milk, Jellies; what not? The Summer coming on, she was bathed in Milk and Water lukewarm, and by cordial Juleps her spirits were kept up. By these various Prescriptions the Fermentation in the Humours was calmed, and her hectical heat remitted, also the Defluxion upon the Ulcer diminished, and the Sinus was in a condition to be laid open. I designed to have done it by one snip of a Probe-scissors: but it being suspected she might thereupon faint or fall into Convulsions, I laid it open by Caustick; and from that time digested, incarned and cicatrized. I met with many rubs in the work, it frequently fretting out in one part as it healed in another: and after a year and a half's attendance, I left a small Ulceration on the upper part of the Knee, of the breadth of a silver Halfpenny, and a sinuous Ulcer in the hollow of the Thigh near the Knee, which was not capable of being laid open. In that I ordered a hollow short Tent of Lead, whereby it was kept open, and the Matter was seemingly discharged, it scarce at all mattering. Her Leg was all this while kept outstretched, whereby she was able to stand or walk. In this condition she removed to drink the Waters at Scarborough, and returned afterwards so well, that they were thought to have cured her: yet she hath been since frequently subject to Eruptions, but her Attendant is her Chirurgeon.  
A Child of about eight years of age was brought to me in the year of the great Plague during my being in the Country. 
12. Observat. of a Tumour on the Knee.  He had one white Swelling on the right side of the Rotula, another beneath it. There had been one on the left side, but it had been formerly opened at London, and left sinuous. I began with the laying it more open by Incision; and having deterged and disposed it to cicatrize by the common ethod of curing Ulcers, I opened the other beneath the Rotula, and gave vent to an albuginous Matter, than laid it open the whole length, and dressed it with Dossills' spread with mundif. Paracelsi. This being deterged, and disposed to incarn, I than opened the third, and discharged the same kind of Matter. I deterged it as the former, and by the addition of pulv. myrrhae, sarcocol. etc. incarned it. I cicatrized the second with unguent. è calce, and having disposed this to do so, I left him to his Chirurgeon, who cicatrized it. During the cure of the Ulcers, the Ham was daily embrocated with unguent. dialthaeae, ol. lumbricor. etc. and was brought out strait, and left flexible by me. Soon after he recovered strength of it, and walketh now well on that Leg.  
Another about 7 years of age was brought out of the Country on me, 
13. Observat. of the like.  and lodged near me in Convent-Garden. He had been 2 years exceedingly lame of his left Knee by reason of the like Swell about the Rotula; his Ham was also retracted, and his Leg emaciated. I began with the stuping them with aq. calcis wherein had been infused summitat. hyperici, hyssopi, majoranae, flor. sambuci, chamaem. ros. rub. bacc. myrt. juniper. etc. and applied empl. diasulphuris, etc. But the Swell not diminishing thereby, I opened that beneath the Rotula first, and the rest afterwrds. That on the outside of the Rotula was an Atheroma, and grew sinuous; and upon search I felt the Cartilege bore. I laid it open the whole length, kept it so with Dossills' dipped in spir. vini and syr. de ros. siccis, and attended the Exfoliation. During which the Patient was purged with Calomel. and diagrid. once aweek, and on the intermitting days drank a decoct. sarsaes, etc. Bezoard. mineral. etc. were also prescribed. Emollient Embrocations were made to the Ham, and a laced Knee-piece put on to make Compression, and dispose the Lips of the Ulcers to cicatrize: by which two of the Ulcers soon cured, and some while after the other incarned and healed to the very Cartilege. I kept it dilated with a Dossill, and thereby the Matter lessened daily, and that Ulcer cured (by leaving out the Dossill) without any visible Exfoliation. The Ham was much relaxed: but there being some contraction remaining, I fitted him with an Instrument which by virtue of its Screws gradually extended the Joint, and dismissed him with satisfaction to his Parents.  
A Child of about six years of age was brought to me with soar Eyes, 
14. Observat. of a Tumour on the right Knee.  and a white oval Swelling on the inside of her right Knee. I applied a Caustick on it, and the next day opened it. It lay deeper than the Caustick had reached; and the Incision appearing too small for the emptying of it, I laid it more open with a snip of my Probe-scissors, and discharged a Cheesie Matter. I than dress it up with Digestives, and the fourth day took of Dress, and saw part of the Cystis come away with my Dossills'. I dressed it with mundif. Paracelsi, and having thereby deterged it, I added sarcotics to the Mundificative, and commended the prosecution of the Cure to their neighbouring Chirurgeon, with direction to proceed with Internalls to evacuate and contemperate the acid Humours. Many Instances of this kind I could present you: but they not differing in the manner of Cure, I shall forbear, and give you one Instance of the sad consequences of these tumors.  
A Young man, 
15. Observat. of tumors on the right Knee.  19 years of age, had been lame from his Childhood with several of the aforesaid Swell about the Rotula of his left Knee, with a retraction of the Ham: he had also Glands' swelled in Inguine, etc. At length a Defluxion seized upon the uppermost Tumour of the Knee, and increased it and the rest with great pain. A frequent Vomiting and Diarrhoea accompanied it, and sometimes a Cough. I being consulted endeavoured to resist the several Acidents by Pectoralls, Opiates, Cordials, etc. and began the Chirurgery by the application of a Caustick on the Tumour above the Knee, by which I gave a great discharge to a purulent Matter; than dressed it up with Lenients, hoping to intercept the Matter in its descent downwards: but before that Escar separated, the Matter made its way down to the external parts of the Knee; which put me upon the necessity of opening it there, and afterwards on the inside of the Knee, and in two several places of the Joint itself. In some of which I felt the Cartilages and Bones corrupted; to which I applied an actual Cautery, and afterwards kept them open by a Paste made of pulv. rad. aristoloch. rot. panacis, etc. Having thus given evacuation to the Matter by the several Apertions, I fomented the Parts with Stupes wrung out of a discutient and corroborative Decoction, and applied Cataplasms ex far. fabar. hordei, lentium, flor. ros. rub. ballast. etc. decocted in some of the forementioned Fotus, with the addition of oxymel scillitic. etc. than by the application of mundif. Paracelsi, Praecipitate and the Vitriol-stone, I deterged and disposed the Ulcers to a better condition, that on the upper part of the Knee healing up. But the while I attended the Exfoliation of the Bones, the Caries increased, and the Patient languishing died at last tabid.  
A Child of about 6 years of age was brought to me extremely emaciated. 
16. Observat. of a strumous Ulcer on the Ankle.  He had a strumous Ulcer on the outside of his Ankle, with a Caries on the end of the Fibula: he had also three of the Spondylls of his Back distorted. I laid the Ulcer open by Caustick, and afterwards deterged it, and dressed the Bone with Dossills' of Lint dipped in spir. vini; over which I applied Epuloticks, with Compress and Bandage. His distorted Spine, being somewhat inflamed, I embrocated cum oleo myrtill. & aceto, and applied an empl. è bolo, with a soft Compress and Bracer. During which Dr. Bate and the deceased Dr. Stanley were consulted, and prescribed him as followeth: ℞ Merc. dulc. gr. xv. resinae jalapii gr. seven. bezoard. min. gr. iiij. cum succo gran. chermes fiat Bolus, capiat hora somni, & maeneʒiij. syrup. de cichoreo cum rhab. in ℥ iij. aq. germ. querc. iteretur quarto quoque die. ℞ sarsaparillae incis. & contus. ℥ iiij. ligni lentisc. ℥ ij. rad. Chinae ℥ iss. ras. eboris ℥ j milleped. contus. num. 1000 uvar. passular. enucleat. ℥ x. radic. rusci ℥ iiij. Misc. pro sacculo pro tribus cong. Alae tenuis non lupulat. bibat pro potu ordinario. ℞ aq. calcis lb j. sarsaparill. ℥ j rad. Chinae ℥ ss. uvar. passular. enucleat. ℥ iiij. glycyrrhizaeʒuj. fiat Infusio. ℞ hujus infusionis ℥ iiij. rad. eryngii conditiʒuj. sem. melon. ʒij. fiat Emulsio S. A. dulcoranda sacchar. tabellat. perlati, sumat ℥ ij. mane & vesperi. After the removal of the Defluxion upon the Spine, I applied an empl. ad herniam with Bandage as before. Whilst I attended the Exfoliation of the Bone by the application of Lint pressed out of spir. vini, I healed the Ulcer in the Parts about to the very Bone, and as that mouldered of, the Ulcer incarned and cicatrized, and the Child perfectly recovered within the space of two months, continuing strait and well to this day.  
One about 13 years of age, grievously diseased with the King's-Evill, 
7. Observat. of several strumous Ulcers with Caries.  was commended to my care. He had a Struma on the right side of his Neck movable, and of a round figure: he had also a Struma ulcerated in each Arm; the one on the inside near the Elbow-joint, and the other on the outside of the Biceps. His right Hand was ulcerated near the Bone leading to the first Joint of the Thumb, and passed its Matter close by the Bone to the inside, corrupting the Bone. One of his Ankles was much swelled and ulcerated on the inside in several places, which Ulcers upon search with a Probe appeared to have communication with one another, and served for the discharge of an abscess lying in the Joint, with corruption of the Bone. He had also in the Groin of the same side a Cluster of Strumae; which I suppose were occasioned by the anguish in the Ankle. Sr. Alex. Fraser and Sr. Fra. Prujean were his Physicians, and prescribed him medicated Broths, traumatick Decoctions, with other Specificks proper in his weak condition. I began my work with the laying open those Ulers in his Hand and Ankle by Caustick, and proceeded by Detersives to consume the Hypersarcosis, and make way to the Bones, accordingly as hath been showed in the Treatise of Ulcers. After I had made way to them, I dressed them with Dossills' pressed out of spir. vini, keeping those Ulcers dilated. During which I endeavoured to digest the ulcerated Parts about, and cicatrize them to the carious Bones, likewise to cherish the native Heat in the Members, and defend them from Fluxion by good discutient and corroborative Fomentations and Bandage. By this means the Matter daily lessened, and the Patient recruited his strength. I attempted the Exfoliation of these Bones some days, by dressing them with a Solution of unguent. Aegyptiac. spir. vini, pulv. myrrhae, euphorb. etc. upon Dossills' hot; and it succeeded well to that Caries on the Hand. But the Corruption was too great in the Ancle-joint to yield to that Medicament; wherefore having healed that Ulcer to the Caries, I applied an actual Cautery through a Cannula. At the first application, pressing upon the Caries, the Matter spurted out upon us. I pulled out the Cautery and Cannula, and dried the Ulcer with armed Probes, repeating the use of the Cautery till I had consumed the Caries; than dressed it up with Lenients, to appease the heat. After two or three days I dressed the Bone with Dossills' pressed out of spir. vini, and the Lips of the Ulcer with unguent. alb. camph. and attended the Exfoliation. During which I laid open those Ulcers in his Arms by Caustick, eradicated the Strumae with Merc. praecipitat. and cicatrized them. I also cut the Struma out under his Jaw, and soon cicatrized it. The Ulcer on the Bone leading to the Thumb was a painful work, the Tendon lying over the Caries; which put me at last upon the laying open the Ulcer on the inside, and applying my Medicaments that way, by which I exfoliated the Bone more easily, and cured the former Opening the while, and this soon after. The Caries in the Ankle was slower in Exfoliation, and did not cast of its Shell till I touched it with ol. vitrioli: after which it soon exfoliated, and the Ulcer cured. The Tumour in Inguine was embrocated with valentia digitalis during the Cure, but did not resolve till afterwards. The Cure of this person was the work of a year, and was so doubtful for some time, that it was difficult to determine which should be dismembered first, Hand or Foot. But he happily enjoys the use of both, with a perfect good health, to this day.  
A weak sickly Child, 
18. Observat. of a Struma on the right Foot.  about 10 years of age, was commended to my care by Dr. Mapletoft. She had a Struma suppurated on the right Foot amongst the Tendons and Bones leading to the two lesser Toes: I suspected them corrupted. But there being a necessity of opening it, I applied a Caustick proportionably, and gave vent to an albuginous Matter, and felt those Bones bore from the Tarsus to the first Joint of the Toes. I fomented the Part affected with a discutient Decoction, and dressed the Escar with Lenients, to hasten separation of the Slough: and as it began to separate, I deterged with Merc. praecipitat. and the Vitriol-stone, making way through the luxurious Flesh to the Caries. Than with Dossills' dipped in mel ros. and spir. vini, and pressed out, I dressed the Bones, and kept the Ulcer so dilated, as to see the Bones so far as they were carious. But in the applying my Dossills', they pressing upon the Tendons, rendered the Ulcer painful, and subject to great Defluxion of a thin serous Matter, and threatened worse mischief. To remedy which, I cut of those Tendons, dressed up the Ulcer with Digestives, and applied Refrigerants externally to restrain the Fluxion. At the next dressing, finding the Tendons contracted, and the Bones more easy to come at, and seeing the Exfoliation of them by Medicaments like to be a tedious work, the Matter having made its way under them, threatening Apostemations in the Sole of the Foot, I resolved to attempt them by actual Cautery. To which purpose I dressed them with Dossills' of Lint, to dilate them more for my view; and the next day I burned them the whole length; than with my Forceps pinched them to pieces, and pulled those broken bits out: after which I cleansed the Ulcer, and applied my Dossills' pressed out of a mucilaginous Decoction between and over the ends of the remaining Bones, dressing up the Ulcer with Digestives, and applying externally Compressed dipped in aceto wherein had been infused sal nitri, myrrh. etc. over which a laced Sock was put on. Thus I restrained the Influx, and pressed forth the Matter from its several Cavities. Yet I was necessitated to make afterwards an Apertion through the Sole of the Foot, and to lay open the Ulcer beneath the Ankle, for the readier discharge of Matter. I continued the application of Dossills' pressed out of spir. vini to the ends of the Bones, till a Callus thrust forth, filled up the voided space, and supplied the want of the Bones During this work, the Patient was afflicted either with a Cough, Diarrhoea, or Vomiting: in all which cases Dr. Mapletoft assisted with various Prescriptions, and contemperated the acid quality of her Blood: after which by good Nourishment the Child recovered her strength. She being thus at length disposed to a fair way of Recovery, the Ulcer near cicatrized to the Bones, and there being nothing more to do but to keep it open with dry Dossills' and a Pledgit of diapompholyg. with the usual Bandage, I by degrees left it to her Mother to dress, and saw the Child afterwards upon her Feet; and at length she recovered. And thus Time may be said to contribute much to the Cure of this Disease: but without the Surgeon's careful attendance, they miserably languish and die. For Amputation in this Disease signifies little, the Ulcers rising with Caries in one Part while you are extinguishing them in another.  
A Gentleman sent two of his Sons out of Ireland to Westminster-School: 
19 Observat. of a Struma on the Thigh, and several other tumors.  they seemed both healthful Youths, but soon after the elder of them grew indisposed with a Cough, and died tabid. His Body being opened by his Physician, his Lungs were discovered full of Strumae. The other, a Youth about 12 years of age, had the while a Soar burst forth of his Thigh, and had been dressed by a neighbouring Apothecary. His Brother being dead of the King's-Evill, the Relations enquired into the cause of this Youth's Lameness, and discovering several white Swell about him, brought him to me. That Ulcer which the Apothecary dressed was strumous. He had one Struma in Perinaeo, another large one upon his right Thigh, and two upon that Leg. On his left Leg there was one upon the head of the Fibula near his Knee, another upon the Calf of that Leg, a very large one lying on the outside of that Ankle, one lying upon the middle Toe of the same Foot, and two upon his right Arm. These were all suppurated, and there was great suspicion that the Bone was carious in those of his Ankle and Toe. In order to the Cure, they required all to be laid open. But how the Patient could bear so great an evacuation at once, I much doubted: and to open them one after another, would be a slow way of proceeding, and subject to many inconveniences. I concluded it best to lay them all open at one time, while he was in heart, and had strength to bear it. To which purpose I caused a quantity of soft Caustick to be made, and the next day applied it proportionably large upon every one, so as to take of all their Covertures, and dispose them to a healing condition. For a simple Opening in these tumors signifies nothing, but to tender them so many sinuous Ulcers. The Escars being made, I divided them, and gave vent to the Matter in the several tumors, than dressed them with Lenients to hasten Digestion. During which Dr. Tho. Cox was consulted, who directed this following Course of Physic. ℞ tamarind. cassiae recent. extract. an. ℥ j fol. senaeʒuj. Rheiʒij. sem. coriand. praeparatiʒj. macisʒss. infund. & ebulliant in ss. q. aq. pomor. addendo vini albi & succi pomor. an. ℥ ij. Colaturae lb j. add syr. violar. & mannae an. ℥ iss. clarificetur ovi albumine, & fiat Apozema pro tribus dosibus alternis auroris sumendis. ℞ sarsaparillae ℥ vj. Chinae ℥ iiij. ligni lentisc. ℥ iij. sassafras ℥ ij. ligni guaiaci, eboris, corn. cervi, an. ℥ iss. passul. enucleat. lb j. court. Winteranae, flaved. aurantiorum, eitr. nuc. moschat. an. ℥ ij. incident. incidantur & contund. contundantur, & add fol. cochlear. marin. ad biduum siccat. Muj. salviae Mij. anthos Mj. milleped. lb ss. furfuris frumentac. Mj. frust. chalybis recent. num. iiij. fiat Sacculus suspend. in cong. vj. cerevisiae dimid. part. lupulat. & sit pro potu ordinario. ℞ ligni sassafras lb ss. infund. in aquae font. lbxuj lbxuj. dein add eboris & corn. cervi an. ℥ vj. fol. agrimon. cochlear. marin. becabung. nasturtii aquatici, an. Muj. cochlear. hortens. berber. an. Miiij. passular. enucleat. lbij. lbij. court. Winteran. cinnamomi, an. ℥ ij. vini albi lbiiij lbiiij. lactis recentis lbuj lbuj. distillentur organis commun. capiat. aq. distillatae ℥ vj. extra pastum ter in die, dulcoretur syrupo nostro balsamic. After the separation of the Escars I rubbed the Hypersarcoses with the Vitriol-stone, and dressed them with unguent. basilic. and Merc. praecipitat. I cut of the thin Skin which covered the old Ulcer, dressing it after the same manner, and afterwards cicatrized them all, except those upon the Ankle and Toe, with the common Epuloticks, in less than two months. But those being carious were a longer work, the Matter there rising from within the Bones: they were also full of lose Flesh, and that of the Ankle sinuous and accompanied with Fluxion. The end of the Fibula being likewise corrupted by the same Matter, I deterged it with the Vitriol-stone and Praecipitate, dilated it to the Bone with Gentian-roots, and fomented the diseased Part with a Decoction of absinth. centaur. hyperici, flor. ros. rub. ballast. bacc. myrtill. etc. in Wine and Water; than dressed the Ulcer with Digestives, and hastened the cicatrizing of it to the Sinus penetrating to the Bone. While that was cicatrizing, I kept the Bone bore with Dossills' pressed out of spir. vini, and dressed the Bone of the Toe after the same manner, till the Ulcer about it was digested and ready to cicatrize to it. Than I consumed and dried the Caries in the Bones of the Ankle and Toe with actual Cauteries, penetrating very deep into that of the Ankle; and repeated this way again and again, till I had wasted the humidity in each Part of it: than dressed them with Dossills' of Lint pressed out of Read wine, and the Parts about with Refrigerants. After I had thus calmed the heat in the Ulcers, I kept the Bones dry and bore by the application of Dossills' in spir. vini, and attended their Exfoliation. But in the mean while a Spina ventosa arose in one of his Hands, and the next Toe to the diseased one began to swell. Upon sight whereof Dr. Cox was consulted, and prescribed Calomel. and other Specificks. The Swelling increasing in the Toe, I proposed the cutting of the other, supposing that to be the cause of it. The Patient appearing unwilling, I brought in Mr. Hollyer, who encouraged him; and about a fortnight after I prevailed, and cut it of, and some while after that cut of the other Toe, to save that Foot. I digested and cicatrized these Ulcers to the Bones, but could not make them exfoliate, till I had burnt the ends of them with an actual Cautery; and than they cast of but slowly. The Ulcer in the Ankle I cicatrized down to the Bone, that it lay dry; yet did that Bone make no haste away. During my attendance on these, a Swelling arose on the outside of one of his Arms near the Elbow. He concealed that from me till it was grown very large, and ready to burst. There also arose in one night a Spina ventosa on the Forefinger of the same Hand where the other arose: upon which I applied an empl. de ranis cum Mercurio dupl. I laid open the Struma upon his Arm with a Caustick, and endeavoured Digestion in it by the method used in the Cure of the other Strumae: but it grew corrosive, and resisted my Endeavours. I consulted Dr. Cox again; and considering the acidity in his Blood and the approach of Winter, we thought I necessary to attempt somewhat extraordinary, to prevent farther mischief; and together concluded that he should be put into a light Salivation. Accordingly I attempted it with Merc. dulcis. But he having taken of that all along, it worked downwards; and he being weak, I durst not move it by Vomit. But by Suffumigation I raised it, and salivated him about 17 days: during which the Ulcer in his Arm cured, and the Spina ventosa on his Hand resolved. But that other in the Bone of his Forefinger increased, with great Inflammation and Tumour. In the declination of his spitting we purged him, and sweated him with a Decoction of sarsa, etc. Afterwards he drank his former prescribed medicated Ale, etc. recovered daily his strength, and grew fleshy; his Ulcers healed up, and the Bones cast of in the Ankle: so as there remained only a piece of the compass of a silver Twopences, and that loosened and thrust of by virtue of a Callus, which, cicatrizing with the Lips of the Ulcer, made a firm Cicatrix. Yet the Spina ventosa remained, and raised a small Apostemation on the inside of the Finger. I laid it open by Incision to the Bone, and saw it smooth and white. I penetrated into it with an actual Cautery, and dried it, than dressed it with Dossills' pressed out of spir. vini, and digested, incarned and cicatrized it to the Bone. Having thereby disposed it to Exfoliation, and concluding him as it were cured, I left him Directions to dress it, and others to judge of my work, I taking the while a Journey into the Country. At my return I received a Letter from his Mother, dated at Bristol, that the Bone was cast of, and his Finger cured. Since which time he hath enjoyed good health, and is grown a man.  
A Man aged 23 years, 
20. Observat. of a Tumour on the Foot.  of a tolerable good Habit of body, was diseased with a white Swelling on the inside of his Foot beneath his Ankle down to the Heel. There seeming to be Matter in the upper part of the Tumour. I laid it open by Caustick, and discharged an Atheromatous Matter in great quantity, than dressed it up with Lenients. At the next dressing, finding an increase of Matter, I made a search with my Probe, and felt a Sinus running to the Heel. I laid it open thither, and dressed up the wounded Lips with a Digestive ex terebinthina cum vitell. ovi. After digestion of the Ulcer, I felt the lower part of the Heel-bone bore. I proceeded in the healing of the upper part of the Abscess, by laying the nether part open to the Bone, and dressing the Bone with Dossills' of Lint to keep it dry and dilated to my view. I afterwards saw it bore the compass of a Groat: it appeared white and pory. I continued the method of dressing; and after I had disposed the rest of the Ulcer to a healing condition, I consulted Dr. Denton, who had a kindness for the Patient. He met me at the poor man's Lodging, and saw the Ulcer dressed, and those Inequalities with a Caries in the Bone. We applied an actual Cautery to it, and kept it dry with Dossills', according to custom, attending its Exfoliation; the Physician prescribing Internalls, and taking care of his health. Thus all things succeeded well, as we thought: but some while after he was seized with a Phrenitis. He had no Fever, yet died some days after, notwithstanding all our Endeavours by Bleeding, Cupping, Blistering, etc.  
A Child of about seven years of age having been diseased with a Swelling on the outside of her Heel the space of two months, it apostemated, 
21. Observat. of a strumous Tumour on the Heel.  and discharged its Matter, terminating in a painful Ulcer. Her Friends being informed it was the King's-Evill, recommended her to me. I saw her Hectic, and upon a search into the Ulcer felt the Bone carious, but had no order to dress her till about two months after; and than I began with the laying open the Ulcer, and bringing the Bone into view. Which after I had done by Dilatation, I perceived it so lose that I could easily have taken it out whole: but it looking white, and seemingly sound, I perforated it with a Terebra, and felt the external part of it hard: though after I had pierced that, I felt the interior parts soft and rotten. I applied a Bolt-cautery into that Perforation, to dry up that humidity: but the Matter spurted out of it. When I saw it irrecoverably lost, I resolved to take it out: to which purpose I invited Sr. Charles Scarburgh, who upon sight of it agreed to the pulling it out. I laid hold of it with my Forceps, and easily drew it forth, not a drop of blood following it: than dressed up the Ulcer with sarcotics, and put on a laced Sock, to bring the Parts close and shape the Heel. Sr. Charles prescribed Internalls, and visited her often. I proceeded hopefully for a month or two: but there had been formerly a cluster of Strumae in that Groin, which had been raised by the anguish of the Ulcer in the Heel, that apostemated, and discharging its Matter down the Thigh, terminated in a sinuous Ulcer, which exhausted her strength so that she died tabid.  
A Child about 7 years of age was commended to me by Dr. Tho. Cox. 
22. Observat. of Strumae on the Arms, Leg, and Heel.  She had some Strumae in both her Arms, and one large one lying on the outside of the Calf of her Leg, stretching downwards towards the Ankle. She had another possessing the outside of that Heel. That on her Leg was suppurated: this of the he'll burst some weeks before she came out of the Country, and discharged its Matter by a small Opening. I began with the laying open these two by Caustick. Out of the uppermost I discharged a serous and curdled Matter. After separation of the Escars, I deterged them with Merc. praecipitat. and the Vitriol-stone, must suspecting a Caries in the Heel. During which her Physician purged her with this: ℞ julep. cathartici ℥ iij. syr. de pomis magist. ℥ ss. aquae cinnam. hoard. ʒj. syr. è flor. persic. ℥ ss. Misc. fiat. Potio. This following Decoction she drank those days she did not purge: ℞ rad. Chinaeʒx. sarsaparillaes, ras. corn. cervi, eboris, an. ℥ ss. infund. & ebull. in aq. font. lbiiij lbiiij. debito tempore, add. rad. tormentillae, bistortae, an. ℥ j millefol. summitatum caryophyll. mont. flor. hyperici, an. Mj. cons. ros. rub. ℥ ij. dactyl. exossat. num. vj. cinnam. confractiʒij. sem. coriand. praeparati ℥ jss. colaturae lbiiij lbiiij. add syr. de symphyto Fernelii ℥ iij. To the Strumae in her Arms I applied Celsus' Malagma, and disposed them to Resolution. The Ulcers in the Leg and Heel being deterged as aforesaid, they healed in few weeks: but the latter brake out again the third day, and confirmed me that it was carious. I went one morning whilst she was asleep, and applied my mildest Caustick on it; and after digestion of the Escar I made a search, and penetrated at lest half an inch deep into the Bone. I had before given suspicion to the Parents of the Caries, and it now appearing to have risen originally out of the middle of the Bone, I thought it necessary that they should consult some Chirurgeon in order to the Cure of it. Mr. Hollyer met the Physician and myself, and after search declared the Caries as I had represented it. He approved of the dilating the Ulcer, and dressing the Bone dry. Calomel. Bezoard. min. etc. were than resolved on and prescribed by the Physician. The next day I began with the dilating the Sinus with prepared Sponge, and having brought it to view, I dressed it daily with Dossills' pressed out of spir. vini, and the while healed the Ulcer down to the Bone; by which the great discharge of Matter which so frequently threatens a Hectic in others was prevented, and our work succeeded well. But this Child had a Grandmother in the Country, that out of abundance of kindness to the Child did much frustrate her Cure, not only by her frequent Letters, but also by a Woman she sent up, who pretended to Chirurgery, and seeing the Ulcer without inflammation, swelling, or considerable discharge of Matter, reported to her that it was an inconsiderable Soar, and would soon cure, if the Chirurgeon did not keep it open by thrusting Lint into it. Others both in the City and Country informed the Grandmother, that the casting of of the Rottenness in the Bone was the work of Time, and that the Ulcer needed no such Dress as I applied. Upon which she persisted in soliciting the Parents to bring the Child back to her in the Country. These things coming to my knowledge put me upon as great a desire to be freed of the Patient, and made me cautious in the dressing the Bone: for it did certainly require the actual Cautery; but I dressed it only some days with an armed Probe dipped in a Solution of unguent. Aegyptiac. and extract. scordii scalding hot, and afterwards with Dossills' dipped in a Composition of ol. myrrhae distillat. etc. by which at length the Rottenness seemed to be cast of. I likewise complied with all their inclinations, leaving out the Dossills', and permitting the Ulcer to Time. At the first leaving out the Dosslls the Ulcer contracted, and being callous, and dressed with a Pledgit of unguent. tutiae, retained an Opening large enough to discharge its small quantity of Matter: which gave hopes of its being as it were cured. The laced Stocking with Compresses under it restrained the influx of Humour, and strengthened her Foot so that she walked tolerably well on it. But not long after he Blood fermented, and the Smallpox burst forth abundantly, threatening her life. But she happily recovered out of them: yet from that time her Eyes began to be afflicted with sharp Defluxions, and the Humours fermented in one of the Glands' in her Arm, which was seemingly before dissolved. This put me upon the opening it by Caustick, and proceeding in the Cure: which I did, and accordingly soon cured it. In order to the Cure of her Eyes, fontanelles were made, Leeches applied behind her Ears, blistering Plasters to her Neck, Intercipients to her Temples, and Applications were made to her Eyes; lenient Purgatives and Alteratives were also repeated: by which she was relieved. But they being weakened by the Defluxion, were frequently subject to it. Thus she returned with her Parents into the Country, supplied with Directions from hence. After her being there some time, her Heel apostemated, and I was consulted by Letter. But her Grandmother, listening to every Prattler, governed the Child accordingly, and I suppose it continues still diseased.  
A Gentlewoman aged 16 years, of a seeming healthy Constitution, 
23. Observat. of an Abscess in the Foot, with rotten Bones.  was seized with a pain in her right Foot. Various Remedies were applied; a Bonesetter was also employed, But the pain increasing with Tumour, a Chirurgeon was entertained; who, after several Applications, seeing somewhat like a Suppuration, opened it: but from that time it growing more sinuous, and the Swelling greatly increasing, he consulted others of his Profession, and afterwards left her to be dressed by one and another. After she had languished near the space of a year and half, I was consulted, and found her Foot leapt up in a Cataplasm. Upon the taking which of, I saw it extreme big, and all apostemated, discharging its Matter round, at the outside, inside, Sole of the Foot, and Heel, so that it was easy to pass a Probe through any way. The external Ulcer on the Foot was large, and overgrown with an Hypersarcosis: the Bones within the said Foot were most of them carious in one part or other; some of them were rotten to pieces. If this Patient had been tolerably strong of Body, Amputation had been of use: but she was emaciated, and frequently afflicted with a Diarrhoea, Cough, and a great weakness and dejection of Appetite. Upon which considerations the Ulcers were superficially dressed with Pledgits of unguent. Apostolor. and the Patient persuaded that the Exfoliation of the Bones was the work of Time. But it being visible, that Nature could do nothing in her case without the help of Chirurgery in drying up the luxurious Flesh, and making way to pull out the rotten Bones, and dressing of the others which were lesle carious with Medicaments accordingly drying; I declined the meddling with it, unless I were permitted so to dress it. Not that I had any great hopes that way: but if that were not attempted, she would certainly die. At that instant we dressed up the Ulcer on the upper part of the Foot, which was overspred with luxurious Flesh, with Merc. praecipitat. the other with unguent. diapomphol. etc. and with Compresses and Bandage endeavoured the pressing out of the Matter, and restoring the Foot to some shape. This method was repeated every other day, with Compresses of Tow pressed out of acetum wherein had been dissolved sal. nitri, myrrha, camphora, etc. But finding the Fungus still increasing, we applied the actual Cautery; and thereby at once consumed it down to the Bone, and dressed it up with Lenients. From that day's dressing the Matter lessened daily, and grew well digested. After the separation of these Sloughs, we attempted the remaining Hypersarcosis in some parts with the Caustick-stone, and in others with ol. vitrioli. We applied Dossills' of Lint dipped in spir. vini on the Bones, and sprinkled the luxurious Flesh in the circumference with Merc. praecipitate. as we saw cause. If this Patient had been any whit stronger, I should have used the actual Cautery oftener, and thereby laid all the rotten Bones bore, and dried them with it: but by reason of her weakness and great indisposition of Body, I proceeded for the most part with Praecipitate, as aforesaid, and dressed her twice aweek, or every third day; during which the Foot recovered a better shape, the Ulcers also discharged lesle Matter, and she was more at ease. Her Physician prescribed Internalls, to resist the several Accidents, and corrected the acidity in her Blood; so that she seemed to recover: but of late, the weather being very cold, 
24. Observat. of strumous Ulcers on the right Foot, Aems, etc.  she is subject to a Diarrhoea, and I fear will die of it.  
A sickly weak Child, scarce 7 years of age, having long laboured under a pain and discharge of Matter from many strumous Ulcers, was at last recommended to me. He had one large strumous Ulcer possessing the inside of his right Foot, of the compass of a Five-shilling piece in silver, and another on the outside of the same Foot, passing its Matter between the Bones leading to the third and fourth Toes into the Sole of the Foot. He had also Ulcers in both his Arms near the Elbow-joints: likewise a Struma suppurated upon the second Joint of his right Thumb. The middle Finger of his left Hand had a Spina ventosa; also the fourth Finger of the same Hand was ulcerated, and the Bones rotten from the second Joint to the Knuckle. In order to the Cure of this Child there was required a necessity of nourishing it, and of correcting the Habit of body: for he was extremely emaciated, and the Ulcers were all corrosive and exceeding painful. Upon which consideration I declined the meddling with him till they should consult some eminent person of our Profession, who might see his deplorable condition, and assist in the Cure. They sent for Sr. Fra. Prujean, who prescribed medicated Broths, cordial Juleps, Decoctions of Sarsa, and other Specificks proper in his weak condition. Mr. Battersby was his Apothecary.  
I began with the opening that Abscess on his Thumb by Incision, whence I discharged a curdled Matter; and feeling that Bone carious, I dressed it up with a Dossill spread with unguent. basilie. and a Plaster of the same over it: the other Fingers I dressed with some of the same Unguent, mixed with Merc. praecipitat. and with unguent. tutiae over all, endeavouring Digestion there. My main business being, to dispose those Ulcers to a healing condition which were in the Foot, which discharged so large a quantity of Matter, and threatened the corruption of the Bones. I made a search into that Ulcer on the inside of the Foot, and finding it hollow round, I stopped up the Orifice with a Dossill, and applied a Caustick the whole compass of it. To the Ulcer on the other part of the Foot I also applied a Caustick. The next day I divided these, and after the stuping them with Read wine, I dressed them up with Lenients and good Bandage. In the dressing of the Ulcer on the outside of the Foot, perceiving the Matter likely to raise an Abscess in the Sole of the Foot, I passed a Seton-needle between the Bones through that Abscess, and prevented its farther insinuation by keeping that Apertion open. As these Escars cast of, I deterged with Merc. praecipitat. or the Vitriol-stone, and by Epuloticks lessened the Matter, and cicatrized that Ulcer on the inside of the Foot in three months. The other Ulcer I cicatrized also to the very Sinus passing to the Sole of the Foot: but one of the Bones being there carious gave me a longer trouble. I dressed it dry with a small Dossill; and by keeping the Apertion open under it in planta pedis, I drained the Matter, secured the Exfoliation of it, and cured it some time after. While these Ulcers were digesting and cicatrizing, I proceeded in digesting and deterging the other Ulcers in the Thumb and Fingers. That in the Thumb I dilated with Gentian-roots, and afterwards dressed the Bone with a mixture of unguent. Aegyptiac. spir. vini, myrrh. and euphorbium hot upon an armed Probe, and kept it dilated with Dossils' and Refrigerants over it. But finding the Sinus to abound with Matter, and the Bone rendered incapable of Exfoliating, I passed a small flat-pointed Fistula-needle through the Sinus, and made way for the Matter to discharge into the inside; than enlarging that Aperture, I dressed the Bone through it, and permitted the Ulcer above to cicatrize the while. Having thus disposed this Bone to exfoliate, I laid open the Spina ventosa by Incision to the Bone; and after dilatation of the Lips, seeing the Bone white, I cut into the thin Shell, and made way for the application of unguent. Aegyptiac. etc. by which I dried it within, and disposed it to Exfoliation: and at length a Callus filled up that Trough, hardened into Bone, united with the Flesh, and cicatrized firmly. The fourth Finger I would gladly have cut of: but not being permitted, I laid it open by Incision, pinched out a piece of that Bone next the Knuckle, and exfoliated the rest. But the Knuckle itself, being rotten, was so long in exfoliating, that the Joint contracted, and the Finger remains so weak, that it may well be asked why I took so much pains to keep it on. But I have told you, they would not permit it to be cut of. Those Ulcers in his Arms were cured as generally all such are, viz. by removing their Coverture, by the application of Caustics, and eradicating the strumous Flesh; of which I have said sufficient. Thus this young Gentleman was at length cured. He bears the marks of his Sufferings, but yet without Lameness or Deformity, save in that little Finger.  
A little Boy diseased with the King's-Evil was brought to me with an Ulcer between the Joints of one of his Thumbs, and the Bone carious. 
25. Observat. of a strumous Ulcer on the Thumb.  I laid open the Ulcer on the inside according to the length of the Bone, and dilated it with Gentian-roots. After Dilatation I dressed the Bone with Dossills' dipped in spir. vini, rubbed the lose Flesh with the Vitriol-stone, and applied Epuloticks over it with convenient Bandage. After a few days dressing, observing the Bone rotten, I took hold of it in the middle with a pair of Nippers, pinched it in pieces, and pulled the bits out; than cleansed the Ulcer, and dressed the remaining ends with Dossils' of Lint as before. By this method of dressing the Caries separated, and the Callus united the ends of the Bone. Upon sight whereof I left out my Dossills', brought the Lips together, and with Epuloticks and Bandage cicatrized it firmly. A day or two after the Child came to me with his Thumb bent inward. I reduced it, and sent for a Tin-man, who made me an Instrument, which being put on and fastened about the Wrist, retained it strait. So I dismissed him into the Country: but by their neglect it is somewhat bend.  
A young Gentleman about 14 years of age, 
26. Observat. of strumous Ulcers on the Back of the right hand.  of a weak sickly Constitution from his Infancy, was brought to me soarly afflicted with strumous Ulcers on the Back of his right hand. They had been of many years' continuance, and had rotten the Bones. I stopped the Ulcers with Lint, and applied a proportionable Caustick over all. The next day I divided the Escar, and as it separated, I rubbed the Hypersarcosis with a Vitriol-stone, and sprinkled it with Merc. praecipitat. Thus I made way to the Bones, and pulled out what was lose and lay entangled in the spongy Flesh: the others I kept bore with Dossills' dipped in spir. vini, applying Pledgits spread with Epuloticks, and Bandage over them. After I had dressed them some days, and had a full sight of them, I pinched the most rotten of them in pieces, dried the others with actual Cautery, and continued the dressing the Bones dry as aforesaid. Mr. Hinton was the Apothecary, and supplied him with cordial Juleps and somewhat Antistrumaticall, he not being capable of much Purging; nor did he need it, for by the method aforesaid the Bones exfoliated, and the Ulcers cured in the space of eight weeks with a smooth and firm Cicatrix. He since enjoyeth his health, and strength in his Hand.  
Whilst the aforesaid Patient was under Cure, 
27. Observat. of an Ulcer on the left Hand.  a poor Woman brought her Child to me with a strumous Ulcer on the left Hand swelled and inflamed. I made a search, and felt the Bone leading to the middle Finger bore. It not being the time of public Healing, I made Incision upon it, filled the Ulcer with Dossills' of Lint dipped in Merc. praecipitat. and dressed it up with Digestives and empl. è bolo. After Dilatation, finding the Bone lose, and started up at that end next the Knuckle, I raised it, and separated it from the Metacarpium: than dressed the Ulcer with Dossills' dipped in pulv. Galeni, and from that time deterged and incarned; during which it contracted narrow, and cicatrized by the application of the common Epuloticks.  
A young Woman came out of the Country with strumous Ulcers in the Bones of one of her Thumbs and one of her great Toes, 
28. Observat. of Ulcers on the Thumb and great Toe.  near the last Joint of them. I laid them open by Caustick, and dilated them with Gentian-roots and Dossills' of Lint: afterwards I dried them with actual Cauteries, and kept them dilated with Dossills' of Lint pressed out spir. vini some weeks. During which time I let her blood, purged her, and prescribed Antistrumaticks, accordingly as hath been proposed in the method of Cure. One day in pulling the Dossills' out of the Ulcer in the Toe, a big piece of the Bone came away with them. Finding no more upon search, I permitted that Ulcer to heal up by lessening the Dossills'. But growing afterwards weary with the expectation of the Bone's exfoliating in the Thumb, I pinched of the rotten part of it, dressed the Bone with Dossills' as before, and soon after saw a Callus rise out of that broken Bone, which uniting with the rest of the Ulcer incarned it, and it cicatrized in few days after under the Dossils'.  
A Child about 4 years of age, 
29. Oservat. of strumous Ulcers on the Wrist and great Toe.  of a sickly and indisposed Habit of body, being diseased with strumous tumors, was commended to me by Sr. Alex. Fras. and Sr. Fra. Pruj. who were his Physicians. One of the tumors lay transverse the inside of the Wrist, and seemed to have Matter in it: the other lay upon the Joint of the great Toe under the Nail. I concluded the Bones foul in both places, and began with that on the Wrist by the application of a mild Caustick. That night the Child was seized with a pain in its Side and a Fever. This was thought by the tender Mother to proceed from the application of the Caustick: but the Child soon recovering out of it, she was satisfied by her Physicians otherwise, and I was permitted to prosecute the Cure as I judged necessary. Whereupon I went on in dividing the Escar, and gave vent to a curdled Matter, dressing it up with Lenients, and provided against the next dressing a Fotus discutient and drying. At the next opening I fomented the Tumour, sprinkled Praecipitate into the divided Escar, and dressed it up. After separation of the Escar, the Ulcer appeared full of a luxurious Flesh, and the Matter abounded much. I made a search with a Probe, and found a Sinus between the Radius and Vlna, and the Bones carious. I laid open that Sinus by Caustick, and after separation of the Escar deterged with Merc. praecipitat. etc. and kept that part dressed with Dossills' pressed out of spir. vini. There was in the Child such an acrimony in his Blood, that I could not keep the Ulcer digested 2 days, nor check the influx of Matter, it insinuating itself into the Wrist in spite of all my endeavours. The very transpiration behind his right Ear ulcerated, and grew difficult of cure. Upon sight whereof the Physicians prescribed as followeth; ℞ antimonii diaphoret. in crucibulo per duas horas ignit. q. s. sumat ad quantit. gr. seven. tribus horis medicine. in cons. anthosʒss. superbibendo aquae infra prescript. cochl. seven. pro singulis vicibus, quarto quoque die sumat Calomel. gr. xij. resinae jalapii gr. iij. cons. flor. cichorei q. s. & fiat Bolus: abstineat illis diebus ab usu antimonii diaphoretici. ℞ sarsaparillae lb j. ras. corn. cervi, eboris, an. ℥ iij. fol. agrimon. veronicae utriusque, an. Miij. santali albi, rubi, an. ℥ ij. liquiritiae Anglicae lb j. lactis vaccini cong. ij. in organ. common. distil. liquoris distillati singul. lb iij. add table. ocul. cancror. ℥ ij. sumat ad quant. ℥ vj. singulis dosibus, addendo aq. cinnam. hordeat. cochl. ij. During the Patient's taking these Prescriptions, the Matter relaxed the Ligaments and Tendons; insomuch as, coming one day to dress his Hand, I found it crooked, as if it had been falling of from the Joint. I raised it up, and causing it so to be held, I took of the Dress, and saw the Joint far separated in the upper part. I presently sent to Mr. Stockdale, and directed him in the making an Instrument to retain the lower side of that Hand and Arm, and hold it even, and in the mean time I boulster'd it up. The Instrument being made, I placed the Hand in it, and by Screws fixed to it I kept the Joint close and firm, and did not take it of till that Ulcer was cured, but proceeded in the way of dressing as above said, laying open some Sinus' on the Back of the hand, and making Compression upon others. The carious Bones were dressed with a mixture of unguent. Aegyptiac. extract. scordii, pulv. euphorbii, and spir. vini, applied hot with armed Probes and Dossills': the luxurious Flesh was dried and consumed by Escaroticks, and the Ulcer cicatrized from the circumference with unguent. tutiae, etc. Having thus in some measure checked the Fluxion, and disposed the Hand to cure, I began with that Tumour upon the Toe by the application of a Caustick, and gave vent to a curdled Matter. Upon search, finding the Bone carious, and part of it lying under the Nail, I was necessitated to apply a small Caustick thereon; which having softened the Nail, I cut it of, made way to the Bone, and dressed it with Dossills' of Lint pressed out of spir. vini: afterwards I dressed it with a mixture of unguent. Aegyptiac. etc. upon an armed Probe hot, and disposed it to exfoliate. This Child had an extreme ill Habit of body, the Ulcers frequently corroding one part as it healed in others, or fermenting in his Blood, and affecting his Lungs or his Bowels with bilious Colicks, etc. so that the Physicians met also with much difficulty. But at length an Exfoliation of the Cartilege of the Joint of the Toe cast of, so also the Caries in the Bone, and that Ulcer cured: 2 slips of the Nail also thrust out from the remaining Ligament alongst the sides, but there grew none on the middle. The Ulcers on his Hand and Wrist also cicatrized firm: but the Ulcer between the Radius and Vlna did not cast of its Bones; but being well digested, and the Bone disposed to Exfoliation, it was thought fit to supply them with Medicaments and Directions, and remove him into his own Country, to take the benefit of the Air. He did so, and Dr. Barker of Newb. took care of him there. During his being there he recovered a better measure of health, and was afterwards removed into Northamptonshire; where I attended him, dressed that Ulcer between the Rad. and Vln. and left my Servant Mr. Yo. who perfected the Cure. Since which time the Patient hath enjoyed his health very well, and the use of that Joint. And indeed, if the Member be kept in its true position, and the Joint above it, whether, Elbow, Knee, etc. be some time stretched out, such young people fail not of the use of their Limbs: but where the position of the Member is neglected, the Cure succeeds ill, and a Lameness remains ever after.  
A young Gentleman aged 12 years, 
30. Observat. of strumous Ulcers on the Foot with rotten Bones.  being much emaciated and diseased with the King's-Evill, was brought to Dr. Bate's house, where Dr. Willis and myself met at the Consultation. He had an Ulcer on the outside of his left Foot. Upon search with a Probe the Bone leading towards the little Toe felt carious the whole length; the Foot was much swelled, and seemed to have several Abscesses lying amongst the Bones of the Tarsus and Metatarsus. The way I proposed to Cure was, by the laying open the Ulcer, and exfoliating of that Bone, and so to proceed in the rest of the work as I saw cause. This being approved of by Dr. Bate, he prescribed a lenitive Bolus with a few grains of Calomel. to be taken once in 4 days, and Bezoard. mineral. witha Decoction of sarsaparill. and lign. lentisc. etc. to be drank the intermitting days. The next day I began my work with the application of a Caustick, and enlarged that Ulcer; than laying the Bone bore, I found it rotten the whole length, and a Sinus stretching transverse over the Foot, from whence a quantity of Matter flowed, which being retained by the foresaid Bone, threatened a corruption of the rest, as also a passing of its Matter down to the Sole of his Foot. Upon which consideration I thought it necessary to remove the lower rotten Bone by pinching it in pieces: but it not yielding thereto, I sawed it, and took it out. By the removal of this rotten Bone the Matter had a free discharge, and I had the conveniency of applying my Medicaments to exfoliate them, and to cleanse the Ulcer; which I did by mundif. Paracels. unguent. fusc. tinctura myrrhae, etc. and digested the Lips of the Ulcer with unguent. basilicon, and cicatrized them with unguent. tutiae and the Vitriol-stone. During which I applied Stupes of Two pressed out of a Solution of Nitre and Myrrh in Wine-vinegar, and by Compression with a laced Sock thrust the Matter out of its several Cavities. Yet in declining part of the inside of the Foot I afterwards feeling a small collection of Matter which could not be discharged that way, I gave vent to it by Caustick, and digested it. After I had thus made way for discharge of the Matter, I restrained the Humour from flowing into the Foot, and restored it to its natural figure, having no more left to do, but attend the Exfoliation of the several Bones. Dr. Willis began to purge the Patient with the above-prescribed Bolus: but there happening thereupon a Superpurgation, he declined the repeating of that Purge, and omitted the prosecuting of the aforesaid Course prescribed by Dr. B. upon which the Matter fermented, and caused a pain in the Knee of his other Leg. Dr. Bate being deceased, Dr. Tho. Cox was consulted, and advised the repeating of Calomel. etc. But it not being prosecuted, other pains arose. During which it happened that an old. Gentleman came in, who had formerly lived in the Barbadoss, and practised Chirurgery amongst his Slaves. He desired to see our Patient dressed, and seeing the Foot without Tumour, and the Matter little and well digested, confidently undertook the Cure, by the giving him a Wound-drink, and applying an Ointment to the Ulcers. The Parents rejoicing to hear their Son might be so easily cured, desired me to give way to it, and permit my Kinsman Jaques Wiseman to dress him with that Unguent, (which was no other than the Juice of Clowns All-heal made up with Butter or Hogs-lard.) I complied with their desires, but withal advised them to leave of the use of the Bandage, knowing well that it would swell, and discourage the Undertaker. But they continued it; and after some of their Servants had learned how to dress him, they dismissed my Kinsman. I would gladly have finished the Cure, but I took my leave by the way of a Letter, wherein I predicted what followed: for what could be expected from greasy Ointments, but corruption of the Bones? This young Gentleman being thus taken out of my hands, gave occasion to some envious men of my Profession to report it otherwise to my prejudice; wherefore I have here inserted the Letter I received from his Father in answer to mine.  
Sir, I do not doubt but you used your best Endeavours, and observed those Rules and that method which your judgement thought best for the Cure of my Son; and consequently you may well have those Apprehensions which you yesterday signified to me both by discourse and Letter, that the way he is now in may be prejudicial, if not ruinous to him. Upon which intimation you will easily believe I am in a straight, and cannot regulate my actions with that clearness and satisfaction as I desire. But having heard of divers instances of undoubted truth, and from Persons of Honour and Quality, of Cures that to their knowledge had been wrought by plain and empirical Medicines in short time, and with much ease, after the means more potent and noble, and managed by expert Artists, had been long tried, and proved successeless; I resolved, though with some reluctancy, to run the like adventure, and make an essay of Col. Midd.'s Receipt, and see whether my Son may have the like good fortune. And being entered into that Course, without any discouragement hitherto discernible, and being to leave the Town to morrow, I cannot now of a sudden recede, and take up a new resolution. I shall leave my Wife here with the Child for some weeks: in which time if any Alteration appear to make it evident that we are in an Error, I shall thankfully accept your offer to rectify us, and set us in a more rational way. In fine, if the issue be unfortunate, I must confess that you have discharged your duty in giving us the advertisement; and that nothing of blame can reflect upon you; the fault as well as the loss will be our own.  
Sir, I am your very affectionate Friend and Servant, W. Y.  
A Child of about 5 years of age came out of the Country the Summer after the Burning of the City of London, 
31. Observat. of strumous Ulcers with rotten Bones.  with an Ulcer in his Heel and another in his Arm, with carious Bones. His Friends consulted a Chirurgeon of their acquaintance, who persuaded them to return with the Child into the Country, telling them Time would cure it. But that proving an ill Chirurgeon, and not performing it, they brought the Child again about a year after to London, and came to me with him. He was than languishing under a hectic Fever, the Ulcer in the Heel was very large, and the Bone totally rotten. There was also another upon the Os astragali as bad, and others upon those Bones which lead to the second and third Toes. On the outside of the other Leg there was a sinuous Ulcer, and the lower part of the Fibula was carious, as likewise was the inside of that Ankle. The right Hand was ulcerated from the Wrist up the Arm between the Radius and Vlna, making Ulcers on both sides of the Bones: they were also carious the length of between two and three inches: his Neck was also full of Strumae: and to these he had an Ozaena, and a thick chapped Lip. I would gladly have declined the meddling with him, as being myself than much indisposed, and the more at the sight of this miserable creature, whose condition I knew not how to help. For to propose Amputation of a Leg or Arm in this Patient, might have savoured of much cruelty, but availed nothing, while the other Parts were so diseased. But his Friends would have no nay: they brought him to my house, and obliged me to dress him. I began my work with that Ulcer beneath the Ankle on the inside of the Foot. The Opening being small, and the Ulcer and Caries large underneath it, there was a necessity of laying it open to come to the Bone; Injections signifying nothing there but to make the Ulcer more sinuous: yet the laying it open was hazardous, by reason of the Artery which passed over the carious Bone: but there was no avoiding it. Therefore placing the Child upon a Table near me, I applied a Caustick, upon the Abscess. Than, while it was working, I dressed the other Ulcers, which was at lest an hour's work. That done, I caused an actual Cautery to be put into the fire, ready for my use in case need, than took of the Dress from the Foot; and finding the Caustick had worked as I defigned, I made Incision overthwart the Escar to the Bone, by which I divided the Artery. The blood bursting our with great force, I filled up the Incision with Dossills' dipped in pulv. sine pari Jo. Ardern. with Emplaster over it: Whilst I was binding it up, I bethought myself, if by any accident it should chance to burst out again, the Child might bleed to death before I could have notice; or they might alarm me in the night upon a suspicion of his bleeding, when I should not be so provided to resist the Accident as now I was: and withal considering, I might at the same time secure the bleeding, and dry the Caries in the Bone, I unbound it, threw out the Dossills', and applying the actual Cautery in the place, stopped the bleeding, and dried the Caries. That done, I dressed the Bone with Dossills' dipped in a newlaid Egg, and applied on the Escars' unguent. refrigerans Galeni cum empl. è bolo, with Compress and Bandage dipped in Oxycrate. After which they carried him home. Dr. Quarterman was their Physician, and prescribed him Antistrumaticks, etc. The Ulcer in the Ankle bled no more, nor was that Bone much troublesome after. We laid open the inside of the Arm by Caustick; and feeling the Bones carious, and the great Artery lying in our way, we cut of that, and by the actual Cautery dried it; than made way to the other carious Bones, and laid them open. Than cutting open the outside of the Heel, and seeing that extremely rotten, in some parts quite through, we opened the other side, took part of the Heel-bone out, and dried the remainder with the actual Cautery, than dressed the Ulcers with mundif. Paracelsi with and without Merc. praecipitat. Some of the Bones lesle carious we dressed with extract. scordii, and others with unguent. Aegyptiac. and pulv. myrrhae, etc. applying unguent. tutiae over the tender Lips. To the Ozaena we used Injections of decoct. hordei cum sem, cydon. etc. and ol. amygd. dole. to bring of the Crusts: than with Decoctions of rad. bistort. tormentil. rad. ireos, flor. ros. rub. and bacc. myrtill. decocted in a Chalybeat-water, we dried the Ulceration. To his Lip we used a Fotus of an emollient Decoction, also a Pomatum with arcan. corallinum. Thus we proceeded with great industry: but as some Parts cured, others broke out, and the Patient died in a Marasmus after all our Endeavours. Yet that you may not be discouraged in giving your assistance towards the curing these sort of Ulcers with Caries, I have here inserted one Observation as it was communicated to me by Mr. Clarke, a Chirurgeon dwelling at Bridgenorth in Shropshire, who was sometime my Servant.  
Honoured Master,  
You may please to remember that about 2 years and a half since I writ to you concerning a Scrofulous person, who was extremely diseased, and had passed under several hands unsuccessfully. To which you returned me a long Letter of advice. He had a large hard Tumour in the right Inguen, which reached down in scirrhous Knots all that Thigh and Leg. He had many Ulcers on that Foot, one whereof passed through the Ankle, and rotten part of the Os naviculare. There was an Ulcer on his Heel, and another upon the Tarsus; in both which the Bones were foul. He had also many Ulcers upon the Metatarsus. You were pleased to prescribe him a purgative Pill, with Merc. dulcis to take twice aweek, also a decoct. sarsaes, etc. for his usual drink, with antimon. diaphoret. to sweated thrice aweek. All which we observed. The Ulcers were laid open as you advised, and those Bones I could lay bore were dressed with pulv. rad. aristoloch. rot. euphorb. etc. by which they were exfoliated. I kept the Ulcer in the Ankle open with a Skein of filk the space of ten weeks, and syringed in daily with a Tincture of Myrrh in aq. Mercurial. and aq. calcis, till the Bones cast of, than healed it. The aforesaid Water served me to deterge and cure the other Ulcers. The scirrhous Tumour and Knots were embrocated with unguent. ad strumas, and at length resolved thereby. He walks abroad with an underhand Staff and laced Boot with a high heel, and is ever bound to thank you for it, and so is  
Your most obliged Servant, William Clarke. Bridgenorth, Novemb. 26. 1675.   

CHAP. V Of Ophthalmia.  
SOar Eyes are frequently a Species (as I have said) of the King's-Evill, and take their beginning from vicious Humours inflaming the Tunica adnata, which increasing doth also sometimes affect the other Tunicles, as the cornea, etc. with great pain, tension, pulsation, etc. whence Pustulae arise and suppurate, terminating for the most part in Ulcers, which leave hard Cicatrices, and by reason of the sharp Defluxion falling upon the edges of the Eyelids, do make a Blearedness: upon which account these Inflammations are generally called Lippitudo by the Latins.  
This differeth from the common Ophthalmia, in that it is periodical, 
Difference.  and is accompanied either with strumous Swell in the Neck, a thick chapped upper Lip, Ozaena, or some other Accident.  
The Causes are the same with those of the King's-Evill; 
Causes.  yet may it be more particularly imputed to abundance of humidity repleting the Head, and descending to the weak Eyes.  
The Signs of Ophthalmia are apparent by what I have already delivered of the Disease. Those of the Causes are as followeth. 
Signs.  If the Ophthalmia be from Plenitude, the Face is high-coloured, the Eyelids somewhat swelled and inflamed, the capillary Veins large and full; yet the Humours are not so apt to fret as in other cases, nor is the pain extremely vehement. If the Disease be from Choler, the Visage is not read, but the pain is sharper, and with Excoriation of the Eyelids. If the Ophthalmia proceed from Pituitous Humours, all the forementioned Symptoms of Inflammation, pain, etc. are more remiss, and the lacrymal Humours are not corroding, unless there be a mixture of saline Humour joined with it. Whether an Ophthalmia may arise from Melancholy, I doubt; but if it do, there is small fluxion or pain. That proceeding from the King's-Evill is of an acid quality, with sharp fluxion and pain; the Eyelids are also more apt to be gummed together with a viscous Humour than they are in those from the other aforesaid Causes. Whether the Humours affecting the Eyes flow from the external or internal Vessels, may be discerned by their complaint. For if they flow from the Pericranium, etc. the pain, pulsation, with heat in their Forehead and Temples, will demonstrate it: but if the contrary, the pain will be more intense, and deeper within amongst the Membranes; there will be also an itching in the Palate and Nostrils, with frequent Sneezing.  
The Time of the Inflammation aught also to be considered in order to the Cure, and is thus discerned: in the beginning the Eyes look read, and the Humours distilling upon them are thin; in the augment, heat and pain increase; in the state the accidents of inflammation and pain are great, and the Humours thicken, and do gum the Lids together, especially in the night; in the declination, the fluxion, pain, etc. do visibly diminish.  
Ophthalmia strumosa is of most difficult Cure, and in Children very vexatious, 
Prognostic.  by reason of the humidity they abound with; also because of their frowardness, and incapacity of taking proper Remedies, or admitting external Applications: and in consideration of the laxity of their Eyes, they are subject to relapse upon every little disorder. Those arising by consent from the internal Parts, the Dura mater, etc. are incident to more grievous Symptoms than those which proceed from the Pericranium and other external Parts.  
If in an Ophthalmia the pain, etc. persevere any long time, there is danger that the Tunicles of the Eye may be corroded: and if the cornea hap to have been long ulcerated, a Blindness followeth, or at lest a Dimness of sight, by reason of the condensation of a gross Matter about the Pupil.  
In order to the Cure, 
Cure.  their Diet aught to be of Meat of easy digestion, as hath been showed in the method of Cure of the Evil, with great moderation avoiding all sharp, salt, hot or spicy meats, and such as may beget Crudities. In the beginning of the Disease Wine is forbidden. Hydromel is allowed: but in hot bilious Defluxions decoct. hordei cum tantillo aq. cinnam. is only permitted. The Air aught to be pure and temperate; that which is windy, dusty or smoky, being offensive to the Eyes; so is Sunshine: therefore we advice them to wear somewhat of Silk or Linen before their Eyes, commonly a piece of green Sarsenet. Exercise of all kind is forbidden, and Quiet enjoined. Sleep is in these Diseases necessary, when they can get it, the Eyes enjoying Quiet the while, which mightily conduces to their Recovery. Their Bodies aught to be kept soluble by Clysters and lenient Purges; strong Catharticks being not approved of in Diseases of the Eyes. Yet according to Hypocrates, Ophthalmiâ laboranti alvi profluvium bonum est: and we sometimes see after a Superpurgation the Fluxion much diminished: but that may rather be imputed to Nature, which so disburtheneth herself. In prescribing to these Diseases the Constitution must be considered, and after Purging Anodynes are necessary, to quiet the Fermentations raised thereby; to which purpose conduce syrup. paralyseos, de papavere erratico, de papavere composit. Mesuae, of which this is the Prescription. ℞ capitum papaver. albi & nigri cum suis seminibus an. ℥ vj. & ʒij. capill. Venerisʒxv. glycyrrhiz. ʒv. jujubar. num. xxx. sem. lactucae ℥ v. malvae, cydon. an. ʒuj. coq. in lbviij lbviij. aq. font. ad medietatis consumpetionem; post modicum ℞ colaturae lb iij. penidiorum, sacchar. alb. an. lb j. fiat Syrupus. All the testaceous Powders prescribed in the general Cure of Strumae are here of use, also Calomel, Merc. praecipitat. alb. Merc. diaphoret. bezoard. mineral. antimon. & ceruse. diaphoret. avoiding Salivation, by purging the Mercury of sometimes with infus. rhab. syr. rbab. & de ciehoreo cum rheo, diasereos, etc. In the declining of the Ophthalmia, and indeed after general evacuation and diversion of the Humours, you will found bathing the Body in Water lukewarm of great advantage to contemperate hot and sharp Humours, if the Season of the year and their Age be capable of it.  
Derivation is necessary in this Disease; and if there be Inflammation, or that Blood abound, they may bleed by Lancet in the Arm, Neck, etc. otherwise by Leeches behind the Ears. Shaving the Head, Blistering, Cupping, fontanelles and Seton's are of frequent use: but fontanelles made in the Neck do often 'cause Strumae to arise thereabouts; therefore Sir Fra, Prujean, some years before his death, prescribed them behind the Ears.  
In the application of external Remedies to the Eyes, we aught not to be overforward; for the mildest Medicaments dropped into them prove generally offensive in the beginning of Inflammation: besides, we see in our daily practice, that the lesle disturbances of them go of by general Evacuation and Derivation; and that those Eyes have fared worst which have been most treated by Topics, We may apply Intercipients upon the Temples, of Mastic, Takamahaca, empl. ad herniam, etc. frontals may also be applied of bol. Armen. sangu. dracon. ballast. cum aceto & albumine ovi. If you judge the Humour to flow from the Pericranium and external Parts, you may apply Astringents to the Jugulars and round about the Neck. But if the Inflammation be sudden, and the pain vehement, after Evacuation by lenient Purgatives, or a Clyster and Venaesection, you may have recourse to Anodynes; amongst which Breast-milk and the White of a newlaid egg have precedency, applied externally, or dropped into the Eye. There are Objections made against the use of them both, viz. that by the dropping of Milk into the Eye it may curdle, and by its acrimony offend the Eye: so also the White of an egg may be its incrassating quality increase the heat in them. To prevent these inconveniences, you may mix them with Rose-water, or use them with more caution. In the preparing Medicaments to drop into the Eyes, the Ingredients mixed with the Collyria aught to be well washed, that they may be without acrimony, and so subtly powdered, as that they be not in the lest gritty. The Decoctions aught also to be cleanly made: and in the dressing of the Eyes there aught to be especial care in cleansing them and their Lids of viscous Matter; to which purpose an Eye-cup is most necessary. This being observed, you may apply mucilaginous Liquors, or Cataplasms; for they are good Anodynes. ℞ mucilag. sem. psyllii, cydonior. cum aq. ros. & papaver. extract. extract. an. ℥ j camph. croci, an. gr. vj. album. ovi, Misc. Or, ℞ medullae panis alb. in lacte & aq. ros. maceratae, pulpae pomorum dulc. an. ℥ j mucilag. sem. psyllii & foenugraec. aq. papaver. extract. an. ℥ ss. vitell. ovi, camph. gr. vj. croci ℈ j Misc. If pain be vehement, you may add to either of them two grains of Opium, or a mucilag. sem. papaver. albi extracted cum aq. plantag. ros. etc. applied in the form of a Cataplasm.  
But if the Ophthalmia be not accompanied with grievous pain, you shall than consider whether the Disease be in its beginning, state, or declination, and proportion your Medicaments accordingly. For let the Empirics boast of this or that universal Collyrium, they cannot cure these Ophthalmiae with any one particular Medicament: for in the Beginning of Inflammation they require Repellents, and in the increase somewhat of Resolvents aught to be mixed with them; in the State they aught to be treated with Resolvents of a digestive quality, and in the Declination with Resolvents and Detersives of an exsiccant quality. Authors do not all agreed of the set time when we should begin our Applications to the Eyes; but all of them concur in the proceeding first with general Evacuation and Diversion of the Humour, and afterwards, suppose about the third day, to use Collyria. They aught to be moderately repelling; not too styptic, jest the Tunicles of the Eyes be thereby dried, and prohibit transpiration, and so increase the pain.  
We begin with Repellents: of which sort the strongest are the Whites of newlaid eggs beaten to a froth. You aught to apply it to the Eyelids, the Patient lying upon his Back the while. This is only proper in the beginning of hot Defluxions. ℞ troch. alb. Rhas'. ʒss. bol. Armen. ℈ j aq. ros. rub. lact. muliebris, an. ℥ jss. mix them in a Stone-mortar, and strain it out for use. ℞ pulpae pomor. acidor. vel cydonior. coct. in aq. ros. & plantag. ℥ ij. sumach, ballast. flor. ros. rubr. pulver. ʒss. far. hordei ℥ j succ. sedi maj. plantag. an. q. s. Misc. & fiat Cataplasma. After the taking of the Cataplasm, foment with this: ℞ fol. plantag. Mj. flor. ros. rub. Pj. ballast. ʒij. coq. in aq. equiseti & ros. an. q. s. fiat Fotus. The third day, or accordingly as the Disease indicateth, we add Discutients to the Repellents. ℞ flor. stoechados, sambuci, an. Mss. flor. ros. rub. Pj. coquant. in aq. plantag. pro Fotu. ℞ colaturae superscript. ℥ iij. sarcocollaeʒj. lap. tutiae praeparat. ʒss. nutriatur in mortario marmoreo, & coletur pro usu.  
In the State of the Disease Authors generally apply Resolvents, viz. sem. lini, foenugraec, althaeae, flor. melilot. chamaem. etc. decocted in Water, and applied warm with Stupes. It assuaged the pain by breathing out the gross Matter. The Collyria may be a Solution of thus, sarcocol. sacchar. albi, lap. tutiae, etc. in the preceding Decoction: or, ℞ decoct. sem. foenugraec. ℥ iij. thuris, sarcocollae, an. ʒss. croci ℈ ss. Misce probe, & oculo instilletur. To prevent the gumming of the Eyelids, cut a piece of Sponge fit to cover the Eye, and at night, when the Patient is in bed, dip it in aq. verbenae, enphrasiae, rosar. any one of them, and lay it wet upon the Eye, the warmer the better, so it do not scald. This will keep the Eye cool, and suck up the moisture.  
In the Declination, ℞ tutiae praeparataeʒj. aloes lotaeʒss. sacchar. alb. ℈ ij. infund. in aq. foeniculi, verbenae, euphrasiae, rutae, an. ℥ j postea colentur, & ad usum serventur: or, ℞ vitrioli albi, tutiae praeparat. an.ʒj. camphorae ℈ j infund. in aq. ros. pro Collyrio. In case the Tunicles of the Eye grow too dry, ℞ folior. endiviaes, nymphaeae, lactucae, solani, flor. violar. ros. rub. an. Mj. radic. althaeae, ℥ jss. sem. foenugraeci ℥ ij. coq. pro Fotu. After the use whereof you may apply unguent. tutiae mag. ad oculos; or this, ℞ butyri Maialis sine sale, unguent. rosat. lot. in aq. ros. an. ℥ jss. lithargyr. aur. & argent. an.ʒj. aloesʒij. camphoraeʒss. Miso. S. A. in mortario plumbeo pro usu. These are to be put into the Corners of the Eyes at night going to bed; and in the morning cleanse them with this or such like: ℞ aq. agrimon. rosar. lactis muliebris, an. part. equal. Misc. In other cases greasy Unguents aught not to be applied to the Eyes.  
A Child about six years of age, 
1. Observat. of Ophthalmia.  heretofore subject to the King's-Evill, was the last Summer distempered with a heat scattering over her Head, Face, Neck and Shoulders, which meeting with some check returned inward, and affected her Eyes with Inflammation and great Fluxion. Upon notice thereof, I directed a Clyster of Milk, Sugar, and a little Salt, applied empl. ad herniam upon her Temples, and prescribed the dressing her Eyes with Breast-milk cum albumine ovi conquassat. and  to be dipped in the same, to lie on all night. The next morning Leeches were applied behind the Ears, and 4 or 5 ounces of blood was taken away; that day also a Clyster was again repeated, and the Applications to the Eyes continued. The next morning were given her 7 gr. of Calomel. with 15 gr. sacchar. alb. which purged her 4 times. That night she took of the anodyne Syrup cochl. 1. in aq. papaver. ℥ iij. aq. cinnam. hordeat. cochl. ij. also a Cataplasm ex pomis acid. etc. was applied. She rested well that night, and in the morning her Eyes were marvellously recovered.  
A Child of about ten years of age, 
2. Observat. of Ophthalmia.  having been long diseased with soar Eyes, and passed through most of the Empirics hands in the Town and Country, came to me, with great Fluxion, Pustulae and Cicatrices from former Eruptions. She had also some small Glands' on both sides of her Neck. I applied Plasters upon her Temples to resist the Influx, and made fontanelles behind both her Ears by Caustics. I likewise fomented her Eyes with a Decoction ex flor. Sambuci, chamaem. stoechad. ros. rub. & furfuris, and brought her an Eye-cup, and a Collyrium of sarcocol. lap. tutiae & sacchar. in aqua pomor. dulc. to wash her Eyes. I purged her the next morning with infus. senae, rhab. etc. cum syrupo ros. & agarico, and laid her to rest at night with an Anodyne draught. The day after I drew some blood by Leeches behind her Ears; and the next day prescribed her a medicated Ale of sarsa, lign. lentisc. with milleped. etc. for her constant Drink; with which she took antimon. diaphoret. Once in 4 or 5 days I purged her with Merc. dulc. cum faccharo; and those days she did not purge, I bathed her in Milk and Water temperately warm. I did not use many Collyria. A Solution of lap. tutiae cum sacchar. in aq. plantag. & ros. finished the Cure; which indeed was done by contemperating the acid Humours. There remained some Cicatrices, which I left to wear of, it being the work of Time; which accordingly effected it. The Glands' did resolve during her Course of Physic, and she continueth very well to this day.  
A Child aged about 10 years was diseased with a sharp Defluxion on both her Eyes, with an Ozaena, and thick chapped upper Lip. 
3. Observat. of Ophthalmia.  She had also a fontanel in her Neck, which was much inflamed, and many Wax-kernells about it: which I supposing to arise from the anguish of it, threw out the Pea, and dressed it with Lenients, at the same time applying Caustics behind her Ears. I also applied empl. ad herniam to her Temples, and prescribed a Fomentation and Collyrium, as it is set down in the method of Cure in the State of the Fluxion. I advised the snuffing up of ol. amygd. dulc. to free her Nostrils of the crusty Matter which hindered her breathing, and afterwards prescribed her a decoct. hordei cum radicibus althaeae, which was cast up her Nostrils with a Syringe, desiring her to forbear picking of her Nose. Her Lip was fomented with some of the said Decoction, and anointed with this following Unguent: ℞ sevi vitulini & agnini an. ℥ jss. unguent. refrig. Galeni ℥ j succ. plantag. solani, an. ʒ x. coquantur ad succour. consumptionem: Colaturae add cerussaeʒ ij. plumbi ustiʒ vj. litharg. aur. & argent. an. ℥ ss. antimonii, tutiae, an. ʒ iij. olei vitell. ovor. ʒ x. cerae alb. q. s. fiat Vnguentum S. A. During these Applications a Clyster was prescribed, and she was purged with infus. senae, rhab. etc. and afterwards Calomel. was appointed her once in 3 or 4 days, also a medicated Ale of sarsa, lign. lentisc. milleped. etc. for her constant Drink. Bezoard. mineral. was likewise prescribed those days that Purging was intermitted. By this method the Fluxion was removed from the several Parts, and the Ulcerations dried up: those in her Eyes by Collyria of lap. tutiae, calamin. etc. and the Ozaena by decoct. rad. tormentil. bistort. sumach, ballast. etc. in aq. chalybeata. Towards the end of her Course of Physic, observing her Skin rough and dry, I caused her to be bathed in Water temperately warm, with a bag of Bran to sit upon. A Cicatrix remained upon one of her Eyes, but it afterwards wore of.  
A Child of about 5 years of age was brought out of the Country to me with great Defluxions in both his Eyes, 
4. Observat. of Ophthalmia.  and his upper Lip swelled from the same Humour. He had passed through various hands unsuccessfully in the Country. I purged him with infus. rhab. in small Beer, cum syr. diaser. and once in 2 or 3 days gave him a few grains of Merc. diaphoret. and some nights an anodyne Syrup in aq. papaver. I also prescribed a Fotus and Collyrium, as is set down in the method of Cure in the State of the Fluxion. By which method the Fluxion ceased, and he recovered in 10 or 12 days. A few days after he fell sick of the Smallpox, of which he likewise recovered. I than designed the Purging him: but his Friends not thinking it necessary, I desisted from visiting him, till his Eyes inflamed again; and than they sent for me. I purged him with Whey, Manna, and sal prunell. applied Repellents to his Forehead and Temples, and drew blood by Leeches behind his Ears; also repeated lenient Purgatives with Calomel. once in 3 or 4 days, and made fontanelles behind his Ears; his Hair was shaved of his Head, and a quilted Cap was put on. Anodynes were dropped into his Eyes, according to the method proposed in painful Defluxions; by which they were eased. But soon after he fell into a Diarrhoea, by which he was perfectly freed of the Defluxion on his Eyes and Lip. But the Diarrhoea terminated in a Dysenteria, and weakened him much. I prescribed him decoct. corn. cervi usti, with a few rad. scorzonerae, cinnamomi, which he drank with Milk. Clysters of Milk cum vitell. ovi were frequently administered, and a few drops of a liquid Laudanum at night in the foresaid Decoction. Afterwards I strengthened his Bowels with elect. diascord. cons. ros. rub. pulv. Rhei, etc. by which he was also moderately purged. He afterwards recovered strength by continuing his Milk-drink. During his Diarrhoea I healed up the fontanelles behind his Ears, and after his Recovery made him a fontanel in one of his Arms, and dismissed him. He was afterwards in the Country subject to some little weakness in his Eyes at times, upon some accident of cold; upon which account his Friends consulted me: but of late years he hath been very well.  
A Child aged 3 years was brought to London to me with sharp Defluxions upon both his Eyes, 
5. Observat. of Ophthalmia.  and Strumae on both sides of his Neck. I applied empl. ad herniam to his Temples, fomented his Eyes with Repellents and Discutients, and made fontanelles behind both his Ears. The second night after I gave him viij. gr. Merc. diaphoret. and in the morning purged him with Rhubarb-drink, repeating this method once in 5 days: and on the intermitting days I gave him a scruple of Dr. Walter Needham's pulv. antistrumat. By this course the Child recovered, and was returned into the Country. Since that he hath frequently relapsed, and new Strumae have arose: but by prosecuting the former method he hath recovered as often, and the Strumae afterwards resolved, we scarce applying any thing to them.  
A young Gentleman of about 16 years of age was, 
6. Observat. of Ophthalmia.  after the Smallpox, afflicted with soar Eyes, with a Pustula in one of them; which not yielding to the common method of Purging, etc. I was consulted, and prescribed a Fotus and Collyrium, as in the state of the Fluxion; and by giving him 3 Doses of Merc. dulcis of 15 grains per dosin, in 10 days I cured him of his Distemper so perfectly, that it returned not more.  
A Child of about 8 years of age had been diseased two months with sharp Defluxions upon both her Eyes, 
7. Observat. of Ophthalmia.  with Pustulae and Excoriation of the Lids; she had also an Ozaena and thick upper Lip chapped. I purged her with syr. diasereos in a draught of Whey in the morning, and some hours after sent her some astringent Emplasters to apply to her Temples and Forehead, prescribing the bathing her Eyes with Breast-milk mixed with aqua plantag. That night she took an anodyne Syrup in a draught of Mace-ale, and slept with Sponges upon her eyes dipped in the foresaid Liquor. The next morning I let her blood in the Arm 6 ounces, and syringed her Nostrils with decoct. hordei & radic. althaeae, advising her to forbear picking her Nose. Her Lip was anointed with unguent. tutiae ad oculos, with an addition of Merc. praecipitat. finely poundered. The next morning I gave her 12 gr. of Merc. diaphoret. and from that time purged her once in 5 days with Calomel. in cons. rosar. damasc. and caused her to be bathed the intermitting days. After I had cleansed her Nose of its crusty filth, I syringed it with this following Decoction: ℞ fol. plantag. summitat. rubi, equiseti, an. Mss. myrobalan. citr. ʒ ij. flor. ros. rub. Pj. pom. granat. num. j contund. & coq. in aq. plantag. & ros. rub. an. lb j Colaturae add syr. diamoron, de ros. sicc. an. ℥ jss. mellis Aegyptiaciʒ j Misc. pro usu. Her Eyes recovered after the first bathing so well, that she was able to look upon the light, and in lesle than 14 days was perfectly recovered. But about a year and a half after she grew indisposed, and was seized with Convulsions. I purged her with infus. senae, rhab. etc. and afterwards prescribed her three or four Doses of Merc. dulcis, and thereby freed her of those Convulsions.  
A Child aged about 6 years, 
8. Observat. of Ophthalmia.  of a weak tender Constitution, having been long subject to Defluxions upon his Eyes, Catarrhs, etc. was after several unsuccessful Attempts recommended to my care. I began with the making him a fontanel in his Neck by Caustick. (It had been made sixteen days before he knew of it, and than it was descried by the clinging of his Hair to the Plaster. From that time he grew froward with it, and in compliance with him it was healed up again 2 or 3 months after.) Having fixed the fontanel, I began to purge him with an Infusion of Rhubarb in a small Ale, and gave him 6 grains of Merc. diaphoret. in a spoonful of White-bread and Milk, repeating this Powder and the Infusion of Rhubard once in 4 or 5 days. So often as I designed larger Evacuation, I mixed a purging Syrup with the Rhubarb-drink: and the following night prescribed him a spoonful of the anodyne Syrup in Mace-ale, or what else he best relished. A Pearl-julep was made him of a distilled Milk, cum aq. cinnam. hordeat. & sacchar. alb. also a medicated Ale was prescribed him of sarsaparill. lign. lentisc. santal. alb. passul. maj. enucleat. flor. salviae, beton. euphrasiae, milleped. court. citr. & nuc. moschat. He was extreme nice in taking any thing of Physic, so was for the most part cheated into it. He was also more shy in admitting of Topics. Sometimes in extremity of pain in his Eyes Stupes were applied to them wrung out of a decoct. flor. sambuci, cham. ros. rub. etc. Collyria were more rarely applied: those that were used were aq. pomor. dulc. and sometimes other distilled Waters wherein had been infused troch. alb. Rhas'. or sarcocol. lap. tutiae, saccharum. The Water was filtered clear. The Medicaments we laid the stress mainly on were, infus. rhab. and pulv. Merc. diaphoret. By which and the anodyne Syrup he was certainly relieved in his greatest extremity. He was frequently well three or four months together, and at length hath in a great measure worn of the many Disturbances; yet, being of a tender Constitution, may be incident to Defluxion upon his Eyes: but he hath been hitherto certainly relieved, as I said, by the foresaid Prescriptions.  
A young Woman about 23 years of age had many Strumae on both sides of her Neck, down the length of the Musculi mastoides, some large, 
9 Observat. of Ophthalmia.  flat and round, others oval, of a different size: she had much pain in her Head, and was subject to a Catarrh. I purged her with infus. senae, rhab. cum syr. ros. cum agarico, etc. and prescribed her a decoct. sarsae with Antistrumaticks, also Bezoard, mineral. and purged her afterwards once in 5 days with Calomel. and diagrid. cum syr. de pomis magistral. I fomented the Glands' with decoct. rad. gladioli, cucumeris agrest. bryoniae, etc. and embrocated them with ol. ex ped. bovin. some time, and afterwards applied a Malagma of Corn. Cells. by which they dissolved very much, and she recovered good health. But about 6 months after she came to me afflicted with a severe Defluxion in both her Eyes. I let her blood in the Arm 10 ounces, and repeated the former Course of Physic; than prescribed a lenient Fotus, and a Collyrium ex mucilag. sem. psyllii, etc. and let her blood in the other Arm 7 or 8 ounces; applying empl. è pice Burgund. to her Neck, and Intercipients to her Temples: by which she recovered of the Defluxion in her Eyes, and by the use of a Collyrium ex infus. croc. metal. her Sight grew strong.  
A young Gentlewoman came to London labouring under great Inflammation with a Pustula in her left Eye. 
10. Observat. of Ophthalmia.  She had also a Struma in her left Foot about the Instep, lying very hard and big amongst the Tendons. Dr. Pruj. and Dr. Bate. were her Physicians. She began her Course of Physic with this Prescription: ℞ fol. senaeʒ vj. rhabarb. turbeth, an. ʒ jss. hermodact. ʒ j salis tartari ℈ j flor. sambuci Pij. fiat jufus. in aq. scrophul. q. s. ad ℥ vj. colat. add syr. è pom. purge. mannae Calabr. an. ℥ jss. sumat ad quantit. cochl. seven. sing. matutin. cum debito regimine, augendo vel minuendo dosin pro ratione operationis. ℞ aq. scrophul. ℥ ij syr. de meconio ℥ ss. sumat hora somni singul. noct. post purgationes. This following Decoction was also prescribed: ℞ infund. in aq. font. lb vj. deinde add rad. rusci ℥ iij. fol. millefol. agrimon. ling. cervinae, an. Miij. ciner. spong. combust. ʒ vj. uvar. passul. enucleat. ℥ vj. liquiritiae ℥ jss. aq. recent. lb iij. coq. ad consumption. tertiae partis, & fiat Colatura; add mellis q. s. & clarificetur; bibat bis in die ad ℥ iiij. & etiam pro potu ordinario cum cerevis. ten. 2 part. in pastu. ℞ pulv. milleped. ℥ jss. ceruse. antimoniiʒ vj. Merc. dulc. ℈ ij. Merc. vitae gr. ij. pulv. court. citr. conduit. ℥ jss. cons. euphrasiae, beton. an. ℥ ij. syr. è court. citr. q. s. fiat Electuar. ℞ resinae jalapiiʒ ss. amygd. j Merc. dulc. ℈ ij. Merc. vitae gr. ij. syr. è court. citr. q. s. fiant Pilulae num. xij. deaurat. sumat num. iij. summo mane superdormiendo. This was repeated every sixth day. While she passed through this Course of Physic, fontanelles were made under her Ears, and Collyria were applied ex mucilag. sem. foenugraeci, etc. in aq. & lacte; also the Fomentation prescribed in the method of Cure, and empl. ad herniam upon the Temples and Forehead. The Struma upon the Foot I designed to have taken out by Incision: but I complied with their desires, and applied a Caustick the whole length of it, and divided the Escar; than, with a Caustick-stone rubbed into the body of the Struma, and dressed it up with Lenients and emplastrum è bolo, with Bandage over it. After the Escar separated, I rubbed deeper into the Struma, till I came near the basis of it: than, in consideration that it lay upon the Periosteum, I dressed it with Merc. praecipitat. upon Dossils' of Lint, till I had digested it all out: after which I left of the use of the Dossils', and suffered the Ulcer to incarn. By the application of a Pledgit spread with unguent. basilic. mag. it contracted close in few days, and cicatrized well. During the time I was curing her Foot, the Defluxions on her Eye remitted, and the Ulcer cured by aq. lap. calam. and she returned to her Friends. But I have of late heard that both her Eyes have been since frequently soar.  
A Child of about 4 years of age, 
11. Observat. of Ophthalmia.  having been long diseased with the King's-Evill from the one Ear to the other, with soar Eyes and a swollen upper Lip, was commended into my hands. The Strumae were many of them ulcerated, and the Parts about them fretted and inflamed by the Matter which was penned in by gummy hot Plasters which had been applied to them. His Head was also ulcerated under an Emplaster that had lain long upon it, and his Eyes almost blinded by the defluxion of a hot Rheum. By means of all which the Child was much emaciated. I dressed the ulcerated Strumae with Pledgits spread with unguent. diapompholyg. applying cerat. Galeni over them, and clipped the Plaster of his head; and after I had cleansed it of the crusted Mucus with which it was covered, I bathed it with Wine wherein were boiled flor. ros. rub. summitat. absinth. ballast. nuc. cupress. & bacc. myrtill. than bound a Compress dipped in the same upon it: by which in a day or two it dried up. To his Eyes I applied a Fomentation, and an anodyne Collyrium ex lacte mulier. & aq. ros. was dropped into them. Emplasters ad herniam were applied to his Temples: I embrocated his Lip with unguent. refriger. Galeni. I also prescribed him a distilled Milk, with Antistrumaticks, and purged him with Rhubarb-drink, also a few grains of Merc. dulcis once in three days. At other times he drank a distilled Milk, Water with new Milk, and some nights an Emulsion ex sem. 4 frig. By this method his Eyes recovered, the Ulcerations healed, and at length the Glands' resolved, by the use of the Malagma ad strumas, or suppurated, and wasted themselves that way, and he recovered flesh. But this Child was of an ill Habit of body, and frequently relapsed or fell into other Diseases: the Cure of some of these indisposed Bodies being the work of Time.  
A Child of about 11 years of age had been long diseased with Inflammations of her Eyes, 
12. Observat. of Ophthalmia.  with other disturbances from acid Humours. After various endeavours to cure her, she was at last with much despondency recommended into my hands. I applied Emplasters add herniam to her Temples, and prescribed her a Fomentation to breath forth the impacted Humours, and a Solution of lap. calaminaris in aq. foeniculi to wash her Eyes. The next day I purged her with infus. senae. rhab. etc. and sent her half a dozen papers of a few grains of Calomel. cum saccharo, with directions to take one every 3. 4. or 5. day. From her very first Dose the Fluxion ceased, she recovered, and continued so some months, and is relieved thereby constantly. But lately she was seized with a pain in her right Ear, and many small Strumae arose on both sides of her Neck, which I removed by Purging, and by embrocating it with unguent. ad strumas.  
THese Inflammations of the Eyes are generally attended with Lippitudo, 
LIPPITUDO,  and are called so by the Latins: but that which I here mean by it is, a Blearedness of the edges of the Eyelids; of which there are two sorts, Lippitudo humida, and sicca. They are both the effects of great Defluxions excoriating the Lids, and relaxing the tone of them. 
Humida,  The Humida is more remarkable upon Accidents of burning by Fire, Gunpowder, or the like: but that which I shall here speak of is, a Lippitudo with an Hypersarcosis which ariseth upon the excoriated Lid, and turneth it outward, being always accompanied with Fluxion upon the Eye. The Lippitudo Sicca is an Excoriation of the Lid, 
Sicca.  but ariseth from a salt Phlegm mixed with a bilious Humour, and lieth upon the Cilia amongst the Hair with a branny white Scale, not much unlike an Elephantiasis, and is attended with an itching. I shall give you an Instance of each.  
A Man of about 56 years of age, of a full Body, 
1. Observat. of Lippitudo humida.  had been subject to a Lippitudo of both Eyes some months. I fomented them with decoct. euphrasiae, salviae, beton. flor. ros. rub. etc. and after I had cleansed them of the mucus, I touched them daily with tincture. vitrioli dulcificati lightly, and prescribed him some of the aq. viridis set down in the Chapter of Aegilops to drop into his Eyes at other times: by which method he was cured.  
A Man aged 28 years, of a tolerable good Habit of body, 
2. Observat. of Lippitudo humida. with Hypersarcosis.  came to London with a Lippitudo on the lower Lid of his left Eye, overgrown with an Hypersarcosis arising from within, overspreading the Tunicle, and heaving it outwards. Dr. Walter Needham was his Physician, and prepared his body by Purging, etc. In order to my work, I placed him in a Chair in a clear light, and turned the diseased Lid more outward, the while bringing the upper Lid close over the Eye, and holding it so whilst I rubbed the Hypersarcosis with a Caustick-stone, wiping the Salts away as they dissolved with armed Probes. After I had thus extirpated the overgrown Flesh, I clipped of the lose Sloughs, and with a Sponge in a Basin of water I washed the lixivial Salts out of the Escar, dropping into his Eye mucilag. ex sem. althaeae, psyllii & cydonior. extracted in aq. plantag. than laying him upon his Back, I covered over the external parts with Whites of eggs beaten with a piece of Alum to a Froth, and thereby restrained the Fluxion. After the Escar separated, I rubbed the remaining Superexcrescence with a Vitriol-stone, washing the Salts out afterwards with fair Water. During this work he was let blood, and frequently washed his Eye with a Solution of troch. alb. Rhasis and aq. plantag. & solani. Thus in the space of 3 months it was extirpated and cured, the Eyelid returning naturally as the other.  
A Man of about 26 years of age, 
3. Observat. of Lippitudo sicca.  having been afflicted from his infancy with soar Eyes, consulted Sr. Fra. Prujean, who sent for me. The Patient had a certain Blearedness of both the left Eyelids from the external Canthus downwards, but more especially on the lower Lid; which Blearedness was covered with small white branny Scales investing the Hair. His Physician purged him with an infus. senae, rhab. etc. and prescribed a fontanel behind that Ear, also Venaesection in that Arm, which was accordingly done. I fomented the diseased Parts with a Decoction of summit. malvar. violar. flor. sambuci, meliloti, sem. lini & foenugraeci, and anointed them cum ol. vitell. ovor. at lest twice aday. By this the dry Scales were suppled, and after picked of from the Hair and edges of the Eyelids. Than I touched the bleared edges with aq. viridis, and anointed them with unguent. tutiae, as it is described in the Pharmacopoeia Londinensis; by which and internal Prescriptions he was cured.   

CHAP. VI Of Aegilops.  
AEGilops is a Tubercle in the inner Canthus of the Eye, either Scrofulous, Atheromatous, or of the nature of a Meliceris, or sometime with Inflammation. It hath obtained two names amongst the Grecians: 
Names.  viz. Anchylops, when it is not ulcerated; Aegilops, when it is. In which latter case it is very apt to grow sinuous; and being so, whether it prove callous or not, is however called Fistula lacrymalis, sometimes passing through the Bone of the Nose itself.  
The Causes of Aegilops are the same that produce the like tumors in other places. 
Causes.  But in some cases it is made by Fluxion, and appeareth first as a small Phlegmon. This Disease frequently occurreth in Lues Venerea: but these I here treat of are Strumous.  
If it be Struma Atheroma, 
Signs.  etc. it is than made by Congestion, and the Tubercle is round, without discolouring the Skin. If it be made by Fluxion, pain and redness do appear, with Inflammation over all that Eye. Sometimes it beginneth only with a weeping of that corner, and is not discovered till it affects the Eye with redness; and than, by pressure with your finger upon that Canthus, a mixed Matter may be discharged, part whereof is not unlike the White of an egg. Sometimes this Matter eateth quite through the Bone, and dischargeth itself downwards through the Nose with a foetid smell.  
Fistulae lacrymales are difficult of Cure from what Cause soever they arise. 
Prognostic.  The Part being lose and spongy, the Eye very sensible, and the laxity of the Part, maketh Humours apt to soak into it, and to penetrate even to the Bone itself. The sensibleness of the Eye renders it subject to pain and fluxion, as also unfit to be dressed with sharp Medicaments, such as these Diseases require.  
That Fistula which is recent, with sufficient opening is the easiest of Cure. Those of a long continuance are for the most part accompanied with Ulcerations of the Gland, and Caries in the Bone, which makes them subject to a weeping after they are cured. If the Ulcer be accompanied with Erosion, it will be apt to terminate cancerous; in which case the Cure is deplorable.  
The indication of Cure is taken from the condition of the Aegilops, 
Cure.  whether it be in its beginning with Inflammation, or by Congestion, passing its Matter forth under the Cilium into the Eye: in which case it is fistulated. Anchylops hath also its peculiar way of treating, as other tumors of the Glands'.  
In the beginning of Aegilops Bleeding by Lancet is necessary, and so is Purging, also such Alteratives as have been prescribed in the general Cure of Strumae, with regulation of Diet accordingly.  
Externally we apply Repellents to the diseased Part, to prevent Fluxion, of aqua portulac. lactucae, plantag. equiseti, solani, sperm. ranar. etc. cum albumin. ovor. bolo Armen. etc. To intercept the Matter we apply gum. mastic. takamahaca, emplast. ad herniam, to the Temples and Parts about. If the Tumour increase with tension and pain, it will than be reasonable to endeavour Discussion by Medicaments already described in Ophthalmia, of summitat. absinth. flor. sambuci, rutae, far. lentium, orobi, etc. decocted in Wine or common Lixive. In the Anchylops rancid Nuts beaten and applied are much commended: so likewise is calx viva cum melle contrita. If the Tumour tend to Suppuration, than hasten Concoction cum radic. lilior. mucilag. sem. althaeae, foenugraeci, lini, far. tritic. axung. porcin. etc. The Matter being well concocted, lay it open large, that you may have way to apply your Medicaments. Authors have proposed various Escaroticks to open these; but I use the opening them by Knife or Caustick. The only Caution is, that you open it such a distance of from the edge of the Eyelid, that you divide not that: for in so doing you will leave a remediless Blemish, and the Eye will be apt to water ever after, and be subject to Fluxion. Therefore if you open it by Caustick, it will require your greater care. I for the most part open them by Incision. Than digest them with a Dossill dipped in oleo ros. & vitell. ovi; over which apply cerat. Galeni, or such like Anodynes, with a Compress dipped in some of the abovesaid distilled Waters, to contemperate the heat in the Part; and afterwards deterge with mel ros. sir de ros. siccis; or, ℞ mell. comm. ℥ ij. viridis aerisʒ j spir. vini ℥ iiij. coquantur ad tertiae partis consumptionem: and than dispose them to cicatrize with this; ℞ myrobalan. citr. ʒ j thuris, myrrhae, an. ℈ ij. floris aeris ℈ j camphorae gr. ij. infund. in aq. ros. & vini albi an. ℥ iiij. & coquantur ad tertiae partis consumptionem, filtrando pro usu. And afterwards by unguent. tutiae, aq. calcis, etc. with good Compression incarn and cicatrize them.  
If it be Fistulous, and the Orifice small, dilate it with Gentian-roots, or such like, and proceed with Detersives, as hath been said. If thereby the Callus do not waste, you may inject this following Decoction; ℞ fol. rutae, chelidon. min. agrimon. an. Mss. infund. per noctem spir. vini lb ss. coletur pro usu: and apply this following upon Dossills'; ℞ zinziberisʒ ij. viridis aeris ℈ ij. mell. ros. ℥ iij. aceti oped. ℥ iiij. coq. ad crassitiem. If there be Caries, apply this: ℞ vitrioli usti, cantharid. absciss. alis & capitibus, calcis vivae, salis armoniac. alumin. roch. an. p. aeq. cum urina pueri inspissat. These are the Medicaments proposed by Authors of good authority.  
In the applying them the Parts about must be well defended, and the Fluxion restrained by the application of Refrigerants; and after all it is a most painful tedious way. Therefore I propose the use of the actual Cautery; which being applied through a Cannula will with one touch waste the Callosity and Caries: after which dress it up with a Dossill dipped in a mixture of ol. ros. cum albumine ovi, and a Compress in the same over all: than digest and deterge with the milder Prescriptions, keeping the Orifice dilated with a Dossill dipped in tinctura myrrhae, etc. till the Bone exfoliate: than with unguent. tutiae, etc. with Compression cicatrize.  
The Anchylops requires Extirpation, and is to be cured accordingly to what is proposed in this Treatise.  
A Young Gentlewoman, abounding with acid Serum, 
1. Observat. of Aegilops with Inflammation.  was seized with an Inflammation and Tumour in the great Canthus or Angle of her Eye. She had been dressed by some neighbouring Friend till the Inflammation closed up her Eyelid, and alarmed her by the great discharge of a mixed ferous Matter I, observing the Tumour perfectly suppurated, and the Matter shining under the Cuticula ready to burst through, opened it by the point of a Lancet, without drawing one drop of blood. The Matter discharged, I dressed it with a Dossill dipped in vitello ovi, with a Plaster of cerat. Galeni, and  dipped in Read wine over all, with convenient Bandage to retain them on. The next day I took of Dress, and fomented it with decoct. fol. malu. viol. betonic. salviae, & flor. ros. rub. in Wine and Water, repeating the Dress as before, and let her blood in the Arm. At the next day's dressing I found the Swelling of her Eyelid relaxed, and the external Inflammation mitigated, but the Eye itself inflamed. I fomented and dressed the Abscess with a Dossill dipped in syr. de ros. siccis, applying a Pledgit of unguent. tutiae over it, with a soft Compress thereupon; leaving the Eye at liberty to be refreshed by the Air, and to be dressed with Breast-milk, etc. as they pleased. To the Forehead Frontlet's were applied to restrain and intercept the Influx. Sr. Fra. Pruj. was her Physician, and prescribed her lenient Purgatives, traumatick Decoctions, etc. I also kept the Orifice open sufficiently for discharge of the Matter and conveniency of dressing, applying externally refrigerant and exsiccant Medicaments, and adding a few drops of tinctura viridis to the Syrup in which I dipped my Dossills'. Yet notwithstanding our endeavours, the Matter having made its passage into the Eye during the time of Suppuration, it continued its course, and flowed both ways in too great a quantity for some time. Upon which consideration I dressed the Ulcer with a Dossill dipped in Praecipitate, and applied over it a Pledgit cum unguent. tutiae Vigonis, with Compress and Bandage. After I had thus digested it, I dressed it with a Dossill dipped in aq. viridis, (as it is prescribed in the method of Cure,) lessening the said Dossill daily, and at last cicatrized it firm.  
A scrofulous Child of about 4 years of age having an inflamed Tubercle in the great Angle of her left Eye, 
2. Observat. of Aegilops with Inflammation.  the Matter being suppurated, I opened it by Incision, and discharged a well-concocted Matter; than fomented the Tumour with Wine, and filled the Abscess with Dossils' dipped in sir. de ros. sicc. with a Pledgit of unguent. basilic. over it, also a Plaster of cerat. Galeni over that, and bound it up, proceeding daily in the fomenting and dressing it, till the Inflammation and Swelling remitted. After which I added a few drops of tinctura viridis to the Syrup, and kept the Ulcer dilated with a Dossill dipped and pressed out of that Mixture, applying a Pledgit of unguent. ex lap. calamin. with Compress and Bandage over it. And the better to dispose the Ulcer to cure, I purged her once in 4 or 5 days with an Infusion of Rhubarb in Small beer, and once aweek with a few grains of Merc. dulc. cum saccharo. The Matter diminishing, I lessened the Dossill, and cicatrized it with the aforesaid Tincture, making good Bandage upon the Sinus till it was close united, and ceased weeping.  
A Gentlewoman of about 25 years of age having been between 3 and 4 years' subject to the King's-Evill and a Fistula weeping into the Eye from the great Canthus, 
3. Observat. of Fistula lacrymalis.  I prescribed her aq. lap. medicament. Crollii to drop into that corner of her Eye, and directed her the making a constant Compression upon the external Parts by an Instrument made to that purpose: by which she was in few months cured. And by the same way, with the help of Internalls, I have cured many of those, where the Bone hath not been carious, or the Habit of body extremely indisposed.  
A Boy about 7 or 8 years of age, 
4 Observat. of Fistula lacrymalis.  of a very ill Habit of body, had also been two years diseased with a Fistula lacrymalis, and consulted some of our Profession. But they deterred him and his Parents with the mention of the actual Cautery: whereupon he was put into my hands to cure. I made Incision into the Cavity, and put into it a proportionable piece of Gentian-root, with a Pledgit of Basilicon over it, and a Compress pressed out of some of the aforementioned distilled Waters. The second day after I repeated the same manner of dressing, and continued to keep it dilated with some of the same Roots. During which I endeavoured to restrain the influx of Humours, and dry up those affecting the Part, according as hath been set down in the method of Cure, and by Antistrumaticks disposed the Humours to a healing condition. The Fluxion being thus removed, and the Matter little, I left of the use of the Gentian-root, and dressed the Ulcer with Dossils' dipped and pressed out of aq. med. Crollii, and after some days lessened them daily. Afterwards I left of the Dossills', and cicatrized the Ulcer with Pledgits of unguent. tutiae, etc. Many such I have so cured: but some years after I have seen divers of them thus cured weeping again.  
A Girl of about 12 years of age having a Fistula lacrymalis of some years' continuance, discharging a mixed crude Matter daily into the Eye, 
5. Observat. of Fistula lacrymalis.  I laid it open by Incision, dilated and digested it, and endeavoured by Internalls to dispose the Body to a better habit, and prosecuted the Cure by Exsiccants. But it not yielding thereto, I separated the Periosteum from the Bone, made Exfoliation of it, and incarned upon that, supposing I had by Compression cicatrized the Ulcer. But it broke out again upon the leaving of the Bandage; upon which I dilated it again, and by actual Cautery consumed the Callus and Bone: after which it cured more easily.  
A Gentlewoman aged about 38 years had a Fistula lacrymalis discharging its Matter into the Eye in great quantity. 
6. Observat. of Fistula lacrymalis.  I applied a small Caustick upon that part of it where I felt the Cavity; and having eaten into it, I passed an actual Cautery through it to the Bone, whereby I cauterised it, than dressed the  Escar with Lenients to hasten its Separation, and afterwards deterged and cicatrized the Ulcer as hath been afore showed.  
A Young fellow, aged 28 years, was commended to me out of the City, 
7. Observat. of Fistula lacrymalis.  having a Fistula lacrymalis discharging a great quantity of purulent Matter into the Eye. He had suffered many years by it, and passed through many hands unsuccessfully. I laid it open by Incision, and dilated it, endeavouring some while to digest it, and to that purpose prescribed various Internalls: but the Matter rather increasing, I passed a Cannula into the Cavity, and with an actual Cautery pierced through that side of the Bone of the Nose, thereby diverting the Matter, and afterwards cured the Ulcer with more ease; the Bone also exfoliated, and filled up with Callus.  
I could give you more Instances of the Cures of Fistulae lacrymales: but the manner thereof differeth not from what hath before been said; and by the actual Cautery I never failed in the Cure of the worst of them.  
A Woman aged about 30 years having a Tubercle in the great Canthus of the right Eye of the bigness of a Pistol-bullet, I made Incision of the Skin, 
8. Observat. of Anchylops.  and separating it from the preternatural body, I raised it up. In taking it out, the Cystis broke, and shown itself by its Matter to be a Meliceris. I cleansed the Wound, and cut it out, bringing away the Cystis; than closed up the Lips of the Wound, and applied a Pledgit of unguent. basilic. with Bandage over it, and cured it by Agglutination. These Tubercles' do frequently yield to Discutients: and some times, after they have resisted all our Endeavours, they have of themselves resolved. Particularly I saw it in an Ensign in the Low-countrieses, who was troubled with a Tubercle of the bigness of a Pigeon's egg, which had been of many years' continuance. He intended to have been my Patient there, and some years after designed to have put himself into my hands here: but a while after it dissipated so as there remained no mark of it.  
A young Gentlewoman came to London recommended to me having a Tubercle in the great Angle of her right Eye, 
9 Observat. of Anchylops.  of the bigness of a Lupin. Many endeavours had been used in the Country to resolve it. I began with Discutients, Bleeding, Purging, etc. and thought I had thereby dissipated the Matter: but after a few days discontinuance of Topics and Bandage, it appeared again: upon sight whereof I opened it by Incision, and discharged a Matter like the White of an egg. I could not perceive any Cystis, yet judged it an Atheroma. Having dressed it with a Dossill dipped in Praecipitate, I applied another over it spread with basilicon, with a Compress over that dipped in aq. ros. rub. & solani. The third day I repeated the same kind of Dress, and continued them till I had well deterged and digested the Ulcer; than dressed it with a Dossill dipped in a Sarcotick tincture of Myrrh, Aloes, etc. and afterwards proceeded with Epuloticks, and thought it had been cicatrized. But pressing with my finger one day upon the upper part of it, and a disproportionate quantity of Matter flowing forth, I passed in my Probe, and feeling the Bone carious, I dilated it with Gentian-roots, passed in a Cannula to the Caries, and with an actual Cautery dried the Bone. I applied to it ol. ros. cum albumine ovi; and afterwards dressed the Ulcer daily for the first 4 or 5 days with Dossils' dipped in decoct. hordei, rad. consolid. maj. and when the anguish was mitigated, with tinctura myrrhae, keeping the Orifice open till the Exfoliation was perfected; than cicatrized it, as hath been showed in the former Observations.  
A poor Woman came to me out of the Country with a large Tubercle on the right Canthus: 
10. Observat. of Anchylops with a Polypus.  she had also a Polypus in that Nostril. I began with the Tubercle by the application of a Caustick. After the separation of which a Fungus thrust forth, and grew very vexatious in the eradicating. After I had spent some time unsuccessfully in the work, I began with the Polypus, attempting to thrust it out with my finger: but it not yielding that way, I took hold of it with a Forceps Ducks bills, and having pulled it outward, I passed a Needle with a twisted brown Thread through it, according to Fab. ab Aquapend. and pulling by that and my Forceps together, it came away about the length of two inches, but was attended with a flux of blood from the Nose, Mouth and Eye; which was stopped by the syringing up of Oxycrate. At the next dressing of the Ulcer in the Canthus I miss the Fungus,, and found a great hole in the Bone of the Nose. Upon sight of which I concluded the Fungus which had been there was the root of that Polypus. The Bone was much corrupted: but I hastened the external Cure of the Ulcer, and returned her into the Country, leaving the Exfoliation of the Bone to Nature.  
Having treated accidentally of a Polypus, I thought myself obliged to give you one Observation of an Ozaena, it being an Ulcer within the Nose; and though it be not the King's-Evill, yet it too frequently accompanieth it, and is occasioned by those sharp Humours passing that way, and yieldeth not otherwise to Cure than by the general method prescribed in this Treatise.  
A young Gentlewoman aged about 15 years, 
11. Observat. of Ozaena.  of a lean dry Constitution, was diseased with an Ozaena in both her Nostrils, a thick upper Lip, and some Glands' on both sides of her Neck. She was put into the hands of Dr. Barwick and myself. He prescribed her as followeth. ℞ sen. oriental. ʒ ij. Rhei oped. ineis. ʒ ss. pulp. tamar. ℥ ss. syr. è pom. purge. & man. oped. an. ʒ v. infund. S. A. in vini alb. ℥ iiij. Colatura clarisicetur cum ovi album. & propinetur mane ad ℥ iiij. cum regimine. Singulis noviluniis & pleniluniis sumat Calomel. gr. xij. diacryd. sulphurat. gr. vj. in formam Boli redactor. cum conserv. viol. ʒ ss. syr. syr. viol. tantillo. ℞ ocul. cancror. Mercur. diaphoret. coral. rub. praeparat. an. gr. iij. Misc. Capiat bis vel ter quotidie in cochl. j lact. vacc. cum asellis distillati, & superbibat cochl. v. vel vj. cum sacchar. oped. dulcorat.  
I began my work with the moistening of the crusted Matter sticking in her Nostrils, by frequent injecting of this: ℞ hoard. mundati ℥ j sem. althaeaeʒ iij. sem. cucurbit. melon. siccat. an. ℥ ss. infund. & coquantur in aq. font. ad lb jss. cobetur pro usu. After her Nostrils were herewith syringed, she snuffed up a little ol. amygd. dulc. Her upper Lip and Neck were embrocated with unguent. ad strumas morning and evening. After her Nostrils were freed of that crusty stuff, this following Errhinum was snuffed up into her Nostrils twice aday at lest: ℞ fol. plantag. summitat. equiseti, an. Mj. rad. bistortae, tormentillae, an. ℥ j flor. ros. rubr. Mss. ballast. ʒ iij. coquantur in aq. chalybeat. ad lbij. lbij. Colaturae add syrup. nostrimag. as it is prescribed in the Cure of Ozaena in the Treatise of Lues Venerea. The edges of her Nostrils were anointed with unguent. refriger. Galeni cum ceruse. antimonii. By the frequent repeating of the aforementioned internal Prescriptions and external Applications, she was happily cured in the space of a month, and so continues to this day. And by this method all these kind of Ozaenae may be cured.  
The Eyelids are frequently diseased with glandulous Tubercles'; which, how different Matter soever they contain, are generally called Hordeoli, and do take their original from the same Martyr that those tumors do which are described in this Treatise of Strumae, and are cured after the same manner. Sometimes they resolve or suppurate: but for the most part they are taken out by Knife or Caustick. These only that lie between the inner Tunicle and Cartilege are capable of being extirpated by Incision: the other may be eradicated by Caustick; the manner I shall show you in a few Instances.  
A Gentleman of about 26 years of age had an Hordeolum on his right Eyelid, lying between the external Tunicle and Cartilege. 
12. Observat. of Hordeolum.  I applied emplastrum ad strumas on it, with hopes of resolving it: but after some time it suppurated. I thereupon opened it with a Lancet, and let out the Matter; than digested it with unguent. basilic. But feeling afterwards some part of the Gland in it, I sprinkled into it some Merc. praecipit. and applied a Pledgit of basilicon over it, with emplastr. diachyl. simple. whereby I eradicated it, and soon after healed it smooth with unguent. tutiae. Where the Suppuration hath been more perfect, they are easier cured. In others, where they were hard and movable, I have opened them by Incision transverse, or according to the length of the Eyelid, and thrust them out whole, than healed them by Agglutination. Yet in some of these the Cystis hath burst in taking out, and a thick curdled matter hath thrust forth: in which cases I digested them out with Praecipitate, and healed them as aforesaid. But the opening these with a Caustick-stone pointed is most grateful, to Women at lest: upon which consideration I generally open them that way, and upon separation of the Escar thrust them out, and cure them by Digestion with little trouble or pain.  
A young Woman came out of the North-country to me with an Hordeolum on the inside of the Cartilege pressing upon the Eye with great weight, 
13. Observat. of Hordeolum.  and inflaming it. I turned the Lid inside outward, made an Incision into it, and thrust it out: than cleansing the Wound, I returned the Lid down. It cured of itself in three or four days, without any manner of dressing. Yet sometimes Excrescences thrust out there, and inflame the Eye. Sometimes I have seen Excrescences of soft Flesh grow upon the Tunica conjunctiva, and 'cause an Inflammation of the Eye. Several such like have come to me out of the Country: some I have cut away with Scissors; others I have worn of with the Alum and Vitriol-stone.  
A Person of Honour, 
14. Observat. of Sarcoma upon the Supercilia.  aged 29 years, was commended into my hands by Sr. Edward Alston Physician. She was diseased with a Tumour of a dark read colour possessing the upper Lid of her left Eye between the external Tunicle and the Cartilege, spreading to the very edge of the Cilium. It took its original from some Hordeolum ill handled, and seemed to be a Sarcoma. I proposed the eradicating it by Escarotick: which being allowed of, I encompassed the Tumour with Ink, than began with a Caustick-stone in the upper part of it, wiping up the dissolved Salt with armed Probes, proceeding gradually in the work to the very edge of the Lid, with great care to preserve the Hair growing on it. It was a very nice work. After I had sufficiently penetrated into this Fleshy body, I washed the Salts out of the Escar, and scarifying it, dressed it with unguent. basilic. cum oleo lilior. and bound it up. The next day we met again; when I took of Dress, and found the Tumour flat, the Escar lying proportionably as was designed, and the Eye undisturbed. I fomented come decoct. malvae, viol. etc. and dressed it up as before, continuing my attendance daily with her Physician: and as the Escar separated between the Scarifications, I either rubbed the Superexcrescence of Flesh with the Vitriol-stone, or sprinkled it with Praecipitate, or used both. And after the Escar cast of, I deterged and wasted the remaining basis, and cicatrized it smooth, leaving the very Edge naturally shaped, without loss of one Hair: and so it continueth to this day.  
An Italian Gentleman was brought to me by Sr. Theod. de Vo. who had a large Excrescence in the great Angle of his right Eye. 
15. Observat. of an Excrescence upon the lacrymal Gland.  The Extirpation had been attempted both in Italy, and at Paris, as they told me. I passed a Ligature upon the basis of it, and clipped it of close: than drying up the blood with a Sponge dipped in aq. sperm. ranar. I rubbed its remaining basis with the Vitriol-stone, than washed his Eye again with the foresaid aq. sp. ranar. The next morning I visited him, and met his Physician there; but we saw nothing of the Excrescence remaining, neither did it appear any more.  
A Gentlewoman near 40 years of age had a very large Thymus growing upon the side of her Nose, 
16 Observat. of Thymus.  over the great Canthus. It was of many years' growth; and she had been advised not to permit the Extirpation of it. But she at length desiring me to take it of, I passed a Needle under its basis, and cut it out, cicatrizing it afterwards with Epuloticks; and it grew not more.   

CHAP. VII. Of the tonsils.  
THE tonsils, or Almonds of the Ears, are also frequently swelled in the King's-Evill: which Tumour may be very well reckoned a Species of it.  
These Swell are raised by Congestion gradually without pain, and therefore are seldom taken notice of till by their growth they bring inconveniences with them, as Catarrh, Cough, or Difficulty of swallowing: in which latter case their Drink often runneth out at their Nose.  
These differ from the common Swell of the Amygdalae, as tumors by Congestion do from those made by Fluxion: which latter are of sudden growth, 
Difference.  and terminate as soon; whereas the other may have been many years growing, and do increase and decrease with the Moon, as generally all tumors by Congestion in the Glands' do.  
The Causes of the Tumefaction of these Glands' are the same with those of Strumae. 
Causes.   
They are soft fleshy tumors, of a round or oval figure, retaining the natural colour of the Skin; and are of an obtuse sense, 
Signs.  so that you may pierce the body of them with a Knife or Probe without causing pain or drawing blood: yet are they subject to Inflammation, and the like Accidents that other Swell of the Glands' are.  
If the Tumefaction be small, the disturbance is little; many people having had them from their Infancy without great inconvenience. 
Prognostic.  If the Swell be big, there may be danger of Suffocation: but in that case they may be extirpated without running any great hazard.  
In order to the Cure, Physicians do generally prescribe Venaesection, and by Clysters and lenient Purgatives make Evacuation; also by Blistering, Cupping, 
Cure.  fontanelles, etc. they endeavour Derivation: which is necessary in case of Inflammation; in which astringent Lotions may be also proper. But in those made by Congestion the speediest way of Cure is by Extirpation: and that either by Abscission, at once cutting them of; or by actual or potential Cautery. Modern Writers have said little of these Extirpations. Fabritius ab Aquapend. in his Book De operat. Chirurg. renders the Abscission of them difficult enough, and not without danger; as you may see, where delivering Celsus and Paulus' way of cutting them out, he determins at last thus, Ex quibus licet colligere, neque facilem neque omnino tutam hanc Chirurgiam esse, etc. The first Chirurgeon in my memory that attempted the Extirpating them was the late deceased Mr. Ed. Mol. an excellent Operator. He attempted it upon a Person of Honour by actual Cautery through a Cannula well contrived for that purpose. I afterwards saw him burn several. He passed the Cautery through the body of them, and by repeating of it twice or thrice he burned a hole through them, and accordingly crimpled them up; as may be yet seen in that Noble Person, somewhat of the Excrescence still remaining, and not without some uneasiness at certain times: upon which account I had the honour to see it some years since. The way by potential Cautery is, by working with a Caustick-stone and other Escaroticks fixed in such an Instrument as may serve to eat into them, without offending the neighbouring sound Parts. To which purpose I make my way into the body of the Gland, consuming it within; and at last the Shell (or exterior parts) falls in pieces, and is so eradicated. The way by Excision is, by making a Ligature about the basis of them, and snipping them close of with a pair of crooked Probe-scissors. In this work you aught to consider well how they are radicated. For sometimes they are rooted like a Crista deeper in the Throat: in which, if in cutting them out you only cut that part you tied, and cut the Ligature at the same time, it will slip down into the Throat, and hazard their choking. Therefore whilst you hold the Ligature with one hand, you must pass the Scissors down as close by the basis of it as you can, so as by one snip you may cut it clear of. But jest you should fail, it will be necessary to have another Ligature fitted in an Instrument for your purpose, and the Patient's Head to be held steady, that in case you fail in the first attempt, and it fall into the Throat, you may readily return it, and tie it at the same time; which is no difficult thing to do. The Excision made, the bleeding will be soon stopped by Gargling with Oxycrate; and you may cicatrize it in a few days by touching it with the Vitriol and Alume-stones. I shall give you some Instances of my practice therein, and show you my first attempt in the Extirpation of them by Escarotick and Excision in this following Observation.  
A Person of Honour, 
1. Observat. of the extirpation of both the tonsils.  aged 10 years, having been some years diseased with preternatural Swell in her tonsils, with great Defluxion upon her Lungs, also Difficulty of breathing, and at last of swallowing, her Drink frequently running out at her Nose, was brought to London, and put into the hands of Sr. Fra. Prujean and Dr. Luke Rugely. Mr. Arris was Chirurgeon to the Family. Various Remedies had been prescribed: but they proving ineffectual to remove them, I was consulted, and proposed the Extirpation of them by actual Cautery. But that not being admitted, I undertook it by Escaroticks, and came the next day prepared, and placed her in a clear light, her Head leaning to a Bedpost, Mr. Arris sitting behind, holding it steady. I began with the left Tonsill, holding her Tongue down with a Speculum linguae, while I pressed into the body of the Tumour with a long-pointed Caustick-stone fixed to a Stick. After I had held it a while, I pulled it out, and with a Firre-stick dipped in oleo vitrioli pressed into the same place, than pulled out that too, and gave her a Glass of water to wash her Mouth. I repeated the use of the several Caustics; she washing her Mouth always after the use of them. By this method I penetrated into both the tonsils, and divided the left into two. In the time of working with the Caustick, I dried up the Salts of them with armed Probes so well, that her Mouth was not fretted in any part by them: and after I had finished the work, I washed the tonsils with decoct. hordei, and she afterwards gargled with a pleasant Julep made of distilled Water, acet. ros. and syr. diamoron. Having divided the one Tonsill, and diminished the other, I caused an Instrument to be made to convey a Ligature about the basis of them, with design to tie and cut them of one after another. I began with the left Tonsill, passing a Ligature upon the one half, and cut it of close. There happening no disturbance by bleeding, I tied the other, and cut it of: than with a Vitrioll-stone I rubbed the remaining basis, and thereby smoothed and cicatrized it in 4 or 5 days. I than began with the right Tonsill. Mr. Arris holding her Head as formerly, I made a Ligature upon the basis of it, and holding the end of it with my right hand, I passed a pair of Probe-scissors with my other hand close by the said basis, and supposing I had encompassed the root, I clipped; but it not coming away, I thrust my Scissors downwards, and cut again, being confident I had clipped through the fleshy body. I pulled the Ligature, but it not coming, I was somewhat surprised what should be the cause: therefore pulling my Scissors a little back, and turning them more off from the basis, I clipped again, cut of the bigger part of it, and brought it out with my Ligature: at which instant she choked. The Ladies seeing it shrieked, and became troublesome. I desired Mr. Arris to sit still while the Patient choked: she gaping, I passed into her Throat the Instrument I had made the Ligature by, and raising up the remaining Excrescence, she recovered, and cried, Shall I live? I replied, Yes, if you sit still. I passed another Instrument fitted with a Ligature. In changing the Instruments the Excrescence slipped down, and she choked again; but I raised it up, and relieved her: than tied the Ligature upon it, and looked into her Throat; where I saw it rooted like a Cock's Comb, and that in endeavouring to cut the Tonsill close by the root, I had cut below the part I had tied. Which if I could have foreseen, and have passed my Scissors close a little lower, one Snip had brought it clear away: but not supposing it rooted so low, and working blindfold, I was at a loss. But being now better informed, I passed my crooked Probe-scissors down lower, cut it clean of by the roots; and brought it away with my Ligature. I cicatrized it with the Vitriol and Alume-stones in few days. Yet some while after she was cured, a part of her Drink came out at her Nose: which happened by reason of the Tonsils drawing that part of her Palate down lower than naturally it should: and I suppose that was the cause of her speaking so. But some while after she was freed of those Inconveniences.  
A Gentleman aged 25 years, who had been long subject to Defluxions, 
2. Observat. of the right Tonsill extirpated.  etc. from overgrown tonsils, and taken much Physic unsuccessfully, was recommended to me. The right Tonsill being very large, I proposed the cutting it of. The Patient's Friends consulted their Physician and Chirurgeon: they did not readily assent to it. But notwithstanding, the Patient and his Friends perceiving there was no other way of Cure, they recommended him again to my care. I made a Ligature upon it, with design to have cut it of at that instant: but observing their great apprehensions of a Flux of blood, etc. I deferred it till the next morning, and than I saw it shrunk and much lessened. I took hold of the Ligature with one hand, and passing my Probe-scissors close by the root of it, at one Snip cut it of, and brought it away with the Ligature, it scarce bleeding one jot. I rubbed the remaining basis with a Vitriol-stone, and caused him afterwards to gargoyle with decoct. hordet cum syr. de rosis siccis, and in 4 or 5 days cicatrized it. The other being small, I deferred the meddling with it till there should appear more cause. But from that time he recovered a better health.  
A Gentleman's Daughter of about twelve years of age, 
3. Observat. of the right Tonsill extirpated.  frequently diseased with Catarrhs, and after some time with great Difficulty in swallowing, consulted me. Looking in her Throat, and seeing her tonsils, especially the right, very big, I advised the cutting of the bigger. To which they assenting, I made a Ligature upon it, and at the same instant cut it of; and afterwards, by rubbing it with the Vitriol-stone, cicatrized it in few days. She being relieved hereby, hath hitherto deferred the outting of the other.  
A Gentlewoman of about 26 years of age, subject to Catarrhs, 
4. Observat. of both the tonsils extirpated.  by reason of the preternatural growth of the Amygdalae came to London, and consulted her Physician. He advised her to have them cut of, and brought me to her. I made a Ligature upon the one, and cut it of, washing her Mouth after with Oxycrate: than passed a Ligature upon the other, and cut it also of; she gargled and washed her Mouth. I afterwards rubbed the basis of them with a Vitriol-stone, and took my leave for that time. The next day I came again, with intention to dress the remaining Wounds: but she was removed from her Lodgings, or her Physician had undertaken the cicatrizing them; for from that time I neither saw nor heard from her.  
A Gentlewoman aged 56 years had been a long while subject to Defluxions upon her Throat and Breast. 
5. Observat. of the left Tonsill. extirpated.  After various Endeavours to divert this Humour I was consulted. Looking into her Mouth, I saw the left Tonsill very large, and supposed that the cause of her Catarrh. I proposed the Excision of it: which being approved of, I came the next day, and made a Ligature about its root, and with my Probe-scissors cut through it, as was accustomed. But it not coming away as it should, and the blood flowing down her Throat whilst she leaned her Head backwards, feeling herself choking, she fling backwards, thrust away the man behind her, and in struggling slipped of the Chair. At which instant I lost my hold of the Ligature, and she lay choking. I saw the cause, and getting hold again of the Ligature, relieved her, than raised her up, and, having a little refreshed her with Drink, placed her again in a clear light, and passing my Scissors down lower, with one Snip cut it of, and brought it away with the Ligature. She gargled with Oxycrate, and was in few days cured by touching it with the Vitriol and Alume-stones. Since that time she hath not been troubled with Defluxions, but enjoys a good health to this day.  
A young Gentlewoman of about 15 years of age was brought to me out of a neighbouring Village with both her tonsils preternaturally swelled. 
6. Observat. of both tonsils extirpated.  She had been long subject to a Catarrh, and had been frequently in danger of strangling in the night with the Fluxion. I proposed the Excision of them, as the speediest way and least painful: but she not permitting it, I went about the Extirpation of them with Caustick-stones and ol. vitrioli interchangeably used. I began with the right side, which was the lesser Tonsill, and pressed my Caustick to the middle of it: than pulling it out, I pressed upon the same place with a Stick dipped in oleo vitrioli: and so applied them interchangeably, (as I said.) Between while she gargled with Water, and took a breathing-time. Than I proceeded again in the work with Caustics. But it is not imaginable what a disturbance I met with from a frothy Saliva filling her Mouth the while to the very choking of her. I wondered at it, but was told by her Mother than standing by her, that it was her Disease; and upon that account they had been directed to me as their last Refuge. At that sitting I penetrated into the body of the Gland, and eat it hollow, not unlike a wormeaten Nut. Having wearied her and myself, I washed out the Salts, and dismissed her. The next day she came again with it much diminished; the middle of it had been consumed, and the Shell was contracted. I fell to work on the forepart near its basis, and easily penetrating through the external part, worked down the edges afore me, and in three or four sit wasted the Gland so, that there remained only a Prominency in the basis; which being raw, I consumed it by touching it with the Vitriol-stone daily: to which purpose I have them also fitted in Shafts, so as they cannot slip out, though they should break in the use. Whilst this latter was cicatrizing, I began with the bigger on the left side, after the same manner as hath been said of the former. But the work growing tedious by reason of the continual flowing of that spumous Humour, I concluded the Extirpation of that by Ligature and Scissors, and cicatrizing it with the Vitriol and Alume-stones, dismissed her cured. Since which I have seen her often, and am satisfied that she is freed of the former Disturbances by the extirpation of those preternatural bodies.  
A young Gentlewoman of about sixteen years of age, 
7. Observat. of both tonsils.  nearly related to a neighbouring Physician, came out of the Country diseased as in the former Observation, with much the like Accidents of Catarrh, etc. attending. In viewing these tonsils, observing some little Porosity in them, I made search, and did easily pass in a small Probe, without drawing any blood or causing pain. They were perfect Fungi, and required to be eradicated. I would have done it by Ligature and Scissors: but it not being admitted, I proceeded by Caustick, as abovesaid; and not meeting with that disturbance from the Saliva as in the former work, I went on more easily, and the sooner extirpated them. Since when she hath been freed of the foresaid Disturbances, and enjoys a good health.  
There also happeneth an Elongation of the Wula through the abundance of salivous Humour flowing upon it: in which case, if it touch upon the root of the Tongue or upon the Epiglottis, it causeth a frequent hawking, and in progress maketh a vexatious Catarrh.  
Such was the case of a Servant-maid to a Noble Lady in the Country. 
8. Observat.  Various Medicaments had been prescribed ineffectually: I being in that Family was desired to see her. Looking into her Mouth, I saw the Wula hung dangling upon the root of the Tongue. It was not swelled nor inflamed. I supposing it the cause of her Distemper, took hold of the lower part of it with my Forceps, and at the same time cut it shorter with a pair of Scissors. It did not bleed a Spoonful: and afterwards it cicatrized of itself without application of any kind of Medicament, and she was thereby freed of the Defluxion. Such another I cut of in a Servant of his Majesty belonging to Hampton-Court, and some others who were so afflicted, and thereby freed them of their Catarrh, when all other Remedies failed.   

CHAP. VIII. Of Ranula.  
RAnula is a soft Swelling possessing those Salivalls under the Tongue. 
Description.  It is made by Congestion, and in its progress filleth up the space between the Jaws, and maketh a Tumour externally under the Chin.  
It is caused by a pituitous Matter (say Authors) è Cerebro in Linguam prolapsa. 
Cause.  But late discovery hath made it manifest to arise from a congestion of Humour in the inferior salival Gland, which is seated there, as I have already intimated.  
It is a soft Tumour without pain or alteration of colour in the Skin. 
Signs.  It yieldeth to the impression of your fingers, but riseth upon the taking them of; and contained a Matter not unlike the White of an egg, or such as we meet with in an Atheroma. It is also discovered by a Croaking in their Speech.  
They are not dangerous as to life, 
Prognostic.  but are difficult of Cure.  
The Cure consisteth in the prosecuting the same method which hath been proposed in the Cure of Strumae. 
Cure.  The Topics aught to be discutient; amongst which all the sorts of Salts and Aromaticks dissolved in convenient Liquors are proper to hold in their Mouths: viz. ℞ piperis, zinziberis, an. ʒ j sal. common. & gemmae an. ℈ ij. origani, calaminth. rad. ireos, hermodact. an. ʒ ss. mastic. ℈ j Misc. & fiat Pulvis. These may be boiled in Wine, or mixed with Oxymel; or the Tumour may be rubbed with the Powder. To the external Tumour you may apply such Discutients as have been prescribed for Strumae. If by these Applications the Ranula do not discuss, you must open it by actual Cautery, and dress it as shall be showed in the following Observations.  
A Gentlewoman aged 35 years came to me recommended by Sr. Fr. Pruj. 
1. Observat. of Ranula.  She had a large Tumour lying between her Jaws under the Tongue, and reaching to her Foreteeth, making a great Swelling externally under the Chin. It caused a Croaking in her Speech, and seemed troublesome to her. She had passed through a Course of Physic, and used various Medicaments to it unsuccessfully. I proposed the letting out the Matter by actual Cautery: but she not permitting it, I opened it by making an Incision on each side near the Togue, and discharged about two Bloud-porringers full of an albuginous Matter: upon which the Tumour sunk. I than made a search with a Probe, and perceived the Matter had not only made a deep Cavity downward, but also rendered all the inner part of the Tongue hollow. I dressed the Abscess with syrup. de rosis siccis, and applied empl. ad herniam with a third part of empl. Caesaris externally under the Chin; deterging it afterwards with a Solution of mel Aegyptiac. in decoct. salviae, beton. apii, etc. than incarned and cicatrized it. But some while after it risen again in a Tumour as formerly. Upon sight whereof I opened it by actual Cautery on both sides of the Ranula, by which the Matter was again discharged, and the Tumour wasted. During the time I was endeavouring the Cure, she was purged, and put into an Antistrumaticall course of Physic, and was at last cured as abovesaid. Whether she relapsed afterwards I know not, having neither seen nor heard of her from that time to this.  
An old Gentlewoman came out of the country to me with a long Swelling on each side under her Tongue, of a fleshy colour, 
2. Observat. of Ranula.  which felt under my fingers like the Gillss of a Fish. They were not painful, but very uneasy to her. I supposed them to have Matter in them, and attempted to shrink and dry it up, as hath been proposed in the method of Cure; but without success. I than slit the one open the whole length; but there flowed out only a florid blood, which I stopped by washing her Mouth cum aceto: than laid open the Tumour on the other side. They cut like cartilaginous bodies. I stopped the bleeding of this like as I had done the other, and dressed them both with an armed Probe dipped in tinctura vitrioli dulcificati, designing to dry them up that way. From the time I opened them, she complained of Hairs in her Mouth, and frequently endeavoured with her fingers to pull them out, and persuaded me to do the like: but I could feel no such thing. She came to me daily to be dressed. The Abscesses digested, but the tumors would not sink: wherefore I cut of their Lips; yet they did not lie so smooth as I designed. Upon which consideration I would have burnt them by actual Cautery: but the mention of that so terrified her, that she came no more to me. I have inserted this Case for the rarity of it, and am confident the actual Cautery was the proper and certain way of Cure.  
A Young fellow was commended to my hands who had a painful Tubercle in his tongue. I made Incision into it according to its length, 
3. Observat. of Ranula.  and thrust out a Stone bigger than a small Olive. I dressed the Abscess with syr. de ros. siccis, and thereby cured it in few days.    

A TREATISE OF WOUNDS.   

OF WOUNDS.  
The Fifth Book.  

CHAP. I. Of WOUNDS in general.  
A WOUND is a Solution of continuity in any Part of the body suddenly made, by any thing that cuts or tears, 
A Wound defined.  with a division of the Skin.  
This Definition differs much from what is usually delivered by Authors; and it is fit it should. For they generally defining a Wound by a Solution in part molli, do thereby exclude a Cut made into a Bone, as that into the Cranium by a Pole-axe, etc. which why it should not be called a Wound I know not. I say, It is made by any thing that cuts or tears. Other Authors define it to be made by an external Instrument, etc. How than do they call that fracturam cum vulnere, a Fracture with a Wound, where the Bone from within makes the Wound, and thrusts itself quite through the Flesh? Sennertus adds to his Definition, that it be done à re secante & acuta: yet he reckons those for Wounds that are made by Bullets, although it be Canonshot. I do therefore think it fit to make my Definition more comprehensive, and to take in whatsoever makes a sudden Solution of continuity, at lest immediately and by itself, on what Part soever it lighteth. So a Cut into a Bone is a Wound: Tearing the Flesh, Nerve, Sinew, Tendon or Cartilege, by Bullet, Stone, Splinter, etc. is a Wound. Only I add this restriction, that the Skin must be likewise divided: by which last words I exclude Fractures that come not through the Skin, and Contusions if the exterior Parts be continuous. But by the word Skin I understand not only the external Cutis, but also the inward Membranes of the Gullet, Ventricle, Guts, Bladder, Vrethra, and Womb; all which are capable of Wounds from sharp Instruments, either swallowed, or thrust into them.  
A Wound thus defined admits of many Differences, 
Difference of Wounds.  of which I know none that can be properly called essential. Great or small, deep or shallow, wide or narrow, strait or crooked, round or angular, are but accidental Differences. Distinctions taken from the Weapons, whether sharp or blunt, Sword Rapier, or Bullet, Cut, Prick, or Tearing, are likewise but accidental. Those that look most like essential Differences are they which are taken from the Subject in which the Wound (which is itself but an Accident) inhereth, viz. from the Flesh, Skin, Brain, Nerve, Tendon, Artery, Vein, Gristle, Bone, etc. All which, being the several Subjects of Wounds, may well be allowed to specify them; and so much the rather, because from the nature of them we raise our greatest Indications of altering the method of Cure. To this Head may likewise be referred the division of them into Simple, or Compound.  
Wounds are in themselves so visible, 
Signs.  that they need no general Marks to be known by. But the peculiar affections of the particular Parts hurt, and the methods of discovering what inward Part is wounded, by observation made of the Symptoms that hap, are fully handled in those Chapters which treat of the Wounds of the several Parts.  
The Prognostics are there also delivered, 
Prognostics.  that the young Chirurgeon may be informed how to make judgement of them, and avoid the engaging himself in promising a Cure of such Wounds as are mortal. The greater Symptoms of Gangraena, Paralysis, and Spasmus, I have translated to Gunshot-wounds, they being there more frequent and usual. Haemorrhagiae are spoken of in this present Treatise.  
The Wound being a Solution of continuity, 
Intentions of Cure.  doth require to be made one again, Unity being the perfection of whatsoever hath a being. To effect this is the work of Nature and Art; both must mutually join their helping hands: and unless both the vital Faculties and nourishment of the Part do assist the Art of the Chirurgeon, it will be lost labour: here must be a joint meeting and agreement of all in one.  
In Simple Wounds the Chirurgeon is to afford his assistence five manner of ways; the omitting of any of which will tender him negligent or ignorant in his Trade.  
The first is, in careful and diligent taking away all such extraneous bodies as by their interposition may hinder the true Agglutination of the disjoined Parts, whether they be concrete Blood, Hair, Sand, Dust, pieces of Bones, Cartilages, or pieces of the Weapons, Rags, etc.  
The second is, in bringing the Lips of the Wound even together, which were separated.  
The third is, in retaining the Lips so brought together, that they may by Consolidation be restored to their former figure.  
The fourth is, in conserving the Temperament and natural Heat of the Part, in order to Unition.  
The fifth is, in preventing ill Accidents, and correcting such as have already seized on the Part.  
Thus much is required if the Wound be only Simple: 
What is required in compound and contused Wounds.  but if it be a Compound Wound, with loss of Substance, or Contusion, than he hath somewhat more to do. As where there is loss of Substance, there he must assist Nature with his sarcotics, for regaining what is lost: and where there is Contusion, there he must endeavour the turning what is contused into Pus or Matter, which must be performed before there can possibly be any Reunion.  
As long as there is any strange body or different substance to keep of the Unition, 
The first Intention, in taking out extraneous bodies.  you must not hope to make any Cure of a Wound. Therefore if any such be to be drawn forth, before you attempt it, consider seriously, first, whether it can be done or no; secondly, whether safely.  
For, first, sometimes the Weapon sticketh so fast, that by no art it can be extracted. Than it is of necessity to be left to Nature, who in this case sometimes worketh Miracles. For I have known pieces of Splinters, etc. sometimes stick so fast in the inward Parts, or to have been so enclosed, that we could by no means get them out: yet at length, upon Apostemation of the Part, they have thrust forth.  
Secondly, you are to consider whether you may with safety pluck out the Weapon or no. Some will live a day with the Weapon in their Body, who would expire upon the moment of Extraction. But if your judgement suggest to you that the Patient is recoverable, make haste, out with it before the Part be inflamed.  
If the Weapon have pierced deep, 
Which way the Weapon is to be drawn out.  and through great Vessels and Nervous places; or if the Part opposite to it be full of Veins, Arteries and Nerves, or have a Bone lying in the way, or over against the Wound; if there be no great fear of Laceration, pull it out the same way it went in. For the effecting of which, our Masters have left us variety of Instruments, the Figure and Use whereof you may see in Scultetus. But if the Point of the Weapon have pierced above half way through the Member, and there be no Bones nor notable Vessels to hinder you, (here is use of your Anatomy and exact knowledge of the Parts,) either thrust the Weapon through, or make way for it by Incision on the contrary side: but beware the Weapon be not too big, jest you do make two large Wounds for one.  
If the Weapon stick in the Bone, move it up and down to loosen its Point, 
Weapon stuck in a Bone.  and than pluck it out: but in case it will not move, cut away the Bone before you extract it.  
If a Weapon be fastened betwixt two Joints, 
Weapon stuck between the Joints.  make an Extension of the Parts both ways, as it is the manner in Fractures and Dislocations, that so the Tendons and Ligaments being stretched, the Weapon may with more ease come out. But do this with moderation, jest you break some notable Vessels, and a Flux of blood or some ill Accident befall you in your extracting it. It will be necessary in this work, that you consider the position the Part was in when the Wound was inflicted. Gesner hath a Story, in his Observat. de Chirurgiae dignitate & praestantia, of a Chirurgeon, who when he could by no means get forth an Arrow, asked the wounded Patient in what posture of his body he received the Wound. Understanding it was done an Horseback, he placed him in a riding posture, and immediately drew out the Weapon.  
The Weapon thus drawn out, cleanse it from Rags or aught else, and permit the Wound to bleed, accordingly as you in your judgement shall think fit, still having respect to the Constitution and Habit of body, that what is in the small Veins cut asunder may flow out, as well to hinder Inflammation, as the generation of much Matter. The Bleeding stayed, if there be Hair growing about the Wound, shave it of: than wipe away the clotted Blood with a Sponge dipped in Read wine, Oxycrate, or Water. But if it stick deep in the Wound, be not too busy with your armed Probe, for thereby you may stir up a new Bleeding; whereas this concreted Blood keeps the Wound warm, and defends it from the outward Air; and by digestion Nature will thrust it forth.  
The second Intention is performed by bringing the Lips of the Wound exactly together. 
The second Intention, in making Unition.   
This Intention is delivered in a few words, but they are to be observed as a Law; for without that Reduction of the Lips, a slow and deformed Healing follows. Nature hath nothing to do here in bringing the Lips together, that is the sole work of the Chirurgeon; who must not lay a Pledgit, or crowd a Dossill of Lint or Tent into a little Wound: not, that is the way to keep the Wound open, and make it painful, whereby Defluxions are stirred up, the Temperament of the Part weakened, and the Cure prolonged; contrary to the intention of all who have writ of Wounds, and to the practice of our knowing Surgeons here. Yet amongst the Pretenders to that Art we often meet with such work. As for instance:  
A Young man was wounded near Highgate in the Back, 
Observation concerning Dossills' in simple Wounds.  slanting under the right Scapula; he had another Wound also on the Back, and another through the upper part of the left Shoulder, with a long Gash over the Forehead, and others besides, some whereof were not considerable. The next day being carried thither to dress these Wounds, I found them all distended with Tents and Dossills' of Lint, disposed to inflame and swell, and the Patient exceeding full of pain. After I had taken out these extraneous bodies, my endeavour was to dress them so, as I might incline their upheaved Lips to return to their natural site. To which purpose I fomented them with Milk, and applied Pledgits spread with a Digestive ex terebinth. cum vitell. ovi, embrocating them with ol. ros. them by empl. è bolo, and Bandage with gentle Compression, I dressed him up; and afterwards here in Town cured him by sarcotics and Epuloticks, as in Compound Wounds; a longer work, which at first aught to have been done by Agglutination. Parts separated and disjoined are to be brought together gently and equally, that they may touch one another, and so be prepared for Unition.  
This must be done (I say) first gently; 
Unition to be effected, first, gently:  sensim & sensim, as Fallopius hath it, by little and little; not hastily at one pluck. If the Parts be equally soft, bring them equally together: if the one soft, the other hard, and not to be moved but with difficulty, bring the soft part to the stubborn. If the Parts be grown stiff with cold, as when the party hath been left in the field all night, which after a Battle hath often happened, (and particularly to a merry fellow, a common Soldier, that used to wear an iron Scull under a Cap, and from thence was called by a Nickname; his Wounds were large, and the Lips hardened with the cold, and it was well for him, his Bleeding being thereby stayed;) in this case you are to suppling them by fomenting them with Milk or warm Water, or else embrocate them with Oil, till you perceive the Lips made soft enough for your purpose, before you endeavour Reunion.  
Secondly, 
secondly, equally.  equally, that the Parts cut asunder may answer one another, as well in the top as the bottom, brim to brim, and, if possible, underneath Vessel to Vessel; that Nature may be in a capacity of doing its own work, and by virtue of its Balsam reunite, agglutinate, consolidate, and heal the Wounds: in all which Intentions she is the Agent, and the Chirurgeon only the Assistant. Which Assistence that it may be the more effectually given, we must go on to the Third.  
The Third Intention is, 
The third Intention, in retaining the parts united.  Deligation, or retaining the Parts so joined together.  
For the effecting of this, our famous Masters have left us two principal means, Fasciae and Suturae, Rolling and Stitching: to which some, nay most of them, added Fibulas, or Clasps. But I will not put you upon that. If the Wound be small, and in a Fleshy part, and according to the length of the Fibres or Member, you may perform the Cure by Bandage; for here Nature will truly act her part, by application of blood and nourishment to both sides indifferently, and finish the Coalitus without your farther assistence. And this is that which gives such credit to the Sympathetick Powder. In the application of this, it becomes every Chirurgeon to be much experienced, in respect of the unspeakable commodities which the whole Art receiveth thereby.  
By Bandage not only are Parts dextrously accommodated for Union; 
Their use.  but such also as would unnaturally grow together are kept asunder. In Burn, Scaldings, etc. the Fingers would many times grow together, the Chin would grow to the Breast, the Arms to the Sides, were they not this way hindered. By them are Fluxes averted, and the delapse of Humours into the inferior Parts forbidden; and, being already lodged, they are pressed out. By these are good Juices advantageously forced into Parts emaciated. As, if the right Arm pine away, roll up the left from the Hand to the Armpit, that the Blood being pressed out into the Vena cava, or rather hindered to flow in so fast by the Artery, may with more eagerness flow into the other side, where it was wanting. By these we see great Fluxes of blood, large Haemorrhagiae every day stayed. By them are ill-shaped Wounds brought into better figures, and made more apt to be cured. By them is the force of your Applications helped and furthered, they keeping them close to their proper places, where your care hath bestowed them. By them is the true natural form and beauty of the Part commonly preserved.  
Three especial sorts of Fasciation or Rolling, 
Three sorts of especial use.  pertaining to our present work, have the Worthies of our Profession commended to posterity. The first they term Incarnatrix or Agglutinatrix, the Incarnative or Agglutinative: the second, Retentrix, or Retentive: the third, Expultrix, or Expulsive.  
The Incarnative is that which brings the Lips of the Wound together, 
1. Incarnative.  and conserveth them in their right figure. It must be more strict than the Retentive, and more lose than the Expulsive; and is the most useful in simple, fresh, and yet bleeding Wounds. The manner of performing it is thus.  
Have in readiness a Rowler of such matter, length and breadth as I shall anon show you; roll it up at both ends firmly to the middle; than lay the middle part of the Rowler on that part which is opposite to the Wound, to prevent pain and inflammation. You are than, after you have made a turn upon the Wound with both ends of the Rowler, to go up with the one, and down with the other, and take so many turns about the Part as may be requisite for the restraining the Flux of blood, or, according to the Season of the year, to defend it from cold, and yet not keep the Wound too hot, for that may weaken the Part. You must also be careful that your Bandage be not too hard, so as to intercept the Spirits. Your Rowler running downwards will press out the Matter from the affected Part, and by passing upward hinder the influx of Humours.  
The Fascia Retentrix is used to keep your Dress on close about the Wound. They for the most part are only of use in Wounds of the Head. 
2. Retentive.  There must be a moderation in binding with this Bandage.  
Fascia Expulsiva is performed by a Rowler of one head: 
3. Expulsive.  the special use of it is, to expel Matter out of Fistula's or Sinuous Ulcers; as also to prevent the descent of Humours, and to expel such as have already seated themselves upon the Part wounded or otherwise. Do it in the manner following.  
Begin in the sound part, beneath the seat of the Humours, 
How hard to bind.  and roll upward pretty straight at first, and by degrees; as you come nearer the Mouth of the Wound, gentlier and gentlier. If you will press out the Matter contained in the Cavity of the Wound, you must roll loosely there a turn or two, than harder, and yet a little straighter, the higher you go, to hinder the descent of Humours; but not too hard, for fear of harm. Terminus sit bona laborantis tolerantia; Celsus: Let it be made with such moderation, as the Patient may well endure it. Hypocrates de Offic. Medic. Vinculorum alind per se (saith he) remedio est, aliud iis quae remedio sunt subservit: Amongst Ligatures, some of themselves are Remedies, others are servants to Remedies. And true it is in these: for the Incarnative and Expulsive are in themselves, as you may perceive, Remedies; and the Retentive the common servant to them all.  
To these Fallopius, 
Four other Bandages added by Fallopius.  in Tract. de Vulneribus in genere, adds four more; viz. 1. Fasciam disjunctionis, 2. Fasciam directionis, 3. Fasciam facientem Apostema, 4. Fasciam prohibentem Apostema.  
1. Fascia disjunctionis. By this Rolling Parts are kept from joining together, as the Fingers when they are bared of the Cutis.  
2. Fascia directionis is that which assisteth in making a crooked Part strait, or bendeth a Part unnaturally strait to his proper figure.  
3. Fascia faciens Apostema is that which will procure an Aposteme, by summoning the Matter up into one part, which might perhaps dangerously flow into others, and those more principal.  
4. Fascia prohibens Apostema is that which forbiddeth the collection of Matter, and consequently hindereth the generation of an Aposteme.  
For the matter of your Rulers, 
Of what Rulers are to be made.  they must be made of good strong even Cloth, white, clean, and gentle, without Hem, Seam, or Thread hanging by.  
Let the Length be such as the Member affected and the multitude of circumvolutions require; 
Their length.  longer in Winter than in Summer. Hyeme (saith Celsus) saepius fascia circumire debet; Aestate, quoties necesse est: Rowl on, on, and again, in the Winter; in the Summer not oftener than needs must. His ground, I suppose, he had from our great Master, Sect. 5. Aphor. 20. Frigidum ulceribus mordax, cutem obdurate, dolorem insuppurabilem facit: Cold nippeth a Wound, makes the Skin hard, and causeth pain which cannot be digested. For the Breadth of the Rowler, 
Their breadth.  Petr. Pigraeus, Lib. de Vulneribus, is most punctual. Let them be for the Shoulders, saith he, of six inches broad; for the Thighs, of 5 inches; for the Legs; of 4 inches; for the Arms, of 3 inches; for the Fingers and Toes, of one inch broad. But this your judgement will teach you to altar, according to the conformation, shape and positure of Parts.  
Fasten not your Rowler by tying a knot; nor yet sow it upon the Wound, or where you cannot easily come at it again; jest you hurt your Patient. Quickness and neatness distinguisheth the Workman from the ignorant and unskilful. As the Subject is more noble you work on, so strive to perform your office more excellently; intending not only your profit, but decency in the dispatch; that you may please the Eye, both in the time of, and when you have done your work: thus shall you gain credit to yourself, and endear your Patient to submit the more readily to your Rules, which is not the lest part of the Cure.  
The next thing that offers itself for keeping the Lips of the Wound together are Sutures, 
Sutures. Three sorts.  and they are of three sorts; first, the Incarnative, secondly, the Restringent, and thirdly, the Conserver.  
The first is that which is in most use amongst us, 
1. Incarnative.  and is by making so many Stitches at a distance.  
The second is the Glover's Stitch, 
2. Restringent, or Glover's Stitch.  and much in use among the Spaniards, who stitch almost all Wounds by it. In the Forehead and Face I have seen them bring the Wounds very close: the third day they commonly cut the Knots of, and draw the Thread out; than with dry Stitches keep them so brought together; and in two or three days more they cure them.  
The third Stitch is of use in great Wounds, and those of the Oesophagus, 
Conserver.  etc. to hold them forcibly together. It is performed with Pins or Needles, as in Hair-lips.  
There are four sorts of Stitches, mentioned by the Ancients, for the Wounds of the Belly, whereof I shall take notice only of one, which I have made use of myself in the stitching of those Wounds; the manner whereof is thus: You are to take up the Peritonaeum on one side, and leave it on the other; and than take it up on the other side, and leave it on this. It is so made, that the Peritonaeum, which is a dry body, may be united with the Musculous flesh: otherwise only the Fleshy parts would unite, and the Peritonaeum lie open, upon which a Hernia would certainly succeed, and the Patient be put to the trouble of wearing a Truss the rest of his life. The Thread you are to use for this purpose aught to be a strong round white Thread proportionable to the Needle, and both accordingly as the Wound requireth. You must remember to cleanse the Wound of its clotted Blood, if you can: but however go on with your work, that Blood will found its passage out.  
In great Fluxes of blood the Glover's Stitch is best. Endeavour in your Stitching to bring the Artery and Vein to its wounded fellow; so shall you the likelier secure yourself, and make the work more seemly.  
In the Incarnative, you are to consider the Wound. If you found it but the length of a finger's breadth or a little more, 'tis not worth the stitching: your Medicaments and Bandage will keep the Lips together, and quickly heal it.  
If the Wound be of two Finger's breadth, make one Stitch in the middle; 
The distances of Stitches.  if three fingers breadth, make two Stitches; if four finger's breadth, three Stitches; and so go on, making a Stitch lesle than the Wound is in number of fingers. Sometimes in declining Parts we make our Stitches at a little more distance.  
The time of taking out the Stitches is, when the Parts are agglutinated; 
Time of taking out the Stitches.  which is sooner or later according to the Habit of body, or Season of the year. Commonly in great transverse Wounds eight days are required; in lesle Wounds not so deep, three or four days: in the Face, do it the next Dressing, jest the Stitches make so many Scars. But in this work you must use your judgement: 
Caution.  for sometimes the Wound may seem to be agglutinated, while the Lips are held together by Suture, which, after the Stitches are cut out, is not so exactly cicatrized, but that you might have done better to have left the Stitches a day longer. But in this case the dry Stitch may help you; 
Dry Stitches.  and that is another way of keeping these Wounds together. They are made with little bits of strong linen Cloth, triangular or quadrangular, or of such figure as may serve your purpose. These are most proper in the Face, to avoid the other way of Stitching: yet they are of use in other Parts, to preserve the Lips close. They are commonly spread with a Mixture of sang. dracon. thuris, aloes, farin. tritic. gumm. tragacanth. an. part. equal. cum albumin. ovi. They aught to be of such a consistence, that they may adhere firmly to the Skin. They must be applied at such distance as they may best perform their work. After they are dried on, you must bring the Lips of the Wound close together, and retain them so, taking care they be not wet by the Matter.  
The Fourth Intention is, the preserving the natural Temperament of the Part, that thereby Agglutination may be obtained. 
The fourth Intention, in preserving the natural temperament.  Which Agglutination indeed, as I have already hinted, is the work of nature alone, by whose only power all Parts wounded, disjoined and broken, are knit and made one again. But in regard there is a certain Medium, which answers in proportion to a Glue, required in this work, Nature taketh what is next hand, even the Nourishment of the Part which is hurt, to make it of. Vbi morbus, ibi remedium, 
Nature agglutinative of Wounds, healing,  is here as an Oracle; Where the Disease is, there is the Remedy. Not sooner is the Wound made, but the Balsam is discovered. Blood (at lest the serous part of it) is the Glue which she useth, both in curing by the first and second Intention. 
1. per Symphysin;  The first being performed per Symphysin, i e. a Reunion of the Parts without any Medium; by which word I here mean any Callus or Flesh, or other body interposed; for in another sense the Balsam of Nature is the Medium, the instrument of Unity, and knits the Parts together: the second per Syssarcosin, 
2. per Syssarcosin.  i e. with a Medium, or interposition of some Flesh or Callous substance, that fills up the space between the Lips of the Wound. Great care must therefore be taken, that the Blood offend neither in quantity nor quality. Too much bringeth on proud and lose Flesh; as too little doth defraud the Part, and affordeth not a competency of Matter for the work. If the quality of the Blood be ill, it cannot produce good Flesh: as the Blood is, such is the Flesh.  
The means whereby this Intention is performed is a Regiment of the Patient: 
Regiment, 1. Universal.  and that is either Universal, as to his Diet; or Particular, as to the peculiar management of the Part itself. As to the Universal, we are to consider, first, whether a full or slender Diet be to be used. This hath been a Dispute in former Ages: but I think, no man of common sense but knows, that as a full Diet is hurtful for those of a Plethoric Body, in Wounds where there is great Inflammation and like Symptoms; so when a Body hath been exhausted through loss of blood or the like, it's reason that a greater liberty should be allowed, as to take Broths, Jellies, newlaid Eggs, etc. Withal I conceive there should be Consideration had of the Patient's manner of living. 
Consideration from the Patient's manner of living.  Some people have so accustomed themselves to drinking of Strong drinks, that without such a proportion they cannot live. I could instance it by many Stories, if it were necessary; but I shall give you one for all, and that from abroad.  
Ed. Br. an old Servant to a Person of Honour, 
Ed. Br. cured by allowing him Wine.  was bit by a Monkey in the Back of his hand. To prevent Inflammation, I forbade him Wine. The next morning he complained he had not slept that night, that he was faint and sick, and that his Wound was the lest of his ailment. That day he continued faint and ill, and the next morning complained again of his want of Rest; and that afternoon he swooned, and complained he could not live without Wine. He had good Broths, Caudles, and such like; and I believe he did drink some Wine. (But he was allowed by his Master a Bottle of a Quart every morning for his Draught, and was seldom sober.) His Wound was indigested and inflamed. I complied with his desire; he drank again as he pleased; his Sickness went of, his Wound digested, and he was soon after cured.  
This I have seen often in some of the Dunkirk at Sea, who drank extraordinarily, and were full of drink at the time of their Sea-fights. I could scarce ever cure any of them without allowing them Wine; and thereby their Spirits were kept up, and I had the liberty to bleed them as I thought fit. When these kind of people eat as plentifully as they drink, they than upon a sudden change of Diet labour under a Crapula, and are subject to Fainting, or have Colic, Dysuria, etc. and if the Wound hap in the Abdomen, it gives a suspicion (to those that are not well skilled in the Symptoms of Wounds) to think that it ariseth from the penetration of the Wound, when there is no such thing; and so by the perseverance in those Rules the Patient suffers.  
It hath been a common Saying, A Hair of the same Dog, and thought that Brandywine is a common relief to such. What than must become of such a one, after a hard drinking for many months together, if he chance in heat of drink to be wounded, and from that time his Chirurgeon condemn him to Ptisan for a week together, nay two days? will he not faint and languish, and his Wounds become indigested and inflamed? You may laugh at my pleading for them: but I hope you will consider I am a Water-drinker the while.  
As for other things, such Diet is to be observed as their Strength will permit. We do not use to purge with Catharticks in Wounds, jest by stirring Matter it flow to the weak Part: but we allow Lenitives, as Cassia, Tamarinds, Manna, Senna, Rhubarb, with Sal prunellae; also Electuaries, as elect. lenitiv. diaprun. syr. ros. solut. de cichor. cum rhabarb. also Broths wherein have been boiled Lettuce, Succory, Endive, Sorrell, Purslane, borage, bugloss, etc. And we let them blood according to the Strength of their body, and as Symptoms indicate.  
Another part of the Regiment of wounded persons will consist in giving of Vulnerary drinks: of which we found many mentioned by Authors, 
Vulnerary Drinks, Powders, and Electuaries.  and the materia medica very large; witness that great tribe of Vulneraries in Parkinson's Herbal.  
The most common Simples with us in England are Comfry, Bugle, Ladies-mantle, Agrimony, Sanicle, Pauls-betony, Fluellen, Perwinkle, Mugwort, Plantain, Horse-tail, Adders-tongue, Avens, Cinquefoil, Wild-tansie, Vervine, Ground-ivy, Goldenrod, Herb-trinity, Centory, St. Johns-wort, Snake-weed, Knotgrass, Mouse-ear, Yarrow, Scordium, Strawberrie-leaves and roots, tormentil Bistort, Valerian, Read roses, etc. Some of these are made choice of to be boiled in Water, or White wine, with an addition of Honey: of which sort you have sufficient examples in the Decoctum traumaticum of the Pharmacop. Lond. Their principal use is in Wounds of the Thorax and Abdomen: yet they are frequently prescribed in all great Wounds. Sometimes also, if the Disease run out to a length, we add Guaiacum, Sarsa, and scorbutical Medicines. There are likewise Powders made of Crab's-eyes, Coral, Nutmeg, etc. and Electuaries of some of the foresaid Roots and Herbs beaten up with these Powders.  
The Particular Regiment is, 
2. Particular.  in preserving the natural Heat and Tone of the Parts, without which we can hope for no Union. For the better understanding hereof, I must put you in mind, that there is not any Part of our body admits of a Solution of continuity without Pain. Every Scratch in the Skin, and little Cut in the Finger, is painful: much more are the deeper Wounds in the Flesh. This Pain stirs up a Heat fermenting in the serous part of the Blood, which readily makes way to the Wound, and, if not timely prevented, distendeth and raiseth the Part into a Tumour with Inflammation. If this happens in a full Body, or one of an ill Habit, where the Blood is serous, and more apt to ferment, the mischief is the greater. And if the Wound be in a declining Part, as the Legs, the influx of Humours is more abundant; and the Member through its weakness not being able to assimilate, nor yet expel them, is the cause that Crudities do heap upon the lower Parts, and make an Oedematous Tumour.  
To make this more plain, I shall give you one Instance of the many that hap daily. A young Gentleman about 18 years of age, 
A person pricked with a Thorn in his Leg.  of a good Habit of body, one day sporting in the Country with his Gun and Dogs, was pricked with a Thorn on the outside of the Calf of his Leg. He took little notice of it till the Evening, and than dressed it with a little Balsam. The next Morning it was more painful and inflamed, and at length terminated in a Phlegmon. I was than sent for, and found the Tumour large and full of Matter, and in the lower part about the Foot an oedematous Tumour. I opened the Swelling above, and, discharging a quantity of Matter, cured the Patient as is usual in Phlegmons.  
If this person had been treated according to the universal Regiment, by Bleeding and lenient Purgatives, etc. nay, if only after this particular Regiment, in preserving the Temperament of the Part, he had been dressed, as in this case he aught to have been, 
Medicaments proper in the beginning of a Phlegmon.  by Refrigerants and Astringents, to have prevented the influx of Humours, and with a Pledgit of basilicon, to cause Maturation in the festered Scratch, with convenient Bandage over all; it had preserved the Tone of the Part, and cured the Soar without farther trouble.  
To proceed rationally by this Intention in Wounds, your first Application aught to be of such Medicaments as have an agglutinative faculty, as bolus Armois. sang. dracon. thus, aloes, gum. elemi, colophon. terebinth. and apply over them such as are cooling, and of an astringent quality, to resist the influx of Humours, as  dipped in the Juices of the following Plants, fol. plantag. equiseti, millefol. vineae pervinoae, ulmi, or Read wine, or Oxycrate. To which you may add some of these Powders, flor. ros. rub. ballast. nuc. cupress. gallar. far. board. & fabar. & oleum olivar. matur. These simple Medicaments may be proportionably mixed according to the Habit of body and condition of the Wound. In small and superficial Wounds, Nature of her own accord is want to effect the Cure; she seldom requiring more from us, them that the Lips of the Wound be brought close together, and defended from the Fluxion, etc. as aforesaid, and with Bandage so retained. A Pledgit of lineament. Arcei with empl. diapalmae frequently serves the turn. But in greater Wounds that will not so easily be cured, we stitch the Lips together, and sprinkle them with such like Powder: ℞ bol. armen. thuris, sang. dracon. an. part. equal. and apply a Mixture of some of the same Powder with the White of an egg over them, with a Compress pressed out of Oxycrate, and a suitable Bandage over all. This is generally the way: but jest by the adhesion of this emplastic Medicament the Lips of the Wound should be torn or disturbed in taking the Dressing of, I choose rather to apply overe the sprinkled Powders a Pledgit with some of these following sarcotick Unguents: ℞ terebinth. Venet. ℥ iij. gum. elemi ℥ ij. sang. dracon. thuris, mastic. an. ʒ j Misc. & fiat Unguent. S. A. or this; ℞ terebinth. ℥ ij. resin. pin. oliban. colophon. an. ℥ jss. mostich. ℥ j crociʒ j cerae ℥ ij. olei hyperic. q. s. fiat Vnguentum. Over which may be applied any of these following Emplasters, viz. empl. diapalmae, diachaleit. de lithargyr. de bolo, etc. In all Wounds where I design to cure by Agglutination, and would preserve my Stitches, I forbear the use of Fomentations and slabby Medicaments: nor will you have occasion for such Applications, if you proceed rationally, as hath been above said; for Nature will do her part towards the Agglutination of the Wound, if you defend it from the influx of Humours. I always accounting these Wounds near cured, when the Lips are retained close together, and dressed as abovesaid.  
Thus far I have proceeded in the Agglutination of Simple Wounds: 
Of compound Wounds.  I shall now consider of Wounds with loss of Substance made by Bill, Pole-axe, Sword, etc. some cutting twice or thrice in one or near one place, whereby the Wound is large, transverse, yea and obliqne, at the same time, and the Lips contracted various ways, and so the Cure is rendered much more difficult. These kind of Wounds are not so often seen in times of Peace, but in the Wars they are frequent, especially when the Horsemen fall in amongst the Infantry, and cruelly hack them; the poor Soldiers the while sheltering their Heads with their Arms, sometime with the one, than the other, until they be both most cruelly mangled: and yet the Head fareth little the better the while for their Defence, many of them not escaping with less than two or three Wounds through the Scull to the Membranes, and often into the Brain. And if the man fly, and the Enemy pursue, his Hinder parts meet with great Wounds, as over the Thighs, Back, Shoulders, and Neck, Mr. Sanderson, now one of the Surgeons of St. Bartholomew's Hospital, was once with me assisting in the dressing such. At Sterling in Scotland Mr. John Chase, Apothecary to his Majesty, helped me in the like work. One of the Soldiers had such a gash thwart the Nape of his Neck, that it was a wonder to us he lived. His Wound was full of Maggots; and so were those of all the rest that were inflicted on the Hinder parts, they having been some days undressed.  
In order to the Cure of these Wounds, you are in the first place to cleanse them, and than to endeavour the bringing of the Lips together by the Incarnative Suture, making so many Stitches as may retain them together. And if you doubt this way not sufficient, you may than, as in a Hair-lip, pass Needles or Pins through the Lips of the Wound, with little Plates of Lead to secure them from tearing. But if the Wound be so deep as you suspect its incarning in the bottom, you must leave a declining Orifice for the discharge of Matter. If the Wound hath lain long undressed, or were not stitched at the first dressing, and be now so contracted and stubborn that the Lips of it will not be brought near one another; you must than foment them warm with some lenient Decoction ex fol. & rad. althaeae, malvae, viol. sem. hini, etc. or with new Milk; than join them together, as hath been said, and dress them as Wounds so stitched. But if you left a declining Orifice, keep it open by a small Tent dipped in some such Medicament as shall be by and by prescribed, and after Digestion withdraw the Tent, and heal it as such like Wounds. The greater Wounds, which cannot be brought together by Suture, must be digested, and so disposed as that new Flesh may be generated to fill up the Cavity: to which purpose ℞ terebinth. ℥ iij. far. hoard. ʒ vj. thurisʒ j Misc. cum vitell. avi. To this after a day or two may be added mel ros. During which the Humours aught to be diverted from the Wound by the universal Regiment set down of Bleeding, Purging, etc. and by the external application of Refrigerants with good Compress and Bandage, to press the Lips of the Wound together, that it may be the sooner cured. After the Wound is digested, you may deterge with mundif. Paracelsi, or with this of Quercetan's, which is also a good Sarcotick: ℞ fol. plantag. apii, an. Mj. ros. rub. Pij. vini rub. ℥ viij. coq. ad medietat. in colat. dissolve sacchar. rub. ℥ ij. terebinth. ℥ j far. juniper. & orobi, an. ʒ vj. aloes, myrrhae, an. ʒ j decoq. rurfus, & addendo cerae q. s. reduc. ad formam Unguent. or with this Balsam of the Spanish Priest, commonly called ol. Aparici; ℞ ol. olivar. ℥ iij. terebinth. Venet. ℥ viij. frument. integr. ℥ j sem. hyperici ℥ ij. rad. eared. benedict. rad. valerian. an. ℥ j pull. thuris, vernieis, an. ℥ ij. The Seeds and Roots are to be cut and beaten, and infused two days in White-wine: than the Oil and bruised Wheat must be put to it, and so boiled together to the consumption of the Wine; than strain the Liquor hard out, and add the terebinth. thus, etc. giving it two or three walms more, and reserve it for your use. In these larger Wounds, it will be necessary to apply warm Stupes wrung out of Read wine wherein have been infused flor. ros. rubr. ballast. nue. eupress. etc. But those Wounds that are full of Maggots or Worms aught to be washed with a Decoction absinth. card. benedict. rad. gentian. myrrh. aloes, etc. and deterged as abovesaid with Mundificatives: after which you may proceed in the same method of Cure as is before mentioned. As to the time of dressing Wounds, the second dressing aught not to be till the third day, by which time we suppose them somewhat digested: from that time every other day may be sufficient. Galen, speaking of the dressing Ulcers, saith, he dressed them but every third day, though the Matter flowed very much; and but every fourth day in Winter. Indeed the too frequent dressing is hurtful: yet there may be occasion of opening them sooner than by him proposed, for the strengthening of Bandage, or for the preserving of the Stitches by putting on dry Stitches. Also the retention of Matter causeth the Suture to relax, and the Lips of the Wound to open again: therefore that aught to be left to the discretion of the Chirurgeon.  
After the Cavity in the Wound is incarned, you may cicatrize with unguent. desiccat. rubr. aq. calcis, etc. or with the Vitriol or Alume-stone, and dry Lint.  
If the Wound be made by a Fall or Blow with great Contusion, 
Of contused Wounds.  you must endeavour that the bruised Flesh be digested and turned into Matter; to which purpose unguent. basilic. is proper, applied warm upon Lint, or dissolved in ol. lumbric. lini, or such like, anointing the Parts about with ol. ros. & myrtill. cum album. ovor. with which you may also make up a Restrictive, with an addition of bol. Armen, sang. dracon. balanst. flor. ros. rub. and apply it over all. But if the Wound were of some days continuance before you were consulted, you must than foment it with Discutients, and embrocate the contused Parts with ol. cham. sambuc. rutac. etc. and continued the application of Maturatives, proceeding as is set down in the Chapter of Ecchymosis. After separation of the contused Flesh, the loss of Substance must be restored by sarcotics, and the Wound cured as abovesaid; remembering that in these Contusions Venaesection is most necessary. If the Wound be deep, and the Orifice narrow, yet capable of enlarging; it must be laid open proportionably, that the Matter may not be retained, and tender the Wound more hollow. But if the Sinus be of any great length, and so depending that the Matter cannot discharge by the Wound; you may than make a Perforation in the lower part for discharge of it, by Knife or Caustick, or both, first Caustick, than Knife; or by a Seton-needle with a twisted Silk or Thread, as hath been showed in Sinuous Ulcers; and proceed accordingly.  
What I have said of Wounds cut and hacked in heat of Fight by a broad Sword, happeneth sometimes in fight or foining with a Rapier. For if the Thrust be redoubled, an Attrition may be made in the lower part of the Wound: and if there be such an Attrition there, or if some tendonous body be there wounded, it will be too painful to heal by the first Intention; and if it run far, and deep amongst the Muscles, it may be a maiming of the person, or an endangering of his life, to cut such a Wound open from top to bottom. Wherhfore you aught to consider well the manner of the Wound; and if it penetrate so deep, and be not capable of being laid open by reason of the thickness of it, make a search with a Probe to the bottom, and feel how far distant it is there from the Skin: and if it do not lie far of, nor under any considerable Vessel, the speediest way of curing the Wound will be by passing in a Director, and cutting it open. Which done, keep it open, and permit the upper part to agglutinate. But if you think it not fit to open, yet mark the place, that in case there be a necessity of doing it afterwards, you may make the Apertion more certainly. That done, dress the Wound with a proportionable short Tent armed with a Digestive ex terebinth. cum vitell. ovi; and embrocate the Parts about with ol. ros. myrtill. & aceto; over which apply empl. è bolo, or such like and afterwards proceed as aforesaid. For your farther information and more caution, I shall give you one Instance of the ill effects of cutting open such Wounds the whole length.  
Some years since a young Gentleman was wounded in a Duel; 
Of a double wound by Puncture.  the Rapier entered into his right Side slanting by his short Ribs under the Muscles, reaching within a finger's breadth of the Spine, with a redoubled Thrust. He was carried to a French Surgeon's house, and dressed by him. The third day after I was fetched, and saw the Wound inflamed and undigested, likewise the Orifice over-stretcht by the extraordinary bulk of the Tent. I advised the dressing it with one lesser, and armed with a Digestive, also Embrocations, etc. as abovesaid. But it was in vain. This Pretender dressed the Wound with a Tent proportionable to the former, anointed with some Unguent wherein was sang. dracon. binding a Stupe over it. By this way of dressing the pain and inflammation increasing, I was fetched again two days after, and than made a search; and feeling my Probe penetrating obliquely down deep amongst the Muscles, within a finger's breadth of the Spine, (as abovesaid,) I concluded it best to make an Opening there. Accordingly I used a mild Caustick, than dressed up the Wound with a lesle Tent, spreading it with a Digestive ex terebinth. etc. embrocating it come ol. ros. etc. and soon after applied an anodyne Cataplasm, and so left the Patient to rest. But in the night, he turning in his bed, the Cataplasm slid of, and our Monsieur discovered a discolouring in the Part, and supposing it an approach of a Gangrene, I was fetched out of my bed. Upon sight of it, I found it only stained with the Saffron and Lupins which were in the Cataplasm, and applied it again, leaving the Patient better satisfied. But the next morning I met another Chirurgeon of the forementioned Monsieur's acquaintance. We took of Dress, and saw the Wound digesting. I proposed the dividing the Escar below, to give vent that way to the Matter; but they were positive for the cutting open the Wound thwart all the Muscles, the length of between 5 or 6 inches. To which purpose Sponges were pressed out of Melilot Emplaster, and the Wound filled with them. The next day this latter Operator laid the Wound open with a pair of Scissors so far as his Sponges had dilated it, and dressed it up his way. The morning following the Wound appeared dry, and the Parts about inflamed and swelled very much, and continued exceeding painful to the third day. Than they, being at a loss, were contented to divide the Escar; upon which there discharged a quantity of Matter made by Apostemation in that part: yet notwithstanding they would not enlarge that Opening, but began where they ended, and cut open the Wound to the Aperture made by the Caustick, and dressed it up as formerly. Thus they having increased the pain, the Fluxion also increased, and a great quantity of Matter discharged from the lower part, also a large Sinus discovered itself stretching over the Spine to the other Side. In order to the curing of this, they designed Injections; which I endeavoured to dissuade them from: but they persisting in the use of them, I protested against their proceeding, and left them. They laughed at me: but about the ninth day after the Patient died, and made good my prediction. For, alas! what else could be expected from such a Division of parts, and casting in Injections, but to tender it more sinuous from Side to Side? whereas possibly by Digestion and good Compression it might haply have healed.  
The Fifth Intention is, in preventing of evil Accidents, 
The fifth Intention, inpreventing ill Accidents. Of Haemorrhagia, or Bleeding.  and correcting such as are already fallen upon the Part. And these are Haemorrhagia, Pain, Fever, Intemperies, Convulsions, Syncope, Delirium, and Palsy.  
We shall begin with Haemorrhagia, as being incident to all Wounds more or lesle, and sometimes the cause of all other Accidents; wherefore I have treated purposely of the Wounds of Veins and Arteries in a Chapter by itself; so intent here only to speak of it as it is made by some Authors the second Intention. The way to stop the Bleeding as it is common in all Wounds, is, by bringing the Lips of the Wound close together by Suture, and by applying such Medicaments to them as have a drying and agglutinative faculty; as Galen's Powder of Aloes Pj. thuris Pij. and Hares-furre mixed with the White of an egg, applied upon a Pledgit, also a Plaster of the same Restrictives, with Compress and Bandage. But if the Wound be such that you cannot bring the Lips of it together, apply the aforesaid Powder upon Dossills' on the bleeding Vessels, and your Astringents next, with Compress and Bandage over all: than place the Member in such a position as may be for the ease of the Patient.  
You aught to be speedy in the mitigating Pain, 
Of Pain.  for that nothing disspiriteth your Patient more, nor maketh more disturbance in Wounds, the Humours flowing abundantly to the pained Part, whence ensueth great Inflammation and Tumour. Wherhfore you must hasten to secure it by Anodynes; amongst which Phlebotomy is proposed by Authors in the first place, for that it maketh evacuation and derivation of the serous Humour which causeth the grievance. The external Applications proper to ease Pain are, fol. & rad. althaeae, malvae, viol. hyoscyami, thaps. barbat. flor. ros. cham. melilot. sem. lini, foenugraec. cydonior. psyllii, papaver. alb. etc. which may serve for Fomentations and Cataplasms, being boiled in the Broth of a Sheep's head and feet, or new Milk. In the beginning of the Pain a Cataplasm may be applied of far. hoard. fabar. flor. ros. rubr. sambuci, decocted in Read wine or Oxycrate, with an addition of ol. ros. etc. If the Parts be already inflamed, take fol. hyoscyami boiled in Milk, with White-bread crumbs, a newlaid Egg, a little Saffron and ol. ros. and make them into a Cataplasm. For more variety, I refer you to the Chapter of a Phlegmon, in tumors. If after this it tend to Suppuration, you may proceed as in a Phlegmon. If it yield to none of these, you may truly conjecture some Nerve is offended: than proceed as is said in the Wounds of the Nerves. But if Pain be caused by Matter that wants a passage out, give it one by Knife or Caustick.  
If some hot Distemper from Choler offends the Part, 
Of distemper by Choler.  which may be perceived by what hath been said of an Erysipelas, than these Unguents, nutritum, alb. camph. refrigerans Galeni, populeon, are proper; or this following: ℞ succi plantag. solani, semperviv. an. ℥ j bol. Armen. ℥ ss. lithargyr. loti, aq. plantag. & tutiae praeparatae, an. ℥ j ol. ros. omphac. & nymph. an. ℥ ij. aceti rosacei & cerae tantillum; fiat Vnguentum. If the Distemper be oedematous, than Fomentations wherein flor. cham. aneth. meliloti, sem. foenug. and such like have been boiled, may, with good Bandage, serve your purpose.  
Fever accompanies great Wounds; 
Of Fever.  especially where there is Inflammation, it is almost inseparable; therefore you are the less to trouble yourself thereat. But if it continues after the Pain and Inflammation is removed, and hath Delirium or Syncope with it, there is great cause to doubt the welfare of your Patient: therefore hasten Revulsion by Venaesection or Vesicatories, also use Clysters and lenient Purgatives, to loosen the body; and prescribe Juleps, Emulsions, Epithems, which, by refrigerating and contemperating the heat, may relieve the Patient. The other Symptoms of Gangrene, Convulsions and Palsies, are translated to the Discourse of Gun-shot Wounds.   

CHAP. II. Of Wounds of the Veins and Arteries.  
THE next thing that offers itself to our consideration is, the Wounds of particular Parts; and first of the Veins and Arteries, which are subject to great effusion of blood, therefore require your speedy help. You may distinguish whether the blood be from an Artery or a Vein, by the flowing of it, and by its colour.  
From the Artery the blood rushes impertuously and per saltum, 
Signs of the Artery wounded. Of the Vein wounded.  by reason of the dilatation and constriction of the Heart, and is of a florid colour. The Venall blood flows with a more smooth and even stream; it is of a grosser consistence, and of a darkish colour.  
Of these latter Wounds there is no great danger; 
Prognostic of Vein, and Cure. Prognostic of Artery,  Galen's Powder with the White of an egg, and the formerly proposed way of dressing, will stay their bleeding, and cure the Wound in few days. But those of the Arteries are most difficultly stopped, for that the blood is in a most vigorous and strong motion.  
If these Wounds be not with loss of Substance or bruised Lips, 
and Cure. Suture.  you may bring the Lips and Mouths of the Arteries both together, and retain them by Suture, passing your Needle with a strong waxed Thread through both of them, making the Glover's stitch, which Guido calls Suppressio. Than apply such like Emplastic as this; ℞ bol. Armen. ℥ iij. sang. dracon. thuris, aloes, glutin. sicc. an. ℥ j gypsi, farin. volatilis, an. ʒss. hypocistid. acatiae, sumach, an. ℥ iij. Misc. cum album. ov. to the consistence of Honey, and apply over it a Compress squeezed out of Oxycrate or Read wine; 
Rowler.  than roll up the Member with the agglutinative Rowler, beginning on the opposite part, bringing both the heads over the Wound: and having taken a turn or two there, roll upwards and downwards, so as to press the blood upward, and restrain the Influx from above. Your Bandage must be so made, that it be to the ease of the Patient: the Position aught also to be such as may prevent Pain. 
Ordering the Part, and Diet.  He must keep cool and quiet, and observe a slender Diet. His Drink aught also to be cooling and astringent; as Fountain-water with sal prunell. or acetum, or with gads of Steel quenched in it, and sweetened with Syrup of Coral, Pomegranates, Lemons, etc. or this following Draught of Quercetan's, ℞ croci Martis, essentiae corallor. an. ℈ j syr. de ros. sicc. & myrtill. an. ℥ j aq. papaver. rhoead. ℥ iiij. Misc. so also a decoct. hoard. cum sem. papav. alb. & hyoscyam. with an addition of Rose-water, and Sugar of Roses, to sweeten it; also a grain or two of laudanum in case of extremity, if the Patient bears it well. You may also let the Patiented blood, 
Bleeding where.  by opening a Vein on the contrary part, if his strength will permit it, taking a little at a time only for Revulsion. You may use also Cupping, Friction, and Binding the remote Parts, for Derivation.  
In Wound of the Artery, dress not oftener than you needs must; once in five or six days may be sufficient, whilst there is danger of Bleeding. But if you found the blood hath made its way through all the Dress, and the Bleeding continues, take them of: and if you discover the Stitches broken, and the Lips of the Wound incapable of being stitched again; consider whether the bleeding Artery may not be taken up and tied: if it may, do so. The way of doing it you may see in the Chapter of Aneurisma, and in one of the following Observations. Than proceed in the Cure by sarcotics, etc. But if the Artery lieth so deep that you cannot possibly come to make Deligation on it, proceed by application of Escaroticks to the Vessel, or by an actual Cautery.  
If by Escaroticks, than you aught to cleanse the Wound of the clotted blood, 
Escaroticks.  and dip your Dossills' in some such like Powder; ℞ thur. pulv. ℥ ij. aloes, glutinis sicc. an. ℥ j chalcanth. ust. ℥ ij. arseniciʒ vj. gypsi ℥ iij. Apply these with Lint on the bleeding Artery, and over it Dossills' of Lint dipped in album. ovi cum pulv. Galeni, and dress up the Wound as aforesaid. At your next dressing, leave the Escarotick sticking on the Artery, and incarn as fast as you can. For want of the abovesaid Powders, take Vitriol powdered and tied in a fine Rag, and apply it to the Artery with convenient Dress over it, as before-said.  
But if after these your Endeavours the Artery yet continued to bleed, 
Cautery.  you must use the actual Cautery; by which the Vessel will shrink up at both ends. You may convey the Cautery down to the Artery through a Cannula: and that the Cautery may not burn through it, you may cover the outside with a Plaster or Rag wet with the White of an egg, etc. That done, dress the cauterised part with Dossills' dipped in Mucilage of Quince-seeds, or with the White of an egg, and embrocate the Parts about cum ol. ros. applying emplastr. diachalcit. cum succis plantag. etc. over all. After you have allayed the heat of the Part, digest, incarn, and cicatrize the Wound as followeth.  
A Gentleman of about 35 years of age was wounded with a Rapier on the right side of the Aspera arteria into the internal Jugular, 
1. Observat. of a wound of the internal Jugular.  through his Neck, it passing out below the last Vertebra. The Wound was small, yet bled with a full stream. A Servant stopped it with his fingers, whilst I made Dress ready of our common astringent Powders, with the White of an egg and a little acetum, spread upon a Pledgit of Lint, and an Emplaster of the same, with Compress and such Bandage as it would bear. The Wound behind bled when that before was dressed. I applied the said Medicaments to that, and caused them to be held close till they were dried on. Than we put him to bed, and kept him cool and quiet. I used all my endeavours for the contemperating his blood, as is usual in such cases, and dressed him but once in four or five days, unless I were necessitated by the bursting forth of the blood: yet he bled at times about 16 or 17 days. His Wound by the Vertebra of the Neck healed in few days; and the other near the Aspera arteria was cured by this way of Agglutination the 19 or 20. day.  
A Man wounded in the Artery under the right Eye was immediately dressed by Mr. Faucet Chirurgeon; 
2. Observat. of an Artery wounded.  but the next day in the afternoon the blood burst out impetuously. The Wound had been made by the corner of a Trencher, and was not so big as a Silver-peny. I dressed it with pulv. Galeni, and applied a Plaster over it made up with my common restrictive Powders cum album. ovi, with good Compress and Bandage. The next day his Wound bled again, and upon stopping thereof with my finger, the blood was observed to beaten all along the Artery, from the Aperture to the Temporal Muscle, with a greater force than is commonly seen in an Aneurisma. I pierced through both the Lips and Artery with a curved Needle, and by Deligation restrained the bleeding, than dressed it up with Emplasticks as before, concluding I should have very little more trouble from that Wound. But 2 or 3 days after it burst out again, and in my absence some other Chirurgeon was called in and dressed it. Afterwards, at another bleeding, Mr. Faucet dressed him, and at another time Mr. Arris. The Wound being thus enlarged with the crowding in of Dossills', and lying in a very inconvenient place for Bandage, it bled often, and was dressed by such Surgeons as they could meet with in their necessity. By the frequent application of Escaroticks to stop the bleeding, his Eye was so much inflamed and corroded, that it was verily believed by us, that if he did recover of his Wound, yet that Eye would be lost. But his continual bleeding thus many days had so exhausted his Spirits, that there was small hopes of his surviving it. At the last bursting out of this Vessel, Mr. Ed. Molins deceased, Mr. Faucet and myself met together at his Chamber. We found him lying as dead with his Hand out of the Bed upon his Breast. We endeavoured to feel his Pulse, but it not beating, we concluded him dead, and took the Dress hastily of the Wound. It did not bleed, though it was open. We supposed the blood exhausted. The Artery lay in the Wound torn by the Escaroticks. We took up the ends of it, and tied them, dressing the Wound with lineament. Arcei and a Plaster over it, not believing that the man would ever recover. But from that time the Bleeding of the Wound ceased, and it daily incarned by very common Remedies and was soon healed, to my admiration. He was in lesle than a month perfectly cured both of his Wound and Eye. This Patient had been subject to the like Bleeding formerly upon very small Wounds.  
A Butcher living at Westminster was wounded in the Artery between the Thumb and Forefinger. 
3. Observat. of an Artery wounded.  After he had been dressed 3 or 4 days by some of his neighbouring Surgeons, the Wound continuing to bleed, he came to me late one night with Dossills' crowded in it. I threw them out, and with a Needle and Thread stitched up the Artery, and the Wound with it; than sprinkling some of my agglutinative Powders upon the Suture, I dressed it up with a restrictive Plaster and Bandage, as in the former Wounds is said: and in three or four times dressing he was cured. But afterwards there appearing some Pulsation extraordinary under the Cicatrix, which proceeded from the too lax Incarnation of the Wound, I dressed him with a Pledgit dipped in a dulcified Tincture of Vitriol, with good Compress and Bandage. At the next dressing it was dried and shriveled, so that there was no more Pulsation to be observed.  
One in the New Exchange had an Aneurisma in the Palm of his hand reaching to the third and fourth Fingers, which at last broke out, 
4. Observat. of an Aneurisma broken open.  and bled at times the space of 8 or 10 days. I dressed him with the Tincture of Vitriol abovesaid once in 4 or 5 days, stopped the Bleeding, and cicatrized it firmly, so that there appeared not the lest Pulsation under it.  
A sedentary young Gentleman, of an ill Habit of body, 
5. Observat. of a wound of the Sural Artery.  was wounded by a Penknife in the inside of the Calf of his leg into the sural Artery. A Chirurgeon dressed up the Wound with Dossills' dipped in escaroticall Powders, chalcanthum ustum, etc. with Plaster and Bandage, by which he stopped the Bleeding. The next day I was consulted, and being informed of the Wound, and the manner of dressing, I deferred the Opening it, and advised him to keep his Bed. He did so, but complained than of a throbbing pain in his Wound, and was very apprehensive of its bleeding, looking himself often upon the Bandage, and alarmed me by frequent messages. The third morning I met his Chirurgeon there, and looking upon his Leg, found the Bandage all bloody. We took of the Dress, and saw the blood fresh in the Rulers; but in taking of the Plaster, the Dossills' came out only fouled with a bloody Sanies, as is usual in like Wounds after the filling them with such Powders. The Wound and Parts about were inflamed and swelled; yet I had much ado to dissuade the young Chirurgeon from dressing it again with Escaroticks, though he saw the Accidents arising thereby. But at last I prevailed, and dressed the Wound with a Dossill spread with the common Digestive ex terebinth. cum vitell. ovi sprinkled with pulv. Galeni, embrocating the Parts about with ol. ros. cum aceto, and applying emplast. è bolo over all with good Bandage. By this way of dressing he was eased, and the Wound at liberty to discharge the Sloughs and Sanies which were made, and choked in by the former dressing. If it did not thus digest, yet I concluded that at the next dressing it would be in our power to lay open the Wound, and divide the Artery, without hurting the Nervous or Tendonous bodies near it. But the next day I found the Patiented unsatisfied how his Wound could cure so dressed, without a Tent, and often murmuring that it would rankle; yet he continued pretty easy, and did not bleed during those three days. The fourth day at the opening we found no Blood but what was mixed with Matter, the Wound also looked well; yet I complied with the Patient, and put in a short Tent spread with the Digestive as before. The third day after we opened it, and saw upon the Dressing some fresh Blood followed by a thick white Matter, as from a Phlegmon. It proceeded from an Apostemation made by the Escaroticks. The Wound thus digesting, I left of the use of the Tent, and dressed it with a Dossill, and by good Embrocations, Compress and Bandage endeavoured the pressing out of the Matter: which accordingly lessened each dressing, but was not well digested, nor free from some small tincture of Blood. But this proceeded from his ill Habit of body, he being highly scorbutical, and subject to Fainting, loss of Appetite, and pituitous Swell on his Feet. Upon which account Doctor W. was confulted, and somewhat relieved him. After his Wound was cured, I caused a straight pair of Stockings to be laced on both Legs, to restrain the Swelling, and prevailed with him to rise daily: and after he was able to walk, he retired into the Country, but hath not yet got of the Disease he heightened by keeping within doors with this little Wound. Doubtless this Cure had been speedier, if immediately at the first dressing his Leg had been bound up with Agglutinatives, and the whole committed to Nature.  
A poor fellow living in the Country was accidentally in letting blood pricked in an Artery. 
6. Observat. of an Artery pricked in letting blood.  The Arm swelling and growing painful, he put himself into another Barber-surgeon's hands, who by unfit Applications rarefied the Tumour, and made way to the Extravasation of the blood; which increasing the Tumour, and rendering it soft, was supposed by the Barber to be a Suppuration of Matter. He accordingly opened it by Knife or Lancet: at which an impetuous Flux of blood burst forth, to the quantity of 4 flagons, (as they told me.) They made a shift to stop it: but the Bandage being made too hard and unequal, the Arm swollen, and inclined to gangrene. While this poor man lay thus afflicted, we his Majesty's and Royal Highness' Surgeons, attending the Court, visited him, and prepared for the taking up this Artery, or, in case of failing, to cut of his Arm. The Patient being taken our of his Bed, and placed in a Chair towards the light, we took of the Dress, and I viewed the Arm: where finding no Gangrene, according to the report of the Chirurgeon, but rather an Ecchymosis, we made a Bandage above the Wound, to prohibit the Influx of blood. One of the Surgeons making a gripe thereon, we made an Incision into the Tumour on the inside of his Arm, according to the length of it, over the Artery; and after we had pulled out the coagulated blood, and laid the Vessel bore, we passed a Needle with a Ligature under the Artery, and tied it, than cut of the ends of it, and loosened the Bandage above: and seeing it bleed not more, we dressed it up with Pledgits dipped in the common Digestive ex terebinth. cum vitell. ovi, applying them with pulv. Galeni next the Artery, and lightly filled up the Wound with Pledgits of the Digestive dipped in ol. ros. warm; than embrocated the Arm with some of the same Oil, and laid a diachalcit. Plaster over the Wound and Parts about, also applied empl. Paracelsi and diachalcit. over the Hand and Arm, which were oedematous. Than with Bandage we began at the Hand, and rolled up to the Wound, taking a turn or two over it, and so rolled up to the Axilla. He being returned again to his Bed, we placed his Hand upon his Breast, and felt his Pulse beaten strongly in that Wrist. At the next dressing we found the Tumour dispersed, the Wound fresh, and tolerably digested. We than passed another Ligature upon the Artery above the first, and in pulling the first to divide the Artery between the Ligatures, the Artery broke; which was as well. We dressed it up as before we had done, only leaving out the Powders. At the next Opening, finding the Wound in a very good condition, the Lips of it being digested and contracted, we dressed it up with mundif. Paracelsi, etc. Than seeing it in a hopeful way of Cure, I returned to London, leaving the Patient to my Fellows, who dressed it successfully the space of 10 days without any appearance of blood. In some of their absence the Barber-surgeon dressed the Patient. Whether it was in wiping of the Knot, or crowding in Dossills', but it burst out again: yet the Artery being divided, it soon stopped by the application of Colcothar, and from that time it bled not more. The ancient way of Deligation is, as I have already said, by tying it in two distinct places, and cutting the Artery of between: but the Patient's often fainting interrupted us in that work. And truly in this case, where a Barber was to be entrusted with the Cure, it had been better that the Artery had not been divided; for than it would not have been in his power to have rubbed of the Ligature, and before the Wound could have been ready to cicatrize, the Ligature would have fallen of of itself, without danger of bleeding.   

CHAP. III. Of Wounds of the Nerves, Tendons and Ligaments.  
NErves may be many ways wounded, viz. by Scission, or Puncture. 
Wounds of the Nerves and Tendons.  The former way they are usually cut through, and than occasion no new consideration in Chirurgery, because they wholly cease from action, and are irrecoverable: but when pricked by a sharppointed Weapon, which kind of Wound is called a Puncture, they are much to be regarded. So also Tendons: not the small Fibres of them, (which are in every Wound of the Fleshy parts,) but the main body of them, which usually make up either the tail or head of a Muscle. If you would know whether these are wounded or not, consider the place wounded, viz. whether near the Joint in the inside of the Arm or Leg, or the end of the Muscle, or in the Tendonous parts of the Hand and Foot.  
The Symptoms are, 
Signs.  great Pain and Inflammation, also a contraction and hardness in the Nerve or Tendon. But if the Nerve be quite divided, the pain is little, only a kind of Stupor or numbedness. According as the Nerve is more or less considerable, so also the particular Part is lame more or less.  
The most frequent Wounds of Nerves, 
Ill consequences of bleeding not always from a prick of a Nerve or Tendon.  and most to be taken care of in Chirurgery, being Punctures, I shall instance in them, and choose the most common, viz. those which are made accidentally by letting blood. And here by the way you must take notice, that, in letting blood, sometimes the Apertion happens to be made, when the Skin, by reason of the Bandage, or Position of the Arm, lies equal with the Vein, yet afterwards is not so; or the Apertion is made too small in the Skin, so that part of the blood is choked in, and lies there extravasated, whence a small Phlegmon ariseth: or it may hap in some that are well let blood, that yet through the indisposition or ill Habit of body, the Part pricked festers, (as they usually say,) and groweth soar a day or two after, and, if neglected, may raise a Tumour, which lying upon the Nerve or Tendon, may at that time contract the Arm. If a Boil in a Fleshy part be painful, than much more these in the Joints amongst the Nerves and Tendons. Such Accidents have and will hap to all that let blood, whether Physicians or Surgeons: which is the reason that some of our old experienced Surgeons did, after letting blood, always apply a Pledgit of basilicon upon the Aperture, with emplastr. diachalcith. over it, which by its digestive quality secured it from corrupting. But we by a contrary way, as by a little Compress dipped in Water, endeavour to restrain the flowing of the hot Serum to the Aperture; and we should be laughed at if we continued that old method of Dressing. At the time we let people blood, they are commonly labouring under some great Fermentation, or apprehended it so: no wonder than if it sometimes fall upon the Part, where it was invited by Bandage. I have been sent for into the Country to a person, that, after a letting blood, was seized with an Erysipelas or bilious Inflammation the whole length of the Arm. The Aperture in the Vein might possibly be the cause; but that place was not afflicted at all. Dr. Ringall complained once of a Chirurgeon, who was so unconscionable, as he said, to ask five pounds for curing an Arm he had made soar by his letting blood. But I hope no person is so ignorant or malicious, to impute such Accidents to a Puncture of the Nerve or Tendon.  
For when they are really pricked, their Symptoms (as you may read in all those that have writ of them) are sudden, with vehement Pain, Faintings, Convulsions, and attended with great Defluxions. They do not terminate presently in Suppuration, but gleet, and will not yield to a simple anodyne Cataplasm of White-bread and Milk.  
All Wounds of the Nerves and Tendons are dangerous, 
Prognostic.  but more or less according as they are of use. Those of the Nerves are attended with the severest Symptoms, and seize the Patient more suddenly. But whether it be Nerve or Tendon, the transverse Wound is most dangerous, and difficult of Cure.  
In order to their Cure, 
Cure.  there are other considerations required; and in the first place, whether the Nerve or Tendon lie open in view, or under coverture of the Skin. If they lie covered under the Skin or Membrana adiposa, than you aught to open the Skin, that the Medicaments may penetrate to the wounded Nerve or Tendon. Your Medicaments proper in these Grievances aught to be such as are of hot, dry and subtle parts, to consume that Ichorous water which first affects them, and causeth the Putrefaction. In the beginning use ol. ros. with a little Bay-salt dissolved and dropped into the Part scalding hot; upon which may be applied a Pledgit spread with basilicon dipped in the same Oil, and the Part embrocated about cum ol. lumbric. and emplast. è bolo over it as a Defensative. But if the Inflammation and Tumour be great, apply this Cataplasm: ℞ farinae hoard. & fabar. an. ℥ iiij. sem. lini & foenugraeci pulv. an. ℥ j flor. ros. rub. flor. cham. sambuci, & summit. absinth. an. ʒ iij. boil these in Wine, or in the common Lixivium, adding oxymell. ℥ iij. ol. ros. ℥ j Misc. so roll up the Part gently. If there be much pain, dress it twice aday. If the Part requires Medicaments of more drying and subtle parts, dress with balsam. sulphuris terebinth. or else, ℞ ol. sabinae & terebinth. an. ʒij. Misc. or oleum costinum, rutae, sabinae, aneth. scorpion. etc. These are all proper Medicaments to dress them with; but ol. ros. and Salt have always served my purpose.  
In your application of Medicaments you must consider what degree of heat and siccity is proper for the offended Nerve or Tendon. 
Caution.  If in your use of these Medicaments your Patient feels not the heat of them, or feels it vehemently, they are not than rightly fitted: for in the former case they do not enough dry that Sanies; in the latter they do inflame the Part. If the Patient feel the heat moderately, the Medicine is good: but if from the use of the Medicine the Part itch and smart, and the Aperture made by Puncture gape, than the Medicament is stronger than it should be. If the hardness go of with the contraction, and the Lips of the Wound relax, 'tis a good fign. I shall give you one Observation for the farther confirmation.  
A young Chirurgeon having accidentally pricked a Tendon in letting a Maid blood in the Saphena near the Ankle, he dressed it up with ol. terebinth. hot. 
Observat. of a Tendon pricked.  Her pain increasing, I was consulted, and saw the Chirurgeon ready to apply his hot Oils: but upon sight of the Wound, the Lips being turgid and dry, also the Parts about inflamed, I shown him his error, and prevailed with him to dress it with unguent. basilic. warm, and to embrocate cum ol. ros. also to apply empl. diapalm. malaxed with some of the same Oil, and to forbear dressing it 2 or 3 days: during which she was cured. The overusing hot Oils hath been in these cases very mischievous to many.  
If they yield not to Cure by such Medicaments as have been proposed, than you aught to divide them, to prevent worse Accidents, viz. Convulsions, Spasma's, Gangrene, etc. After which they cure as other Wounds; only require more care in the position, and keeping the Member steady, if it be in such a Joint where there are Nerves and Tendons that move contrary wise.  
The Ligaments require much one method with the Tendons; 
Cure of Ligaments wounded the same with Tendons. 1. Observat. of a wound in the inside of the Wrist.  only your Medicaments are here to be more drying, as euphorbium, sulphur viv. calx lota, tutia, etc.  
A Youth about ten years of age, one day in the Sessions-yard leaning over the spiked Pales to see the Malefactors, was suddenly frighted down by the Marshall's men: in his falling he was catcht by one of those Spikes in the middle of his Wrist, it passing between the Bone and Tendons: he hung thereby till he was taken down. They carried him home, and fetched me. I found the Tendons stretched out to a great length, some of them broken and torn in pieces, and one of the Bones of the Carpus lying lose in the Wound; which I took out, and cleansing the Wound, placed the shattered and over-stretcht Tendons within it, and made my first Stitch in the middle, bringing the Lips as close together as I could. Than I made two Stitches more, on each side one, dressing him up with a Digestive ex terebinth. etc. dipped in this following Balsam; ℞ terebinth. lbij. lbij. olei olivar. lb iij. ol. laurini ℥ iiij. cinnamom. ℥ iij. euphorbii, garyophyll. baccar. juniper. an. ℥ j gumm. hederae, sagapeni, ammoniaci, opopanacis, galbani, an. ℥ jss. myrrhae, mastic. colophoniae pulv. an. ʒ iij. distillentur pro usu. Over this I applied empl. è bolo, with a Compress dipped in Oxycrate, and so rolled up the Member. Some hours after I let him blood, and gave him that night a Draught of aq. paralyseos with syr. de meconio & aq. cardiac. cochl. iij. He rested ill that night, and in the morning was full of pain. I took of the Bandage, and bathed the affected Member with decoct. rad. althaeae, malvar. violar. cham. verbasc. byoscyam. and applied a Cataplasm over the Dress of farin. hoard. fabar. flor. ros. rub. balanst. decocted in Oxymel, with the addition of ol. lumbric. & rosar. The next day his pain was much mitigated, the Tendons all drawn up, and the Stitches lose. I thought to have drawn the Lips close, but found them too painful to admit of it; therefore I cut the Stitches out, and brought them as close as they easily would come, dressing up the Wound as before. After some few days, the Wound being tolerably digested, I dressed it with Unguent dipped in the former Balsam, and applied over the Wound empl. diasulphuris Rulandii, with Bandage and Compress as before. ℞ terebinth. resinae pin. ol. hyperici, an. ℥ iiij. sarcocollae, myrrhae, thuris, an. ʒ iij. cerae q. s. fiat Vnguentum S. A. Thus I happily deterged and incarned, and by unguent. tutiae and my ordinary Epuloticks cicatrized the Wound; and some while after he recovered the use of his Hand.  
A Coachman was wounded transverse the back of his Wrist, 
2. Observat. of a wound on the inside of the Wrist into the joint.  deep into the Joint, so that his Hand doubled inward. I caused a Ferula to be placed under his Hand to support it; than searching the Wound, pulled out many fragments of Bones: and having cleansed it, I brought the Lips together by three distinct Stitches, leaving a vent for Matter in the ends of the Wound, which were both depending. Than I sprinkled the Powders of Myrrh, Aloes, Thus, etc. upon the Suture, and applied a Digestive ex terebinth. cum vitello ovi on the rest of the Wound, with a Defensative over all, and rolled it up. Than I let him blood, and prescribed him ʒuj. syr. de meconio in a draught of Mace-ale for his Supper, with hopes to dispose him to rest. But he slept little that night. The second day after I took of Dress, and fomented the Wound and Parts about with an emollient Decoction, as in the former Chapter, and dressed up his Wound with Digestives as before, embrocating the Parts about with ol. lumbric. and applying empl. è bolo over the Wound and adjacent Parts. It digested in the declining ends a little, but continued painful, especially in the Fingers. The third day after, dressing him again, and seeing the Wound digested, I took out the Stitches, and dressed the Wound with my Digestive of terebinth. dipped in my formerly mentioned Balsam, applying a Cataplasm warm over all the Wound and Hand, as in the former Observation hath been set down; than rolled up the Member again. At the next dressing there appeared more Inflammation; yet the Wound was not altogether well digested, nor did the stitched Lips seem to incarn, but thrust forth a soft white Flesh: wherefore I cut the Stitches, and digested with Merc. praecipitat. and laid Pledgits spread with mundif. ex apio, with a Cataplasm as before over all. Thus I deterged, and afterwards incarned with the common Sarcotick, and with calx lota cicatrized it. Than I put on a Catagmatick Emplaster, and by the use of a laced Glove scattered the pituitous Swelling, and strengthened it. Yet it continued long painful, and so extremely weak, that he was necessitated to support it a long time by wearing the Ferula. Since the writing of this, I am informed he continues in the same Service; his Wrist is stiff, but serves him to drive his Coach. 
3. Observat. of a Finger bitten of by a horse.   
A Gentleman aged 54 years, of an ill Habit of body, passing in the Street by a Coach, one of the Horses snapped of the end of his Finger with the Glove. I dressed the Stump with the common Digestive dipped in a little ol. ros. warm, and with emplast. diachalcith. malaxed with a little of the same Oil, and rolled up the Stump. This Patient kept not his house with this little hurt, but came to me to be dressed once in two or three days, or dressed himself; he not thinking it worth the observation of Diet, Bleeding, or the like. One day he came to me complaining that his Finger would not heal. I looked upon it, and seeing an undigested crude Ichor dropping from it, and the Parts about blistered, I scarified them, and dabbled the Wound with ol. terebinth. warm, strewing Merc. praecipitat. over all, and dressing it up with Pledgits dipped in basilic. etc. than rolling it up with empl. diachalcith. That night I went to his Lodging with a Fomentation and other Medicaments prepared for a Mortification, but found it checked; so I continued the application of unguent. basilic. and ol. terebinth. and afterwards let him blood, and purged him with infus. senae, etc. After the Wound was well digested, I incarned and cicatrized the Stump by such Medicaments as in the former Observation have been set down. Thus sometimes great mischiefs attend little Wounds, through the contempt some of our Patients have of them.   

CHAP. IU. Of Wounds of the Face.  
A Lady was wounded down the whole length of the Forehead to the Nose, 
1. Observat. of wounds in the Forehead and Eyebrow.  also transverse the left Eyebrow to the Temporal Muscle; her Eye and Face were also much bruised. It happened to her travelling in a Hackney-Coach, upon the jetting whereof she was thrown out of the hinder Seat against a Bar of Iron in the forepart of the Coach. At the first sight of the Wound in her Forehead, seeing the Bone bore and herself so disturbed, I doubted whether I should stitch it, or keep it open with Dossills': but seeing no Fissure or inequality in the Bone, and considering the Deformity in that place would be great, I brought the Lips of the Wound close together with one Stitch, and dressed it with sarcotics, resolving, if any Symptom prognosticated ill, to cut the Stitch, and lay it open again; but if there were none, than at the next dressing to bring the Lips of the Wound nearer by dry Stitches. On the Eyebrow I made four Stitches, at such distance as they might be able to retain the Lips together, taking in a triangular piece of Skin that was divided by a Wound above it, which rendered it not unlike a double Hair-lip. Than I dressed up the Wounds with Arceus' Lineament and empl. è bolo, with a Compress dipped in Oxycrate, and made my Bandage over all. Having thus dressed her Wounds, I caused some aq. ros. rub. cum alb. ovi to be beaten together, and dropped in her Eye; than applied soft folds of Linen wet in the same Mixture over that diseased Eye, and an empl. è bolo over her Cheek, forbearing the Bleeding her that night, in consideration that she had bled the space of 5 miles in her returning back to London. The second day after I took of the Dress, and finding lesle suspicion of Fracture or Fissure in the Wound of her Forehead, I brought the Lips of that Wound together with dry Stitches, and strengthened those Sutures of the Eyebrow by the same Medicament, jest the continual motion of the Lid should relax them: than I dressed it up as before, and made the Bandage begin behind, bringing both the heads of the Rowler forward, passing one by another, to press the Lips of the Wound in the Forehead close together, and dressed her Eye with aq. pomor. matur. wherein a few grains of Vitriol were dissolved; by which I removed the Suffusion upon the Cornea. Than I applied upon her bruised Cheek Pulp of the Roots of Orpin beaten in a Mortar, with the White of an egg. Two days after I dressed her again, and finding that the dry Stitches kept those Lips of the Wound close together, I cut of the other, and dressed her with sarcotick Powders, which supplied the place of Epuloticks; and that morning I let her blood in the Arm about ten ounces, and purged her the day after with infus. senae, rhab. etc. By this the Defluxion was removed, and in the space of seven days the Wounds were all perfectly cured, and she returned back the eighth day.  
A Servant of a Nobleman was wounded on the right Cheek over the Os zygoma, 
2. Observat. of a wound in the right Cheek.  down the Muscles of the same Cheek. In cleansing of the Wound, I felt a piece of that Bone, which had been cut of by a slanting blow: it hung only by some fleshy Fibres in the Wound. I took it out, and, in consideration the part would not well admit of Bandage, I made two Stitches, bringing the Lips of the Wound even together, than sprinkled the Suture with sarcotick Powders, and dressed it up as the former. The third day after, taking of Dress, and finding his Wound agglutinated, I cut out the Stitches, and dressed him with some of the same Agglutinatives as before. Two days after, dressing him again, I found his Wound perfectly cured.  
Whilst I served amongst the Dunkirk, where Snick and Snee was as it were a fashion, I had much of this sort of work; and for your diversion shall set you down one Instance in that kind.  
Whilst our Squadron road at Anchor in the Groin, 
3. Observat. of a Dutch Hamburger marked with a cross on the right Cheek.  there came in some Hollanders, under the notion of Hamburgers, with three Ships new trimmed up for the King of Spain's Service. A Boatswain of one of these Ships happened in company ashore with some of our men, where drinking together, the Hollander began to prate of Religion, upbraiding one of our men for wearing a Cross; and after a while, growing more heated with drink, he became quarrelsome, and swore Sacrament he would not wear a Cross, not, the Devil take him, repeating it often. One of our men beaten him down, and fell with him; than kneeling upon his Breast, and holding his Head down, he drew out a Knife sticking in his Sash, and cut him from the Ear towards the Mouth, than from the Os zygoma to the nether Jaw. Now, said he, you shall wear a Cross, that the Devil do not carry you away. I was sent for from the next house as a friend to that Religion, and stitched the Lips of the Wound close together; than sprinkling them with a little pulv. Galeni, applied Pledgits with a sarcotick Unguent, and with Astringents and Bandage dressed him up. The next morning he was let blood, and the third day after I took of the Dress, and finding the Wound as it were agglutinated in the Slits, I cut out some of the Stitches, sprinkled the Wound as at first, and dressed him up with sarcotics, with Compress and Bandage. The second day after I dressed him again, and cut out the remaining Stitches; and in a dressing or two more cured him. This being the work of Nature, who rarely faileth in acting her part, if we perform ours, in retaining the Lips close together, and defending them from Fluxion. The Patient was well pleased with his Cure, though there remained some marks of a Cross. These sort of people wearing them with much pride in their Faces, as marks of their Courage.   

CHAP. V Of Wounds penetrating the Oesophagus and Aspera arteria.  
WOunds penetrating the Oesophagus and Aspera arteria require to be stitched close, especially those of the Oesophagus, where the sustenance and Saliva so continually presseth into it. Therefore if your Stitches slacken before the internal Wound be agglutinated, you aught to make new Stitches, or pass Needles or Pins through the Lips of the Wound, and with strong Thread twisted about them, as in a Hair-lip, keep them close together, till the Wound be united. During which, dress it up with Agglutinatives, and prescribe a thin Diet: so shall you cure the Wound in few days, when as otherwise observe what followeth.  
A Child of about six years of age, playing with a wooden Dagger, 
Observat. of a wound in the Gullet.  fell upon it, and wounded himself into the Oesophagus or Gullet, so as his Saliva froathed out of the Wound. I being fetched, stitched up the Wound, and applied Astringents, with Compress and retentive Bandage, than put him into bed, and let him blood in the Arm, advising a Lambative of album. ovor. rec. cum sacchar. alb. to be taken as necessity should require, with directions to abstain from all other Sustenance till the next morning. At which time visiting him again, I was told their Chirurgeon had taken of my Dress, cut of the Stitches, and given a greater liberty in Diet. I wondered what peculiar Art he had in curing that Wound. But about a month after I was informed, he had been foiled in the Cure, and had left it to Nature; and that the Child was fed with Pudding, and such soft Food, part whereof came daily out at his Wound.   

CHAP. VI Of Wounds of the Limbs.  
ONE of our Mariners in Spain, 
1. Observat. of a puncture of the Arm.  fight on shore, was thrust with a Rapier into the outside of the Arm nigh the Biceps. A Chirurgeon in the Town, seeing him bleed much, stitched the Wound close, and applied his Restrictives, rolling up the Part well. After three or four days, the Patient came aboard, and, being in pain, desired me to dress him. The Arm being swelled and inflamed, I cut the Stitches open, and gave vent to a bloody Sanies, after which followed a digested Matter. Finding by search with my Probe the Wound wanted little of passing through, I embrocated and dressed it up with a short Tent armed with my common Digestive, and endeavoured by good Bandage to cure it. But it not yielding thereto, I passed a Seton-needle through, discharging the Matter downward; and after that Apertion was digested, I dilated it, and kept a Tent there a few days; during which the upper part of the Wound healed up: and the Wound below digesting well, and the Matter daily lessening, I also healed that up. This I insert, to show you that such Wounds aught not to be stitched, but dressed up with Astringents, Compress and Bandage: for so these Wounds in a good Habit of body, with Compress and Bandage, do frequently agglutinate in a few days; whereas dressed by Tents they are of longer continuance, and rendered at last difficult of Cure.  
While I was in the King's Service in the time of the War in the West-country, 
2. Observat. of a wound in the Thigh.  I was fetched to Captain M. who in fight a Duel was run through the Thigh with a broad Sword: I was also sent for at the same time to the other. I hastily dressed this Officer's Thigh with Pledgits spread with sarcotics, and some astringent Powders mixed with the Whites of eggs, applying them over both the Orifices, and bringing the Lips of them close, with Compress and Bandage, and so left him to be by his Servants put to bed. From thence I went to dress the other, who had many little Wounds, on his Fingers, Hands, and Head. At my return I visited my former Patient, whom I found in his bed with little pain. The second day after I attended him, and finding all in good temper, without pain or swelling, I dressed the Wounds as I had done before, there being good signs that they would heal up by Agglutination; for there was little either of Matter, Pain, or Swelling. If it had appeared inflamed with Tumour or Pain, I aught than to have dilated the Orifice most distempered; and if they had both suffered, I might have kept them both open with small short Tents spread with the common Digestives, and have let him blood, and proceeded as in a Body ill habited: but there was no need; there only required a quiet position of the Part, which he submitted to, and was happily cured in 7 or 8 days. This was really performed by the Balsam of his blood, I neither bleeding nor purging him in the time of his Cure.  
A fat Gentleman came from Rochester wounded in the Thigh with a Tuck. It was much inflamed, 
3. Observat. of a wound in the Thigh.  by reason of the Tent in it, which was very long; his young Chirurgeon supposing the Wound could not be cured unless the Tent reached to the bottom of it. I threw out the Tent, and dressed the Wound with a Pledgit of unguent. basilic. embrocated it with ol. ros. and applied empl. è bolo, than let him blood. He being feverish, I also prescribed a Clyster, and sent him an Anodyne draught to dispose him to rest that night. The next day I found him in good temper, and his Wound inclined to heal. I dressed it as the day before, and advised him to keep his bed three or four days. About two days after I visited him again, and taking of the Dress, saw his Wound perfectly cured: so it continued, and he walked abroad the next day.  
A person was wounded in the inside of the Arm, 
4. Observat. of a wound in the Arm.  the Sword passing over the Joint slanting to the outside of the Arm. He was first dressed by a Chirurgeon near the place where he was hurt, and had bled much. The next day he complaining of pain, I opened the Wound, and found it tented at both Orifices, the Arm swollen, and a little disturbed; as Wounds in that place are subject to be, when the blood is shut in by Tents, and not dressed rationally by Astringents and good Bandage. The Swelling was most between the two Orifices, and appeared afterwards to be the blood choked in by the straightness of the Bandage, and was not likely to yield otherwise than by Suppuration. I fomented the wounded Member with Discutients, and kept both the Orifices open with small Tents dipped in the common Digestive, embrocating the Parts about cum ol. ros. & gut. aliquot aceti, and applying over all empl. è bolo. The third dressing there appeared blood from that Orifice in the inside of the Arm. I filled it with Praecipitate upon a Dossill, and dressed the Wounds up as before; than acquainted the Patient with my thoughts of Opening the Swelling between the two Orifices, there being no likelihood the Matter could discharge itself by either of them, yet it was not safe to heal them up. Wherhfore I opened that Tumour lying between them by a little Caustick, and discharged a grumous blood with a corrupt Serum. From that time I left of the use of Tents, and healed that Wound up in four or five days: and as the Escar separated, the Ulcer digested, and I cured that latter Opening soon after. That the Bone was bore under the Tumour, may I suppose yet be felt, from the adhesion of the musculous Flesh to it.  
A person was wounded in the outside of the right Leg below the Gartering-place, 
5. Observat. of a wound in the Leg.  the Wound running upward. After 6 weeks dressing by the neighbouring Surgeons, the Wound being much disturbed by a Flux of Humours, I was consulted, and found it sinuous (some two inches) upward, and accompanied with Inflammation and Tumour. The Small of the Leg and Foot were oedematous, and the whole Member so weakened by the Influx, that it was neither able to assimilate its Aliment, nor yet to resist the Crudities that fell upon it, and so was like to be of difficult Cure. In order to which I laid open part of the Sinus by Incision, and deterged the Wound with mundif. Paracels. mixed with Merc. praecipitat. embrocating the Parts about with ol. ros. cum aceto, and applying cerat. Galeni over the inflamed Tumour. I fomented the oedematous Tumour with a Decoction of absinth. scored. flor. sambuci, cham. ros. rubr. bacc. myrtill. & balanst. and applied over the Swelling a Mixture of empl. diachalcit. & stict. Paracelsi, with good Bandage, not renewing those Dress more than once a week, to give a breathing to it. By the foresaid method of dressing, that part of the Wound which I had laid open deterged, and the Inflammation and Tumour remitted. I afterwards divided the remaining Sinus, and deterged it as the former, and with unguent. diapo●pholyg. etc. cicatrized it, by the help of a laced Stocking, in the space of about a month. This person had been long kept in his Chamber by his Wound, and now supposing himself well, he rid to his Countryhouse, (unknown to me:) but that night his Leg swollen much, and the Cicatrix, being scarce confirmed, broke out again; upon sight whereof he returned back the next day, and sent for me. His Leg being inflamed, and the Cicatrix fretted quite of, I fomented the Member cum decoct. malvar. violar. plantag. solani, & flor. ros. rub. and endeavoured by the application of basilicon, etc. to digest it: but it not yielding thereto, I applied Refrigerants on the external Parts, and a fine Lawn wet in a Solution of troch. alb. Rhas'. made in decoct. plantag. equiseti, etc. over the Excoriation, also unguent. alb. camph. over the Lawn, upon Pledgits somewhat distant from one another, jest the Matter should be shut in by the adhesion of them, and fret the Cuticula more of. Thus I dressed it twice aday, he keeping his Leg upon his bed, to prevent Defluxion. By this method the heat and acrimony of the Humour being mitigated, I applied over the Lawn Epuloticks more drying, viz. pulv. corn. cerv. usti, etc. and at last with much difficulty cicatrized the Ulceration: whereas if this Wound had been treated methodically in its recency, it might possibly have been cured in few days by Agglutination.   

CHAP. VII. Of Wounds of the Breast.  
WOunds of the Breast are penetrating, or not. If they do penetrate, than we are to consider the depth; whether it be only between the Mediastinum, in the hollow Cavity of that, in the lower part of the Breast; or whether it penetrate into the Cavities of the Thorax; or what the Parts are that be hurt. How the Breast is circumscribed, with the Symptoms of each Part when hurt, you may found in the following Discourse of Gun-shot.  
The Signs of Wounds penetrating are discovered by the proportion of the Searching-candle or Probe, 
Signs of penetrating wounds.  which enters into the Cavity. You may also perceive when it penetrates the Cavities of the Thorax, by laying a Down-feather upon the Wound, or by holding a lighted Candle near it, the Patient holding his breath the whilst. In this case the Wind (or Air) will move the Feather or Flame; if it do not blow away the one, and extinguish the other. The Air also makes a noise in its passing forth. Sometimes it is discovered by the quantity of blood discharged by the Wound or Mouth, or both, with Difficulty of breathing.  
Wounds in the hinder part of the Thorax are reckoned dangerous, 
Prognostic.  by reason of the Nerves and Tendons; and if they penetrate that way, there is another danger from the great Vessels of blood, which are nearer to the Weapon in this case than in those Wounds which are made forward: yet all Wounds in the Breast are dangerous, by reason of the continual motion of the Lungs, and of the blood that falls down on the Diaphragma, and corrupts it. If the Lungs be wounded deep amongst the great Vessels, though they escape the first nine days, yet they commonly terminate in a Phthisis, or Fistula.  
A Wound in the external part of the Breast is cured as a Simple Wound. If it penetrate, 
Cure.  you are to endeavour first the restraining the blood; than that the extravasated blood be discharged: and that either by the Mouth, by Expectoration; or by the Wound; or by Urine. The way by Urine Fabr, ab Aquapend. says is by a branch of the Azygos, which, saith he, passeth near the Diaphragma, by the Spine, to the Emulgents. Those that own the Circulation will hardly allow of his Hypothesis: however, if the matter of fact be true, that there is sometimes a discharge by Urine, which I confess I have not yet observed in my own practice, it will be reasonable to propose, as he doth, in this case, Diuretics, as decoct. capill. Veneris, polytrich. rad. petroselin. beton. apii, foeniculi, asparagi; also Ptisans, with ol. sulphur. vitriol. Barly-cream, Emulsions, etc. to contemperate the blood. The Ancients gave acetum with warm Water to restrain the present Flux, and to dissolve the concreted blood.  
The second way is by Expectoration; and thereto serve decoct. pectorale. Lohoches, syr. capill. Ven. jajub. glycyrrhiz. oxymel, etc. whereof the Pharmacopoeia Lond. is full. This I have mentioned for their sakes who cannot have a Physician. But here I leave this work to them, those Cures consisting much in their well ordering and prescribing internal Remedies; contenting myself in the Dressing of the Wound as it appertains to Chirurgery. 
Whether the wound is to be kept open, or not.  In the treating of which there is a Question, whether the Wound should be kept open, or agglutinated. They that are for a speedy Agglutination, do urge it, jest the internal Air corrupt the Parts within, and the heat expire. They that propose the keeping them open, do design thereby a readier discharge of Matter. For, saith Aquapendent. if the Matter be to be discharged by Urine, it must pass into the substance of the Pleura, than into the Vein Azygos, so into the Emulgents, than to the Kidneys, and through the Ureters and Bladder: if by Expectoration, than it must also first pass into the substance of the Lungs, than into the Aspera arteria or Weasand, and from thence be coughed up, and spit out by the Mouth.  
In my practice, in these Wounds of the Breast, I consider the Wound, 
The Author's judgement.  how it is capable of discharging the extravasated Blood and Matter. If it be inflicted so, that the Blood or Matter may be thereby discharged, than it is to be kept open, the welfare of the Patient depending mainly upon the well dressing and governing it: but if it do not lie well for Evacuation of that extravasated Blood, than it may do hurt, and so aught to be healed up.  
A Person of about 23 years of age, of a good Habit of body, 
1. Observat. of a penetrating wound of the Breast.  being wounded into the Breast, there followed immediately a great effusion of Blood, almost to the exhausting of his Spirits. Mr. R. Chirurgeon and myself were presently sent for. We found him lodged in an Inn near Fox-ball, and viewed his Wound. It was four fingers above the Cartilago eusiformis, a little to the left side: he had a small Pulse, and fainted often. Dr. Wedderborn and Dr. William. Denton came in while we were providing Dress. The Wound was large and penetrating. We made a soft Tent, with a Thread fastened to it; 
How to order Tents in penetrating wounds of the Breast.  which in these Wounds you must be sure to do, jest you lose it in the Body. This Tent we dipped in a Mixture of Powder composed of bol. Armen. sang. dracon. thus, mastic. etc. cum albumine ovi, and applied over it a Pledgit spread with the same, also empl. è bolo, with convenient Bandage. The Physicians prescribed internally such things as restrained the Bleeding, and were proper to resolve the concreted blood, and withal to relieve his fainting Spirits. That night he rested ill. The next day when we met, seeing him labour under great Difficulty of breathing, with pain above the Diaphragma, his Pulse quick, little Urine, and that high-coloured, we agreed he should be let blood presently; which was done accordingly in the left Arm. The blood flowing with a quick stream, we took away about 6 or 7 ounces, a mere Serum: but the Patient was relieved by it. We than took of our Dress, to look upon the Wound, whereupon we found some Blood and Sanies discharged. We dressed him with terebinth. lot. in succo lamii, adding some of the former Powders come vitell. ovi upon a Tent as before, with a Plaster and Bandage over it. Thus we continued to dress him until we saw the Bleeding cease. After which there was nothing for us to do, but to further the discharge of Matter from within, by keeping the Wound open until it lessened, and the ill Symptoms went of: the casting in of liquid Medicaments, which are not easily to be gotten out again, being very destructive. Therefore we diligently attended in assisting Nature, by keeping a way open for the evacuation of what was extravasated and corrupted within the Cavity, committing the Cure to her; who indeed acted her part so well, that in few days the Wound agglutinated within: and we thereupon leaving of the use of the Tent, cured the external Wound in few weeks by the common sarcotics, leaving him in perfect health, which he yet enjoyeth.  
Another person was wounded into the Breast below the fourth Rib on the right side. 
2. Observat. of a wound in the right Breast.  He coughed up much blood at times. Sr. Fra. Pruj. was his Physician; who prescribed him Ptisans, pectoral Decoctions, etc. by which and frequent Phlebotomy the Symptoms went of. After the Wound digested, the Patient rambled abroad, and was cured by such Dress as I left for him at his Chamber, I seeing him no more until he was wounded again.  
Another was wounded in the right Breast, 
3. Observat. of a wound in the right Breast.  coughing up much blood, with great pain and Difficulty of breathing. I took away ten ounces of blood presently, and ordered him (it being than night) some syrup. de meconio & jujub. in a Draught of aq. papaver. with a few drops spir. sulphuris. He slept well that night, and against the morning he had decoct. pectoral. come. (the hotter Herbs left out,) sweetened with syr. de ros. sicc. & jujub. of which he drank in the morning, and at other times as he listed. By his disorder he frequently relapsed, and coughed up blood at times: I let him blood as often, and kept his Wound open and digested. But he relapsing again, I began to be sick of him, and dealt with him to sand for a Physician. Sr. Ed. Graves was consulted, who saw his Wound almost cured. We repeated Venasection; and from that time he recovered, and continued well.  
A Footman was wounded into the left Side: 
4. Observat. of a wound in the left Side.  he caught blood, and discharged much by the Wound. A Servant of mine dressed him with a Tent, by which the Bleeding was stopped from flowing thereout: and by letting him blood in the Arm, the Coughing of blood was checked. The other Symptoms were afterwards removed by Dr. Walter Needham's Prescriptions. Some few days after, a Tumour arising about the Wound, I gave him a visit, and felt the swollen Parts crackle under my fingers. Concluding it Wind got out from the Cavity within the Thorax, I made an Incision into the Swelling about an inch long, by which the Wind was discharged. We digested the Wound cum terebinth. etc. and kept it open two or three Dress, till the Penetration into the Breast was incarned; than lessened the Dossill, and healed it as in the former Observations hath been showed.  
A Gentleman of about 23 years of age, 
5. Observat. of wounds in the Breast and right Arm.  of a full Body, was wounded in the Breast and right Arm. He was carried into the next house, and dressed by a French Chirurgeon. The next morning I found him much afflicted with a Colic and Dysuria. These Symptoms happening thus upon his Wounds, gave some occasion to think they proceeded from the Wound inflicted on the Breast; but were indeed the effects of his ill Habit of body and manner of living; for he had been a Good fellow, and at that time over-warmed with Drink, and had lain upon a Pallet that night in a cold Chamber, which together seemed cause sufficient for his complaint: however Bleeding was repeated. Fomentations were also applied to the Abdomen, Clysters administered, and all things done which were proper in such cases; Purging excepted, in consideration of his Wounds: the one whereof was said to be on the Region of the Heart, and the other in the Artery of the Arm. The third day after we prepared to dress his Wounds, and found the one, lying upon the Sternon, penetrating under the Skin to the Cartilago ensiformis, whereout we pulled a Tent near two inches long, and proportionably big. The other was a Puncture on the outside of the Arm, with a Tent crowded into it. I dressed this latter Wound with a Pledgit spread with a Digestive ex terebinth. & empl. è bolo, and in two or three dress cured it. To the other I applied some of the same Digestive upon a small Tent; and having embrocated the adjacent Parts with ol. ros. I used empl. è bolo with Compress and Bandage, and designed that way to cure it. But the Sinus being depending, and the Wound disturbed by the unreasonable great Tent, hindered the Agglutination: wherefore after a dressing or two I snipt it open with a pair of Probe-scissors, and cured it by incarning, etc. The Wounds appearing so inconsiderable, the Patient was purged, and the Dysuria remitted: but a few hours after he was seized with a pain in his left Hip, for which he was again let blood, Plasters were applied, and Purging repeated. But after all, a Diarrhoea happened, which freed him of the Sciatick pain. Being thus relieved, he observed not longer the strict Rules prescribed him, but took the liberty to eat and drink as he listed, and attributed his Recovery to that.  
A person run through the Body the breadth of three fingers under the right Clavicle, and out below the Scapula, 
6. Observat. of a wound through the Body.  was first dressed by a Chirurgeon near the place where he was wounded. I came some hours after, and found him in bed faint and weak, but without Pain or Difficulty of breathing. The next day I met Dr. Bacon Physician, and Mr. Shocque Chirurgeon to his Highness' Prince Rupert. The Patient had rested very ill the preceding night, his Wound in his Back had bled very much, even quite through the Bed; he had also fouled many Napkins in coughing up Blood. We took the Dress of the Wound in his Breast, from whence there had been some blood discharged, and more came out soon after. I dressed up the Wound with a short Tent dipped in a little terebinth. cum farin. volatili, and a few of our agglutinative Powders mixed with the Yolk of an egg, and applied empl. diachalcith. over it. The other Wound under the Scapula was painful, but so small, that it was not reasonable in our judgements to keep it open. We therefore laid a Pledgit of the same Mixture with a Plaster upon that, and from that time dressed it not more; but dressed the Wound in his Breast daily, and repeated Venaesection as occasion offered. The third day he caught up blood, and some little issued from his Wound that day and the next. Four or five days after I waited upon him to his Lodgings in London: by the way he caught some blood, and so more or lesle day and night; but by the care of his Physicians it lessened daily, and his Wound being better digested, I kept the Orifice open by a short hollow Tent made of a Sparadrope, which was composed of resin. pin. gum. ammoniac. bdellium, galban. terebinth. & cera, with pulv. ireos, dipping it in a little mel ros. This way of dressing I continued until the coughing of blood diminished, from 12 Napkins in a day and night to 10, 8, 7, 4, 2, 1; yea to 1 in a week. After I saw no blood one way or other, nor any Symptom of ill, I desired his Physicians and others might be consulted together and severally; and having all their positive judgements for throwing out the Tent, and healing up the Wound, I did so, and in a week more cured him. Five or six days after he sent me his thanks by his Servant: after which I made him a visit, and there met Dr. Willis, who enquiring of me whether his Wounds were cured, I desired the Patient that he would show the Doctor whether they were or not. He presently stripped himself of his Shirt, and shown the Doctor, who both saw and felt the Cicatrices, and replied, They are well.  
A Young man wounded in the Breast, 
7. Observat. of a wound in the Breast.  labouring under very great Pain and Difficulty of breathing, with a Cough, sent for me late one night, and shown me some little blood he had than caught up. He had been wounded the night before by a man standing at a Door some steps higher than himself, as it were over him, thrusting his Rapier into his Breast, within two fingers breadth of the right Clavicle, downward into the Lungs. The Patient ran into that House bleeding much, and was seized with such Difficulty of breathing, that he was forced to stretch his Arms at length over his Head, without which doing he could not breathe. He had been let blood twice, and prescribed Ptisans, etc. but for all this he was very little relieved. I presently let him blood about ten ounces, and ordered the Apothecary to give him a draught of aq. papaver. cum syr. de meconio & de ros. siccis, with a little aq. Saxoniae frigid. and against the next morning appointed them to sand for a Physician to meet me. They did so. When I came in the morning, I found the Patient marvellously relieved, and resolved to remove (he being than in Sctoland-yard) to his Lodging in Wild-street. In the presence of his Physician Dr. St. I took of the Dress, found his Wound small, and healed up within, but not cicatrized: which if it had, yet the Wound within was so much below this without, that it was not capable of discharging the Matter, and so not worth my attendance,, their Cure indeed consisting in internal Prescriptions. However he continued me with his Physician, and we bled him again, taking away about ℥ viij. of blood, and proceeded in the method of Cure usual in such cases. That afternoon the Patient, unknown to me, pursued his intention of removing to his old Lodging in Wild-street, where going up three pair of Stairs to his Chamber, he relapsed into the former Difficulty of breathing, with pain, and caught much blood. The morning after we met there together again. The Patient seemed to us quite spent, labouring under great oppression; and by his pains about the Diaphragma and Back there was suspicion of extravasated Blood. We bled him some 4 or 5 ounces more, and repeated Embrocations, Lohoches, pectoral Decoctions, etc. and got of this difficulty in 5 or 6 days: than I left him. But after that by disorder he relapsed again, yet was freed again the same way by his Physician, and recovered to be hanged at last.  
Of all these wounded Patients, 
The Author's Observation concerning the discharge of the Sanies of the Breast by Urine.  and many more I have helped to cure, I never saw any that I could say passed their Disease by Urine, nor many of them that vented their Urine well during the time of their lying under these Wounds; nor have I often seen them who recover expectorate any such quantity of Matter, as might be thought to proceed from the great quantity of Blood extravasated. They caught fresh blood most of them, like to what they discharged from their Wounds, but more florid.   

CHAP. VIII. Of Wounds of the Belly.  
WE shall now say somewhat of the Wounds of the Belly: the Description whereof you will found set down in the Discourse of Gun-shot-wounds, with the Symptoms that attend the Wounds of each particular Part that shall hap to be hurt in it.  
Wounds of the Belly either penetrate, or not. 
Difference.  The Wounds not penetrating are such as reach not farther inward than to the Peritonaeum. If the Peritonaeum be also cut through, it is reckoned a penetrating Wound: in which case, if the Wound be large, the Omentum or Intestines slip out. These penetrating Wounds are also frequently accompanied with Hurt of some of the contained Parts, viz. the Intestines, Stomach, Liver, Spleen, etc.  
If the Penetration be large, 
Signs.  it is discovered by the thrusting out of the Kell or Gut. If the Wound be small, you must search it with your Probe. What internal Viscera are wounded, may be guessed by the external Part hurt, but more certainly by their peculiar Symptoms.  
Wounds not penetrating are without danger. 
Prognostic.  Those in the middle of the Belly are worst, by reason of the Nervous body that lieth there, and consequently more painful to be stitched, and difficulter of Cure, by reason of the Intestines and Kell pressing most upon that Part. If any of the internal Viscera be hurt, the danger is great, all such cases being accounted mortal.  
Wounds not penetrating are cured as other Wounds of the Flesh: 
Cure.  But those which do penetrate require other manner of handling. If the Intestines or Omentum do thrust out, you must speedily reduce them, jest the former inflate, or the latter over-cool and corrupt. But if the Gut be so puffed out that you cannot return it in, you aught to foment it with warm Water, Read wine, or some discutient Decoction ex summit. origan. puleg. fol. beton. salviae, flor. cham. sem. anethi, foenic. dulc. anis. etc. If by such means you cannot reduce it, you must enlarge the Wound by Incision, and restore it to its place.  
If the Omentum be slipped out and tainted by the Air, make a Ligature above the solid part, and cut it of; than stitch up the Wound, leaving the ends of the Ligature hanging out of it to cast of. But if it be fresh and warm, reduce it with your fingers. Authors have proposed several ways of Stitching these Wounds, which I shall not trouble you with; but advice you to make your Stitches so deep, that the Peritonaeum may be united with the Flesh: for if you fail therein, a Hernia must necessarily succeed.  
If the penetrating Wound be so small that neither Omentum nor Intestine slip out, (as it frequently happens when they are inflicted by Tuck or Rapier,) you may than consider what Symptoms there are of the internal Viscera hurt: and if there be neither Inflation of the Belly, Colic, Vomiting, or aught extraordinary by Urine or Stool, you may conclude all well; and being so, your best way will be to heal up the Wound by Agglutination: for by dressing it with Tents, you may 'cause disturbance; and by exposing it to the external Air, Putrefaction, Colic, etc. may ensue. Therefore I think it necessary that these Wounds be healed with all expedition, and that the Patient do keep his Bed the while: for in sitting up, the weight of the Bowels will stretch the Peritonaeum, and make way through it. And though the external Wound in the Skin do not yield them passage, yet they will so nest themselves between it and the Peritonaeum, as to make a Hernia. To prevent which, you aught to hasten the Cure, and not only to keep the Patient in Bed, but to make good Compression upon the Wounds, that the Parts may unite while they are recent.  
If in such a penetrating Wound the Small guts be wounded, the vehement Pain, continual Vomiting of Choler, and dejection of Chyle by the Wound, will discover it: but in that case, the keeping of it open to seek the Intestine will be a hard task; and when you have found it, what will it signify, but to increase the Accidents? Therefore it will be better to follow the method of the Ancients, to embrocate all the Region of the Belly with ol. mastic. & lumbric. to dress the Wound with sarcotics, and to keep it close and warm with Compress and Bandage. But if the great Intestines be wounded, and the Excrements discharge that way, it may be reasonable to lay open the Wound, and stitch the Gut with the Glover's Stitch, sprinkling it with some of the aforesaid Agglutinatives; and reducing it back, stitch up the external Wound of the Belly, as hath been said. In all these Wounds Venaesection is necessary, and may be repeated as occasion shall offer. Regulation in Diet aught to be with great moderation. Clysters may be administered after the second day of Chicken or Veal broth wherein Barley hath been boiled: to which may be added Yolks of eggs, mel comm. or Sugar of read Roses, etc. Also Internalls may be prescribed, viz. Vulnerary decoctions of fol. plantag. equiseti, pimpinel. pilosell. rad. consolid. to which may be added cons. ros. rub. cons. cydonior. Bolus' may be also proper of species diatragacanth. with Balsamicks. Wounds of the Liver, Spleen, and other Viscera, require to be treated much after the same manner by Internalls. They aught more especially to be kept open, either for the dressing them, or for the discharge of Matter. Also Cataplasms may be applied ex far. hoard. fabar. flor. ros. rub. coct. cum hydromel. For farther satisfaction therein, I refer you to Wounds made by Gun-shot.  
A Man was brought to Lambeth wounded transverse the Belly a little below the Navel on the left side; 
1. Observat. of a wound in the Abdomen.  the Omentum and Intestines were thrust out, and kept close to the Wound with a Handkerchief in his hand. The Omentum was much out; but not being altered by the Air, I caused warm  presently to be held upon them very close, and the Patient to be placed low with his Head, and his Hips raised up: than by the help of his Friend raising them yet higher, and shaking his Body, I reduced them. After which, they having laid him down with his Hips raised, and his Body somewhat declining to the right Side, my Assistant pressing with his hands something above the Wound, (by which the Lips of it were a little turned upward, and the Viscera down,) I prepared to stitch the Wound with a strong Needle somewhat curved at the point, threaded proportionably, taking hold of the lower Lip; and passed my Needle first through the Peritonaeum, 
The manner of sowing the Peritonaeum in this case.  and than to the opposite side, through the Flesh and Skin, leaving the Peritonaeum; and so along, taking it up on one side, and leaving it on the other, till I had sowed up the Wound. Than I pulled the Stitches as close together as I could, and fastened my Thread. The Wound thus stitched, I sprinkled the Stitches with pulv. aloes, colophoniae, sang. dracon. mastic. etc. and applied sarcotics with a Plaster over all, made up of some of the aforesaid Powders cum album. ovi, and with Compress and a strong Towel braced them all fast. After a while I let him blood, and ordered him to lie quiet upon the sound Side, and to keep his body soluble by Clysters, also to be moderate in eating and drinking. I dressed him after the same manner every other day; and when the Wound seemed to be cicatrized, and that my Stitches began to fret, I cut them out the eighth or ninth day; but continued the use of sarcotics till it was firmly cicatrized.  
These Wounds are not subject to great Inflammation or Defluxion; but by reason of the fatness and thickness of the Lips, and by pressing of the Kell and Guts, the stitching of the Belly is a troublesome work: and yet if the Wounds be not so stitched that the Peritonaeum and Fleshy parts may unite together, a Hernia will follow, as I told you, for the Peritonaeum bears a great stress. Therefore you must be sure to take good hold with your Stitches: and if you doubt their holding, make dry Stitches over them, with good Bandage.  
A Man was wounded with a Rapier into the Belly through the right Hypochondrium out by the Back. 
2. Observat. of a wound in the Belly.  I considered the Wound, and saw the Orifices were small, and little advantage to be made by keeping them open: yet I put in two small Tents dipped in a little Digestive ex terebinth. cum vitell. ovi, and dressed them up with empl. è bolo and Bandage, advising him to keep his bed and be quiet. I also prescribed ʒuj. syr. de meconio mixed in a draught of aq. papaver. to take that night. The next morning I found him hot, and his Pulse a little disturbed, but without any Symptoms of the Viscera wounded; 
Signs of the inward Viscera hurt by a wound of the Abdomen.  neither Tension of the Belly, Colic, Vomiting, or aught extraordinary by Urine or Stool: however I let him blood about 10 ounces, directing him a Clyster of Milk, etc. to be administered that afternoon, and at night his Anodyne was repeated. The next day I took of Dress, and considering there was no Symptom of hurt within, only the Wound a little heated by the Tents, I threw them out, and dressed both the Orifices with Pledgits spread with the abovesaid Digestive, embrocating the Parts about with ol. ros. etc. applying a Plaster and Bandage as before, and desiring him to keep his bed five or six days longer. I dressed him afterwards again; and finding the Apertures well disposed to cure, from that time I dressed him not more, but advised him to be temperate in eating and drinking, and if there were occasion, I would see him again. My Servant dressed him afterwards, and before the seventh day was expired, he was cured, and walked abroad, not complaining any more of that Wound.  
Thus it frequently happeneth, that a Sword passeth through the Body without wounding any considerable Part. Yet if the Wound had been kept tented, it might have been subject to Inflammation, by reason of the disturbance there, from whence ill Accidents might have happened. And what could the Chirurgeon, have advantaged the Cure by keeping such little Wounds open, supposing blood had been extravasated, which is the common pretence? Yet if it be not done, he is usually condemned by the common vogue. Therefore it is that some of our Profession, possibly against their own judgements, keep them tented often, to the ruin of their Patient.   

CHAP. IX. Of Wounds of the Head.  
I Shall now discourse of Wounds of the Head, not only as they are made by Cut, Stab, or Bruise, but also of those made by Gun-shot; and so by anticipating part of the Discourse next ensuing, give you the full Doctrine of them, by what Instrument soever made, without a necessity of future repetitions. And that you may understand the basis whereon these Cures are wrought, I shall represent the Head to you as it is framed.  
The Head, 
Parts of the Head considered.  according to Galen De usu part. is the noblest Member of our Body, the principal Faculties being there seated, for the use of which it was ordained; and is so contrived, as to be the foundation of Animal Spirits, and also to contain the principal Organs both of the internal and external Senses.  
In the first place the Hairy scalp presents itself to our eyes: 
The Hairy scalp.  and therein is to be considered its Thickness, Sense, and Vessels, with the Muscles that lie under it. The Hairy scalp is thinnest on the top of the Head; nor is there any Muscle between it and the Scull in that part, unless you will call the Membrana carnosa a Muscle; which some men of late do, and possibly not improperly; and the rather, because by it many men move the whole Scalp. If you doubt of a Fracture there, you may boldly cut into the Hairy scalp: it is of an obtuse sense, 
Forehead.  and easily healed up again. But be cautious how you make your Incision in the Forehead, where a transverse Wound may 'cause the Eyebrows to fall over the Eyes. Therefore if you are forced to make Incision, let it be according to the length of the Fibres. And be careful that you make no Incision upon the Temporal Muscles, 
Temporal Muscles.  for thereby Convulsion and other ill Accidents may hap.  
Under the Hairy scalp lies the Pericranium, 
Pericranium.  which we are to cut through in making way to the Cranium. You are to raise them both together, when you lay bore the Cranium for the use of the Terebra. For (say Authors) if in perforating the Cranium you tear this Membrane, Inflammation and Fever may follow; the Pericranium arising from the Dura matter through the Sutures, by which continuity that may also partake of the Inflammation.  
The Cranium follows, 
Cranium and Sutures.  which is a Bone composed of many jointed together by Sutures, of which there are five concern us; Coronalis, Lambdoïdes, Sagittalis, and two false ones. In perforating the Cranium, you are to eat these, (if you may,) for through them the Dura matter passes, as I told you, and is continued unto the Pericranium. The Sutures divide the Bones of the Cranium, by which one part of it may be preserved entire, while the other is broken, which otherwise would be in hazard. These Sutures are weak in resisting Blows, and between them Matter may be unhappily retained, and 'cause a Caries, and sooner work through to the Dura mater than in other parts of the Scull. It is necessary to know them well, lest, as Hypocrates gives good caution, you take them for Fissures. The way of finding them is, by passing one String from Ear to Ear, and another from the Nose to the Crown of the head. The former of these will show you the coronal Suture, the second the sagittal, which usually gins at that point where these Lines interject, being the part where we make fontanelles, and reacheth to the Crown of the head, and joineth with the Lambdoides. Sometimes it beginneth quite at the Nose. The Lambdoïdes ariseth at the end of the sagittal, and goeth forked down the two sides of the Occiput. Of the Suturae nothae, the two chief to be regarded are the Squamosae, which run under the Temporal Muscle of each side, round about the outermost verge of the Ear. You are also to take notice, that the Cranium is thinnest in the middle part of the Head, and thickest in the hinder part, and of a middle thickness in the Forehead. Hence it is that Wounds are most dangerous in the Crown of the head, where the Scull, by reason of its tenuity, easily communicates its hurt to the Brain; and also for that the upper part of the Brain lies there high, one of the largest Sinus' being immediately under the Scull, and many capillary Veins running so close with it, as to make themselves Trenches in the internal part of the Cranium. Wherhfore upon a Blow or Contusion in this place, the Veins may easily be broken, and the blood extravasated between the Cranium and Dura matter, and ill Accidents follow.  
The Dura mater, a strong Membrane, is placed under the Cranium; 
Dura mater.  the wounding of which is attended frequently by Palsies, and in progress of the Distemper by Convulsions, with other ill Symptoms; and the greater, if the Wound be in the middle part of the Head according to its length, there being many Vessels there, which, if they chance to be cut, will fill the vacant space between the Cranium and Dura matter with blood.  
The Pia mater lies upon the body of the Brain, so close, 
Pia mater.  that a Wound cannot be made into the Pia mater, and the Brain escape: and from its many Veins a Flux of blood must follow.  
The Brain lies under the Pia mater, 
Brain.  in whose Ventricles is lodged the Plexus choroïdes, and under whose basis lie large numerous branches of Arteries and Veins, which by great Blows of the Head may be broken.  
From the Description of the Head we shall proceed to the Description of its Wounds, which are strictly so called, where any part of the Skin, Flesh, 
Description and Difference of wounds in the Head. Concussions, Contusions, and Fractures.  Bones, Membranes or Brain is cut or torn.  
But where the Skin remaineth whole, Concussions and Contusions do often hap, and will deserve to be treated of in this place with the Wounds: not only because they are the frequent Companions of Wounds; but also because, when alone, they produce grievous Accidents resembling those of Fractures, nay often exceeding them. I shall therefore gradually describe Concussions, Contusions and Fractures, under the following Heads.  
1. There may hap Concussions of the Brain from a Blow, Fall, etc. nay sometimes from a Box on the ear, wherein the Symptoms may arise to a great height, without breaking either the Skin without, or Scull within. Which Concussions if they be of the lesser sort, wherein no Vessel is broken or blood extravasated, so that the person is only stunned, he soon recovers. But if of the greater sort, with rapture of the Vessels and extravasation of blood, they produce Stupores, Vertigines, Deliria, and many the like Symptoms, and are every whit as dangerous, nay often more dangerous than Fractures themselves.  
2. Contusions, when great, do usually produce a Fissure or Crack of the Scull, either in the same part where the Blow was inflicted, and than it is called Fissura; or in the contrary part, in which case it obtaineth the name of Contrafissura. These Fissures are through both Tables of the Scull, or one only. If one only, than either outward, or inward, the other Lamina remaining whole. They are long, short; wide, narrow; strait, crooked; etc.  
3. Contusions are considerable whether they be with a Wound, or not. Those without a Wound are for the most part accompanied with great Concussions, and sometimes Fissure and Fracture, or Depression of one or both Tables: in which case the spongy medullary interval that intercedes between the 2 Tables is frequently broken into its minute Fibres, and squeezed together. Hereupon Extravasation of blood followeth, and other Accidents that will be taken notice of in the Prognostics and in the Observations.  
4. Next to these are Contusions with Wounds, which are generally attended with Fracture properly so called, where a piece is wholly divided from the rest of the Scull. This Fracture sometimes consisteth of many pieces, some whereof are depressed upon the Membranes, yea into the Brain itself, while others lie entangled in the Flesh.  
5. Next to these are Wounds made by any sharp Weapon, which, according to the force, cutteth into the Bone many ways, which Cuts are called Sedes, and are reckoned amongst the Fractures; and so those made by Pole-axe, Halberd, and such obtuse heavy Weapons, may justly be termed. But those made by a Sword have seemed to me Wounds, and not Fractures; and when they do not penetrate the first Table, require no other Cure than that of Wounds; as may be seen in some of the Observations. But when the Penetration is deep, I do treat it as a Fracture, and so I place it here.  
6. Out of these proceed several Species of compound Fractures; as the Ecpiesma, Camarosis, Eccope, etc. which every man's experience will suggest to him.  
Celsus, 
Signs.  in his 8. Book and 4. Chapter, advices, when you are called to a Patient in such cases as above mentioned, to inquire whether he was stunned, or fell down with the Blow, or vomited presently after. You are also to inquire how he was hurt, whether by Blow, or Fall. For from the force of the Weapon, and manner of the Fall, you may shrewdly guess at the case. You are also to consider the Tumour, whether it be great, or small. If there be a Wound, nothing is more sure than your Finger to discover the Fracture. If you feel any Asperity, if it be not a Suture, you may be sure it is a Fissure or Fracture. But supposing there be neither Wound nor Tumour, yet if the Patient suffer under a Palsy in any part, or lie stupefied or raving, it is most certain the Membranes of the Brain are oppressed. And if the Hair lie cut in the Wound, you may suppose the Cranium hurt, it being no small force can divide Hair in that place. The holding a Thread between the Teeth, or biting a Crust, is mentioned by Authors as a way to found out a Fracture: but I think it of no great moment, unless the Fracture be near or under the Temporal Muscle.  
Wounds of the Head, 
Prognostics.  according to Hypocrates, are not without danger, how slight so ever they may appear to common judgement. Incised Wounds of the Hairy scalp reaching to the Cranium, cut by a Rapier, are the least dangerous or difficult of Cure. Those made by a Halberd, Bill, and such like heavy Weapons, are not without danger; so also those made by Puncture with a Dagger. By how much the nearer they penetrate to the Brain, so much the more dangerous they are. All Contusions of the Head are to be suspected, for from those the greatest Symptoms do arise. If in laying open the Cranium the Patient recover not his Senses, you may suspect an Extravasation of blood under the Dura mater; in which case his Life is in great hazard. Those Fractures made by Gun-shot do for the most part beaten pieces of the Scull into the Brain, and so may be determined mortal. But be the Hurt what it will, if it penetrate not farther than the Dura mater, it is curable, if it be timely laid open, and dressed, as shall be showed in their proper places.  
We begin with the Cure of simple Contusions of the Hairy scalp happening by Blow or Fall, attended with Pain, Inflammation, and Tumour. 
Cure.  In order to the preventing or removing of which, you aught in the first place to shave of the Hair, if there be any, and embrocate the Tumour and Parts about cum ol. ros. myrtill. & aceto, and apply this or such like Cataplasm on the affected Parts: ℞ far. hoard. fabar. an. ℥ vj. pulv. nuc. cupress. ballast. aluminis roch. ʒj. ros. rubr. ʒuj. ol. ros. ℥ iij. album. ovor. num. ij. aceti q. s. fiat Cataplasma. After you have thus dressed the Patient, let him blood in the Arm or Neck of the same side, and some hours after let a Clyster be administered; and lay him to rest at night with a Draught of an Emulsion of the cold Seeds, etc. The next day repeat the former method of dressing; and after you have thereby restrained the afflux of Humours, you may foment the remaining Tumour with Read wine wherein have been boiled fol. betonic. flor. anthos, stoechad. cham. ros. rub. bacc. myrtill. etc. and embrocate with ol. ros. & cham. But if it grow hard and painful, and threaten Apostemation, foment it with decoct. summitat. malvae, rad. althaeae, sem. lini & foenugraeci, and make a Cataplasm of the Faeces, adding far. hoard. etc. And if it suppurate, treat it as a Phlegmon. But if the Pain do mitigate, and the Tumour be continued with extravasated blood, as in an Ecchymosis, you aught than to discuss and dry up the Serosity by such like: ℞ far. hoard. fabar. an. ℥ iij. flor. ros. rub. bacc. myrtill. an. ℥ j summit. absinth. fol. beton. flor. sambuci, cham. an. ʒiij. sem. cymin. ʒj. pulver. & coq. in vin. rub. addend. mell. come. ℥ ij. ol. ros. & cham. an. q. s. fiat Cataplasma. If by these the Humour doth not dry up, nor the Tumour discuss, open it, and digest and cure it as in its proper Observation will be showed. If there be a Concussion with the Tumour, you aught to begin with letting blood, and repeat it as you see occasion, even to failing of the Spirits; and keep the Body soluble by Clysters; also contemperate the Ferment in the blood by frequent Draughts of Emulsions, etc. The external Applications are much the same as have been above said, by shaving of the Hair, and embrocating the Head and Neck cum ol. ros. myrtill. album. ovor. & aceto, and applying Cataplasms as above said decocted in Read wine or Oxycrate. After some days, when the Symptoms are remitted, apply empl. Vigonis ad contusiones, or this following, which is also his; ℞ furfur. tritic. ℥ iij. far. lentium ℥ ij. flor. ros. rub. bacc. myrtill. ballast. an.ʒj. calam. aromatic. ℥ jss. flor. cham. melilot. an. ℥ ss. nuc. cupress. num. vj. pulver. omnia, & coquant. in vin. austere. q. s. ad consist. Cataplasm. addendo ol. ros. cham. an. ℥ iij. Or with Wax, etc. you may make it in the form of a Cerote. Fomentations may likewise be made of the foresaid Ingredients. But in case the Concussion do not cease by the prescribed Remedies, than lay open the suspected Part, and proceed as hereafter shall be showed.  
In great Contusions without a Wound, if the Tumour be large, feel pappy, and increase notwithstanding your application of Refrigerants; you may suspect the quantity of Serum raising the Tumour to proceed from within, through some Fissure in Cranio. In which case (having considered the Symptoms) make Incision into the Tumour proportionably. And if you feel no part of the Cranium bore or depressed, dress it up with Digestives, and make your Applications over it of such Medicaments as have been prescribed in the former Contusions. And if thereupon the Tumour do flat, and the Wound digest, proceed in the Cure accordingly. But if there be Depression, or other ill Symptoms of internal Parts hurt, lay the Hairy scalp more open, and make way for farther inspection.  
In the Cure of Wounds of the Head, 
Simple incised wounds.  if they be made by a Rapier dividing the Scalp to the Cranium, nay though it cut the Scull, if there be no Symptom of an internal Hurt, the Lips of the Wound aught to be brought close together, and healed by Agglutination. The Stitching of these Wounds is objected against by some, jest Matter should be thereby penned in, and foul the Bone. But if you can satisfy yourself that the Wound aught speedily to be healed, the work is safe, if done judiciously. A broad in Spain I have seen them as commonly stitched as other incised Wounds: and in the Wars we stitched them successfully; and here in Town I have stitched up great Wounds of the Hairy scalp. However you aught not to crowd these Wounds with Dossils', for thereby you may raise a Fever, and prolong the Cure. Therefore having clipped away the Hair, dress the Wound cum pulv. Galen. and empl. è bolo, or some Defensative, with Compress and Bandage bringing the Lips close together; and afterwards let the Patiented blood, if he did not bleed sufficiently at the Wound: and the day following administer a Clyster, if the Body require it. At the next dressing, embrocate the Parts about cum ol. ros. etc. and dress the Wound with lineament. Arcei upon Pledgits, and it will soon cure. But if the Lips of the Wound were not retained close together at the first dress, it may be necessary to dress it with Digestives' ex terebinth. etc. embrocating the Parts about, and apply Plasters accordingly. Thus in a few days all these incised Wounds may be cured.  
One Smith, 
Observation of an incised wound transverse the temporal Muscle.  sometime a Tanner in Chester, was afterwards a Captain of a Company of Dragoons, which he picked up in haste, to disturb us in our Retreat from the Battle of Worcester. He was wounded by some of our Soldiers transverse the right Temporal Muscle, and was bleeding almost to death, when I was brought to his Quarters. I stitched his Wound, taking the Artery up with the Lips, and, for want of other Remedies, dressed it with a little Wheat-flower and the White of an egg, applying over it a Compress pressed out of Vinegar with convenient Bandage. The third day after I took of Dress, and found the Lips near agglutinated. I being than better provided by an Apothecary from Warrington, sprinkled the Lips of the Wound with pulv. thuris & sang. dracon. and applied a Pledgit spread with lineament. Arcei, and over it empl. diachalcit. The second day after I cut the Stitches, and applied Epuloticks; and afterwards by a Dressing or two more cured him. I am sure he was well of his Wound before he had recruited his Spirits he lost with his Blood.  
In Wounds of the Head which you cannot cure by the first Intention, 
Wounds of the Head with loss substance.  as where they are inflicted by a Weapon with an obtuse edge, or where there is loss of Substance, as part of the Lips torn of, there you must digest; and to that purpose the common Digestive ex terebinth. cum vitell. ovi, & farin. hoard. is proper. It may afterwards serve for a Detersive, if you add mel comm. aut rosat. pulv. ireos, sarcocol. etc. With a farther addition of Myrrh and Aloes, it is a good Sarcotick. Or you may incarn with lineament. Arcei, which was by him designed for Wounds of the Head. 
Unguent. Matrissylvae.  Vigo commends this; ℞ ol. rosac. ℥ vj. ol. mastic. ℥ ij. pingued. vitulin. porcin. an. ℥ iiij. fab. plantag. matrissylvae, beton. pimpinellae, pilosellae, flor. anthos, an. Mss. vini odoriferi cochl. iiij. coquantur ad consumpt. vini; colat. add mastic. gumm. elemi, resinae pin. an. ℥ j lithargyr. auri & argenti an. ℥ ij. miniiʒx. terebinth. Venet. ℥ iiij. cerae q. s. If in the incarning the Wound the Flesh grow luxurious, touch it with a Vitriol-stone, and it will deterge, and dispose it to cicatrize; which you may than complete with Pledgits of Lint pressed out of spir. vini, aq. calcis, etc.  
In Wounds made by Contusion where the Cranium is a little naked, you aught not presently to crowd in Dossils': for if that contused Flesh be well digested, the Bone will incarn underneath with the Wound without much difficulty. In those of the worst Habit of body I have happily incarned, by keeping the Orifice a little open by a small Dossil pressed out of spir. vini, and defending the Parts about from Fluxion by Medicaments and Bandage, as hath been showed in such cases. Take care that the Matter be not shut in by your Dress; for thereby the Wound may be made more hollow, and the Cure prolonged. To prevent which, I have been sometimes necessitated to apply a Compress round, leaving a hole in the middle of it, for the discharge of Matter, whilst the Parts about incarned by Compression.  
But if the Wound be with so great Contusion, that it casts of a Slough, and leaves the Cranium much naked; though it be not fouled either by the Matter or Air, yet it will than be necessary to rasp it: for the Bone is naturally smooth and slippery, as if it were polished, and Flesh difficultly groweth upon it. Wherhfore to hasten the Cure, you aught, by the authority of Galen and the most practical men, to rasp the Bone thin, till you see the blood ready to come out of it: the Bone will thereby be the sooner supplied with materials for generation of Flesh. But if your Patient will not admit of Raspatories, than you aught to keep your Dossils' close to the Lips of the Wound, and make your Exfoliation from the edges, that the sound part may thrust of the rotten Bone. For neither Crabs-eyes, nor any Medicine inwardly prescribed, or Wine outwardly applied with Lint, or other Medicaments to the middle of a Bone, will signify any thing to the Exfoliation of it: nay, the while you are so trifling, the Matter from the edges will rot the Bone underneath, and in continuance pierce through the first Table, and run down between the two Tables, thereby doing much mischief, and so will put you upon the use of the Terebra. After the Bone is scraped, you may dress them with Pledgits dipped in lineament. Arcei hot. If it require Digestion otherwise, apply them pressed out of spir. vini, either simply, or such wherein hath been infused pulv. radic. ireos, aristoloch. peucedan. etc.  
If in a Wound of the Head made by a Sword the Scull be cut flaunting of, or into the second Table, if there be no Symptoms of Concussion, you aught not to lay open the Wound to set on a Terebra, but cleanse and dress it up with a proportionable Dossil pressed out of spir. vini, and digest the Lips of the Wound as above said, and attend the Exfoliation; than heal it. Some Authors have advised the Rasping of these Bones; but in this case it is needless: for if the Bone be dressed as I have said, the Flesh will soon arise in that Cut of the Bone, and make Exfoliation of what is necessary, and incarn it without your farther trouble.  
If the Cranium be hurt by a sharp-cutting Weapon, 
Fissure in Cranio.  it cannot be without Solution of continuity in the Hairy scalp: but by a Fall or Blow the Scull may be fissured or fractured, and the Hairy scalp whole, and this Fracture or Fissure may be under the Contusion, or in some other Parts. If the Symptoms do demonstrate that there is a Fracture or Fissure, you are than without delay to open the Hairy scalp according as the Part will admit, angularly, or in the manner of a Cross, or of the Letter T, that the Fracture may be discovered by the raising of it up with its Pericranium. 
Against round Incision upon surmise.  For if you shall in doubtful Fissures or Fractures make a round Incision, and take out the whole piece; than, if there chance to be no Fissure, you have made yourself a long work to little purpose: and if the Fissure run under the Hairy scalp farther than you made your Incision, you may than be necessitated to cut it open that length: by which it will appear you have through mistake laid it open more than was necessary in one place, and too little in another, doing that which neither Hypocrates nor any judicious Chirurgeon would ever allow. Whereas if you had laid it open by a cross Incision, you might by only raising the Scalp have discovered the Fissure or Fracture: and if yet part of the Fissure or Fracture had lain undiscovered, you might have stretched your Incision to it: and in case after all there had been no Fracture nor Fissure, which often happens, especially in Contrafissures, than you might have laid the Hairy scalp down again, and easily cured it; which by an excision of part of the Scalp you cannot do.  
As to what may be objected, 
Objection.  that the raised-up Lip might be troublesome to the Chirurgeon in his work, and painful to the Patient; there is no such thing: for if the Incision be made the way proposed by the Ancients, and that the Fracture or Fissure be all in your view, you may order the Lips of the Wound as you please.  
The Cranium laid bore, you are to fill up the place opened with Dossils' of dry Lint, or pressed out of Read wine or Oxycrate, or a Sponge pressed out of either of the same Liquors; and apply a Plaster over all of diachalcith. malaxed with ol. ros. cum aceto, and bind it up.  
At the next dressing you must consider the Fissure. 
Trial of Fissures.  If it be so small, that you doubt whether it be one or not, than wet it with Ink, and wipe it of again, and the Ink will discover where the Fissure is. But if it do not, than this Emplaster may be applied: ℞ cerae novae flavae, thuris, ladani, an. ℥ ij. farin. fabar. terebinth. aceti, an. ℥ j Misce ad ignem. You aught to apply it on the suspected Part, and the next day, where you shall found it moist, there you are to rugine it.  
Fallopius tells us, that where the Cranium is contused, certain Spots will appear read, not unlike those white ones which are usual in the Nails of the fingers; but after the third day the blood exhales, and that redness ceaseth. If by the Emplaster you discover the Fissure, or that the Bone contuses, you are to rasp the contused Part the whole length: to which purpose you aught to be furnished with various sorts of Raspatories. Whilst you are working with them, the Lips of the Wound aught to be covered with some soft Linen, that you neither hurt them, nor yet the Air offend them. Sometimes very small Fissures, how inconsiderable soever they may seem, are the cause of the Patient's death, there being often found extravasated blood upon the Dura mater, and the Veins broken, either by the Concussion from the Blow, or by the rough edges of the inner Table. Therefore you are to consider the Symptoms, and accordingly lay open the Wound either by Raspatories, or otherwise cutting into it, so as the Sanies may be discharged, and the asperity taken away. 
Fracture in Cranio with depression.  But if there be a Fracture of the Cranium, you aught to satisfy yourself whether it be in one or both Tables: if in both, than, whether the Depression of the Bone be great, and what Fissure there is: and accordingly make way to relieve the Dura matter underneath; for it cannot be without great disturbance, viz. Inflammation, Fever, and Delirium; from whence Coma, Convulsions, Palsies, and Death ensue, if neglected. But if there be a Fissure so large as to discharge the Serosity, you may take more deliberation in laying it open, or rasping the Bone. If it be otherwise, than the Trepan aught to be applied, to give vent to the Serum, and to make way for the raising the depressed Bone. But if the Bone be not much depressed, and the Fissure considerably large, it is than at your choice whether you will enlarge that Fissure, or continued it for evacuation of the Matter, and forbear the use of the Trepan, not doubting but a small Depression of the Bone will either rise, or cast of, by the benefit of Nature. I know it will be hard to dissuade some Surgeons from applying a Trepan in this case; for I myself have been glad to comply with some of them, in setting on a Trepan where the Fissure was sufficiently large, and when all the ill Symptoms were remitted, and where there was no Depressure of the Cranium. But what did it signify? Indeed, where the Fissure lieth untowardly for discharge of Matter, or where the Depression of the Cranium is deep, there a Trepan aught to be timely applied.  
In order to the Perforation of the Cranium, 
Perforation.  the Bone must be cleared of its Pericranium, jest in setting on the Terebra, or Modiolus, (which are two several names for a Trepan,) you tear the Membrane. The Lips of the Wound aught also to be covered the while. The Terebra aught to be set on that side which is most depending. And in case of a Depression, make your Perforation so near, that you may afterwards be able to raise up that by it. When you have set on your Trepan, press upon it with your left hand, and turn it round with your right. You must use a little ol. ros. or Milk to 'cause it to move the easier, and as it fouls, brush it; in doing of which it will cool. Before you approach to the second Table, (which you may know by the blood that appears,) it will be required that you take out the Pin, and proceed more warily, not listening to the prattling of the Standards by, but often lifting up your hand, jest by your compression or haste you unawares fall upon the Dura mater, and wound it. Some Surgeons do bring out the Bone in the bore; but it will be safer to raise it up with your Levator, when it is so cut, that it is but lightly retained in some part. During this work, it is fit the Patient's Ears were stopped with Lint, jest the noise disturb him. The Room aught also to be close. The Perforation made in Cranio, and the Bone taken out, you are to smooth away the Asperity which remains in the lower Table by the Lenticular instrument made for that purpose.  
If after this the Membrane be fouled by the Sawdust of the Bone, 
First dressing after Perforation.  you must wipe it of with a soft Sponge, or a little Lint upon your Probe. The Part being cleansed, you are to dress up the Membrane. About this first Application Authors differ much. Avicen dressed them with Lenients, viz. ol. ros. Celsus dressed the Part with siccantia, viz. cum aceto acerrimo. You may found him positively for it in these words; His factis, (the Perforation being made,) ea membrana acri aceto respergenda est, ut si intus concretus cruor remanet, discutiatur, etc. He sprinkled the Membrane with sharp vinegar, to prevent the Bleeding, and dissolve the concreted Blood lying upon the said Membrane or Dura mater. But the most part of the Ancients, and many of the Moderns, have advised Lenients, as ol. ros. that the blood extravasated, and lying upon the Dura mater, in pus convertatur, may be digested. But in this you are to be guided by your Eye. If there be Sanies or Putrefaction, mel ros. spir. vini, and higher Detergents may be used, accordingly as the Putrefaction is more or lesle. If there be much blood extravasated, or that you fear bleeding, that of Celsus may be proper: but if the blood be recent, and exceed not in quantity, it possibly happened from some Scratch of your Trepan, or some little Asperity of the inner Table. If there be neither of these, but the Membrane fresh, and of its natural colour, than you are not to grieve that Membrane now exposed to the Air with Detergents, nor by the acrimony of Vinegar: for if you shall by scratching of the Membrane make it bloody, and than dress it with either acetum or mel ros. spir. vini, etc. you shall than proceed contrary to the common Indications in Chirurgery, which teacheth to digest recent Wounds before you deterge: and indeed what would you deterge?  
Therefore I do advice the use of Lenients, not only by the authority of those ancient and modern Surgeons, but by my own practice. Galen proposed sang. columb. and the blood of Turtles dropped warm from their wings. Falop. and Fabric. ab Aquapend. proposed ol. ros. with resin. abietis: and afterwards they increased the Resin, and lessened the Oil. But if there be Putrefaction through the long lying of concreted blood, etc. than mel ros. and spir. vini are proper, yea mel Aegyptiac. and higher if occasion shall offer. But in the common cases, after recent Terebrations, Resin by its emplastic quality mixed with ol. ros. perfects the concoction sooner, and by its anodyne quality secures the Part from Inflammation. It aught to be proportioned to the Habit of body: dry Bodies require more of the Resin, and lesle Oil. And by this simple Medicament I never failed of good Digestion; and afterwards by the tempering of it as I have said I have deterged and digested, always continuing the use of it until the Membrane was well digested, never finding the lest prejudice the bore Bone received from it. 
Caution.  But you must take care that you do not use Digestives unseasonably, for thereby you may relax Parts. Therefore after Digestion add more Resin, and lesle Oil. Or you may mix mel ros. with the Resin in stead of the Oil, which will answer your intention, both to deterge and incarn. Or you may use this to both purposes; its Composition will commend itself: ℞ terebinth. Venet. ℥ j ol. ros. ℥ iiij. mell. ros. ℥ iij. croci ℈ j granor. kermes ℥ ss. sem. hyperici ℈ ij. vini Hispanic. ℥ iij. coq. ad consumpt. vini; colat. add aloesʒj. Misc. These Medicaments may be applied upon the Dura mater, and a Button of Lint over, to fill up the hollow in the Bone: the rest of the Bone may be dressed with dry Lint or lineament. Arcei, and the Lips of the Wound with a Digestive as aforesaid cum terebinth. over which apply empl. diapalmae malaxed with ol. ros.  
In the use of Medicaments you are to consider the Part and Habit of body, and add or diminish your Simples accordingly as you design to deterge or incarn, etc. and so they will perform all intentions. Some Authors have limited us a time to dress with this or that Medicament; viz. to use Digestives to the fourth day, from that time to deterge to the seventh, and to incarn to the fourteenth day. But herein you must make use of your own judgement, persisting to cherish the native heat. If the Wound penetrates to the Dura mater, you must consider the force of the Weapon, and make haste to relieve the Parts under the Cranium. 
Observation.  Yet a day or two before the Battle of Worcester, a Gentleman attending the Earl of Derby in his Retreat thither received a large Wound between the sagittal and coronal Sutures by a Sword, it cutting through the Cranium to the Dura mater. The Membrane was covered with the small Shivers of Bones. He had only a thin linen Cap over it, his haste not permitting him to be dressed. And it may be it was the better for him: for if Dossills' had been hastily crowded upon the Bones, severe Symptoms would have followed; whereas the Shivers lying lightly upon the Membrane, he was free, and being ignorant of his danger, rid a great Journey. I after took them out, and dressed the Membrane with Digestives the short time we were together. 
Gun-shot.  But when Fractures are made with Bullets or Slugs, there the Hairy scalp and pieces of the Cranium are driven in together upon the Dura mater. In which cases you must presently lay open the Hairy scalp, and raise it up with the Bones, and relieve the oppressed Membrane. If the Flux of blood be great, cleanse it with a Sponge dipped in Read wine or Vinegar, and dress it as hath been showed. If the Opening in the fractured Cranium be not sufficient, make one in the most declining part, and raise up the Bones, and free the Membrane of whatever may offend it. But do not take out more Bones than needs must: like some of those Surgeons I have met carrying them about in their Pockets, boasTing in that which was their shame. For if you look well upon such, you may see many of them were corrupted by the Matter through the ignorance of the Chirurgeon. For recent Fractures of the Cranium do frequently unite like those in other Parts, if the Matter hath liberty to discharge from within. Therefore having raised up the Bones that are lose, dress the others dry with Catagmaticks, etc. and take care that they be not overgrown with lose Flesh, and they will happily agglutinate.  
It sometimes happeneth in great Concussions, that we lay open the Hairy scalp; and though we discover neither Fissure nor Fracture, yet we perforate the Cranium, to relieve the Patient: but if notwithstanding the Symptoms of Coma or Paralysis do not remit, you may shrewdly suspect the Extravasation of blood lieth deeper. For it sometimes happeneth in Concussions, that the extravasated blood lieth between the Dura and Pia mater, and otherwhile amongst the Ventricles of the Brain. In which cases, if the Perforation of the Cranium relieve them not, you must make Apertion through the Dura mater; and if the blood lie between it and the Pia mater, it may haply be discharged. How that is to be dressed, I shall show you presently: but for the most part, the long retention of Matter spacelates the Brain; and as the Patient suffered from the beginning under the severe Symptoms of Coma or Paralysis, so he dies at last Convulsive.  
In these Wounds of the Dura matter the Lenients of ol. ros. or warm Pigeons blood are proper: they are anodyne, and digest. Ol. hyperic. and Mastich are also good mixed with Resin. Fabr. ab Aquapendent. citys Galen, and he Archigenes, as dressing these Wounds with succ. calaminth. and afterwards sprinkling pulv. milii on the Membrane to incarn it; the milium moderating the heat of the other. He delivers them to us as siccantia, detergentia, and incarnantia, The Unition and Incarning of the Lips of the Dura matter is performed by a Fleshy substance that ariseth upon the Membrane, which afterwards, as it increaseth, doth unite them, and overspreading that part groweth up to the Cranium, and unites with that Callus, (after Exfoliation of the Bone,) and becomes one body with it, filling up the place that was perforated, and in time groweth more firm than the Bone itself. But the while you must be careful that your Lenients make not the Flesh too lax by their greaziness; for so a Fungus will thrust out thence, which may be vexatious to you. This in the beginning may be prevented by Desiccants, and wasted by Mercur. praecip. pulv. court. granat. ballast. ros. rub. or alumen ust. alone. But if it grow very big, it must be taken of by Ligature. Yet to tell you truly, I never met with any such like disturbance as is represented to us by Authors; nor shall you, if you use your Desiccants timely. For the Vitriol-stone takes this of with little pain, and disposes the Part to cicatrize, if it be used with moderation and timely.  
The Pia mater is (as I have elsewhere said) a most delicate fine Membrane, and adheres so close to the Brain, that it can scarce be hurt without a Wound in the Brain itself: which Wound is for the most part mortal, partly for that the Membrane is full of Veins, and subject to great effusion of blood; partly also because the Brain being exposed to the Air, is thereby overcooled, and corrpting groweth fluid, and is thrust forth by the contraction of the meanings, (or Membranes,) which are irritated by the constant pain they suffer from the putrefaction of the Brain; and so it happeneth that it worketh out at the Wound. So long as any remaineth in that Ventricle, you must make way to these Wounds by removing the shattered Flesh and Bones: but if they will not come easily away, leave it to Nature, jest the Patient die under your hands, and you be thought to hasten his death. Your Dress must be with Galen's Powder and Hares-fur cum albumine ovi upon Pledgits, to restrain the Bleeding, and retain the Brain within its bounds. Apply over them your Dress, as in the Wounds of the Dura mater: 
Note.  remembering in all these Gun-shot Wounds to cut of the shattered Lips of the Hairy scalp, jest a Gleet drop from them upon the meanings and Brain, and heighten the Accidents. If the Brain be retained within its Membranes, the Pia and Dura matter, and they digest and incarn, than you may proceed in the rest of the Cure as in Fractures of the Cranium, as hath already been said.  
In all Hurts of the Head, what sort soever they be of, the Body is to be emptied; and the rather, if there be Plethora or Cacochymia: for in such Habits of body Humours are more apt to stir up ill Symptoms. Therefore you aught timely to let them blood in the Neck or Arm on the same side; and repeat Bleeding according to the exigency, and the strength of the Patient's body. Also Cupping (with or without Scarification) of the Neck and Shoulders, with fontanelles under the Ears, is necessary. Than lenient Purgatives, such as may evacuate the serous blood, which by reason of its tenuity and heat readily flies to the affected Part. These Purgatives must be such as have been proposed in the Fourth Intention of Wounds in general, to which I refer you. Cordial Species and Electuaries may be proper, if they be proportioned to the Temperature of the body, hotter or colder, as there are Fever or other Accidents joined with the Malady; in which cases Juleps and Emulsions are necessary. Vulnerary drinks are sometimes in use here, if they be fitted according to the nature of the Part. The Ingredients for these are beton. artemis. caryophyll. primula veris, lilium convallium, salvia, hyperic. sanicula, veronica, plantag. flor. ros. rub. nuc. moschat. etc. as in the Chapter forementioned. Of these you may make Drinks with Wine and Water, or small Ale: ℞ sanic. beton. veronic. artemis. an. ℥ j cons. ros. rub. caryophyll. an. ℥ ss. tormentil. ʒ ij. coquantur in aq. font. & vini Rhenani an. lbij. lbij. vase clauso in B. M. colentur per manicam Hippocratis. Give ℥ iiij. of this morning and evening. Or take a few of each of these Plants well dried and cut, boil them, and than sweeten the Decoction with Honey or Sugar to the Palate of the Patient, and give him a Dish of it to drink twice or thrice aday. You may aromatize it with Sanders, cassia lign. or sassafras, etc.  
The external Applications have been already set down all along as I treated of the several Accidents befalling the Head, 
Externalls.  whether made by Contusion, or Wound affecting the Hairy scalp, Cranium, or meanings of the Brain. Yet for the more confirmation of the young Artist, I shall make a short repetition of what I have delivered concerning the Application of them, that he may not stagger in following the Doctrine here set down. I shall also supply you with more variety of Medicaments, that you may not be to seek for choice elsewhere.  
In every Contusion of the Head, whether a Wound be joined therewith or not, it will be necessary that in the first place you defend it from the Influx of Humours; and your Medicaments thereto aught to be refrigerant and exsiccant, to contemperate the heat, and dry up the Humours already extravasated. To which purpose Hippocrat. prescribeth this: ℞ far. board. ℥ viij. ol. ros. ℥ iiij. coct. in aceto ad consist. Cataplasmatis. In Winter he added flor. ros. rub. pulv. ℥ ij. decocted in Wine. Others have since added bacc. myrtill. & ballast. the more to corroborated the relaxed Part. Before the application of these the Hair must be shaved, and the Head and sides of the Neck embrocated cum album. ovi, ol. ros. & aceto. If there be a Wound with it, you aught to digest it with that ex terebinth. or this; ℞ terebinth. Venet. ℥ iij. ol. hypericiʒ vj. thurisʒ ij. vitell. unius ovi, Miso, or that of far. hoard. cribrat. ol. ros. & vitell. ovi. These aught to be spread upon Pledgits, and dipped in ol. lumbric. hot. The Fluxion restrained, apply Discutients in the form of Cataplasms, Cerots, or Emplasters; as empl. Vigonis, de beton. de gumm. elemi, de matrissylva, cerat. isidis: or, ℞ succi beton. ℥ ij. ol. ros. ℥ iiij. mastic. myrtillor. an. ℥ j pingued. hirci ℥ jss. coq. ad succ. consumption. colat. add gumm. elemi, takamahac. an. ʒx. terebinth. ℥ ijss. cerae alb. q. s. iterum bull. ad consist. Cerat. or, ℞ gumm. elemi ℥ iij. opopanac. ℥ ij. bdellii ℥ ss. resin. pin. ℥ j cerae q. s. fiat Ceratum. In all Wounds of the Head gumm. elemi is much commended; it mitigates Pain, and corrects the evil Temper of the Part by a peculiar virtue it hath thereunto. Fabr. ab Aquapend. commends this Emplaster: ℞ beton. virid. Mviij. contund. contus. add. ol. lbiiij lbiiij. cerae, terebinth. an. lbij. lbij. coquantur, & exprimatur; colat. add succ. beton. lb j. iterum coquantur ad succ. consumption. pro usu. And after Digestion of the Wound you may deterge with such like; ℞ terebinth. ℥ iij. mell. ros. ℥ ij. succ. plantag. apii, an. ℥ iss. coq. ad succour. consumpt. dein add far. hoard. ℥ j sarcocollaeʒ iss. And afterwards incarn, by adding myrrhae, mastic. aloes, an. ʒ ss.  
If the Contusion were without Concussion or Wound, and through want of timely repelling it it apostemate, treat it with Lenients, viz. ex rad. althaeae, flor. melilot. far. hoard. vitell. ovor. & ol. ros. And if it suppurate, open it, and dress it as afore said, with Digestives, Detersives, etc.  
If the Scull be fractured, lay it bore by cutting, and raising up the Hairy scalp, fill the Wound with Dossills', and apply over it the Cataplasm of Hippocr. or such like, embrocating cum ol. ros. etc. as hath been said. At the second dressing, digest it with ol. ros. cum resina, as before is directed. But if it be sanious, deterge with mel ros. spir. vini, etc. as you see cause, and dress the Lips of the wounded Scalp with this or the like: ℞ terebinth. lot. in aq. salviae ℥ j ol. ros. ℥ jss. gumm. elemi cum oleo super ignem solut. & colat. ℥ ss. croc. pulv. ℈ j vitell. oviʒ j Misc. By the speedy Digestion of this Wound you will facilitate your Cure.  
After Digestion, spir. vini will be found of good use, 
Spir. vini of what use in these cases.  it having such a siccant quality as is requisite for these Wounds, not only of the Calvaria, but of the meanings, either alone upon Lint, or mixed with mel ros. or syr. de ros. since. Or use this following; ℞ spir. vini ℥ vj. myrrhae ℥ ss. aloes ℥ j sarcocol. thuris, an. ʒ ij. or this Balsam; ℞ spir. vini lb jss. vin. malvatici ℥ xuj. myrrhae, thuris, an. ʒx. pulv. rad. consolid. ℥ j pulv. centaur. min. ℥ jss. flor. hyperici pulv. ℥ ss. terebinth. lb ss. infund. in balneo S. A. apply it warm upon the Meninge. If the Dura matter have changed its colour, and do not deterge with what is proposed, than ℞ terebinth. lot. in vin. alb. ℥ iij. mell. ros. spir. vini, an. ℥ j myrrhae, aloes, sacchar. alb. ʒij. Misc. If these Wounds tend to Putrefaction, scarify the Lips of them, and apply this or such like; ℞ Mithridat. ʒuj. theriac. Venet. ʒij. mell. Aegyptiac. ʒj. pulv. scored. myrrhae, an. ℈ j spir. vini q. s. The Putrefaction got of, you may than dress with this Johan. Andraeae à cruse: ℞ ol. terebinth. Venet. mell. ros. p. aeq. apply it warm. All these Medicaments are to be applied upon a Sindon to the Membranes. A Sindon is a piece of Silk or fine Linen cut round proportionably to the Perforation made in the Cranium, and is to be placed under the edges of the Cranium by the Lenticular Instrument, that those edges of the fractured or perforated Cranium hurt not the Dura mater. A Thread or Silk must be fastened to it, to pull it out at pleasure. Apply over it soft Dossills' of Lint, to fill up the voided space in the Bone, thereby to keep the Dura matter from rising above it.  
In Wounds of the Membrane of the Brain and the Brain itself, ℞ succ. beton. ℥ iiij. succ. calaminth. ℥ ij. flor. centaur. min. Pjss. hyperici contus. ʒij. vini odoriferi lb j. Infuse these three days, than boil them to the consumption of the Juices; strain it, and add to it terebinth. clarae ℥ iij. gumm. elemi dissolute. in spir. vini ℥ ij. ol. hyperici ℥ jss. mell. ros. ℥ iiij. boil these a little, than add pulv. myrrhae, aloes, sang. dracon. thuris, an.ʒj. Ol. Aparici prescribed in Wounds in general is an excellent good Medicament in recent Wounds of the meanings of the Brain. Fabr. ab Aquapend. proposeth this in Wounds of the Brain: ℞ far. milii ℥ ss. ol. Aparici ℥ j Mithridat. ʒuj. balls. Peruvian. ex Aegyptoʒiij. spir. viniʒv. and if it require to be more desiccant, he adds 
* Quaere, whether the dose of Chalcanth. be not mistaken, at lest if by is he mean ol. vitriol.  olei de chalcanthoʒjss. Drop this (saith he) warm and your Digestives over the Wound, than embrocate the Head and Parts about with ol. ros. and lay this Emplaster over all; ℞ far. hordei ℥ viij. pulv. cham. ℥ iiij. pulv. spicae, schoenanth. an. ʒiij. pulv. beton. stoechad. an. ʒij. ol. mastic. lb ss. ol. ros. ℥ iiij. oxymel. simple. ℥ v. vini alb. potent. q. s. fiat Emplastrum. If the Bone be carious, and do not readily exfoliate, you aught to rugine it, and dress it with lineament. Arcei. If that be too relaxing, ℞ spir. vini ℥ x. myrrhae ℥ j aloes ℥ jss. rad. peucedan. aristoloch. court. thuris, an. ℥ ss. pulver. & misceantur pro usu; apply it upon Dossils'. In dry Bodies this; ℞ pulv. aloes, pumic. ust. pomphol. an. ʒij. myrrhaeʒj. pulv. ostr. combust. ℈ ij. mix them with mel ros. & spir. vini, and apply this Emplaster over all; ℞ cerae, resinae pin. gum. ammoniaci, elemi, an. ʒuj. terebinth. ℥ iij. pulv. myrrhae, mastic. aristoloch. rotund. ireos, aloes, opopanac. euphorb. an.ʒj. ol. ros. q. s. fiat Emplastrum. After the Wound is incarned, you may cicatrize it with one of these, or such like: ℞ plumbi usti cum sulphur & loti, litharg. aur. an. ℥ ij. antimon. ust. & loti, cerussae, an. ℥ j ol. ros. q. s. fiat Vnguentum; or, ℞ calcis putaminum ovor. calcinat. ℥ ss. alum. ust. ʒj. croci Martis ℥ j fiat Pulvis. Thus I have set you down variety of Medicaments, whereof you may fit yourselves according to the exigency of the case. I shall now show you some of my work, wherein I used but a few.  
I Was sent for to a young fellow who had been shrewdly cudgelled about the Pate. 
1. Observat. of Contusion without wound or concussion.  He was sick in bed, and dozed with the pain. I looked upon his Head, and saw it swelled in several places: some of the Swell were big and pappy, abounding with extravasated Serum. I presently looked for the Jugular Veins, and seeing them full, I opened the fairest, and took away at lest a dozen ounces of blood: than caused the Hair of his Head to be shaved of, and embrocated all his Head, Neck and Jaws with a Mixture of ol. ros. myrtill. acet. cum album. ovor. and applied a Cataplasm over all his Head of far. hoard. fabar. flor. ros. rub. ballast. bacc. myrtill. decocted in Oxymel. A Clyster was that evening administered, and an Anodyne draught disposed him to rest that night. The next morning I was informed he had slept at times, but I found him hot, and his Pulse quick. I opened the other Jugular Vein, and seeing him bleed with a full stream, I permitted it to flow proportionably: than having a Fomentation ready of Claret-wine wherein had been infused flor. ros. rubr. ballast. nuc. cupress. etc. I took of Dress, and stuped them, and thought to have opened one of these tumors; but seeing it diminishing, I forbore, and embrocated his Head again cum ol. ros. myrtill. & aceto, and applied the Cataplasm as before. By these Applications I dried up the Humour in a great measure before the seventh day; than added some Cephalicks to the former Ingredients, and boiled them in Wine and Water, with which I caused his Head to be fomented, and afterwards applied Vigo's Cerat. ad contus. During the first seven days I permitted him only Water-gruel or Panado, and kept his Body soluble by Clysters; but afterwards gave him more liberty, and purged him: by which method he recovered, without any manner of laying open. And thus all external Contusions may be happily cured.  
A Person of Quality, 
2. Observat. of Contusion with an Ecchymosis opened.  aged between thirty and forty years, by accident of a Fall out of her Coach bruised her Head a little above the right Temporal Muscle. She was stunned with the Fall, but did not vomit. She was dressed by some of her Servants with such Medicaments as those of her own Sex advised. About fourteen days after, being indisposed, she came to Town, and sent for me. I saw a large Ecchymosis remaining, and a Tumour of the bigness of a Pheasant's egg: it was soft, and seemed to be full of a corrupt Serum. There appeared no hopes of discussing it, and yet it was not safe to permit it to lie longer so near the Bone. Wherhfore I applied a mild Caustick upon it, and dividing the Escar gave vent to the Serum and some Clots of grumous blood; than fomented it with Wine, and dressed it up with a Dossil spread with a Digestive ex terebinth. and unguent. basilic. over it upon the Escar, and embrocating the Parts about with ol. cham. applied empl. diapalm. with Compress and Bandage. At the next opening I saw the Ulcer well digested, and no part of the Bone bore; nor was it painful in the time of dressing or afterwards: yet from the first day I dressed her, she usually fainted the while, and put us upon a necessity of laying her down in her Bed some time before we had finished our Applications; where after she had lain an hour or two very sick, she recovered again, and walked about her Chamber very well. Her Friends and Relations, who visited her often and saw her thus distempered, suspected it to arise from the Wound, but I supposed it Vapours, and prevailed with her to consult a Physician. The Physician being come, I took of Dress, and shown him the Ulcer well digested, and disposed to heal, without the lest sign of ill: the Physician also concluded so. But before I had dressed her up, she fainted, and was carried to her Bed sick. These Faintings increasing, her Physician began to suspect it proceeded from the Contusion; but her recovering again so well afterwards, confirmed him that they were Vapours, and that by Purging she would be relieved. She complied, and was moderately purged once in 3 or 4 days, whereby she was somewhat freed of these Fits, and I had liberty to cicatrize the Ulcer. After which I made her a fontanel in her Leg, and she retired to her House in the Country, where she took Physic, and recovered perfectly well. If these fainting Fits had proceeded from the preceding Contusion, they would not so have intermitted and gone of as they did.  
A person of about 36 years of age was wounded upon the Road by a Blow with a Spintree-bar upon the Os frontis, near the coronal Suture, 
3. Observat. of a contused wound.  about the length of two inches. I cleansed the Wound with a Sponge, and clipped the Hair away: than putting my Finger into the Wound, I felt the Pericranium sound and smooth; and seeing no Symptoms in the Patient of Fracture or Concussion, I brought the Lips of the Wound close together, dressed them with a Digestive ex terebinth. upon Pledgits with an empl. è bolo, and Compress over it, putting him on a linen Cap, and his Peruke over that. I forbore to let him blood that night, in consideration that he had bled much upon the Road. The next morning, finding him in good temper, I did neither let him blood nor dress him; but the day after I took of Dress in the presence of Dr. Cox and Dr. Walter Needham. The Wound seeming near closed, I applied a Stupe or two wrung out of Read wine, and dressed him with lineament. ●rcei. The second day after I viewed it again, and seeing the bruised Flesh between the Lips of the Wound cicatrizing, I dressed them with unguent. tutiae, and continued to do so every other day. During his Cure, he kept his Chamber, and was healed in very few days; whereas if his Wound had been filled with Dossills', a Fever would have followed, and other Accidents which would have confined him longer to his Chamber.  
A Coachman being wounded with a Rapier to the Bone between the sagittal and coronal Sutures about an inch in length, the next Barber dressed him, 
4. Observat, of a wound betwixt the sagittal and coronal Sutures.  and called in a young Chirurgeon to help him. They (as they said) felt a Shiver of the Bone cut of, and sticking in the Pericranium; whereupon they divided the Pericranium, and laid the Bone bore, filling the Wound up with Dossills'. The fellow being of a full Body, and the blood fermenting, a Fever followed, and the seventh day the Lips of the Wound and the Parts about were inflamed and swelled. They than dressed the Bone with Dossills' dipped in spir. vini & mel ros. and deterged before they had digested; by which the Bone was stained, and a necessity followed of exfoliating it: whereas such an incised Wound might have been incarned by lineament. Arcei. But this practice will not want those that will defend it: and who can help it?  
A poor Woman near Ludgate coming out of her Chamber one night, 
5. Observat. of a large wound of the Calvaria.  and pulling the Door to her by the Key, it slipped out, and she tumbling down Stairs, cut and raised up the Hairy scalp from the beginning of the Lambdoïdes downwards. I caused the Hair to be clipped and shaved away from about the Wound, and cleansed it from the blood, than brought the Lips close together by three or four Stitches, embrocated the Parts about cum album. ovi, aceto, & ol. ros. and dressed her up with Agglutinatives, applying over all empl. è bolo and Bandage; than gave her an Anodyne draught, and left her to rest. The next morning I took of my Bandage and emplast. and embrocated the Parts about with ol. ros. cum aceto, applying a Cataplasm ex farin. hoard. & fabar. decocted in Oxycrate, and adding ol. ros. I took away a little blood by opening a Vein in her Arm, and prescribed her a Clyster of Milk and Sugar that afternoon. I continued the Cataplasm morning and night, but dressed not the Sutures till the third day; and by that time the Tumour being diminished, and the Wound inclined to Agglutination, I dressed up the Wound again as before. At the next opening I cut out the Stitches, and dressed the Wound with sarcotics and empl. beton. over all, in stead of the Cataplasm; and in a few days cured her of that Wound by Agglutination.  
A Young fellow, 
6. Observat. of the Calvaria torn of.  Servant to a Horse-courser, was thrown of his Horse against some of the Bars in Smithfield, whereby the Calvaria or Hairy scalp was torn up from the coronal Suture to the Temporal Muscle, on the left side; the Scull was bared between two and three inches in breadth. He was led to the next Barber, who cut the piece of, and hanged it up in his Shop. The day after the Patient was brought to me. I caused the Hair to be shaved of from about the Wound, and dressed the Bone and Lips with lineament. Arcei warm, embrocated the Parts about cum ol. ros. & chamaemel. and applied empl. è bolo over the Wound, with Compress and Bandage rolling up his Head. He had been let blood the day before, without consideration of the great quantity which he had lost from his Wound. I continued the former way of dressing the Wound and Bone, until they were well digested: during which the edges of the Bone incarning round, I rasped the middle of the Bone, and thereby disposed a Callus to put forth. After Digestion, I deterged with mundif. Paracelsi; and as the Callus thrust of the Bone, I dressed it with Pledgits dipped in spir. vini pressed out dry, and afterwards by Epuloticks, as unguent. tutiae, etc. cicatrized the Lips of the Wound even with the Callus which risen from the Bone; and about that time, to dispose it the better to cicatrize, he was purged. Thus it was cured as Wounds with loss of Substance; a troublesome and vexatious work to the Patient and Chirurgeon; which might at first have been cured by Agglutination, with a lesle Cicatrix, and thereby he might have enjoyed the natural tegument of his Hair, whereas now that part remained bald and unseemly.  
A Servant of the King's, 
7. Observat. of a contused wound.  of about 28 years of age, being distracted, and suspicious that every man he saw would do him a mischief, walking abroad one day, thought himself pursued, and ran into the next house up 2 pair of Stairs into a Chamber, when hearing some body following him he threw himself out of the Window just as a Coach was passing by, and pitched with his Head upon one of the Wheels. He was taken up stunned and shrewdly wounded, carried into the next house, and dressed by a Chirurgeon, who also let him blood. The next day I was sent by his Majesty's command to take care of him, and saw the Dress taken of. His Wound was between the sagittal and coronal Sutures to the Bone, with great attrition of the Hairy scalp. I considering the manner of his Fall, with the Frenzy and Stupour he lay under, opened his Wound by a cross Incision, and cutting of the corner'd Lips, dressed it up with dry Dossills' of Lint, with Astringents and Bandage. I directed a Clyster to be administered that afternoon, and let him blood that night, repeating it again the day after. Dr. Walter Needham prescribed him an Emulsion of the cold Seeds, etc. to drink often in a day. By all which he was notably relieved, and recovered his Senses soon after. I opened his Wound the third day, and saw the Cranium smooth and natural, the Lips also tending to Digestion. I fomented it with a Stupe wrung out of Claret-wine, and dressed it up with a Digestive ex terebinth. cum vitello ovi, and embrocating the Parts about cum oleo ros. applied emplastr. diachalcith. with Compress and Bandage. After I had thus digested the Wound, I rasped the Cranium to the quick, dressing it up with unguent. Arcei, and the Lips of the Wound with unguent. diapompholyg. and by the help of the Vitriol-stone I deterged them: and as the Callus grew up out of the Cranium to unite with the Lips, I dressed it with Pledgits pressed out of spir. vini, cicatrized it, and restored him cured.  
A Cookmaid, by the fall of a Jackweight upon her Head, 
8. Observat. of a great contused wound.  was beaten down, and stunned for some while by the Blow: she vomited, and was carried into her Chamber. There were three Wounds in the Hairy scalp to the Cranium, with a great Tumour. The Bone seemed to me to be depressed and fissured. I presently made a circular Incision, and raised up that part of the Hairy scalp in order to Terebration, and filled up the Wound with Dossills' of Lint pressed out of Read wine; than embrocated her Head with ol. ros. cum aceto, and put on an empl. è bolo with Compress: than shaving the Hair from the Parts about, I applied Pledgits spread with my Digestive upon the Lips of the Wound, Compresses dipped in Oxycrate, and rolled up her Head. Some hours after I caused her to be let blood about eight ounces, and that night gave her ʒuj. syr. de meconio in a draught of aq. papaver. with a little aq. cardiac. The next day I took of Dress, and viewing well the bore Bone, I found neither Depression nor Fissure. I was deceived by the shape of her Head, she being double-crowned, the Tumour great, and the sagittal Suture running underneath. I fomented the Parts affected with vin. rubr. wherein were decocted flor. ros. rub. cham. flor. beton. summit. absinth. bacc. myrtill. etc. than dressed the Bone and Lips, the former with lineament. Arcei warm, and the latter with my Digestive ex terebinth. dipped in ol. hyperici warm: and having embrocated her Head well with ol. ros. & cham. I applied a Cataplasm exfarin. hoard. ulu. ballast. & ros. rubr. dococted in Oxycrate cum ol. ros. with convenient Bandage. This method I continued till the Wound was digested, and the Tumour wasted. Than I deterged the Lips of the Wound with mundif. Paracels. and the Vitriol-stone, dressing the Bone with sarcotics, and applied over all one of Vigo's Cerots in stead of the Cataplasm. By this method the Bone incarned; after which she retired with Medicaments to be dressed by some of her Fellow-servants at her Master's house a few miles of. She sometimes came to Town, and was assisted by me in the cicatrizing of the Wound, so as hath been showed in the former Laceration of the Calvaria. I did not believe so great a Blow could have been without a Fracture and great Accidents; otherwise I should not so presently have raised of the Hairy scalp.  
A Tradesman returning from visiting some of his Friends in the Country, 
9 Observat. of concussions on the Forehead and Face.  near Knightsbridge fell of his Horse to the ground, bruising and wounding his Forehead and Face. He was taken up as dead; but some while after recovering life again, they put him into a Coach, and brought him to his house. I found him in his Bed labouring under a great Concussion. He was not capable of giving any account of his Ailment. His Face and Nose were much bruised; there was also a Wound upon the Os cribriformis. I caused the Blood and Gravel to be washed out of his Wound, and with my Knife laid it open a little higher up towards the Forehead. Than viewing the Bone, and seeing it without Fissure, I brought the Lips close together, and dressed the Wound with Agglutinatives, and empl. è bolo over it and his Face; and having caused the Hair to be shaved of the forepart of his Head, from the coronal Suture down to his Ears, and embrocated the diseased Parts with ol. ros. cum aceto, I applied a Cataplasm of farin. hoard. pulv. flor. ros. rubr. ballast. bacc. myrtill. decocted in Oxymel, than let him blood 10 or 12 ounces. A neighbouring Physician visited him that night, and prescribed him what he thought necessary. The Patient lay dozing all that night, groaning frequently, and was not better in the morning: he spoke not willingly to any of us, nor so as we could understand what he said. That day I took of Dress, viewed and felt the Parts about. The left Eye was inflamed, the Lid swollen, and the Forehead bruised. I was not able to make out any thing whereby I might take new indications; and therefore dressed him up again as before, ordering a little Breast-milk to be dropped warm into his Eye, and renewing the Embrocation and Cataplasm. That day he was let blood again, and a Clyster administered, with what else his Physician thought necessary. The next day he being nothing better, the deceased Mr. Boun a Chirurgeon was consulted. We took of Dress, and viewed the Wound. The Bone was fair, without the lest impression. Mr. B. concluded that the Wound should be cured without farther enquiry into it; which accordingly was done in few days after without Exfoliation. Blistering of his Neck and Shoulders, and Cupping with Scarification was made; also fontanelles behind his Ears; Fomentations and Plasters were likewise applied to his Head: but the relief was small. Yet by these and frequent Purging, after a month or 6 weeks, he was so well as to get abroad, but was indisposed in his Head. His Eye was cured; but after he had followed his affairs abroad some weeks, on a sudden that Eyelid fell down, and some months after he lost the sight of the Eye without any outward soarness, it being the effect of the Concussion. He was alive at the time of the Fire, and may be so still for aught I know. If aught was omitted for his Recovery, it was farther Bleeding.  
A Gentleman of about 30 years of age, 
10 Observat. of another Concussion, with a broken Leg.  coming out of Hartford-shire through Tottenham, and riding upon the Causey near an Inn, one emptying a Chamber-pot out of the window as he was passing by, his Horse started, and rushed violently between the Signpost and a Tree which supported part of the Sign. The poor Gentleman was beaten of his Horse, and lay stunned on the ground. The people fetched immediately a Barber-surgeon from London. Sr. T.B. upon notice of his Friend's mishap, sent me thither; where I found the Gentleman lying upon the ground, the people and Chirurgeon gazing upon him. I felt his Pulse much oppressed, the right Brow bruised, and inquired whether they had let him blood. The Chirurgeon replied, he had opened a Vein in his Arm, but it would not bleed. I replied, We must make him bleed, though it be by slitting his Veins. Turning his Head on one side, I saw the jugular Vein on the bruised side turgid, and opened it. He bled freely. After I had taken about twelve ounces, the blood ran down from his Arm, which had been opened before and would not bleed. We bled him till he came to life, and than he raved and struggled with us. Having stopped the Bleeding, we caused the people to carry him into the Inn, and put him into a Bed. All the while they carried him, and were making him unready, he roared and was very unruly, especially whilst they were pulling of his Stocking from his right Leg; which enquiring more particularly into, we found broken short in the middle of the Thighbone, close by a bony Wen, (of the bigness of a Tennis-ball.) 
A great bony Wen.  Upon sight whereof we prepared Dress, and endeavoured to set the Fracture. He opposed us mainly in the setting of it, and dressing it up. But some of the people holding him down in his Bed, we set and dressed his Leg as is showed in the Lecture of Simple Fractures. But his Hands being at liberty, he loosened the Bandage which we had put on the fractured Bones in spite of our resistance. We contented ourselves in what we had endeavoured, and from that time left his Leg to lie unset, he not permitting so much as a Plaster over it. We than prepared Applications for his Head, shaved the Hair from that side of the Temporal Muscle, embrocated the part which seemed to us affected cum ol. ros. & aceto, and applied a Cataplasm of Bean-meal (which was speediest to be had) boiled up with Oxymel, etc. he permitting it patiently. That bound on, I left my Assistant to stay with him, and returned myself to London. The next day Sr. T. B. sent for Sr. Charles Scarburgh, and carried us with him to Tottenham, where we found the Patient raving, and by their report he had done so all night. We understood not one word he spoke. His Pulse was low and intermitting. Upon which consideration Venaesection was deferred. What was necessary for him to take, the Physician than prescribed. His Bruise was upon the Temporal Muscle, a Part not to be laid open upon a bore Surmise; wherefore we renewed our Embrocations and Cataplasms, and left my Assistant to wait upon the Patient, Sr. Charles Scarburgh making a Journey farther into the Country. The next day I returned, and finding the Patient raving as I had left him, I supposing his Distemper proceeded from an Inflammation of the Membranes of the Brain, and that by Venaesection only he was to be relieved, I let him blood on the same Jugular as before about 10 ounces, and so proceeded every day, or second day at lest, the Patient bearing it well, and seeming to be relieved. His Pulse risen upon it, and he slumbered sometimes, and took his Nourishment, which before he did not. About the seventeenth day I coming to Tottenham met my Assistant going to London, who told me that the Patient was grown more sensible of his fractured Thigh. I persuaded him back, rejoicing to hear that the Gentleman was so well: but coming near his Chamber, I heard him hallowing. It troubled me what to do. I knew his Bleeding had much relieved him; but the people, as also my Assistant, disliked my so often letting him blood, and was want abusively to say, Now you shall see our Master let him blood again: they concluding that I would be the death of the Patient. However I resolved to bleed him once more, and no more. This I declared, with the necessity of doing it, and accordingly opened the same Vein again, and held a white Stone-porrenger to receive the blood, which flowed with a sprightly stream, the Patient lying quietly the while upon his Back. I put the Porringer into my Assistent's hand, and seeing the blood flow with much Vigour, I catcht up hastily a Pewter-porrenger, purposing to take a little in that. (In bleeding these Veins in the Neck, we usually holding the Porringer close to their Neck, it serves us as a Bandage to intercept the descent of the blood.) I put this Porringer into my Assistent's hands, with pretence to make Dressing to lay upon the Vein; but stood at a little distance, looking my Patient in his Face, with a resolution to bleed him until I saw his Countenance change: which I did, and than stepped to the Patient to stop the Vein. The while the Porringer was taking away, the blood ran out of it on one side, it having been melted, and the hole so covered by Soder that I did not see it before. During the while he was bleeding I thought him long, and wondered to see so little blood in that Porringer from so full a stream: but seeing the Bed so bloody, it was evident that when the melted hole pressed not against his Neck, the blood ran into the Bed, which deceived me. But the Patient upon taking a little of his cordial Julep refreshed his Spirits. I sat a while by him, and left him pretty hearty. The next day I returned sooner than I used to do, being doubtful how I should found him: but, to my wonder, he was perfectly well in his Senses, and discoursed soberly of what passages he remembered in the time of his Delirium. We presently prepared to set his fractured Thighbone, it having lain seventeen days unset, yet was without Inflammation, Tumour, or Pain. The Callus I suppose was thrust out at the ends of the Bones, and that had covered the asperity of them, and the large Bleeding and Disease had made Revulsion and Evacuation. We brought the ends of the Bone together by an easy Extension, and dressed it up as is usual in simple Fractures. In lesle than twenty days the Callus dried, and his Leg was so strong as to bear him again: and some weeks after he went abroad about his affairs.  
A Youth about ten years of age was struck down by a blow of a Cudgel on his Head. 
11. Observat. of a Fracture with a long Fissure and depression of the Cranium.  I found him lying upon a Bed deprived of his Speech and the use of his Legs. Taking the Plaster of his Forehead, there was no Wound nor considerable Swelling; but searching with my Fingers I felt a Depression of the Bone: upon which having advertised the Parents of the danger of the Child, and the way of my proceeding, I sent for the Chirurgeon dwelling at the next door, who had applied the first Plaster, desiring to retain him for the more constant attendance. We made Dress ready in order to Dilatation; than causing the Hair to be shaved of, I made an Incision so large as to set on the Terebra, if occasion should be, for the raising up the depressed Bone. In dividing the Hairy scalp towards the coronal Suture, I espied a Fissure running up from the fractured Bone beyond my first Incision; wherefore I laid the Fissure more open, out of which I saw a quantity of serous blood flow immediately forth. The Depression was a piece of Bone as broad as a Threepences sunk under the Scull. I filled up the Opening with Dossills' of dry Lint, and applied over all a Digestive ex terebinth. & vitell. ovi upon Pledgits, and empl. è bolo, with Bandage to keep them on. The next day in the presence of Dr. Barwick and some Country Physician with Mr. Arris Chirurgeon, I took of the Dress, and set the Trepan above the fractured Bone, so to avoid the great Scar that must have been if I had set it below the Fracture, and considering withal the Poriness of the Bone below. The Terebra set on, the Bone taken out, and the inner edges smoothed by the Lenticular instrument, I put in a Levator, and raised up the depressed Bone even with the rest: that done, I placed in a Sindon dipped in ol. ros. with a third part of Resin; than with a round Dossil filled up the Boar: after which I opened the Fissure with my Rugines, scraping away its edges, that no Sanies or Matter might be detained, and dressed up the Bone with lineament. Arcei warm, so as to give way to the Lips to fall in; I desiring not more Opening than was necessary for discharge of the Matter from within. Over these Dress I applied empl. diachalcith. malaxed cum ol. ros. & aceto, and with Compress and Bandage concluded the second Dressing. From that time all our threatening Symptoms vanished. Indeed the first Opening and letting blood that same night recovered his Speech; and after this Dressing the use of his Legs was also restored: yet we kept him in the dark, and to a slender Diet, allowing no Flesh. What concerned Internalls Dr. Barwick took care of. The other Physicians and Mr. Arris coming no more, I continued the same method in my dressing until Digestion, which was made in 4 or 5 days. Than I added mel ros. in stead of the Oil, and afterwards incarned, by increasing the Resin and lessening the mel: the Flesh rising in little grains presently after the Digestion was completed, and after a few days covered the Dura mater. I hastened the Exfoliation of the Bones by the application of tinctura myrrhae, and deterged the wounded Lips with mundif. Paracelsi. My work being afterwards to keep down the lose Flesh, I rubbed it frequently with the Vitriol or Alume-stone, and dressed the Lips with unguent. tutiae, etc. whereby in lesle than six weeks the Bones exfoliated, and the Wound being ready to cicatrize, I left it to the neighbouring Chirurgeon; the cicatrizing of these being for the most part the work of my Servant.  
A person was wounded near the Vertex (by a Blow I told you in the former Edition, but have been since informed it was) by a Puncture of a Dagger. 
12. Observat. of a contused wound by a Puncture in the Crown.  He sent for a Chirurgeon, who dressed his Wound and cured it; during which the Patient went daily abroad without any consideration of it. About the seventeenth day, towards the Full-moon, as he was coming home one morning, he felt his Legs falter, and before he was got up stairs into his Chamber his Tongue failed him. His Friends and Servants put him into bed, and sent for me. They declared to me how he had been wounded such a day, and the manner of his being seized with the Paralysis. I saw a necessity of laying open the Hairy scalp, and offered to go away, that I might sand for some of my Servants to help me. He apprehending that I was leaving him as deplorable, catcht hold of me, and would have spoke to me, but could not. He made Signs for Pen, Ink and Paper, and endeavoured to writ, but could not form one letter. He than threw himself down in his Bed, breathing out Jes. I prayed his Patience, telling him I would return suddenly. But before I went I let him blood ten ounces, and returned again within an hour, and found that he had lost the use of his Arms. I considered the Wound, and concluding a necessity of setting on a Trepan, I caused his Head to be presently shaved, and made a circular Incision about the Wound. Than raising up the Hairy scalp smooth of with my Spatula, I both saw and felt the Bone, but could discover no fault in it. I dried up the blood with Sponges dipped in Vinegar, raised up the Lips round with my Spatula from the Bone, and with a fresh Sponge having dried up the blood, I looked again under them; but could discover nothing ill in the bared Cranium. I than filled up the Wound with Dossills' of dry Lint, and applied a Digestive ex terebinth. over the Lips, embrocating the Parts about cum ol. ros. and laid on a Cataplasm è farin. hoard. flor. ros. rubr. ballast. in vino rubr. with syr. de ros. sicc. etc. That day Sr. Fr. Pruj. gave him a visit, and prescribed him a Clyster, Cordials, Juleps, and what else he thought necessary. The next day was Full-moon, at which time the Brain is thought to rise high, and the Vessels are turgid; wherefore I deferred the setting on the Trepan, contenting myself with the letting him blood again. All this while he was in a Fever, and deprived of his Speech and Limbs. The next morning, between 10 and 11 of the clock, in the presence of Sr. Fr. Pr. Sergeant Pyle, Mr. Arris and Mr. R. who thought himself concerned for his Servant, and had first dressed him, I took of Dress, and looked into the Wound. We found no Fissure, however there was a necessity of perforating the Cranium. Wherhfore without delay I began to work with the Trepan, which I much prefer before a Trephine, it being an Instrument which doth its work lightly, and cutteth the Bone equally, or how you please, without pressing so heavily upon the Head, and is approved by all the Surgeons abroad, being much to be commended before the Trephine. After I had bored the Bone, and taken it out, I looked into the hole, and seeing the Dura mater retaining its natural colour, without Matter or Blood, I dressed it up with a Sindon dipped in ol. ros. with a little Resin warm. This way of dressing was objected against, as I expected; but I dressed it up, and assured them that I would cure this Patient without applying any other Remedy to the Dura mater than these two simple Medicaments: but withal, I was much unsatisfied in myself, that such grievous Symptoms, as loss of Speech and Limbs, with a Fever, should afflict the Patient, and yet not depressed Bone or Fissure, nor aught of Matter or Sanies appear upon the Dura mater. This, I say, troubled me much, I fearing some other place, or that the blood lay putrefied under the Dura mater. But I dressed it up with a soft round Dossil next the Sindon, and the Bone with lineament. Arcei, continued the Digestive to the Lips of the Wound, and applied an empl. de beton, mag. over all, than laid him down in his Bed. Going presently out of his close Room (where I was crowded up with great Lights burning near me) into the fresh Air, I presently burst out with a violent Coughing of blood: yet the next day I dressed the Patient again, and found his Speech and Limbs restored; but he was hot, and his Pulse quick. I opened his Wound, and finding all as well as I could expect, I dressed up the Dura mater again as before, with the same Oil and Resin: and after I had bound him up as is usual in these cases, I let him blood 10 ounces, and advised the repeating of Clysters, etc. as occasion should offer. The Physicians and Surgeons visited him no more after the first Dressing; but I retained the young Chirurgeon that had first dressed his little Wound, he dwelling near the Patient. After three or four days dressing, this Wound digested, and all the Symptoms went of. Upon which consideration I diminished the quantity of the ol. ros. and increased the Resin; making good my word in curing him with those simple Medicaments; I deterging and incarning as firmly and speedily this way as by any Sarcotick I ever used. While the Bones were casting of, I cicatrized the Lips as hath been set down in the preceding Observations. Coming one day to dress him while the Wound was cicatrizing, he being abroad, I substituted the young Chirurgeon in my place; yet I saw him twice or thrice dresed afterwards. He was well cured, and remaineth so to this day.  
I was called to consult with Dr. Tho. Cox about a Gentlewoman who was grievously diseased with a great Pain between the coronal and sagittal Sutures, 
13. Observat. of a Concussion of the Brain.  occasioned by a Blow she had many months before received riding under a Penthouse. The Blow had stunned her, yet she recovering her Senses was brought to London, and viewed by some Surgeons of the City, who cured her little Wound, and returned her back: but from that time her Pain increased daily with a Vertigo, and she returned again to London. We judged it to arise from that Blow, and concluded the extravasated and putrefied Blood had caused that Pain. We viewed the Hairy scalp, and took notice that it was thicker in the upper parts of it than was usual; but we could not distinguish with our fingers any inequality under it in one part or other. The Humour was pituitous, and yielded to the pressure of the Finger, as such Swell do. She endeavoured to point to us the place with her Finger, but could not fix it within so narrow a compass as we might certainly relieve her by laying it open. At that Consultation we resolved to begin with Fomentations and Cataplasms to discuss the Humour, and to make Derivation by Bleeding, Cupping, Blistering, and Purging: all which was afterwards done; but proving ineffectual, we proposed the laying open that part of the Scalp which appeared to us most suspicious, and to set on a Trepan: but she would not admit of it. At length, feeling herself languishing, she yielded to the making a fontanel in the Part most affected by a Caustick. Which I did, and by Dr. Cox's consent I made it to the Bone, and so large, that I might afterwards set on a Trepan; and than dressed it with Lenients. After separation of the Escar, there appeared neither Fracture nor Fissure. We moistened the Bone with Ink, and rubbed it out again: but no mark of the Ink remaining, I rasped it; and no Crack appearing, I sprinkled the Bone with pulv. myrrh. aloes, etc. and dressed the Ulcer with basilic. etc. Her Pain increasing, with other Indispositions which threatened her life, she yielded to the application of a Trepan; which accordingly I set on, and opening the Scull, found the Dura mater retaining its natural colour, but a smell arose from within as in corrupt Wounds of the Brain. I dressed it up with Lenients as the former, viz. ol. ros. and a little Resin. The next day I dressed her again, and found the Wound digesting; yet was she extremely stupefied with the excess of pain in her Head. The third day I dressed her again, and in the Opening found good Digestion, and a beginning to incarn, a little read Flesh arising upon the Dura mater. The next day it was increased, and so the next: but when I opened it a day or two after, I found the Lips of the Wound sinking, and little Matter; but that which appeared was of good colour. The Dura matter seemed drier, the little ruddy Flesh was not increased. The next day the little Flesh upon the Dura matter beginning to look pale, I than left of the ol. ros. and added mel ros. to the Resin, with a little pulv. myrrhae, and a few drops of ol. terebinth. and dressed the Lips of the Ulcer with unguent. basilic. mag. Vigon. cum ol. terebinth. warm, laying over the bared Cranium Lint dipped in a Tincture of Myrrh, Aloes, etc. and applying empl. melilot. with a good Compress wrung out of a Lixivium wherein was boiled some of the greater Cephalicks, as flor. anth. beton. majoran. origan. etc. But that night she was seized with Convulsions, and the day after the Lips of the Wound appeared without heat; all things looked ill; and she died within a day or two after. We would have opened her Head, but she had forbidden it: but in bowing her Head a putrid Matter of a brown colour flowed forth her Nostrils, of the same smell that I complained of in Trepanning the Bone, only more foetid. I believe this Putrefaction proceeded from the corrupt blood extravasated between the Pia and Dura mater; which at first by large Bleeding and proper Applications might have been relieved. Nay possibly, if we had timely opened the Dura mater, this Matter might have there discharged itself. But if it had been attempted, and not succeeded, her Death would certainly have been imputed to that.  
A little Girl was brought to me with a soft Swelling upon the left side of her Head, about two fingers of the Temporal Muscle, 
14. Observat. of a large Fissure, the Dura matter putrefied.  of the bigness and shape of half a great French Walnut. This Swelling happened from a Fall down a pair of Stairs some weeks before: but, whether through ignorance or negligence, the Fracture was not suspected by them, though there were visible Symptoms of a Concussion, as that of Vomiting, etc. The Child even languishing of it, I acquainted the Mother, that the only way to relieve her Child was by opening that Tumour wide, and afterwards I supposed that there required as much to be done to the Scull underneath. She prayed my help, and submitted to the laying open the Swelling, or what else I should think fit to be done. The way of opening this in a stronger Body had been, to have cut round the Tumour, and raised of the Skin: but the Child was so weak, that I feared it might the while die under my hands. Wherhfore, to avoid that danger, I applied a mild Caustick, and delivered the Child to her Mother, who bound on the Dress, and carried her home. About two hours after I took of the Caustick, and finding it had worked well, I divided the Escar, and discharged about three or four Spoonful of a filthy Sanies. I took of this Caustick the sooner, suspecting jest it might by longer lying penetrate through, and offend the Parts within. Upon dividing this Escar, the Bone appeared bore the whole length, and a long Fissure ran transverse over from the Temporal Muscle backward: the Scull was very thin, yielding to the lest pressure of my Finger, as a piece of velum; so that I might have enlarged it with my Knife, if I had thought it necessary. I bowed the Child's Head on one side, and dropped in a little mel ros. with a few drops of Tincture of Myrrh, Aloes, etc. and with Pledgits dipped in the same lightly covered up the Bone. Than dressed up the Escar with unguent. basilic. malaxed cum oelo liliorum, and laid a cephalick Emplaster over all, with convenient Bandage. I continued the same method of dressing daily, and saw pieces of the Dura matter purge out, and hung in the fissured edges of the Bone; and for some while a thin Ichor issued thereout. The Escar being separated, I dressed the Lips with mundif. Paracelsi, and the Bone with lineament. Arcei, dropping into the Fissure the Balsam prescribed by Vigo; by which it incarned, and, as the Bone exfoliated, united with the Lips of the Ulcer. There was a Tumour behind the Ear before I began the Cure: but by embrocating it with ol. ros. daily, it went of after the Digestion of the Ulcer above. Thus this Infant was cured: but she being the product of a diseased Mother, grew lame about a year after of a Pain in her right Hip, whether it happened by accident of a Fall, or that it was Strumous; but when I saw it, it was dislocated. I suppose no rational man will believe this Accident on her Head occasioned that Defluxion on her Hip.  
A Gentlewoman fell down with her Child of half a year old in her Arms. 
15. Observat. of Caries through the Cranium, wherein the Pericranium and Dura matter were grown together.  The Mother was hurt, and the Child a little scratched on the left side of its Head. It was viewed by some Pretender to skill in such things, and judged inconsiderable: but from that time the Child grew indisposed, and vomited often, especially after the receiving her sustenance; and as she grew able to speak, complained of a pain in that part of her Head; and by reason of her often vomiting and constant pain in her Head, she languished daily. After 10 years, a small Tumour appeared in that part of the Head where it had been hurt. They again consulted, and afterwards brought the Child to me a very Starveling. I viewed the Tumour, and felt in it a Pulsation, which at first I thought an Aneurisma: but pressing my Finger more into it, I felt the Membrane of the Brain without any Scull the breadth of an old English Shilling. This at first a little amazed me: but upon consideration of the Fall, and the Symptoms succeeding, it was evident to me that by the Fall the Scull was fissured, and being of a thin cartilaginous substance at that time of her Infancy, had through continuance mouldered away, and the Dura mater thrusting outwards, had by Adhaesion to the Pericranium united in one body with it. This I supposed the case. The Presage here was a sudden death, if the Cure was not attempted: and in the attempting it she was in great danger. To begin this Operation by a circular Incision, the compass of the Tumour in the Scull, was not difficult: but than to separate these two Membranes, the Dura matter from the Pericranium, or this from that, was an hard task even in a dead Body; here in a weak Child much more, where the blood would be apt to blind me, and the impatience of the Child tender it hazardous, the work of Separation requiring a great Steadiness in both of us. Wherhfore I resolved to lay the Scalp open by Caustick. To which purpose, I forewarned them first of the danger, either in leaving the Child to die by its Malady, or in attempting the Cure doubtfully. But they having consulted others before, were sensible of the danger the Child was in by its Disease, and readily commended her into my hands, and lodged her near me. I caused the Hair to be shaved of from the Tumour, and applied upon it the most gentle Caustick I could design. At such time as I thought it might have made its way through the Superficies of the Calvaria, I took it of, and with a Caustick-stone rubbed into the musculous Skin's than washed out the Salts well, with Wine first, than Milk. After that I embrocated it with warm Oil, and cut into the Escar, embrocated the Part again, and dressed it up cum unguent. basilic. with ol. ros. applying emplastrum è bolo over all, with Compress and Bandage. That night she was seized with a fit of Convulsion, frequently vomited, and was very ill. Doctor Fisher was fetched, and prescribed her a cordial Julep proper in her case, and relieved her. The next morning I took of Dress, and raised up the Hairy scalp round from the Scull so far as the Caustick had spread, which gave a breathing to it, and discharged a little Ichor. From that time her Vomiting ceased, as also the Convulsive fits, and she began to be more lively than in ten years before. We kept her in bed warm and close, and prescribed her a slender Diet, allowing her only Spoon-meats. Her Physician took care in what concerned her health by Internalls. I proceeded to hasten Digestion, and by Fomentations and the like to cherish the native heat of the Part. Some places I digested, others I deterged. It was a nice work, but succeeded happily. Whilst some Sloughs were separating, other parts incarned and cicatrized. The Patient at length being in a fair way of Recovery, I invited Sir Ch. Scarburgh and Doctor Walter Needham to see her dressed. The Dura matter was than incarned, and the edges of the Bone exfoliating; after which the Wound cicatrized, and contracted to a very narrow compass. The Child afterwards returned to her Friends perfectly in health, and is a witty Child; but it's thought she will be but a Dwarf.  
A Person of Honour about ten years of age, 
16. Observat. of a large Fissure by contusion without a wound.  by accident of a Fall from his Horse, bruised his Head on the right side a little above the Temporal Muscle. He was somewhat stunned by the Fall, and vomited. Going to him within an hour after, I felt a large Tumour in that place, and, judging the Scull to be fractured, proposed the laying it open. But the Physician not being come, I opened the Jugular Vein on that side, took away some ounces of blood, and prepared Dress. Doctor Lower being come, I laid open the Cranium by a circular Incision, and discovering a Fissure, filled up the place with Dossils' of dry Lint, pulv. Galeni & empl. è bolo, with Compress and Bandage over all. The next morning we found our Patient relieved; a Clyster was administered that day; and the day after, the Physician and Mr. Holier being present, we took of Dress, and saw a large Fissure stretching from the coronal Suture to the Temporal Muscle. The Serosity being discharged thereby, and the Patient freed from the preceding Symptoms, I did not think it necessary to set on a Trepan: but it being by others thought reasonable, to prevent farther dispute, I complied with them. But than the Patient's Relations and Friends desired to be informed what Instruments we would use, and asked to see them. I shown them a Trepan and Trephine, and gave them liberty to try both upon a Scull. They did so, and unanimously preferred the Trepan, which accordingly I set on in the declining part, somewhat distant from the Fissure; and after Perforation dressed the Dura matter with ol. ros. and Resin, the Cranium with dry Lint, and the Lips with a Digestive ex terebinth. etc. than embrocated the Parts about, and applied empl. è bolo with Bandage. By the application of these the Dura matter digested, and soon after incarned. But the Serosity discharging by the Fissure, the Evacuation by the Perforation of the Trepan was small, and thought not sufficient. I being desirous to justify my way of dressing, yet ready to comply with the common practice, dressed it up with mel ros. & spir. vini. But the Matter at next dressing appeared lesle; and the day after we found the ruddy Flesh upon the Dura matter pale and withering. I applied again the ol. ros. and Resin, and at the next dressing saw the Flesh ruddy and better digested; and after a dressing or two the Membrane so incarned, that I was glad to keep it within compass by the application of a Dossil of dry Lint: and from that time my business was to suppress it with Merc. praecipitat. and good Compression. During this the Cranium was dressed with Pledgits pressed out of spirvinis; and while the Bone was exfoliating, we deterged and cicatrized the Lips, disposing them to incarn with the Flesh rising from the exfoliated edges of the Bone. At length the Bone changed colour and shook. It appearing afterwards lose. I raised it up with a Spatula, and took it of; we supposing it an Exfoliation. But by the Pulsation in the Flesh under, it appeared to be both Tables of the Cranium. If you will ask the occasion of this, I must tell you, that, according to our judgements, it was the effect of the Contusion, of which there indeed appeared no marks: yet, without doubt, by the force of the Blow the heat was extinguished in the Bone, and as a dead Bone it separated. And this sort of Contusions is taken notice of by the Ancients. It is without danger to the Patient, if there be a sufficient Discharge otherwise for the Matter, as here there was by the Fissure. This Pulsation lessened as the Flesh grew callous and hardened, which it did soon after into a Bone. About which time the fissured Bone cast of its edges, and that Fissure incarned, and supplied the place of the Bone; the Wound also cicatrized by the common Epuloticks. This young person had formerly been subject to pains in his Head and frequent Vomiting from his Infancy, upon which account we did not hasten the cicatrizing it; but after Purging, etc. we cicatrized, and he enjoyeth a better health since.  
A young Fellow, 
17. Observat. of a Fissure with a Fracture and depression of the Cranium under the temporal muscle.  a Mason by Trade, being at work with others making a Stack of Chimneys three Stories high, the Foundation of the house sunk under him. He was taken up speechless; but being presently let blood by a Noble Lady's advice, he recovered his Senses, and was removed to his Lodging. The Part contused and swelled was the right Temporal Muscle, and that side of his Head. He vomited often, and had shrewd Symptoms of a Fracture. I caused the Hair to be shaved of, and made an Incision in the upper part of the Tumour, from his Ear forward, above two inches in length, passing as near the Temporal Muscle as I durst; and having at the same time divided the Pericranium, I thrust it of from the Bone; than with a Sponge pressed out of Read wine wiped away the blood, and saw a Fissure running the whole length of the Wound. I also espied another Fissure stretching from this downwards towards the external Canthus of that Eye; and the lower I pressed with my Finger, the more rough the Bone felt. I was unwilling to cut the Temporal Muscle; but there seeming to me a necessity of it, I drew my Knife downward, and laid open the Wound in the form of a Roman T. But the lower Lips, being musculous, would not so turn back to bore the fractured Bone was I designed; therefore I contented myself with what I had done, and filled up the Wound with Dossils' of Lint, embrocating the Parts about with ol. ros. cum album. ovi, and applying empl. è bolo over it, with Compress and Bandage, than laid him to rest with an Anodyne draught. The next morning I found the Patient in a Fever. He had rested ill, and had vomited often, and complained of much pain in that lower Jaw. I took of the Bandage and Emplaster, and dressed the Lips of the Wound with a Digestive ex terebinth. etc. upon Pledgits dipped in ol. hyperici hot, embrocating the Parts about with ol. cham. & ros. and applied a Cataplasm ex far. hoard. flor. ros. rub. ballast. etc. as you may found it described in the method of Cure. Than we let him blood in that Jugular, and advised a Clyster: a Ptisan and contemperating Juleps were also made him. Having afterwards considered of the necessity of making more way to the depressed Bone, and the danger which might hap by cutting of more of this Muscle, I resolved to consult Doctor Walter Needham; to which purpose I sent to him, and he accordingly met me the next day. We found the Patiented restless, and accompanied with an increase of all the forementioned ill Symptoms. We took of Dress, and discerned the upper Lips of the Wound digested, but the lower more dry and swelled, especially upon the lower part of the Temporal Muscle; upon the pressure whereof a white Matter discharged from within, between the Cranium and musculous Flesh, where we judged the Depression of the Bone to be. There was a necessity of cutting of part of the Temporal Muscle, and that in the form of a Semicircle: wherefore we marked it with Ink from the upper part, so passing within an inch or more of the external Canthus of the Eye, and carrying it towards the Ear, to take of that Lip which was lying over the Depressure. This being so marked, we cut it of. There was an effusion of blood out of both ends of the Arteries: but having Dossils' ready dipped in in the Royal Styptic, we applied them; and having filled up the bared Cranium with our Dress, we bond up the Wound. From this time his Jaw was so weak, that we were forced to muffle it up with Chin-cloaths. At our next dressing we set on a Trepan: after which with a Levator we raised up the depressed Bone, and dropped into that Wound a Solution of resina in mell. ros. We than dressed the trepanned hole with ol. ros. upon a soft Dossill; and the rest of the Cranium we covered with Dossils' pressed out of spir. vini, and applied Digestives over the Lips of the Wound. At the second Dressing Doctor Walt. Needham was present, and saw the Dura matter under the trepanned Bone incarned so well, that from that time we only applied a little round Dossill to keep the Flesh from thrusting out of it. But from the Fracture below much purulent Matter came away daily: we supposed it was the more increased, by reason of the hollowness which it had made between the Muscles and fractured Bone, which being depending, did yet retain its Cavity, notwithstanding our endeavours by Compress and Bandage. Therefore to prevent the enlarging of that Cavity, we applied a Caustick on the outside, and the next day divided it; from which time the Matter discharged itself that way, and thereby the internal Cavity was disposed to cure. The Fissure that stretched itself from his Ear towards his Brow did lie so undiscovered, that we neither saw beginning nor ending of it; nor did we care: that part of it which we saw served to discharge the Serum sufficiently. I rasped the Cranium, and covered it up with Dossills' dipped in spir. vini, etc. keeping them close to the Lips of the Wound; and by timely rubbing the aforesaid Lips and every Superexcrescence with the Vitriol-stone, I kept the Cranium dry, and disposed it to exfoliate. After the discharge of Matter ceased from within the Cranium, I left the Exfoliation and Incarning of it to my Servants, visiting the Patient but seldom myself. His Wound was cicatrized in lesle than two months: as indeed they all usually are, if they be treated as they aught. But if they fall into such ignorant and obstinate hands, who suffer the Cranium to be overgrown with lose Flesh, a great discharge of Matter will follow, and the Cranium must of necessity corrupt, and consequently the Cure must be prolonged.  
During the Wars I was frequently employed in the dressing some one person or other, 
18. Observat, of a Soldier wounded in the Head.  wherein I have seen all or most of the several sorts of Fractures mentioned in this Chapter. Particularly at the Battle of Worcester, a Soldier came to us where we were dressing, with his Sword in his hand, the Blade broken of near the Hilt, with many Wounds on his Head. I seeing the Hairy scalp of one side of his Head hanging down his Neck, went to him, and calling my Friend William. Clerk to me with a Sponge to cleanse the Wound, we saw six pieces of the Scull sticking on it: some of them were of the first Table, others of both Tables. Besides which there were various Fissures, Sedes, and some Fractures, with Depression, made by Sword, Musket-stock, etc. We free the Scalp of those Bones, and returned it upward so far as we judged it necessary; than cutting of what was superfluous, tacked it to the sound parts by several Stitches distant from one another, leaving a space to dress the Depression and greater Fractures. Than we dressed up the Wounds with Digestives' ex terebinth. etc. and where the Dura matter lay bore, we applied Pledgits dipped in ol. ros. and to the other parts of the Cranium lineament. Arcei. The Alarm growing hot of the Enemies entering the City, I left William. Clerk to bind it up, and made my way out of the Town. But this young Chirurgeon, being taken busied in dressing the wounded Soldiers, had liberty, after the heat of the Fight was over, to employ his Charity in dressing some of them, and writ me since this Soldiers particular Case: viz. The third day he found him pretty hearty, and his Wounds mattering so very much, that he was necessitated to cut lose two of the Stitches, to give vent to it: than he dressed the penetrating Wounds with mel ros. and the Cranium with Lint pressed out of spir. vini; and proceeding accordingly in the Cure, saw the depressed and mangled Bones cast of, incarn, and cicatrize with the rest. The Soldier being thus cured by him made a Voyage to the Indieses, and since that served a Soldier in the Tower of London.   

An Additional Discourse of Wounds of the Brain. THE greater Symptoms that are usually said to attend the Wounds of the Brain do show themselves more uncertainly than a speculative Chirurgeon would imagine; 
Uncertainty of Symptoms in wounds of the Brain.  and in Cuts or Wounds made by sharp Weapons, or sudden strong force, more uncertainly than in Contusions, Concussions, and Depressions of the Scull; the highest of them, viz. Vomiting, Stupour, Loss of speech, with a Paralysis of Legs and Arms, arising more suddenly in these latter cases than in the former. These Symptoms have appeared in one of the forementioned Observations, where there was nothing of Fissure or extravasated blood seen upon the Dura matter after the terebration or perforation of the Cranium. Nay, we see many die suddenly from a Box on the Ear, and from small Blows or Wounds. In some whereof, upon opening the Cranium, there hath been much blood extravasated; in others none at all, or aught else that may be thought to have killed the Patient.  
A Young man by reason of a Blow with a Cudgel upon the Forehead presently took his Bed, 
Observation.  and became delirious: a Sopor followed, and after some days he died. I was fetched to see his Head opened. In opening his Forehead, I saw a small Hair like a Fissure running from the great Canthus of the Eye upward. We took of the Scull and Dura matter, and found but little blood extravasated, the Pia mater as little altered.  
Others I have been called to see opened, where there had preceded only a Contusion of the Calvaria, without any Fissure, or more extravasated blood than is usually seen in every opening or taking of the Cranium: yet the Patient lay, as I am informed, under all those Symptoms of Delirium, Coma, etc. The again I have dressed many that have been cut through the Scull, the Shivers of Bones lying pashed with the Flesh and Hair upon the Dura mater; yet the Patient hath been without any Symptom of such a Wound: which I suppose happened by reason of the Bones lying lose upon the Membrane.  
At Sterling Mr. John Chace was present when a poor Servant-maid came to me to be dressed of a Wound she had received on her Head by a Musket-shot, 
Observation,  in the taking of Calendar-House by the Enemy. There was a Fracture with a Depression of the Scull. I set on a Trepan for the elevation of the depressed Bone, and for discharge of the Sanies. She had laboured under this Fracture at lest a week before she came to me, yet had none of those Symptoms aforementioned. But after Perforation, and raising up this depressed Bone, and dressing her Wound, she went her way, and came daily thither to be dressed, as if it had been only a simple Wound of the Hairy scalp. Mr. Penycuke, an eminent Chirurgeon of that Nation, did assist me in this work. I think the Brain itself was wounded. I left her in his hands, who I suppose finished the Cure.  
At the beating up of some of our Our-guards near Truro, 
Observation.  the Enemy pursuing them, a Trouper wounded between the right Brow and Ear, espying me amongst the crowd, importuned me earnestly to dress him, and would admit of no excuse. We stopped at an apothecary's house on the right hand going out of the Town towards Perin. I called to the apothecary's Servant to bring somewhat to dress him. Meanwhile I hastily lifted up the bloody Hair, and saw a quantity of the Brain lie among it. I took it up with my fingers, and shown it him: the sight whereof so calmed his passion, that I had liberty to fly from the Enemy, who was entered the Town. Here the Prognostic was certain, yet there appeared none of those cruel Symptoms which accompany Concussions or lesser Fissures.  
From Battles and Sieges of Towns and Garrisons we meet with many such Wounds: in them we hasten our way to the extraction of extraneous Bodies, 
Manner of dressing the Brain.  by cutting of the shattered Hairy skin first, than pulling out whatever was carried within the Cranium. If this be well performed, we than dress up the Brain and Membranes with a Sindon of Silk or soft Linen of a bigness proportionable to the Wound, dipping it in a warm Digestive, such as is proper for the wounded Membranes. For however Surgeons have proposed to dress the Brain with one kind of Medicament, and the Membranes with another; that is not possible to be done: for if the Membranes or meanings should be washed with the same Medicament, and be offended by the Acrimony thereof, Inflammation, Fever and Delirium will the speedilier follow. Therefore in the Cure of these Wounds of the Brain, I consider the Brain as an insensible Body, and that the dressing of them consists in keeping it within its Membranes, and treating it as Wounds of the Membranes with Lenients, etc. If this can be done, as in small Wounds of the Brain it doth sometimes hap, (if the Fracture of the Scull hath not been very large,) than the Patient may recover.  
But if the Fracture in the Scull be large, and the Wound in the Brain proportionable, so that the Brain cannot be retained within them, than it corrupts by reason of the external cold, and offends the Membranes by its putrid Acrimony, and is frequently the cause of all the ill Accidents that attend them. The Patient sometimes lives until that Lobe be consumed, or hath wrought itself forth; as for Instance,  
A Few days before the Battle at Worcester, 
1. Observat, of a Fracture of the Cranium by Musket-shot.  while we were dressing the wounded Soldiers, one was brought to us shot with a Musket-bullet on the right side of his Head. My Servant William Clark, now dwelling at Bridgenorth, in dressing his Wound felt the Shot sticking deep in the Scull. I hastened to him, and saw the man speechless. We laid the Cranium bore by a circular Incision, and permitted it to bleed a while; than cleansed it with a Sponge pressed out of Vinegar, and filled it up with dry Lint. After an hour or two, the Bleeding being stopped, we opened the Wound again, endeavouring to get out the Bullet: but it not yielding thereto, we set on a Trepan close by it in a depending part, and gave vent to a quantity of blood: than passing in a Levator we raised up the Bullet, and pulled out the depressed Bones, with which there came away some blood and a little of the Brain. This being wiped away, there appeared a large Wound in the Dura mater. We dressed it with a Sindon dipped in ol. ros. & resina, and filled up the Cavity with Dossils' of Lint. Having so likewise dressed up the trepanned Bone, we applied our Digestives to the Lips of the Wound, with empl. è bolo and Bandage over all. Before we had dressed him up, he lifted up his Eyes, and asked how he came amongst us. Several other things he demanded of us. We caused him afterwards to be removed, and continued our care of him. The Wound did digest, and somewhat of the Brain came away each day; yet his Speech continued: but what became of him after our Defeat, I do not know.  
At the Siege of Melcomb-Regis, 
2. Observat. of a fractured Scull.  a Foot-souldier of lieutenant-colonel Ballard's, by the grazing of a Canonshot, had a great part of his Forehead carried of, and the Scull fractured into many pieces, and some of it driven with the Hairy scalp into the Brain. The man fell down as dead, but after a while moved; and an hour or two after, his Fellow-soldiers seeing him endeavour to rise, fetched me to him. I pulled out the pieces of Bones and lacerated Flesh from amongst the Brain, in which they were entangled, and dressed him up with soft folded Linen dipped in a Cephalick Balsam, and with Emplaster and Bandage bound him up, supposing I should never dress him any more. Yet he lived 17 days; and the 15. day walked from that great Corner-fort over against Portland to the Bridge which separates Weymouth from Melcomb-Regis, only led by the hand of some one of his Fellow-soldiers. The second day after he fell into a Spasmus, and died, howling like Dog; as most of those do who have been so wounded. About the same time a Maidservant was shot into the right side of her Head by a Musket-bullet deep into the Brain. She lived so long till that Lobe of the Brain wrought out or corrupted.  
At the Siege of Taunton one of Colonel John Arundell's men, 
3. Observat. of a fractured Face, Nose, etc.  in storming the Works, was shot in the Face by Case-sot. He fell down, and in the Retreat was carried of among the dead, and laid into an empty house by the way until the next day: when in the morning early, the Colonel marching by that house heard a knocking within against the Door. Some of the Officers desiring to know what it was, looked in, and saw this man standing by the Door without Eye, Face, Nose, or Mouth. The Col. sent to me (my Quarters being nearest) to dress the man. I went, but was somewhat troubled where to begin. The Door consisted of two Hatches; the uppermost was open, and the man stood leaning upon the other part of the Door which was shut. His Face, with his Eyes, Nose, Mouth, and forepart of the Jaws, with the Chin, was shot away, and the remaining parts of them driven in. One part of the Jaw hung down by his Throat, and the other part pashed into it. I saw the Brain working out underneath the lacerated Scalp on both sides between his Ears and Brows. I could not see any advantage he could have by my Dressing. To have cut away the lacerated Parts here had been to expose the Brain to the Air. But I helped him to clear his Throat, where was remaining the Root of his Tongue. He seemed to approve of my Endeavours, and implored my help by the Signs he made with his Hands. I asked him if he would drink, making a Sign by the holding up a Finger. He presently did the like, and immediately after held up both his Hands, expressing his Thirst. A Soldier fetched some Milk, and brought a little wooden Dish to pour some of it down his Throat: but part of it running on both sides, he reached out his Hands to take the Dish. They gave it him full of Milk. He held the Root of his Tongue down with the one Hand, and with the other poured it down his Throat, (carrying his Head backward,) and so got down more than a quart. After that I bond his Wounds up. The dead were removed from thence to their Graves, and fresh Straw was fetched for him to lie upon, with an old Blanket to cover him. It was in the Summer. There we left that deplorable creature to lodge; and while we continued there, which was about 6 or 7 days, he was dressed by some of the Surgeons with a Fomentation made of Vulnerary Plants, with a little Brandywine in it, and with Stupes of Tow dipped in our common Digestive. So we bond him up.  
I could tell you of many more wounded into the Brain, but I think these may serve to prove what I would demonstrate, viz. that the Brain is of itself insensible; that those Symptoms which accompany these Wounds proceed from the pain which the meanings, Dura and Pia mater suffer, which if oppressed by extravasated blood, or a Depression of the Scull, do quickly suffer the greatest Symptoms, as Vomiting, Stupor, Paralysis, etc. much more if they be pricked by any Speel of a Bone, or other extraneous sharp body. When the Brain itself ouzeth out between them in the manner already mentioned, it is a mild soft substance and lenient to them, so that the Accidents appear not till that gins to corrupt between them, and with it the Membranes themselves putrefy; upon which there follow Convulsions, Howl, and a dispatch of the Patient. From which very observation may be seen the folly of dressing these Wounds with powerful Desiccatives, which, so far as I could observe, did always hurt the Membranes, but never either digest or incarn the Brain. For, according to Hypocrates, non coalescet, but as it gets liberty works itself forth, not unlike unto Barm. At sea those wounded into the Brain die soon after, we having no conveniency of lodging them or dressing them so warm as they require. In the Wars my employment did not permit me to see the finishing of their Cures; and here, in my practice in and about the City, I never was called unto any so wounded where there were any hopes of Cure; therefore must leave that to others to treat of. But by what I have seen of them heretofore, their Cure consists, as I have already said, in dressing them as Wounds of the Dura mater, and in keeping the Brain within its Membranes; without which no Incarnation can be made on the Membranes.    

A TREATISE OF Gun-shot Wounds.   

OF Gun-shot Wounds.  
The Sixth Book.  

CHAP. I. Of Gun-shot Wounds in general.  
GReat hath been the contention amongst the Learned about Fire and Venom in Gun-shot Wounds, 
Gun-shot Wounds whether fiery or venomous.  some maintaining the one to be in them, some the other; and others holding that there is neither. That which I suppose might be the occasion of their suspecting a burning and a poisonous quality, was the deadly Colour of these Wounds, which in those early days, when the invention of Guns was novel, surprised them, they looking not unlike poisoned and burnt Wounds. Where the Bullet pierceth, it extinguisheth the natural heat, and the Lips of the Wound are livid or blackish; and if they be not dressed rationally, they inflame, and are accompanied with Tumour, and Blisters frequently rise about them, also the Matter is of a foetid smell. In this condition the Wound is commonly the first day, and so to the seventh; and, if not succoured, it gangrenes, and so the Patient commonly dies. If in those days the Learned were thus deceived by their aspect, and dressed them as venomous Wounds; it can be no marvel that they should writ so of them; I verily believing, that in their way of treating them they were directly as poisoned Wounds difficult to digest and cure.  
In these our later times, although they do not call them venomous, 
Errors in dressing Gun-shot Wounds.  yet is it a difficult thing to dissuade many of our Surgeons from dressing these Wounds with Tinctures of Myrrh and Honey of Roses, and thrusting in of great Tents: by which way of dressing I have seen these Wounds undigested the tenth day; one whereof was in the Cheek, with dry and staggy Lips. These lesser fleshy Wounds being undigested, at last gangrene: and in truth it is not to be wondered at; I will undertake to show you the Experiment every day, and that in a fontanel or Issue made by a Caustick. Cut you through this livid or black Escar, and put in a Pea in the middle of it, with Tincture of Myrrh and Honey of Roses, as I have seen some of them dress Gun-shot Wounds, and the next two or three days after, when you dress it again, it will be to your sight not unlike a Gun-shot Wound: continued your dressing with a Pea, and with your Tincture of Myrrh; and if it do not gangrene, yet it will be inflamed, and slow in Digestion. And this is from the improper Application in the dressing it. For if you dressed this Escar in the fontanel with Emollients and Digestives, as you aught to do, the Escar would separate with Digestion in the worst Habit of body: and so it will in Gun-shot Wounds with little distemper or difficulty, if you have timely extracted the extraneous bodies. But the ignorance in some, and the discontinuance of others in this kind of Chirurgery, hath occasioned these Errors.  
Thus at our entering into Worcester, 
Observation.  when the King came out of Scotland with an Army of that valiant People, a Townsman was shot. The Pistol being fired by the Cheek, shot him through his lower Jaw and Tongue, and out at the contrary Cheek. The Chirurgeon of the Town, upon sight of it, concluded it gangrened from the black colour, and declined the dressing it the way he rationally aught: upon which the Part grew exceedingly painful, swelled and inflamed; it also gleeted much. After two days I was consulted, and by lenient Medicaments, and good Bandage keeping up the fractured Jaw, I assuaged the Pain, and digested the Wound, leaving it in the same Surgeon's hands, who cured it. In this person the Wound was burnt by the flame, the very Powder sticking in some parts of his Cheek. This, with the Putrefaction occasioned by the hot weather, and the improper Applications, contributed to our Brother Surgeon's apprehension. It is this ugly aspect that puts the inconsiderate Chirurgeon out of his method, and so renders Gun-shot more difficult of Cure than otherwise it would be. For if such Wounds were rationally dressed, they would digest and heal as easily as any complicated Wound. What I have said of Gun-shot, happeneth at Sea frequently by Splinter, which though it may have lost its force to make a Wound, yet it sometimes bruiseth the Skin to the Flesh so forcibly as to extinguish the natural heat, and to make it black. If this be dressed as a Gangrene with spir. vini and unguent. Aegyptiac. or leapt up with a warm Stupe, the Escar will grow dry and parched, and the Humours which flow plentifully to it will 'cause an Inflammation with Tumour, and an Apostemation is the best that can be expected underneath the Escar, and consequently it will terminate in a hollow Ulcer; but for the most part it corrupts and gangrenes. Whereas if this contused Escar were dressed with Lenients according to that Aphorism of Hypocrates, Omne quod contusum, etc. and the Parts about embrocated with ol. ros. cum album. ovor. & aceto, and a Defensative applied over all to prevent Defluxion, the Escar would separate as easily as those made in fontanelles by Caustick, and afterwards incarn and cicatrize with much ease to the Patient.  
Many Instances I could give of this kind, 
Observation.  but shall make choice of one that will give lest offence, and that in the outside of the Leg. It was somewhat broader than a Five-shilling piece in Silver. How it had been dressed on Shipboard I will not insist; but on the Shoar I saw it black, and the Pretender to Chirurgery had dressed it with spir. vini & unguent. Aegyptiac. etc. till it was as hard as Shoe-leather, and the circumjacent Parts inflamed and swelled. I did not perceive he had ever cut into the Escar: if he had, it was superficially done. I advised it to be presently divided, and to be dressed warm with unguent. basilic. cum ol. lilior. But he replied, he knew how to dress a Gangrene. It was no easy task to persuade him out of his method: but I prevailed, and thereby the Matter was discharged, and the Patient more easy, and sooner cured.   

CHAP. II. Of the Cure of Gun-shot Wounds; and first, of Extraction of Bullets, etc.  
WOunds made by Gun-shot are the most complicate sort of Wounds that can be inflicted: for they are not only a Solution of continuity, but have joined with them Contusion, Attrition, and Dilaceration, in a high and vehement kind. To this we may add all sorts of Fractures and Accidents, as Haemorrhagia, Inflammation, Erysipelas, Gangrene, and Sphacelus; besides the extraneous bodies which are violently carried into the Wound, and multiply Indications. 
Compound intentions.  The number of the Indications in compound Affections must answer to the variety of Disturbances. Were it a Simple Wound, the Cure of it would presently be performed (as you have read in the preceding Treatise of Simple Wounds) per astringentia & exsiccantia, by such Medicaments as are of an astringent and drying quality. The Cure of a Wound is the Exsiccation of it. But here is always joined with these that which indicateth the use of emollientia & suppurantia; according to that of Hypocrates, Omne quod contusum, necesse est ut putrescat, & in pus vertatur, What is contused must necessarily putrefy, and be turned into Matter.  
That which is fretted and torn must also be reduced to the whole, 
What is torn is to be reduced to the part, or cut of.  or cut of, before your ordinary intention of Incarning. Moreover, in these Wounds, not only the Bullet itself is ordinarily lodged, but many times other strange bodies are carried along with it; for Extraction of which, judicious care and industry are required in you. In these recent Wounds we very rarely have a Flux of blood. Though the Veins and Arteries be wounded, they commonly lie quashed in the contused Flesh, until separation of the Escar; and about that time, when you least think on it, they may burst out violently. 
Haemorrhagia.  I have seen them thus often break forth. But if such Vessels do bleed upon the receipt of the Wound, and interrupt you in drawing out the extraneous bodies, you must endeavour to suppress the Bleeding, for thereupon depends the life of your Patient: but withal so proceed, that you may extract the Bullet first; and than be careful, that in the restraining the Bleeding you bring not on a Mortification by your crowding in Dossills'. Too many Instances may be given hereof: therefore I rather advice you to use an actual Cautery.  
A great Haemorrhage happening to a Soldier at the Surprise of Weymouth by the Garrison of Portland, by a shot through the Heel, 
Observation.  I endeavoured the stopping the blood by Astringents, Bandage, etc. But after all, I was put to the use of the actual Cautery; which I did apply successfully, and have since seen Botallus' authority for it. Tutius enim est (saith he) eam ignite ferro constringere. These Wounds are also accompanied with Pain, which aught to be appeased by Anodynes. 
Anodynes.  But you must be well advised in the application, jest you extinguish that small remainder of heat that is left. How you shall deal with all these Inconveniences, and not add one evil to another, I shall plainly deliver to you. And first, what must be first put in execution; which is, the Extraction of Bullets and other extraneous bodies.  
The Part is at first dressing to be cleared with what diligence you can of all such foreign bodies as have made violent intrusion into it, 
Dress presently during the heat of battle.  while the Patient is warm with the heat of Battle, and the Wound fresh, and very little altered by either Air or Accidents: upon which consideration lesle Pain must necessarily follow upon the Extraction.  
In the Armado Naval of Dunkirk, 
Necessity of it.  where we Surgeons were often employed in this kind of work, we after every Fight went together visiting one another's wounded men. It was thought amongst us a great shame, if any thing of this work of Extraction were than to be done: for after the first and second day the Wound proveth tumefied, also the neighbouring Parts are inflamed, and so changed in their temper, that they conceal from your sight both the Bullet and his companions, so that the place they are couched in can hardly be known; or, being discovered, you cannot without hazard of your Patient, or great trouble of the Part, make Extraction of them. In which case it may than be reasonable to defer that work, and by Lenients to hasten Digestion.  
Yet if the Wound be near a Joint, or the Shot lodged amongst the Tendons, it's much to be feared the Pain will not cease, and consequently the Wound will not digest. In which case the omission of drawing out the Bullet may bring a Mortification. It hath been the cause of the death of many a brave Soldier, and is the ground of all the mischiefs these Wounds are subject to, as Pain, Inflammation, Spasm, Convulsion, Gangrene, Sphacelus; what not? every Battle producing Instances of it, to the discredit of our Profession. Therefore to prevent the increase of such Accidents, neglect not to make Extraction of it one way or other.  
But if the Bullet be lodged in a lesle noble Part, as in the Musculous flesh, you may with more safety content yourself till the seventh day, or till the fierceness of the Accidents be over, and the Wound digested. But withal it will require more care, for the Wound will be more painful, and slow in Digestion, than otherwise it would be. Yet be the confession of those that allow Fire and Poison in it, the Bullet may lie long there, and do little harm. Nay, I suppose there are not many but have heard of or seen Bullets, that, without grievance to the Patient, have continued lying long in the Fleshy parts of wounded men. Conceive this spoken of Leaden Bullets; for Iron or Brass cannot (by reason of their aptness to rust) remain without doing harm. However, let nothing of this encourage you; for the Bullet pierceth not any Part without carrying Rags along with it, which corrupt in the Wound, and make Apostemations, occasioning a prolonging the Cure; as must needs be observed by all men in their practice.  
The Servant of a Nobleman was wounded and shot in the Thigh by Highwaymen. 
Observation.  The Bullet not having been extracted by his Country-Chirurgeon at the first Dressing, could not be drawn out by me at the second, but occasioned great Pain and Inflammation, burning Heat and Watch. And although he had many other considerable Wounds upon him to make a Derivation, yet was his Gun-shot more vexatious than all the rest, until I extracted the Bullet, and Rags carried in with it: yet this was but a Pistol-bullet. But after I had drawn it out, my Digestion became good; and by equal Bandage, with gentle Compression of the Parts, I united and healed it in ten or twelve days, which I doubt would not have been cured in three months.  
Nay, while any of the Rags remain in the Wound, it will never cure: but the extraneous bodies drawn out, there is little difficulty in the healing these Simple Wounds, if dressed rationally.  
An Instance whereof I shall give you in a poor Soldier, 
Observation.  who was shot at the Castle of Dunbar with a Musket-bullet a little above the left Clavicle, in amongst the Muscles of that Scapula. The Bullet was drawn out by one of my Servants, and the Wound dressed up with Digestives. But some days after, he being brought to Saint-Johnston's, I found it inflamed, and very much swelled. We dressed it up according to the method set down in this Treatise: but it apostemated, and mattered very much. After several unsuccessful Applications, I made an Incision by the side of the Scapula into the Cavity, and pulled out the Rags that had been carried in by the Shot: and from that time all Accidents ceased, and the Wound cured soon after. But if such be handled as some have lately taught, they are as so many poisoned Gun-shot Wounds.  
Now for the taking out of the Bullets, and other extraneous bodies, 
2 methods of extracting Bullets.  there are two methods. First, one to extract them by the way they went in: the other, to open the way by which they would, if their force had not failed them, have passed themselves through.  
For to take them out the way they were forced in, 
First, the way the Bullet went in.  you must place the Patient as near as may be guessed in the posture he was in when shot: and if, by reason of his weakness or other infirmity, he cannot without prejudice be so situated, let him be laid in a Position which may as nearly answer it as may be, jest some part of a Muscle, Tendon or Ligament obscure what you desire to make manifest. 
Methods of search.  Than make search for them with your Finger or Probe. The figure of these Wounds is always round: the Bullet forces the Flesh in with it, and the place by which it enters presently contracts closer; but its going out is more lax. You may guests by view of the Wound the largeness of the Bullet; and comparing the one with the other, make choice of a fit Instrument for Extraction, wherewith you aught always to be well furnished. Your main care in this work must be to found out the Bullet: but if you fail of it by searching into the Wound with your Probe, than try if you can feel it by handling the Parts about: it being wonderful to consider how these Shots do twirl about, at lest seem to do so, when the Posture is changed in which the Wound was received.  
As for example, a man hath been shot in the Cheek, and I have cut out the Bullet behind in his Neck. Another was shot in the outside of the Small of one of his Legs; the whole Member extremely swelled and inflamed; no possibility of finding out the Bullet either way: at last by chance I felt it in the inside of the Thigh above the Knee. And so another being wounded in the outside of the Arm, I have cut out the Bullet below the Scapula. If the Bullet hath not lain in so long (as in some of these cases) that the Parts are extremely pained with Inflammation and Tumour, the Pain where the Bullet lodges doth sometime help to discover it.  
A common Soldier, shot in the Breast through the Sternon, 
Observation.  lay roaring very grievously, complaining of a pain in his Back. I was fetched to him, and turning him on his Side, I saw the Bullet lie like a small Wen or Scrophula thrusting out under the Skin not far from the Spine. I made Incision over it according to the length of the Part, and thrust out the Bullet as easily as I could desire. Than I dressed it with Digestives, the Soldier ceased his crying, and acknowledged before us his Pain was from the Bullet in the Skin. For indeed the Lungs and other internal Parts are seldom so sensible of Pain, though wounded through.  
An Instance whereof I saw in one run through them with a Rapier. 
Observation.  He complained of no other pain than that external one in his Back where the Sword passed out. Sometime after his being cured, he died of another Disease. I opened him, and saw his Lungs sound, and that the pain of his Back proceeded from the edge of the Rib which had been cut by the Sword's passing out. The Lungs discover their hurt by other Symptoms. The common Soldier died, as most do that are shot through the Lungs.  
If in your searching for the Bullet you light on the Part, though there be no Extuberance or aught to be felt, yet his Pain there will be a good sign of it. If no Accidents occasioned that Pain, make your way there by Incision, avoiding the Vessels, and take out the Shot, and what else offers itself. By this you do both quit the Part of its troublesome Lodger, and withal make way commodiously for discharge of Matter; which, in regard most of these Wounds are sinuous, (the Bullet turning aside when it is hindered in its journey forward,) for want of discharge, might in those places occasion Fistula's and hollow Ulcers, not without ill quality.  
So a man being shot with a Slug near the external Canthus of the right Eye through that Bone, 
Observation.  it seemed to the Chirurgeon that dressed it to have passed directly forwards, and accordingly he crowded in a Tent, and daily increased the bulk, to stop the Bleeding it was subject to. But the Bleeding continuing, I was fetched, and saw him pull out a Tent above an inch and a half long. I cast in some of the Royal Stiptick-water, and stopped the Flux of blood. His Cheek was very much swelled, and had apostemated on that side of his Neck, and discharged its Matter two inches lower than the Tumour. I cut afterwards into that Tumour, and felt the Slug: it lay partly under the Os jugale or Cheekbone. It was a wonder to me how it came there; but I drew it out: and from that time his Wound above and the Apostemations below cured.  
In the work of Extraction, 
Caution.  take great care you lay not hold of some Nerve or Tendon, and so pluck them along with the Bullet: for by so doing you will 'cause intolerable Pain and grievous Accidents. You must therefore neither open nor dilate your Instrument, until you take hold of the Bullet without any of the circumjacent Parts.   

CHAP. III. Of Dressing Gun-shot Wounds after Extraction.  
AS soon as you have made a Separation of these extraneous bodies, 
First dressing after extraction.  if you judge the Wound to be so well conditioned, that there is neither Putrefaction, nor any thing tending that way, (as in recent Wounds there is not,) be not discouraged at whatsoever evil aspect it than hath, but consider its livid colour (as I have said) to be usual in these Wounds, where the Contusion is not only simple in the Skin, but through Flesh and all, as far as the Bullet or Splinter went, extinguishing the natural Heat: so no wonder if it hath the colour of a gangrened or poisoned Wound. Therefore be not disturbed in your thoughts, but, having taken out the Bullet or pieces of Splinters, dress it up as a contused Wound with oleum catellor. or such as followeth, as hot as the Part will bear, not giving credit to any that shall persuade you to the contrary, not, though it be near a Bone; for the Gleet will foul it more than your greasy Medicaments; therefore dress it with some of these: ℞ ol. lilior. alb. lb vj. boil in this two new-whelpt Puppies until the Flesh fall from the Bones, than add lumbric. terrest. in vivo lotor. lb j. boil these a while, than strain them by a gentle compression: to the strained Liquor add terebinth. ʒiij. spir. vini ℥ j Reserve this for your use. Or this: ℞ ol. lini, cannabin. an. ℥ iiij. ol. lilior. chamaemel. an. ℥ ij. terebinth. ℥ j Misc. Or this: ℞ terebinth. oped. ℥ iiij. thuris, 
See ol. Apa. rici in Simple Wounds.  mastic. an. ʒiij. myrrhaeʒj. ol. Apariciʒij. ol. lumbric. & sambuc. an. ℥ iij. Misc. S. A. ℞ ol. olivar. lb j. terebinth. lb ss. gum. elemi ℥ ij. aeruginis pulv. ʒij. or this; ℞ spir. vini lb ss. terebinth. lb j. ol. hyperici & lini an. lb ss. sang. dracon. subtle. pulv. ℥ j Misc. S. A.  
With this latter I cured a Servant of A. D. shot into his Hand. 
Observation.  This digested the Wound; and after the Slough began to separate, I felt part of a Bone bore, which I dressed with extract. scored. dissolved in mel ros. with which I deterged; and feeling the Bone afterwards incarned, I also incarned the Wound, and cicatrized it with unguent. tutiae, etc. and in few days cured it without any difficulty. Lineament. Arcei with any of the  Oils is very good, adding a few drops of ol. terebinth. which by its subtlety penetrates, and by its heat rouzeth the natural heat in those cold Parts, and putteth them upon Digestion and Separation.  
Quercetan commends this: ℞ succorum tussilag. oxalidis, an. ℥ iij. earicas ping. num. xx. thur. ℥ ij. resin. laric. ℥ ijss. axung. gall. anser. an. ℥ ij. butyri recent. lb ss. ol. visci pomorum comp. lb j. put these all together in a Vessel close stopped, boil them on a moderate fire the space of six hours, than strain them out hot, and evaporate them to a good consistence. This following is another of his: ℞ cerae novae, resin. picis naval. an. ℥ iiij. sevi hircin. medullae cruris vitulini, an. ℥ ij. oesypi ℥ j ol. olivar. aut lini lb j. liquefactis omnibus & transcolatis fiat Vnguentum, quod reservetur ad usum. He adds ʒj. of Praecipitate to every ℥ j of this. But in recent Wounds this will not be necessary: for you will found by experience, that these Wounds will digest and suppurate without it, (and that frees them from Putrefaction.) Nor will it be always for your credit, if you consider the quantity of Balsams we use in such Wounds, and what prejudice some people may receive either by its Salivating them, or otherwise affecting their Spirits. Yet Praecipitate and axungia with a few drops of ol. terebinth. was a common Medicament amongst us: but I refer that to you, it being a good Remedy to resist Putrefaction, and hasten separation of the Escars. You aught to dress up these Wounds lightly with a proportionable soft Tent, and Pledgits dipped in some of these Digestives very warm, but not to scald them. After that embrocate the Parts about with such like: ℞ ol. lumbric. ros. myrtill. an. ℥ iij. aceti cochl. ij. mix them. In the dressing, your Applications over the Wound and Parts circumjacent should be such as have a virtue to hinder the flux of Humours, and strengthen the Parts: to which purpose, ℞ far. hoard. & fabar. an. ℥ vj. ros. rub. bacc. myrtill. an. ℥ jss. sem. cydon. ʒuj. boil these in posca to the consistence of a Cataplasm, adding at last two newlaid Eggs, with oxymel ℥ ijss. If you apprehended this too heavy, you may add ol. myrtill. & ros. with Wax as much as is necessary, and make it into the form of a Cerote. Above the Wound lay one of the following Defensatives, which you may have always ready by you. ℞ bol. Armen. ℥ iiij. terrae sigil. ℥ iij. sang. dracon. ℥ jss. corn. cerv. ust. or burned Bones ℥ iijss. or Juice of Sloes dried ℥ iij. ol. ros. & myrtill. an. ℥ vj. aceti ℥ xij. boil these to the consistence of a Cerote, addendo in fine decoct. album. ovor. iiij. Or this: ℞ pulv. ros. rubr. myrtill. ℥ j bol. Armen. terr. sigil. an. ℥ vj. succ. plantag, solani, an. ℥ ij. aceti oped. ℥ iiij. ol. ros. & myrtill. an. ℥ vj. cerae q. s. Misc. Apply your Compress dipped in aceto or Oxycrate: let your Bandage be put on equally and gently, to retain your Dress, and hinder the influx of Humours.  
Having thus dressed the Patient, 
Bleeding.  presently consider of letting him blood, to prevent ill Accidents, and especially if he lost little or no blood from the Wound, or if there be a Plethora joined with it. In which case Revulsion made from the same side is commended by Galen. Revulsio enim quae è directo fit celerrimam utilitatem adfert: Galen. De Sang. missione.  
A Clyster should precede Phlebotomy. 
Clysters.  It may be made of the common Decoctions; or of Mallows, Violets, Beets, Mercury, Bay and Juniper-berries, with Oil of Linseed, Honey of Roses, hiera picra, Elect. lenitiv. etc. But if you have not these in readiness, make your Clyster with the Broth of Flesh. ol. chamaemel. Sugar, and the Yolk of an egg, with a little Salt, if your Broth be not salt, or, in case of necessity, salt Water; or Broth out of the Kettle, with a few Flowers of Camomile boiled in it, and stained, adding a little Butter or Oil and read Sugar. Any such like may serve for a good Clyster.  
It will also be requisite you be furnished with some Cordials, 
Epithemata.  to resist the putrid Vapours, and refresh the Spirits; which you may do externally by some Epithemata of distilled Waters, as of Balm, Bugloss, Roses, acetum, with the Powder of the Roots of tormentil. scordium, scorzonera, contrayerva, or other cordial Species, of which you have variety in the Pharmacopoeia Londinensis, which may be for your purpose. This following may serve for an example: ℞ aq. melissae, borrag. bugloss. an. ℥ ij. aceti rosati ℥ j speciei diarrhod. ʒj. croci ℈ j Misc. fiat Epithema.  
And with some of the foresaid Waters you may make Cordials also, 
Cordials.  by adding Syrup of Citrons, Gillyflowers, and confect. Alkermes. For instance, ℞ aq. bugloss. cinnamom. an. ℥ ij. confect. Alkermes ℈ j lap. bezoard. occid. ℈ ss. syr. è succ. citr. cochl. ij. Misc. For the common Soldier a dram of London-treacle or Mithridate dissolved in Wine may serve. 
Diet.  As to their manner of Diet, in great Wounds it is necessary to observe a spare one, as Barly-grewells, Panadoes, thin Broth, or a Potched egg, this much availing to the preventing of Inflammation. But in this the Patient's custom must be considered. Also the Air aught to be temperate; for cold is an enemy to Wounds. Rest is likewise required, as well to the Mind as the Body. Therefore having dressed him, lay him to rest with ʒuj. syr. de meconio cum cochl. ij. aq. cardiacae in ℥ iij. aq. papaver.  
We shall now proceed to the Second day's work, 
The second day's dressing.  and therein consider the Habit of body, and more particularly what concerns the Wound. In these Gun-shot Wounds it may be convenient the body be gently purged by Lenients, as is formerly said. Purgatio enim per alvum plerisque vulneribus prodest. Purging avails much for the carrying of bilious and serous Humours, which from their heat and tenacity are most apt to ferment and flow into these Wounds, and cause Pain, Inflammation, and other ill Symptoms. In which cases cassia, manna, tamarind. syr. de cichor. cum rbabarb. ros. solut. are prescribed, and may be taken in Whey or Ptisans.  
But as for stronger Purgatives, 
Purging.  Hypocrates saith well, Cocta sunt purganda, non cruda: which is more especially true when you speak of Scammoniate Medicines.  
Having thus proposed a general way of Purging, we shall again consider what is requisite for Dressing the Wound, and prepare our Dress, and apply such Medicaments as may be necessary. In order to which you aught to have a Fomentation ready, 
Fomentation.  whereout may be wrung a hot Stupe. To which purpose, ℞ summitat. hyperici, centaur. scordii, absinth. an. Mj. flor. ros. rub. chamaemel. melilot. sambuci, an. Mjss. furfuris Pj. coq. in aq. font. ad lbijss lbijss. colat. add vini austeri lb j. spir. vini ℥ vj. fiat Fotus. These will give a breathing to the Parts, and defend the Wound from the Air while you consider it. If all be well, continued the use of Digestives. But if it be accompanied with very great Pain, you may foment with this: ℞ decoct. rad. althaeae, malvar. fol. verbasc. chamaemel. melilot. sem. lini, foenugraec. boiled in Sheeps-head-broth, or other. And of the faeces of this Fomentation you may make a Cataplasm, adding farin. hoard. lb ss. sem. lini. eydonior. pulv. an. ℥ j unguent. basil. & unguent. dialthaeae an. ℥ jss. axung. porcinae vet. q. s. crociʒj. in fine coctionis addend. ovor. integr. recent. num. iiij. Apply it over all, or the former Cataplasm. It cherishes the heat of the Part, furthers Suppuration, and is anodyne. You are to make the Bandage as before, and continued this way of dressing to the seventh or ninth day, until you have separated the Sloughs, digested the Wound, and have a laudable Pus, (as you are want to call it,) which is album aequale, leve, & minimè foetidum; a perfect white Matter, of good consistence, and not foetid or ill scented. If the Matter be defective in any of the said qualities, Praecipitate will be of good use mixed with the latter Unguent of Quercetan's, or that mixed with unguent. Apostolor. Or this following Unguent may be applied alone, or with Praecipitate: ℞ succ. agrimon. centaur. min. plantag. apii, an. ℥ j mucilag. hoard. ℥ iiij. boil these together, adding terebinth. Venet. ℥ iij. mell. come. ℥ ij. far. hoard. cribrat. ʒiij. croci pulv. ℈ j fiat Mundificativum. To this you may add Aloes, Myrrh, sarcocol. rad. aristoloch. gentian. ireos, for the incarning these Wounds. If you desire rather Injection, the same Ingredients may serve. But in the use of Injections be sure you do not stop the Orifine to keep the Liquor in; for so you shall distend the Ulcer, and make it more Sinuous.   

CHAP. IU. Of Accidents befalling Gun-shot Wounds, and of Sinuous Ulcers.  
BUT from the first to the eleventh day many Accidents are want to hap to these Wounds, which not only impede the Cure, but often, without timely help, destroy the Patient. And these are, vehement Pain, Inflammation, Erysipelas, from whence Gangrenes and Sphaceli do frequently hap. These latter take their beginning from Inflammation. Therefore I have elsewhere particularly treated of Inflammation and Erysipelas, that you, seeing what it is, may in its beginning prevent its increase. 
Inflammation.  It commonly proceedeth in this case, either from a very ill Habit of body, or from the ill handling of these Wounds in the beginning.  
The Remedy is, timely to prevent the Influx of Humours, and evacuate that which already affecteth the Wound. The first way is, by Bleeding and Purging; both which are directed you in the first day's work. If you omitted that than, you must perform it now. The second way is, by external Applications. If Pain be the cause, you must secure it by Anodynes, which may mitigate and repress the heat of the Part; of which you may have your choice in the Chapters of Phlegmon and Erysipelas in general; and in the first Chapter of the Treatise of Wounds, where we have particularly treated of Pains, and proposed their Relief, etc. viz. in their Beginning with Refrigerants and Repellents, and in their State by moderate Calefaction and Discutients, and afterwards by Concoction of the Matter; to which Treatise I refer you.  
The next and most cruel Symptom is Mortification of the Part, 
Gangrene.  which very often attends great Inflammations, and is shrewdly to be suspected when they yield not readily to Discutients or Suppuratives. In these Wounds it happens most commonly through a Suffocation of the natural heat of the Part, by reason of the great concourse of Humours, or too refrigerating and repellent Applications in the time of great Inflammations, which have enfeebled and hindered the transitus of Spirits into the Part. It may be perceived by the Gleet and change of colour, it beginning to look livid; also by a diminution of the Tumour, etc.  
When you see such a change begin, you must presently prepare to withstand a Mortification by Scarification, not only until the blood come about the Lips of the Wound, but deep into it through the Escar to the quick, and suffer it to bleed freely, and make the Part sensibly feel, that by such means you may disburden it of part of what would have choked it, and make way for the entrance of the operation of the Medicine. Than foment the Part with a good Lixivium made of Ashes, to which may be added Salt and Vinegar. Or you may boil scored. absinth. centaur. and such like, in the aforesaid Lixivium. After you have well fomented the place, wash the Scarifications, and dress the Wound with Aegyptiac. cum theriac. Venet. dissolved in aceto vin. adding calcined Vitriol, etc. than apply a Cataplasm ex farin. hoard. fabar. orobi, lupinor. decocted in some of the same Lixivium, with an addition of Oxymel to it. But as to this Matter I refer you to the particular Chapter of Gangraenae and Sphaceli, for farther directions therein. The Gangrene stopped, hasten separation of the Escars by Digestives, and than deterge with mundif. ex apio & Paracels. etc. and so proceed with sarcotics and Epuloticks to finish the Cure.  
But in the separating of contused Parts, 
Haemorrhagia. Observation.  as I have often told you, great Fluxes of blood usually burst out upon us. Thus in a Patient of mine, wounded by a Shot through the inside of the Radius, upon separation of the Escar a great Flux of blood happened. While I was stopping the first Orifice, which was nearest the Artery, the blood burst forth of the other. Hereupon I stopped both the Orifices with some astringent Powders, (I suppose that of Galen's prescription of Aloes and Hares-fur, I most frequently using those as the best in such cases,) rolling up the Wound with a good Compress dipped in a Styptic Decoction, laying my common Defensative over all, and did not open it till 3 or 4 days after. 
See Treatise of Wounds.  How such Fluxes of blood are farther to be treated, you may see in the Chapter of an Aneurisma.  
Gun-shot Wounds after separation of the Escar are apt to become Sinuous Ulcers, 
Sinuous Ulcers.  especially after great Fluxion, and where Bandage cannot be used to preserve the Tone of the Parts, as in the upper part of the Thigh and Hip, etc. These Cavities causing much pain to the Patient, and difficulty and trouble to the Chirurgeon, we shall consider their Cure, taking our Indication from the Parts affected, with the largeness of the Wound, Contusion and Laceration of Parts: for from such Wounds there must necessarily be loss of Substance, and the quantity or evil quality of the Matter must needs tender it Sinuous, especially where Bandage cannot be conveniently made to thrust out the Matter.  
And if the Bullet or any extraneous body be yet remaining within, and the Parts extremely tumefied, and troubled with pain and influx of Humours, the included body will be the more straightened in its passage out, and tender the Cure so much the more difficult. And if a Cacochymia or Lues Ven. be joined with it, you will scarce cure your Patient without exhibiting Antivenereall and Scorbutic Remedies.  
Therefore to prevent Sinuosities, you are to enlarge the Orifice at first, and keep it so wide open, that the Matter which is daily there engendered may have free passage out: which if it may not by the way the Shot went in, than you must consider how in another place the Sinus may discharge itself. This being prudently effected, and the Matter thereby discharged, you shall than more easily perfect your Cure.  
But before you make this Apertion, you must consider whether by altering the position of the Part, or by Compression with Bandage, or by hollow Tents, the Matter may not be brought out. And to make the Cure of these Cavities the more facile, you must endeavour to place the Member in such a figure that the Orifice may be depending. Also you must endeavour by Stupes, Sponges, Compress and good Bandage, to press out the Matter, that the Cavities may unite. They should be wrung out of Read wine wherein have been infused flor. ros. rubr. myrtill. court. granat. ballast. nuc. cupress. sumach, acacia. And if the Matter do not well discharge between Dress, you must dress it the oftener. Also Injections may be made with a Decoction of some of these following, myrrh. aloes, sarcocol. rad. iridos, aristoloch. spir. vini, mel ros. aq. calcis, alum. and such like, to dispose the Sinuosities to heal.  
Sometimes in a Wound inflicted on the upper part of a Member, the Matter not being likely to discharge itself thereout, I have by a Seton-needle perforated it through; and retaining the twisted Silk in the Ulcer till the lower Orifice was digested, than drawing out the Silk, I kept it open by a Tent a few days, till the upper part agglutinated; and afterwards, as the Matter lessened in the depending Orifice, I left of the use of the Tent, and healed it up.  
SO in a Gun-shot Wound on the inside of the Thigh, 
1. Observat. of a wounded Thigh.  passing under that Inguen slanting up to the Os ilion, and apostemating in the upper parts, it not yielding to Cure by Injections, Bandage, etc. I made a Cannula, through which I passed a Needle with a twisted Silk, and kept in the Silk as a Seton, till I had by Gentian-roots dilated the Orifice sufficiently for the discharge of Matter. To make the Perforation of the Needle more certain and easy, I applied a Caustick first upon the place, the better to feel the end of the Cannula. By this Apertion the Matter discharged itself in what position soever he lay, and he was thereby happily cured.  
One was shot in the Face betwixt the Nose and Eye on the right side into the Ethmoïdes by a Pistol-bullet. 
2. Observat. of a shot in the Face.  After he had been cured some years of the external Wound in his Face, he became troubled with a fretting Ichor, which discharged by that Nostril; and especially at his first rising in the morning out of bed it would run half a Spoonful of a yellowish colour, which had made a chop or gutter at the lower end of that Nostril by its acrimony. After some years he felt, upon bending his Head backwards or forwards, the Bullet to roll to and from over the Roof of his mouth. He complained to me of his Grievance at the Hague in Holland, a little before his Majesty's going into Scotland. I offered to his consideration the casting in Injections, or passing a Probe into that Nostril downwards, to try if either way it might be washed or thrust downwards in the Gullet, or be excreted into his Mouth. But these ways had heretofore proved ineffectual. We therefore resolved upon the cutting through the Palat-bone. To which purpose I placed him in a clear light, one holding his Head steady, while I cut into the Roof. But the Flesh was so close tied to the Bone, that it would not yield to my Spatula as I expected: wherefore I applied a bit of a Caustick-stone, and held it to the place with a Pledgit of Lint a few minutes; by which I consumed the soft fleshy part over the Bone, and afterwards cut into the Bone such a hole, that in the moving of his Head I could see the Bullet lodged in the Hole: which encouraging us to proceed in our work, the Bullet was afterwards taken out, and he eased of that discharge of Matter which threatened a filthy carious Ulcer. My attendance upon his Majesty into Scotland hindering my prosecution of that Cure, I left him in the hands of a Chirurgeon there, and since have often seen him at Court. But the Ulcer did not close up with a Callus; however the place is supplied by a small Plate without offence.  
If the Sinus run transverse the Veins, Arteries, Nerves, Tendons, etc. you may than, (if you think it not safe to pass a Needle in a Cannula through it, or if you cannot do it by reason of the make of the Part, you may than, I say,) make use of that Instrument described in the Treatise of Fistulae and Sinuous Ulcers in Ano, by which you may cut as assuredly upon the end of the Director which passeth within the Sinus, as if you saw it before you. It is commonly used where the end of the Sinus lieth most distant from the Skin. After which Apertion it must be kept open by a Tent, for the discharge of Matter, till it be well digested, and fit to cure. If the Orifice be small, and the Sinus lie but under the Skin, and in such a place as may be safely opened, it may be dilated with prepared Sponge, or Gentian-roots, and afterwards snipt open by a pair of Probe-scissors, or cut by a Knife upon the Director within, or laid open by Caustick. And after you have divided the Sinus, you may digest it with terebinth. cum vitell. ovor. or deterge by some of the Mundificatives set down in the Cure of Ulcers in general: and if there be occasion of more sarcotics, you may add mel comm. pulv. myrrhae, thuris, rad. ireos, to make it more exsiccant. But commonly, the depending part once opened, the Wound cureth in few days by Bandage, etc. as above said.  
But if after all your endeavours these Ulcers grow Fistulous, you shall found the Cure of them in another place.   

CHAP. V Of Gun-shot Wounds with Fracture.  
HAving declared unto you the way of curing Gun-shot Wounds in the soft and fleshy Parts, I purpose now to proceed to the curing them as they are complicated with Fracture of the Bones, whose firmness, dryness, stability and solidity, cannot defend them from these Inconveniences; nay, in the case I am to speak of, they are rather Discommodities. For when the Bullet striketh like Lightning, were they softer, it were the better, that the Bullet might pass, and not shatter them. There is not any of the five sorts of Fractures mentioned by the Ancients which these Blows will not occasion. Sometimes they will cleave the Bone assulatim, according to the length; and otherwhile they will break it athwart; other times they will divide it like the Scales of a Fish. Nay, if the Bones be drier than ordinary, (as in elderly men, and such in whom nature or Diseases have made them so,) they will grinned the Bone like Meal. Yet I have seen and dressed a Soldier that hath been shot through the Joint of the Ankle without ever breaking the lest part of the Cartilege.  
The ways to know when there is a Fracture in the Bone are many. 
Signs of Fractures.   

1. Hypocrates bids us compare the sound Parts with the Parts affected, and observe the inequality.  
2. You shall perceive a Cavity, if you touch the Parts above and under the Fracture.  
3. If you handle the fractured Member, you shall perceive a crashing of Bones, by reason of the mutual attrition of the hard bodies.  
4. There will be extraordinary Pain, in regard of the divulsion of the Nerves, and distortion of the Tendonous bodies; also a pricking in the Fleshy parts by the sharp ends or Shivers of some Bone.  
5. There will be an impotency of the broken Member, so that the Patient cannot lean upon it.  
6. The antecedent cause (Gun-shot) will teach much in this case, than which there never was (nor ever will be I believe) invented a more powerful one.  
7. The asperity and inequality or roughness of the Bone manifest it to you: but the search will give you no small assurance.   
Concerning Prognostics, you shall understand, 
Prognostics.   
1. Bones receive a quicker Agglutination in Sanguine than in Choleric bodies, by reason of the benignity of the Serum, which sendeth out better matter for a Callus.  
2. Bones are broke with lesle danger in the middle than near the Joint, where they are both more hard to be restored, and to be kept so restored; and because of the multitude of Symptoms, (which in such Wounds cannot but supervene,) are not without great difficulty to be cured.  
3. And lastly, those Fractures are most dangerous which are made so deep in the Fleshy parts, that your hands cannot well come at them, to extract the lose Bones, and place the other right, and retain them so by Bandage; as those of the Pubes, Os ilion, sacrum, etc. So also all those Fractures made by Splinter are exceeding dangerous, they generally shattering the Bone to pieces; in which case the Nerves, Tendons, etc. are grievously pricked and torn, and are subject to extraordinary Pain, Inflammation, Convulsions, and Death, unless immediate Remedy be had by removing those Bones, or by Amputation of the Member.  
Amongst the Cruisers in private Frigates from Dunkirk it was complained, that their Surgeons were too active in amputating those fractured Members. As in truth there are such silly Brothers, who will brag of the many they have dismembered, and think that way to lie themselves into credit. But they that truly understand Amputation and their Trade, well know how villainous a thing it is to glory in such a work.  
In the Roman History you will found it was not allowed at all: Livy tells you their reward amongst them. But later experience judgeth it commendable, if it be necessary, and in such shattered Limbs where there is no hope of preserving the Patient's life otherwise. And than it must be done in its proper time, that is to say, suddenly upon the receipt of the Wound, before the Patient's Spirits be overheated either with Pain, Fever, etc. Of the necessity of doing it speedily I shall here give you one remarkable Instance.  
A Scotish Soldier was brought to me out of the field at the Battle of Worcester shot with a Musket-bullet into the Elbow-joint, 
Observation.  which fractured not only the ends of the Radius and Vlna, but likewise that of the Adjutorium. Upon sight whereof I called William. Clarke (now a Chirurgeon at Bridgenorth) and other my Servants about me, to cut of the Arm, and the while I endeavoured to encourage the Soldier to endure it. In answer thereto he only cried, Give me drink, and I will die. They did give him drink, and he made good his promise, and died soon after; yet had no other Wound than that. By which may be perceived the danger in delaying this work to the next day, when the foresaid Accidents have kept them watching all night, and totally debilitated their Spirits. Which happens not, if it be done in heat of Fight; for than, while they are surprised and as it were amazed with the Accident, the Limb is taken of much easier: and if it be the Arm, some of them will scarce be kept in the Hold while the Ship is close engaged in Fight. In the heat of Fight I cut of a man's Arm, and after he was laid down, the Fight growing hotter, he ran up, and helped to traverse a Gun. And a Walloon earnestly begged of me to cut of his shattered Leg: which whilst I was doing, he cried, Depeche vous connous vendrone a terre mous bioron. Also others have urged me to dismember their shattered Limbs at such a time, when the next day they have professed rather to die. But amongst us aboard in that Service it was counted a great shame to the Chirurgeon, if that Operation were left to be done the next day, when Symptoms were upon the Patient, and he spent with Watch, etc. Therefore you are to consider well the Member, and if you have no probable hope of Sanation, cut it of quickly, while the Soldier is heated and in mettle. But if there be hopes of Cure, proceed rationally to a right and methodical Healing of such Wounds; it being more for your Credit to save one Member, than to cut of many. This following method is the best.  
Cleanse the Wound first from all strange bodies, 
Cure.  as Bullets, Armour, Apparel, and Shivers of Bones; so shall the Cure succeed more happily. For instance;  

Observation.  A Gentleman-Voluntier skirmishing with the Enemy before the City of Worcester, was brought to us run through his Arm in the middle of the Biceps with a Sword, and shot with a Musket-bullet in the same Shoulder under the Os scapulae, which took away the Coracoïdes, and tore the Ligaments in other parts of the Joint. We dressed the Wound inflicted by the Sword with Agglutinatives, healing it by the first Intention. We enlarged the Gun-shot Wound, pulled out the Bullet and pieces of the Coracoïdes, etc. and dressed it up with Digestives and lenient Embrocations, etc. and afterwards deterged with mundif. Paracelsi. He being William. Clark's acquaintance, he took care of him, and hastened the Exfoliation of the Bones with mel ros. & spir. vini. Afterwards, being near cured, he made his escape into his own Country. Many Instances of this kind may be given, if it were necessary.  
If the Fracture be near a Joint, the violence of the Blow will many times add a Dislocation also to it. If that hap, restore the Joint first to its place, before you meddle with the Fracture. These Dislocations are made by great Shot or Splinters of wood, whose force shatters the Limbs in pieces, or carries them quite away. But this latter rarely happens, but usually when the Member is shattered, it hangs by some little part of a Tendon, Musculous flesh, or Skin. In which case your work is, with a good Razor or Knife presently to plain the Stump, and pull up the Flesh, 
Smooth the Stump.  that you may saw of the end of the Bone close to it.  
One had his Arm shot of above the Elbow. 
Observation.  We dressed him up at first in haste, and at the next dressing his Shoulder proved out of Joint. We could not set it, by reason of the anguish of the Stump; which was a greater Pain to him than his Wound, and troubled him many months after. But so it happened, and in short Stump it is remediless. One of our Captain-Reformadoes had been served so formerly with his stumped Arm.  
If you will endeavour the remedying it, you must do it by help of a Bandage made above the Stump. But if it be above the Elbow, how will you fasten it. Yet in some bodies the Bone will be restored easily: therefore attempt it before you dress the Member.  
In another that had his Leg shot of, 
Observation.  in the place of Amputation below the Knee, some two months after, when I wondered the Bone did not exfoliate, I put in my Forceps to try whether any part of the Bone was lose: and finding it very lose, I took hold of it gently, and feeling it willing to come away, I pulled it out. It was the Apophysis or head of the Os tibiae, which makes the Knee. I was surprised at it; but considering what was lose must away, I pulled it out, to the amazement of the lookers on. This was relaxt from its Ligaments by the force of the Blow.  
In these fractured Wounds made by Gun-shot the Chirurgeon aught to propose two things to himself; first the Fracture, and than the Wound. To proceed orderly, you begin with the Fracture, 
Extension.  viz. with the Extension and Coaptation, that thereby the Fracture may be reduced to its proper seat: which in all these cases must be performed with much steadiness and discretion; not with such force as in those Fractures that are without a Wound, jest the Musculous or Nervous parts, being torn, bruised or crushed, should suffer extreme Pain, Convulsions, etc. Before you begin this Operation, if the Wound be not large enough, make it so, that you may be better pull out the extraneous bodies, whether Slug, Bullet, Rags, Splinters, or Shivers of Bones; so shall the Extension be made the easier, and be lesle subject to Inflammation, though you should not set it at that instant; for a small Extension will afterwards serve. Whereas if the Wound be not so cleansed, those extraneous bodies, nay the smallest Shivers of the Bone, will raise such disturbance as will tender it incapable of Digestion. Therefore what Hypocrates saith of attending to the 3.7. or 11. day, in case the Fracture be not reduced before Inflammation, would in these cases never be; for by that time the best that could be expected would be Apostemations and crude tumors, too big to be discussed. Therefore however the Reduction of the Fracture may have been omitted, yet it will behoove the Chirurgeon than consulted to extract the extraneous bodies immediately, so shall it lie more quiet, and fit for Reduction at his more leisure. But to avoid these Inconveniences, make your Extension so soon as you may, and restore the Bones to their former place with what gentle dexterity and lenity you can possibly. If the Wound be narrow, dilate it, as I have said, by Incision at the first: for these Wounds require more Dilatation than any other, that not only the bruised and vitiated Blood and other Excrements may have a free passage, but also by this means the Shivers of Bones (of which these Wounds use to be very full) may with lesle trouble be extracted by yourselves, or discharged by Nature.  
If you make not this Dilatation in the beginning, you may afterwards perhaps be forced to do it when the Part is accompanied with great Defluxion and Pain, or when the Bones are corrupt by retention of the Matter: and what condition it will than be in to admit of Incision, may easily be guessed by any one that hath common sense.  
After it is laid open, consider whether the Bone be bore or not; which you may satisfy yourself in by your Eye, Finger, or Probe. If it be bore, you must apply next to it some dry or exsiccant Medicine; 
Dressing of Gun-shot with Fracture.  Sicca siccis gaudent; dry to dry. Of this sort are dry Lint, Powders of the Roots of Iris, Myrrh, Aloes, Thus, etc. Forbear the application of greasy Medicaments to it, for they make the Bones foul, and hinder Callus. Yet the Parts adjacent require Digestion; therefore apply over them your Suppuratives warm, such as have been proposed in Simple Gun-shot. Than dress up the fractured Member with empl. è bolo, or this following: ℞ empl. diachalcith. with the addition of colophon. pulv. rad. consolid. maj. boli Armen. court. granator. succ. plantag. cum ol. myrtill. & lumbricor. an. q. s. Misc. & fiat Emplast. Than apply over the Wound a Stupe or double  wrung out of Read wine wherein have been infused flor. ros. rubr. ballast. sumach, bacc. myrtill. summit. absinth. or such like. This Compress will serve to keep the Lips of the Wound smooth, and defend it from the injury it may receive by Bandage.  
The next thing which is required in these fractured Wounds is Deligation: 
Deligation.  for unless they be rightly fitted, none of these Fractures, of what sort soever, can be well united. In simple Fractures without a Wound, all kind of Bandage may be admitted; whereof you may see in my Lecture of these Fractures various sorts, with many Circumvolutions about the Member. And once opening in seven days will serve their turn. 
Bandage to be daily loosened in Gun-shot Wounds with Fracture.  But in these another method of binding is required; for here the Bandage is to be loosened daily, and the Wounds to be looked into and dressed, they being here to be long kept open for discharge of excrementitious and purulent Matter, with which they abound, also for the Exfoliation of carious Bones, which lying there would corrupt the sound ones.  
Therefore in these kind of Wounds you must use such a Bandage as may lest shake the fractured Members. 
Manner of Bandage in Gun-shot Wounds with Fracture.  For they being every day to be dressed, the so often rolling them up would 'cause grievous Pains, and hinder union. Therefore it is that Authors have invented so many kinds of Bandage, to answer the Intentions of dressing them, and yet keep the Member immovable. Your Bandage in this case is to be made of softer and broader Linen  than what we use in Simple Fractures, that it may comprehend both the Fracture and the Wound, and keep the Lips down, yet not hurt them by its too hard Compression.  
Therefore we make choice of a piece of Cloth folded three or four times double, to give it the more strength, and of such a breadth as may encompass the Lips of the Wound and the fractured Parts, also of such a length as to come once about the Fracture. This Cloth must have three Slits from the ends to the middle, which middle must lie undivided underneath, to bear more equally the fractured Member, and the ends must come over one another with a Compress between over the Wound, to press the Lips thereof equally down, which would otherwise become crude, and pout out with great Lips. The Compress also serves to receive the Matter, and fill up the Inequality. These are so to be fastened, that you may dress and undress the Wound without disturbing the Member.  
But because it happeneth, that in these Gun-shot Wounds the Bones are shrewdly shattered, and the Wound lacerated, and by reason of the largeness of the Fracture and Wound it is extremely painful, the Member also is rendered so weak, that it cannot be kept steady by this Bandage; therefore we make use of Ferulae or Splints, 
Splints.  whereof I have made mention in my Lecture of Fractures in general, with the Judgements of the Ancients, who have been very industrious in contriving ways to make equal Compression, and leave a way for the dressing of these compound Fractures.  
They are not to be used till the Inflammation and Flux of Humours be of, 
When to be used.  which is not until the seventh day; during which we use Splenia, which are linen  folded four times double, and cut in length and breadth like the Ferulae. These are to be spread with Galen's Cerote, or any Ointment, that so they may adhere to the Part only until you have put the Bandage over it. And this is that I propose in all Fractures where there is Pain, and fear of Inflammation, and is especially necessary in these.  
They will handsomely strengthen the Part, and make such equal Compression, that the Bones may be kept in their place, the serous Humours pressed out of the Cavernulae, and the fractured Member lie soft; which is a great help in these Wounds, the whole welfare of the Patient depending upon the easy Bandage and Position of the Member. The Pain and Inflammation gone of, and the Wound digested, (if you think the Member not so subject to Inflammation, or that it requireth a greater strength to support it,) you may use Pasteboard cut into pieces proportionable to lay over those Splenia: or, having fastened the Splenia by the broad Bandage with three heads, cut a piece of Pasteboard fit to receive the lower part of the Member, and leave a place commodious for dressing the Wound. Over the other part of the fractured Member you must place another piece of Pasteboard to answer unto the former. These aught to be wet, that they may lie more pliant. About the Pasteboard make a Bandage with three Ligatures, which you must fasten in the most convenient place for the ease of the Patient. But if the Splenia be wet in Whites of eggs, and applied, they will strengthen the Member, and also keep it steady, without those.  
If you think those of Pasteboard not strong enough, you may use Laminae, 
Laminae or Plates.  Copper or Tin-plates lined with soft Linings, to receive the fractured Member, with Loops in the outside, to receive the three Ligatures answerable to those which lie underneath next the Plaster, that they may be fastened and loosened at pleasure, without disturbing the Fracture, in the daily dressing of the Wound. And if it be in the Thighs, the Plates are best; these Parts requiring such as are of great strength and length, and of such compass as may take in the lower half of the Member. These Laminae, or whatever else you use, must have a large Hole cut in them for the Wound to be dressed through.  
But I have always observed inconvenience in these Plates; that there is not so good Compression made upon the Lips of the Wound through those holes as to hinder them from thrusting out; whence there ariseth a Laxity and Indigestion in the Wound; and besides, the Matter that so dischargeth heats the Parts, and in hot weather corrupts and breeds Maggots. Therefore I make the Pasteboard or Laminae over my first Bandage to encompass so much of the lower parts as may support the Fracture, and come within an inch of the Wound; and over the Wound itself I fasten a Splenium of Cloth folded four times double, or a Ferula of Tin, Copper, or Pasteboard, lined according as I judge the Part can bear, and such as may be taken of at each dressing.  
The first Bandage next to my Cerote makes an equal Compression by its three heads meeting over one another: the lowermost presseth the Humours from below upward, and with the help of its next fellow keeps the Bones together, and forceth the Matter out of the Wound: also, by the help this middle Bracer hath of the uppermost, the Matter is pressed out of the upper part of the Fracture and Wound to the Orifice: it also restraineth the influx of Humours from above, by virtue of the Defensative lying under it. In the dressing these Wounds, you are only to undo the middle Hinder to come at the Wound; having a special care that this Bandage be neither too hard nor slack, but indifferently made, to the ease of the Patient.  
Having thus proposed to you the way of Deligation, I shall now proceed to the last Operation performed in these Fractures of a Wound, 
Position of the Part.  which is a commodious Position or placing of the Member, which (as I have told you in the Lecture of Simple Fractures) aught to have three Conditions.  

1. It must lie soft, jest the Compression offend the hurt Parts, and cause Pain and Inflammation.  
2. Equal: for if the Member be placed otherwise, it becomes distorted, and the Operation succeeds ill.  
3. Lastly, it must lie higher than the Parts next the body, especially the first three or four days. For if it incline downwards, the Humours by their own weight will easily flow to the Part afflicted. How this Position is performed, I have set down in the Lecture of Simple Fractures, to which I refer you.   
The fractured Bones of the wounded Part thus restored to their natural places, and the Wound digested, also the Inflammation and other Accidents gone of, which is commonly about the seventh or ninth day, you shall than unloose the Bandage, take of your restrictive Medicament, and apply the Emplastr. catagmat. in our London Dispensatory (or some of these under-written) over the fractured Member, which may add strength to the Part, and further the generation of Callus. ℞ resinae abiet. cerae, an. lb j. pulv. court. tiliae ℥ iij. succ. geranii ℥ iiij. coq. ad Cerati consistentiam: or this; ℞ mucilag. rad. consolid. maj. visci pomor. & populeon. an. ℥ iiij. succ. geranii ℥ vj. osteocoll. ℥ iij. pulv. court. tiliae ℥ ij. vitell. ovor. num. xx. terebinth. lb jss. ol. lumbricor. ℥ iij. coq. omnia bene permixt. ad Cerati consist. pro usu. But if you keep up the temper of the Part, you need not doubt of a Callus. I commonly in these cases make use of empl. stict. Paracels. part. ij. empl. diachalcith. part. j Over these apply a double Cloth dipped in Read wine wherein have been boiled some of the abovementioned Plants. Than place the former Bandage again, and over it those Laminae of Copper, or Splenia of double  dipped in Whites of eggs, and wrung out hard. These latter will sit close to the Part, and after they are dry, will support the fractured Member well.  
After the ninth day we suppose the Wound well digested; therefore we forbear the use of Suppuratives, and use such Medicines as are detergent, as the mundif. Paracelsi: or, if you please, ℞ vincae pervincae, peti, persicariae, beton. an. Mj. flor. hyperic. verbasc. an. Pj. rad. aristoloch. utriusque an. ℥ ss. thuris, myrrhae, sarcocol. ireos, an. ʒij. coq. in vino albo, addendo colaturae mellis rosacei q. s. This being cast in with a Syringe will deterge and incarn: or you may make it into an Unguent by the addition of terebinth. Wax, and ol. hyperic. and apply it upon Dossills', Pledgits, or Tents.  
If there be Caries, you may make a Decoction of scordium, vinca pervinca, peucedanum, gentian. court. guaiaci, rad. ireos, myrrha, in Wine, adding spir. vini, or extract. scordii. If the Caries yield not to these, touch it now and than with some of the following Medicines. ℞ ol. myrrhae distillat. per descensum & purificat. cum spir. vini ℥ ss. olei caryophyll. ʒij. ol. sulphurisʒjss. Misc. This will in a short time remove the Cariosity; afterwards you may proceed by Epuloticks.  
Vulnerary Plants are here of great use, and may be prescribed as followeth. ℞ aristoloch. rot. ʒij. fol. serpentariae, consolidae utriusquae, geranii, columb. saniculae, an. Mj. beaten them into gross Powder, and boiling them in a gallon of Wine in a Vessel close stopped, give the Patient thereof morning and evening ℥ iiij. at a time. You may give ʒj. of osteocoll. powdered in a draught of it, or the Decoction of vinca pervinca made with Wine, for confirming and hastening the Callus. In the rest proceed as in the latter end of Simple Fractures is mentioned.  
A Soldier being shot by a Musket-bullet into the force-part of the Arm near the Biceps, it fractured the Bone, and passed quite through. 
1. Observat. of a fractured Arm.  I endeavoured by Extension to place the fractured Bone even together, but could not: upon which I dilated the latter Orifice by a large Incision according to the rectitude of the Member, to pull out those Fragments of Bones which hindered their right Coaptation; and putting my Finger into the Wounds to that purpose, I pulled out a ragged piece of a Bullet; whether it was part of that which had passed through was the question. Some of the Bystanders thought he was shot with a brace of Bullets: but I rather think the Bullet was torn by the Bone, and that this part was it which had made its way through. However, by this Extraction the main Bone was rightly placed, the Shivers with the extraneous bodies removed, the Matter happily discharged by this depending Orifice, and the Patient was cured by the common Intentions of Healing these fractured Gun-shot Wounds. Whereas, if I had taken it for granted that the Bullet was passed through, and contented myself in having endeavoured the reducing of the fractured Bones, and so dressed him up, it had certainly inflamed and gangrened. This confirms that Doctrine in setting of Bones, that if any Bone will not be placed equally amongst his fellows, you aught to cut upon it, and take it out.  
In heat of Fight at Sea, amongst the many wounded men that were put down into the Hold to men, 
2. Observat. of a Facture made by a Splinter.  one of them had his right Arm extremely shattered about two finger's breadth, on the outside above the Elbow, by a great Splinter. I aught to have cut of this man's Arm presently: but a sudden cry that our Ship was on fire put me in such disorder, that I rather thought of saving myself than dressing my Patients. I hastily clapped a Dressing upon the Wound, and rolled it up, leaving his Arm in his other Hand to support it, and endeavoured to get up out of the Hold as the others did, verily believing I should never dress him nor any of them more. But our men bravely quitted themselves of the Fireship by cutting the Sprit-sail-Tackle of with their short Hatchets, (which they wore during Fight sticking in their Sashes.) So we were freed of the Fire, and by our hoisting up the Topsails got clear of our Enemy, and I returned to my work. But I was at a loss what to do with this man, who lay not far of complaining of his Arm. I would have cut it of instantly with a Razor, (for the Bone being shattered, there needed no Saw:) but the man would not suffer me to meddle with his Arm, he crying, it was already dressed.  
The Fight being over, and we gotten into the next Port, I caused this Mariner's Bed to be set up: (which was four pieces of Wood nailed together and corded, and a Bear's Skin laid upon it, and fastened between two Guns to the Carriages:) upon this I saw him placed; and having ordered his Arm to be laid so that I might the better come to dress it, I sent for Dress, and laid them orderly upon a small Pillow well stuffed and quilted in the middle. Upon this Pillow I first laid a soft double linen Cloth, next to that three Ligatures, than a Pasteboard wet in Vinegar, to make it more soft and pliant; upon that I laid a double Cloth, of such length and breadth as might serve to encompass the fractured Member, which I cut from each end to the middle into three Binder's: over the middle of this I placed a Splenium of Cloth four double, four fingers in breadth, and of such a length as to give strength to the Fracture: over this lay my Defensative spread upon a thick Cloth, of such a breadth and length as to take in the whole Arm. Dress thus laid upon the Pillow, I cut of the other from his fractured Arm, and placed the Pillow with these Dress close by his Side; so that I saw his Arm laid as I designed upon my Restrictive, and his Hand upon his Breast. Than putting my Fingers into his Wound, I pulled out first a piece of a Splinter an inch thick or thereabouts, more or less; than Rags and Bones, great and small; I left not the lest Shiver. When I had so cleared the Wound of all the extraneous bodies and lose Bones, I was amazed to feel what a voided space there was between the ends of the Bones. But I proceeded, and cut of the lacerated Lips, which were of no use, and dressed up the ends of the Bones with a couple of Dossils' dipped in spir. vini and mel rose. warm. The rest of the Wound, and upon Pledgits without, with an empl. diachalcith. malaxt with ol. myrtill. over all the Wound. Than I embrocated the fractured Arm cum ol. myrt. & olivar. immatur. and a little acetum, bringing my restrictive Emplaster, which lay under the Arm, over the whole Arm, from the Armpit to the Elbow and close round about, only leaving a space to dress the Wound.  
This gave a strength to the weak Member, and was designed to prevent the Influx from above. Just under this Emplaster there lay a Splenium. To answer that I applied three more, one on each side, and another above: which four were of such a size, that they, lying a little of from one another, encompassed the Arm. They were spread lightly with a little Cerote made of axungia and Wax, to make them adhere where I placed them.  
Than I brought the Bandage which lay under the Splenium, with three heads at each end. The lowermost of these took in the lower part of the Arm, from the Elbow upward, with part of the Fracture, and was fastened on the exterior part of the Arm. This pressed the Sanies from the nether part of the Arm to the Wound, and hindered the lapse of Matter that way. The middlemost was made to press the Matter out of the Wound, and keep the Lips down. The uppermost served to restrain the Influx, as I said, and pressed that Matter out which was already in the Part. This Bandage was made with great moderation, and so fastened, that it might be loosened without trouble to the Patient. Than I brought the wet Pasteboard close to the sides, and cut another piece to answer it, which I wetted in aceto, and by the three Ligatures under made them fast, but without disturbance to the Patient. If it could not have been so put on, I should have forborn the use of them, the Cure of these Wounds consisting in the easy Dressing and quiet Position, without which you will not cure one of them. The Pasteboard as it dried, stiffened, and retained its shape, preserving the Fracture in the position I left it, and that with a very slack Bandage. Thus I finished the first dressing, leaving my Patient in much ease. He slept pretty well that night, and was the next day as well as I could expect. He was let blood the second day, and kept to a spare Diet: but we allowed Wine as a Cordial to all our Patients.  
The third day I dressed him again, took of the upper Pasteboard, and loosened the heads of the main Bandage; also I took of that Splenium which was over the Wound, and raising up the Emplaster from the Wound, took out many Dossills', found it warm and well disposed, and dressed it up quick with my Suppuratives hot, and an Emplaster as before, I stirred not the Restrictive, but made now a Compress more particularly for the Wound, purposing not to remove the two outermost heads of the main Bandage, unless it were sometime to give a little breathing to the Member: but themiddle I opened as often as I thought fit, to dress the Wound. The other two had short Splenia to make the Bandage equal. But I was not than satisfied how the space between the fractured ends of the main Bond could be supplied with Callus. My Patient was easier than any of my other with fractured Wounds. When it came to my turn to be visited by my Brother Surgeons of our Squadron, they did not dislike the Wound, nor my way of dressing, (for we being used to see one another's Patients, had all much one way of dressing:) but they laughed at the excuse I made for not cutting of his Arm, and doubted I should yet be forced to do it. But I kept my Patient flat on his Back, and that after a while was his greatest pain; for the Wound digested, and the Tumour was not than considerable. After the Wound was well digested, and the bruised Flesh separated, I renewed the Dress, taking all the old ones of, and fomented the Member with warm Water, to give a breathing to it; than applied a Catagmatick Emplaster, dressed the Wound with mundificat. Paracelsi or such like, and bound up the Member as at first, and so continued my way of Dressing as I saw cause, putting into the Wound only a Dossill or Tent made upon a Skewer soft and hollow, to give way to the Wound to incarn; I scarce using any Injection, but by gentle Compression assisting Nature, who seldom faileth in supplying the lost Substance in Wounds, if we disturb her not by improper Applications. The next taking of and renewing these Dress of this fractured Member was occasioned some 16 or 17 days after, by a troublesome itching of the Part, which was occasioned, I suppose, partly from his liberty in Diet, partly by the heat of the Wether, and want of Transpiration. Upon this account I took of the Dress, bathed the Member with Sea-water, and dressed him up with emplast. de lithargyro. The Wound was about this time well incarned within, and the Lips beginning to cicatrize from their edges, I dressed them with Epuloticks, as unguent. tutiae, etc. All this while I kept my Patient upon his Back, and renewed not the whole Dressing until I was again necessitated. One day coming from the Shoar, (where our wounded men had liberty to lodge if they desired it, and were dressed by us there,) I found this Patient with a heat all over his Body like an Erysipelas: at which he was much affrighted. He had, it seems, drank Wine too liberally with his Mates, (as they would most of them do, if they were any thing well.) Unless it rather proceeded from a generation of Callus, 
Erysipelas upon the generation of Callus.  in which case it usually happens. I let him blood, and dressing him as in an Erysipelas, finding his Arm pretty strong, and his Wound healed within, and in a fair way of cicatrizing, I raised him up, after he had lain about eight weeks. All which while I believe he never stirred his Arm from the time I first placed it, but only while I renewed the Dress; he being the most patiented man in that respect I ever attended: and in truth, without that Submission he could scarce have been cured.  
There was in this Patient a strong Callus filling up the voided place of the lost Bone at lest two inches, with little or no shortening of the Arm: but the Joint of the Elbow was so stiff from the position it lay so long in, that he could not stretch that Joint whilst I knew him, which was until that Ship was cast away.  
My memory will be much cried up, for remembering so many Particulars in a Patient so many years since cured by me. But if you consider how remarkable a case it was, and in my Trade, there will be lesle wondering at the possibility of it. You may inquire what was done by me in the Cure of Captain Read, where the loss of his Jaw was supplied by a strong Callus, and that Cheek made uniform with the other. It will be long remembered by the than Standers-by, though not of our Profession.  
In our Sea-fights oftentimes a Buttock, the Brawn of the Thigh, the Calf of the Leg, are torn of by Chain-shot and Splinters. All these are contused Wounds, and look black, and do too often deceive the unexperienced Chirurgeon, he taking them by their aspect to be gangrened, and by dressing them as Mortifications with Aegyptiac. and spir. vini, doth certainly sphacelate them; and those persons die miserably afflicted.  
Whereas if they be considered rightly, though they look like Flesh long hanged in the Air, of a dry blackish colour, yet they have warmth, and by Lenients, as is prescribed in Simple Gun-shot Wounds, they would digest, separate their Sloughs, and incarn. But they are flow in Digestion, and require good Fomentations and Embrocations to cherish the native heat, which is much weakened by so great a loss of Substance. These require oleum terebinth. to be mixed with your Digestive: but you must have a care you do not inflame them and cause pain by adding too much of it: a Spoonful to six ounces of your Suppuratives is enough in the driest Habits. Your judgement will best direct you, and your Patient's complaint: it being unreasonable to hope that Wounds can digest, while they are accompanied with much Pain.   

CHAP. VI Of Gun-shot Wounds in the Joints.  
THE Wounds of the Joints are subject to more grievous Accidents than those I have heretofore mentioned; 
Great care to be used about these Wounds, and why.  therefore they require your more particular care; the Tendons and Ligaments being inserted near the Joints for the motion thereof: there are also Membranes, which do consequently tender them of a most exquisite sense. The Trunk of Nerves also in every great Joint passeth through, for the use of the Member that is beyond it. To which I add, that the Part being exsanguous, the natural Balsam of the Body is here more sparingly supplied for the help of the Cure.  
What the Pains are, may be judged by the Wounds in the lesser Joints. Captain F. in Musselborough Fight was shot in one of his Fingers, and the next day so grievously tormented, that he walked up and down like a Madman, and could take no rest until his wounded Finger was digested: yet his Pain was not so great in his wounded as in his well Fingers.  
The greater Wounds are attended with much more vehement Pain, 
Prognostic.  Inflammation, Delirium, Convulsions, Gangrene, and are commonly deadly.  
In these Gun-shot Wounds, 
Cure.  the extraneous bodies and Shivers of Bones must be presently drawn forth: therefore if the Orifice be not large enough, make it so. But in enlarging the inner or lower Parts in the hollow of the Ham, Arm, Armpit or Groin, have a care, for they are subject to great Bleeding. The extraneous bodies being drawn forth, hasten Digestion, by dropping and applying warm upon Dossills' or Pledgits some of these following Digestives: for Tents are to be used with caution in these Wounds.  
℞ terebinth. lot. in spir. vini ℥ iiij, thuris, myrrhae, mastic. an.ʒj. ol. hyperici ℥ iij. vitell. ovor. num. ij. croci ℈ ij. Or, ℞ terebinth. ℥ ij. myrrhae, thuris, corn. cervi usti, an. ℈ iiij. ol. scorp. de castoreo, lumbricor. sambuci, an. ℥ ss. vitell. ovor. num. ij. Apply either of these warm. If stronger be required, you have ol. terebinth. de castoreo, scorpion. etc. ℞ ol. terebinth. ℥ j ol. hyperici cum gum. ℥ ij. euphorb. pulv. ʒj. drop this very hot, and apply the forementioned Digestive over all; than embrocate the Parts about with ol. lumbric. & hyperici, and lay over all this following Cataplasm: ℞ farin. hoard. & fabar. an. lb j. flor. cham. meliloti, ros. rubr. scored. absinth. pulv. an. ʒuj. Decoct it in the Broth of Offal, if you would have it lenient, otherwise in Oxymel, adding ol. ros. & chamaemel. Or this; ℞ mucilag. radic. althaeae, consolid. maj. an. ℥ iiij. flor. ros. rubr. beton. cham. subtle. pulv. an. ℥ ss. farinae lini, foenugraeci, an. ℥ iij. farine hoard. & fabar. an. ℥ vj. coq. in vino, add ol. ros. & lumbricor. an. ℥ jss. mell. ℥ ij. vitell. ovor. num. iij. The Wound digested, you may deterge with this; ℞ farinae orobi ℥ jss. thuris, rad. ireos, an. ʒuj. succi apii ℥ iij. mell. comm. & terebinth. an. ℥ ij. Misc. fiat Vnguentum. The Wound deterged, you may dress it with this Sarcotick. ℞ summit. hyperici, equiseti, plantag. beton. an. Pj. rad. consolid. maj. tormentillae, an. ʒiij. sevi hircini ℥ iiij. lumbric. terrest. lot. ol. mastic. an. ℥ ij. vini odorif. q. s. coquant. ad consumptionem vini, postea colentur cum forti expressione, deinde adde resinae pin. ℥ j thuris, myrrhae, mastic. aloes, an. ℥ ss. cerae ℥ iiij. Misc. fiat Vnguentum S. A. Ol. Aparici is excellent in these Wounds, either alone, or heightened by any of the former Prescriptions: so is the Balsam in the Chapter of Wounded Nerves. If the Bone be bore, you must be careful that you do not foul it by your greasy Medicaments: and if Pain be violent, and yield not to Anodynes, cut of the affected Tendon, and whatsoever corrupts, jest it taint the rest. But in these great Wounds you are at first to consider how curable they are, and endeavour to preserve the Life of your Patient by a timely Extirpation, before his Spirits be too much exhausted. Of which this following Story will give you warning.  
A Page of lieutenant-general D. L. 
Observat. of a Shot through the Knee.  was shot through the Knee. The Bullet entered in by the lower and exterior side of the Rotula, and passing through the Joint out in the hollow of the Ham, tore the Ligaments and Nerves, and fractured the Joint as it passed, rending the Artery in going out. This Wound was mortal the very minuit it was inflicted, and the party aught than to have been dismembered: but such Proposals were not admitted of in the first dressing, whilst there was, as they judged, hope. Afterwards the vehement Pain brought suddenly on severe Accidents, as Fever, Delirium, etc. and than it was too late to make Amputation. I made my first Dressing by the Application of a Digestive dipped in ol. lumbric. warm, and embrocated the Parts about with ol. ros. cum aceto, applying my Restrictive over all. In the depending Orifice there was a throbbing of the Arterial blood, as in an Aneurisma, the blood being choked in by the contused Flesh: it therefore was not there to be tented, for fear of making a Flux of blood; nor yet could we hope to stop the Bleeding by Cautery, actual or potential, that Part being full of Ligaments and Tendons, the burning whereof would have been difficult, and grievous painful. Wherhfore I dressed that Wound with the same Digestive mixed with pulv. Galeni upon Dossills' with thick Pledgits, and some of the same Restrictive over that, with such Bandage as that Part was capable of; hoping this way to hinder the Influx of Humour, and thinking by such Dress the Wound would digest. But the Pain increased vehemently, and yielded to no Application, nor was there any possibility of conveying any Instrument, whereby I might thrust or pull out the Shives of Bone, if any such were in between the heads of the Joint. Mr. Penicuke, formerly General Chirurgeon to the Scotish Army, and other Surgeons were with me at the dressing of this Patient: but in spite of all our Endeavours, the Putrefaction increased, and was attended by Delirium and Spasm. Death followed, as commonly it doth in all such Wounds of the great Joints. I could instance it in many, but the late case of Sr. J. L. may serve for all. He had many of our most experienced Surgeons, with the eminentest Physicians to help them; yet they had no better success. Therefore at Sea, while they are warm with heat of Fight, we dismember them, and by actual Cautery stop the Flux of blood.   

CHAP. VII. Of Gun-shot Wounds in the Belly.  
I Have now briefly run through the Parts not principal, and purpose next to say somewhat of the principal Parts, as the Belly and Breast. And that you may the more certainly know the Part wounded, I shall give you a short Description of them, and than show you how such Wounds are to be handled in order to their Cure.  
The Belly is called Abdomen, or the inferior Venture. 
Abdomen described.  It gins from the Bastard-ribs, and extends itself to the Goins; and is divided into three Regions by our Anatomists, the upper, middle, and lowermost. The uppermost is called Epigastrium, the middle Regio umbilicalis, the inferior Hypogastrium. The sides of the uppermost are termed Hypochondria. The right Hypochondrium possesseth all the Liver: in the left is the Spleen. Between these is placed the Ventriculus, or Stomach. In the middle part of the Abdomen is the Navel; round about which lie the Guts, and behind those on each side the Kidneys. In the sides of the inferior part are the Ilia, with the Pecten or Pubes in the middle: under which lies the Bladder. Thus much to the internal Delineation.  
The Abdomen consists moreover of Parts containing, and contained. Parts containing, or Teguments of the Abdomen, are either the common, which reach all over the Body, as the Cuticula, Cutis, Pinguedo, Membrana carnosa: or the particular and proper to this place, which are the Muscles of the Belly, the Peritonaeum, and in respect of the Guts the Omentum. The Parts contained are some of them designed for the Nutrition of the whole Body, others for Expurgation, and others for Generation. The Stomach, Small intestines, Mesenterium, Vena porta, cava, Arteria magna, and coeliaca magna, the Liver and Spleen, serve for Nutrition. The Bladder, Gall, all the Intestines, but especially the great ones, Kidneys all Ureters, for Expurgation. And for Procreation, the Vassa praeparantia & deferentia, Prostatae, and Vterus in Women. These Parts containing and contained are subject to Gun-shot; whence various Species arise of these Wounds. Sometimes the containing Parts, 
Wounds not penetrating.  as the Cutis, Pinguedo, Caro musculosa, only are wounded; so as neither the Peritonaeum nor the other internal Parts suffer any hurt.  
And this hath happened to many in Service, who have been brought to me as mortally wounded, whereas upon search I have found the impression only upon a greasy Leather Jerkin, or their Bellies black and a little scratched by the Bullet. Yet even these are subject to Tumour, and so do require lenient Embrocations, with an empl. è bolo or the like. In others the Skin, and Flesh under it, is sometimes wounded, and no farther. These are by us called Wounds of the Belly not penetrating, and are cured as Gun-shot Wounds in Fleshy parts: in which cases all those Applications are approved of which have been delivered in Simple Gun-shot Wounds.  
But this I must take notice of to you, as having often observed it, not only in Gun-shot Wounds, but in Abscesses of the Belly, that from the Laxity of the Parts, they are subject to great Defluxion: especially in scorbutical and ill Habits of body, the Matter is apt to insinuate itself amongst the circumjacent Muscles, raising them up, and rendering them Sinuous Ulcers difficult of Cure; and that because we cannot make such Bandage on them, by reason of their Figure, Site and perpetual Motion, as elsewhere may be made. These thus briefly considered, 
Wounds penetrating.  we pass to the other Species: for the Bullet is for the most part carried with such force, that it not only wounds the Fleshy parts, but also pierces the Peritonaeum, hurting most an end the Internalls; it being indeed impossible that the Bullet piercing the Parts containing should miss the contained, which are soft and tender.  
I have seen sometimes in the Wars a Soldier shot scarce to the Peritonaeum, yet the Contusion hath been so great, that the Peritonaeum hath come of upon Digestion: in which case the Bowels commonly suffer under severe Colicks, and there ariseth Difficulty of breathing, etc.  
If the Bullet penetrates through the Peritonaeum, though not farther, yet the Contusion makes foul work, and requires speedy relief. But if it hath wounded the internal Viscera, than you must consider what the Parts are that are wounded, whether the Liver, Stomach, or which of the Intestines; which you may apprehended from the Site of the Part, and the Accidents accompanying such Wounds, also by the proper Symptoms of each Part.  
According to Celsus, Lib. 
Signs of wounds of the internal parts of the Abdomen.  5. Cap. 26. the Liver being hurt, there followeth an Effusion of gross blood: if the Porta or Vena cava be hurt, the right Hypochondrium is oppressed: if the Artery be wounded, the blood is florid, and bursts impetuously forth, and the Patient expires with it. But if the Stomach be hurt, Singultus or Hiccough follows, with Vomiting and Nausea, and the Patient's Sustenance comes out of his Wound with the Chyle, and cold Sweats show his languishing condition. If the lesser Intestines be wounded, he will be troubled with poraceous Vomiting, and what he eats or drinks will pass out of his Wound in lesle than half an hour; and so it will continued to do as long as he lives. If the great Intestines be wounded, the Excrements and filthy Smell will demonstrate it. If the Wound be on the left Hypochondrium under the Short ribs, you may conclude the Spleen wounded; the blood which floweth forth is black; there is also a Tension, and Difficulty of breath. If the Kidney be hurt, the Wound is in the Region of the Loins, near the Vertebra under the Diaphragma. The more certain sign thereof is from the Pains reaching to the Groins and Testicles, with difficulty of Urine: and that Urine which he voids is either mixed with Blood, or else pure Blood. If the Ureters be wounded, the Urine comes out at the Wound. If the Bladder be wounded, that part of the Belly is tense, he hath great pain in his Groin, and his Urine is discharged by the Wound; the Stomach suffers by consent, and the Part wounded demonstrates it. If the Womb be wounded, the Groins and Coxa are afflicted with the Pain, and the blood not only flows by the Wound, but per Vulvam; they are troubled in Mind, and have other shrewd Symptoms of Death.  
For what concerns the Presage of these Gun-shot Wounds, 
Prognostic.  if they be only in the Region of the Belly, they are not without peril, especially if in the middle, where the Linea alba is: but if they penetrate, there is great hazard, for these Parts so shattered seldom recover. What we have sometimes since seen, of a man discharging his Excrements out of the Colon on the left Side, and heard of other like Wounds of the Stomach, are rather Miracles than the work of the Chirurgeon. But they were happy that were instrumental in those Cures. If Celsus in his time determined those Wounds mortal made by cutting Weapons; how much more must they be such that are made in our age by Gun-shot? Yet Nature, as one saith in his Vulneribus, saepe miracula facere solet, is often as merciful and miraculous in the Cure, as the Blow was cruel.  
In order to the Cure, you must begin with the Extraction of the Bullet, 
Cure.  jest it sink into the most inward Parts, and there afflict the Viscera; as als of the Rags carried in with it, jest they beget Putrefaction. That done, you must reduce the Intestines and Omentum, jest they inflate and corrupt. After the Extraction of the extraneous bodies, you must hasten Digestion, and mitigate the Inflammation.  
The Intestines and Omentum are disposed to Reduction by warm discutient Fomentations: but if there be not an Opening wide enough, you must enlarge the Wound. If the Omentum be corrupted, make a Ligature below that corrupt part, and cut if of, leaving the end of the Ligature hanguing out, till it shall be cast of by Digestion.  
If there be Haemorrhagia, you must inject such Medicaments as have a refrigerant and astringent quality: and those may be, aq. urtic. plantag. spermat. ranar. or Read wine, cum syr. de ros. sicc. with Pulu. bol. Armen. terr. sigil. sang. dracon. aloes, thuris. Make a Mixture of some of the same Powders with a newlaid Egg, ol. mastic. & lumbricor. and apply it upon a Tent fastened to a Thread, as is before described, than spread the rest upon a Stupe, and lay it over all. But if there be no Flux of blood, digest as fast as you can.  
In order to the Cure, 
Wounds of the Stomach and Guts.  Fallopius hath recommended to our use this following, by the use whereof he cured Wounds of the Stomach and Intestines. ℞ fol. pilosellae, plantag. rad. tormentil. consolid. maj. flor. hyperici: decoct these in Read wine; strain it out, and add to the said Liquor mannae, thuris, ol. mastic. resin. abiet. terebinth. Cypriae, croci & verm. terrest. an. q. s. fiat Sarcoticum S. A.  
In all these Wounds of the Belly I have used such like Medicaments as I have offered unto you, and applied to the Wound itself Digestives, as in Simple Gun-shot, and endeavoured by good Fomentations, Embrocations and Cataplasms, to preserve the natural warmth of the Part.  
In Wounds of the Kidneys, 
Wounds of the Kidneys.  you must inject such Medicaments as have an abstersive and drying quality; as rad. consolid. irid. aristoloch. rot. also myrtill. caud. equin. plantag. ballast. Decoct these in aq. chalybeat. adding afterwards some Read wine and syr. de ros. sicc. thereto. Than dress up the Wound with a Digestive ex terebinth. cum integr. ovo, with a little terra sigil. thus and Mastic, and embrocate with ol. hyperici; applying empl. diachalcith. malaxt with ol. ros. or a Cataplasm ex far. hoard. fabar. & orobi decocted in Oxymel, and made up with a newlaid Egg and ol. ros.  
If the Liver or Spleen be wounded, 
Wounds of the Liver, Spleen, etc.  there will be a great Flux of blood; in which case I offer this to you: ℞ plantag. pentaphyll. polygon. millefol. myrtill. ros. rubr. decoct these in chalybeat Water. You may use it as an Injection, with an addition of syr. de ros. sicc. or you may add to it pulv. thuris, sang. dracon. bol. Armen. acacia, and so it may be applied as a Lineament upon Tents or Pledgits.  
Thus you are to dress all the Wounds in the particular Parts of the Belly.  
The Wounds of the Womb are accounted deadly, the very lest of them, and so are all the abovesaid made by Gun-shot; yet you are to proceed in the univerfall Regiment, and with Clysters, Bleeding, and good Vulneraries, endeavour to dispose the Parts to Sanity.   

CHAP. VIII. Of Gun-shot Wounds in the Thorax.  
AMongst the principal Parts which are subject to Gun-shot, the middle Venture or Thorax is reckoned, with the Parts contained in it, viz. the Heart, Lungs, great Artery and Vessels, with the Mediastinum.  
These Wounds are distinguished as those of the inferior Venture. 
Difference.  Sometimes the Wounds are only of the external parts, without penetrating into the Breast; othertimes they penetrate through the Ribs and Pleura: in which latter case the principal Viscera are wounded, or not wounded.  
If the Wound do not penetrate into the Cavity of the Breast, but is only in the Musculous flesh, 
Not penetrating.  it must be cured as Wounds in the Fleshy parts. If there be a Fracture with it, it must be treated as a Wound with Fracture, taking care to extract the broken Bones, jest they prick the Pleura, and cause Inflammation.  
But if the Bullet hath penetrated deep into the Cavity, it may be discerned by the passing forth of the air with noise: 
Penetrating. Signs.  there will also follow a Flux of blood by the Wound, or Mouth, or by both; unless the blood fall down upon the Diaphragma; and than the Difficulty of breathing and such like Symptoms will demonstrate its Penetration. And if the Lungs be wounded, there will be a Cough, with Difficulty of breathing, and frequent Sighing: if there be an effusion of blood, it will, accordingly as it is much or little, flow forth of the Wound, or be caught up, sometimes both: the Patient will incline to lie much upon the Wound. If the Heart be hurt, the blood floweth impetuously, and is reeking hot, their Spirits sink, and cold Sweats bedewing their Face foreshow their approaching Death.  
The wounded Diaphragma is accompanied with Difficulty of breathing, also a a Hoarseness, with great Pain about the false Ribs; the Diaphragma is drawn upward, and the Spine is affected.  
If the great Vein or Artery be hurt, a terrible Flux of blood follows. If it flow from the right Side, the Cava is hurt; but if from the left Side, we suppose it the Artery. You will discover it by its Saltation and florid colour. If the Porta be wounded, the Patient dies at the instant; and so he doth of all the rest. If the Spinalis medulla be wounded, the Nerves are resolved, and a Palsy follows, but more immediately in the Part under the Wound.  
Almost all these Wounds made by Gun-shot are mortal; but it is not consistent with Religion or Humanity, to leave such people without help: for sometimes we haply prolong the life of some of them, and now and than cure one.  
I shall therefore proceed to deliver you what concerns their Cure, 
Cure.  both as to the internal Remedies given by the Mouth, and to those which relate externally to the Wounds.  
In the first place, you must make Extraction of the Bullets and other extraneous bodies, Shivers of Bones, etc. to give way for the discharge of Blood and Matter contained in the Cavity of the Thorax: than dress the Wound with a Tent dipped in this or such like; ℞ bol. Armen. corn. cerv. ust. ol. ros. & sambuc, farin. volatile. cum ovo integr. Misc. Spread a Compress with some of the same, and apply it over the Wound. If the blood stop not by this Dressing let blood in the Arm, and repeat it as often as you see cause, applying some of the Astringents set down in the preceding Chapters. Or you may inject some astringent Decoctions, which is otherwise than was advised in Wounds made by Puncture: for in Gun-shot Wounds the Orifice is wide enough for the Injection to return out again, insomuch that not only the astrictive Intentions aught to be pursued, but also the detersive; here being loss of Substance. Therefore in case of Bleeding you may inject a Decoction of fol. plantag. ulmi. urticae, vincae pervincae, ros. rubr. fol. myrtill. in aq. germ. querc. adding a little bol. Armen. and syr. de symphyt. Or for present occasion use Read wine, it being excellently good in such bleeding Wounds, either given inwardly by the Mouth, or cast in by a Syringe. Having thus stopped the blood, you are to digest the Wound with such like: ℞ terebinth. lot. in decoct. hoard. ℥ ij. pulv. thuris, myrrhae, an. ℈ ij. sem. foenugr. pulv. ʒj. ol. hyperici q. s. Arm short Tents with some of it; than apply over it a Pledgit with some of the same, or with such Suppuratives as in Simple Gun-shot Wounds are prescribed, and embrocate the Breast and Parts about with a Mixtrue of ol. amygdal. dulc. lumbric. and unguent. dialthaeae, applying over all an empl. diachyl. simple. malaxed in some of the same. After Digestion you will found it necessary to deterge and incarn. It is not material whether the Detersion be made by Injection or Unguent, there may be use for both; to which purpose I have set you down both sorts, and shall begin with an Injection, as supposing the Matter may thereby be disposed to discharge by the Wound. The milder may be a Decoction of pilosella with mel ros. If stronger be needed, ℞ extract. scored. dissolved in vino albo; or, ℞ fol. pilosellae caud. equin. plantag. tormentil, consolid. aristoloch. rot. rad. iridis, & sarcocol. boil these in aq. font. adding Wine thereto with mel ros. q. s. The Unguent may be this following Mundificative: ℞ terebinth. ℥ ij. farin. hoard. cribrat. ʒj. thuris, sarcocol. rad. iridis, an. ʒiij. mellis ros. ℥ iiij. Misc. S. A. and dress the Wound in the Fleshy parts with the same. The Wound deterged, incarn and cicatrize as is said in other Wounds; but keep a Cannula in it until it cease to run. Celsus proposes, that in all these internal Wounds the external Parts be vesicated, to make more powerful Revulsion from; within: and the Medicament he proposes thereto is Sal bene contritus cum cerato mixtus, quia leviter cutim erodit, eóque impetum materiae quo pulmo vexatur evocat. This his Proposal may be proper in Wounds made by sharp Weapons, as by Arrows, etc. But here in these Wounds there is vexaction enough outwardly to make a Revulsion, if that signified any thing. In the dressing these you must be careful to cut of the Sloughs without, jest from them a stinking Gleet distil upon the Viscera within. In order to the Cure, Clysters are also required, to keep the Body open: and the more temperate pectoral Decoctions are here proper, such as that in the London Dispensatory. To them may be added syr. violar. de cichor. de liquiritia, jujub. capill. ven. de symphyto, and such Lohoches as may take of the harshness in the Aspera arteria. Their Diet aught to be slender, and their Drink: medicated Ale or Hydromel wherein Pectorals have been decocted are proper in all these Wounds; so are also Emulsions: and after the Fever and such like Accidents are diminised, Asses and Goat's milk may be necessary; yea a Diet of Cow's milk alone, or mixed with distilled Milks, and sweetened with Conserve of Roses. But this will be work for the Physician, when they come ashore. Many Instances may be given of Gun-shot in the Breast: but few do recover that are shot into the Lungs.  
At the Battle of Worcester there was one brought to us shot with a Musket-bullet through one side of the Sternon, 
Observation.  which passed out between two of the Ribs on the other side, without any visible Symptom of danger. We dressed the Wounds with a Digestive dipped in ol. lumbric. warm, and kept the lower Orifice between the Ribs open for discharge of the Matter, it being the depending Orifice. He was let blood, and prescribed Pectoralls, etc. as occasion offered. His Wound digested, and was afterwards deterged with mel rosar. etc. After our Defeat he was dressed by William. Clarke, now of Bridgenorth; and, as I have been since informed by him, was concealed by some Housekeeper until he made his escape.  
From the Defeat of the Scotish Army near Dunbar there came many of the wounded to Saint-Johnstons, 
Observation.  and amongst them there were several wounded into the Breast. They who were so shot as to have the Ribs broken, were in extreme Pain from the Shivers; whereas the rest whose Bones were not hurt had scarce any Pain at all, but what proceeded from Difficulty of breathing; they all coughing up a stinking Sanies both before and after the separation of the Sloughs. One of them caught a very great proportion daily of thin Matter, of a brown colour and rank smell. None but this died under my hands; the rest after some while retiring to their homes, where (as I have often heard them say) their Leeches performed great Cures, by virtue of some Plants which they gave internally, and which with Fats they made Balsams of. Yet I believe this man died tabid.   

CHAP. IX. Of Symptoms of Gun-shot, (omitted in the Fourth Chapter.)  
THE Symptoms attending Gun-shot are Pain, Phlegmon, Erysipelas, Fever, Delirium, Syncope, Gangrene, Convulsion, and Palsy. The Pain occasions Inflammation, whether it be Phlegmon or Erysipelas; of both which I have elsewhere purposely treated. But that of Gangrene I thought fit should accompany Gun-shot, they of all Wounds being most subject to it. The Fever it symptomatical, so is the Delirium, and will go of with the Pain; but may, with the forementioned Inflammations, be relieved by Bleeding and lenient Purgatives, such as I have mentioned. And to fortify the Spirits against Fainting, which proceeds from putrid Vapours affecting the Heart, there are Cordials and Epithemata already prescribed. So that there remains only Convulsion and Palsy to be here treated of.  
Convulsion is, An involuntary Contraction of the Nerves to their original, 
Convulsion.  by which Contraction the Member is also drawn up; and it is said to be caused by Repletion and Inanition. In this our case it ariseth from putrid Vapours, or acrid Matter offending the Nerves, which is often found in these Wounds. The Part affected is the Brain, which being thus provoked causeth an involuntary Contraction and Rigidity in Parts dismembered, as near the Knee or Shoulder. There the Contraction cannot be discerned but by a Trembling, which Trembling is usually attended by a Convulsion of the Joints. It likewise follows upon great Inflammation, especially in the Nervous parts. The Prognostic here is always fatal, a Convulsion upon a Wound being he forerunner of death.  
In the Wars I was called to see a poor Soldier, 
Observation.  who had his Arm shot of near the Shoulder. The bruised and shattered Stump seemed to his Chirurgeon to be gangrened, and accordingly he dressed him with Aegyptiac. as a Gangrene: from which sharp Dress the Wound gleeted, and, by reason of the Pain, inflamed. He had roared some days through the vehemency of that Pain. When I came to him, I saw a great Trembling of the Part, and a frequent twitching upwards of the Tendons and Musculous flesh in the Stump; also the Flesh in the whole Stump was of a whitish colour, as if it had been scalded. I dressed him up with Anodynes, as Lineament. Arcei cum vitell. ovi, and fomented the Part with fol. malvar. violar. thaps. barbat. decocted in Milk, embrocating it cum ol. lumbric. & ex ped. bovinis, and applied empl. diapalmae cum succis over all; than anointed the Parts about, as the Neck and Spine, with unguent. nervin. I also blistered the Legs and Thighs: but it was too late, he died howling.  
Paralysis is generally defined, A privation of sense or motion, or both, 
Palsy.  in some Part or Parts, and affects the Brain and Spinalis medulla. But in Palsies which arise from Wounds the Parts immediately affected are the Nerves of that place only. This doth not take away the life of the Patient, though it may sometimes threaten a Mortification through defect of natural heat in the Member.  
In a Sea-fight an Irish Mariner having discharged his Gun, 
Observation.  which was honycombed, and loading it suddenly again, whilst he was ramming in a Cartridge, the Powder took fire, and shot the Rammer out of his hand, tearing the Palm of his hand, also some of his Thumb and Fingers. The Wound was not considerable, but the force of the Blow extinguished both sense and motion of the Member. I dressed him up with our common Suppurative, (of which at such times we had great quantity ready,) and applied over all a common Restrictive, so rolled it up, there being than no time for Bleeding him. But after the Fight I let him blood, and a day or two after purged him, than fomented and embrocated the Member with ol. lumbric. cham. anethi, lilior. unguent. nervin. and such like, and did all that we Surgeons of the Squadron thought fitting; but without success. One night after he was cured of his Wound, lying asleep in his Hammock, he was wakened by the wet he felt upon his Breast and Belly; and getting up to a Candle, he found the Dressing upon his Hand all bloody, as also the place whereon it lay. I being called took of his greasy Dress, and found the Palm of his hand and Fingers gnawed by Rats. They had eaten through the oiled , and had gnawed his Hand more, if he had not wakened by the trickling of his blood. I dressed his Wounds with Digestives to hasten Suppuration, supposing the discharge of Matter might contribute to his Recovery. After I had cured them, I made him a fontanel in that Arm, and bathed the Member frequently, also cupped and scarified it; and afterwards applied Plasters of Pitch, to stir up a heat in the Member. He was a young man, and otherwise of a strong Constitution, and was not over-solicitous to have it cured, as designing to make some profit by it. To which purpose he took an opportunity of landing, and hastened away to Madrid: where having gotten some reward for his service, he returned to the Navy, and had more use of his Arm.  
Paralysis doth often hap in great Contusions and Luxations; of which more elsewhere.    

AN APPENDIX To the Treatise of Gun-shot Wounds.  

To the Reader.  
HAving thus finished the Treatises of Wounds, I considered with myself that my Design was to help the Sea-Chirurgeous, who seldom trouble their Cabins with many Books. I therefore thought it convenient to make this as comprehensive for their use as I could, by comprising in it all those things which may easily be foreseen to be of use to them in other cases besides Wounds. We know by our experience, that Burn by Gunpowder and other materials do too frequently hap at Sea; and also, by ill Dress of Wounds, Gangrenes and Fistulae arise, and that much the sooner, if broken Bones, especially those with Wounds, be not well brought together, and so held. All which matter we occasionally handled in the foregoing Work: yet not so much, but that, for their farther Instruction, I thought it requisite to anticipate something of other Discourses which I intent for the Press, by the following Appendix; which, if well perused, may perfect the Chirurgeon in what remains to be known concerning Wounds, and save him the labour of reading many Authors.   

CHAP. I De Ambustis, or, Of Burns with Gunpowder, etc.  
FOrasmuch as it often happens, that in close Fights at Sea men are sometimes burnt by Gunpowder by their Enemies, and by various Accidents amongst themselves; I shall therefore deliver to you the most plain way of curing them. For, however people cry, It's nothing to cure a Burn: yet, by what I have seen of these Cures from Country or City, they are often very ill performed. Whether they are burnt by Gunpowder or any other way, their Cure is much alike, they only differing secundum magis & minus. Only if they be burnt with Gunpowder, they must pick out the Powder first; else they will carry the same blue Mark, if it be in their Faces, which some people use to do in their Hands and Arms, which I have often been employed to take out, when done wantonly in their youth; but could never remove them otherwise than by taking of the Skin.  
If the Burn be superficial, it raiseth the Cuticula up in Blisters: if it go deeper into the Skin, it causes an Escar: if it burn deeper into the Flesh, the force of the fire makes a hard Crust with a Contraction. In all these the Pain is excessive.  
Once as I was dressing a gangrened Leg with warm Spirits of terebinth. etc. Mr. Arris and Mr. Hollyer Surgeons and others being close about me, and I upon my Knees, the Candle being too near the hot Spirits, catcht the flame, and burned my Thumb and Fingers before I could get free from those behind me to throw it into the Chimney, which was some distance of. I felt much more Pain for the while in the superficial Scalding, than where it was burnt to an Escar.  
The Indications of Cure are of two kinds: viz. either by Refrigerants to bath or anoint the Part, 
Cure of a Burn.  until the Heat be of, and the Escar separated, and than to digest and cicatrize; or by calefactive Medicaments to relax the Skin, and resolve and dissipate it, which by accident will assuage the heat and Burning. 
Refrigerants.  The Refrigerants are, aq. solani, plantag. hyoscyam. lac ebutyratum; and all the cooling Juices and Unguents, as unguent. album, nutritum, populneum, rofat. etc. These must be used warm, until the Heat and Pain cease, or the Fire be taken out, (as the common expression is;) else they will rather 'cause Pain. 
Calefactives.  Hot Medicaments assuage the fiery Heat and Pain by Rarefaction. Which in the first place may be done by the holding a burning hot Iron or Fire to the Part: so whilst the Fire calls forth that Fire it made, it becomes its Alexiterium. But the common remedy is, to apply Salt and an Onion beaten together. But this is not to be done after the Blisters are risen, nor by any means where the Part is raw; for so you will exasperated the Pain, and increase the Inflammation. There are many other things do extinguish the Fire. Fimus equinus doth it, fried in ol. nucum, uvae immaturae, sambucus, and ebulus in oleo coct. calx viva extinct. & cum unguent. rosaceo mixta ad consist. unguenti. These are to be renewed often, until the Pain and Heat be of, which they in few days effect. If these Applications do not prevent the rising of Vesiculae, you must cut them as they arise, jest by their erosion they make hollow Ulcers, and inflame with sharp Pains, Fever, etc. But where they are burnt to a Crust or Escar, you must hasten its fall with Emollients, than digest, incarn, and cicatrize.  
Here is required Bleeding and Evacuation by Lenients: but if there be Cacochymia, you must purge more powerfully. A spare Diet is requisite, 
Regiment in Burns.  with all otehr Regulation proportionably according as the Burn is greater or lesle. I shall give you for your farther information two remarkable Instances of Burns: the first in the Wars, occasioned by Accident thus.  
A Soldier in the time of service being in the fort-royal at Worcester, 
1. Observat. of burning with Gunpowder.  hastily fetched his Bonnet full of Gunpowder; and whilst he was filling his Bandeliers, another Soldier carelessly bestrides it, to make a Shot at one of the Enemies which he saw lying perdue. In firing his Musket, a spark flew out of the Pan, and gave fire to the Powder underneath him, and grievously burned the Hands, Arms, Breast, Neck and Face of him that was filling his Bandeliers. And as to himself, he likewise was burned and scorched in all the upper part of his Thighs, Scrotum, the Muscles of the Abdomen, and the Coats of the Testicles to the Erythroïdes, so that the Cremasters were visible. And indeed it was to be feared, that, when the Escar should cast of from his Belly, his Bowels would have tumbled out. We dressed the several Parts of them both with mel saponis, and embrocated the Parts about cum ol. ros. & albumine ovor. beaten together, and let them blood. I did not see the issue: but William. Clarke, who was than one of my Servants, and assisted me in the dressing them, stayed there, and attended their Cure, after the Defeat of our Army. And he lately told me, he cured the latter of these with unguent, tutiae, etc. and the former made his Escape out of Town.  
A young Gentleman of aoubt ten years of age, 
2. Observat. of a Burn with Gunpowder.  boarded it a School a few miles of, the Evening before the fifth of November having filled his right Pocket full of Squibs and Crackers, threw one of them into the Chimney amongst the Emberss. It took fire: but whether it scattered the Fire, and some spark of that flew into his Pocket, or whether it was the Cracker, but those in his Pocket took fire also, and his  burnt. At the sight whereof his little Chamber-fellow ran out for help. In his absence a little Boy from some other Apartment took the alarm, came in, and seeing his School-fellow in a flame, catched up a Basin of water, and threw it upon him; than ran away for help. Others came in and rescued him out of his  . A neighbouring Chirurgeon was sent for who dressed him. The next day they brought the Patient to Town. I found him burnt into the Flesh from a hand's breadth below that Armpit down that Side, with part of his Belly, and from thence it spread down to the Os ileon and Gluteus, and along the Thigh almost to the Knee. And by endeavouring to free his Pockets of the Crackers, he also burned his Hand from the Fingers ends along the inside of his Arm to his Elbow-joynt. The Parts which were burnt to an Escar I anointed with mel eum succo cepar. & pulv. iridis mixed, and fomented the Parts about with a Decoction of hyoscyam. malvar. solan. violar. sem. cydon. psy●ii, adding to it a third part of lac ebutyratum, and embrocated the other Parts with unguent. stramon. He should have been let blood, but would on't. Clysters were admitted, and Pearl-Juleps and Ptisans prescribed, his Fever being very great by reason of the Pain. As the Blisters arose, we snipt them. Those which were raw I dressed with fine Lawn dipped in the foresaid Decoction; and with a Feather dipped in unguent. de stramon. mixed with ol. amygd. dulc. anointed the Lawns: by which means those places which were superficially burned healed. As the Parts deeper burnt threw of their Escars, I digested them with the Yolk of an egg and a little terebinth. lot. in aq. solani, adding some farin. hoard. finely scarsed cum ol. amygdal. dulc. Upon others I applied unguent. diapomphol. and anointed the fretted edges with unguent. de stramon. To others I used unguent. album campb. mixed cum albumine ovi. Thus each part required to be particularly considered, and special care was taken that no Matter should be any where penned in. 
Several indications in a large bourn.  In these large Burn there are required variety of Intentions at one and the same time. Some require Anodynes, others Detergents and Digestion, others Desiccants. Some of the Parts require to be dressed twice aday; others but once. Some of them I dressed with this Unguent: ℞ ol. sambuc. lb j. cerae ℥ iij. litharg. aur. ℥ ij. cerussae ℥ j calcis lot. ʒ vj. thuris & sarcocoliae an. ʒ iij. fiat Vnguentum S. A. Upon some of these Lawns I laid afterwards Pledgits dipped in a Solution of troch. alb. Rhas'. made in a Decoction equiseti, ros. rub. & summit. rubi, to cicatrize them. Thus I happily cicatrized this young Gentleman's Ulcers even and smooth without the lest Inequality, nothing remaining but the read colour to make it discernible.  
And I must tell you, in these great Ulcers it will require your care that no Hypersarcosis grow upon them, for thereby the Cicatrices will be deformed. I have had some Persons of good quality come to me so deformed with these, that they have suspected them to be Wenny; and where they have happened upon women's Breasts, they have supposed them Cancerous. In others, from ill Chirurgery, the lose Flesh hath grown so high and callous, that one of them who came into my hands required to be burnt again in order to his Cure. 
Medicines for Eyes burned.  In the Face there is a special care to be had as also in the Neck and Breasts of the Female Sex. A great care must be had likewise of the Eyes, that they be not daubed with greasy Medicaments, and that the Lids be not dressed with too drying ones, jest they contract and make a Blearedness. In the Cure of the Eyes you may use Pigeons blood, Breast-milk, aq. solani, plantag. ros. poma, sem. cydon. foenugr. troch. alb. Rhas'. tutia. lap. calam. thus, sarcocoli. washed or not washed. I have seen the Ears for want of care adhering to the Scalp, also the Fingers to one another, and in others close contracted to the Palm with hard Callus. In that case of the Ear, I divided the Callus by Incision, and applied soft bits of Linen dipped in aq. spermat. ranar. between the Scalp and lower part of it, which was rumpled up. Afterwards I rubbed the unequal Callus with the Caustick-stone; and as the Escars separated, i cicatrized them with the Vitriol-stone, unguent. desiccat. rub. etc. and left the Part in its natural shape. Where the Fingers have been all grown to one another almost to the middle Joints, I have separated them by Scissors and Knife, and afterwards by the Caustick-stone rubbed the Cicatrices of, and healed them smooth.  
A Boy came out of the Country with all the Fingers of his right Hand close contracted. 
3. Observat. of Fingers burnt.  I cut the Cicatrix of each Finger, and caused a Rowl of wood to be placed under his crooked Fingers, which being carried with Bars to the inward part of his Wrist, and fastened by Screws, thrust the Rowl gradually forward, till it had born all the Fingers before it, and by a complete Extension restored them to their former liberty. The Wrists and other Joints would be subject to the same inconveniences, if they were not prevented by the knowing Artist, without whose help the best Medicaments signify little.   

CHAP. II. Of Gangrene and Sphacelus.  
THe most cruel Symptoms that attend Gun-shot and great contused Wounds are Gangraena and Sphacelus.  
Gangrene is a tendency to Mortification: it invades the softer Parts, 
Definition.  as the Skin, Flesh, etc. and is the beginning of a Sphacelus.  
Sphacelus is a perfect Mortification, with the extinction of the native Heat and privation of Sense, not only in the Skin, Flesh, Nerve, Artery, but the very Bones.  
They differ from one another, as the Mortification is more or lesle. 
Difference, Causes.   
The Causes of Gangrene are various, viz. whatsoever destroyeth the natural Heat: as Interception of the motion of the blood by over-strict Bandage in Wounds and Amputations, want of timely extracting of extraneous bodies in Gun-shot, etc. from whence Pain and Fluxion do arise; so excess of Cold in hard Winters, also in Old age, and the like. A Gangrene doth arise also in Phlegmons, through the unseasonable application of over-cold Medicaments; or for want of timely Digestion; or by excess of Heat, such as becometh causticall, as we found in Carbuncles and all Escars. But that which most of all contributes to it is the Degeneration of Humours in unsound Bodies: in some of which not only all great Operations, but even the application of a Caustick, cutting a Corn, or pairing a Nail of a Toe to the quick, will endanger Mortification. Some I have seen (you may call them scorbutical persons if you please) who upon the appearance only of a small black Spot on the Foot without Tumour, have suffered a very quick unavoidable Mortification. But I would not have you therefore conclude every scorbutical Spot a Gangrene: for this latter lies dry in the Skin without either Inflammation or Pain.  
In one of the abovesaid cases, where the Gangrene was stopped by the speedy assistence of Art, an Apoplexy followed in few days after: of which more anon.  
The Signs of a Gangrene are, change of the natural colour in the Skin to a pale livid, with diminution of Tumour; Blisters also arise, 
Signs.  and the Part turneth black soon after. In Wounds, the Lips sink and are flaccid; a Gleet followeth, and the Flesh within withers; also the Pulse and Sense in the Part do both languish.  
A person having been shot in the Arm, and the Wound undigested, 
Observation.  I being consulted advised the laying open of the Wound, and extraction of the Bullet, Rags, etc. but was overruled by others, and it was deferred to farther consideration. Two days after I visited the Patient, and asked the Chirurgeon whether he had laid open the Wound. He replied, there was no need, for he could turn his finger in it, and pull out the Bullet and Rags, if it was necessarry. As I was going out of the house, I met the Physician, who enquiring of me the Patient's health, I replied that the Chirurgeon had unwittingly given me the certain sign of his Death. For in magnis vulneribus & pravis, fi Tumores non appareant, ingens malum. That was a great Wound, and not being digested, should have been accompanied with Fluxion and Inflammation; the Lips should have been full, the Orifice contracted: but on the contrary, the Heat was decayed, the Lips were lank without sense, and at that time Sphacelated. A day or two after he died, too certainly justifying my Prognostic.  
Sphacelus is distinguished from a Gangrene by the total Corruption and Stink, it being also insensible both of Knife and Fire. If a Gangrene proceed from Pain, the Tumour and preceding Inflammation will show it, and the sudden sinking of that Tumour is the beginning of the Gangrene. If the Gangrene be from Cold, the Part is first benumbed, than accompanied with a pricking Pain, also a Redness, which by degrees turneth black, and a Horror and Rigour seizeth upon the Patient. If it be from Interception of the Spirits by reason of over-strict Bandage, there is neither Fluxion nor Pain, but a Flaccidity joined with an Insensibility in the Part. If it be from Old age, the Patient is lean, nature visibly decayed, his Legs and other extremities are first seized, and the Part is most commonly without Tumour.  
All Gangrenes are dangerous, 
Prognostic.  as threatening the Life of the Patient they affect. Those that begin in the external Parts by reason of Inflammation are of lest danger, if the Habit of body be tolerably good, and the Mortification timely treated. Those that arise deep within the Wound from Gun-shot or fractured Bones are extremely hazardous, especially if they be in or near the Joints, though the Habit of body be good.  
Gangrenes arising from Parts abounding with too much Humidity are in great danger, for thereby the natural Heat is soon overcome: for which reason Grangrenes in very fat and Hydropical bodies, especially in the latter, are rarely extinguished. So also those arising from an internal cause are exceedingly more dangerous than those that arise from an accidental. Yet in all these there are some hopes of Cure. But in Sphacelus there is no remedy, save only by a speedy separation of the sphacelated Part: for if any of it remain, it soon creepeth up by the Nerves, etc. and infecteth the whole Member, and is accompanied with Watching, Raving, frequent Faintings, Convulsions, Hiccough, and cold Sweats; which foreshow the Patient's approaching Death in the Treatise of tumors.  
In the Cure of Gangrenes, 
Cure.  I shall begin my discourse of that which ariseth from Pain with Flux of humours and Inflammation. These most frequently attend great Contusions, Gun-shot Wounds, etc. and by suffocating the native Heat produce Mortification. In which cases a cooling and slender Diet aught to be observed: the Humours abounding in the body must be evacuated by Bleeding and Purging: Revulsion aught also to be made to avert the Humours from flowing to the diseased Parts. For the rational performing of which I refer you to the Chapter of a Phlegmon in the Treatise of tumors.  
Cordials and Epithems are also necessary, to resist the Putrefaction, and strengthen the Vitals, from what cause soever the Gangrene ariseth. For your choice of which I refer you to the Chapter of a Carbuncle, which is another sort of Gangrene. Having thus provided in general, we shall in the next place consider the Part affected, whether it be only a Tumour, or a Wound with a Tumour, etc. In which latter, if the Tumour and Inflammation have been very great, and it change colour suddenly, and sink, the Pain continuing, you may conclude a Gangrene beginning. And if there be a Wound or Abscess, and that Wound, etc. grow more painful, if the Flesh also lose its ruddiness, and look pale and withered, and the Matter change to be thin and gleety, you may suspect it corrupting: in which case it will be necessary that you scarify to the quick, and make it bleed freely. By your Patient's sensible feeling, and by the fresh trickling down of the blood, you may judge of the Mortification. But if the Gangrene have crept deeper, or arose from the bottom of the Wound, than scarify accordingly unto the fleshy Parts: and if there be any Abscess lying under the Muscles or Lips of the Wound or Ulcer, let it out. If in making such Scarification you chance to cut some Vessel, whereby a Flux of blood happeneth, have a care you choke not the Heat of the Part by crowding in Dossills'; for so the Mortification may be increased. To avoid which, I do rather advice the actual Cautery, for thereby you will not only stop the Bleeding, but dry up the Putrefaction. After the use of it, dress up the Wound as hath been advised in the Chapter of Burning. If in scarifying you prick a Nerve or Tendon, you will increase the Gangrene. So you may do if by the actual Cautery you burn them but in part, or if you apply sharp Medicaments on them when newly hurt by Scarification. For we frequently see great Fluxion arise from little Disturbances of the Nerves and Tendons. Therefore consider well, and if such lie in your way, you had better cut them of or burn them through, than scratch or prick them. For the confirmation hereof, you may see some Instances in the Cure of Ulcers amongst the Nerves and Tendons in the Treatise de Strumis. Whilst I was writing this, I cut of some of them in one Patient: they lying over the carious Bones would not admit of the coverture of a Pledgit without grievous Pain; but those once divided, the Ulcer grew easy. But if you meet with none of these Accidents, than, after Scarification, cleanse it of the clotted blood, by washing it with Brine, a strong Lixivium of Wood-ashes, or Tincture of Myrrh, etc. and fill up the Scarification with Merc. praecipitat. troch. polyidae, musae, or with Dossills' dipped in ol. garyophyll. terebinth. etc. actually hot. Unguent. Aegyptiac. is also hereto useful, whether it be that made by the Pharmacopoeia Londinensis, or by other Authors, with the addition of sal Armoniac. nitr. theriac. camph. etc. The usual Fomentation is a Lixivium wherein have been boiled summit. absinth. centaur. min. carduus benedict. scordium, vincetoxic. rad. aristoloch. rot. rad. gentian. spir. vini, etc. or that of aq. calcis, with a Solution of Merc. sublimat. or aq. lap. medicament. Cataplasms are also of use exfar. hoard. fabar. lupinor. lentium, pisor. Mithridat. etc. boiled in a Lixivium, with an addition of Oxymel, etc. While these are applied to the gangrened Part, a good Defensative should be laid upon the Joint or Parts above; of which you may find choice in this Book.  
In the dressing of these Mortifications, you aught to consider well in the application of your Medicaments, that you do not in the extinguishing one Gangrene raise another, by the too long use of sharp Medicaments. Therefore, when you shall feel the Ulcer warm, and found it cease gleeting, it may be reasonable to forbear the use of them, and to dress it up with warm Digestives, as unguent. basilic. cum ol. terebinth. hot: and after Digestion deterge with mundif. ex apio magist. or such like, according as the Sloughs require; than proceed by sarcotics and Epuloticks, as in such Ulcers hath been showed.  
OF Gangrenes from strict Bandage you may see several Instances in this Book. The Cure differeth not from that of others made by Fluxion: 
1. Observat. of a Gangrene from strict Bandage.  but they are much more hopeful, considering the cause may be so easily removed by the loosening of Bandage. I shall give you one Instance here of a fractured Leg set in the Country by one pretending to Bone-setting. It had been bound up with Splints. About the third day after, I passing that way was desired to see him. The Fracture was of both the Focills of the left Leg. He had been in great pain from the time of the setting: it was extremely swelled from the Knee to the Toes. I saw it was occasioned by the too straight Binding. I therefore loosened the Bandage, and took of the Splints, the ends of them sticking in the Skin, as also did the two Ligatures which encompassed the Fracture. Many Blisters were raised, not only about the Fracture, but also about the Foot; some whereof were blue, and others of a dark read colour. I scarified them, permitted them to bleed, and fomented the Member with Stupes wrung out of hot Milk: by which I gave a transpiration to the Humours, than dressed the Gangrene-spots with unguent. basilic. hot, and applying an anodyne Cerote over all the Leg, laid it upon a soft Pillow, with Splenia of  under it, which I fastened about the fractured Member; and bringing the sides of the Pillow close to the Leg, it was supported with much ease: than I let the Patiented blood. By this way of dressing, the blood circulated, the Pain accordingly diminished, and so did the Swelling, and the gangrened Parts digested of, and healed by the application of unguent. diapompholyg. etc. After the diminution of these Accidents, the Leg was dressed up closer, and the fractured Bones united together, according to the method set down in the Treatise of Fractures; where also you will found a Gangrene arising from Fluxion occasioned by the Shivers of Bones, with the manner of its Cure.  
Of Gangrenes arising from Gun-shot I have showed you sufficiently in the preceding Treatise, and in the Observations of Phlegmon have treated of those rising from Inflammation, to which I refer you; and shall now give you some arising from other Causes, and first from Fluxion.  
A Gentleman of a full Body having accidentally broken his Shin by a Fall, 
2. Observat. of a Gangrene on a contused Wound.  the Wound inflamed, and grew very painful. It not yielding to their Applications, I was fetched, and saw the Heat decaying, and Blisters rising about the Lips of the Wound, also a thin Ichor dropping from the contused Flesh. I cut out the bruised Flesh, scarified the Wound, and dabbed it with ol. terebinth. than filled it up with Praecipitate, and applied unguent. basil. warm with some of the said Oil, and a Cataplasm over all of wheaten Bread-crums decocted in Brandy, with the addition of Saffron, Yolks of eggs, and mel communis; than let him blood, prescribed a Clyster that afternoon, and laid him to bed with an Anodyne draught. The next day I came better provided: but in taking of the Dress, I saw the Wound dry, and felt it warm, and took notice of a small Escar made by the former Application over it. The Lips of the Wound inclined to a Digestion. I fomented it, and dressed it up with unguent. basilic. cum ol. terebinth. and repeated the use of the Cataplasm: by which Dress the Wound digested, and the Parts about recovered their natural Heat, and he was cured by Detersives, sarcotics, etc. as a hollow Ulcer.  
A Woman came out of the Country to me with an Ulcer in her Leg. 
3. Observat. of a gangrened Leg.  It had been of a long continuance, and by reason of her Journey it inflamed and swelled. When I saw it, the Heat was decaying, and the Tumour was sinking; Blisters were risen near the Lips, and the Skin under some of them was of a purple, and under others of a blue colour. The Ulcer itself being putrefied, I scarified it and the Parts about so far as I thought necessary, permitting them to bleed freely, and thrust out the rotten Flesh: than I fomented them with Brine, sprinkled the Scarifications with Merc. praecip. and dressed up the Ulcer with Dossills' dipped in a Solution of unguent. Aegyptiac. in spir. vini, to which I added some of the said Praecipitate, and applied a Cataplasm of medull. panis tritic. pulv. summit. absinth. flor. centaur. rutae, scored. cham. decocted in Brandywine. After I had thus dressed her, I let her blood, and disposed her to rest with a Cordial draught. Her Body was the next day made soluble by Clysters, and afterwards by lenient Purgatives.  
At the next dressing I was provided with a Fomentation and Cataplasm, as is proposed in the method of Cure. I scarified again the Lips and Parts about, and designed as much to the Ulcer: but in taking of the Dress, I felt it warm, and a kind of Escar made by the foresaid Dressing. I therefore dressed it with unguent. basil. & ol. terebinth. hot, and applied the Cataplasm over all. By these Applications the Ulcer and Parts about were restored to their native Heat, and the Soar digested, and afterwards healed with sarcotics, as is usual in such like Ulcers.  
A Lady aged about 63 years, of a very fat gross Body, 
4. Observat. of a gangrened Elbow.  was seized with an Apoplectic fit, which afterwards terminated in some kind of Lethargy, with loss of Memory. During which, she lying in bed, and leaning for the most part on her Elbow, bruised it, and at length the Putrefaction reaching to the Skin, it inflamed, and seemed to have Matter. Some Pretenders to Chirurgery, judging it a simple Apostemation, thought it not worthy the consulting a Chirurgeon, but opened it and put in a Tent with basilicon, and left it to an Apothecary to dress by their direction, not forbidding the Patient to lie upon it. It being thus dressed, the Putrefaction within increased, and spread up towards that Axilla, and she died of that Mortification before it was discovered by them, so that the Chirurgeon came in only time enough to embalm her.  
A Gentleman of about 60 years of age, 
5. Observat. of a sphacelated Leg.  having been long diseased with an Ulcer in his right Leg about the Ankle, came up to Town, and sent for me. The Lips of the Ulcer were without Tumour or Heat: the Flesh within the Ulcer was livid, and in some parts of a blackish colour, and discharged a gleety Matter. Indeed there were all the signs of a Sphacelus: yet the Patient talked of going abroad the next morning; and by his other discourse seemed to be somewhat delirious. I fomented his Leg with a Stupe wrung hot out of Spanish Wine; and whilst I provided other Dress, I prevailed with him to sand for an eminent Physician dwelling near his Lodging, to whom I represented the condition of the Ulcer, and undressed it in his presence, scarifying the Lips and Parts within, than washed it with ol. terebinth. hot, and applied Merc. praecipitat. etc. with a Cataplasm è medull. panis tritic. pulv. summit. absinth. with scored. etc. decocted in Brandywine. The next day a Consultation was held of two Physicians, Mr. Arris and Mr. Hollyer Surgeons, with myself. We took of the Dress, and found the Ulcer sphacelated, but not much spread externally. The Patient had rested ill, and was delirious, and his Pulse weak. We scarified the Lips and Ulcer, and permitted them to bleed; than fomented the Member, and dressed the Mortification with Merc. praecipitat. and applied a Cataplasm as above prescribed. We continued our Endeavours daily: but the Venom spread up and down that side of the Foot amongst the Bones and Tendons. The Physicians prescribed Cordials. etc. but his Delirium, etc. increased, and he died before it had encompassed any part of the Leg.  
Cold extinguisheth the natural Heat of a Part, and frequently happens to poor people travelling in Frost and Snow. Some Instances I have seen of this Gangrene. The Recovery of them is not very difficult, if timely treated; otherwise they sphacelate, as other Gangrenes do. When any particular Part beginneth to decay in its natural Heat, the common Remedy is, to rub it with Snow, and afterwards to foment it with Decoctions of Turnips or of the hotter Plants, such as are usually found in every Kitchin-Garden; than to embrocate it cum ol. lini, rutae, aneth. and ol. terebinth. mixed with them; and after to lap it up in woollen . But if any Part be directly gangrened, we scarify and dress it as hath been said in the method of Cure. If the whole Body be overcooled, the Cure consists in the using Brandy, aq. vitae, and other good Spirits, theriac. and Mithridate dissolved in Wine, and laying the Patient by the Fire, but not too near, or putting him into a warm Bed, and d sposing him to sweated.  
Of Gangrene through deficiency of Heat in Old age I shall only give you one Instance, 
6. Observat. of a Cangrene through old age.  and that in a person of a very great age. He is yet alive, and kept so by the great Kindness of a noble Kinsman, with whom he hath a good Chamber well furnished, good Firing, Diet, and Attendance. This Gentleman was seized the last Spring with a simple Inflammation about the Ankle without Tumour. Upon notice thereof I went the next day, and saw it turned black three inches in length, and about two in breadth. We fomented the Part with a Decoction of warm Plants, to which we added Brandy; than scarified the Escar, and dapped it with ol. terebinth. and after dressed. it with a Mixture of the same Oil cum unguent. basilic. embrocating the Parts about with ol. lumbricor. etc. and applied a Plaster ex theriaca. Thus the Escar separated, and my Kinsman Jaq. Wiseman dressed and cured it. Before this was cicatrized, the inside of the other Leg upon the Ancle-joynt inflamed as largely, and turned black: but by the same way of dressing a separation was made of that Escar, and he was cured by my said Kinsman according to the common method of Ulcers: but it was well-nigh the work of four months. Since that, new Inflammations have begun to arise more than once, but hitherto have been timely remitted.  
From an indisposition or malign quality of the Humours within our Body's Mortifications frequently arise; insomuch that we can scarce make a fontanel in some Bodies without running the hazard of a Gangrene: nor indeed can they be kept from Defluxion after they are made, without the assistence of our Art. Instances hereof may be seen in several places of this Book, particularly in the Treatise of Ulcers with Intemperies.  
A Woman of about sixty years of age, 
7. Observat. of a gangrened Arm.  extreme fat, and of a Scorbutic Habit of body, sent for a Chirurgeon to make her a fontanel in her Arm. He cut it, and put in a Pea. She discharged him, and dressed it herself. About ten or twelve days after the fontanel growing painful, she sent for the Chirurgeon, who seeing it gangrened, sent for me. The impression of the Pea into the Fat before it was digested had corrupted that, and the Parts about were thereby infected. We scarified the Lips, and cut into the Fat I believe above an inch deep. We dressed it with ol. terebinth. actually hot upon an armed Probe, filled up the Incision with Praecipitate, and applied a Cataplasm of Mithridate. By this method of dressing the Heat was restored, and it digested in few days, and I left it to the Chirurgeon, who cured it.  
In a person of about forty years of age I applied a mild Caustick below on the inside of the Knee, 
8. Observat. of a gangrened Knee.  to make a fontanel. The Escar being small, I divided and digested it with little or no Pain; and the Escar began to separate kindly: but it afterwards grew painful and gleeted, and the Ulcer corrupted very deep before the first Escar separated.  
This happened whilst the Patient dressed it herself with those Dress I left her Servant, she not taking much heed of it, till she was so lame that she could not stir out of her Chamber; and than she sent for me, and to my amazement I saw it gangrened. I presently cut out the lose Escar, fomented it with Wine, and dabbed it cum ol. terebinth. hot with an armed Probe, than lightly scarified it in the bottom and edges, and after dabbed it again with ol. terebinth. filled it up with Praecipitate, and fomented it till I had made a Cataplasm cum medull. panis triticei, pulv. summitat. absinth. & scored. decocted in Wine, with an addition of Brandy, Saffron and the Yolk of an egg, which I applied over it, having first embrocated the Parts about it cum ol. ros. Thus in three or four dress I took of the Fluxion, and the scarified Lips digested; but the Ulcer itself lay dry, till the Sloughs made by the Praecipitate cast of by Digestion. From that time it incarned, and being contracted nearer I dressed it with a Pea. It was very remarkable, that whilst the Ulcer was distempered she was free from her other Complaints; but after it was digested she relapsed into her former Distempers, and lay some days ill of a bilious Colic. In several others I have seen the like in spite of all my endeavours to prevent it. So also in making fontanelles sometimes by Incision in people where there was no likelihood of pressing on a Tendon, I have been glad to throw out the Pea, and heal them up again.  
But as people are sometimes subject to Gangrene by making of fontanelles; so others we hear of that have been gangrened from paring of a Corn or Nail on their Toes. Amongst the Observations of a Phlegmon you may see somewhat of it arising from a less cause.  
I was once sent for to a Person of Honour about sixty years of age. 
9 Observat. of a gangrened Toe.  He was of a full Body, and seemingly healthful; but in his latter years had omitted Exercise, by reason of a Stone in his left Kidney. One morning in making himself ready he perceived a black Spot on the upper part of his Foot leading towards the Toe next the little one. It was no bigger than a Spangle, without Tumour, Pain or Inflammation. It appearing bigger the next morning, he sent for his Physician and Chirurgeon; they cut into it, and found it insensible. From that time it was rationally dressed; but it enlarged itself amongst the Tendons, and especially toward that Toe, and affected the Bones. I being than consulted, and joined with that Chirurgeon, we cut of that Toe, and checked the Mortification. After which with much difficulty we extinguished the Gangrene in the other Parts by the various Applications prescribed in the method of Cure, and healed the sinuous Ulcer. During which the Physician purged him frequently, and prescribed an Antiscorbutic Decoction of sarsa, China, lign. guaiaci, with the Plants proper in such cases, to dispose him to sweated; which he did some days. One evening whilst he was sweeting, I being accidentally present, he told me he felt a numbness in the Balls of his toes of the other Foot. I looked upon them, and seeing them all black and dry, cut into them, and found them insensible. I supposed they might have been burnt by the Bricks: but neither the Patient nor the Apothecary that sweated him having discovered any thing of it before, we concluded it from the malignity of the Humour, for they were directly gangrened; and by that method I cured them some weeks after. But three or four days after that he was seized with an Apoplexy about eleven a clock one Sunday morning. He recovered out of that Fit, but died that afternoon in another.  
Some other Instances I could give of this kind; but this may serve to show you to what little purpose Amputations are in these cases. But if the Body be youthful, and the Habit of body tolerable, if Gangrenes resist the Applications above proposed, and penetrate more inwardly, you may than attempt them by the actual Cautery. For, according to that Aphorism of Hypocrates, 
Actual Cautery.  Illi affe●●us qui medicamentis non sanantur, ferro sanantur; qui ferro non sanantur, igne sanantur; qui igne non curantur, hos existimare oportet insanabiles; Those Diseases which will not cure with Medicaments, are cured by a Knife; and those which yield not to that, are cured by Fire; and those which will yield to neither, are counted incurable.  
The actual Cautery doth indeed not only resist Putrefaction, but corroborates the Part.  
But after all our vigilancy and industry in contriving Remedies to resist the Gangrene, if it does yet delude us, and terminate in a Sphacelus. There is than no more need of taking indication from antecedent causes, or changing of Medicines according to the variety of the causes that introduced it. For whether a Gangrene arise from an hot Intemperies or cold, moist or dry, Sphacelus is always the same, extinction of the native Heat, and destruction of the Member. The Mortification creepeth on, and not only infecteth the Member, but the Spirits to the very Heart, with its corrupt Vapours mortifying the Vessels all along the sound Parts, and leaving the Member immovable, 
Extirpa. ion.  without sense or heat, rotten, black and cadaverous. Wherhfore there is nothing more to be thought of in this case but timely Amputation or cutting of the Member; the Cure of this Disease not consisting (as I said) in outward Applications, but manual Operation: and what success may be therefrom expected, is much to be doubted. At satius erit, with Celsus, anceps auxilium experiri, quàm nullum. It is a miserable kind of help; yet it is the determination of all Authors, that in Sphacelus membrum corruptum abscindendum est. In this case it becomes the Chirurgeon to acquaint the Friends with this kind of Remedy, and withal to make his Prognostic accordingly. But before we proceed in this Operation, we shall take notice of what some knowing Authors have writ hereof. For in those places where Amputation cannot be made, as in the Buttock, Shoulder, Back, etc. Fab. Hildanus proposeth the use of potential Cauteries applied to the mortified Part, and often renewed, till the last Escar reacheth to the live Flesh. Yet he condemneth Arsenic, as being venomous, and producing many dangerous Symptoms. It is true, that I myself have often used that method of Cure in Sarcomata with good success: but in a Mortification there appear to me many greater Inconveniences that attend it. First, from the Caustick itself, as he proposeth it, of Salts: it will melt in the working, and is more disposed to spread in the Skin than penetrate deep into the Flesh. This every young Chirurgeon knows in his making of fontanelles, that he cannot apply a bit of Caustick so little, though he use all his Art in defending it, but that it will have spread much farther than he designed it. Than the separation of such Escars is too slow to effect the design: and in an ill Habit of body such Medicaments are apt of themselves to procure a Mortification rather than Cure. Whereas on the contrary, an actual Cautery answers all Intentions: it not only consumeth the Mortification, but drieth up the venomous Humour, thereby preventing its farther progress; and also communicateth warmth to the languishing Parts, by virtue of which the Separation is much farthered, and by working upon the gangrened Sloughs performed more easily, as you may see in my Practice elsewhere. But where Amputation itself is feasible, nay altogether necessary, as in the Limbs, there ariseth a new question, whether it aught to be done in the sound Part, or in the dead. Fab. ab Aquapend. adviseth the dead Part within a finger's breadth of the live, (as also do many others.) Than with a Cautery they burn up all the remaining Mortification. Others do perform the Operation with a hot Knife, the figure of which you may see in Hildanus. Aquapend. speaks so confidently of his success in the practice of this way, that utterly to deny the thing were to give him the Lie. I shall only make this Objection, that the Sphacelus doth seldom affect the Member so equally round, as that an Operation in the dead Part is feasible: nay, which is worse, when once the Mortification seizeth on the great Vessels, it runneth up so fast under the Skin, that before any considerable part of the Member is outwardly gangrened on the one side beyond the Knee or Elbow, the other side will have reached to the Inguen or Axilla. This I confess frustrates all manner of Amputating, whether in sound or mortified Parts. Yet generally speaking, the Gangrene doth not grow so fast, but that if you make Amputation two fingers breadth, more or less, within the live Flesh, you may prevent it; and that far better than it is possible to be done by the other way of operating. For if you work there by actual Cautery with a hot Knife, your Knife will stick fast in the Flesh till the moisture be wholly dried up, and than you must repeat many Knives and Cauteries, in every one of which you will meet with the same inconvenience: yea, before you can cut through with your hot Knife, it is very probable that you will near the Bone meet with some Parts that are alive and sensible, especially when you come to the Periosteum; (for the Membranes do not usually corrupt at the same rate of swiftness with the Flesh;) and than all your pains and trouble with be as great or greater than if you did it in the sound Part. As to the other inconveniences, I shall refer you to Hildanus, who hath taken pains in confuting this Opinion.  
Both these ways of Amputation seem to me much more difficult and painful than our common way; which makes me presume they proposed them to prevent the effusion of blood.  
But modern Surgeons have answered this Objection by good Bandages and Deligation of the Vessels, and when we cut above the Knee, by clapping Cauteries to the Vessels only; which sufficiently answers that Intention. Thus have I seen in my first Sea-voiages Amputations made above Knee, and afterwards practised them with great ease and safety.  
Now since not only in this Chapter of Gangrene, 
The manner of performing Amputation.  but frequently elsewhere in this Book, we have mentioned Amputation, I think it necessary to take this occasion of showing the manner of performing it; the rather, because the Operation is much the same, whether it be done upon the account of Gangrene, or for other reasons. I shall therefore in general terms insert the whole Doctrine of Amputation, though briefly, not mattering whether the Examples instances be Sphaceli or not, all Instances being alike instructive.  
In heat of Fight, whether it be at Sea or Land, 
What is to be considered in heat of fight.  the Chirurgeon aught to consider at the first Dressing, what possibility there is of preserving the wounded Member; and accordingly, if there be no hopes of saving it, to make his Amputation at that instant whilst the Patient is free of Fever, etc. Therefore that you may the better make your judgement of the Wounds, I shall give you some few Remarks of such as require Amputation. viz. If a Leg or Arm be shattered by Splinter or great Shot, the loss of Substance will direct you. If the principal Muscles be torn of, and the Bone fractured in pieces, or if the Wound be with Musket-shot in the inside of the Joint of the Elbow, or in the Knee or Ankle, with a Fracture of the Bones of the said Joint, nay, supposing it hath not fractured them, yet if the Bullet be so lodged that you cannot extract it, you shall than presently make Extirpation of the Part. If it be the Arm, cut it of in the place where it is so shattered, and saw of the end of the Bone smooth, your Assistant the while pulling up the musculous Skin and Flesh. If the Ankle be thus maimed, you shall than cut of the Leg within three or four finger's breadth under the Knee, in regard so long a Stump would be troublesome. But if the Leg be shattered of by the Calf, do not put your Patient to the pain of new Amputation for the shortening it a hand's breadth or a little more. Save what you can of a shattered Hand. And if the Toes with part of the Foot were shot of, cut of the lacerated Parts smooth, but with care to save as much of the Foot with the Heel as you can; it being much better than a wooden Leg. But if the Arm or Leg be not so shattered, though the Wound be large on one side, and hung gaping down with great Fracture of Bones, yet be not discouraged, the largeness of the Wound will make for your better pulling out those extraneous bodies, Shivers, Splinters, Rags, or aught else, and for the easier discharge of Matter. Dress it as a Wound by a Splinter.  
If the great Joint be so shot by Musket-bullet, that you think it not reasonable to cut of the Member, be sure you make Extraction of the Bullet, and free it of all extraneous bodies, leaving not the lest Shiver to prick the Nerves or Tendons: and make such way presently, that you may be able to dress the wounded Nerves, Tendons, etc. without making new Incision, when the Part is inflamed and unfit for it.  
If after some days the Wound do not digest, but inflame and gangrene, and the Gangrene do not yield to your Applications as hath been proposed in Gangrene; than, as in a Sphacelus, you are to proceed with the Extirpation of that rotten Member while the Patient is free from Delirium, and hath strength to bear the Operation.  
Seat him so as it may be for your conveniency. At Sea they sit or lie, I never took much notice which; nor do I remember I had ever any body to hold them; but with the help of my Mates, and some one or two that belonged to the Hold, I went on with my work. At Sterling I made an Amputation above the Knee, and had as little help; besides my Servants, there was only a Sea-Chirurgeon assisting me. We stopped the Flux of blood by actual Cautery, and the Wound digested and cured without any ill Accident. Yet where we have convenience to proceed more formally, we always place the Patient to our most advantage, where he may be held firm, and in a clear light, and so that our Assistants may come better about us. The Member is to be supported by some one, whilst another standeth behind the Patient, and draweth up the Skin and Musculous flesh. Than make your Ligature two fingers breadth or thereabout in the sound Part; so that if you amputate in case of Mortification, you may be sure to quit yourself of it. This Ligature is omitted by many of our Surgeons here in the City, they only making a turn with a Tape, pinning it on as a mark to circumcide by: and in stead of the Ligature I propose, they make a Gripe, which Gripe is commonly made by some Assistant who hath stréngth to do it. Indeed this is good, where a shattered Member is to be cut of, to smooth the Stump; in which case there is no great fear of Bleeding. But in Amputations it seems to me to be very inconvenient: for I never yet saw any man so gripe, but that still the Artery bled with a greater force than was allowable; yea, when Mr. Woodall gripped, who was so applauded, and in truth made for the work. It being so, in what a huddle is the Stump than dressed? But suppose the uneasy posture and the long griping tires the Griper, or that his Hand be cramped the while, what condition is the Patient than in? Whereas by this ancient way of Ligature the Vessels are secured from Bleeding, the Member benumbed, and the Flesh held steady, ready to receive the impression of your crooked Knife, (or Razor, which I have often amputated with.) This Ligature made, the Assistant strengthens it, whilst he draws up the Musculous flesh. In the mean time the Operator, with a sharp crooked Knife, by a turn with his hand cuts the Flesh of round to the Bone; than with the back of it he scrapes the Periosteum from the Bone; if there be two Bones, than with a dividing Knife he separates the fleshy Membrane from them. The Bones freed of the Periosteum, Guido proposes a linen Cloth, and Hildanus a kind of Purse, to be brought over the upper divided Flesh, to pull it upward, and make more way for the Saw. But I think that needless. The Flesh divided, the Parts separate enough of themselves, besides the Assistent's pulling up the musculous Flesh and Skin is sufficient. That done, you are at liberty, whether you will cauterize the Vessels by a Button-cautery, or by Ligature stop the Bleeding, or by Agglutination. The use of Chalcanthum I do not approve. To apply Escaroticks to the ends of the Nerves and Tendons newly incised, causes great pain, weakens the Part, and makes way for Gangrene; it not being likely you can so apply them to the Artery, but that you must burn the Parts about, which are, as I said, the Nerves, etc. The way Hildanus proposes, by drawing the Vessels out by a Forceps, is not a work to be done in heat of Fight, nor without a clear daylight. If you attempt it on Land, his Arm would be bowed, and his Leg stretched out, that the Vessels may be the longer after Extirpation, that you may the better take hold of them. Ambros. Par. proposes a more easy and sure way of Deligation, by passing a Needle with a strong twisted Thread through the Skin near the great Vessels; making your Stitch over the said Vessels by piercing through the raw Flesh and Skin: than make your Ligature upon a fold of a Rag. Thus you bind the Artery and Vein. These several ways have been practised by eminent Surgeons for the stopping the blood of the Arteries in Amputation: but the late discovery of the Royal Styptic hath rendered them of less use. But in heat of Fight it will be necessary to have your actual Cautery always ready, for that will secure the bleeding Arteries in a moment, and fortify the Part against future Putrefaction: they requiring after Cauterization no such strict Bandage as that thereby you need to fear interception of the Spirits. When we cauterize the Artery, we do than touch the end of the Bone, it hastening the Exfoliation. The next thing is the loosening the Ligature, and bringing the Lips close over the Stump. Than whether you should with a cross Stitch hold them so, or content yourself by Bandage as well as you can, is by some controverted. They that object against the former say, it causes Pain and Inflammation. So doth Bandage also, if it be made too straight. Therefore they should object against that also. The most that I have seen without the cross Stitch have the next dressing been broad Stump, some of them with Lips turned outward by the Bandage; in the lest of them the whole Stump hath been bore: whereas in those in which I have made the cross Stitch, the Lips have been found close to the Bone at the next dressing, covering the great Vessels, and a third part or half of the Stump hath been well digested, and by the second dressing hath been near agglutinated so far as it lay under that Skin, and without Inflammation happily cured. Whereas the broad Stump is a certain sign of a long Cure, and commonly the death of the Patient. The exposing these incised Parts too much to the Air causes Pain, and the want of native Heat makes them gleet: or if they do digest, the discharge of so great a quantity of Matter commonly exhausts the Spirits of the Patient. If the musculous Flesh and Skin are well pulled up in time of Amputation, and brought over by a moderate Extension as far as they will easily admit, you will found it not painful. You aught to pierce the Skin with a Needle and strong brown Thread ceared about half an inch from the edges of the Lips. Having made them cross from side to side equally tie them with a moderate Astriction, than apply a Pledgit on the cauterised Vessels with pulv. irid. suce. cepar. cum melle. But if no Cautery was used, than Buttons of Tow spread with your Restrictive, and dipped in pulv. Galeni, must be applied to the Mouths of the Vessels. Afterwards sprinkle the Stump thick with this Powder; ℞ bol. Armen. farin. volatile. picis naval. an. ℥ iiij. aloes, thuris, mastic. sang. dracon. an. ℥ j gypsi ℥ jss. pill. lepor. corii raspati, an. ℥ iij. Misc. S. A. You may mix some of the same cum album. ovor. and apply it upon a thick round Stupe, which hath first been wet in Oxycrate and dried; and over that another Stupe spread with the same so broad as to come over the first, and up a pretty height above the Stump. This latter must be snipt deep in the edges, that it may lie smooth about the Member. An Ox-bladder ready cut and wet is to be turned over it, and a cross Cloth next the Bladder, to hold the Dress steady. Than with a Rowler with two heads begin upon the Stump, and roll up to the next Joint, and so again about the Member, to retain your Dress firm. Than fasten it so as that it may not be capable of falling of. But before you make this Bandage, you aught to apply your Defensative over the Parts above the Stump. Some apply it before they begin the Amputation: but than it is apt to wrinkle, and to sit uneasy. In the dressing of the Stump, you aught so to apply your Medicaments, that you may without much bungle roll up the Member. Than place it to the ease of the Patient, one holding his Hand some while upon the Stump. Your Defensative may be of the same which is prescribed in Gun-shot Wounds: or, ℞ far. hoard. bol. Armen. an ℥ iij. sang. dracon. ℥ jss. flor. ros. rubr. ballast. nuc. cupress. pulv. an. ʒ vj. acet. ʒ x. album. ovor. num. viij. ol. ros. & myrtill. an. ℥ j cerae q. s. Boil these Powders in acetum, than add the rest to it, to make it of the consistence of a Cerote. The third day take of the Dress; and than you may cut the cross Stitch, and sprinkle the Wound with pulv. Galeni, and dress it with this Digestive: ℞ terebinth. lot. in decoct. hoard. ℥ iij. ol. lumbr. ℥ jss. gumm. elemi dissolute. in praedict. ol. ℥ ss. farin. hoard. cribrat. ʒ ij. vitell. unius ovi, croci pulv. ℈ j Misc. Apply to the Bone a Pledgit of dry Lint, or pressed out of spir. vini. After the Wound is digested, you may deterge with mundif. Paracels. or apii, or this; ℞ terebinth. Venet. lot. inspir. vin. ℥ iij. pulv. rad. irid. aristoloch. rot. sarcocol. thuris, mell. ros. an. ʒ j Than incarn and cicatrize, as hath been said in Compound Wounds.  
Whilst I was a Prisoner at Chester after the Battle of Worcester, 
Observation of the ill consequences of wounds in the Joints.  I was carried by Col. Duckenfield's order to a man that out of much zeal to the Cause, pursuing our scattered Forces, was shot through the Joint of the Elbow; the Bullet entering in at the external part of the Os humeri, and passing out between the Vlna and Radius. He had been afflicted with great Pain the space of six weeks. I found the Wound undigested, and full of a lose soft white Flesh, the Bones fractured, and not likely to unite, many Shivers lying included within the Joints, and incapable of being drawn out: the lower part of the Arm was oedematous to the Finger's ends as full as the Skin could well contain, and the upper part was inflamed, also about the Os humeri and Axilla a perfect Phlegmon was form. The Patient thus tired with Pain, desired to be cured, or have his Arm cut of. To which purpose he had procured the governor's leave for my staying with him. But while that Phlegmon was upon the upper parts, there was no hope of a prosperous Amputation, nor of Cure while those Shivers of Bones lay pricking the Nervous parts within the Joint. The Phlegmon was too forward for Repercussion, and yet not likely to suppurate in less than a week's time. Wherhfore I endeavoured by Emollients and somewhat Discutients to secure the grieved Shoulder and Parts thereabout by hindering the increase of the Phlegmon, and to give some perspiration to the Part. Than with good Fomentations I corroborated the weak and oedematous Member below: to which end I also raised his Hand nearer to his Breast. Also by Detergents and Bandage I disposed the Wounds and fractured Part to a better condition, made way for discharge of Matter, and endeavoured to extract the Shivers of Bones; than applied Medicaments to remove the Caries. After some days the Abscess suppurated in the upper part of the Shoulder and in the Armpit; and while the Matter discharged from thence, the Tumour discussed, and that upper Orifice cured soon after. But the continual Pain in the fractured Joint kept that Opening in the Axilla from healing. The Patient growing weaker, and without hopes of Cure, I was necessitated to proceed to Amputation. To which purpose I sent to Chester for Mr. Murry, a knowing Chirurgeon, (since Mayor of that City,) to come with Instruments and other necessaries whereby I might the better do the work. He accordingly came, and we prepared Dress ready; which were Stupes or Pledgits of fine short Tow well worked, some like Splenia, others were round, and bigger or less. We wetted them all in Oxycrate, and dried them. We also made some Buttons of Tow, Compresses of linen  dipped in Oxycrate, three or four Rulers with one or two heads; provided Needles threaded and ceared for making the cross Stitch, and lesser Needles threaded for common use, with Filleting for Ligature, and Bladders ready cut and wet in Oxycrate; also a Defensative of the  prescription spread upon a soft linen Cloth, to apply upon the Parts above more distant, and a Mixture of the astringent Powders with Whites of eggs, to spread upon the Splenia and Buttons, which Buttons were also dipped in some of the same Powders. Than for the round Pledgits which were designed to be applied next to the Stump, Mr. M. proposed that they might be spread with a Mixture of Umber and calx viva with Whites of eggs, according to Doctor Read in his Observation of an Amputation he performed upon a Servant of the Lord Gerrard's at Gerrard's Bromley, whose fame yet lives in that Country, and will amongst us Surgeons as long as his elaborate Lectures have a being.  
The Apparatus thus made, and the Patiented some while before refreshed with a draught of a good Caudle, his Friends took him out of his Bed, and placed him in a Chair towards the light. One of his Servants held his Arm; another of his Friends held his other Hand. Than Mr. M. drew up the Skin and Musculous flesh of the Arm towards his Shoulder, whilst I made a strong Bandage some three or four finger's breadth above the affected Part. Than with a good Knife I cut of the Flesh by a quick turn of my hand, Mr. Murry pulling up the Flesh whilst I bared the Bones. After which with a few motions of my Saw I separated the Bone, the Patient not so much as whimpering the while, After this Mr. M. thrusting his hands downwards with the musculous Flesh and Skin which he had drawn upwards, I passed a strong Needle and Thread through the middle of the flesh and Skin on both sides, within half an inch of the edges, and brought the Lips close within a narrow compass: and having tied that Ligature fast, and cut of the String, I passed the Needle again through the two contrary sides, which I tied as close; than loosened the Ligature above, and applied the little round Stupes of Tow spread with a quantity of Galen's Powder mixed cum album. ovi. The long Pledgits were applied from the middle of the Stump each way upwards along the Arm, over which I put on a Bladder and a cross Cloth, than rolled up the Stump, and made the Bandage under his other Arm and over his Neck. This Bandage prevented an Accident which hath since happened to a Patient here in London, where many of the best Surgeons were concerned. He being thus dressed up, we put him into his Bed. The third day we took of the Dress, and found the Stump well digested, and at lest two Spoonfuls of Matter discharged. We than dressed it up with a Digestive ex terebinth. lot. in decoct. malvar. the Yolk of an egg and ol. ros. spread on a large Stupe of Tow, on which was sprinkled a proportion of Galen's Powder: than embrocated the Parts about with ol. ros. applying emplast. è bolo over all, with moderate Bandage, and afterwards deterged with that of Paracels. and with sarcotics incarned the Wound. During which the Bone exfoliated, and the Stump soon after cicatrized. Than having procured a Pass to come to London, I hastened away. 
Observation.   
At the Siege of Weymouth I was called at break of day to an Irishman of Lieutenant-Col. Ballard's Regiment, who shooting of his Musket, it broke, and tore his Hand to pieces after a strange manner. I designing to cut of his Hand, sent presently to my Quarters to one of my Servants to bring both Saw and Knife, also Dress, of which at those times we had always ready. They being brought, I took a read Ribbon from of my Case of Lancets, and bound it about his Arm some four fingers breadth above the Carpus; and having cut the Flesh round of, I bared the Bones, and separated the Flesh between them. Than I sawed of the Bones, and untied my Ligature, and bringing down the musculous Flesh and Skin over the end of them, without making any cross Stitch, I dressed up that Stump with Restrictives and good Bandage, and returned again to my Quarters. I had not been one hour gone, but I was sent for again to this Soldier, he being (as the Messenger said) grievously pained. I wondered at it, and hastened away: but before I came to his Hut, I heard him crying. I enquiring the cause, it was some while before he would answer me. But at last he told me, he was not able to endure that read Ribbon that I tied his Arm with. I was at first surprised to think I should leave the Ligature upon his Arm, that being a sure way to bring a Mortification upon the Part. I therefore put my hand in my Pocket, and feeling the Ribbon on the Case of Lancets, shown it him. He seemed at first to doubt it; but after he saw it was so, he laughed, and was from that time in ease. Two days after, our men were chased out of the Town and Chappell-fort. I was at the same time dressing the wounded man in the Town almost under the Chappell-fort, and hearing a woman cry Fly, fly, the Fort is taken; I turned aside a little amazed towards the Line, not knowing what had been done: but getting up the Works, I saw our people running away, and those of the Fort shooting at them. I slipped down this Work into the Ditch, and got out of the Trench; and as I began to run, hearing one call, Chirurgeon, I turned back, and seeing a man hold up a stumped Arm, I thought it was the Irishman whom I had so lately dismembered: whereupon I returned, and helped him up. We ran together, it being within half a Musket-shot of the enemy's Fort; but he outran me quite. I afterwards cured him in few weeks by the method already proposed in the preceding Discourse.   

CHAP. III. Of Fistulae.  
A Fistula, according to the vulgar denomination, is a Sinuous Ulcer supposed to be of two or three months' continuance. But to speak strictly, those only are Fistulae which are at lest of so many years' growth, and are accompanied with a Callus. Every part of the body is subject to these Ulcers; but especially the Arms, Legs, Thighs and Hips. The worst sort of these, at lest that ever I saw, was from Gun-shot Wounds with Fracture, where there hath been loss of Bone, or where through long continuance the Caries hath chambered the Bone: in which cases the Lips of the Wound and the Wound itself become callous, by keeping them long open in order to the Exfoliation of the Bone, in which case the Lips grow hard, and become thick and inverted. In these the Sinus' are more or fewer in number, accordingly as the Abscess or Wound was more or less sinuous.  
This Callus of the Fistula is hastened by the transpiration and resolution of the thin and subtle Humours, 
Cause.  and the incrassation of the more pituitous; by the congestion of which a long Pipe of Skin is made, which brancheth itself inwards from the Orifice quite through all the Cavities of the Ulcer: from whence it hath its name.  
The Differences of these Fistulae are made not only from the Parts affected; 
Differences.  as some are in Fleshy parts, others in Tendonous, or in the Bones or Joints, or in the Breast, Belly, etc. but also from the figure, magnitude, and number of the Sinus'; as sometimes there is only one, than again two or three, crooked or winding till they enter the Bones themselves.  
They are known by the view, and by the touching of the Parts, 
Signs.  or by searching with a Probe, and from the discharge of a thin serous foetid Matter, also from the arched Hollowness they have. If by your searching the Parts are pained, or if blood follows your Probe, the Fistula is not confirmed: but if neither hap, than it is.  
All Fistula's are heard to cure, 
Prognostic.  and those of long continuance with great discharge of depraved Humours from the Viscera are worst. Those amongst the Bones and great Joints are very difficult to cure, by reason of the Sensibility of the Parts, which for the most part admits neither of Dilatation nor Incision. Those which are in such places where you may safely lay them open, or remove the Callus, are more easy of Cure.  
The way of Cure is performed either by manual Operation, 
Cure.  or by Medicaments. But before you proceed in either, you are to consider that these Fistula's are subject to Pain and Defluxion: wherefore you are in the first place to proceed by Evacuation of those Humours which may disturb you in your work; and that is done by Purging and Bleeding, good Traumatick Decoctions, with observation of Diet, etc. as is said in the universal Regiment of Ulcers.  
To proceed in the Cure by manual Operation, you are to consider the Part affected, whether the Callus be only in the Lips, or in the basis of the Fistula, or throughout the whole length of the Sinus. And this is discovered, as I have said before, by the Probe, etc. If there be neither Pain nor Matter, and the Fistula be tending only down directly to the Bone, it will than be best to let it alone, accounting it as an imperfect Cicatrix, and that it will in time grow more close: but if it be otherwise, you must than remove the Callus in order to the Cure.  
If the Sinus be in a place where it may conveniently be laid open without Dilatation, divide it with Knife or Scissors the whole length. If after laying it open the Sinus be not throughout callous, remove that which is, and heal it according to the common method of Ulcers. But if the Orifice of the Fistula be so straight and narrow, that you cannot lay it open, you must than dilate it with Tents of Sponge, Gentian, Aristolochia, Eldern-pith, etc. until the Sinus be large enough for your purpose. And to further this work, it may be proper that you outwardly apply such Medicaments as may by their emollient and digestive quality resolve and dissipate the Matter impacted in the Parts about it: and these are rad. althaeae, lilior. enulae campan. sigil. Solomon. cucumber. agrest. sem. lini, foenugraec. medull. ossium. axung. porcin. axung. human. anseris, gallin. unguent. dialthaeae, gum. galban. Ammoniac. etc. Of these you may make Fomentations, Cataplasms, or Cerots. You have also to this purpose empl. de ranis cum & sine Mercurio, empl. de mucilag. diachyl. cum gum. The Fistula thus disposed for laying open, you must consider whether you may not remove the Callus by Cathaereticks: to which purpose Celsus proposeth lachr. papaver. Cadmia, atramentum sutorium, aerugo, sandarach. alum. We commonly use lap. caustic. Vigon. troch. de minio, arsenicum, ol. chalchanth. Or thus: ℞ cerae, resinae, an. ℥ j sublimat. ℈ ij. or more or less; mix this upon the fire, and dip a Sponge in it, but not too hot, jest you burn your Sponge: than press it out, and cut it into such a form as may serve your purpose. Guido commends aq. fortis as most excellent for destroying the Callus of all these Fistula's. But if you had rather have an Injection, you may make this or such like: ℞ unguent. Aegyptiac. ℥ ss. sublimat. ʒ ss. arsenic. ℈ j lixiv. sapon. ℥ j aq. ros. ℥ ij. aq. plantag. ℥ iiij. boil this ad tertiae partis consumpt. cast in a little of it with a Syringe three days together, shutting the Orifice up with Wax or some Plaster: so shall you consume all the Callus. But you must consider well the situation of the Fistula, jest by its too far penetrating it hurt the Bone or Parts underneath. After the application of these stronger Medicaments, you must by Lenients mitigate the Pain, and defend the Part from Defluxions, which for the most part attend such Escaroticks. These are, Decoctions of fol. malvae, bismalvae, violar. verbasc. hyoscyam. sem. cydonior. hoard. or ol. vitell. ovor. butyrum, axung. porcin. unguent. basilic. cum ol. lilior. dialthaea, etc. And apply over them Refrigerants; as empl. è bolo, oxelaeum, diapalm. cum succis; or some of the Defensatives mentioned in this Treatise. When the Inflammation is repelled, and the Sloughs cast of, you may deterge with this: ℞ terebinth. in aq. vitae lot. ℥ iij. succ. apii, cynogloss. an. ʒ vj. mell. ros. ℥ jss. decoq. ad succ. consumpt. deinde add rad. aristoloch. rot. pulv. ʒ ij. far. lupinor. ℥ ss. you may add to it pulv. ireos, myrrh. sarcocol. thuris, and thereby incarn: than cicatrize with unguent. desiccat. rubr. etc. If the Bone be carious, you aught to consider how far the Caries hath entered into it, and proceed in the removal of it either by actual Cautery, or Rugines, scraping the Rottenness of: than by Catagmaticks hasten the Exfoliation of the Bone, and proceed in the rest of the Cure with sarcotics and Epuloticks. But if the Fistula be near or over some noble Part, or if there be Nerve, Tendon or Artery near, or if it be deep in the great Bones or in the Joints, where you may not safely proceed by actual or potential Cautery, and it will not yield to milder Medicaments; you shall do better to palliate it by some Waters and Unguents, which may dispose the Part to quiet, purging the Patient sometimes, and observing the universal Regiment in Diet, etc.  
AN Officer of the King's Army laboured long of a Fistula, 
Observat. of a Fistula with Caries in the Os tibiae.  occasioned by a Gun-shot Wound in the upper part of the Os tibiae near the Knee, where it had formerly been shattered, many fragments of Bones casting out at times. He had been sometime my Patient in France; but here I finished what I there attempted, and had not time to do. After general Evacuation, I applied a Caustick the whole length of the Sinus, whereby I took of that Callus, gave vent to the discharge of that foetid Ichor made in the Ulcer, and took out several pieces of the rotten Bone which were shut in there. That done I scraped away the remaining Rottenness, and dressed the Bone with Catagmatick powders, etc. by which means after some time a Callus thrust forth, and united with the neighbouring Flesh, which incarned with the Lips, and was afterwards cicatrized by the common Epuloticks.  
It often happeneth, that in the time of the Exfoliation of carious Bones, as in Gun-shot Wounds and old Ulcers, while we are attending Exfoliation, the Lips grow callous, so that the Cicatrix is deep, and the Lips lie at some distance. In which case heretofore I have taken much pains to smooth them: but have since by experience found, that in time those Lips sink of themselves, and as the Callus riseth up to them the Cicatrix becometh firm and seemly, without giving the Patiented that trouble of removing them by Cautery or Knife.    

A TREATISE OF FRACTURES AND LUXATIONS.   

OF FRACTURES.  
The Seventh Book.  

CHAP. I. Of Fractures.  
A Bone is a similar Part of the Body, and the hardest and driest of all. 
The Office and Use of Bones.  The general Use of which is, Stabilimentum ac fundamentum reliquis omnibus Partibus largiri, to be a firm Prop and Foundation, upon the strength whereof all the rest of the Parts are built. The whole Sceleton considered jointly, may be looked upon as performing that office to the Little world, that Atlas hath been fabulously reported to do to the Great one: it bears the whole bulk of it, and sustains it in all its motions; none of which could be performed, if either the Bones were not, or not so articulated and jointed as upon defection they appear to be. Nam si ossa abessent, non flecteremus manus, non nervos & fibras. Nay, if the lest Bone be but a little maimed, the use of the Part is hindered. But they are not only Fulcimenta, as Galen says De Vsu partium, sed etiam Defensio, but also a Defence. The Cranium, veluti Galea, as a Helmet defends the Brain from external injuries. So Pectus Ossibus clauditur; the Heart, Lungs, and great Vessels of the Thorax, are guarded by a Wall of Ribs. The Spina is a Bulwark to the Marrow included in it: and such a defence is the Os pubis and the Os coxae and Ileon to the Womb and Bladder. Others otherwise serve the uses of Nature. As the three little Bones in meatu Auditorio, by firming the Tympanum, are a great help to the Hearing: the Os hyoïdes assisteth the swallowing, by managing the Root of the tongue and the Epiglottis: the Rotula serves the motions of the Knee: and the Teeth prepare the Meat by Mastication. Not a Bone but hath its particular end set out. There was a reason of the Temper, of the Magnitude, of the Number, of the Substance, of the Situation, of the Connexion of them; the wise Creator as much shunning superfluity as deficiency. Indeed, the whole Fabric is so full of Excellency, that it would take up much time to express it. But that is not my business. The Subject I have undertaken to treat of is their Misfortune: and that is twofold; to be fractured, and dislocated. That of Fractures I have proposed for the first part of my present Discourse; and that only in general, it being sufficient for my design.  
To proceed methodically, 
Definitions of Fractures.  I shall begin with their Definition of a Fracture, who, according to Galen de Methodo medendi, make it to be Vnitionis sive continuitatis solutio quaecunque in osse. But this being too general, and taking in all Cariosity and Ulcers of the Bones, which hardly belong to this Head of Chirurgery, the Moderns have more closely defined it to be, Ossis divisio seu ruptura à causa violenter irruente. But this likewise seems to me to be liable to many Exceptions. I shall name only this, viz. That a Cut made into a Bone by a Sword or a sharp Instrument seems to be rather a Wound, than a Fracture. And for this reason Guido de Cauliaco makes it to be continuitatis solutio in osse non à re qualibet facta, sed ab ea quae contundit. But I must still beg pardon, if I be not yet satisfied with this Description, because it leaves out all such Fractures as are made by any accidental bowing of a Bone, either in a Wrench, or any other case where, without any Blow or Contusion of Parts, the Bone snaps in sunder, and than wounds the neighbouring Muscles, even to the thrusting of itself very often quite through the Skin. These are (cases of Battle excepted) the most frequent of all Fractures; yet not without some violence to be reduced to any of these latter Definitions. I shall therefore choose to define a Fracture in the following words; 
The Author's Definition of Fractures.  It is a Solution of continuity in a Bone, suddenly made, either by Contusion or Flexure. By Contusion I mean, either a Blow by a blunt Instrument, or a Pressure by a great Weight; either of which usually bruiseth the Flesh about the Bone, as well as the Bone itself. In Contrafissures indeed the Bruise is not immediately upon the Fracture, but in the place where the Blow is given. In Flexure there is seldom any Bruise, but what is made by the edges of the Bone itself after it is snapped in sunder. All other Fractures are reducible to these.  
Amongst the Greeks it was commonly known by the name of Catagma. I purpose not to trouble you with the nice Distinctions in Fractures, nor yet with their various Names. Galen in his Book de Method. medendi complains thus in his time: Non desunt ex Medicis junioribus, qui ambitiose omnes Fracturarum differentias propriis nominibus interpretantur; There want not (saith he) young Physicians who affect to give proper names to all the several kinds of Fractures: At non Hippocrates hujus fuit sententiae; nor shall I spend my time so, but, according to Galen, do take the Difference in Fractures to arise, 
Differences.  1. à figura, 2. à magnitudine, 3. ab ossium fractorum varietate. First, from their Figure: and that is either right, quae fit per longitudinem; or transverse, per latitudinem; or obliqne, which is as it were compounded out of the two former. Secondly, à magnitudine, according as the Fracture is greater, or lesle. The third Difference is, ab ossibus ipsis, that is, from the Bones themselves that are broken, whether it be the Arm, Leg, Ribs, etc.  
Causes of Fractures internal there are none, 
Causes.  unless they proceed ab humoribus corporis erodentibus; and of that sort you may read many in Schenckius, Fabr. Hildanus, and others. I myself have seen some, and lately. But these, being from Erosion, are rather to be called Ulcers with Caries, and therefore more fit to be discoursed of amongst Ulcers of that kind, to which I refer you.  
Of Causes external there are many; as the too violent Assaults or Strokes of all external things, which may bruise, break, shatter, or bend. In this number of Causes may also be reckoned Falls from on high, etc.  
The Signs of a Fracture without a Wound are for the most part very evident. 
Signs.  The first and most certain is, when in our handling the Part we feel the pieces of Bones severed asunder, and hear them crackle. Secondly, the Impotency of the Member. Thirdly, vehement Pain. Fourthly, a Distortion of the Part. It may also be discovered by comparing the one Member with the other; the fractured being the shorter. But if there be a Wound joined to the Fracture, than if the Bones thrust themselves not forth, yet you may easily know the Member to be fractured, if you search with your finger or Probe. There is also a Curvednesse, which may be reduced to a Fracture. I have seen it in Children often, as in D. C's little Daughter in the Old Bailie, and Mr. N's Son in Blackfriars, and others. It is as it were when you break a green Stick; it breaks, but separates not: so is cured by a due Extension, with little Trouble to the Chirurgeon, or Pain to the Patient after the Extension is made.  
If the Fracture be secundum longitudinem, it will appear first by the unnatural thickness of the Member, than by the Pain and Inequality of the Part.  
As to the Prognostic or Presage, 
Prognostics.  a Fracture of the Bones cannot be without danger: for of necessity the Solution of continuity must be great. If a Wound be made in a Fleshy part, it is than proportionable to the Weapon that made it, & non ultra: but if the Bone be broken, propter rigiditatem & continuitatem non potest frangi, nisi totum frangatur. The Fracture is more dangerous in a great Bone than in a small; and the greater, if both the Bones be broken, as the two Focills in the Leg, or if it be the Arm, where the Radius and Vlna are: yet if it hap in the middle of the Bones, it is the less dangerous. Those in or near the Joint are more painful, and difficultly cured: and if any Shivers press upon the Nervous parts, ill Accidents commonly follow; but of all the Fractures that with a Wound is most dangerous.  
As to the time of Cure, the lesser Bones are perfected in fourteen, eighteen, 
Cure.  or twenty five days, the bigger in forty or fifty, according to Guido. Yet let me advice you not to be too hasty in taking the Patients out of their Beds; for in some Bodies the generation of Callus is very slow, and a new Distortion may hap, and ill Accidents follow. I have been called into Consultation upon such an Accident, the Patient did recover, but by lying very long within doors contracted such an ill Habit of body, as was not got of in a long while after.  
In the Cure of Fractures Unition is required: but that cannot be made, unless Pain and Inflammation be prevented. For a Fracture of the Bones is not made without an internal wounding of the Periosteum and Parts next to it, whence grievous Pain arises, which stirs up Defluxion, and is attended often with great Inflammation; and from the weakness of the Member many Excrements are made and received, which it is neither capable to assimilate, nor yet expel. And the mischief is so much the greater, by how much the Bones lie deeper under the Muscles, where they cannot be set, by reason of the great quantity of Flesh interposing between them and the hand of the Artist. The Intention pursued in this case is the Union of Bones, as I have already said; which is not performed by the first Intention, unless it be in little Children, but by the second, viz. an intervening of Callus.  
The Method I thereto propose is, first, to join the fractured Parts together; 
Intentions of Cure.  secondly, to keep them so joined: thirdly, to preserve the Tone of the Part; fourthly, to generate Callus; fifthly, to correct Accidents.  
That the Parts may be rightly joined together, there is need of Extension, 
1. Intention.  and Coaptation. For in Fractures, especially transverse ones, the Bones are commonly distorted, the rectitude of the Member lost, some Parts are prominent, and others hollow, the fractured Bones lying one upon another; and so the Member is made short: & quia musculi perpetuò membra trahunt versus suum principium; 
Extension.  therefore Extension is necessary, that the Parts which are indirect may be brought right, and the Parts that stick out may be reduced to their Cavities. And although sometimes the Member seemeth not to be short, as if it consists of two Bones, and one broken, or that the fractured Bones do not lie one over another; nevertheless you aught to make due Extension in all Fractures, because the Bones never lie exactly equal, and most frequently they ride one over another. The want of which Extension is one reason why the fractured Thigh-bones hap to be so often shorter than they should be, as Celsus hath it in these words; Si femur perfractum fuerit, breve erit; his reason is, quia nunquam in antiquum statum revertitur. And I found in Galen, that Hypocrates says the same of the Leg and Arm; and withal tells us, it is so, nisi ante confirmationem extensio debita abhibeatur, & commodâ deligatione ossium coaptatio servetur. By which you may observe, the fault is want of good Extension, and keeping the Part in its right seat: for unless that be done, you shall hazard the starting again of the Bones, and thereby their fractured ends may hap to be broken of by mutual Attrition in the act of joining together: and if those pieces do chance to fall in between the main Bones, they will than hinder their uniting: and if those Shivers slide outwardly towards the Membranes, they will 'cause extreme Pain. This inconvenience is therefore to be shunned by the help of Extension. But again in Extension there must be observed a mean, as Vigo notes: Ad magnam quidem Extensionem futurus Spasmus valde suspectus est. Yea sometimes the very Muscles are torn asunder, as Galen tells us: and Albucasius cries out, Cave Extensionem vehementem & Compressionem fortem, sicut faciunt multi stolidorum: multoties enim faciunt Apostema calidum & contractionem in membro. By which it seems in his time there were such people, who thereby drew sad Accidents, as Convulsions and Inflammations, upon their Patients. But if the Extension be lesle than it should, than, as I said before, the ends of the Bones rub one against another, and are broken, or not seated in their proper place. Therefore the bigger Bones having large Muscles, which draw the Member forcibly to their Original, do require the stronger Extension; and such are those of the Thighs, Legs and Arms. And if both the Focills of the Arm be broken, the Radius requires the more Extension, because it hath no Muscles to draw it upwards, its motion being only secundùm pronum & supinum. In Extension it behoves us to observe debitam figurationem, that the Member be extended in ea figura quae minimum facit dolorem, saith Galen: which is done, if the Fibres of the Muscles be stretched according to their rectitude. Children, and such as are of a soft Habit of body, do best suffer Extension: elderly and dry Bodies the contrary.  
In the next place is to be considered the most reasonable time wherein to reduce the Fractures. And herein we all agreed, the sooner the better, and that to avoid Inflammation; and according to Celsus, Si in primis diebus non restauratur, inflammatio oritur, etc. If at the first or second day the Fracture be not reduced, it is in danger of Inflammation and Mortification: for indeed after the second day, it is supposed the Fracture is accompanied with great Defluxion, and so yields not to Extension without hazard of drawing such ill Accidents upon itself.  
Therefore Fallopius in his Exposition upon Hypocrates De Capitis vulneribus, and by his authority, tells us what we shall do in such a case. Si os non fuerit in suo loco, says he, ideo ad septimam, qui est primus terminus Inflammationis, vel usque ad nonam, qui est secundus, debemus bene advertere: & oportet impedire inflammationem. If the Bone was not restored before the time of Inflammation, than we aught to attend till the seventh day, which is the first period of Inflammation, or until the ninth day, which is the second period: and all this time we aught to restrain the Defluxion, vel per lenitionem doloris, vel expressionem & deligationem loci. Lenimus autem medicamentis oleosis, quae habent vim refrigerandi, vel per deligationem pluribus fasciis; either by lenient Medicines, or by Deligation. We lenify with soft cooling Oils: we make our Deligation or Bandage by many turns of the Rulers. These are to be done until the seventh or ninth day. Inflammation abating gives you opportunity for reducing the Fracture. 
Instruments of extension.  The Instruments for Extension are threefold. First, the Surgeon's Hand, for gentle Extension: and let him place his Hand near the Fracture; otherwise he shall hurt the sound Part by too much Compression, and not avail himself much in his Extension. Secondly, for the middle Extension there are Funes and Habenae, a sort of Bandage fit to pluck at in order to Extension. Thirdly, there are Organa and Machinamenta, Engines used often by us, but invented by the Ancients: and they are for the most strong Extension. But before you make your Extension, consider whether the Member be not fractured in more places than one. An old Gentleman came out of the Country, and by a Fall going down Ludgate-hill broke his right Arm a little above the Wrist transverse; and near the bending of the Arm was a second Fracture obliqne. This double Fracture hath happened to others in the Leg. It requires your circumspection, jest the one escape your sight, and the Member be left deformed, and weakened in its action.  
The Extension made, the Extenders are to be loosened gently, 
Coaptation.  and the Operator must with his hand endeavour as gently to press down the ends of the Bones, and join them smooth and even together. And if there be any little Shiver that will not be placed even with its fellows, cut upon it, and take it out. You shall know the perfect Coaptation of Parts by these Signs. 
Signs of good Coaptation.  First, if the fractured Member answer to the sound; secondly, if by your handling of it you feel no Inequality; and thirdly, if Pain be abated.  
The second Intention in curing of Fractures is, 
2. Intention.  that the Parts brought together may so be preserved: and that is performed by Bandage, which aught to be so made, as not only to keep the Parts so joined together, but to defend them from Inflammation. And to this purpose I commend to you that of Hypocrates from my own practice. It consists of three Rulers made of linen Cloth, not too course, jest thereby it should offend the fractured Member; nor yet too soft and fine, jest it break.  
With the first Rowler you are to begin upon the Fracture, 
1. Rowler.  and take three Turns there. Than roll upward to the sound part, and so a little higher, and there end this Rowler. It will keep the Fracture a little steady, until the other Bandage be made, and restrain the influx of Humours which might 'cause Inflammation.  
The second Rowler aught to be as long again as the first, 
2. Rowler.  and must be rolled contrary to the first; as for instance, if the first was made to the right hand, this must be turned to the left: so that if the Muscles by the first Bandage were wreathed too much on one side, they now may be restored again to the other. This second Rowler must begin upon the Fracture, and after a Turn or two there, must be carried downwards, that so you may press the influx of Humours from the fractured part. And so having made three or four Turns downwards upon the sound part, you may roll upwards again by the Fracture, and making a Circumvolution upon the Fracture itself, pass upwards, until you come to the end of the first Rowler. And there Hypocrates terminates this second Bandage, because there is fear of the descent of Humours à parte superiori: and these two Bandages do more defend the Part from Inflammation, than strengthen the Fracture. But they being made, 
Splenia.  Hypocrates puts over them Compresses of linen Cloth three or four times doubled, of such length as to reach over the Fracture; but so narrow, as that five or six might be placed round about the Fracture, the distance of a finger one from another. These are to be spread with a little Cerote, only to make them stick. They are called Plagulae and Splenia from their figure, and do supply the defect of agglutinative Medicaments, and lessen the Pain, by hindering the Compression of the Bandage.  
The third Rowler of Hypocrates fastens the said Compresses; 
3. Rowler.  and its first Turn is made upon the Fracture, the one head being carried upwards, and the other downwards. And you are to take notice, that the Bandages are to be drawn more straight upon the fractured Parts than elsewhere, that the said Parts being more weak, may be kept from Defluxions.  
Celsus in his eighth Book, 
Celsus' way of Rolling.  and tenth Chapter, proposes another way of Bandage. First, he dipped a Cloth in Read wine and Oil, and applied it over and about the Fracture, and over that he brought six Rulers, his two first being those of Hypocrates, and so he rolled them; than he used a broad double linen Cloth, spread with Cerote, to keep them close down. And his reason is, because the fractured Bone hath always a propensity that way whither it tended when fractured; therefore, saith he, you are always to put a Compress of linen Cloth, dipped in Wine and Oil, ei parti quae contraria est parti in quam membrum inclinat. And over this he brings the four remaining Rulers; so as the following Rowler be rolled contrary to the former, and the third end in inferiori parte, in the lower part, reliquae omnes in superiori terminum habeant, all the rest end above.  
These are the Bandages of Hypocrates and Celsus, men of the greatest Authority in Chirurgery, and are followed almost by all that have writ since, and are of excellent use in Fractures in and near the Joints, where there is fear of Inflammation. But than in your Binding you must observe such a mean as confists with the ease of the Member bound. 
Signs of good Bandage.  A small and lax Tumour appearing at the extremity of the Member a day after, is a sign of good Bandage; but if there appear no Tumour, or if the Swelling be great and hard, than the Bandage is naught; the first showing the Bandage not to be straight enough, and the last too straight. Therefore you should often visit your Patient, to inform yourself how the Bandage is.  
But if no Accident hap, 
When to loosen Bandage.  you shall not unbind the Fracture until the seventh day: and than, if all be well, the Bandage will begin to slacken of itself; and if it be not well, you may than see your error, and timely help it. And that is one reason, why Fractures should be opened about that time. Another may be, for that often in Fractures there is an intolerable Itching, through the detention of Humours, which are made sharp by Deligation, (Perspiration being thereby hindered,) and that is want to terminate in a most painful Excoriation and inflamed Redness. In which case you are to bathe the affected Part with warm Water, that the Matter may be evaporated: and than the Member is to be bound up again. But here you are to put Ferulae or Splints in stead of the Splenia or Compresses. Whereas in Fractures with great Contusion, or in and near the Joints, I have continued the use of Compresses wet in Whites of eggs during the whole Cure with good success. And lately a Youth about ten years of age, 
Observation.  labouring under a carious Ulcer in his Foot, the last great Frost broke his Thighbone according to the length of the Member. This Fracture was covered with empl. è bolo and Splenia moistened in album. ovor. with Bandage, etc. as is proposed in this Treatise; by which the fractured Bones were kept even and close together with much ease to the Child, and agglutinated firmly by the Callus intervening. Mr. Yowel, sometimes a Servant of mine, set his Thighbone for me, I being at that present otherwise employed.  
But all the Ancients after the seventh day did use Splints; and so have I where they might safely be used: for they not only keep the Member steady, but strait. And of these some are made of Tin, others of Scabbard, Pasteboard, and of Wood, sowed up in linen . Those of Tin do very well, by reason of their lightness. Those of Scabbards are apt to bow, and so those of the thickest Pasteboard, especially if they chance to be wet. And those of Wood are heavy, and apt to inflame the Member. Yet through the Artist's care they may be all used with good success, yea from the first day of the Fracture. As in the case of a Reverend Divine, who broke both the Focills of his left Leg within a few finger's breadth of the Ankle. This person laboured under an Asthma, which grievously shook the fractured Member; wherefore I was necessitated to put on Ferulae the very first dressing, which I continued the use of during the whole time of his Cure. He lately told me, that he never felt the lest pain in that Leg since I took of the last Plaster, which is more than ten years since. But Hypocrates used them not until the seventh day. For before that day there was more need of hindering the Inflammation, than of strengthening the Fracture; post septimam contra, but afterwards the contrary is required.  
The third Intention in curing of Fractures is, 
3. Intention.  in preserving the Tone of the Part. Natura enim os unire nequit, nisi pars sit sana; Nature cannot knit the Bones while the Parts are under a Distemper: and that cannot presently be removed. For though fractured Bones be very well set, yet there will remain some Cavernulae, which will be apt to fill with Sanies, which the Part through its weakness can neither well assimilate nor expel, and so is like to be burdened with excrementitious Humours. Therefore Phlebotomy may be here of special use, and the keeping of the Belly soluble by Clysters, or otherwise, and a slender Diet must be prescribed. This is the work of the Physicians. But they not being always at hand, I thought fit to mention it, and so to proceed to our own work, in keeping up the Tone of the Part. And hereto we have need of such Medicines quae materiam influxam desiccant, & inflammationem repellunt, which dry up Serosities, and repel Inflammation. And these in a word are Astringentia, of which we have choice. Hypocrates used Cerote, than Read wine: Celsus, as you have heard, used Oil of Myrtills and Roses, Read wine, and Whites of eggs together: others again used Whites of eggs alone; and others added Oil of Myrtill, ballast. ros. rubr. sang. dracon. bol. Armen. and with a little Wine made it up to the consistence of a Lineament, and applied it upon  over the Fracture. By the use of this latter Medicament I cured a man whose Arm was soar bruised, and fractured in many pieces, by the fall of a piece of Cannon, which broke lose in a Storm, while we were preparing to lay aboard our Enemy. Over this Restrictive I applied Splenia of double soft Linen with Bandage, as in Compound Fractures, and happily cured him. If the Inflammation be not great, I than take empl. diapalmae, and some of the forementioned Powders, with a little Oil of Myrtill and Vinegar, made up to the consistence of an Emplaster, which I spread upon Cloth pretty thick, and apply over the Fracture. It not only restrains the Defluxion, but strengthens the Fracture. The Medicaments proposed are all very good, and excellently preserve the Tone of the Part, if they be proportioned according to the greatness of the Malady.  
There is yet farther requisite to the performance of this Intention, 
Position of the member.  a right Position of the Member: and that, according to Galen, debet esse mollis; the hurt Part aught to lie soft: for that hard lying presses upon the bruised Bones and Flesh, and causes Pain and Inflammation. Debet esse aequalis, nè distorqueat; It must lie smooth or equal, because an uneven placing distorts or draws awry the Part. Sursum versus, nè humores descendant; It should lie somewhat high, jest a painful Defluxion fall upon it. Oportet congruam membri figurationem considerare: It behoves, saith Hildanus, to consider the convenient figure of the Member, that the Muscles be kept in their right Site, which is most free from Pain. Haec autem est figura media; which if it be not observed, exiguo post tempore membrum dolere solet. What those Pains are, you may possibly guess, but no tongue can express. Therefore you aught to handle the Member very tenderly; and if the Fracture be made in cubito, place it in a Case made of Pasteboard, with a soft Pillow under it, and bring it up to the Breast with a fine Towel, or the like. But if it be the Leg that is fractured, we than place it in a Bed, or in a Cradle, or upon a Pillow quilted in the midst with Junks to support it; having a special care that the Hollow of the Ham and he'll be filled up, jest the weight of the Foot hurt the Heel, from whence grievous Pain doth ensue, and sad Accidents may follow, as at large you may read in Fabr. Hildanus.  
The fourth Intention is, 
4. Intention.  calum generare, to make Callus; which is to be endeavoured after the fear of Inflammation is over, quia natura partis laesa non potest Callum generare; and that ceaseth circa diem septimam, about the seventh day, sooner or later. And if after that time the Fracture be to be set, possunt diversa & mala accidentia generari, saith Vigo. Yet after the seventeenth day of the Fracture I have set the Thighbone, and cured the Patient, without any ill Accidents: he is yet living to testify it.  
How the Callus is made, you may read at large in Fallopius, in his Exposition of Hypocrates. And though it be not Bone, it is so hard, saith he, that if the Member hap again to be broke, potiùs in alia parte frangitur, quàm ubi Callus est genitus, it breaks anywhere rather than in the Callus.  
Two things are therefore required: first, that it be supplied with fit matter; secondly, that that matter be not washed from the edges of the fractured Bones, aut foras evocetur, saith Galen. As for the matter to make Callus, most Authors do agreed, 
Diet for the engendering of Callus.  that there be a greater liberty in Diet. At quo tempore (saith Galen) Callus gignitur, nutriendum corpus est cibis boni succi, & qui multùm nutriant. And that must be viscous: his reason is, quia ossis alimentum crassum. And for that reason Authors commend at this time Offal of Flesh, and Broths of Kid and Veal, and the like, boiled with Rice or Wheat. They also allow sweet Wines. But this liberty in Diet I think is better forborn, for thereby we often see great Obstructions arise, especially there where our Patients are inclinable to feed plentifully. Therefore in such Fractures where the Patient is constrained to keep his Bed, I propose a slender Diet, and of such things as are of easy Digestion. For without that liberty surely we cannot fail to complete our Cure; the Bones having naturally a Porinesse in them, in which is always contained a matter fit for their Nourishment; and ex illo ipso nutrimento in fracturis generatur Callus, of that Nourishment Callus is made. So if we be careful to prevent Inflammation, and the like Mischiefs, which disturb Nature in her actions, and apply such Remedies as may dry the proper Nourishment into Callus, we shall not fail than of our desire: and those remedies, according to Galen, aught to be Emplastic and moderately hot. For, saith he, ea Callos tum promovent, tum augent: quae digerendi vim obtinent, ea magnos jam Callos diminuunt. Therefore it behoves us with care to fit our Medicines to the Age and Constitution of our Patients. For those which are proper for Men of ripe age, if applied to Children and tender Bodies, would so dry the Callus, that they would quite diminish it, and frustrate our Cure. In Children Albucasius commends to us the application of Whites of eggs alone, or with a little farina volatilis: in those of more years, pulv. myrrhae, aloes, acaciae, gum. tragacanth. thus, labdanum, etc. Emplastrum stict. Paracels. diapalm. oxycroceum, severally or mixed, are proper. But this latter Vigo is very angry with, and says it is a Diabolical Emplaster, too hot for the Summer, and not very proper for Winter. Vigo's emplastr. ad ossium fracturas is excellent; and so is our Catagmaticum in the London Dispensatory. As to internal Medicines, there are many; but I shall only recommend to you osteocolla, and that by the authority of Fabr. Hildanus, who often experienced it. The Dose was ʒ j in aq. rad. symphyti: and with this so given he cured a compound Fracture in one above sixty years of age. At in juvenibus & succulentis non putat convenire osteocollam.  
Thus I have proposed fit materials for the generation of Callus: now jest that the matter of which it is to be generated should be hindered from thrusting forth, it behoveth you to altar the Bandage, the Member not requiring to be rolled now so straight; by which means the nutritious Juices will have liberty to flow in, and there by gradual Digestion to thicken into a Callus. In taking of your Dress, you are to consider whether the Callus generated be such as is required. how the fault of the Callus is to be remedied, if it be greater or less than it should be, you shall hear presently.  
If the Fractures be simple, whether transverse or secundum longitudinein, they are cured by the same methods; only these latter require a more strict Bandage, otherwise the Bones will be apt to rise and make a gibbous Member.  
The fifth Intention is, 
5. Intention.  the correcting of those Accidents which happening in Fractures retard their Cure: and they are many; as Pain, Inflammation, Apostemation, Gangrene, Itching, Excoriation, Callus more or less than should be, Weakness of the Member, and depraved Figure. If Pain invade the place, than Lenients are proper, and such Remedies as restrain Defluxion, and hinder Inflammation; of which sort I have mentioned some, and for more variety refer you to those which are set down in the Chapter of Phlegmon. If Gangrene appear, slacken your Bandage, and foment the Part with a Lixivium in which have been boiled scordium, absinth. centaur. and the like. You may also apply over all a Cataplasm of Barley-meal, Lupins, with the addition of such Ingredients as have been prescribed in the Chapter of Gangraenae. But if Itching affect the Part, than foment it with warm Water, which will give a breathing to it by the Pores; or with Salt-water, quae propter salem expurgat, & poros aperit. The Itching neglected is want to terminate in excoriationem dolorosam, in a very painful Excoriation, cui occurrendum est exsiccantibus & refrigerantibus; such are unguent. alb. camph. nutritum, populeon, etc.  
As to the Callus, it is sometimes just, sometimes greater or lesser than it aught. 
To lessen Callus.  If it be too great, you will perceive it by its bunching out; as also it will be painful to the touch or pressure; and besides it renders the Part unapt for motion. In this case abate the Patient's Diet, make your Bandage more strict, and foment with Discutients, also apply empl. de cicuta, de ranis cum Mercurio, etc.  
But if the Callus bell ess than fit, 
To increase Callus.  the signs are, quòd ad motum redditur debilis, the Bone is weak, and if the Part be touched you scarce feel the Callus. And this was thought by the Ancients to proceed from slenderness of Diet, or that it was not enough incrassating. But I think it rather proceeds from improper Applications, or too straight Bandage. Yet if the Patient be in years, and of a spare Body, you may both increase and incrassate his Diet: but withal slacken your Bandage, and invite forth the Humours by warm Water, not too hot, donec pars rubescat, & in tumorem attollatur, until the fractured Parts a little swell; tunc enim defistendum. But if the Member be extenuated, it is either from the too straight Bandage, or overmuch bathing with warm Water: therefore you must now bathe with fresh Broths, and other good Embrocations. Also a Pitch-plaister applied, and presently pulled of again, will by its adhesion to the Hair and Skin cause Pain, and likewise an attraction of Aliment to the Part, and so the Member may be nourished.  
Sometimes also after the Fracture is cured, the Member is found to be of a depraved Figure, by reason the Bones were not well set, or through ill Bandage, or some inordinate motion, aut propter inscitiam Chirurgi. To resolve this Callus, some Authors have adventured to prescribe sundry Medicaments; but they have hitherto proved unsuccessful. Yet if it be true what a Chirurgeon lately affirmed of empl. de minio, the work would be very facile. But Celsus and Fabr. ab Aquapend. after the prescribing various Remedies conclude at last thus: If the Patient be young and lusty, and the Callus but six months old, there is yet one refuge, that is, fracturam de novo rumpere: and in order thereunto, you are to foment the Part with Decoctions ex althaea, rad. lilior. fol. malvar. taps. barbat. cicuta, etc. and than rursus os frangitur manibus vel digitis, impellendo seu comprimendo. But if the Callus be so hard that it yields not to your hands, than says Fab. ab Aquapend. frango eum instrumento attrahente in diversas parts. But this, Albucasius, a Chirurgeon as hold as any, and one that had seen the effects of such rash undertake, utterly condemns, saying, it is operatio valde vituperabilis, perducens ad mortem: therefore he adviseth the Patient not to give ear to such vain people, but rather content himself with such help as emollient Decoctions, Liniments, and Emplasters may effect. Which in truth is safer, if you consider, that after the Callus is so confirmed that it will not yield to Extension, than if you should break it anew, or any other way separate it; yet it would not more yield to a right Coaptation, than a Hair-lip or my two Fingers will to Agglutination without separating the Callosity; which is not possible to be done in Bones.  
I could have here inserted many Instances of my work in the Cure of the several Fractures of particular Parts: but it would signify little more than I have already written, their Cure consisting in the very same Extension and Coaptation, and they being subject to no other Accidents than what I have set down: all which I have writ as plainly and feelingly, as if I had been performing the work in your presence. Yet as a rarity I shall give you one Instance.  
SOme years before the Fire, 
1. Observat. of a fractured Face.  I was sent for to a poor Widow inhabiting near Bridewell, whose little Son, of about eight years of age, playing about the Wharf, was struck by one of those great Cart-horses full in the Face, beating the Ethmoïdes quite in from the Os cribriforme, without any great Wound. The Boy lay for dead a while, and dozed longer. It appeared a strange sight at first to me, his Face being beaten in, and the lower Jaw stickling out: nor did I presently know how to help him, or by what art to make my Extension. But after a while, he a little recovering his Senses, was persuaded to open his Mouth. And there I saw the Os palati and Wula beaten so close backwards, that it was not possible for me to get my finger behind, as I designed; and other way of Extension there was none. Upon which I presently form an Instrument bended up at one end, by which I got up behind the Wula; than raising it a little upward, pulled it forward with the Bone into its former place very easily. But I not sooner let go my Extender than the fractured body returned back again. I than contented myself in dressing up the Face with a restrictive Cerote, to prevent the Influx of Humours, and let him blood, and within a few hours after caused an Instrument to be made, whereby the great fractured body was more easily brought into its natural place, and also kept there by the hand of the Child, his Mother and my Servants helping him some while: other way there was none. Thus by their and our care, the Tone of the Part was preserved, and a Callus thrust forth, which as it hardened, the Part grew stronger, and the Face was restored to a good shape, better than could have been hoped for from such a Distortion in that place. The Patient is yet alive and well.  
A Page attending a Noble Family, riding behind the Coach, fell down, 
2. Observat. of a fractured Clavicle, etc.  bruised his Face, and broke his right Collar-bone. He was taken up and carried to the next Pretender to Chirurgery, who seeing his Face much swelled, and his Nose bloody, concluded it fractured, and filled up his Nostrils with Tents, binding them up with Plasters; and finding his lower Jaws standing unequally with the upper, concluded them luxated, and that part of the Sternon under the Collar-bone was broken down. Things being thus represented, I was sent to view this Youth: and pulling of the Plaster, and the Tents out of his Nose, I saw neither Wound nor Fracture. His Jaws did not answer equally to one another; but by his frequent motion and champing with them, it was evident they were neither luxated nor fractured. But by his Fall the Bones of his Face seemed to be pressed inward, and the uppermost Jaws were crushed nearer one another than they should: and this made the Inequality which our Chirurgeon thought a fault in the lower Jaws, and by his pulling them had like to have broken or dislocated them. The next day he called in a Chirurgeon to justify his proceed. But there appearing nothing of Luxation or Fracture in the Jaws, we looked upon the Sternon, and found it well; but that Collar-bone was broken obliqne, which we set and bound up, with resolution not to open it till it should be united. All things being in this hopeful condition, we advised him to keep his Bed, and left him to observe the Directions of his Physician, by whose prescription a Clyster was administered that evening, which he voided into a white earthen Chamber-pot, which his Chirurgeon looking into called it blood, and alarmed his Friends. But a discreet person looking afterwards upon it, concluded it only the Clyster tinctured with read Sugar, Hiera picra, etc. I being soon after fetched, confirmed the same, and appeased that clamour. About the tenth day our Chirurgeon, contrary to former order, undressed the fractured Clavicle: upon whose binding it too slack the Bone started, and from that time it grew painful; so that he dressed it again four or five days after: but the Pain increasing the more, I was fetched, and upon opening saw one end of the Clavicle riding over the other, and pricking against the Skin. The Callus being confirmed, the Patient was removed from his Surgeon's house to his Mother's in the City, where being in great Pain, his Chirurgeon dressed him again; and the straighter he made the Bandage, the greater was the Pain. He not imagining the cause, imputed the fault to the unruliness of the Patient, and declared that the Fracture was yet in the Bone, and that it was incapable of Cure. Upon which I was sent for, and seeing the Pain to proceed from the end of the fractured Bone pricking in the Skin, and the more when it was bound, I caused half a Wallnut-shell to be plastered over it: and having thereby defended it from Pressure, he made use of his Arm, and complained no more of Pain. I than designed to cut of that end of the Bone, if it again pained him: but from that time it continued easy, and he recovered the use of that Arm very well.  
Thus have I done with that which concerns Simple Fractures. 
Compound Fractures.  In a Fracture with a Wound, if neither the Bone be bore, nor yet prominent through the Skin, than you are by Extension to bring the fractured ends of the Bone together, as was proposed in the first and second Intentions of Simple Fractures. And the Lips of the Wound are likewise to be brought together by Suture, if it be any whit large, and not too much contused. Which manner of dressing is contrary to what is taught in Gun-shot Wounds with Fracture; the method being to be altered upon that occasion for the reasons there alleged. Than endeavour, as in our third Intention, to keep the fractured and wounded Parts together by Dress, which may as well mitigate the Pain, as keep of Apostemation, by repelling the Matter flowing to the Parts, and drying up that which already affecteth the Fracture and wound: qualia sunt Astringentia, that is by Astringents; with which I have sufficiently furnished you in the Discourse of Simple Fractures Galen, by the authority of Hypocrates, recommends Cerote of Roses. But if there be no Pain, you are to endeavour the strengthening of the Fracture, and preventing Defluxions, by  spread with that Composition of astringent Powders, mixed with the Whites of eggs and Read wine, which is already proposed. Than follows Deligation of the Part: and in this case Bandages are to be made of softer and broader Linen than we use in Fractures without a Wound, that they may comprehend both the Lips of the Wound, and keep them down, yet not hurt them by too hard Compression. Minùs astringendae sunt fasciae quàm si vulnus non adesset, says Celsus. And therefore it is that Hypocrates and Celsus make so many Circumvolutions; cùm melius sit saepe circumire quàm astringere, saith Celsus again. The third day they loosen the Bandage: than ferulae vel non apponendae, nè vulnus comprimant, saith Albucasius; or if they be put on, super vulnus apponi non debent. Rather in these Fractures do we use Deligation, pluribus fasciis, with many Rulers, saith Albucasius. And so all along he proceeds in his Discourses of Fractures, as if he had been rather bred under Hypocrates or Celsus, in Greece or Italy, than where he was. But in truth this way of Deligation is not only very troublesome to the Chirurgeon, to put on and of, but so very painful to the Patient, that it is almost impossible that he should ever be without a Fever, if his Wound be every day to be so rolled and unrowled. Therefore in these Compound Fractures we choose rather to follow the method of some of the Moderns, who, in stead of these many long Rulers, make choice of two or three short , folded three or four times double, to give them the more strength. We also make them of such breadth, as to encompass the Lips of the Wound and the fractured Parts; and of that length, as to come once about the Fracture, and so stitch together on the most convenient side. And under these may be placed Compresses of fine Tow, or double ; which will not only keep the Lips of the Wound down, but fill up the Inequality, and further the expulsion of Matter. And so the Wound may be dressed, and the fractured Member relieved at your pleasure, without giving the Patiented the pain to have the fractured Member removed, or yourself the trouble of rolling and unrowling so many long Rulers as the Ancients proposed. With this method I have cured Arms and Legs, so shattered by Splinters from Canonshot, and with such loss of Substance, that I even despaired of their Cure. But in some of these I have made use of Hippocrates' Plagulae; and often, for the more strengthening the shattered Member, have been glad to make use of some Splints from the first day; but so as their compression was gentle and equal, and so placed that the Lips of the Wound might be kept even, and that the discharge of Matter was by them furthered. But if the Wound be transverse, it than requires more caution, jest the Matter should at any time be pressed back into the Wound, and so not only dilate it, but foul the Bones.  
Thus much for a Fracture with a Wound where the Bones are not exposed to the Air. But if the Bone be bore, and thrust itself out of the Wound, you shall endeavour presently to reduce it; and after it is restored to its natural place, let the Wound be stitched and dressed, as I proposed to you even now in the Compound Fracture.  
A Commander at Sea, 
2. Observat. of a fractured Leg.  valiantly fight in the midst of the enemy's Fleet, had his Leg fractured by the fall of his Mizzen-top-mast, it breaking his Leg transverse near the Ankle, the edge of the Bond thrusting out through the Skin. He not suffering the Bone than presently to be set while it was warm, afterwards, when it was swelled and stiff, it did not yield to Extension, but became painful and inflamed. After some few days he was brought to London, and I was sent to him. He was of an ill Habit of body, subject to the Gout and dysentery; and the Fracture being accompanied with great Defluxion was not in a condition to admit of Extension. Therefore, according to Fallopius and Hypocrates, before cited by me in this Treatise, I proposed to his Chirurgeon to proceed by Lenients, to mitigate Pain, Inflammation, etc. and by Bandage to hinder Defluxion. Which we did; and his Chirurgeon continued that method a few days, by which the Accidents were remitted. When we met again, finding the Patient in ease, we took of the Dress, and agreed to make Extension, and reduce the Fracture. The Patient was of a dry tough Body, and the Member yielded difficultly to the Stretches: upon which consideration we satisfied ourselves with a moderate Extension, doubting that upon a more forcible one ill Accidents might follow, (as an Inflammation presently did. (We dressed it up as a compound Fracture: and after some days dressing a Callus thrust forth, and united the Bones. That Callus being confirmed and dried, we hastened the Exfoliation of the foul Bone by a little Aegyptiacum and pulv. myrrhae dissolved in spir. vini, applied hot upon an armed Probe. Thus the Bone was exfoliated, and the Ulcer cured by the ordinary Intentions in such cases. Yet the inward leaning of the Bone continued a weakness in the Member a long time, as is usual where the Fracture hath not been timely or well reduced. To remedy this, I caused a Bar of Steel to be fixed in his Shoe with joints, and by a Bracer of Cloth to be laced on, or tied with Ribbons on the outside of his Leg; by which it was marvellously strengthened.  
But if the end of the bared Bone do chance to thrust itself so out, as that without great force it cannot be restored to its place; tunc è duobus malis minus est eligendum; than that end of the Bone which hath thrust itself so far out is to be sawed of: and if this be done timely, before a Gangrene hath seized upon the Part, it may be performed with good success.  
In St. 
4. Observat. of both the Focills of the Leg fractured.  Clement's Parish behind the Church, some years since, while I was one evening preparing my Dress for the setting a fractured Thighbone in a little Child, I was hastily fetched to assist one Mr. powel, a Barber-chirurgeon, in the setting a Fracture of both the Focills of the Leg in a Man about sixty years of age, of a tough dry Body. There I met Mr. Tatham, an industrious knowing Chirurgeon. The Fracture was obliqne, almost secundum longitudinem; and the Os tibiae or greater focil had shot itself out by the inside of the Ankle a great length. We endeavoured by a strong Extension to reduce this fractured Bone into its place; but it yielded very difficultly to our endeavour: yet we reduce it, and afterwards cleansed the Wound of what Shivers or pieces of Bones we met with, and brought the Lips of the Wound together by Suture, hoping thereby to keep the fractured Bone the closer. Than we dressed the Wound with our Digestive warm, and with an empl. diachalcit. malaxt with ol. ros. and over the fractured Parts we applied the Mixture following spread upon a double Cloth: ℞ flor. ros. rubr. ballast. baccar. myrtill. bol. Armen. sang. dracon. an. q. s. pulveriz. cum albumin. ovor. ol. ros. & acet. Misc. ad consist. mellis. This we fastened by Bandage, as hath been showed in Compound Fractures: and for the more strengthening the fractured Member, we placed Splenia over that Bandage, with Ferulae upon them; and having fastened them by three Ligatures, we placed the Member as much to the ease of the Patient as we could contrive, upon a Pillow quilted in the middle, with Junks to keep it steady. But these great Fractures with large Wounds, and near the Joint, are always subject to grievous Pain; and this much more, for that the Tendons and Musculous flesh were soarly torn, and stretched by the great Extension: so it was not likely to be attended with less mischief than afterwards befell it. We let him blood that night, and gave him an Anodyne draught to dispose him to rest. But he slept little, his Pain continuing with much disturbance: a Fever also followed, and within two or three days he became delirious, and in the absence of his Attendants got out of his Bed; upon which the great Focil flew out as at first, and the poor man fell down on the floor as half dead. We were both presently fetched, and taking of the Dress, we saw the Bone distorted, the lower Stitches broken, and the Wound of an ill aspect, as it were tending to Mortification; also the Bone thrust out so far, that there was no hopes of its being any more reduced by a new Extension. Upon which consideration we resolved to saw of the end of it: and to that purpose having prepared all things ready, we cut out the remaining Stitches, and turned the Foot on one side towards the Small of the leg, thrusting the Bone more out; the one sawing the end of, whilst the other with a Spatula defended the Tendonous flesh underneath from being wounded by the Saw. That done, we cleansed the Wound from the Sawdust, as also from the Shivers of little Bones which we had not discovered in our first dressing, they lying pricking the Periosteum, between the fractured Bones and Membranes, by which those sad Accidents had been hastened. The Wound thus cleansed, we turned the Foot right into its natural place, there being no need of Extension: which being done, we scarified the Lips of the Wound, and washed them cum spir. vini, with a little Aegyptiac. dissolved in it, and applied to the ends of the Bones Pledgits dipped in the same, and pressed out. We also dressed the rest of the Wound cum unguent basilic. with a little ol. terebinth. warm, and applied a Mixture of an Emplastrum Paracels. and diachalcit. over the Wound and Parts about, and than a Compress and Bandage over that, as in Compound Fractures. The great work was now, how to support the Foot, and keep it even with the rest of the Leg, there being so great a distance between them without any Bone. But we having placed the Leg upon a quilted Pillow, laid him again in his Bed, and fitted it in a Wainscot-case, where it was kept steady and equal, and lay conveniently for our daily dressing him. This done, we committed him to the care of his Friends to keep him there quiet, and ordered him cordial Juleps, etc. After some hours we let him blood again. From that time his Pains lessened, and his Fever and other ill Symptoms went of as the Wound digested. But after some days the Heel became very painful, and a Slough was discovered to us inflamed with an Ulceration sticking to the very Bone. The Patient not permitting to have the Case, wherein his Foot and Leg was, stirred, it had not been raised up, as for perspiration it aught to have been; whence this Ulcer became very troublesome to us. For a present Relief, we laid him upon his Side, and dressed the Ulcer with Lenients, to hasten separation of that Escar. And because the Patient grew soon weary of this Position, which also was inconvenient for our dressing the great Wound, we therefore designed an Instrument of Tin to receive his Foot and Let, this Heel to lie hollow in a place cut for that purpose, whereby we could daily dress it without disturbing the Patient, only placing him down lower towards the Bed's feet, that the Heel might lie over it. The side of this Instrument, that came up by the Wound, was to be taken of at the time of dressing his Wound, and afterwards placed close again; whereby he was dressed without disturbing the weak Member. It lay also soft, by reason of the Folds of Linen we placed under and between the Leg and Instrument: it was also kept strait, in hopes it might be supplied with Callus. But the Wound became sinuous, and the Matter fouling the Bones hindered the growth of Callus; and while we waited for Exfoliation, the Lips of the Ulcer became callous, which prolonged the Cure. The Ulcer in the Heel we digested: and after we found the Bone would not incarn, we dressed it with unguent. Aegyptiac. with a little Merc. subls. dissolved in it; by which dressing we hastened the Exfoliation of the Bone, and cured the Ulcer. The Wound above was a larger work: but after the generation of Callus it cured as a Fistula with carious Bones. The Patient lived many years after: but through the ill disposition of the Ulcer, the callus was hindered in its growth, whereby the Leg remained the shorter, almost as much as had been sawed of of the Bone. Yet this was better, I suppose, than to leave the Bone distorted until Digestion, as in such like case I have seen done. But if the Bone be not so much distorted as that you may come to saw of the end of it, or if you cannot reduce it after the ordinary way; than you may with a Chizell-like instrument thrust between the fractured ends of the Bone, and use it after the manner of a Lever, for the reduction of the Prominencies. But than it is supposed these fractured ends of them are within the Wound, and have not much over-shot one another, and the Fracture is transverse or obliqne: otherwise this may will do little good; nay may possibly rive up the piece of Bone, and make another kind of Fracture, and grievously pain the Patient to no purpose. And that you may easily do, if the ends break of upon your hard and unsteady Extension. Therefore it becomes you to be very wary in making this Extension; else, I say, you may put the Patient to sad Pain, and do him little good.  
But to conclude, after your Extension is made, and the Bone reduced, you are to feel if there be any Shivers of Bones lose, and pull them out. And if you perform this Operation in a Fracture newly made, than you are to prevent Inflammation, and all other Accidents, by dressing up the Patient with such Medicines as have been proposed in Compound Fractures; and make your Bandage so, that you may come to dress the Wound, as occasion shall offer, with as little molestation of the fractured Member as is possible; having a care you grieve not the tender Parts with Splints, until the Inflammation be over, and the Wound well digested.  
Than afterwards 'tis to be endeavoured, that the Bones robbed of their Periosteum may again be incarned or exfoliated; which is the work of Nature, yet aught to be helped by Medicines which have a manifest hot and drying quality, and a peculiar faculty thereto, of which there are enough set down in the Treatise of Gun-shot Wounds.  
The Bones exfoliated, and Cure of the Ulcer will succeed of course, or may be performed by Epuloticks, of which you may have choice in this Book.   

CHAP. II. Of Luxations in general.  
IN several Observations in this Book I have had occasion to take notice of the inconvenience many people have fallen into through the wickedness of those who pretend to the reducing luxated Joints by the peculiar name of Bone-setters: who, (that they may not want employment) do usually represent every Bone dislocated they are called to look upon; though possibly it be but a Ganglion, or other crude Tumour or preternatural Protuberance of some part of a Joint. In which cases their rash Extensions do frequently 'cause sad Accidents. But their more gainful way is, by extending and dressing up Joints rather wrenched than dislocated: in which if they escape undetected, they must needs reap great credit, the Patient recovering so soon the ease and use of them. Whereas if the Joints hap really to be luxated, scarce one of them knoweth how to reduce them. In consideration of this daily abuse, and the inadvertency of the young Chirurgeon, whose not timely discerning the Luxation renders it more difficult to reduce, I have thought fit to say somewhat to this part of Chirurgery; and first in general.  
He that will give an account of Luxations, 
Connexion of Bones.  and the manner of their Cure, aught first to describe the Connexion of the Bones to each other: on the divers manners of which depend the great variety of methods in reducing and handling of them. These Connexion's we found to be of two sorts; 1. Symphysis, 2. Articulatio.  

I. Symphysis in its original signification denotes a Connascency or Growing together; 
Symphysis.  and perhaps is meant of those Bones which in young Children are distinct, but after some years unite and consolidate into one Bone. So the Os ileon and Os pubis are two distinct Bones in a Child, but unite into one in a Man: the Epiphysis of the Os femoris is a distinct Bone from it in a Child, whereas in a Man they do entirely unite. But custom and the usage of Authors hath found out another sense of the word, fitted to adult persons; in whom it is used to mean such a Connexion, or two Bones together as is immovable: and of these there are two sorts. 

1. An immediate Conjunction, or Juxtaposition, (if I may so call it,) without the interposition of any other Body. Of which we found three Species. 

First, Sutura, or the indented Conjunction of Bones in the Scull.  
Secondly, Harmonia, when without toothing or interfearing they do join immovably in a strait line: as the Bones in the upper Jaw.  
Thirdly, Gomphosis, or the Connexion of a Tooth to its Socket.    
2. Mediate, where the Connexion is made by interposition of another Body. Of these we likewise found three sorts: which notwithstanding are not so peculiar to the Symphysis as it is opposed to Articulatio, but that they may be found in that also. They are these that follow. 

First, Syssarcosis, when two Bones are joined together by the intervention of Flesh. An instance of this in the Symphysis is, the Conjunction of the Teeth to the Mandible by the Flesh of the Gums. In Articulations we see it in the Elbow or any other Joint, where one Bone is connected to another by Muscles.  
Secondly, Synneurosis, when the Connexion is made by a Ligament. Of this in Symphysis we found instances in the Connexion of the Ossa pubis together, especially in Women, by a ligamentous substance. In Articulations it is either round, as that which unites the head of the Os femoris to the Coxa; or broad, as the Tendon of the Patella, which unites it to the Os tibiae.  
Thirdly, Synchondrosis, which is an Union by Gristles. A Symphysis of this kind we have of the Sternon to the Ribs. Articulations are most of them so joined, there being few Bones destined for motion which have not cartilaginous heads for the facility thereof. These two latter sorts of Union are compounded in some Articulations; as in the Ossa coxae, where you have Tendons and Gristles both to join them together. This is by Galen called Neurochondrosis.      
II. 
Articulatio.  Articulatio is a Connexion of Bones with aptness of Motion. Something hath been anticipated already concerning this Head, because of its coincidence with Symphysis, in the forementioned instances. But take it as it is in itself, and you will found it to have this difference. There is, 

1. A conspicuous Motion, which where it happens, the Conjunction is called Diarthrosis; as in the Elbow, Thigh, and Knee.  
2. An obscure one, where the Conjunction is called Synarthrosis; as in the joining the Carpus to the Metacarpus, the Tarsus to the Metatarsus. And both these are divided into the three following Species. 

First, Enarthrosis, where a good round Head enters into a Cavity: whether it be Cotyla, or profound Cavity, as that of the Os coxae receiving the head of the Os femoris, or Glene, which is more shallow, as in the Scapula where it receives the Humerus. Of more obscure motion is that Connexion of the Os tali with the Cymbiformis, which is an Enarthrosis.  
Secondly, Arthrodia, where the Cavity is very superficial: as between the head and the first Vertebra of the Neck, in Diarthrosis; and between the Carpus and Metacarpus, in Synarthrosis.  
Thirdly, Ginglymus, which is a mutual Indenting of two Bones into each other's Cavity: of which the Elbow is an instance, in Diarthrosis; the Vertebrae of the Back, in Synarthrosis.       
Many other things might be said on this subject, were it pertinent to my present design, which is only to regard the Union and due Conformity of Joints, in order to the Doctrine of Luxations, in which the Articulations are chief concerned. For when those that are united by Symphysis, as the Sutures of the Head, and the Bones of the Maxilla superior, are dislocated, there is always a Fracture concomitant, and the whole is treated as a Fracture. When the Teeth are dislocated, or to the dislocated, a Tooth-drawer is consulted.  
Articulations therefore, whether by Diarthrosis or Synarthrosis, are the Subject on which my present Discourse concerning Luxations is founded.  
When therefore two Bones, 
Definition of a Luxation.  which being naturally united make up a Joint, are separated from each other, we call it a Luxation.  
The Ancients called it a Slipping of the Head of a Bone out of its Cavity. Which is true of the great Joints, but not of all: for the broad end of the Clavicle, where it resteth upon the Scapula, hath neither Head nor Cavity, yet is capable of Luxation.  
Luxations admit of several Differences. 
Differences.   

1. From the Subject; viz. whether it be a place of obscure motion, or a manifest one. An instance of one is, when the Clavicle recedes from the Scapula; which the Arabians call a Disjunction. Of the other, where an Elbow, Shoulder, etc. is disjointed; which is most properly termed Luxation. There is also a peculiar Luxation proper to Children, viz. when the Epiphysis of a Bone separateth from the Bone, they being not throughly consolidated into one; which however is treated like a Fracture, and consequently deserveth no place in this Discourse.  
2. From the Degree of it; viz. whether it slip out wholly, or only in part, viz. to the margin of the Cavity that containeth it. To this latter sort may be referred those Elongations which are the effect of an Humour soaking upon a Ligament, (as that of the Coxa,) thereby making it liable to be stretched, and to be thrust quite out upon every little force.  
3. From the Situation and Figure of the Part, as whether upward, downward, forward, backward, on the right side, left side, etc. of which more in the following Chapters.  
4. Differences may also be taken from Accidents attending them; as Inflammations, Wounds, Fractures, etc.   
Causes of Luxations are internal, 
Causes.  or external. The internal are the Humours which affect the Joints, and either by relaxing the Ligaments give way to the Bone to departed from its natural seat; or by a contraction of the Tendons put it upwards out of the Cavity. Both these sorts I have seen in Children, and it's likely it was in some of them hereditary; as Sennertus hath well observed, à gibbosis gibbosoes, à claudis claudos generari. The external Causes are, Blows, Falls, violent Extension: in which latter cases Infants sometimes suffer by the hands of Midwives, or at more age by the negligence of Nurses.  
The Signs of Luxation may be taken from the loss or imperfect motion of the Joint, 
Signs.  and from the different resemblance it hath with the contrary sound Member; there appearing to the eyes or touch a Cavity in the Part whence it receded, and a Protuberance where it is lodged: the Member is also rendered longer or shorter, according as the Bone is distorted.  
The Signs of Reduction are the contrary to what have been before delivered. 
Signs of Reduction.  There is also a crashing noise made by the Bone in its return to the Cavity. But this is not always a certain sign; for it may proceed from an Eruption of some part of the margin of the Cup or Cavity. In which case the Luxation is for the most part rendered incapable of Restitution. But this Fracture maketh a different noise from the other, and may be easily distinguished by the discerning Artist.  
In Children and moist Bodies luxated Bones are easiest reduced, 
Prognostic.  but are with great difficulty retained: in elderly and dry Bodies the contrary happeneth.  
Luxations of long continuance are difficultly reduced, and are for the most part as hardly retained, the parts growing emaciated. Those of the Vertebrae occasioned by external Accidents are for the most part mortal: whereas some of those by Congestion are frequently cured.  
The Bone luxated maketh compression on the neighbouring Parts whither it slippeth; 
Cure.  and accordingly as those Parts are of more or lesle sense, so are the Pain and Accidents that attend it. You aught to hasten the restoring it to its place as soon as may be. The work is purely chirurgical, it having no dependency upon Nature, but the Extension and forcing back of the Bone into its proper seat is done by the Hands of the Artist. There are four Intentions necessary to the Cure: 1. Extension, 2. Reposition, 3. Deligation, 4. Collocation, or placing of the Member in a right Position.  
Extension is first required, 
1. Intention.  because of the situation of the Bone, which being out of its due Socket rendereth the motion of the Muscles useless, or rather hurtful, which the more they pull the Bone, the more they distorted it, and contract the Joint. This therefore cannot be committed to Nature, but requireth manual Operation.  
The Extension being well made, 
2. Intention.  you are at the same instant to restore it to the place it fell from. And to do this, you must consider well the luxated Joint, and which way it slipped out; for it requireth to be returned in the same manner. If it lie on the right Side, it must be pressed back to the left: and so if it be luxated forwards, it must be forced backwards. The Shoulder requireth one way, the Elbow another, and the Knee or Ankle another. If the Luxation hath been of any continuance, or if the contraction of the Muscles be great, it will be reasonable that you first relax them by emollient Embrocations, viz. unguent. dialthaeae, axung, human. etc. jest by your violent forcing in the Bone you affect the Nerves, and 'cause a Paralysis, etc.  
Being satisfied in the Reposition of the Bone, 
3. Intention.  you shall than take care to keep it so: and that is performed by Deligation. But before make the Bandage, you aught to apply such Medicaments as have virtue to resist the Influx of Humours, and strengthen the Part: and those are Astringents, and such as have been proposed in the foregoing Chapter of Fractures; viz. bol. Armen. sang. dracon. farin. volatile. ballast. flor. ros. rub. cum albumine ovi, aceto, aut vino rub. If there be great Pain, you may embrocate cum ol. ros. lumbricor. mastichin. and apply empl. è bolo, diapalm. de minio, etc. Than place a Compress wrung out of some of the aforesaid Liquors on that Part whither you suspect the Bone may again tend, and roll it on close accordingly as you see occasion.  
The last Intention is Collocation, 
4. Intention.  or placing of the Member; and that aught, for the ease of the Patient, to lie soft, and somewhat raised up, neither much extended, nor too much bend, a middle figure being best to prevent Pain. Yet if it be the Shoulder that is luxated, the Elbow aught to be kept to the Side, and the Hand upon the Breast. If no Accident hap, you must not dress it again till the seventh day; and than you may altar the Position, and move the Joint a little to and from, and dress it up with such Medicaments as may give a breathing to the Humour, and corroborated the weak Joint. In case it itch, bathe it with Salt-water; otherwise with a Decoction ex summitat. absinth. flor. cham. ros. rub. ballast. bacc. myrtill. juniperi, nuc. cupress. etc. to which may be added spir. vini. All greasy Applications relax the Tendons, and prolong the Cure.  
Luxations made by Congestion do require Emollients to resolve and breath forth the crude Humour affecting the Joint, Ligaments and Tendons: to which purpose ℞ rad. althaeae ℥ vj. rad. cucumeris asinini ℥ iij. summitat. majoran. Mij. coctis in brodio ex pedibus vitul. & contusis add pulv. sem. foenugraeci & lini an. ℥ j ol. lilior. axung. human. an. part. aeq. fiat Cataplasma. You may also use emplast. diachyl. cum gummi, de mucilaginibus, de ranis cum Mercurio, etc. That Matter being thus resolved, you may than proceed in the Reduction of the relaxed Bone: and after you have reduced it, apply such Medicaments to it as may dry up the superfluous Humidity, and strengthen the Joint: of which sort I have given you an example in the fourth Intention. There will also be required some extraordinary Bandage to retain the Bone in its place: but of that I shall have more fitly occasion to discourse in some of the following Observations, as also of Paralysis, etc. which frequently attend great Luxations.   

CHAP. III. Of Luxation of the lower Jaws.  
THE Processes of lower Jaws are two on each side. 
Processes of the Jaws described.   

1. One more acute, called by Anatomists Corona; which hath no Socket properly so called, but playeth in the Hollow of the Cheek according to the motion of the Temporal Muscles, whose Tendon is inserted into it.  
2. Another more obtuse, with a roundish Head, called Condylus. This hath for its Socket the first Sinus of the Os temporum, in which it moves; and is kept close to it by the Muscles which lay hold either of the Corona before mentioned, as the Temporal, or of the outward broad Angle, as the Masseter, or the inside of the broad part of the Jaw, as the Pterygoïdes. These Muscles, by their perpetual tendency to a contraction, (which is the nature of all Muscles,) keep the Bone steady in its situation; but much more so when they are voluntarily contracted for Mastication, Speech, etc.   
It is remarkable, that though Nature hath made other Muscles to open the Jaws, as well as these to shut them, yet they are in themselves slender, and not inserted into this part of the Jaw, but quite before at the Chin; so that in their motion they do not pull down this part of the Jaw, but the forepart only: whereas the attollent Muscles being laid nearer to the Condyli on each side, keep them so close to their Sockets as to make them a Joint, or centre of motion: from whence, according to the custom of Levers and Balances, it falleth out, that those little diagastrick Muscles, by being applied to the remoter part of the Jaw, which maketh the circumference, become equipollent to all the bigger Muscles before mentioned; nay, are sometimes so valid, that upon over-stretching, as in Gaping and Yawning, they pull the Condylus out of its Socket. Sometimes the attollent Muscles themselves do pull it, when we violently gnaw any large Bone, Gristle, or other thing that is hard, and withal so big as to be necessarily detained in the forepart of the Mouth.  
This Luxation can be made but one way, viz. when it slippeth over the fore-side of the Sinus, and passeth into the Cavity of the Cheek under the Os jugale; it being so defended by Bones, that other ways are impossible without a Fracture.  
When this Luxation happeneth, 
Signs of Jaws luxated.  the lower Jaw is thrust forward, the Teeth are prominent beyond those of the upper, the Patient can neither swallow nor speak nor chew, nor indeed shut his Chaps. If you see him presently before any Tumour supervene, you will found the Temporal Muscle rigid. If one side only be dislocated, the Mouth is distorted, as if the Patient had a Spasmus; the forepart of the Jaw is thrust down on one side, etc.  
The Reduction of the Jaws is said to be difficult, 
Prognostic.  and that if they be not timely reduced, ill Accidents do hap, viz. Paralysis, Strangulation, etc. To which I can only say, that I never met with any difficulty in the replacing them, nor yet saw any such Accidents as by Authors are mentioned: but certainly they are in danger of famishing, for they can neither eat nor drink while the Jaws are luxated.  
In order to the Reposition of the Jaws, 
Reduction.  the Patient aught to be seated firm, and his Head held steady, jest it start back in the time of Reduction. Than place a couple of Wedges of Wood close between his great Teeth, as far as you can thrust them, and your Thumbs close by them, and your Fingers externally under both the Jaws, extending them moderately; and at the same instant press the farther parts of his Jaws downwards, and raise up the fore part. If his Teeth be too sharp for your Thumbs, put a fold of Linen between. If only one of the Jaws be luxated, move it to the contrary side, and keeping it in that posture, place your Hand as aforesaid, with your Thumb upon his great Teeth, pressing that part downwards, and raise the forepart upwards by a quick moderate Extension, and you shall feel it reduced, and may conclude it so by the equal meeting of his Teeth, and by the opening and shutting of his Mouth, also by his ready Speech. If after Reduction you suspect his Jaws may prolapse, you may apply a Defensative with Bandage; or in case of Pain, embrocate the Temporal Muscles and Parts about with ol. lumbricor. mastichin. etc. But hitherto I never saw occasion to apply any thing.  
A Woman aged about fifty six years was sent to me from a worthy Lady in a neighbouring County: 
1. Observat. of a Luxation of both Jaws.  both her Jaws were luxated, the obtuse Processes of them were slipped forward and shot under the Os jugale, and her Chin was thrust forward and inclining down towards her Collar-bone. She had been so three days, during which she could neither eat, drink, nor speak. I placed her in a Chair, and Dr. Lenthall, who came with her, held her Head. Than I placed my Hands on the outside and under her Jaws, and my Thumbs upon her great Teeth, with a Compress of soft Linen under each; and whilst I pressed hard down the farther parts of the Jaws, I raised up her Chin, and reduced them in a moment: and to satisfy her that they would not slip down again upon an ordinary motion of them, I persuaded her to eat and drink; than dismissed her without application of Plaster or Bandage.  
A Gentleman of about forty years of age, 
2. Observat. of a Luxation of the right Jaw.  of a sickly weak Constitution, had his right Jaw distorted, by which his Mouth being drawn awry, it was supposed a Spasmus, and various Applications had been made to that purpose. One morning, walking amongst my Patients, I met his Apothecary, who telling me the case his Patient was in, I replied, his Jaw was certainly luxated: upon which I was the next day consulted, and saw it so. I laid my Hand on the outside of that distorted Jaw, and placed my Thumb with a Rag wound about it upon his great Teeth as far as I could thrust it, and laying my other Hand upon his sound Jaw, I drew the distorted one strait out; and whilst I pressed down the hinder part, I made Extension, raised up his Chin, and reduced it. He did not at that instant believe it, but he was soon after confirmed by the use he had of it. It continued well without any manner of Application to it.   

CHAP. IU. Of Luxation of the Clavicle, or the Collar-bone.  
THE Clavicle is a crooked Bone made in the figure of an ss. one end of which being thicker, 
The Clavicle described.  and almost three square, is inserted into a Cavity purposely fitted for it in the first Bone of the Sternon, and bound in by a strong ligamentous Membrane. The other end, being broad and flat, is joined to the Acromium, where it not only serveth to keep the Shoulder at due distance from the Sternon, but also assisteth those several Processes which are provided by Nature to preserve the Shoulder-bone from slipping upwards from its Cavity.  
This Bone is capable of a double Luxation, one at the Sternon, and that only outwardly, where it riseth from the Breast, and lieth like a Lump. The broad end near the Acromium is also subject to a twofold Luxation, viz. upward, and forward; being defended from all other Distortions by its neighbouring Bones.  
This Luxation is for the most part occasioned by a Fall and pitching upon the Shoulder. 
Cause and Sign of a luxated Clavicle. Prognostics.  It is discerned by the Prominence it maketh.  
The Clavicle is not so subject to Luxation as other Bones; but being luxated, it is most difficultly retained after Restitution, by reason of the smoothness of its heads, and the little hold they have upon the Acromium and Sternon: and if it be not restored, the use of the Arm is impaired in some of its motions.  
The Reduction of the Clavicle, 
Reduction.  which end soever of it be luxated, must be made by drawing that Shoulder backwards, and by pressing the luxated end even with the Acromium, or to the Cavity of the Bone of the Sternon, whence it departed. Neither of the places affordeth it much room, therefore it will require your greater care: for if you place it not exactly, it will scarce hold right till you make your Applications. Therefore you must have ready Emplasticks, Compresses, and Bandage. Splints are also of use, whether they be of Pasteboard, the Scabbard of a Sword, or Tin. The Bandage aught to be a Rowler with two heads to come over the Shoulders, and under the Armpit, making so many Circumvolutions as may retain the Dress close. This being well made, his Arm must be kept up with a Napkin or Towel, and his Hand placed upon his Breast. If all be well, you aught not to loosen the Bandage till you judge it united, which may be guessed at by the ease and use of that Arm.  
I Was fetched to a young Fellow, 
1. Observat. of a Clavicle luxated.  who by a Fall from his Horse was supposed to have broken his left Shoulder. Upon view of it, I saw the end of the Clavicle separated from the Acromium, and lying prominent without any manner of Fracture; but the head of the Os humeri was bruised, and remained sugillated long after. I caused one standing behind him to pull back the Scapula, and with my hands forced down the end of the Clavicle, and placed it to the Acromium; than applied an Emplaster of astringent Powders mixed cum album. ovor. etc. over the Clavicle and Shoulder, with a piece of Pasteboard wet in aceto and Whites of eggs; over which I applied a dry one, and upon that a Compress wet with some of the former Liquor, and rolled it on with Bandage as above said; than wet that part of it over the Clavicle with Whites of eggs, to strengthen it and retain it firm. That done, his Shirt and Doublet were put on, and his Arm tied up, as hath been said. Than I put him to bed, and let him blood in the other Arm, and kept his Body soluble by lenient Purgatives. After he had lain four or five days in bed, I observing the Bandage tied, and the Pain and Accidents diminished, permitted him to rise, and walk up and down in the house. About the eighteenth day I took of Dress, and saw te Bone right in its place, the Parts about being only marked with the extravasated blood. I embrocated them with ol. lumbric. & spir. vini, and applied an empl. stict. Paracelsi & diapalmae, rolling they up as before, and from that time dressed it not more, but saw him afterwards well abroad.  
Another having by accident of a Fall in wrestling started the end of the Clavicle from the Sternon, 
2. Observat. of a Luxation of the Clavicle.  I made Extension after the same manner as above said, by pulling his Shoulders backwards, and pressing the while with my hands upon that end of the Collar-bone, till I had replaced it, than dressed it as afore said. But the next day, finding the Patient in Pain, and the Dress raised up, I concluded the Bone distorted. Whereupon I caused a Tin-plate to be made in the form of the Clavicle, and to reach form one Shoulder to the other, cut at the ends, to receive the foreparts of the Shoulders, and keep them out. Than I took of Dress, and restored the Bone again to its place, and repeating the former Applications, placed the Tin-plate over the Compress, and rolled it on close. This Plate sat easy, and served to keep out his Shoulders, also retained the Bone in its place, whereby he was happily cured without more dressing.   

CHAP. V Of Luxation of the Shoulder.  
THE head of the Shoulder-bone being round is inserted into so shallow a Cavity in the Scapula, 
Description of the Shoulder-bones.  that were there no other Guards for it, it would fall out or be thrust out almost upon every occasion. But Nature, that found that Shallowness necessary to the variety of motions which is intended for the Joint, found other ways of securing it from running out. Viz. 1. upwards it is prohibited from an excursion by the Acromium, the Process anchriformis, and the broad end of the Clavicle, which reaching over the latter to the edge of the former, addeth to the strength of the place. Nor is this all, for Nature hath made a strong Ligament which reacheth transverse from the Process anchriformis to the Acromium; and to confirm all, hath laid underneath these not only a strong circular Ligament, which involveth the whole head of the Shoulder, (being indeed a collection of the Tendons or the Muscles, which lying under and upon the Scapula particularly serve for the motion of the Humerus, or else lying upon the Humerus, do take their origine from the Scapula,) but also a Tendon of one of the heads of the Biceps, which passing through a peculiar Notch or Trench of the Humerus inserteth itself into the head of the Scapula. Over all these lieth the Musculus deltoïdes, binding all in so strongly, that if the Elbow chance to be so pushed that it forceth the Os humeri upon this Fortress, it sooner breaketh into shivers than maketh a way through. 2. The principal Guard it hath from falling inwards and downwards is its pendulous posture, together with the many Muscles that keep it in that posture, and chief the Tendon of the Biceps externus, (as it is called in our Hall,) and of the subscapularis, with the rotundus minor. Yet are not these so strong, but that between the Tendon of the subscapularis and the Biceps externus it is apt to fly out into the Axilla. All other ways are so barricadoed with Bones or Tendons, that the Luxation is very difficult: yet I have seen it lie forward somewhat under the pectoral Muscle; but whether it was forced thither in their attempting to reduce it out of the Axilla, I cannot certainly say, but do suppose it might.  
The Causes of this Luxation are for the most part external, 
Causes of Luxation the Shoulder.  by some violent force, either in Wrestling, Running, or by a Fall from a Horse, or the like. In the time of War it may hap by the force of great Shot or Splinters. Some instances whereof you may see in the Treatise of Gun-shot. But it sometimes happeneth from an internal Cause, viz. a Catarrh or Fluxion of Humours upon the Muscles or Tendons, which gradually relaxeth them to such a degree, that the head of the Os humeri slideth down into the Axilla.  
It's descent into the Axilla appeareth by an unusual Cavity in the head of the Scapula, 
Signs.  where it naturally is full and round. You may also feel the head of the Os humeri lying in the Axilla hard and round: the Patient's Elbow hangs from his Side, and cannot be brought so close as the sound without great Pain, nor can he bring his Hand to his Mouth, or stretch it upright against a Wall. If the head of the Shoulder be distorted forward, that part will appear prominent, with an unwonted Cavity behind, if you compare it strictly with the other Shoulder: the Elbow also hangeth backwards, and will not endure to be brought forwards.  
If the Luxation be made by a Relaxation of the Tendons, the Patient's complaint will inform you, and the Emaciation of the Arm will make the foresaid Symptoms more apparent.  
A Luxation of the Os humeri from an external Cause is not very hard to reduce in Children or soft Bodies, if timely undertaken: 
Prognostic.  but contrary in elderly people and tough musculous Bodies: and such are frequently slow in recovery of their former strength and motion. Sometimes a Paralysis seizeth them, and they emaciate: but by timely Endeavours they do recover. If in the Reduction or otherwise any part of the Cupula chance to be fractured, the retention of the Os humeri is not an easy task. Luxations made by Fluxion may be easily reduced, but are most difficultly retained in the Capsula.  
The Reposition of the luxated Shoulder is performed either by the Hand, 
Reduction by the Hand.  Bandage, or force of Instruments. He that will reduce it by Hand must put it in a motion contrary to that it went out by. In its going out, it is first thrust or pulled forwards, till it come beyond the edges of the Cupula; than it falleth down below the Cupula, and is by the Muscles pulled backward. He that will reduce the Bone this first way must reverse these motions; viz. first bring it forward, than upward, than thrust it in. By the observing this method I have reduced the Shoulders of Infants and little Children so soon, that the Standards by have hard them knap in before they knew they were out. But the way of reducing the Shoulder in those of more growth must be, if done by one man alone, by placing the Patient in a low Seat, and clapping his Fingers under his Armpit, his Knee or Thighs to the outside of his Elbow, and his Head to the point of his Shoulder. By his Fingers strongly bend together, he pulleth the Bone both forward and upward. By his Thigh or Knee pressing his Elbow to his Side, he doth likewise help to raise it and bring it forward. The pressure of his Head keepeth down the Scapula, that it may not rise with the Bone. But because this application of the Knee, Head, etc. is not easily practicable but upon little and slender men, we generally commit the pressing of the Elbow toward the Ribs to another man.  
After this manner the Elbow is brought quite back to the Spine: which being done, his other Hand must be placed under the Axilla, to raise the head of the Humerus forward and upward, whilst the Chirurgeon with his hands presseth down the Scapula to receive the Bone.  
When the head of the Os humeri lieth distorted forwards under part of the pectoral Muscle, the Patient's Elbow must be drawn backward, and held close to the Spine, whilst the Chirurgeon presseth with both his Hands forcibly upon the head of the Bone.  
There is yet another way of restoring the luxated Shoulder by the Hand thus: You are to make choice of a proper lusty Fellow on whose shoulder you must hung the Patient by the luxated Arm, bringing his Hand over to the Fellow's Breast. If the weight of the Patient be not sufficient to make the Extension, some other body may hung upon him, or pull him by the Legs downward.  
But because these ways of Reduction by the the Hand are not always feasible, 
Reduction by Bandage.  especially in strong muscular people, we therefore make use of Bandage and several sorts of Engines. The most common way of Bandage is by that of the Gird, which Girt hath a Bolster in the middle, and the ends are tacked firmly together. In the use of it the Patient must be placed so, that part of the Gird with the Bolster is to be placed under the Armpit, and the other part over the Surgeon's Neck, that he may thereby with all his force raise up the head of the Humerus: which that he may the better do, his Assistant must sit behind the Patient, and pull his Arm backward with all his might; and if the Chirurgeon presseth with his Hands upon the head of the Scapula at the same time he raiseth up the Humerus, he shall reduce it more easily.  
There is another way of Reduction by Bandage, and that is, by laying the Patiented flat on his Back on the ground, the Chirurgeon sitting behind him, and making Extension by the foresaid Gird or other Bandage placed under the Axilla, whilst his Assistant lieth along at the Patient's Side, and presseth with his Heel upon the foresaid Bandage, and at the same instant taketh the Patient by the Hand, and pulleth his Arm with all his force. Thus by their several Extensions the head of the Shoulder-bone may be raised and reduced.  
Instruments proper for the Reduction of the luxated Shoulder are, 
Reduction by Instruments.  Ladder, Coulstaffe, Pulleys, Glossocomium, etc.  
The way of Extension by a Ladder is, that the Patient climb up three or four Steps of it, and put his lame Arm over one of the Staves, placing it between his Side and the head of the Humerus; and that a strong Fellow take hold of that Arm, and pull it forcibly down backward, whilst the Patient hangeth by it.  
The way by a Coulstaffe is safer. The Staff must have a Bunch in the middle somewhat Wedgelike, and covered with a soft Bolster fit to place under the Patient's Armpit. In order to the Extension, the Patient must be seated near some Post or Pillar, in which the Pulley must be fastened to extend his Arm; and the Bandage must be made a little above the Elbow: which being fastened, and the Coulstaffe placed, and supported by a couple of Fellows, the Chirurgeon must stand on the contrary side, with his Hands on each side of the Scapula, to press it downward, and keep the Patiented firm in his Seat, and govern the Operation, taking care that the Wedge be placed right whilst the Extension is making, jest they break the Bone, or otherwise mischief him.  
The Glossocomium, commonly called the Commander, is of use in the most strong tough Bodies, and where the Luxation hath been of long continuance, and will not yield to the other ways of Extension. There aught to be great care in the use of it, for many shrewd Accidents have happened thereby.  
The Humerus luxated by Relaxation of the Ligaments and Tendons is restored to its place after some of the was above said, but doth require your industry to retain it after it is reduced: more of which by and by.  
A Lady going on evening out of her Coach into her house, 
1. Observat. of a luxated Shoulder.  trodden upon her Gown, and fell down. I being fetched, found her sitting in the same room grievously complaining of her right Shoulder. Lookig upon it, and feeling the head of the Humerus lying in her Armpit, I endeavoured to reduce it by Circumrotation: but it not yielding thereto, I caused one of her Servants to pull her Elbow back towards the Spine, than to thrust it forward. During which I stood on the contrary side, with one of my Hands upon the head of the Scapula, and the other under the Os humeri; and at the same instant my Assistant thrust it forward. I forced it into its place: the people standing by heard it knap in, and the Patient declared it by the ease she felt. Than I applied an empl. è bolo round the weak Joint, with a proportionable Compress wrung out of Oxycrate, and rolled it on. After which her Servants led her to her Chamber to bed. The next morning I visited her. She had rested well, and was so easy, that her Physician, Sir William Gideon, would scarce believe that the Bone had been luxated. The Lady prepared to remove to her Countryhouse, and undertook the Cure herself by some Plasters of her own. But during the application of them her Arm grew weaker, and emaciated very much, and was painful about the insertion of the Muscle Deltoïdes, and so to her Hand, with a numbedness in some of her Fingers. Whereupon she returned back, and consulted Physicians. One whereof, supposing the Bone still dislocated, advised the consulting a Bonesetter. I being present, he acknowledged the Bone well set. What he would have said had I been absent, may easily be guessed by his former dealing with others of my Profession. From that time Antiparalyticks were prescribed, a fontanel was made in that Arm near the Muscle Deltoïdes, also Embrocations and Plasters were externally applied; whereby she recovered the use of her Arm.  
A Nobleman who was a Commander of Horse in that Army which came out of Scotland into England, 
2. Observat. of Reduction by the Foot.  was by some accident thrown of his Horse, and would not be raised of the ground till I came. He complained of his right Shoulder. I looking upon it, felt the head of the Humerus lie distorted in his Armpit. I endeavoured to reduce it by my Hands, as above in the former Observation: but it not yielding thereto, I caused Mr. James Davies, who was Chirurgeon to those Guards, to pull of his Boot from his right Leg, and to lie along upon the ground by his Lordship, to make Extension that way. Whilst he was making ready, I clapped a Compress under the Patient's Armpit, with a Towel over it, and placed myself at his Lordship's Shoulder, and made Extension by the Towel, whilst my Assistant took the Patient by the Hand, and thrust his Heel into his Armpit with all his might. We having thus reduced the Bone into its place, I applied an emplastrum è bolo over the Shoulder, and a Compress of Tow pressed out of acetum under the Armpit, and rolled them on. That done, his Servants made him ready, and helped him upon his Horse. I made him a visit that night at his Quarters, designing to let him blood in the contrary Arm: but his Shoulder being easy, and not hurt in any other part, I took my leave of him, tellig him his Shoulder aught not to be dressed till after six or seven days. But this person forgetting what I had said, thought himself neglected, and complained to his superior Officers of me. Whereas in truth, if the Bone be well set and bound up, it is not material whether it be any more dressed or no. Thus in an Army we are frequently rewarded, if we do not attend them as their menial Servants.  
One morning Mr. Faucett, Chirurgeon to his Royal Highness, 
3. Observat. of Reduction by the Hand.  sent to my house, when I lived in the Old-Baily, to come to him into Blackfriars, to help him to reduce a luxated Shoulder of a man lodged there. The head of the Humerus was fallen down into his Armpit. The way of Reduction proposed by Mr. Faucett was by a Gird. We placed the man on the ground, and that part with the Bolster under the man's Armpit, and put the Girt about Mr. Faucett's Neck, who stood over him with his Hands upon the Scapula; and whilst I drew the Patient's Elbow backward close to his Spine, and thrust the head of the Humerus upward, Mr. Faucett raised up the head of the Bone with all his force, and it knapped in. The Bone being thus reduced, Mr. Faucett slipped the Girt of his Neck, and dressed up the man's Shoulder with Astringents and Bandage as hath been said. 
4. Observat. of Reduction by the Coulstaff.   
In the year 1657. whilst I was riding to a Noble Family in the North, I was desired upon the Road to make a visit to a man who had some days before put his Shoulder out of joint. I did so, and saw his Arm miserably stripped of its Cuticula by the Bandage which the several Bone-setters had endeavoured to make the Extension by; yet the Bone lay lodged in his Armpit. I applied over the Arm cerat. Galeni, and gave direction to have a Coulstaffe made ready against next morning, with a Wedgelike prominence in the middle of it, covered with soft ; and that the Bone-setters should meet me at the Patient's house. The next morning we met, and having all things ready, I caused the Patient to be seated with his luxated Arm near a strong Pillar, which supported part of a Mantletree; than took of the Dress, and fomented and embrocated his Shoulder with Emollients; than folded a Cloth about his Arm a little above his Elbow, and fastened a Bed-cord over that, and tied the ends of it about the Pillar, and with a Bedstaff twisted it, showing one of the company how to twist it, and make Extension of the Arm by it. Than I placed the Coulstaffe with its Wedge close under the prolapsed head of the Humerus, two strong men the while supporting the ends of the Staff proportionably high, I standing on the contrary side with my Hands on the Scapula to draw it back, and press it downward to receive the head of the Humerus, and to govern the Operation, the Bone-setters looking on. All things being thus ready, the one twisted the Cord, and thereby extended the Arm; the other held the Coulstaffe firm and close to his Side. During the Extension our Patient roared, and one Bonesetter called to me to forbear the Extension, saying, Why will you strive against the Lord? and turned from us, declaring that I would kill the man. But the head of the Humerus was than moving; upon which consideration I bid the man twist on: and at that instant the Bone knapped in, and we loosened the Bandage; than dressed it up with empl. è bolo with Bandage, and put him to Bed. There being little more required, I went on my journey.  
In the year of the great Sickness, 
5. Observat. of Reduction by a Pulley and Coulstaffe.  whilst I was in the North-country, a Gentleman sent his Servant to me, who had some half a year before luxated his right Shoulder. He had been with a Bonesetter, who took some pains in stretching it, and made him believe he had set it: but upon sight of it, I concluded it luxated, and felt the head of the Humerus lying in his Armpit. I being than lame of my fractured Leg, and indisposed with coughing blood, advised the man to return to his Bonesetter, and tell him what I had said. He did so, and traveled from one Bonesetter to another. Every one of them attempted the Reduction, and pretended they had set it. But the Patient returning still to me with it unset, I sent for a Pulley, and causing it to be fixed to a strong Post, and a Coulstaffe to be held under his Armpit by two strong people, we made Extension of the Arm, and reduced the Shoulder, as in the former Observation hath been showed, without much difficulty. Than I dressed it up with a restrictive Emplaster and Bandage as above said, and he recovered the use of his Arm.  
The deceased Mr. Edward Molins and myself were sent for to a Fencer who had put his Shoulder out of joint. 
6. Observat. of Reduction by Glossocomium.  We endeavoured to reduce it by the help of the Gird and our Hands: but he being of a strong muscular Body, we could not move it. We therefore embrocated the Shoulder cum oleo ex ped. bovinis, and dressed it up with cerat. dialthaeae. The next day we came prepared with a Glossocomium, well known to the young Surgeons by the name of a Commander, and reduced the luxated Bone; than dressed up his Shoulder as above said. This foresaid Instrument is frequently used in reducing these Bones in strong tough Bodies, and where the Luxation hath been of long continuance: but the use thereof requireth great caution, for sometimes sad Accidents have happened theregby.  
Luxations from internal causes are for the most part irremediable: yet I shall give you a couple of Instances of my attempts therein.  
A young Woman having been long diseased with a Pain in her right Shoulder, 
7. Observat. of luxation by Congestion.  with an Emaciation of that Arm, came to me recommended by Doctor Chamberlain Sen. Her Shoulder seemed to me luxated; but her Chirurgeon not being of that opinion, I declined the meddling with her: yet being afterwards solicited by some of her Friends, I sent her to a Surgeon's house, who was one of the Masters of Anatomy, whither I followed, and met several Masters of that Faculty there at a private Dissection. They together viewed and felt her Shoulder, and unanimously concluding it luxated, prepared for the Reduction of it; and having reduced it by Pulley and Coulstaffe, dressed it up accordingly. But the Ligaments and Tendons were so relaxed, that afterwards upon slackening the Bandage it relapsed.  
A Child of about four years of age having had his left Shoulder luxated from his infancy, the Arm emaciated and grown useless, 
8. Observat. of Luxation by Congestion.  I being at last consulted did presently reduce it by lifting up the head of the Humerus with my Fingers: but the Tendons being extremely relaxed, the Bone slipped down again as soon as I removed my Fingers. Wherhfore I sent for Mr. Smith a Trusse-maker, and appointed him to fit the Child with a pair of Bodies stiffened on the lame side, wherein was fixed a Bar of Steel with a head like a Soldiers Rest, which by a Screw was raised proportionably to support the head of the Humerus. This being made, I placed a fontanel in that Arm, and rolled up the other Arm from the Hand to the Shoulder, and braced it to his Breast, designing thereby to force Nourishment into the lame Arm, and necessitate him to use it. But the Child growing froward, they set it again at liberty. Upon notice thereof I deferred farther proceeding in the Cure, till the Child should be more governable; advising the Parents to repeat the use of the former Prescriptions of their Physicians as they should see occasion.   

CHAP. VI Of Luxation of the Elbow-joint.  
THE Joint of the Elbow is made by the concurrence of three several Bones: 
Description of the Elbow-joint.  1. the Os humeri, 2. the Vlna, 3. the Radius. The Os humeri endeth broad towards the Cubit with a double head, the inward fitted for the reception of the Vlna, the outward for the Radius. The inward head is exactly shaped, and covered with a Gristle, which rendereth it smooth, and fit for the motions of the Vlna, which with a suitable Cavity playeth about it, inserting upon every extension of the Arm its utmost Process (called the Olecranon of Ancon) in the large Cavity that is situate on the backside of the Humerus. In every Flexure its lesser Protuberance playeth into a lesser Cavity in the exterior part of the said Humerus. The Radius meanwhile, being round and flat, with a very small Excavation doth play upon the outer head. These Heads have yet a farther use, viz. by their respective Processes to make a station for several Muscles: the outer Protuberance giving original to all the Extensors of the Hand and Fingers; the innermost to all the Flexors of the same. The Joint itself, besides the Ginglymoïde connexion of the Vlna to the Humerus, is tied fast by a strong Ligament, and well bound in with Muscles. Viz. on the inside it is lined with the strong and thick, but very soft, end of the Brachiaeus internus, whose Ligament, though hard and thick enough, yet hath a soft Pillow of Flesh interposed between it and the Joint, that so the pressure may not hinder the motion thereof, but rather give way to it. Yet is the pressure strong enough to keep the place firm, which the accession of the Tendon of the Biceps doth much more corroborated; so do the Pronator radii teres and Supinator longus, etc. The outer part is well guarded by that great strong Muscle which usually is reckoned for two, viz. the Biceps, and Brachiaeus externus, which uniting together have a fleshy soft inside, but with a strong broad Ligament fixed on the outside to the Olecranon. There is also a little Muscle called Anconeus, which reaching from the end of the Humerus obliquely transverse doth insert itself into the Vlna corroborating the Joint.  
The Radius also is bound close to the side of the Vlna and to the Humerus by two remarkable Ligaments; viz. the circular one that involveth the Joint, and the broad one that uniteth it and the Vlna together: it is also bound down by the neighbouring Muscles, especially the two Supinators and the Pronator teres.  
He that considereth the figure of the Vlna, and the strength whereby it is tied to the Humerus, will think the Luxation of it almost impossible: Yet even this also is sometimes made by the force that may be put upon it, and that four several ways, if we may believe Authors; as ovotwardly, inwardly, and to each side.  
If the Luxation be forward, 
Signs of the Elbow luxated.  the Arm hangeth strait out, or rather outward, and he cannot bend it; a Prominence appeareth in the 'Bout or inside of it, and an unwonted Cavity where the Elbow should be. But if the Luxation be backward, the Cavity will be in the forepart, and the Arm curved. If the Luxation be on the inside, the Cavity will be on the outside; and so the contrary, if it be externally distorted.  
The perfect Luxations of this Joint do rarely hap. 
Prognostic.  When they do, they are difficultly restored: and if there be a Fracture of any of the Processes of the Joint, the case is deplorable.  
If the Cubit be luxated forwards, 
Cure.  the Arm must be extended, but not in a strait line, jest you break the tip of the Vlna, but obliquely. To which end, two persons being employed, one to hold the Humerus, the other to pull the Arm below, a third person must guide the Elbow so as to keep it bend, and to direct the Bone. Which is done by pressing a Bolster upon the bend of the Joint, or by a Gird or other Bandage pulled behind, or by one in the nature of a Stirrup, in which the Chirurgeon may put his foot, and make Extension that way.  
If the Luxation be backwards, the Extension being made obliquely as before, the Reposition is easily guided by the Surgeon's Hand. Yet since the extending Muscles of the Cubit are very strong, it will be necessary that the Muscles serving the Cubit be first well embrocated with lenient Ointments: but if notwithstanding you cannot reduce it by Hand, the Ladder or other Engines must be used. And after Reduction apply Restrictives, etc. for these Luxations are subject to great Fluxion, Inflammation, etc.  
THE former of these Luxations happened to a Servant-maid in White-friar's carrying a Pail of water. Her Feet slipping, 
1. Observat. of a luxated Elbow.  she endeavoured to save herself; but falling backward, she pitched upon her right Hand, and distorted the head of the Bone inward a great way. The poor creature was carried into the next house, being an Alehouse, and Mr. Clarke a neighbouring Chirurgeon and myself were fetched. Dress being made ready, and the Wench seated, one of the company stood on the contrary side of her, with both his Hands upon that Arm below the Shoulder, and held her firm. Mr. Clarks made Extension below the Cubit, and myself with a boulstered Girt upon the prominent Bone in the 'Bout of the Arm pulled it backward. After we had thus come to the very brink of the Joint, Mr. Clarke bowing the Arm suddenly forward, I drew it back into the place; than embrocated it come ol. ros. myrtill. & aceto, and applied empl. è bolo with Bandage, and left her Hand upon her Breast. But she was lame long after.  
If the Cubit-slip out sideway, the Reduction may be made by Extension and impulse of the Hand.  
That of the Radius is also reduced by the like means; so that examples need not be given: only in the other of a curved Wrist, I shall give one Instance.  
A Lady being overthrown in her Coach, 
2. Observat.  the lower Process of the Vlna called Styloïdes was distorted from the Radius, and one of the Bones of the Carpus shoved between. I made Extension of the Wrist, and pressed that Bone of the Carpus to its fellows smooth, than thrust the Process of the Vlna close to the Radius, and applied round the luxated Joint an Emplaster of a stringent Powders cum album. ovi, Splints, and Bandage, as in a fractured Bone, and placed it on her Breast, and thereby restored it to good use and its natural figure.   

CHAP. VII. Of Luxation of the Carpus, Metacarpus, and Fingers.  
THE Carpus is composed of divers Bones. One lieth out of order. Three of them are joined to the Processes of the Radius and Vlna, four to the Metacarpus, and all of them bound in by a strong Ligament, by the strength of which the Joint is made more firm. Yet these Bones may be all thrust out together, or any one of them single, inwardly, outwardly, also towards either side.  
This Luxation is discovered by the Tumour it maketh in the place where it lieth distorted; also by the Flexure or Extension of the Fingers. 
Signs of the Carpus luxated.  Viz. if the Bones be moved inward, the Flexors of those Fingers are so stretched, that the Extensors cannot stir them: and so contrary, if the Bones start outward, the Extensors are immovable: and if they be luxated sideways, the Hand leans either to the Thumb or little Finger.  
The way of Reduction is, 
Reduction.  to lay the Hand and that part of the Arm flat upon a Table, and make Extension above and below: during which the Chirurgeon presseth down the prominent Bones with his Hands into their several Cavities. The Bones reduced, remove the Hand, and place it upon a Ferula, and dress it up with Restrictives, Compress and Bandage.  
The Fingers may be luxated backward, 
Luxated Fingers.  forward, or on either side. The single Luxation of the several Bones may be demonstrated by their Protuberance, and by the complaint of the Patient. They may be easily reduced by Extension, they having no Process to hinder: and being reduced, the common Restrictive and Bandage will retain them so.   

CHAP. VIII. Of Luxation of the Hip.  
THE Joint of the Hip is a Connexion of the head of the Os femoris to the Acetabulum of the Os ischion, 
Description of the Hip.  which is done by two strong Ligaments: one outward and membranous, encompassing the whole head of the Femur, from the edges of the Acetabulum to the farther end of the neck, where it toucheth the great Trochanter: the other inward, of a round figure, like a Cord tying the utmost apex of the Caput femoris to the inner side of the Acetabulum near the centre. This Articulation is confirmed and strengthened by great strong Muscles; viz. on the outside by the three Glutes, on the inside by the Triceps, together with the Levidus, and the four little Rotators. All which being duly considered, it must needs follow, that the force must be great that doth drive this out of its place. Yet when the weight of the Body and the undue position of the Thigh do concur, they frequently make that Luxation: so likewise doth sometime external force.  
It is remarkable, that this place admitteth not of a Semiluxation as others do; the head being so round, and the Cavity so glib, and deep, that whatever the force be, if the head be not thrust quite out, it will slip in again as soon as the force ceaseth. It doth slip out four several ways, outwardly, inwardly, forward, and backward. Yet these two latter I never saw; but by Congestion the Ligaments and Tendons may be so relaxed, that it may fall out either way.  
If the Luxation be inward, 
Signs of a Hip luxated.  the head of the Femur may be felt round and hard a little beneath the Groin. But if the Patient be in bed, you may judge of it by turning up the  at the bed's feet; the Leg will appear longer than the other, and the Knee and Foot lie turned outward. If the Luxation be outward, that Leg will be much shorter than the sound one, and the Toes truned inward.  
In a relaxation of the Hip, the Leg hangs for the most part directly down and lose, is weak, turneth either way, and is much emaciated.  
Luxations of the Hip are difficultly reduced, and being so, 
Prognostic.  are extreme apt to prolapse, by reason of the overgreat Extension or Ruption of the internal Ligament, which should hold the Bone in its Acetabulum. And if it be not reduced, it will be subject to great Pain and Fluxion from the over-stretching of the Muscles, and pressure upon them with its great head: yet after some months those Muscles become callous, and having yielded to the Extension, the Patient makes a shift to go upon it, though lamely. But the Member suffereth an Atrophia, and is shorter than the other.  
When the Luxation happeneth by Congestion, it is subject to Apostemations, and the head of the Bone corrupts by lying slabbed in the Humour, and the Patiented languishes and dies emaciated.  
If the Thighbone be luxated inward, 
Reduction of the Os femoris.  and the Patiented young and of a tender Constitution, it may be reduced by the Hand of the Chirurgeon: viz. he must lay one Hand upon the Thigh, and the other upon the Patient's Leg; and having somewhat extended it towards the sound Leg, he must suddenly force the Knee up towards the Belly, and press back the head of the Femur into its Acetabulum, and it will knap in. For there is no need of so great Extension in this kind of Luxation; for the most considerable Muscles being upon the stretch, the bowing of the Knee as afore said reduceth it. Yet in tough Bodies it may require stronger Extension: and in that case the Patient must be laid upon a Table flat on his Back; and a Pin of a good thickness aught to be fixed in the middle of the Table, to stand up between his Legs close to that Inguen, that the Extension may be made thereby. During which, the Extension must be made by two men, the one pulling him by that Armpit, the other by the Leg: which latter Extension must be made obliquely towards the sound Leg.  
If the Luxation be backward, he must be than laid upon his Belly, and the Pin placed as aforesaid in his Twist: it aught to be as thick as a Rowling-pin, and covered with Cotton, that its hardness may not be offensive. The Extension may also be made upward by a Towel or Girt between his Thighs: and the while that Leg must be stretched by Pulleys or such like strength, and the Bandage fastened above the Knee.  
The Bone once reduced, dress it up with Restrictives and good Compress and Bandage, than bind it to the other Leg, and keep him in bed: for these Bones are apt to start, especially if the Ligamentum teres be broken. If after Reduction and such Regulation the Bone do start again, I should forbear any farther forcing it, to avoid the danger of Apostemation, etc. For, as I have said, they may recover strength to go on it, though it be never reduced.  
A Luxation made by Relaxation or Resolution requireth good drying and corroborating Fomentations, Emplasters, Epispastics, fontanelles, etc. The Habit of body aught also to be treated by Internalls as in the King's Evil; and if it apostemate, to be dressed as such Abscesses.   

CHAP. IX. Of Luxation of the Knee.  
THE Joint of the Knee is made by the connexion of the lower head of the Femur and the upper head of the Tibia and the Patella. 
Description of the Knee-joynt.  The first of these by a double Protuberance is inserted into the double Cavity of the latter, and suffers constriction on the anteriour part from the great and large Muscles, which running to and beyond the Patella, join that to the Os tibiae, and bind it down upon the Articulation, so as of the whole to make a Joint. On the hinder side it is guarded with the two Hamstrings so called, viz. the Tendon of the Biceps outwardly, and of the sartorius, gracilis, semimembranosus & seminervosus inwardly: between which, through a little Cavity made for that purpose, all the great Vessels have their passage to the Legs. Now the Joint being thus strengthened doth scarce admit of any Luxation forward, unless the cause be exceeding violent. Backward and on each side it is subject to both Luxation and Semiluxation.  
The Signs of the several Luxations of the Knee are apparent to the eye, 
Signs of a luxated Knee. Reduction.  by the Protuberance in the one part, and Cavity on the contrary.  
They are not difficult to reduce, nor subject to such Accidents as those of the Elbow.  
Those Luxations which hap on either side of the Knee may be reduced by a moderate Extension with your Hands. The Luxation backward is restored by extending it a little: than bend the Leg suddenly backward, bringing his Heel to his Buttock, and you shall hear it knap in to its place. It being so, stretch it out again, and embrocate the Joints and Parts affected, and apply Astringents with a Compress in the Ham, with good Bandage. I shall show you the manner of reducing the perfect Luxation more particularly as followeth.  
A Gentleman of about 30 years of age, 
Observation of a luxated Knee.  riding upon the Road some few miles out of Town, was by the rushing of a Cart tumbled with his horse into a Ditch, and brought back to London extremely lame and bruised. I being fetched to him found him in bed. The head of the Os tibiae was shot under the Thighbone, and lay stretched out strait, exceedingly swelled, and much blood extravasated amongst the Muscles of the Calf of his leg. I caused the Patient to be laid on the contrary side: than one of the company held him down, and kept that Thigh steady, whilst I took him by the Foot and Calf of his leg: and after I had a little drawn it to me, I forced it backward towards his Buttock; by which very motion it knapped into its place. That done, I extended it again, placing the while my Hand in the Hollow of his Knee. The motion of that Joint to and from, and the filling up that Cavity under the Rotula, were certain signs of its Reduction. I embrocated the Leg cum albumine ov. ol. ros. myrtill. & aceto, and applied empl. è bolo over all, with a Compress in his Ham, than rolled it up, and laid his Leg upon a Pillow to the ease of the Patient. That done, I let him blood in his Arm, prescribed him an Emulsion of the cold Seeds, etc. and kept his Body soluble by Clysters, and advised him a slender Diet. The third day I repeated Embrocations with the foresaid Oils cum aceto, and thereby repelled the Humour so, that there only remained some remarks of the extravasated blood. I than embrocated those Parts cum ol. cham. lumbric. spir. vini, and applied empl. stict. Paracels. & diapalmae on the weak Joint. From the first application he grew daily easier, and by these latter the Joint waxed strong, and he risen and walked with a Crutch in his Chamber: and some time afterwards I saw him walking abroad with a Stick in his hand.   

CHAP. X. Of Luxation of the Ankle-bones.  
THE lower end of the Tibia being joined to the Fibula maketh a ginglymoïde Cavity in which the Os tali is inserted: 
Description of the Ankle-bones.  the two Ankles being on the inside the Product of the Os tibiae, make the outer on the Fibula. Underneath lie all the Ossa tarsi in order; viz. the Os calcis under the Talus, the Os cymbiforme before it. Outward of that, joining to the Os calcis, is the Os cubiforme; and between the Os cymbiforme and the Metatarsus lie the three Ossa cùneiformia.  
This Joint is involved in strong Membranes and Ligaments, and bound in by divers strong Tendons: viz. behind by the Tendon of the Gastrocnemius, and yet close underneath in the Hollow of the Calcaneum by the Flexores pollicis & tertii internodii digitorum lateralis; inward by the tibialis posticus; outward by the preconei; forward by the tibialis anticus. These joined to the strong Ligaments that  bind up the Part, and assisted by the figure of the Bones, do make a Joint that would not easily be dislocated, did not so great a weight lie thereupon. But from great weight and force it suffereth four ways.  
If the luxated Bone be distorted inward, 
Signs of a luxated Ankle.  the Sole of the foot lieth turned outward; so likewise if the Luxation be in the exterior part. If the Luxation be forward, the broad Tendon of the Heel lieth hard and stretched out, and the Foot appeareth shorter, because the Joint is moved forward, and possesseth most part of the Foot. But if the luxated Bone be distorted backward, it lieth over the Heel-bone, in which case the Sole of the foot seemeth bigger and longer. Accordingly as these Signs are evident, the Luxation is perfect or imperfect.  
The Reduction is not difficult; 
Prognostic.  yet these Luxations are subject to great Pain, and are accompanied with Tumour and Ecchymosis, and the Patients are long lame of them.  
The way of Reduction in tender Constitutions may be by Extension with your Hands, the one taking hold of the Leg, the other of the Foot. 
Reduction.  During which Extension, the Chirurgeon must press the Bone the contrary way to which it was fallen. In case the Extension by your Hands suffice not, you may make use of Pulleys or other Engine. The Bone being reduced, apply Restrictives with Bandage as above said.  
Sometimes the Ancle-bone is apt to turn out on either side, by reason of Relaxation of the Tendons: in which case, though you do reduce it, yet upon the lest walking on it the Bone slips out again. Some years ago such a one was brought to me; I reduced it easily, and it as soon slipped out again: whereupon I caused a Shoe to be made by which the Ankle was kept steady, and at length by application of Astringents, etc. it recovered strength.  
The Bones of the Metatarsus and Toes are frequently fractured, but rarely luxated, by reason of their strong Ligation by so many Tendons. But if it so hap, their Cure is the same with that of the Fingers and Hand.   

CHAP. XI. Of Luxation of the Spine.  
LUXations of the Spine, which are most usually from inward Causes, as in Rickety Children, also in the King's-Evill, and other tumors happening upon those Bones, require internal Remedies, so are referrable to a Physician. The chirurgical part consisteth in the application of Plasters, as hath been showed in the Treatise of the King's-Evill; also in good Bandage, which chief belongs to the Bodies-maker.  
When it happeneth from force, a speedy Reposition is required, about which Galen, Hypocrates, Oribafius, Celsus, etc. speak much, who all may be consulted. The case is so rare, that I think it not needful to add any Discourse here; much less that of Hildanus, about reducing the Spine when luxated inwardly. He that pleaseth may look into the Author.    

OF LUES VENEREA.   

OF Lues Venerea.  
The Seventh Book.  

CHAP. I. Of Lues Venerea.  
LUes Venerea is a venomous contagious Disease gotten either Immediately or Mediately from an impure Coition. 
Definition.   
I say Immediately or Mediately, because it is very manifest, 
Ways of Infection.  that not only the Persons so copulating are infected, but also the Children derived from such Parents, and Nurses that suckle those Children, and any other Child that sucks upon those Nurses; and so forwards. It is frequent to mention other secundary ways of the propagation of it; as lying in the same Bed with an infected person, lying in the same Sheets after them, or wearing their . Nay it is affirmed by some, that men have been infected by the same  they themselves wore when they were diseased. Drinking with one so diseased, or sitting on the Close-stool after them, are likewise numbered among the causes of infection.  
These are all such convenient excuses for the more  and coy Patients who will not otherwise be brought to confess their distempers, that it is pity to discountenance them. Nor will I deny the differences of Constitutions to be so great, and some of them so liable to this Disease by some other previous indisposition of body, that they may be infected with the tenth part of what another would escape sound from. And this especially I do acknowledge in Women, the softness and tenderness of whose Sex being frequently attended with thin and sharp serum in the blood, renders them liable to very quick impressions: yet in Men, and indeed in the generality of Patients, we found the Disease not so active as to convey itself from one subject to another without actual coition, or something very equivalent to it. And as to wearing of the same , it is notorious that many hundreds cured by us Surgeons here in the Town, do commit that error (if it be one) without the lest inconvenience. Nay in sound and firm constitutions impure coition itself is not always sufficient to infect. Of which I have seen the frequent Experiment during the three years I served in the King of Spain's Navy, where our Mariners as soon as their pockets were full of money would be getting ashore to the Negroes, and other common women, that usually attended their Landing, and served their pleasures in the neighbouring Broom which grew very plentifully on some of those shores. I have known, and dare say, more than twenty men lay with one and the same woman the same day, and only some of them infected, the rest going free, though they all equally deserved it.  
But Nurses may either infect Children or be infected by them. Children that have had no Ulcers in their Mouths or Lips, nor any other visible symptom of the Lues, have notwithstanding betrayed their own infection by transmitting it to the Nipple of the Nurse. In which case it is frequent to see serpiginous Ulcers arise one after another, growing at length into so many round crusty Ulcers: also Nodes thrusting out of the back of the Hands, Shins, etc.  
Infections of Children are more obscure, for though many of them after they be born have such Scabs and Ulcers as do sufficiently manifest the Disease, yet it is not always so: for generally they do often come into the world very clear, and with the appearance of very sound bodies, which notwithstanding have been certainly infected and have died of it, or at lest have been very infirm; and though they were brought to their ends by some other apparent Disease, yet the Pox hath been judged the foundation of all.  
I shall give you a three-handed instance that may confirm several parts of this Discourse.  
A lusty young fellow brought me to see his Wife, which I did in the company of Dr. Mapletoft; we found upon her face a great cluster of round crusty Venereal Ulcers, yet not only her Husband was seemingly sound, but her Child also, who being half a year old appeared lusty and strong, played merrily in the Nurse's Arms, but that day died suddenly: nor could I impute that accident to any other cause, but the forementioned infection.  
Yet I would not have any man rash in judging all Ulcers to be Venereal that do resemble them, for I have seen Nurses with chapped Nipples, and serpiginous Ulcers on the Breasts, and Maids likewise in the same condition, who have been cured without any respect to the Lues.  
I have seen also many Infants broken out about the Lips, Face, Head and Body, with many suspicious pustulae and Ulcers, that were born of chaste Parents. In our public healings we present many such, if there be any diseased glandules found about the musculus mastoideus, I supposing them rather to be strumous.  
Having thus far treated of the original of the Lues, 
It's Nature.  it will be now seasonable to describe the Disease itself. For the doing of which it will not be necessary to run through all the nice diversity of opinions which Sennertus and other Authors have reckoned up; such an attempt would better become a Chair in the University than a Practical Treatise: I do only in short say, that it is a Disease produced not by excess of any of the four qualities, but by the actual communication of a downright venom, which usually affects that part of the body which it first toucheth, and afterwards the blood itself, by the virtue of which all the solid parts are by degrees tainted.  
The Species or rather Degrees of this Disease have by Palmarius been reckoned four according to the degrees of Infection. 
It's Degrees and Symptoms.  In the first he supposeth only the Hair to fall of without any other hurt of the body; a case, I doubt, very rare. In the second the Skin groweth rough and spotted with many little protuberances. In the third downright Scabs appear in the Head, Face, etc. In the fourth the solid parts are infected, as the Bones, etc. But these degrees are either ill ordered, or at lest not jousted to the appearance of the Diseases that occur in this age. Therefore I shall endeavour to rank the Degrees or Symptoms of it according to the events which we usually observe in our practice.  
Therefore when a Man hath had to do with an impure Woman, either he hath some heat or inflammation on the Penis with excoriation, which ariseth soon after coition, and is caused by the affriction of a virulent humour; or else he finds a heat in his Urine, and in a day, two or three, a Gonorrhoea, or issuing of virulent matter out of the seminal Vessels through the Vrethra. This inflammation is very apt to produce excoriation and ulceration, upon which chancrous Ulcers arise; and sometime when the Infection hath been vement, or the Inflammation neglected, it tends to a Gangreen, and Cyrstalline Bladders arise, and the part mortifieth.  
Sometimes a Gonorrhoea succeeds not; only the infection taking rather along the Cutis to the Groin, doth make impression on the neighbouring Glandules, and produce a Bubo, which according to the degree of its malignancy either proves easily curable, or else improves in its venom and terminates in a Phagedenous Ulcer with jagged lips. At this time of the Disease I have seen many round, hard, venereal Ulcers upon the Scrotum and Perinaeum. Sometimes where none of the other symptoms have preceded, a small chancrous Ulcer ariseth between the Prepuce and the glans, above or below, on one side, or in the entrance of the Vrethra; one while eating through it, otherwhile destroying the fraenum, etc. These Ulcers are sometimes only corrosive, and sometimes callous, or a callosity without an Ulcer.  
The attendance of a Chancre is commonly a breaking out all over the body like a flea biting, which terminates in various sorts of Tetters or Ulcerous Scabs; or it may be that Pustules arise in one or more places of the body, as Head, Face, Arms, Thighs or Legs, or Ulcers in the Tonsil, Palates, etc. and at the same time I have seen a Gumminess upon the musculus mastoideus, drawing the neck on one side.  
Than wand'ring pains begin towards night to affect either the Shoulders, Arms, Legs, or Head; sometimes this last is affected alone to great excess. And about this time Verrucae, Condylomata, Marisca or Ficus appear in the Podex; also Ozaena and Ulcers of the spongiest part of the Os ethmoides and gristles of the Nose; also about this time tumors by congestion arise in the Breast, Arms, Legs, and become Ulcers of difficult cure.  
The pains growing more fixed, Gummata or Nodes usually arise and continually afflict them, but towards night grow more intolerable, and at length the Bones corrupt.  
Coincident with several of these latter degrees are the noise in the Ears, Deafness, a Polypus, Ophthalmia Fistula, Lachrymalis, fierce Catarrhs, Colicks, Diarrhoea, and Tabes.  
These dreadful Symptoms have frequently possessed the imaginations of some people, who having taken the way to get the Pox are soon persuaded that they have it. These men will strangely imagine all the pains and other symptoms they have read of, or have heard other men talk of. Many of these hypochondriack have come to Sir Fran. Pr. in which cases he hath been pleased to sand for me to consider of their complaints with him. They commonly went away from us unsatisfied, nor could they quiet their minds till they found some undertaker that would comply with them; which done, they were never the better, the imagination in which the Disease was seated remaining still uncured; whereupon presuming they were not in hands skilful enough, they have gone to others and so forwards, till they had ruined both their Bodies and Purses.  
There have been three of these people with me lately; one a Tradesman, who told me that since his Wife's death he had fallen into ill company, and being heated with drink, strayed and got a Clap, for which he had been under several hands; that it had cost him 40 pounds amongst them, but he was still worse and worse. I asked him if he had ever a Gonorrhoea? Yea, said he, with great pain in my Back, which still continues: also such a pain in my Nose, that I fear it will fall. Upon more particular enquiry I found no such thing; only upon straining to make Urine or upon the Close-stool, he had an involuntary effusion of Seed, which was an old infirmity he had quite forgot. I endeavoured to satisfy him that he escaped better than he deserved. Whether he continued in the same opinion he seemed to have received from me of his condition I sometime doubted, but lately have seen him and been assured, that since he spoke with me he had taken no Physic, nor felt any cause for it, he continuing very well.  
Authors upon the first entrance of the Pox into Christendom generally looked upon it as not only incurable, 
Prognostic.  but also so highly infectious that they ran away from it as much as the Jews did from a Leprosy; but Latter Ages and long experience have made it lesle formidable: yet even to this day it must needs be acknowledged difficult to cure, in consideration of its malign and contagious quality, and the ungovernable disposition of the Patients.  
If the habit of body be strong, the cure of all these Species of Lues Venerea, whether they be Chancre, Pustulae, Serpigo, Herpes' miliaris exedens, Phagedaena, Ozaena, Ulcers in the Palate or Tonsils, they are all much easier cured than the same are in any other chronic Disease: but to eradicate the virus that it do not return with more malignity, is somewhat more difficult.  
If the Patient hath been formerly clapped, it will be the more difficult to cure him the second time, and worse the third.  
If he hath passed through long courses of Mercurial remedies ineffectually, his cure will be difficult; and if he hath been Salivated by Unction and relapsed, the Cure will be hard, by reason the Mercury is become familiar to him, and his body is for the most part emaciated and squalid.  
Gummata and Nodes are more difficult of cure than the Species , and those whose Bones are corrupted are yet more difficult of cure: but if the habit of body be strong and the Viscera sound, all the species of this Disease are curable if the Patient keep his Chamber, and submit to the rules of Physic and Diet, without which submission we can scarce cure the lesser Species; and accordingly as they have been slubbered over, the malignity that remains will at one time or other show itself either in some Chronic Disease, as Asthma, Catarrh, Colic, Diarrhoea, Stranguria, Rheumatismus, Hydrops, etc. or in some species of the Lues Venerea, when possibly the Patient will not be so willing to acknowledge the Disease, and what hopes is there than of his Cure?  
Also if the Viscera be unsound, or the Patient Hectic, a Marasmus will attend it, and the Cure is impossible.   

CHAP. II. Of the Remedies generally used in the Cure.  
THE Medicines altar according to the degrees of the Malady, and other circumstances, in which the following Discourses will inform you. My present business is to give a general view of them all, with their Natures and Uses. Now the known Remedies, all or some of which we used in this Cure, are Bleeding, Purging, Vomiting, Salivating, Sweeting, 
It's Cure.  Cordials and Opiates; to which we may add Dietetical directions, especially Alterative Drinks, and Topics.  
Concerning Phlebotomy, though it do not cure the Disease, yet in the very beginning of it we usually let Blood, to calm the fermenting Humours, and dispose them for Evacuation, and prescribe a Clyster before or after.  
If the Disease be of long continuance, 
By Bleeding,  and they have been let Blood some months before, yet if we design Salivation, we do again let them Blood, if the Body be not too much emaciated. For in some of those a Favour hath happened in the time of raising the Salivation: and in Bodies of stronger habits I have often seen them to break out in heat all over in the beginning of the Flux, so that than I have been necessitated to let them Blood when it was not so proper. When this Disease appeareth in the Groin with a Bubo, we do not let Blood; yet some have advised it in the Foot, as a way to lead the Humours thither.  
Purging is more universally necessary, 
Purging,  few Cases being to be put in this Disease where it is not required. For whosoever is Infected, either is already Cacochymical, or will quickly be so, if by a sudden evacuation of the corrupted matter you do not prevent it. It is also useful in keeping the Blood low, which the higher it is the more apt it is to be inflamed. Of Purges, some are only Lenitive, fit for weak and extenuated Persons, also to dispose the Body for more strong Purges. The Lenitives are Manna with Cremor Tartari in Whey or Posset-drink, also the decoctions of Tamarinds, Cassia, with the infusions of Sena, Rhubarb, etc. Syr. de pomis purge. de cichoreo cum Rhabarb. Elect. lenitivum, Diaprun. Diacatholicon, etc. ℞ Sarsaparillaeʒiij. scobis Guaiaciʒj. fol. beton. M ss. flor. Paralyseos P.i. Tragae come. ʒij. fol. sennae ℥ ss. coquant. lent. igne; colat. add Rhei, agarici trochiscati seorsim in aq. cichorei infus. an. ʒj ss. Colaturae add Syr. infus. Ros. pallidar. ʒuj. Mannae ℥ j f. potio. ℞ fol. senae mund. ℥ ss. Turbith gummosi, Jalap. hermodactyl. an.ʒj. Zinziberis, Cinamomi an. ℈ j coq. in sufficienti quantit. decoct. sarsaes, etc. ad ℥ vj. Colat. add Syr. de spin. cervina ℥ i ss. f. Potio. ℞ Elect. Diacatholici ℥ ss. diaprun. solut. ʒij. diasennaeʒj. cum syr. de sp. cervina q. s. exhibeatur in cochlearia. These, besides their use where stronger cannot be given, are also preparatives for bleeding, and thence to stronger Physic, viz. such as followeth. ℞ Fol. Sennae ℥ iv. Turbith gummosi, Hermodactyl. an. ℥ ij. Hellebori nigri, pulp. Colocynth. an. ʒuj. ras. Guaiaci, sas. safr. an. ℥ j court. Guaiaci, baccar. Juniperi recent. court. exterior. citrian. ℥ ss. Cinamomis, Garyophyllat. an. ʒij. infund, in equal. part. aquar. melissae, ulmariae, card. benedict. per horas 48. deinde f. ebullitio levis cum express. fort. In colatura dissolve Aloes rosat. ℥ ij. ss. Diagrid. ℥ j coagulentur ad formam extract. pro usu. Does. ʒ ss. adʒj. ℞ Turbith gummosi, sennae, Hermodact. an. ʒiij. Diagrid. ʒij. Zinziberisʒj. Mastichesʒ ss. Saccbari oped. ʒiij. Pulveriz. omnia subtle. & per setaceum trajiciatur. Dosis ʒj. in vino alb. vel jusculo. Or. ℞ Folior. Sennae, Rhei an. ℥ ss. Agarici trochiscati, turbith, Hermodact. Crystalli Tartari an. ʒij. Jalapii, Mecoacae an. ʒij. f. pulvis subtle. & cum syr. de sp. cervina, & de pomis purge. q. s. f. Electuar. does. ʒij. The stronger are Pil. è duobus, Cochiae min. Extract. Rudii, pull. Cornichini, etc. These aught to be joined with Calomel. viz. ℞ Merchant Dul. gr. 15. aut 20. Extract. Rudii vel Cochiae min. ℈ j velʒss. fol. auri q. s. cum syr. Ros. solut. f. pill. ℞ Extract. nost. ʒij. gum. Guaiaci ℈ ss. Merchant dull. gr. xiv. ascendendo ad ℈ j cum syr. de spina cervina formentur pill. In gross Phlegmatic Bodies you may purge with pull. Cornichini & Merchant dull. In case of pain we add a grain or more of Laudanum. Mercury thus mixed with purgatives is it from which we must expect our main success. For though the other may purge strongly, they of themselves have not virtue to check the malignity even in the lesser species of this Disease.  
This I the rather add, because of the wickedness of many Pretenders, who will in this Cure declaim against the use of Mercury, in which if they speak honestly, and follow their Judgements (and do not give it at the same time when they speak against it, as many do) they will prolong their Cure to no purpose, and meet with disgrace at last; it being very sure, that no species of it will be cured without it. I know Fernelius, and some of his Disciples writ vehemently against it, but the whole current of the Able Practitioners have written on the other side. And by what I found by my experience, I dare say, that Fernelius never cured a confirmed Pox without it, unless the Patient had been in some other hands before who had sluxed him; in which Case some sudorific course prescribed by him might get the Credit of a Cure, whose foundation was laid in Mercury. I writ this the more confidently, because of the many attempts I have myself made, and seen endeavoured by some worthy late Practisers in our Faculties without Mercury, but by omitting of it, our Cures were rendered tedious and unsuccessful, the Ulcers the while spreading and breaking out fresh in some parts while we were endeavouring to Cure them in others, the Disease becoming more fierce in some of them whilst their Bodies were purged with Catharticks without Mercury. Nay, where one of those Inveighers against Mercury gave it in a Course of seven weeks, he could not by all his endeavours of Mercurial Emplasters, Unguents or Waters outwardly applied, nor with his Sweeting Diet-drinks, etc. cure one small Herpes' in the Face, yet was better paid for his Physic than I was for the Cure.  
Vomiting is of use in great disorders of the Stomach, 
Vomiting,  when the foulness of that requires it, or when the Ulcers of some particular part require a sudden revulsion. So likewise when after the use of much Mercury outward or inward to salivate, it doth not arise kindly, we by this means 'cause a motion upward, and derive the humour that way.  
They are generally strong if the party can bear them, viz. some Preparations of Mercury, as Turbith mineral. etc. or. Antimonial, as Crocus Metallor, in stronger Bodies; but in weaker Constitutions we give such as we may.  
The next thing which offers itself to our consideration, 
Salivation,  is, Salivation, without which sew great Cures are done in this Disease. Nay, when a great Evacuation by Salivation is not intended, we are forced to dispose the humours that way by Mercury, that being so disposed they may be rendered more obedient to purging and sweeting Remedies. For the truth of this, I need not produce any Authority, common experience will make it evident to you; but of this hereafter.  
The methods of Salivating are divers, but all by Mercury; besides which faculty of raising a Salivation, it heals, attenuates, resolves, provokes Urine, and moves noxious Humours upwards and downwards, by which not only the more subtle but the more gross and feculent excrementitious humours are expelled, and that according to its several Preparations, either inwardly given, or outwardly applied.  
Inwardly are prescribed various Preparations of Mercury, viz. Merc. sublimatus, dulcis, Merc. praecipitat. albus, rubr. citr. niger, viridis, etc. There are also different Preparations of some of these, as the Turbith Minerale, the Amalgamations of Mercury with Gold, Theriaca Metallor. etc. They Purge, Vomit, and Salivate, or are Sudorific, and are stronger or weaker in their Operations, according as they are freed of their corrosive quality. The strongest of them are capable of being rendered sweet, and of being dispirited both of their Vomitive and Salivating qualities.  
When we design Salivation by Mercurius dulcis, we give it from 20 to 25 grains, and sometimes to thirty, either in a spoonful of white bread and milk, or in cons. ros. rub. cons. boraginis, confect. Alchermes, or some such like Cordial Electuary. When we suspect it may work by stool, we prescribe it in Elect. Diascordii, or Theriacae at night going to bed, and than it also serves to alleviate their pains, and dispose them to rest. If after the taking it 4 or 5 days their chaps do not swell, it may be reasonable to move it upward by a few grains of Turbith Minerale. Accordingly as their chaps swell they will salivate. If their mouths be much ulcerated and sweeled, the Salivation may last 18 or 20 days, during which they are to be kept warm, especially about their head, neck and chaps, and to drink Chicken-broth, or Posset-Ale.  
In the Declination of the Flux, we prescribe them a Decoct. Sarsa. and before it ceaseth, we purge them with some Cathartick Apozeme, and proceed in the rest, as shall be showed in its proper place.  
But the Salivating with Merc. dulcis alone will scarce cure the middle Species of this Disease. For though the Ulcers do cicatrize, and wandering pains remit thereby, yet they will return, or new pustules will arise, as that Salivation declineth, or presently after. And indeed I have found better effects by the frequent purging with it mixed with some good Cathartick, than by the only Salivating with it alone.  
Merc. Praecipitatus albus may be given proportionably, as hath been said of Merc. dulcis.  
Arcanum Corallinum, as it is generally sold in the Shops, may be given from three Grains to 5. One dose of it prescribed by me to a Woman Diseased with Serpigo, etc. vomited her often, and Salivated her twenty days, contrary to my intention, but cleared her skin of its foulness.  
Read Precipitate is also Vomitive, but being well washed may be taken as safely as the White Precipitate. But since I practised here in the City, I have not used it. Praecipitatus viridis is also Vomitive, and the most churlish preparation of Mercury; the dose is much about the same as that of Arcan. Corallin. Hartman prescribed it to eight Grains.  
Turbith Minerale, as it is sold in the Shop, is a rough Medicine, but being somewhat dulcorated first procureth Vomiting, than Salivation, and is proper to make a sudden revulsion in such cases where there is a necessity of giving a speedy relief to an afflicted part, and contributeth to the cure of this Disease in such cases where Merc. dulcis hath not force. That which I commend to your Use is made out of Vigo's Precipitate, and may be given from twelve to eighteen Grains, but I rarely prescribe it to any that have not first taken Merc. dulcis. It takes of nocturnal pains, and resolves Gummata and Nodes which have not been of long continuance, and hasteneth the Cure of the most malign Ulcers that accompany this Disease.  
Mercury Amalgamed with Gold doth Vomit and raise Salivation, but is generally corrected and made a Sudorific: So the Turbith Minerale is made Diaphoretic.  
Bezoardicum Minerale, and Aethiops Mineralis are also Diaphoretical, and of their Use you may see more hereafter.  
Mercurius sublimatus corrosivus dissolved in Aqua fontis given inwardly doth also raise Salivation and Vomiting, if the Dose be proportioned. It is much commended by some Practitioners, but I never made trial of it.  
This following I have frequently prescribed, and so may you if you please: ℞ Merc. sublimat. ʒij. Cinamomis, galangae, curcumae an. ʒij. crociʒj. aq. fumariae lbij. lbij. infundantur in Balneo per horas 24. deinde colentur pro usu. The Dose is 3 or 4 spoonful in a morning, and is to be repeated many days, they drinking Posset-drink, as in other Vomitives.  
There is also a way of Salivating by dissolving of Merc. sublimat. in a Bath; the use and manner of making it you may see in the Chapter of Elephantiasis.  
Crude Mercury is also frequently prescribed internally to raise Salivation, and is given from one Scruple to two or higher, cum terebinth. Veneta. The Pill Barbarosae, which is a mixture of crude Mercury with Troch. Alhand. pull. Jalap. diagrid. etc. and is commonly called the Blue Pill, purgeth powerfully, and frequently raiseth a Salivation. I made some trial of it, but it never answered my expectation; yet may Cure the lesser Species at the long run, if the Patient keep his Chamber, and observe a strict method in Diet, Sweeting, etc.  
These following Pills were prescribed by Sr Theodore Mayern to raise a Salivation. ℞ Terebinth. Venetae cocturae induratae Rhei electi. pulver. ℥ ss. Pul. Sarsaparillae, ℥ j Myrrhae, gum. Guaiaci, Mastich. succin. albi an. ʒij. fol. auri nᵒ 36. Mercurii Philosoph. vel alias ex cinnabar. resuscit ati ad pondus omnium, balls. Peruvianae q. s. Does. ʒj. ad ʒij.  
There is also a way of raising Salivation by suffumigation, the prescription whereof is as followeth: ℞ Cinnabar. ℥ ij. Merc. crud. ℥ j Mastich. Thuris, Sandarachae an. ℥ ss. Styracis, Calam Benzoin an. ʒiij. f. omnium pull. subtle. qui excipiatur Terebinth. q. s. formentur Trochisci ad pondusʒiij. pro usu.  
When the Lues Venerea is grown inveterate, and affecteth the most solid parts with Gummata, etc. and the habit of body debilitated and vitiated by the frequent exhibition of Mercury, it than requireth a more powerful Remedy, viz. Salivation by Unction. There are various sorts of them published by Authors, who have treated of the Cure that way; the principal Ingredient in it is Quicksilver, it is that which doth the Work, the additional Materials may be at your own choice, every one compounding them as they think fit. You have an Example of one in the Pharmacopoeia Londinensis, under the name of Unguent. Neapolitanum, that hath four ounces of crude Mercury to two pounds of Ointment: By others, ℞ Axungiae porcinae ℥ vj. Butyri rect. ℥ iij. Styracis liquidaeʒiij. Hydrargyri triti & extincti ℥ j cerae q. s. This following is weaker. ℞ Axung. porcin ℥ iij. Terebinth. ℥ j pull. Ireos, Thuris, Mastiches an. ʒij. Olei Cham. Lilior. an. ℥ ij. Laurini ℥ j Styracis calamitae ℥ ss. argent. vivi ℥ ij. M. sa. Authors have generally proportioned the quantity of Mercury according to the strength of the Patient, and some of them have undertaken to direct you how much of the Unction you shall use at a time, but that would be extremely troublesome to observe, and may prove dangerous to the Patient at last.  
The Unction which I have used for the most part this last twenty years hath been made by a prescription of Sir Alex. Frasier, whose Practice with it I had frequently seen with good success. In it there is 6 ounces of crude Mercury to 16 ounces of the Materials. If you shall make up an Unction at that rate, you will found your curiosity in the choice of the Ointments to mix with the Mercury not to be so very necessary, for I have sometimes raised a Salivation very well by mixing 6 ounces of crude Mercury extinguished in Terebinth. with 16 ounces of Axung. porcinae, and for Common People a prepared Axung. with an addition of Ol. Terebinth. hath served: For the better sort of People ℞ Axung. porcinae ℥ vj. Unguent. Nervin. ℥ iv. Unguent Laurini, & Dialthaeae an. ℥ jss. Ol. Vulpini ℥ j Stir acis liquidaeʒ iij. pull. rad. Ireos' Florent. Gum. Guaiaci an. ℥ ss. Ol. Caryophyl. q. s. Argent. vivi extinct. cum Terebinth. ℥ vj. Ms. The preparation to this way of Salivating is by bleeding and purging, if their bodies will bear it; otherwise bathe them, and keep their bodies soluble the while by Clysters, Lenitive Bolus' of Cassia, Manna, cum syr. violar.  
In order to your farther prosecution of this course your Patient aught to lodge near your house in a close warm Chamber; If the feason be cold the windows must be covered with blankets, and the bed near the fire, and encompassed with a screen if the Chamber be large. You aught also to have a strong healthy Nurse, such as hath been accustomed to the employment, that she may in the absence of the Chirurgeon know how to wash the Patient's mouth, and direct and encourage him in such Rules as may be necessary in the time of Salivating.  
The most proper place for Unction is a Stove, if it may be had, and the Patient can bear it; if he be weak his Bed must be used, otherwise for want of a Stove he must sit encompassed with a screen (as I said) by the fire side but not too near it. If in the anointing he use his own hands, he may save his Chirurgeon much trouble, and do the work better than it can be done for him: But if other help be required, than we arm our hands with bladders or gloves, and fall to it. The old, and still most common method adviseth to begin at the Feet, and thence to arise to the Legs, Thighs, Hips, and so upwards on the Spine to the Neck, taking in Hands, Arms, Shoulders. The Belly aught to be avoided. And indeed much of the other trouble in weak bodies may be spared, for in such the anointing of the Legs and Arms, (or Thighs, if modesty prevent you not) will obtain the same; and it is sufficient if the Mercury mix once with the blood to such a degree as to 'cause a Salivation. Whatsoever the manner of the Unction be, the parts first anointed aught to be covered before you proceed to the next, as the Legs with stockings, Thighs with trouzes, etc. till at last his neck be well wrapped with a napkin tacked up to his Cap round about to his ears, and fastened before to keep his chaps warm. After this a warm Bed will be convenient, and a draught of Posset-drink in order to a breathing sweat. Having so reposed himself an hour or two, he may rise and provide for his dinner, which must consist of meat of easy digestion, roast or boiled. To his dinner he may drink Beer or Ale with a toast, the rest of the day he must be confined to Posset-drink. Unction may be repeated twice a day if you see cause. But if the chaps swell apace you must moderate your hand, and it may be quite hold it of, jest you bring on the Salivation too fast, and endanger the Patient: when he comes to this state you must keep him to the use of Posset-drink and Broth, which aught to be ready in quantity. Also burned Wine, aq. Theriacalis, etc. must be ready to prevent fainting. His mouth must be syringed with a decoct. hordei cum liquiritia, rad. altheae. etc. New Milk held in his mouth, or Chicken-broath will ease the pain, and digest the sloughs that arise. A rolled clout aught to be placed between his teeth to keep his Chaps from closing. He must be raised high in his Bed, if his weakness constrain him to it, and kept forward that his Rheum may run out and not down his throat; but if he can rise, he will spit better and more plentifully. Salivations by Unctions commonly last 24 or 25 days, sometimes to the 30 day.  
In the height of it our work is to keep up their strength; and if through Costiveness they spit lesle, give them a Clyster that they may spit better, and attend the washing their mouths; but as the sloughs begin to separate, which will be towards the declension of the Salivation, prescribe them a decoction of Sarsa, etc. to drink at lest thrice a day; and before the slough's quite cast of, purge them with some cathartick Apozeme made in some of the foresaid decoct. Sarsae, and as they are able to eat meat, put them into a drying diet and sweated them, etc. as shall be showed in its proper place.  
It happeneth sometimes in anointing, that their Mouths are much ulcerated, and their Breathes smell strong, yet their Cheeks do not swell, nor they spit considerably; in which case forbear the anointing and consider the cause of it, and if the Body be strong and Plethoric, vomit them with Turbith, or infus. croc. metallor. but if they be weak or costive, administer a Clyster, and if afterwards it arise not, dispose them to sweated with draughts of warm Posset-Ale, or bathe them, for that way it will be sometimes raised when by the other it will not. But if they have faintness or palpitation of the Heart, shortness of Breath, Fever, etc. your best way will be to purge it of by some infus. of Sena, etc. or decoct. Senae Gereonis, with the addition of syr. Ros. solut. syr. de Spina cervina, etc. and keep up their spirits the while with Cordials and good Broths. If their Lungs be oppressed, let them blood, and prescribe Lohoches; but if there be also a suppression of Urine, or that they make but little Urine and high coloured, purge them with Barnet or Epsom water turned into Posset, and quicken it with some purging Syrup. If by these ways of purging the accidents remit and the Salivation riseth, it is well; but if it do not, yet there being a colliquation made, you may by well purging, strict diet, sweeting, etc. obtain your end. While you are removing the abovesaid accidents, you must have a special regard to the Ulcers within their mouths, for it is from the fixing of the Mercury that those malign Ulcers are made, which the lesle sensible they are of them the more corrupt they are.  
Sometimes in raising the Salivation by Unction it passeth downwards by Stool, in which case we prescribe Theriaca, Diascord. Laudanum opiate. etc. which being given at night will not only strengthen their Bowels, but dispose them to rest, and encourage them to go on in the anointing. A vomit of Turbith Minerale after the unction hath been somewhile used, doth frequently raise the Salivation; and after it is once well raised, you may heighten or continued it by the application of some of the Emplasters following. But if after all your endeavours to raise the Salivation it doth discharge itself in a Diarrhoea with great evacuation, you are than to defent the Intestines from the acrimony of the humours by Clysters of Chicken broth, Milk with ol. Olivar. vitel. Ovor. jest a dysentery do follow. Suppositories of Dear Suet, or ol. Hyperici, etc. cast up with a Syringe, are proper to appease the tenesmus. Inwardly we prescribe large draughts of Chicken broth, decoct. corn. cervi usti, Milk and Water boiled with a stick of Cinnamon.  
After the Flux is stopped, you must consider the strength of the Patient, and the quantity of the unction which was applied, and the greatness of the evacuation. If it was to the extreme weakening of the Patient, do not insist long upon the thoughts of salivating again, but proceed with Sudorificks, etc. as abovesaid; not doubting of success in the cure. For such Diarrhoeas do for the most part contribute as much to the cure as if they had salivated.  
There is yet another way of Salivating, and that is by the application of Mercurial Emplasters about the Arms, Legs, etc. They were first designed I suppose for the more tender and delicate sort of people who would not admit of the unction. There are various prescriptions of them, whereof I shall offer you one, viz. ℞ Empl. Diachyl. ireat. lb j. Empl. de minio ℥ viij. Gum. Caranae, Tacamahaccae an. ℥ iv. Benzoini, Styracis, Calamitae, Succini, an. ℥ ij. Styracis liquid. & Balsam. Peruvianae an. q. s. Misceantur super ignem, deinde amove, & addantur merc. crudi ℥ viij. cum terebinth. extincti, & fiant magdaleones. These being spread-upon Cloth thick and applied, you must than put them into a warm bed, and with a draught of warm Posset-drink sweated them daily, and treat them as hath been said in the salivating by Unction. If it arise not by the first Plasters you must apply fresh once in four or five days, and if there be occasion you may hasten the salivation by a few grains of Turbith Mineral. I have sometimes salivated persons by these Emplasters, but for the most part I use them to raise a Salivation, or continued it in such where I began it with Internals, and to that purpose it is of excellent use.  
The humours being evacuated by Salivation and Purging, 
Sweeting,  Sweeting will be necessary; Therefore we shall now say somewhat of their manner of Sweeting. They may sweated in Bed, or out of it. The Bed is proper for the weaker sort, and there they may sweated by Bottles of warm Water or Bricks heated and placed about them, or they may sweated under a Frame. If they sweated with Bottles or Bricks, they must have many , as Blankets, etc. to cover them close, and the Bottles or Bricks may be wrapped in Napkins and applied, accordingly as you design more particularly to sweated any one part. Generally they are placed on each side near the axilla, the Ischia and at the soles of the feet. If you sweated with Bricks, let them be heated rather by boiling water than fire, left in the bed they burn the Patient.  
The way by a Frame is this; You are to sold a well aired Sheet four double, and lay it under the Patient, than his Shirt being stripped of, the Frame must be placed over him, and a Sheet over that Frame, and as many Blankets over that Sheet, and both Sheet and Blankets must be brought over the end of the Frame, and be tucked down close to the neck; than a pan of well  Charcoal or Spirit of Wine must be put into the lower end of the Frame: this done shut the door and take care that the heat be kept in, especially about the Patient's neck jest it stifle him. His head aught also to be covered warm that it may sweated. If he took not his Sudorific before he was placed under the Frame he may take it now; the Diet-drink must be warmed, and may be commodiously given with a Glass-pipe. There is required a couple of Servants to attend the Patient during his being in the Frame: The one of them must attend him with a warm Napkin to wipe the sweat of his Face, and to give him  to rub his body, which  aught to be thrust in and taken out at the one side of the Frame. This Servant aught to have regard to his Master, that upon the lest complaint he may give warning to his fellow to renew the fire or take it out according as there shall be occasion. The fire being removed and the sheet next the Frame somewhat cool, the one of his Servants shall hold the  close to the Patient's neck and shoulders, whilst the other draws the Frame away. Than shall they both tuck the Blankets and covering close to him, and give him another draught of his Diet-drink, and continued him in his sweat half an hour or more if he can admit it; than gradually cool him and pull away the wet folded sheet from under him; than rub him with dry  and put on his shirt; and if he be disposed to slumber an hour, he may; otherwise he may rise and dine at his pleasure. They commonly sweated 3 quarters of an hour in the Frame, and an hour in Bed after the Frame is pulled away.  
These are the ways of sweeting in Bed.  
The ways of sweeting out of Bed are by Stove, Tub, Chair or Cradle. The Stove is the most easy in regard they may sit, stand or walk up and down; but when they go out of them to bed the danger is in taking cold, whence new pains do sometimes arise. Therefore those Stoves that are near to a good bed are best; the other which you must go up or down stairs to, are not allowable. Tub and Chair were the old way of sweeting, but if the Patient 'swounds in either of them, it will be troublesome to get him out; possibly he breaks his shins, if he did not hung some while by the neck before they got him out. To avoid which they must take them out upon the lest complaint of fainting, and have some Cordial to relieve their Spirits.  
In the Cradles they are subject to accidents by the disjointing of the Frame or breaking of the Girts, etc. but in every of these I have sweated my Patients with much safety, and so may you.  
Bathing is of great use in the cure of this Disease, 
Bathing,  whether it be new or old. In the recent it serves to contemperate the great heat and acrimony of the humours, especially in the Gonorrhoea.  
In squalid and dry bodies where the Lues hath been long confirmed, Bathing is necessary to humect and rarify the humours and dispose them to salivate. They are also proper after the Patient hath passed through the strict course of Salivating, Purging, Sweeting, etc. The body being thereby dried and emaciated, is hereby cooled, moistened and restored to its natural temper.  
In order to the Bathing we generally let Blood and Purge, if there be plethora; but in poor emaciated dry bodies a Clyster may serve, or their bodies may be kept soluble by a lenient Bolus of Cassia, Manna, Syr. Violar. etc. and before the Patient enter into the Bath he may drink a draught of Caudle or Broth, and in the Bath he may take a spoonful or two of Hartshorn Jelly, etc.  
The Vessel we bathe in is a Tub, wherein he may sit up to the neck. For want of such, a Barrel may serve, the one end being beaten out and a Stool placed in it to sit upon. The Bath Liquor is according to the occasion and quality of the Patient, sometimes it is all Milk, othertimes Milk and Water, or only Water, with a Bag of wheaten Bran, which serves the Patient as a Cushion, and makes the water milky. They are sometimes perfumed with Lig. Cassiae, Rhod. saint. citrini, Calam. aromat. Junc. odorat. flor. Ros. damasc. etc. The Baths of Milk are apt to sour, therefore aught to be renewed daily, the other will last longer sweet. In the time of Bathing there aught to be plenty of hot and cold water to continued the Bath of a moderate temper, neither too hot nor cold. Some Hoops should be fastened over the head of the Tub, whereon a Blanket or Sheet as a Canopy may be cast, in case the Air be cold. A Servant or two aught also to be attending in case of fainting, jest he sink into the water. Therefore upon his complaint raise him up, and casting a sheet about him put him into a warm bed, where he may refresh himself, and at his leisure arise and  himself, and dine or sup as his Appetite requireth. They may bathe twice a day, but never upon a full Stomach.  
During the Cure of this Disease it will be requisite that the Patient keep his Chamber, and that it be made temperately warm; The taking of Physic and rambling abroad in the cold being extremely prejudicial to their Cure, and is frequently attended with a diarrhoea, or noise in their Ears with deafness. There is also a special care to be taken concerning their Diet, 
Diet,  that on those days they purge, their Dinner be of good nourishment, boiled or roasted. We also allow them good Broth, and Beer or Ale to raise their strength, so as they may be able to bear the evacuation which is required. But in the time of their sweeting we confine them to a very slender and drying Diet, only sufficient to support their Spirits. A chop of a neck of Mutton, or two Ribs dry roasted was the old stint. I permit them to make choice of some one sort of meat and keep them to that, which amongst the better sort is a Partridge, and that without sauce. Their suppers may be Biscuit, Raisins of the Sun and a few blanched Almonds, and their drink decoct. Sarsae, etc. But in weak and extenuated bodies China-Broths, or a mixture of Milk with their Diet-drink may be necessary.  
Exercise is of use in the beginning of this Disease, and may serve to rouse the Native heat to thrust forth the malignity and waste superfluities. But after the Disease is more confirmed, violent Exercise is hurtful, exhausting the Spirits too much, and renders them lesle able to resist the Malignity.  
Sleep is allowed in the day to refresh them, they being for the most part disturbed in the night by their pains, which are therefore called Nocturnal.  
In the time of Salivation they must sleep when it affects them. To sleep also after Bathing and Sweeting is necessary to refresh them.  
Venery aught to be avoided during their course of Physic, it being one main cause of the unsuccessfulness of it: Yea, the very thoughts of it is destructive to their healths; nay, though he believe himself Cured I would not have him over-confident that way, till he hath passed a Spring or Autumn. For if he be married, and bed with his Wife, and afterwards relapse, he may possibly fancy that she infected him; which may not be unlikely, if he bedded with her before he entered into Cure. However it was, the consequences of it may be very ill, and may 'cause a loathing in him of her Bed, when it's possible he was not well Cured, and would have relapsed with a Gonorrhoea or Chancre, though he had not touched any Woman.  
The passions of the Mind aught to be calmed, and the Patient to be well satisfied in the Integrity and skill of his Physician or Chirurgeon, that he may the more cheerfully submit to the Rules prescribed in order to his Cure.   

CHAP. III. Of the Specificks in this Disease.  
IN the former Discourse I have had occasion to speak of the Deococt. Sarsa. etc. as sudorificks. Indeed those kind of Decoctions are the great hinges on which the Cure depends, as being supposed to contain in them besides the Sudorific Virtue other Specific qualities. Which appropriation of some Simples to the Disease more than others makes it necessary, before I proceed any further, to discourse of the nature of these Specificks, which I reduce to three heads, viz. either Vegetable, Antimonial or Mercurial.  
The Vegetables are usually reckoned these; 
Specificks,  guaiac. lign. & court. lign. sassafras. rad. china, sarsaparilla, saponaria. Of these all but saponaria are known Sudorificks, and may be easily supposed to perform all that is pretended to by them by that only faculty, unless we please to add dulcification. Whether Saponaria be a Sudorific I know not; nor indeed whether ever it cured the Pox otherwise than in conjunction with the former Specificks and so any other Herb will do it. Lanreola is in the West of England much commended. I suppose what it doth is only by strong purging, and when it is mixed in Diet-drinks, it serves to keep the Body open. What other Virtue it hath I know not.  
Antimony and Mercury are Medicaments of so large a compass, that they take in all the intentions of Physic. Hence we have Vomits, Purges, Sudorificks, Salivations. Vomiting and Purging are certainly of great use in this Disease; so is also Sweeting, which is very effectually procured by several preparations of both these, viz. Cerussa Antimon. diaphoret, etc. Bezoard. Minerale, Aethiops Mineral. etc. They have the vogue of exceeding other Medicines both by their strength and power of dulcification. And therefore it is that in purging also we make so much use of Mercurial preparations. But that Mineral hath also another faculty more eminent than all these, so peculiar to itself, that we found not yet any other medicine, Mineral, Vegetable or Animal that can imitate it, and that is Salivation; by virtue of which it melts down the serum of the blood, and with it all the acid venom contracted in it by this disease, bringing it away by the mouth.  
These are the so highly commended Specificks of which the former are the constant Ingredients of the decoction to be taken during the whole Course, but are accommodated to the Palate and other necessities of the Patient by the addition of other Simples. Mercury is also boiled either crude or prepared: So is Cinnabar and crude Antimony: which practice I have declined, and therefore I shall not say more of it. I shall only proceed to inform you how to mix other Simples with these already mentioned as occasion shall require.  
First therefore for aromatization we add sem. anisi, foenic. dull. coriand. calamus aromaticus, lig. Aloes, cassia; for other gratefulness Liquorish, Raisins, Ivory, Hartshorn. In complication of Diseases if the Head be affected, we add Betony, Sage, Rosemary. If the Breast, adianth. tussilago, scabiosa, marrubium, Hyssop, Figs, Dates, Sebestens, Jujubes. If the Heart, rad. angelicae, borag. Violets, Balm, scorzonera, scordium, Clove-gilly-flowers, Saffron. If the Stomach, Wormwood, Agrimony, centaur. card. benedict. If the Liver, Rhubarb, Turmerick, Liverwort, Succory, Dock-root. If there be Dropsy joined with it, than Briony of both sorts, Spurge, Laurel, Esula. For the Spleen, Dodder, Fern, Capers, Tamarisk, Spleenwort, Germander, Calamint, Hellebor, etc. In the diseases of the Kidneys, the five opening roots, also rad. althaeae, gram. rusci, alkekengi, eryngii, the cold seeds, etc. If Colicks infect the Patient, bacc. laur. juniperi, Galangal, Zedoary, etc. Than there are the greater and lesser Scorbuticks, also rad. bardanae & petasitidis, which are believed to have virtue to mitigate pain in the membranes of the bones, and resolve nodes; also rad. caryophyllatae, consolidae, bistortae, tormentillae, and many others which are thought proper to be added to Decoctions, and to medicate Ale or Hydromel. All which several forms of Medicines may be varied according to several intentions. In weak Stomaches we add Wine to the decoctions. In emaciated bodies Milk. Of the Sarsa decoctions I shall for the ease of the young Surgeons, set down some particular prescriptions, such as I have seen prescribed by worthy Physicians, and have practised with myself successfully.  
℞ Sarsaparillae ℥ viij. lig. guaiaci ℥ iv. court. ejusdem ℥ ij. lig. sassaffr. ℥ jss. ras. corn. cervi, 
1. Decoct. Sarsa. etc.  eboris an. ʒ vj. infund. per noctem in aq. font. lbxx lbxx. deindc coq. in vase clauso ad tertiae part. consumpt. addend. sub finem fol. saponariae cum radicib. M. ij. fol agrimoniae, veronicae utriusque an. M. j passular. enucleat. ℥ vj. sem. foenic. dull. coriand. an ʒ vj. liquiritiae Hispan. ℥ ij. aromatizetur colatura cum pauco cinamomi pro usu.  
℞ Sarsaparillae ℥ vj. lig. sancti ℥ iij. court. ejusdem ℥ j lig. sassafr. ℥ ij. rad. bardanae, 
2. Decoct. Sarsa. etc.  scorzonerae an. ℥ j santal. albi, citri an. ℥ ss. fol. laureolae praeparatae cum. aceto M. ij. passular enucleat. ℥ iv. rad. glycyrrhizae ℥ j sem. foenic. dull. coriand. an. ℥ ss. infund. in aq. calid. lbxij lbxij. coq. ad tertiae partis consumptionem.  

3. Decoct. Sarsa. etc.  ℞ Rad. sarsaparillaes ℥ vj. lig. guaiaci ℥ iij. court. ejusdem. ℥ j rad. chinae nodos▪ ℥ iij. lig. sassafr. ℥ jss. ras. C. C. eboris an. ℥ j rad. bardanae ℥ iij. santal. rub. alb. calam. aromat. an. ʒ vj. passular. ma. exacinat. M. j sem. anisi, foenic. an. ℥ ss. infund in lbxuj lbxuj. aq. font. per horas 24 in loco calido in vase bene clauso, deind. coq. lento igne ad consumption. tertiae partis, addendo sub finem decoctionis summitat. uphrafiaes, beton. salviae sic. & flor. 3. cordial. an. P. 1. cassiae lig. ℥ ss. nuc. moschat. nᵒ 2. coletur pro usu.  
℞ Sarsaparillae ℥ viij. scobis guaiaci ℥ iv. sassafr. ℥ ij. rad. bistortae, bardanae, 
4. Decoct. Sarsa. etc.  tormentillae, consolid. masc. an. ℥ ij. fol. agrimon. scolopend. utriusque, ceterach, endiviae cum toto an. M. j sem. anisi, foenic. dulc. coriand. an. ℥ ss. passul. ma. enucleat. ℥ iv. liquiritiae ras. ℥ jss. post debitam macerationem in aq. font. lbxx lbxx. coq. lent. igne ad medias, aromatizetur cum pauco cinamomo.  
℞ Sarsaparillae ℥ iv. lig. guaiaci ℥ iij. court. ejusdem ℥ ij. sassafr. ℥ jss. rad. petasitidis, bardanae an. ℥ ijss. lig. Rhodii, 
5. Decoct. Sarsa. etc.  santal. citr. an. ℥ j seen. cardui benedict. juniperi recent. an ʒ vj. court. exterior. citri siccat. ʒ ij. infund. in aq. font. lbxij lbxij. per noctem, & coquantur ad dimidias.  
℞ Sarsaparillae ℥ vj. chinae ℥ iij. sassafr. ℥ j lig. nephrit. ℥ ij. ras. C. C. & eboris an. ℥ ss. santal. albi ℥ ss. rad. petroselini, graminis, rusci, 
6. Decoct. Sarsa. etc.  eringii an. ℥ j liquiritiae ℥ ij. dactyl. exossat. nᵒ vj. sem. carui, coriand. an. ʒiij. infund. in aq. font. lbxiv lbxiv. coquantur ss. a. & aromatizetur cum lig. Cassia.  
℞ Rad. sarsaparillaes ℥ vj. ras. C. C. santal. alb. an. ℥ ij fol. sapon. agrimon. beton. an. M. j liquiritiae Anglic. Hispan. an. ℥ ss. f. infus. & decoct. in aq. font. lbix lbix. ad lbuj lbuj. vase clauso. Colaturam effund. super fol. cochlear. hortens. M. vj. post debitum refrigerium fiat secunda colatura. 
7. Decoct. Sarsa. etc.   
℞ Sarsaparillae ℥ ij. scobis guaiaci ℥ j court. ejusdem ℥ ss. lig. sassafr. ℥ j rad. tormentillae, bardanae, 
8. Decoct. Sarsa. etc.  vincetoxici an. ℥ ss. ras. buxi & lig. Rhodii an. ʒ iij. baccar. juniperi recent. ℥ ss. sem. cardui benedict. & oxalydis an. ʒ ij. flaved. citri ʒ j f. infus. in duabus partibus aquar. petroselini, parietariae, melissae, & una vini albi, uttiusque ad lbuj lbuj. & post macerationem coquantur ad medias: colaturae adde guttas aliquot sp. vitriol. aut sulphuris, & reservetur pro usu.  
℞ Sarsaparillae ℥ iv. lig. guaiaci interioris resinosi ℥ iij. court. ejusdem ℥ j sassafr. ʒ vj. rad. bardanae, scorzonerae, contrayervae, tormentillae, 
9 Decoct. Sarsa. etc.  petasitidis an. ℥ jss. macerentur in lbiv lbiv. vini albi tenuis super cineres horas 24. deinde additis aq. font. lbxij lbxij. coq. ad medias, addendo sem. anisi, foenic. dulcis, coriand. an. ʒiij. liquiritiae ℥ ij. coletur pro usu.  
℞ Sarsaparillae ℥ x. rad. chinae ℥ iv. rad. filicis foem. rec. ℥ iij. santal. albi ℥ ij. ras cornu cervi, eboris an. ℥ jss. infund. per hor as xij. in aq. hoard. lbxx lbxx. & coquantur ad tertiae partis consumpt. sub finem addendo passular. ma. enucleat. lb ss. deinde fiat colatura per manicam Hipp. addendo pro singulis libris liquor. sacchari optimi ℥ j sem. coriand. ʒj. & reservetur in lagenis lapideis subere obturatis in loco subterraneo faigido.  
After Decoctions some of the following Electuaries may be prescribed to provoke sweat, 
Electuaries.  the Patient drinking a draught of some of the forementioned Drinks warm after them.  
℞ Sarsaparillae pulver. ℥ ij. lig. guaiaci interioris resinosi ℥ ss. C. C usti, troc. hè viperis an. ℥ j santal. citr. tormentillae, succini an. ℥ ss. antimonii diaphoret. ad pondus omnium, cum syrup. de pomis alterant. de rubo idaeo an. part. aeq. f. electuarium. Does. ʒj. superbibendo decoct. sarsae ad sudorem provocandum.  
℞ Sarsaparillae pulv. ʒuj. rad. chinae nodosae ʒij. oculor. cancr. cerussae antimonii an. ʒiij. gum. guaiaci ℥ ss. Bezoard. occident. ʒj. ambregriseae gr. viij. confect. alchermes ℥ j syr. è cortic. citri q. s. f. opiatum.  
℞ Bezoard. minerale ℈ j pull. viperar. ʒss. Ms. f. bolus cum syr. de court. citri. Sum. manè superbibend. haust. decoct. sarsaes, etc.  
℞ Antimonii diaphoret. gr. xiv. lapid. contrayervae, ol. sassafr. gut. iij. confect. alchermes q. s. f. bolus, capiat ante ingressum hypocausti.  
In case of pain or diarrhoea from Mercury, ℞ Antimonii diaphoret. ʒss. laudani gr. ijss. cons. ros. rub. ʒj. syr. garyophyl. q. s Ms. sumat hora somm. Or, ℞ Diascordii ʒj. lap. bezoar. orient. gr. seven. C. C. usti gr. x. confect. alcherm. ℈ j cum ol. cinamomi gut 5. f. bolus; sumat hora somni. Or, ℞ Cons. rub. vet. ℈ j theriac. Venetae ʒss. cons. lujulae ʒij. laud. gr. iij. confect. alchermes ʒj. sumat bis in die.  
These following Prescriptions are Sir Theodore Mayerne ' s.  
℞ Guaiaci ℥ iv. court. ejusdem ℥ ij. sarsaparillae ℥ vj. gum. guaiaci, 
Electuar. Antisiphyllicum.  troch. viperar. an. ℥ ss. C. C. primar. recent. succini albi, coral. rub. margaritar. an. ℥ j santal. citr. lig. Rhodii, ras. buxi, rad. aristoloch. utriusque, gentianae, valerianae utriusque, Asclepiadis, scorzonerae, angelicae, imperatoriae, tormentillae, contrayervae, zedoariae, poeoniae maris, cypri, enulae campanae an. ʒuj. folior. sicc. scordii, chamaedryos, chamaepityos, centaur. min. melissae, rutae, calendulae, anthos, lauri, veronicae utriusque, ulmariae an. ʒx. court. citri & aurantior. siccat. an. ℥ ijss. sem. anisi, foeniculi, card. benedict. nigellae Romanae, poeoniae an. ʒv. baccar. junip. ℥ ij. myrrhae, styracis, calam. benzoin. croci an. ℥ ss. fiat omnium pulv. subtle. cui adde pro singul. ℥ vj. mellis despumati lb j. fermentetur per duos aut tres menses. Dosis ℥ ss. superhansto decocto sarsae, etc. ad sudoris provocationem semel quotidie per xxx. dies: & si catharticam cupis, add pulver. sennae, turbith & hermodactylor. an. ℈ j pro dosi.  
℞ Ras. lig. guaiaci lbuj lbuj. court. ejusdem, ras. buxi an. ℥ vj. sassafr. chinae an. ℥ x. court. median. ulmi, fraxini, radicum vincetoxici, scorzoner. tormentillae, bardanae. pet asitidis, baccar. juniperi an. lb ss. santali citri, lig. Rhod. an. ℥ iv. rad. cichor. ℥ iij. sem. cardui benedict. coriand. praep. an. ℥ ij. fol. agrimoniae, pimpinellae, beton. salviae, hepaticae an. M. ij. sem. halicacabi, melissae, milii solis an. ℥ iij. flavedinis exterioris court. citri siccat. ℥ iv. turbith, sennae, hermodactylor. an. ℥ vj. vini albi tenuis lb xxx. incisa vel contusa macerentur 24 horas in praedicti vini lb x. & coq. ad medias. Liquor calidus indatur doliolo, & affundatur residuum & obturetur; sinantur residere per quatriduum, postea bibat ℥ vj. mane & sero.  
℞ Ras. guaiaci ℥ x. court. ejusdem, sassafr. an. ℥ iv. sarsae ℥ viij. passul. ma. enucls. lb j. rad. bardanae siccatae, tormentillae, scorzoner. contrayervae an. ℥ iij. bacc. juniperi ℥ ijss. fol. agrimonii, pimpinellae siccae an. M. j coquantur in sacculo laxo in gallonibus vj. ad 4. partis consumptionem; postea infund. in alio sacculo in praedicti liquoris ferventis colati gall. iv. fol. sennae, sem. carthami contus. an. lb ss. court. & rad. esulae ℥ iv. hermodact. turbith gummosi an. ℥ vj. sem. anisi, foenic. dull. coriand. an. ℥ iij. & suspend malum aurantium garyophyllis transfixum; fiat in doliolo castae capacitatis fermentatio, & postea obturetur vasculum, & bibatur mane & vesperi cum diaeta tendi & exsiccante.  
℞ utrumque sacculum post debitam coctionem & infusionem nec non mediocrem expressionem in liquore praedicto, & coquantur in cervisiae recent. gall. viij. ad quartae partis consumptionem pro potu ordinario. Aromatizetur cum aurantiis duobus transfixis garyophyl. & flaved. court. citri & pomor. fragrantium.  
℞ Succour. recent. express. fol. bardanae, 
A qua Antisiphyllica Sir Theod. Mayern.  petasitidis, cardui benedict. card. Mariae, calendul1ae, ulmariae, scabiosae, melissae, canabis aquat. tapsi barbati, salviae, beton. fraxini, chamaedryos, pimpinellae, hyperici an. lbij. lbij. dent. leonis, cichorei, lujulae, acetosae, oxylapathi, nasturtii aquat. cochleariae utriusque, becabungae an. lb iij. rad. recent. filicis foemin. lbij. lbij. bardanae, petasitidis, caryophyl. pentaphyl. tormentillae, enulae campanae, cypri, valerianae utriusque, poeoniae maris an. lb j. calami aromat. ireos Flor. gentian. zedoariae, aristoloch. utriusque, vincetoxici, court. citri, aurantior. an. ℥ vj. ras. lig. sancti, sarsae an. lbij. lbij. court. ligni sancti, buxi totius, sassafr. lig. Rhod. santal. citri an. lb ss. baccar. juniperi lb jss. sem. anisi, coriand. foenic. dull. poeoniae an. ℥ vj. vini albi tenuis lbuj lbuj. aq. fontis lbxx lbxx. Radices & ligna macerentur in vino super cineres calidos per horas 24. addantur postea succi & aquae, & destillentur in vase aeneo amplo cum capitello, & coletur post validam magmatis expressionem. Fiat liquoris expressi destillatio ad mellaginem, quae addito saccharo aut melle despumato reservetur in vase bene clauso. Magmati affunde aq. fontis lblx lblx. & post duorum dierum macerationem destilla pro aqua secundaria minùs forti, quae cum primaria in morbis minis contumacibus misceri potest, aut cum decocto secundario guaiaci pro potu ordinario.   

CHAP. IU. Of the Cure of the Symptoms.  
THat which now remaineth to be considered of, is, the right application of Medicaments in curing such Symptoms as the LVES is subject to. Fallopius, and others, who taught to Cure this Disease by Galenical Remedies, have taken much pains in contriving Medicaments for the curing the Chancre, Herpes', &c. but that will be needless here. The method of Cure I have proposed by Internals will enough contribute to the Cure of all the External symptoms; so that only which is required from us, will be the resisting the fluxion till our Internal Remedies have taken place.  
In Inflammations, Swell and Excoriations of the Penis and Pudenda: ℞ Summitat. rubi, equiseti, ling. cervinae, fol. plantag. an. M. j flor. ros. rub. M. ss. coquantur in aq. font. ad lbiv lbiv. Colaturae adde mellis come. lb ss. aluminis roch. ʒiij. iterum sinant. parum bullire, & decoctum despumetur. Foment the diseased parts, and inject of it between the prepuce and glans, or in the pudendum. If there be required more detersion (through the neglect of the Patient in not discovering the Malady more timely) add mel Aegyptiac. proportionably as you see cause, and dip pledgets of lint in the lotion, and apply them upon the Ulcerations. If the Ulcer be in the Vrethra, ℞ aq. germinum querci, plantag. & fragariae an. ℥ ij. troch. alb. Rhasis pull. ℈ ij. If that place be affected with a Chancre, than add mel Aegyptiac. instead of the Trochisk. But if Chancres arise in such places where you can see to apply your Medicament, touch them with lac sublimat. or apply pledgets of lint dipped in it, and pressed out. If this prove too sharp, dress them with the former decoction.  
If a Swelling arise in either or both the Groins, and no other symptom of Chancre, etc. afflict the Patient, endeavour suppuration by such like emplaster: ℞ gum. galban. ammoniaci an. ℥ ij. opopanacis, sagapeni an. ℥ i sem. sinap. pyrethri pulv. an. ʒuj. sapon. come. ℥ ij. picis Burgundiae ℥ iv. ol. lilior. ℥ ij. cerae q. s. f. empl. After suppuration open it, and treat it as hath been elsewhere said in the Chapter of Bubo. But if there be a Chancre, etc. accompanying it, do not attend suppuration, but purge it of with Antivenereals.  
In Ulcers of the Tonsils and Palate. ℞ Trachelii totius M. iij. caprifolii, prunellae, veronicae masc. an. M. j flor. ros. rub. P. j santal. rub. lig. juniperi a ℥ j f. decoct. in aq. hoard. lbiv lbiv. coq. ad tertiae partis consumptionem. In colat. dissolve syr. de rosis siccis, diamori. an. ℥ iij. mel. elatim. ℥ ij. f. lotio. With this the Ulcers may be washed daily, either by a syringe or gargling. But if the Ulcers be behind or over the palate, the best way to cleanse them will be to pass the injection up into the nostrils. During the while the Patient must hold his mouth full of water to prevent coughing or kecking. If the Ulcers be sordid, dress them with lac sublimat. upon an armed probe. If there be Caries in the os palati, 
Laminae.  touch it with aq. divina Fernelii. In case the bone he corrupted through, it will be necessary that the place be supplied by some plate, or passed: The former are made of Silver or Gold by our Workmen to good advantage.  
Those of Paste may be made as followeth: 
Laminae catagmatiae.  ℞ mastic. pellucid. pulver. ℥ j emolliatur in sp. vini, olibani, sandarac. gum. guaiaci naturalis, sang. draconis, rad. iridis Florent. myrrhae, C. C. usti, succini an.ʒj. Ms. & f. pasta, ex qua formentur lamellae. Which being fitly applied to the part will dispose the Ulcer to heal, and serve those ends you design it. But if some part of that bone be carious: ℞ Laminae praescriptae ℥ j aristoloch. rot. ʒj. rad. pucedanis, gentianae an. ʒss. caryophyl. ℈ ij. pulveriz. & misceantur cum pauco terebinth. Cypr. s. a. pro usu.  
In Ozaena or Ulcers of the Nose, and Os ethmoides, the matter usually mixing with the excrementitious humours drieth in the passage, and thereby prohibits the discharge, and increaseth the Ulceration, and also the Caries: therefore you are in the first place to suppling and remove that by casting up mucilaginous decoctions of this sort: ℞ hoard. mund. ℥ j rad. althaeae ℥ ij. sem. cydon. ʒiij. liquiritiaeʒij. coq. in aq. font. ad lbij. lbij. colaturae adde olei amygd. dulc. ℥ iij. injiciatur saepe in die. The mucus being thus removed, inject some of these following:  
℞ Sarsaparillae incisae ℥ iij. infunde per debitum tempus in lb iij. aq. plantag. deinde coq. ad medias: ante finem add fol. agrimon. salviae min. summit. rubi an. M.j. flor. ros. rub. ballast. an. M. ss. colatura saepius chalybeatur, & add alum. roch. ʒij. f. injectio. 
Mel Magistrale.   
℞ Succi beton. ℥ ij. succi scrophulariae maj. ℥ vj. succour. pimpinellae, caprifolii an. ℥ iij. mel. rosat. colati ℥ iv. mel. come. ℥ iij. coquantur ad consistentiam mellis pro usu.  
℞ aq. calcis lb j. mel. magistralis ℥ iij. Ms. Which aqua calcis is thus made.  
℞ calcis vivae lb j. aq. pl●●iae lbxij lbxij. coq. ad tertias, filter it through a brown paper for your use. Or, ℞ aquar. ros. rub. beton. majoranae an. ℥ iv. sp. vitrioli dulcicati gut. xxx. mel. magistralis suprascripti ℥ ij. These will deterge the Ulcers, and the while you may by Antivenereals hasten the exfoliation of the bones, and consolidation of the Ulcers. In the extirpation of verrucae, mariscae, condylomata, ficus, etc. aq. divina, lac sublimati, sp. vitrioli, & lap. causticus are proper. Where these will not ferve your purpose, the Ligature and Knife or actual Cautery will: but the recidiveation of them must be prevented by Antivenereals.  
To cure fluttering noise in the Ears, etc. arising in this Disease.  
℞ court. guaiaciʒj. court. sassafr. ʒij. castorei ℈ iv. flor. lavendulaeʒjss. caryophyllor. ʒss. sp. vini rectificat. ℥ viij. f. infus. in vase vitreo per horas 24 super cineres calidos; colatura usui servetur: indatur auribus quotidie tepidè cum bombyce.  
To alleviate pains. ℞ axung. suillae ℥ iv. ol. scorp. ℥ ij. ol. chamaemel. rorismarini, salviae chymic. an. ʒss. olei petrolei, spicae an.ʒj. laudan. Londinensis ℈ j plus aut minus, misceatur; and embrocate the part affected.  
If there be Gummata, apply empl. è bolo, etc. To prevent Ulceration till internals take place. If Nodes be the cause of the pain, foment them with sp. vini, wherein Opium and Saffron hath been dissolved: Or, ℞ empl. de Vigone quater duplicato mercurioʒiij. rad. bryoniae nigrae siccatae pull. ʒuj. cinnab. ʒiij. croci ℈ iv. opiiʒij. ol. nuc. moschat. ʒj. terebinth q. s. Or, a solution of argent. viv. in aq. fortis, cum axung. porcina & cera f. ceratum. If you will proceed higher, and ulcerate the skin, this lineament of Hartman will do it. ℞ unguent. aurei P. iij. merc. sublimat. P. j If you apply it thick spread, it will eat to the bone, and if it be not kept within compass it will ulcerate the skin as far as it spreads; but being discreetly applied it seldom fails: But in my Practice I rarely use any of them, unless it be in people who by reason of their weakness are not able to bear a severe course of Physic; for in others I commonly resolved them by virtue of the internal Remedies: they resolving either in the time of salivating, or sweeting. Nor do I lay open the Gummata, unless they be in Cranio, and there indeed we aught to open them, to prevent rotting of the bones and membranes underneath. But when Ulcers with Caries come under my hands, I dilate the ulcers, and make way to the bones, and treat them as hath been set down in the Chapter of Ulcers with Caries; they not differing otherwise, save that in these the Patient aught to continued in the use of Antivenereals during the Cure.  
In consideration that these diseased people are confined to their Chambers during their Cure, it will be reasonable to make their confinement as pleasant as we can; to which end the following Perfume may be useful.  
℞ gum. guaiaci ℥ j masticb. benzoini an. ℥ ij. styracis, calamitae, lig. rhodii, aloes, flor. ros. damasc. santali citri, juniper. summitat. rorismarini, lavendulae, majoranae an. ℥ ss. f. omnium pulvis crassiusculus, qui cum aq. ros. irroretur; huic additâ duplo quantitate carbonum salicis cum mucagine tragacanthae in aq. naphae extractae.  

Observations of the lesser Species of Lues Venerea.  
A Young Man having been debauched into lascivious Company, 
1. Observation of inflammation and excoriation of the Penis.  complained to me the day after, and shown me the Prepuce much inflamed and swelled and turned backward; there was also an excoriation between the glans and part of the prepuce. I fomented the penis with read wine, and applied pledgets of lint pressed out of the same on the excoriation, and unguent. album camphorat. over all, leaving a passage for urine. Than let him blood in the arm about ten ounces. A Clyster was administered some hours after, and that night at his going to bed I sent him a Bolus of. cons. ros. ʒss. merchant dull. ℈ j and purged it of the next morning with Manna in Posset-drink, and dressed him the same morning with decoct. plantag. summitat. rubi, equiseti, etc. By this method of dressing, and by the repeating the use of the merchant dull. alone, and with purgatives, I dried up the ulceration and inflammation, leaving the prepuce lax as formerly. I had thoughts of prescribing him a longer course, but he continued well without it.  
Another came to me with an inflammation of the prepuce, 
2. Observation.  it was swelled over the glans, and by the quantity of fetid matter which discharged I supposed a Gonorrhoea, at lest a great excoriation between the prepuce and glans. I fomented it with decoct. plantag. summit. rubi, equiseti, etc. and injected some of it with a Syringe, and lapped a stupe about it, and continued that method of dressing it twice a day; sometimes adding a little mel Aegyptiac. to the decoction. I also let him blood, and repeated the method of purging, as in the former Observation, till I had healed the ulceration, and relaxed the swelling. Than returning back the prepuce, and observing that the fetid matter had proceeded only from an excoriation between the prepuce and glans, I dismissed him without putting him into other course of Physic.  
One came to me with an Inflammation and great swelling of the glans and prepuce, this latter being turned back in coitu straitened the glans, 
3. Observation of inflammation of the prepuce.  and hastened those accidents of inflammation, etc. and would soon have gangrened in spite of all applications. To prevent which, I prepared to divide that part of the prepuce which made the stricture. It was not easy to found the way to it, by reason of the inflation of the upper tunicle; but having passed a director under it, I cut through the stricture, and gave liberty to the glans, than fomented the diseased parts with the decoct. plantag. etc. and rolled a hot stupe over it, than let him blood, and treated him as venereal. The next day I found the swelling discussed, and the prepuce lie flaccid and natural; the wound cured in the skin a few days after by the common applications. This turning back of the prepuce is frequently seen in young Lads, who wantonly handle it. Sometimes it happeneth in Conjugal Rites, and not being returned soon over again, it straitens the glans, and accordingly hastens the accidents of inflammation. The Cure is effected by timely fomenting with emollients; but if that way fail, you must divide the prepuce as abovesaid. In some of those who have the prepuce very short, the fraenum is also so straight, that upon the erection of the Penis, the Glans is pulled downwards, so as they cannot endure coition. The remedy is by cutting the froenum in pieces. If you suspect that the divided ends may be troublesome, clip them of at the same time, than put a dossil of dry Lint close between the Glans and that part of the Prepuce to prevent the coalition of them.  
A young fellow came to me with the Prepuce inflamed, and a mortification on the upper part of it, 
4. Observation of the Prepuce gangreened.  which had spread the compass of a broad Shilling on that part over the Glans. In scarifying the Eschar I found it had penetrated through: upon which consideration I made separation of the Prepuce with a pair of Scissors cutting it of round, than dressed it come pull. Galeni & albumine ovi, the next day I gave him a Lenitive Bolus, which purged him moderately. In the making extirpation of the Prepuce I had permitted him to bleed freely, and by the Lenient purge his body was cooled, so that at the next opening I found the Sore digesting. I dressed it with digest. ex terebinth. and the excoriation about the Glans with unguent alb. camph. The day after I purged him again with the same Lenitive and calomel. By the reiterating of those purgations he was freed of the malignity. The Penis was cured by the common applications in such cases proposed in the method of cure.  
One coming to me with a Chancre on the outside of the Prepuce with callus, 
5. Observation.  I sprinkled it with merchant praecipit. and applied a pledget of unguent. diapompholig. over it with bandage, than let him blood and purged him with decoct. amarum, giving him merchant dull. every other night, sometimes two nights together. After the application of the Precipitate 2 or 3 times, I dressed the Chancre only with a Pledget pressed out of aq. calcis, by which, with the help of the Internals, it was soon cicatrized and the calluus resolved. The relics of the Disease which I supposed to be lurking in the body I carried of by the continued use of the Antivenereals, and concluded the course with decoct. sarsaes, sweeting, etc.  
A man of about 26 years of age, 
6. Observation.  of a full body, came to me with a Chancre between the Glans and Prepuce on the right side. I dressed it with lac sublimati. I let him blood and purged him with an infusion of sena, rhab. etc. in a decoct. tamarind. with syr. de spina cervina, and syr. ex infus. ros. cum agarico. The same night after his first sleep he took ℈ j calomel. in ʒss. cons. cichorei, and the next morning I purged it of with some of the former infusion. The second day after I purged him with pill. cochiae min. ʒss. merchant dull. ℈ j and from that day purged him proportionably as his strength would bear, increasing or diminishing the one or other of them so as to avoid making his chaps sore. The Ulcer being thus cured and no hardness remaining, I than prescribed him a decoct. sarsaes, etc. and designed the sweeting of him; but he finding himself well thought it unnecessary, and did not drink four quarts of his Diet-drink, yet continued without relapse.  
One of about 40 years of age of a gross body had a small Chancre on the left side of the Glans, 
7. Observation.  I sprinkled it with merchant praecipit. and applied over it a pledget of unguent. diapomphol. than let him blood, and the next day purged him with pull. cornichini ℈ ij. which gave him 14 or 15 stools. The day after I purged him again with pull. cornichiniʒss. merchant dull. ℈ j I dressed the Chancre with a solution of mel Aegyptiac. in a little of the decoct. plantag. equiset. etc. upon Lint, and left some of it with him to dress himself daily. I also left with the Patiented some papers of pull. cornic. with and without calomel. which he took interchangeably. He had a strong body, and being pleased with the working of the Physic he took it daily, and many days after the Chancre was cured, and the hardness resolved: but the weather growing cold he neither drank his Diet-drink, nor sweat; nor in truth did I think it so very necessary. A month or two after he shown me a round crusty Ulcer rise upon his Arm, and such another upon his Thigh and Breast; I let him blood and repeated purging, and by 3 doses of Turbith Mineral given at distant times, purging him between each dose, I avoided the making his chaps sore, and dried the Ulcers, and by a course of Diet-drink and Sweeting secured him from relapsing.  
A man of about 36 years of age came to me with some small corrosive little Ulcers on the Fraenum, and on each side of it; 
8. Observation of a Chancre in Vrethra and Fraenum.  also a large Chancre in the very entrance into the Vrethra with a hard callus round that part of the Glans. I touched the Ulcers with lac sublimat. and applied over them pledgets pressed out of the vulnerary decoction. I let him blood soon after, and gave him that night ℈ i calomel. and purged it of the next day with an infus. of Sena, etc. For the more speedy relief of the fraenum I gave the next morning ℈ ss. of Turbith Mineral; it vomited him thrice: after which I gave him a draught of the infus. of Sena, and purged it downwards. By this I checked the erosion in the Ulcers, but the fraenum was so far fretted, and withal so painful, that I divided it, and with the Vitriol stone rubbed the broken ends thereof, and continued dressing it as abovesaid, and by frequent repetition of Antivenereal purgatives, I cicatrized those Ulcers about the fraenum. The Ulcer within the urethra healed also much about the same time. The callus on the top of the glans joining to it was a longer work, but was resolved by the said way of purging: after which I put him into a strong decoction of sarsa, and sweated him with antimon. diaphoret. etc. purging him with pill. cochiae min. and praecipitat. alb. every fourth day, by which course I confirmed his cure.  
A young fellow whom I had cured of a Chancre between the Glans and Prepuce, 
9 Observation of Chancre with inflammation.  and was putting him into a course of Diet-drink and sweeting, pretended some extraordinary business for two or three days, in which time he came to me with an inflammation and excoriation of the penis, with a small ulceration on the top of the glans, and would have imputed it to my not having well cured him: but its recency with the inflammation demonstrated sufficiently that it was a new Clap, and I was obliged to him that he came to me again for cure. Others of his metal have not been so kind. I repeated venaesection, and dressed him with the decoct. plantag. summitat. rub. etc. as it is set down in the method of cure, and purged him with pill. ex duobus & calomel. increasing and diminishing the one and the other to avoid the making his chaps sore: than by a course of Diet-drink, sweeting and purging finished the cure.  
One of about 36 years of age came to me with the Prepuce inflamed and swelled over the Glans, the end of the Prepuce being carnous, 
10. Observation of Chancres and Ulceration.  and contracted so close, that I could scarce get in my Probe. The glans felt hard and unequal, and much fetid matter discharged from between it and the Prepuce, which certainly demonstrated Chancres and great ulceration of some continuance. He had also swelled Glandules in both his Groins. I fomented the swelling with decoct. malvae, tap. barbat. sem. lini, foenugraeci, etc. and injected the vulnerary decoction with unguent. Aegyptiac. and put in a short tent of rad. gentianae dipped in oleo lilior. into the contracted Prepuce, with directions that he should put in a fresh one so often as he should urine, or syringe himself. To which purpose he had many prepared bigger and lesser. That day I let him blood, and directed a Clyster, and purged him the next morning with pill. cochiae min. & merc. dull. and repeated the said Physic according to his strength, proportioning the merc. dull. so as to avoid salivating. By this method and by his course of Diet with Sudorificks, the Ulcers healed, and the carnosity resolved; but the entrance into the Prepuce continuing narrow, I passed in a pair of probe scissors as high over the glans as the narrow entrance would admit; than pulling back the exterior tunicle I cut the inner straitened coat, till I had so enlarged it that it turned back. That done, I applied my Restrictives upon the wound and rolled them on, leaving the glans only covered with the circumvolutions of the rowler. The third day after I dressed it again, and saw the wound digesting and healed in some parts, I dressed it with the digest. ex terebinth. cum vitello ovi, and applied a folded linen dipped in albumine ovi over it, and rolled it as before. I afterwards cured the wound with unguent. tutiae, and than permitted the prepuce to return to its place. In this case I have sometime made two or three stitches at equal distance, by which the lips have been sooner united. In those where the prepuce is not retained back, the wound cureth and leaves the prepuce deformed and troublesome in coition, upon which account I circumcised one lately that came out of other hands. You aught to be careful in the dressing ulcerations between the glans and prepuce; for it sometimes happeneth, that they grow together, yea, in such cases the very entrance into the Vrethra will contract extreme narrow, and sometimes close up.  
A poor Gentleman supposing his difficulty in urining proceeded from the Stone, 
11. Observation.  silently endured it till the urine was in a manner suppressed: than I was fetched, and saw the prepuce stretched over the glans, and the entrance into it carnous, and scarce wide enough to admit of a probe. I made a dilatation by a small pair of Plyers, than passed in a probe, but could neither get into the Vrethra, nor pass considerably between the glans and prepuce. The work required dispatch, therefore having drawn out the interior tunicle, and thrust backward the external one, I caused my Servant to make a Ligature upon the prepuce close by the end of the glans, and with a knife cut of the hard carnous end of the prepuce. I thought to have turned it back, but found the interior coat of the prepuce firmly grown to the glans round, as if it had been one body, and the entrance into the Vrethra almost quite closed up by a hard cicatrix. I brought the incised lips of the coats of the prepuce together, and retained them so round by a few stitches; than having wiped away the blood with a sponge, I made an apertion through the cicatrix, enlarging the entrance of the Vrethra, and gave way for his urine; than put in a piece of a searching Candle to keep the passage open. I dressed up the prepuce with pull. Galeni upon pledgets of lint dipped in albumine ovi, and brought a fold of linen over it, leaving a passage for urine. That afternoon I took out the wax-candle, and put in a leaden pipe, which was easily retained for discharge of urine, and the while cicatrized the apertion there. The wound in the prepuce being digested and cicatrizing, I cut out the stitches. This Person pissed out seventeen piples in few days after. Infants are sometimes born without this apertion, in which case if it be not speedily made, the urine makes its way through some part of the ductus, or the Infant dieth miserably.  
A young Blade was commended out of the Country to a Physician here, 
12. Observation of Chancre, and Glands' in both Groins.  who committed him to my Care. The prepuce was swelled and inflamed, between it and the glans there were many Chancres, as I supposed by the hardness I felt, and by the discharge of fetid matter, and from thence I judged the inflammation and swelling in the prepuce to arise. The Glandules in both his Groins were swelled. To have waited for suppuration in these had certainly caused the putrefaction of the other diseased part, it being than in great danger through the so long concealing of it. Wherhfore I began with fomenting and syringing of it with the decoct. plantag. summitat. rubi, etc. with an addition of ʒj. Aegyptiac. to six ounces of the decoction, and continued the dressing of him with that twice a day. The Physician prescribed him a Clyster that night, and the next morning we let him blood in the Arm, and purged him the day after with extract. Rudii & calomel. and the next day repeated a Clyster. The day after he was purged again with extract. Rudii & ℈ j calomel. After this manner he was treated from the 16 of August to the 15 of September following, he drinking a decoct. sarsae upon a Sudorific Bolus those mornings he did not purge; and from the third day of his purging he made that decoction his constant drink, unless it was those morning's while he was purging, and than he drank a thin broth. By this method the Glandules in his Groins resolved, and the Chancres cured: the callosity also on the glans and end of the prepuce resolved, and became naturally lax as before. Than we kept him strictly to his Diet-drink, and sweated him in a wicker-chair with Antimon. diaphoret. gum. guaiaci, and a warm draught of his Decoction, and purged him every fourth day with an infus. senae, etc. and so proceeded to the 4th of October. Those days he sweated he dined upon a roasted Partridge, and at night was allowed Biscuit and Raisins of the Sun; and when he purged he dined upon boiled meat and drank small Ale. During the whole course he kept his Chamber, and by so doing was perfectly cured without making his Chaps sore in the lest.  
A young Woman was put into my hands, 
13. Observation of Inflammation and Chancre in pudendo.  having a great inflammation and swelling in pudendo, with a large round Chancre between the ductus urinarius, and the interiors of the vagina uteri, with great excoriation of the parts without. I let her blood, and the next day purged her with an infus. senae in a decoct. cassiae and tamarind. with syr. de sp. cervina, etc. and sent her the while a pint of the decoct. plantag. summitat. etc. to stupe and syringe the diseased part, which she continued the use of till she was cured. The day after her purging, I gave her 12 grains of turbith min. which vomited her often, and purged her thrice. That afternoon a Clyster of Milk and Sugar was administered, and the next day she took another Clyster. The Flux continuing on the parts I gave her gr. viij. turb. min. with cons. ros. rub. in the form of a Pill, it vomited her more moderately. A Clyster was again administered that evening. The next morning I found her more easy. I than purged her with the former infus. senae the two following days, by which I prevented the swelling of her Chaps. During this the excoriation dried, and the Chancre was disposed to Cure. From that time I purged her with the Extract set down in the method of Cure, adding to each dose ℈ j more or lesle of praecipitat. albus, by which method she was cured in few days. I than put her into a strict course of Diet and Sweeting, and thereby confirmed the Cure. I shall forbear giving many instances of this Sex, in consideration that there is little difference in the Cure, only these are more subject to fluxion, and so require more powerful revulsion, and that your Topics be more drying, jest excrescences arise upon the excoriated parts.  
A Man aged about 38 years, of a plethoric body, 
14. Observation of Chancre, with carnosity of the prepuce.  came to me with the prepuce contracted close over the glans, it was carnous and hard, especially on the right side, under which part I supposed there lay a Chancre. I concluded it venereal, but he not acknowledging it, I prescribed him pill. coach. min. ʒj. calomel. ℈ j to take at twice intermitting a day between, but let him blood in the arm first. The foresaid Pills working agreeably with him, he was supplied with more of them, and drank a decoct. sarsae between while, and took his desired liberty of walking abroad. By this method he sensibly perceived the callosity resolve, and was satisfied that I could cure him if he pleased, but was thereby rendered the more secure, and careless in taking that prescribed Physic; so that after the space of three weeks, when he came to me again he had many scabs on his head, herpes on his face, and other sort about his thighs and arms, and the callosity not much lessened on the penis. At sight whereof I prevailed with him to let me know his Lodging, which being at last granted, I sent him 12 gr. Turbith min. and purged it of that Afternoon with a draught of Sir Alex. Frasiers Potus amarus. I repeated the Turbith once in three days, and gave him the bitter decoction between. Thus I dried the Ulcers, and they shelled soon of: The callosity also resolved easily, and the prepuce relaxed and turned back: yet some Callus remained a longer time upon the inner tunicle of the prepuce; but by Diet-drink, Sudorificks, and repeating the Vomit or Purgative Pill once in four days, he was in six weeks perfectly cured.  
Now jest you may think I am too strict in giving so many Internals in the Cure of so small an Ulcer as a Chancre, 
15. Observation of Callosity.  or rather a Chancrous Callus. I shall give you one instance, and the only one that I ever failed in the Cure of. It was in the year 1654. an Apothecary since deceased, engaged a Physician and myself in the Cure. The Chancre was of the bigness of a cherry-stone seated on the neck of the glans; the Physician prescribed Pil. Rudii & merchant dull. to be given every other day, and a decoct. sarsa. etc. as it is usually made with its additional ingredients. Those Mornings he did not purge, he was to take ℈ j Antimon. diaphoret. in cochl. 1. syr. limon. He having thus prescribed a method of Cure, the Apothecary prosecuted the course, and indeed there was little for me to do; but the Patient desiring my daily attendance, I dressed him with a pledget dipped in lac sublimat. a medicament not inferior to any in such a case. The first 14 days we passed on very secure, not doubting success, but from that time observing the Callus not to resolve as I expected, I began to inquire into the Patient's manner of Diet, and into the Physic he took. As to his Diet, he lodged in the Apothecary's house, who kept a good Table, his drink was decoct. sarsaes, but so small, as it was little better than water. But to that I was answered, it was the second decotion. I than enquired for the first, which he shown me in a four ounce glass in the window, and told me, the Patient drank three of those in a day tribus horis medic. I was surprised at this new way, and did not wonder at my small success. I thought it not reasonable to take notice of it to the Patient, but spoke to the Apothecary to forbear the giving the second decoction, and to make the first proportionably, as it was by the Physician prescribed, and to repeat the Purgative oftener. In this latter I prevailed, but the former he justified, and continued that method to the last. By the frequent purging, and the application of a Cerate made with the solution of crude Mercury in aqfortis, that Callus Chancre resolved after we had spent near six week's time. I than put the Patient upon sweeting, and advised a more strict diet; but before the Patient had spent full out a fortnight he grew weary of the course, and concluding himself well broke of: but he relapsed soon after; whereas if he had been briskly purged, and afterwards kept to a strict Diet, and a strong decoction of Sarsa, and sweat, he might have been perfectly cured in a month without any application to the Collosity.  
In strong Contitutions he Malignity of this Disease is sometimes discharged by a Bubo in the Groin, in which case it aught to be drawn outward by Cupping-glasses, and brought to Suppuration. Yet where it is not very forward (and is accompanied with Chancres, or other virulent Ulcers, as in one of the preceding observations,) I do not attend its suppuration, but proceed in the Cure with Antivenereals, as I have there shown you: but where there is only a Bubo, I proceed as followeth:  
One about 40 years of Age, 
16. Observation of a Bubo.  of a strong sanguine complexion, came to me with a swollen Glandule in his right Groin; it was of the bigness of an Almond in its shell, somewhat painful, but without heat. I supposing it Venereal, applied a Cupping-glass to it, and afterwards an Emplaster of Pic. Burgund. saponis nigri, axungiae porcinae, & aceti an. part. equal. granted the Patiented liberty of Diet, by which, within 3 or 4 four days the tumour fixed and grew bigger, and heated the skin, and by the continuance of that application, it increased with inflammation and much pain. I than applied this suppurative Cataplasm. ℞ rad. lilior. albor. cepar. sub ciner. coctar. an ℥ iv. far. tritic. ℥ ij. axung. porci, anseris an. ℥ iss. croci pulver. ʒj. The Tumour increasing and not growing soft, I added to the same Cataplasm ferment. vet. ℥ ij. pulpae fiicum extract. in sp. vini, by which it afterwards suppurated. I opened it in the declining part by incision, and discharged a slimy crude matter. I dressed it with unguent. basilic. upon a Tent, and afterwards added merc. praecipitat. Whilst I deterged the Ulcer I let him blood, and purged him with an infus. senae 3 or 4. days; but after the first days purging, I gave him ℈ j calomel. overnight, and the infusion the following morning. During thè time it was cicatrizing, I purged him with pill. coach. min. & calomel. every third day. The other days he drank a decoct. sarsae; and after the Ulcer was cicatrized, I gave him a few sweats, and concluded the Cure.  
A young Man came to me having a Bubo in his right Groin. I applied an Emplaster of Galbanum spread upon leather, and continued it there some days, 
17. Observation of a Bubo.  giving him the liberty of Diet. In a short time it suppurated. I opened it by Caustick, and discharged a slimy matter. I dressed it up with Lenients to hasten separation of the Eschar, and applied an Emplaster de mucliag. which empl. melilot. After the Eschar digested of, I deterged with mund. Paracels. purged him with extract. Rudii & calomel. every other day, and prescribed a decoct. sarsaes, lig. guaiaci, etc. which he drank those intermitting days. After the ulcer was cicatrized I sweated him, keeping him that while to a stricter diet, by which method he was secured from relapsing.  
A Man about 34 years old, of a full body, came to London, and lodged himself and Wife in the house of his Physician, 
18. Observation of a Bubo.  he being indisposed with an inflammation on his belly to the left Groin, pretending he had overheated his body by disorder in drinking. He was advised to keep his bed, and dispose himself to a breathing sweat. After a day or two he complained more of his pain, upon which account I visited him, and saw the inflammation discussed on his belly, but there remained a tumour in his Groin near suppurated. A Cataplasm was applied to it ex rad. lilior. etc. by which it suppurated a few days after, and I opened it by a Caustick, and gave vent to a crude sanious matter. Whilst I attended the digestion of this, the Patient took an opportunity to show me some small Chancres upon the Penis near the Fraenum. I dressed them, and gave him a solution of mel Aegyptiac. in decoct. plantag. etc. to cure them.  
The abscess not digesting nor yielding to detersives, I acquainted the Physician that I had discovered the Disease, Venereal, and implored his help. He purged the Patient with pill. Rudii, merchant dull. and prescribed him decoct. sarsaes, etc. by which the Ulcers in pene were cured, and the abscess grew well disposed to heal. But upon the Physicians and my discoursing with the Patient of his Disease he grew passionate, and denied it to be Venereal; and a day or two after removed out of his lodgings two or three miles into the Country, and to avoid the Discovery of his Disease, he dismissed me, and entertained another Chirurgeon, who complied, and promised in few days to cure him without the help of internal Remedies: But after all his endeavours another Chirurgeon was Consulted, by whose advice the Patient was put into a course of Antivenereals at last, and cured of that, but grew otherwise Diseased, and lived not many years.  
A young Man was brought to my house, of a Plethorique body, Diseased with a hard compacted swelling in his left Groin; it was a Bubo, 
19 Observation of a Bubo.  and like to suppurate, I applied an empl. diachyl. cum gummi. About a week or ten days after he came to me again, it was than suppurated; I opened it, and having discharged the matter, dressed it with unguent. Basilic. upon a tent, and applied over it some of the foresaid Plaster, and dismissed him and his Apothecary with directions how to proceed. After two months I was fetched to this Patient, and saw that Bubo terminated in a Phagedenous Ulcer about three inches in length and proportionably broad with indented callous lips. The Ulcer itself was sordid, and has corroded round under those lips; he had also on the scrotum four large round Ulcers and others like them in perinaeo. It was my wonder to see this Disease so rage, considering the course I had prescribed was the same I had cured so many by: and he had taken so much merc. dull. that it was grown familiar to him and seemed to increase the virulency in the Ulcers. I began the work with cutting of the jagged Lips, and filled the Ulcer with pledgets spread with unguent. basilic. dipped in precipitate, and dressed the other Ulcers after the same manner with empl. diachalcith. to retain them on. I did not let him blood because I had permitted those callous lips to bleed freely, but I directed a Clyster to be administered that afternoon. I purged him the next day and two or three after with a decoct. amar. of Sir Alex. Frasiers, and than gave him gr. xuj. Turbith mineral. in a Pill made up with cons. ros. rub. which vomited him well and purged him twice. That afternoon a Clyster was given him of fat broth cum vitello ovi. After the first application of merc. praecipitat. I dressed the Ulcer in inguine with unguent. basilic. and merc. praecipitat. mixed. The other I dressed with pledgets pressed out of lac sublimat. By the repeating of the Turbith min. once in four or five days, I disposed the Ulcers to heal, and by Clysters and purging draughts between while I prevented salivating.  
After the Ulcers in the scrotum and perinaeum were cicatrized, I put him into a strict diet and kept him to the drinking of decoct. sarsaes, etc. with good sudorificks, and by purging him once in four days he was happily cured and continues so to this day.  
Two young Lads, 
20. Observation of Bubones, Chancres and pains in the shoulders.  intimate companions, came out of the country alike clapped by one and the same wench; they having both failed of their Cure there, were commended to my care. They had both swell in their left Groins and callosities about the glans remaining from preceding Chancres. They were also afflicted with verrucae and mariscae in podice, and pains in their Shoulders. These swell in their Groins were without pain or inflammation, so not like to come to suppuration. Therefore without more ado I let them both blood and purged them two or three days with Sir Alex. Frasiers Potus amarus, than gave them each a dose of Turbith mineral. which vomited them well, and took of their pains. The next day I snipt of the mariscae and verrucae, rubbing their remaining roots with the caustick Stone; and having cleansed them, I dressed them up with Lenients, and after separation of the Eschars cicatrized them with the Vitriol Stone and unguent. epulotic. During the Cure of these I repeated the Turbith min. once in four or five days, and between while carried down the matter by Clysters and Lenient purgatives, by which method I resolved the callosities and the glands. Than I put them into a decoct. sarsae with sudorificks, and with extract. Rudii and calomel. every fourth day finished their Cure.  
A Physician and myself were fetched to a man whom we found in bed. 
21. Observation of heat, pustulae, etc.  He was not sick, but broken out all over his body with heat. The Physician advised him to dispose himself to a breathing Sweat upon a draught of warm Posset-drink, wherein was boiled ras. C. C. etc. A Cordial Julip was also prescribed as is usual in ebullition of the serum sanguinis. Three or four days after I visited him again, and found that heat raised into many pustules, which had also overspread his head, and terminated there in as many ulcerous scabs amongst his hair. These were visible symptoms of the Lues, and appeared so to me at the second visit I made him; but he did not acknowledge it till some few days after, and than he shown me some corrosive Ulcers on the penis near the fraenum, and some verrucae in perinaeo, yet denied that it was an infection of a late date. He was contented we should proceed in the Cure, to which purpose he was let blood and the next day purged with an infused Potion. After which was purged him with calomel. etc. proportionably as his strength would bear, avoiding the making his chaps sore. By this method the Ulcers dried and the Scabs shelled of, the Ulcers on the penis were dressed and cured as hath been showed in the preceding Chapters. We than prescribed him decoct. sarsaes, etc. with antimon. diaphoret. bazoard. min. etc. and some few days he seat; but he supposing himself cured broke of from our method: whence it came to pass that the malignity afterwards showed itself in different forms. Sometimes in an ophthalmia threatening his eyesight, in which case he consulted oculists and others, but after all was cured by us with the forementioned purgatives. After that he was afflicted with a fierce Catarrh, in the cure of which he ran long courses of pectorals, but was only relieved by us with Antivenereals. But not prosecuting that method of cure, he was some months after grieved with a Colic which lasted a long time, and a hernia humoralis attended that: upon which considerations he at last submitted to a more strict method, and was freed of his Colicks and other symptoms by purging with Catharticks, mixed with calomel. The course was finished with decoct. sarsaes, drying diet and sweeting.  
A Woman aged 27 years being quick with Child was broken out in her head and face and several parts of her body with serpigo and various pustulae and scabs. I let her blood, and the next day purged her with an infusion of sena, 
22. Observation of a woman with child venereal.  rhab. etc. to which was added manna and syr. ros. solut. and from that time I prescribed her praecipitatus albus from 15 gr. to 25 every other night, or proportionably, to avoid salivating of her. But I not having the liberty of visiting her as I aught, it swollen her chaps and she fluxed 18 or 20 days, and was thereby freed of her pustulae, etc. In the declination of the Flux I purged her with a decoti. senae, polypodii, hermodact. sem. carthami, etc. made in a quantity of Diet-drink, which she drank thrice a day, and took the while a medicated broth for her nourishment. After her chaps were cured I put her into a decoct. sarsae and a drying diet, and sweated her moderately with antimon. diaphoret. gum. guaiaci and bazoard. occident. cum cons. melissae, and syr. limon. in forma boli, purging her between while with the forementioned apozeme, and cured her. She afterwards went our her full time, and was delivered of a found Child: I made it a fontinel in the neck. It died of Convulsions in the Country at three quarters of a year old.  
A Woman big with Child having many ulcerous scabs on her head and other parts of her body with great erosion, 
23. Observation of another woman with child.  I let her blood and prescribed her a decoct. sarsae with some of the milder purgatives, senae, polypod. hermodact. rhab. etc. and after wards prescribed her a few doses, viz. ℈ j calomel. every other night, till I had checked the malignity; than prescribed her this: ℞ Bezoard. miner. ℈ ss. gum. guaiaci gr. xv. antimon. diaphoret. gr. viij. cons. borag. q. s. f. bolus. After which she drank a draught of decoct. sarsae and sweated moderately. By this way of proceeding her disease was palliated, and she went out her full time, and was brought to bed; but the Child died convulsive within three weeks. After which the Mother was removed to more convenient lodgings and cured as hath been said in the former observation.  
A Nurse by giving suck to a diseased Child was infected with great ulceration and chaps with verrucae on the Nipples and parts about the Breasts, 
24. Observation of a Nurse infected.  upon which account the Child was taken from her, it being suspected she had infected the Child. She had also a node upon her right hand and some break out upon her limbs. I enquiring into the cause saw this poor woman's Child which was born within the year very well complexioned and sound. I caused her to be let blood, and purged her with pill. cochiae & merc. dull. three or four times, intermitting a day or two between; than vomited her with Turbith mineral. and repeated it once in four or five days. To the Ulcers and ulcerations I only applied alittle unguent. diapompholig. spread thin upon linen to prevent their fretting and sticking to her shift, for they cured the Internal Remedies. But the Nodes not resolving, I raised a Salivation by the Turb. min. and afterwards confirmed the Cure by purging, dry diet, decoct. sarsaes, lig. guaiaci, etc. with Sudorificks.  
I was sent for to a Child that was broken out all over the Body with some branny and mattery scabs, 
25. Observation of an Infant.  the disturbance whereof had extremely emaciated the Infant. The Mother was also diseased in the same manner, and big with Child; I prescribed her a purging Apozeme, and gave her praecipitatus albus every other night the first week, and afterwards prescribed her a medicated Ale with sarsa, china, lig. guaiaci, etc. for her constant drink, and gave her many days Aethiops mineral. ℈ j at a time, and kept her body soluble between while with a lenitive Bolus.  
I purged the Infant with syr. de Rhab. and afterwards with calomel. from gr. iv. to gr. vj. either in the pap of a roasted Apple, or a spoonful of Milk proportionably as I saw he could bear it, it purged him twice or thrice, and sometime vomited him. His grewel and pap were made with a decoction of sarsa, china, etc. by these Remedies I dried the mattery Scabs, and the Infant was in a great degree freed of his Itch. I also caused him to be bathed in a tub of warm water seven or eight days. In the declining of his Itch a Phyma arose near the podex, which being suppurated I opened by a Caustick, and ordered the dressing of it daily with unguent. basilic. spread upon linen. This discharged matter plentifully for the space of a month, and than it lessened and cured. During this method of Cure, the Infant grew and recovered strength; but upon the omission of the Mercurials new eruptions appeared, which were removed by Aethiop's mineral. and moderate purging, but it died since. His Mother by continuing the prescribed method was Cured, and was in due time brought to bed of a healthful Child, and both the Mother and Child continued well to this day.  
A Woman who suspected herself Venereal was brought to bed of a seeming healthful Child; 
26. Observation.  it thrived very well for some months, and the skin was clear, yet it had a sontanel made in the Neck for caution. This Infant being about four months' old brake out in the Head, afterwards in the Face, and most parts of the Body with such eruptions as shown it to be Venereal, yet the Mother seemed untainted. I proceeded with this Infant by purging it with the infusion of Rhabarb. and between while with praecipitat. albus, which sometime vomited him, and gave him a stool or two. It relieved him much, and disposed the scabs to dry. I prescribed him medicated grewels, and a decoct. sarsaes, ras. C. C. eboris, etc. for his drink; also Bezoard. miner. to take sometime, by which he recovered of his Distemper, but died afterwards of the small Pox.  
By the same method I cured a Girl of two years old, that was broken out of her Body with Pustulae and mattery Scabs, and had a marisca juxta podicem, which I have always observed to be a certain Symptom of the Lues.  
One newly come out of a course of Physic, 
27. Observation of a Herpes' exedens in the Face.  shown me a small dry Scab on one side of his Neck, and enquired of me whether I thought he was Cured. I returned a favourable answer, not being willing to engage in the Cure of a Disease which he supposed himself so well of, but gave him a little Pomatum to dress tha Scab. Some while after other Symptoms arising, he put himself into to other hands, who treated him for the space of eight weeks, and dismissed him cured; and upon that assurance he married: but within few days a new pustula thrust out and ulcerated. He writ to me to sand him somewhat to palliate it till he should be at more liberty to put himself into a course of Physic. I sent him a Box of pill. Rudii with calomel. and an unguent to dress the Ulcer, but he not taking the Pills, the Ulcer terminated in a herpes exedens, and at last he sent for me. He had a callosity on one side of the Glans as big as a small Kidney Bean, he had also some small round corrosive Ulcers about the fraenum, and was troubled with a noise in his ears and deafness. I undertook his cure and began with a Clyster, than let him, blood and purged him the day after with an infus. senae, etc. the next morning I gave him 25 grains of praecipitat. alb. in a Bolus with cons. borraginis, and that afternoon a Clyster: to the Ulcers and callosity in gland I only applied pledgets dipped in a solution of mel Aegyptiacum in some of the decoct. plantag. equiseti, etc. The herpes exedens lay round and hard in the skin and was crusted over with a thick scab, which I loosened by bathing it with a decoct. malvae, etc. The Scab being taken of the Ulcer appeared sordid and corroded round, and the Lips were high and callous. When these hap in the Thighs or other parts which are not so visible, I do not concern myself in the dressing them otherwise than to defend them from adhering to their Linen, till they be dried by internals: but in this place I was obliged to remove the callous lips and the several excrescences in the Ulcer to tender the cicatrix smooth. To which purpose I rubbed them with the caustick stone, and wasted and dried the hypersarcosis by the application of read precipitate; and afterwards by the use of the Vitriol stone and Epuloticks I cicatrized the Ulcer so even, as at this present there are no marks of it. During the work I purged him often with praecipitat. alb. & pill. coach. min. and sometimes vomited him with turbith mineral. by which I also resolved the callosity and cured those little Ulcers near the fraenum. After I had thus freed him of those maladies which affected the skin, I put him into a decoct. sarsaes, etc. with the observance of a strict diet, and sweated him often with a Mercurius diaphoret. and purged him once in 4 or 5 days, by which he was also freed of that tinnitus aurium and restored to a perfect health.  
A Man aged about 40 years, of a gross body and disorderly life, 
28. Observation of sweetening the blood.  frequently consulting men of our profession but never observing any strict method of cure, came one day to advice with me about his Disease, which was a dry scurf with an itch on several parts of his body, as also some wand'ring pains on the scapulae, etc. Amongst other discourse he told me an eminent man in the cure of the Lues venerea had offered to cure him by sweetening of his blood. The method he proposed thereto was by purging, bleeding and sweeting, without giving one grain of Mercury. I did not believe his blood would be the better, yet if he thought so he might proceed in that course, and when he should be let blood I desired he would sand for me. He did so, and I let him blood according to the directions ten ounces. It was of good colour and consistence. About six weeks after when he had finished his course of Physic, he sent to me again. I let him blood about the same quantity as before. His blood was like that some of our Physicians call pleuritical, it had neither colour nor consistence; yet I thought not the worse of it (so he was cured) for upon a return to his wont diet the blood would recover its  colour: but he relapsed some weeks after, and I let him blood again, and it was as at first of good colour and consistence. He was well pleased to see his blood look better, but was so much dissatisfied with his late treatment that he would not be persuaded again into a strict course of Physic, yet I undertook the cure, and purged him frequently with pill. è duobus and calomel. and sometimes gave him the latter alone: he also drank a decoction of sarsa, etc. but with these he went abroad and thereby prolonged his cure, yet at last that malignity was so spent.  
A Man of about 30 years of age having several Herpes' and serpiginous Ulcers on his thighs and about his body with nocturnal pains in his head and other parts, 
29. Observation of Herpes', Ulcer in his tongue and various pains.  also a large Ulcer on the middle of his tongue, I let him blood, and the next day purged him with the bitter drink. The morning after I gave him a dose of Turbith minerale, and the third day after repeated it again, designing to salivate him; upon which account I repeated the Turbith five times. He had taken much Mercury and only slavered with it, but the while he was freed of all the symptoms save that of his tongue, and that seemed inclinable to heal. Therefore I purged of the Mercury with the bitter decoction for several days, till I had run him very low. Than I put him into a strict course of diet with decoct. sarsaes, etc. sweeting and purging him the space of sixteen days, during which the Ulcer in his tongue cured. I designed bathing and a more nourishing diet, but his affairs abroad hastened him away. He was longer in recruiting his flesh than was usual; but by a milk diet he recovered it, and hath from that time continued well.  
A Country Lad was taken notice of by some of his fellow-servants in the house where he lived to have a sore nose; 
30. Observation of Ulcers on the uvula, tonsils and nose.  he told them it was scratched in playing with a Kitten; but in progress of time the inflammation and swelling increasing very much, he was brought to me one afternoon while I was diverting myself thus. I hearing them say it was occasioned by a scratch, I did not much mind it; but so soon as I heard him speak I took notice of his hoarseness and took him to the window, where looking into his mouth I saw the tonsils ulcerated and the uvula black with the mortification, and part of it separating. His nose was also stuffed with crusly Ulcers. I questioned him privately how long it was since he had a Gonorrhoea or Chancre, and who cured them. He confidently denied he ever had any, however the Lues was visible and required a speedy remedy. He was presently let blood, and I gave him two papers of merchant dull. ℈ j in a paper, with directions to take the one at night in a spooonful of bread and milk, and the other in the morning, and two hours after to drink Posset-drink with an ounce and half of Manna dissolved in it. I directed the dressing of the uvula and those Ulcers of the consils with aq. divina Fernelii daily till my interal prescriptions disposed them to a healing condition. To which purpose I repeated the merchant dull. with some of the purgatives between while, and in the space of ten days cured those Ulcers in his throat. His nose was syringed with decoct. hordei, by which the crusty matter which stopped his nostrils was removed. Than we syringed with some of the Errbia set down in the method of cure. After the Ulcers in his throat were digested, I hastened the exfoliations of the bones in his nose by the giving him 2 or 3 doses of Turbith, which made a light Salivation. strict diet and sweeting Towards the declination of it I purged him with the bitter decoction, and by diet drink, etc. finished his cure.  
Coming one day to put him out of his course of Physic I saw the edges of one of his nostrils sore, which I supposed a new eruption: it surprised me to see it so soon break out again. I was angry with the Nurse, suspecting there had been some neglect in the prosecution of his course of Physic; but the Nurse replied, he had made his nose sore by picking of it. For a farther trial I advised the Patient to forbear so ding, and to keep his chamber a while longer; he did so, and 3 or 4 days after I visited him again, and saw that nostril well, and was satisfied that he had picked it. I advised him to be more careful of his health, and dismissed him.  
One of about 20 years of Age came to me with his Head overspread with crusty ulcers; also some serpiginous ulcers about his Body, 
31. Observation of Pustulae, and a Node on the back of the hand.  and a Node upon the back of his hand, with a gumminess on the tendons reaching to his fingers, in somuch as he could not bend one of them. In endeavouring his Cure, heretofore he had run long courses of Physic, and was much emaciated thereby. I began with the fomenting and embrochating his hand with discutients, and applied the mercurial Empl. set down in the method of Cure, and purged him with diagridium, bezoard. minerale, calomel. in cons. ros. Damasc. and the night after gave him an Opiate Bolus with gr. j Laudan. Thus I proceeded according as his strength would admit, and prescribed him decoct. sarsaes, and medicated Broths, by which I dried and shelled the ulcerous Scabs, and eased his Pains. After I found his strength recovered, I gave him 10 gr. of Turbith, and observing that he bore it well, I repeated it a second and third time, and thereby salivated him about 17 or 18 days: all which time I nourished him with the aforesaid Broths and Posset. During the Salivation, the gumminess resolved, and the Node diminished much. As the Salivation declined, I again prescribed him the decoct. sarsaes, and purged him with the bitter Apozeme; than by a strict Diet, sweeting and purging, the Node resolved, and his hand was restored to its former state, and I dismissed him perfectly Cured.  
One of about 40 years of Age, having a Herpes' exedens on his right brow, 
32. Observation of a Herpes' exedens, verrucae, etc.  a marisca in podice, and some verrucae about the glans; also some wandering pains on his shoulders; I let him blood, and purged him with the Cathartick Electuary, and Merchant dull. three or four days, and dressed the Herpes', as hath been showed in some of the preceding Cases. And after his purging I cut of the marisca close with a pair of Scissors, and rubbed the remaining Root with a Caustick stone, than dressed it up with Lenients, by which it was digested, and afterwards cicatrized it by the help of the Vitriol Stone, and the common Epuloticks. Whilst this was digesting I vomited him with turbith mineral. repeating it once in 3 days, and increasing the Doses from 12 or 18 gr. till I had dried the Herpes', and the crust sheled of. During this, I cut and burnt of the Verrcuae, as hath been said in the like Cases. These being also cured, I purged him with the bitter decoct. four or five days, than with decoct. sarsaes, and that Sudorific of Bezoard. miner. gum. guaiaci, etc. I sweated him, and kept him to a strict Diet, purging him once in three or four days. His pains remitted after his taking the first Dose of Turbith, and by this latter course his Cure was confirmed.  
A Nurse was brought to me, who by giving Suck to a Diseased Infant, 
33. Observation of Herpes' in the breast, etc.  had the Nipple and Parts about of her right Breast very much excoriated, and four round, hard, crusty Ulcers somewhat more distant. She had a Node with pains on her right Leg, also a Serpigo on her right hand and fingers. She had not been troubled with a Gonorrhoea, nor was the Pudendum ever Diseased, which confirmed to me that she had gotten the infection by suckling the Child. I began her Cure with letting blood, and purged her with the purging extract and calomel. and after I had repeated it 3 or 4 times, and given her some Calomel. alone at distant times I vomited her with Turbith mineral. and repeated it three days after, and thereby her Chaps swelled, and she salivated eighteen or twenty days: During which, Clysters of Milk with the yolk of an Egg, were often administered, and her mouth frequently washed with decoct. hordei, etc. Before she had salivated six days her Node and Pains removed. As the Salivation declined, she was purged with the bitter decoction, and her Cure was finished by decoct. sarsaes, etc. as hath been showed in the former Observations.  
A Man of about thirty years of Age, 
34. Observation of Herpes', etc.  diseased with mattery scabs about his head, many pustulae and serpiginous Ulcers on his thighs, and several parts of his Body, put himself into my hands. I let him blood, and that afternoon I prescribed him a Clyster, and the morning after purged him with pull. cornichin. and the next morning early he took 25 gr. of praecipitat. alb. and a Clyster that afternoon. The day after I purged him with pull. cornich. ℈ ij. praecipitat. albi ℈ j and the next two mornings gave him ℈ j of Aethiop. mineral. in a Bolus with cons. court. citri, and a draught of a decoct. sarsaes, etc. after it to dispose him to a breathing sweat. The third day I gave him 15 gr. of Turb. mineral. which vomited him often, and purged him twice, and in the afternoon gripped him, and put him upon a Tenesmus; to remedy which a Clyster of Milk cum vitello ovi, & ol. chamaemel. was administered, and Chicken-broath and warm Posset-drink was his drink that day and the next. The day following, I gave ℈ ss praecipitati albi, & Turbith min. gr. vj. in a Bolus which vomited him thrice. That afternoon a Clyster was repeated, and the day after he was purged with an infused Potion of sena, rhab. etc. and repeated the Aethiops mineralis and decoct. sarsaes, as before, three mornings together. Than I gave him 15 gr. of Turbith, as at first, which vomited him often, and from that time the Ulcers dried, and in the worst of them the scabs were ready to shell of. I than purged him with the bitter decoction four or five days, and kept him strictly to the decoct. sarsaes, drying diet and sweeting, with Aethiop's min. and purged him once in four days with pull. cornichini, and praecipitat. alb. and so concluded his Cure in seven weeks.  
A young Fellow sorely diseased with Herpes' and fretting Ulcers from his right hip and buttock down that thigh, 
35. Observation of Herpes' and serpig. Ulcers.  having used many Remedies externally and internally, I applied a cloth spread with unguent. enulat. over the ulcerous parts to defend them from sticking to his shirt, and let him blood that day, and purged him the next with an infus. senae, etc. and the day after I gave him 11 gr. of Turbith min. The day after that I purged him with pull. cornichin. and praecipitat. alb. and repeated it every other day, by which his Ulcers soon dried, and the scabs shelled of. His skin growing smooth, he concluded himself Cured and left me, but in lesle than a month he relapsed, and came to me gain. I repeated bleeding, and purged him with an infusion of sena, etc. and afterwards gave him three or four Doses of Turbith mineral. it made his Chaps a little sore, and somewhat he slavered. This freed him of his serpiginous Ulcers. Than I purged him with the bitter decoction, and sweated him with decoct. sarsaes, etc. purging him once in three or four days with Antivenereals, and at last dismissed him Cured.  
A Man of a full Body, 
36. Observation of a Herpes' exedens.  having been long afflicted with Ulcerous Scabs, Serpigo, and other foulnesses of the skin arising sometimes in one part of his Body, and sometimes in another (his Chirurgeon being dead) was recommended to my Care. The Ulcer that than troubled him was on his chin, the compass of a broad shilling, and covered with a thick scab. It seemed to me to be Vevereal, but I was told otherwise, and durst not dispute it. I thought myself very unhappy in being put upon the Cure of such an Ulcer, without the help of Antivenereals. I fomented it with decoct. hoard. summitat. althaeae, malvae, & sem. lini, and applied a Pledget of unguent. rosat. over it with bandage to retain it on. The next morning the Scab came of, and there appeared a sordid Ulcer with ragged callous lips round it, also many excrescences rising up in the middle, which made the Ulcer not unlike a Honeycomb, as I have elsewhere described it. I sprinkled the Ulcer with Read Precipitate, and applied over it small dossils of dry lint, and some pledgets spread with unguent. tutiae vig. over them, and repeated this way of dressing every other day, till I saw the flesh in those little cells ruddy. Than I dressed them with little pellets of lint, and covered the excrescences with precipitate, and bound up the Ulcer as before, not opening it again till the third day. Thus I wasted them, and the Ulcer cicatrized here and there as they were consumed. I was glad to see it cicatrize any way, and resolved without more delay to remove the callous lips. To which purpose at the next dressing I rubbed them with a Caustick Stone, and clipped of the sloughs, than sprinkled them with precipitate, and after separation of those sloughs, I rubbed the lips with a Vitriol Stone, and by the one and other I smoothed the Ulcer, and at last cicatrized it with pledgets dipped in Lac Virgin. but the cicatrix appearing unequal, I rubbed the remaining eminences again with a little Caustick, and left it at last cicatrized more smooth to the Patient's satisfaction. I was glad I had preserved my Credit with him. But it being Venereal, I suspected that it would show itself again in the same place, but it appeared in a Node upon his skin, as you may read in some of the following Observations.  
A Man of about thirty two years of Age, of a strong Constitution, 
36. Observation of Herpes' exedens overspreading all the Body.  came to me upon a supposition of having the Kings Evil. His Face was o'erspread with Herpes' exedens, some of them crusted high with dry scabs upon his nostrils and lips; his head was covered over as it were with one scab, and in truth his whole body so diseased with eating Ulcers, that he could neither fit nor lie without very great pain; his shirt, drawers and stockings being stiff with the matter that flowed from them. Upon enquiry into the Original of his Malady, I discovered that he had contracted a Gonorrhoea beyond Sea, and had been diseased with pustulae, etc. above half a year. I prescribed him a Clyster that evening, let him blood the next morning in the Arm about ten ounces, gave him ℈ j Calomel. that night going to bed, and purged it of in the morning with an infus. senae, rhab. etc. The next morning he took Turbith min. gr. xij. and drank a draught of Posset-drink after it, which vomited him three or four times, and purged him much. This poor Man's condition being extreme uneasy, obliged me to prosecute the drying up those Ulcers with what expedition I could: Wherhfore I gave him Calomel. and Turbith the oftener, and purged it downward with the bitter drink either the same day or the next, accordingly as his strength would bear, till I saw the several Ulcers dried, and the scabs shelled of: Than I left of the use of the purging drink, and increased the Dose of Turbith min. till I saw him salivate; which salivation lasted about 18 or 20 days. In the declination thereof, I purged him again with the forementioned decoction, and finished the course of Physic with decoct. sarsaes, sudorificks, sweeting and drying diet, etc. according to my usual method. During which I rubbed of the several remaining excrescences (rising from the Ulcers) with caustick stones, and cicatrized them with the vitriol stone, unguent. desiccativ. rubr. etc. and dismissed him Cured.  
One came to me having an Herpes' exedens on his Chin, 
37. Observation of Herpes' serpigin. etc.  and many eruptions about his Body, with wandering pains on his Shoulders, Arms and Legs. He desired to be cured, but would not be confined to his Chamber. I declining to meddle with him upon those terms, he put himself into the hands of an Empirick whom he had formerly known in Italy. He undertook the Cure with great promises. But after the taking that Empirics prescription a much longer time than he had undertaken to Cure him in, the Symptoms remaining, the Patient grew peevish; and the Empirick to recover his Credit with him altered his method, by which it seemed the Ulcers Cured. But in the while his Chaps swelled, and in taking cold a Diarrhoea with a tenesmus followed, and with much disorder he was brought to a Lodging near me.  
I caused him to be put into a warm Bed, and prescribed him a Bolus sudorific, and with a draught of warm Posset put him into a sweat, and some hours after advised a Milk Clyster cum vitellis ovor. etc. to lenify his bowels, and laid him to rest with elect. diascord. and the next morning I purged him with an infusion of sena, rhabarb. etc. and repeated the opiate, by which the griping of his guts were remitted. But in this while the swelling in his chaps was sunk, and he complained of a noise and pain in his ears, and though his mouth was very sore yet did he not spit. I much suspecting how I should cure him without salivating, gave him 4 grains of arcanum Corallinum, by which he vomited often, and thereby I raised the swelling in his chaps and he fluxed near three weeks. All which time I kept him to warm posset-drink and Cordials, and administered Clysters as occasion offered them. As the Flux declined I purged him with the bitter decoction, and by a drying diet, sweeting, etc. I cured him.  
One aged about 26 years having break out in his head, right brow, and several parts of his body with pains on his shoulders and legs, 
38. Observation of pustulae, Ulcers and nocturnal pains.  I let him blood, and the next day purged him with a cathartick potion. Than in consideration he had failed of his cure in other hands through his irregularity, I caused the unction to be applied for some days, but he not salivating well thereby, I gave him ℈ ss. Turbith miveral. and raised it higher, and continued it between three weeks and a month, during which his pains ceased and his skin became clean. In the declining of the Flux I purged him with the bitter drink, and put him into diet-drink, sweeting, etc. and designed to finish his course by bathing; but he supposing this latter course needless, broke of unknown to me. About two months after he was brought to me more diseased, and upon enquiry into the cause I found he had taken too great a liberty of eating and drinking during his Cure. To avoid which inconvenience now I lodged him in a house where there was a more strict guard of him; than repeated venaesection and purged him again with the bitter apozeme 7 or 8 days, and gave him calomel. every other night during his purging: than prescribed him a dose of 15 grains of Turbith min. and repeated the Turbith min. so often as I might conveniently do without fluxing him. After I had thus freed him of all those symptoms, I put him into a more strict diet, and by diet-drink and sweeting him with gum. guaiaci, etc. also purging him once in three or four days, I secured him from relapse and concluded the course by bathing him.  
A Man aged about 50 years, 
39 Observation of an ophthalmia.  of a seeming healthful constitution, having been long subject to inflammations in his eyes had tried ineffectually the several endeavours of Oculists and others by various collyria, purging, bleeding, blistering, shaving the head, fontinells, etc. At length he consulted me, relating to me the manner of his life and the various remedies he had taken. I suspected the distemper in his eyes arose from some relict of the Lues Venerea; upon which surmise I readily undertook his Cure. I began it with the washing his eyes with a solution of troch. albi Rhas. in aq. ros. rub. and applied emplastr. ad Herniam on his Temples. The next day I let him blood and prescribed him a Clyster. The morning after purged him with pill. Rudii & merdul. and disposed him to rest that following night with an anodyne draught. The morning after I gave him bezoard. mineral. gr. xv. gum guaiaci gr. viij. in cochlearia cum syr. limon. and a draught of decoct. sarsaes, lig. lentis, cum flor. anthos, euphrag. etc. as is set down in the method of cure, to dispose him to a breathing sweat, and advised the drinking the foresaid decoction daily excepting when he purged, which was every fourth day. By this method his eyes were cured in the space of ten days, but he prosecuted the method longer.  
A young fellow grievously afflicted with an inflammation of both his eyes, with pustulae and Ulcers in the tunica cornea & adnata, 
40. Observation of an ophthalmia.  also bleardness of the lids, he was returned from the Oculist as incurable; upon which account I was desired by his friends to employ my endeavours in the taking of the fluxion, and to dispose his eyes to some ease, they concluding his sight lost. I let him blood at that instant, and purged him the next day with an infus. senae, etc. He was of a strong constitution and seemed to require such evacuation. The evening after his purging I nade him a seton, and brought a fomentation to give a breathing to the impacted humours, with which I fomented his eyes. I also dropped a colliery into them of aq. chelidon. mirabilis, etc. as it is prescribed in the Treatise de strumis. While I was one day dressing his seton and eyes, I questioned him whether he ever had a Gonorrhoea; he denied it faintly. I urged him farther, and looked upon his penis and saw a hard callus, the remains of a Chancre. Upon sight of this I purged him with pull. cornichini and merchant dulcis, and repeated it often, and thereby took of the fluxion and disposed his Ulcers to cure; and afterwards by Turbith min. vomited him once a week. Between while I prescribed him decoct. sarsaes, with bezoard. mineral. gum. guaiaci, etc. and regulated his diet accordingly. By this method I cured his eyes, and he gradually recovered his sight to walk about the streets, and of late years can writ and read.  
A poor fellow came to me diseased with a fistula lachrymalis, which at first sight seemed by its callous lips to be cancerated, 
41. Observation of Fistula lachrymalis.  but being informed that he had heretofore been clapped, I readily undertook his cure, and began with letting him blood, and purged him with pill. cochiae min. & calomel. During his purging I deterged the Ulcer and disposed it to cure by removing the chancrous lips, and made way to the bone, which being carious I dried with an actual cautery, and from that time dressed it as hath been showed in those observations of fistula lachrymalis in the said Chapter de strumis, and completed the Cure by antivenereals as in the preceding observation hath been prescribed, and dismissed him perfectly well.  
One about 28 years of age had heretofore been afflicted with an abscess on the outside of his right leg, 
42. Observation of a Phagedaenae on the Leg.  which not yielding to the common endeavours of Chirurgery by laying open, digestion, etc. I was fetched; and seeing the Ulcer of a great length, the lips of it jagged and callous, I cut them of and dressed the Ulcer with the common digestive, and sprinkled the Ulcer itself (which was sordid) with merc. praecipit. and pledgets of dry Lint, an empl. è bolo over it, with a compress wrung out of read Wine, and rolled it up. Having thus dressed up the Ulcer, I enquired into the original of the distemper, suspecting it to have risen from some malign Fever, or the relics of some ill cured Clap. But the Patient denying that he ever had either of them, I endeavoured to inform myself of the method prescribed by those under whose hands he had been, and discovered that he had taken merchant dulcis, antimon. diaphoret. and decoctions of sarsa, etc. which method I again repeated, and proceeded in digesting of the Ulcer some days, and put on a laced stocking, but I could not make good digestion in three days. I considering the evil quality of the Ulcer and the manner of life the Patient had formerly led, concluded the disease certainly venereal, and that the merc. dull. etc. prescribed him was not of sufficient force to quell such a malignity. For daily practice showeth that merchant dulcis given once in two or three days will not check the lesser species of the Lues; and where it is not powerful to cure, it maketh the erosion greater, and the disease becometh more inveterate. Upon which considerations without farther enquiry into the disease I attempted the cure by antivenereals, and gave him gr. 12. Turbith min. in a bolus with cons. boraginis; it vomited him 4 or 5 times, and purged him twice, and put him upon a tenesmus, which I took of that afternoon by a clyster of Milk with the yolk of an Egg, and endeavoured to excuse the churlish working of the medicament. The next day I saw the good effects of the Physic in digesting of the Ulcer, and resolved to prosecute the method or quit the Patient. I dressed up the Ulcer with unguent. basilic. cum praecipitat. emplaster and bandage, designing to effect this Cure by Internals; to which purpose I repeated a Clyster that day and the next, and the fourth day gave him 16 gr. of Turbith mineral. in a Pill, which wrought as the former, and directed a Clyster again in the afternoon. That night he spit much, and in the following morning complained of a soreness of his Chaps; but I not observing him likely to flux purged him the day after with Manna in a draught of Posset-drink, supposing I should make a greater revulsion by vomiting him twice or thrice, than by the raising a slight Salivation; but he growing impatient with the soreness of his mouth, I changed that resolution, and gave him 18 grains of Turbith, and thereby fluxed him 19 or 20 days. In the declination of it, I prescribed him a decoction of Sarsa, and purged him with an Apozeme made in some of the same decoction. During the Salivation the Ulcer cicatrized by the application of the above mentioned Epuloticks, and I finished the Cure by drying Diet and Sudorificks. After which he removed into the Country, and by a Milk-diet recovered his strength, and his Leg became useful to him; but he continued the wearing his laced stocking sometime longer. When these Ulcers are treated as Scorbutical, the Patient dieth tabid.  
One of about forty years of Age, 
43. Observation of a Herpes' miliaris in planta pedis.  having been long troubled with a Herpes' miliaris which had spread itself on the sole of one of his feet, came to me for Cure. He had taken Mer. dulcis, Antimon. Diaphoret. etc. Medicines proper enough to Cure the milder Species of the Lues Venerea; but the Patient being irregular, and not acknowledging it Venereal, failed of his Cure. At the first sight of the Ulcers I concluded them Venereal, and resolved to proceed with him by such a method, or leave him to seek his Cure elsewhere; and began by purging him with Pil. Rudii, & merchant dull. and afterwards prescribed him a few Pills of Aethiops mineralis cum terebinth. One of which he took every morning, drinking a draught of a medicated Ale after it. After he had taken six of these Pills, I began with the Cure of the Ulcers, dressing them with the fotus and lineament set down in the Cure of Herpes'; but that not answering my expectation, I washed the Ulcers and parts about them with warm Milk; than having cleansed and dried them, I rubbed the lips of them all with a Caustick Stone, till I had eradicated and smoothed them fit for to cicatrize, and than washed out the lixivial salt to prevent its farther penetration. From that time I dressed them up with Merc. praecipitat. and put on a laced sock. The third or fourth dressing the sloughs crumbled of, and the Ulcers appeared well cicatrized. But within few days they all broke out again. At the sight of which I concluded the Ulcers Venereal, and prevailed with him to take Mercury, and began with a ℈ j Calomel, and the next day gave him a Dose of Theriac. metallor. and repeated it two or three days, I designing that way to Cure these Ulcers. But the Theriaca not moving him by stool or vomit, he wrangled with me, supposing I could not cure him but by such Medicaments as worked one of those ways, whereas we know by experience, that Mercury frequently cureth those Ulcers by altering the quality of the Humours; but I complied with his desire, and gave him a Dose of Turbith gr. xij. in a Pill that vomited him five or six times, and purged him twice or thrice. The next morning he complained of the soreness of his mouth. I advised him to drink warm Posset-drink, and to take a Clyster, but he did neither. I being engaged in the Cure, thought it best to hasten a Salivation before he should be ware of it, and gave him two Doses more of the Turbith, increasing each Dose two grains. These made his Chaps sorer, and would have fluxed him, but he being ungovernable it caused a Tenesmus, and ran down in a Diarrhoea with a large evacuation, and terminated in a dysentery. Upon the sight hereof, I would have prescribed him such Remedy as is usual in those cases, but he was so impatient at the accident as to admit of no excuse from me, nor any of my Prescriptions. Indeed the Herpes' was dried, and he had an eminent Physician his friend who relieved him by his Prescriptions, and restored him to health soon after, and could as easily have than prevented the relapse; but the Patient being well, concluded he should continued so, and broke of abruptly from him without any observation of Diet-drink, Sweeting, etc. and became so good natured as to make me a Visit in acknowledgement of his Cure. But about a month after he sent for me, complaining of an itching he felt in the sole of his foot, he supposed from his too much walking the day before; I looked upon it and saw a heat rising in the skin. I believed it a return of the Disease, but having resolved not farther to engage myself in the Cure, I left him with a favourable construction of it. The next news I heard of him, was, that one pretending to Chirurgery had undertaken the Cure of it by bathing it with a Decoction of Broom, and boasted so confidently of the Cure, as if he had already performed it, calling them a few Kibes. But whilst he was picking of these out, the Patient shown me a swelling upon the shin bone, and desired my judgement of it. It was a very well grown Node, and I guessed by the Patients thin Chaps that it was no small disturbance to his rest, however it was a confirmation of the quality of his Disease, and might serve to alarm him to provide for his Cure. I was than taking a Journey into the West-country, and at my return was informed that the died under some Empirics hand in his course of Physic.  
One of about forty years of Age, 
44. Observation of many Herpes' exedens and Nodes.  having Herpes' exedens very large on several parts of his Body, came to me much emaciated thereby, he having been many years afflicted with them. He had also some Nodes lately risen on his Legs. I purged him with decoct. Epithymi, and afterwards gave him praecipitat. albus ℈ j to 25 grains daily, and washed the several Ulcers with Lac Virgins, and dressed them up with pledgets dipped in the same to dry them, till I could by Internals cure them. But in few days I perceived this Patient had been so accustomed to the taking Mercurials, as the praecipitatus albus was of no force, therefore I forbore the longer use of it, and gave him 10 grains of Turbith mineral. it vomited and purged him moderately. The next day I saw the Ulcers drying, and from that time dressed them only so as to defend them from sticking to his linen, the third day I repeated the Turbith, and the fourth day after gave him another Dose, and between while Clysters were administered, and sometimes we purged him with Manna in a draught or two of Posset-drink. Thus the Ulcers were cured and the scabs shelled of. I than purged him with the bitter decoction four or five days, and confined him to a drying diet, and decoct. sarsaes, sweeting him for some time with Diaphoreticks; but he finding himself well broke of from this Course before he had been fourteen days in it, which occasioned some little eruptions; but by the taking of a few grains of Theriac. metallor. with our purging Extract, and sometimes Bezoard. minerale, with a decoct. sarsaes, they were dried up, and in progress of time the malignity was wasted without keeping of his house.  
One of about forty five years of Age, of a lean dry body, 
45. Observation of Ulcers in the Arm and Leg with Caries.  had an Ulcer on the outside of the Biceps on the left Arm, which upon search with a probe I discovered to be carious. He had also three distinct Ulcers on the os Tibiae of the right Leg a little above the ankle, which were also carious. That on the Arm took its original from a Node, as the other on the Leg did from a Gumma. They had been some years ulcerated, and I suppose the malignity discharged itself there, for other Symptoms of the Lues he had none at that time. I began with the Cure of these Ulcers by the application of Caustics to remove the external Callus, and make way to the bones. That in the Arm lay deep, and required detersion and dilatation, which was the work of some weeks; but the others on the os Tibiae lay superficial; and as the Eschars' separated in some of them, bits of bones came away with them. Where any remained entangled in lose flesh, I sprinkled that flesh with precipitate daily, and with that and the Vitriol Stone made way for the taking out the remaining bones, and with much ease cicatrized those Ulcers, the exfoliation of these from the main bone having indeed been made to my hand by the strength of Nature, and required no more from me than the making them way to come forth. But that caries in the bone of the Arm lay slabed in matter, and was not so easily come to; and when it was, it did not yield to the ordinary application. Thererefore after I had sometime kept it unsuccessfully dilated, I passed a canula in and by an actual cautery, dried the caries, and from that time dressed it dry with dossils pressed out of sp. vini, and waited its exfoliation. And to hasten the work I began to purge him with an infus. senae, etc. and afterwards with calomel. which I repeated often in a lenitive bolus, and put him to the drinking a decoction of sarsa, etc. and with sudorificks sweated him: but after some days observing the bone did not exfoliate, I gave him two or three doses of Turbith, and made a revulsion thereby. From that time the Ulcer dried, and an exfoliation was made of some small rotten bits of bones, and the callus which thrust them of united with the musculous flesh, and the Ulcer incarned as I diminished my dossils, and cicatrized soon after. The Ulcers being cured thus, I concluded the course of Physic by purging, diet and sweeting.  
One about 30 years of age of a gross body having been much pained on his right leg with a great node upon the shin, 
46. Observation of a Node laid open, with the consequence.  put himself into the hands of an Empirick for cure; who after a long course of purging, sweeting, etc. failing in his cure, employed me to lay it open. I obeyed, and having encompassed the tumour within a line, I applied the white caustick. The next day I found the tumour sunk, but the caustick had penetrated to the bone according to the length and breadth that was designed. I cut the Eschar round, and raised it with the Periosteum, and saw the bone sound, and naturally white and smooth. I dressed it with pledgets dipped in lineament. Arcei warm, and the remaining Eschar with unguent. basilic. to hasten its separation. After some few days the Eschar separated, but the Ulcer grew painful and inflamed, and would not digest: upon which consideration I enquired into the internal prescriptions, and finding them not of sufficient force I prevailed to give a few grains of Turbith minerale, and thereby made a revulsion. From that time I digested the Ulcer with that common digestive ex Terebinth. etc. and cured it as an Ulcer with caries; during which the malignity was eradicated by Antivenereals.  
I am not against the applying of medicaments to further the resolving of nodes, but the laying them open till they have made their way by apostemation seemeth to me unreasonable, it being not only painful but also a prolonger of the cure. For supposing you do remove the node and cure the Ulcer, yet unless you do eradicate the malignity, other nodes will arise. Whereas if Antivenereals be rightly administered, you may resolve the nodes by them at the same time. I once saw a very large node upon the os frontis resolved merely by a course of diet-drink, purging and sweeting. Sir Fa. Pruyean was the Physician, and Mr. Pearce the Apothecary attended the Patient for his Master Laxton as I suppose. The course was long and more strict than our Patients will now endure; but by Mercurials we do more certainly resolve them, and in a lesle time.  
One of about 40 years of age, 
47. Observation of Ozaena, Ulcer in the Palate, Nodes, etc.  of a strong constitution, afflicted with nodes in his Arms and Legs, an ozaena and an Ulcer in his palate, in both which the bones were carious, had been eight weeks in Physic under the hands of an Empirick, and being at a loss consulted me. They shown me some Instruments they had devised to hook out the bones; they also shown me some little bits of bones which they had broken of from the whole. I admired the ignorance of the Empirick to glory in such work, but am since satisfied that a confidence in prating is a sufficient basis to build a practice upon amongst some kind of people. As to his Instruments they were well enough contrived to pull out bones, but it would have been more for his credit to have designed some way to have kept them in. For in some of those places the lest diminution of a bone causeth a deformity; and in others, as those of the Palate, there will want a supply of callus, and so consequently it would not only spoil his drinking but his voice. Upon which consideration those Instruments were laid aside, and errhina were prescribed, as in the method of Cure hath been showed, of which he snuffed up or injected some into his nostrils often in a day. In order to his cure I resolved to salivate him by unction; to which purpose I let him blood and purged him with a lenitive bolus, and afterwards bathed him 3 or 4 times; than caused him to be anointed, and thereby raised the Salivation; all which time I had regard to the washing his chaps and keeping up his strength. About the 24. day the Salivation declining I purged him with the bitter decoction, and than put him into a decoct. sarsaes, etc. and sweated him, proportioning his diet drying according as his mouth healed. During the time of his salivating the Ulcers in his Nose cured, and so did that in his Palate, but the bones they had pulled away left the marks; yet that in the Palate was supplied by a small Plate which was retained by a Sponge. Some of his Nodes discussed during his Salivation, and the other in the time of sweeting. He being thus cured we ended our course of Physic with bathing.  
One of about 28 years old being grievously afflicted with a Catarrh, 
48. Observation of the Wula and Palate eaten away.  having used many remedies unsuccessfully, a Seton was advised to be made in his neck. I bieng sent for to make it, found the Patient in bed so emaciated as it was impossible he should continued it there without great pain. I desiring some way to be useful to him enquired into the quality of his Disease, and looking into his throat saw the tonsils extremely ulcerated, the Wula and that part of the Palate eaten away. I concluded it Venereal, and before I stirred from him discovered it was the effects of a Chancre ill cured.  
I took leave of him, and acquainted those that sent me of the nature of his Catarrh. They having satisfied themselves of the truth put him into my hands. There was no great matter of credit to be gotten in endeavouring a cure, where the Patient should be left to snuffle all the days of his life; but I obeyed them, and prescribed him that night ℈ j merchant praecipitat. albus in a spoonful of white bread and milk. I directed the washing his throat with one of the Gargles set down in the method of Cure, and dressed them daily with lac sublimat. prescribing him a decoct. sarsaes to be drank with a third part of milk, at the lest thrice a day. I repeated the praecipitatus albus morning or evening also a Clyster sometime to keep his body soluble. By this method I cured these Ulcers in the space of three weeks. Soon after as he recovered his strength, I left of the use of the milk and prosecuted the course by a strict diet, decoct. sarsaes, diaphoreticks, etc. than fitted his Palate with a Plate of silver which he could put up and take out at pleasure. It form his voice and served to lead the drink its right way. Some months after I saw him fat and well, and he assured me that the ulcerated parts were so contracted together that he had not farther use of the artificial Palate. 
49. Observation of Ulcers in the Tonsils, Palate, etc. with a Node on her leg.   
A Woman of about 28 years of age having been some while vexed with the lesser species of this Disease, put herself under some hands for cure; but during that method she complained of a soreness in her throat, which increasing, she consulted others, and afterwards others, but unsuccessfully. (I suppose from her own irregularity.) Some months being passed, her friends recommended her to me. Both her Tonsils were much ulcerated; there was also an Ulcer upon the back part of her Palate and Wula. She had also a Node upon her right leg, and wand'ring pains; also a fluor albus. I prescribed her a Lotion as in the former observation, and dressed the Ulcers with lac sublimat. I let her blood and directed her a Clyster that night, and the next morning ℈ j calomel. I repeated this latter daily, she drinking a draught of decoct. sarsae after it, disposing herself to a breathing sweat, and once in four days was purged with an infus. senae, etc. Thus I dried those Ulcers, but by the frequent repeating the calomel. her chaps grew sore, and she salivated, which I was not troubled at, her Node requiring it. Upon which consideration I gave her 12 grains of Turbith minerale and raised it higher; and some days after when I saw the Salivation decline and the Node unresolved, I applied a Mercurial Emplaster the whole length of that leg, and thereby continued the Salivation longer till that resolved the Node. That done, I purged her with the bitter decoction, and put her into a strict course of diet-drink, and sweated her. After her mouth was cured, looking into her throat I saw the right tonsil cicatrized, but there remained unequal lips, which were troublesome to her. I also felt with my Probe a sinus running downward; it was made by a coalition of the flapping lips. I suspecting these might 'cause some fluxion, or at lest such an uneasiness as might beget in her a suspicion of relapse, I laid open that sinus and cut of those lips with the other cicatrices, and by rubbing the basis of the Ulcer with a Vitriol Stone cicatrized it afterwards smooth, and dismissed her cured.  
A Woman of about 28 years of age much emaciated was brought to me broken out all over her head, 
50. Observation of a relapse with Nodes, etc.  face, and several parts of her body and limbs. It began with a virulent Gonorrhoea, the cause whereof not being discovered, it continued long upon her, and after some months was accompanied with a pain in her head; for remedy whereof she consulted her Physician, but she being herself ignorant of the cause could not inform him, and consequently suffered very long under it: but after these eruptions the Gonorrhoea stopped, and the pain in her head ceased. What these break out were she had been lately informed, and desired my help. I let her blood and purged her with decoct. senae Gereonis, and by a few doses of praecipitat. alb. and a purging diet-drink I dried up these pustulae and Ulcers, and designed than a decoct. sarsae with sudorificks; but she believing herself cured retired to her own house. Within half a year after she came to me again, afflicted with pains in her head, and Nodes on her shins, and Ulcers in her tonsils. I let her blood and advised a Clyster, and dressed the Ulcers in the tonsils as hath been said in the like case, and prescribed her calomel. ℈ j in ℈ ij. diascord. and purged her the next morning with a solution of Manna in Posset-drink. After I had by calomel. somewhat digested those Ulcers I raised a Salivation by Unction, which she bore very well, and was thereby freed of her Nodes. In the declination of the Flux I purged her with the bitter decoction five or six days, than put her into a decoct. sarsaes, and afterwards by drying diet and sweeting, etc. the pain in her head went of, and the Ulcers of the tonsils were (long before I dismissed her) well and perfectly cured.  
A Woman aged about 30 years came out of the country upon a supposition of the Kings Evil. 
51. Observation of Ulcers in the fauces with a Gumma on the Musc. Mastoides.  She had a hard swelling encompassing the muscle mastoides on the right side of her neck of a great thickness. She complained also of a soreness in her throat, and of a stinking tough phlegm which she frequently hauked out, especially in the mornings. I looked into her throat and saw an inflammation upon the further part of the Palate and Wula, but no Ulcer in the tonsils. The inflammation of the Palate gave me cause to suspect some latent Ulcer, and that her Disease was Venereal; but she denying it, I prescribed her a decoct. hoard. with syr. de ros. sic. & diamoron, also an empl. de mucilag. with de ranis cum mercurio to apply to the Gumma. Dr. Lenthall who brought her to me, prescribed her an opening apozem and to be let blood in the Country. Thus we dismissed her, but within few days after she returned to us again, the Ulcer having seized upon the Wula and spread itself to the edges of the Palate. Upon sight thereof we disputed not of her disease, but considered of her cure. She had of late years been subject to great discharges of the menstrua, and was thereby rendered of a lax and weak constitution, and her body having been so lately purged and bled, there required no other preparation than of a warm room, which was provided with all expedition. For those Ulcers that arise on the interior part of the Palate, soon corrode their way through, if the alarm be not taken from the inflammation that precedes, a little mischief there being for the most part irrecoverable. To prevent which we gave her that night ℈ j of calomel. and repeated it so often as we might conveniently do, and prescribed her a decoct. sarsaes to drink with milk. We also prescribed her some of the Lotions set down in the Method of Cure, some whereof we cast up with a Syringe into her nostrils, and with other she gargled her throat often in a day. But the cure of the Ulcer was completed by frequent taking of merc. dulcis. The Gumma also lessened, but she having recovered some measure of strength, and her chaps being already sore by the calomel. which she had taken, we gave her 2 doses of Turbith, beginning with 7 grains and so higher, by which we raised the Salivation, and thereby resolved the Gumma. In the declining of the Flux we purged her with an Apozeme wherein was decocted sena, polypod. rhab. agaric. turbith, jalap, etc. with the addition of syr. de spina cervina. Than with drying diet-drink, sudorificks, etc. we finished the course and cured her.  
A young man was commended to my care having an Ozaena in his nose affecting the septum and alae; it seemed to be most on the right side, 
52. Observation of an Ozaena.  with inflammation and great swelling. In undertaking the cure of these Ulcers you aught to be cautious in delivering your prognostic; for the bones and cartilages are soft and covered with a thin membrane, which being once corroded corrupts quickly, and the lest defect in them leaveth a blemish in that part of the nose. The external inflammation is a shrewd sign that the Ulcer is deep, and consequently that the bones and cartilages are carious: therefore let not the rectitude of the part deceive you, for that may be supported by the swelling and crusty matter within, and upon the removal of them the nose or sides of it frequently sink; and if any deformity therein hap while they are under your cure contrary to your prediction, they will certainly impute it to your neglect or ignorance. In this Patient I suspected the right ala from the external inflammation, but promised my utmost endeavours, and began my work with injecting a decoct. ex rad. althaeae, sem. hoard. cydonior. and embrocated the external parts with unguent. popul. also applied a Cerote of the same; than let him blood, and directed a Clyster that evening. After his first sleep he took 25 grains of calomel. in cons. ros. and was purged the morning following with an infusion senae, etc. afterwards I purged him with calomel. and pill. Rudii, till I had removed the fluxion of his Nose. After the crusty matter separated from within, I syringed and cleansed those ulcers with one of the decoctions set down in the method of cure. Having thus disposed his Nose to cure, I gave him a few doses of turbith and raised a salivation, but the ulcers cicatrized before he salivated, yet I fluxed him 17 or 18 days. In the declination of it I purged, and sweated him with decoct. sarsaes, and there appeared a small bending in inward of the right ala, I supposed from the Caries had been in that cartilege; it was thrust out to his own satisfaction by a small hoop made by a bit of a searching candle painted of a flesh colour, but after some few days he left that of, it not being worth the while.  
One of a full Body, 
53. Observation of a Node, and of Ulcers in the Tonsils.  and strong Constitution, who had been long diseased with the several Species of the Lues Venerea, and been cured by me some months before of a Herpes' exedens, came now to us with a large Node upon his shin of the right leg. He was purged by his Physician, and prescribed a decoct. sarsaes, etc. also Antimon. diaphoret. Embrocations and Emplasters were applied the while to resolve the Node; but after six week's course of Physich the Node remained almost as painful as before. Upon which consideration it was concluded to lay it bore. I did lay it bore with the white Caustick, and divided the Eschar to the bone, and at the next dressing raised the Eschar of, than rasped the Node of, and dressed it dry, as hath been set down in Ulcers with Caries, The lips of the ulcer I digested with unguent. Basilic. applied warm, and afterwards incarned the bone, and cured the Ulcer in the space of two months, not without great pain to the Patient and trouble to me; whereas I might have resolved it, and eradicated the malignity, and freed him of the Lues almost in half the time. Within one half year he came to us again, not complaining of his Leg, but with Ulcers in both his Tonsils. These were certainly Venereal, and I concluded they would be so acknowledged, and that I should have an easy work of these. But the Patient would not be confined within doors, nor admit of other Physic than a decoction of sarsa, and a few powders of antimon. diaphoret. Three quarts of the foresaid diet-drink were allowed him daily. I have sometime seen him drink it up in a Morning as fast as if it had been Tunbridge waters. I once enquiring the reason why he drank them in such haste, he replied, he was to dine with some good Fellows, and that he did it to make way for better liquor.  
Thus he governed himself till the Ulceration increased, so that it was great pain to swallow any drink. He complained exceedingly to me that I could not at lest palliate those Ulcers, whereas in truth I used my utmost endeavours by all the Medicaments I could device; but they spread, and were accompanied with such defluxion, as at last when he strove to drink, part of it would gush out of his nostrils. Upon which consideration the Physician was fetched, and a submission was promised to his Rules. The Cure was begun by a Clyster, bleeding and purging, with an infused Potion, and the day after 25 gr. of Calomel. was given him in a spoonful of white bread and milk, and repeated daily or every other day, Clysters or Purgatives being prescribed between while to carry the matter downwards. By this method his Ulcers were disposed to Cure, and he finding his throat easier had thoughts of dining abroad with his Friends. Upon notice whereof I got leave of the Physician to give him 14 gr. of Turbith mineral. which accordingly worked very well. I repeated it the next day to 16 gr. it likewise vomited him, and made him spit and his Chaps swelled: The next day he perceiving that he fluxed, desired the Physician would prescribe him Physic to purge it of, which was promised him; but a day or two after the flux not rising sufficiently, I brought him a Bolus of a mixture of turb. min. with cons. borrag. which increased the Salivation. He sent for me, and offered me fifty pound to take it of; but I assured him there was no danger of his Life, and encouraged him to submit to it cheerfully. He did so, and salivated 18 or 20 days as plentifully as I ever saw any. The salivation declining, he was purged with an infused Potion, and Diet-drink was brought him, he promising us that he would keep his Chamber, and observe a strict method in Diet, Sweeting, etc. But he not sooner found his Chaps cured, but he returned to his wont liberty: and being told that he would most certainly relapse if he did not prosecute the Course prescribed by his Physician, he replied laughing, It's thy Course and not the Physicians, that he was very well, and if I would dine with him I should be a witness of it. I took leave of him, and saw him no more in half a year; and about that time he became more extremely diseased: for it is most certain, that Mercurial Remedies serve only to dispose these humours to be evacuated by decoctions of sarsa, etc. with Sweeting. How he was at last perfectly Cured you may see in some of the following Observations.  
A Woman of about forty years of Age, of a strong Constitution, 
54. Observation of an Ozaena.  having been long diseased with an Ozaena, was at length commended by Doctor Bate to the Cure of Doctor Jasper Needham and myself. The matter had corrupted part of the Septum, and other bones within her Nose, and made its way externally between the ridge-bone and cartilages of the Nostrils, and fouled the said bone to the very brows. The gristles being thus separated from the foresaid bone, and having lost that part of the Septum, which should have been their supporter, it sunk downwards, leaving such a breach, that the Injections which we cast into her nostrils with a syringe spurted out there. After we had thus discovered the evil quality of the Ulcer, we considered how to proceed in the Cure; and in regard of the difficulty of the Cure, and the length of time which might be required in the exfoliation of these bones, we resolved without further dispute to salivate her by Unction. To which purpose we let her blood, and purged her with an infus. senae, etc. during which Errhina were prepared of a lenient quality, such as have been proposed in the method of Cure, to loosen the crusty matter; and we enlarged the external Ulcer along the ridge-bone, as far as it was carious, in order to the exfoliation of it. We digested those lips, and dressed the bone dry according to the method set down in the Treatise of Ulcers with Caries. After we had by Errhina and Lotions cleansed the internal Ulcers of their filth, we than proceeded by detersive Injections, as prescribed in the method of Cure, and put a Canula in each Nostril made of a goose quill covered with a bit of empl. diachyl. simp. spread on a soft rag. These served to bear up the cartilages of the Nostrils levelly with the end of the bone (which before stood as it were looking over them) that they might be in a capacity (if it was possible) to unite with it: While we were thus disposing the Ulcers to Cure, we proceeded in the anointing her Legs and Arms, and thereby raised a Salivation, which continued upon her more than three weeks. During that time the Ulcers cured within her Nose, and the cartilages stood firm, and even to unite internally with the bone without the use of the Canula, but the bone there not being exfoliated, we continued the salivation longer by prescribing Mercurius dulcis, etc. and all that while we took care of her mouth, that no inconvenience should hap to her Jaws, etc. and kept up her Spirits with Broths, Posset-ale and Cordials. After we saw the bones exfoliating we purged her with an Apozeme, and prescribed decoct. sarsae with Sudorificks to sweated her. During which the bone exfoliated, and the Ulcers cured with a Cicatrix not unseemly. We than concluded our Course of Physic, leaving her more healthful and strong than she had been in many years.  
A Man of about 36 years of Age had a large Ulcer on the roof of his mouth with a Caries on the os palati, also many Nodes, viz. 
55. Observation of Nodes, Gumma and Ulcers in Os palati.  a great one upon the left temporal muscle reaching to that brow; also two on his right Arm, one whereof was on the os humeri, and the other on the Vlna; one very large upon the shin of the right Leg, and another on the outside of his left: which latter was soft and inflamed, and was by some proposed to be opened, but it seemed to me to be a Gumma. He had been long afflicted with the Disease, and was lately come out of a Salivation raised by merchant dull. in which he had spit very much. I touched the Ulcer with aqua divina warm, and advised the dressing it twice a day after the same manner; to the inflamed Gumma I applied an empl. è bolo to prevent its apostemating. The rest of the Nodes I designed to scatter by a salivation with unction. To which purpose I let him blood, and directed a Clyster, and the next morning purged him with ℈ j Calomel. in a lenitive Bolus; and to dispose him to rest, I gave him some nights ℈ j Calomel. in ʒj. diascord. whereby the Ulcer in his palate was the better digested. Having thus prepared his Body for the Unction, I caused his limbs to be anointed daily till his Chaps swelled much; than I desisted, and advised Posset-drink, Broth, etc. to be always ready for him to drink, and keep up his Spirits. There was also care taken to syringe and wash his mouth. During his Salivation, the Ulcer in his palate cast of a scale of a bone half an inch at lest in length, and presently after cicatrized firmly; his pain ceased, and the Gumma resolved, and all the Nodes diminished much, save that on his shin; yet he did not spit a quarter so much in this Course as (he said) he had done in the former raised by merc. dulcis. I continued him in the Salivation about twenty days, than purged him with the bitter decoction five or six days, and from that time kept him strictly to his Diet-drinks, and with Sudorificks sweated him, and proportioned his Diet more drying accordingly as his Chaps healed till I thought him cured, and than I gave him more liberty to nourish his body, and to drink the decoction of sarsa with milk twice a day, and bathed him 4 or 5 days; and kept his body soluble with a lenient Electuary. Thus I dismissed him, yet there remained somewhat of that Node on the shin, but it being without pain I supposed it would resolve, as indeed it did within a fortnight after, and he continued well.  
One of about thirty years of Age, 
56. Observation of Nodes.  of a full Body, having been long afflicted with Nodes and excessive pains on divers parts, especially onh is head, put himself into my hands for Cure. I designed a Salivation by Unction, to which purpose I prepared his Body by a Clyster, venesection and a purging Apozeme; than caused him to be placed near the fire, and to anoint himself from the sols of his feet to his groins, and so the arms and shoulders, and having put on his stockings, drawers and wastecote he was laid in a warm bed, and with a draught of warm Posset-ale disposed to a breathing sweat. Thus I proceeded daily in the anointing him till I had wasted two pound of Unction, but he had formerly taken so much Mercury, that it seemed to be familiar to him, upon which account I proceeded in the anointing of him, but it ran downwards one night in a Diarrhoea. I was fetched to him early in the morning, and was informed he had had near sixty stools. During the time I was with him they were mucous and bloody, with much pain, he having a tenesmus with it, which put him upon a continual excretion. I caused a Clyster of milk with yolks of eggs to be cast up, and prescribed decoct. C. C. calcinatis to be made, and drank with milk, to some of which I added a few drops of liquid Laudanum. I also injected in ano three or four spoonfuls of ol. hyperici with a syringe, and advised it to be often repeated to defend the interior coats of the intestine from excoriation. I prescribed him a Pearl Julep and elect. diascord. as it is set down in the method of Cure, to be taken once in three or four hours; thus in four or five days the Diarrhoea stopped. Than I prescribed him a Sarsa-drink, with an addition of milk till he had somewhat recovered his strength, purging him in the interval with elect. diacatholic. etc. By this Diarrhoea he was freed of his pains, and of some of the Nodes. Those which remained were much lessened, and by a strict Diet, decoct. sarsae and sudorificks were quite resolved, and he enjoys a good health to this day.  
It may here be objected by some, that if this Person had been more purged or well bathed before the anointing, the Salivation would have risen easier, and thereby the Diarrhoea might have been prevented. I do confess that the bathing doth much facilitate the raising of the Salivation, but we cannot have always that conveniency. Besides, where we do bathe, these accidents have happened, and will befall any one of us in spite of all our endeavours. Yet I must tell you, when a Diarrhoea thus happeneth in the raising a Salivation, it renders your Cure certain if you prosecute the method as I here did. For whether the Mercury work upwards by vomit or salivation, or downwards by stool, it is not material, so the peccant humours be evacuated and disposed to be carried of by Sudorificks, etc. But if the Patient grow froward upon such an accident, and will not submit to a regulation in Diet, Purging, Sweeting, etc. the humours do again ferment and tender the Cure more difficult.  
One of about forty five years of Age, 
57 Observation of Ozaena, Nodes, and Gummata.  having been long afflicted with the Lues in its most inveterate Symptoms, Nodes, Gummata, and an Ozaena, had passed through many courses of Physic, came to me extremely extenuated. He had one Node upon the Os Lambdoides very great, and another upon his right eyebrow; others upon his arms and legs. I began with the letting him blood, and sent him a Clyster that evening. I syringed his Nose with decoct. hordei, rad. althaeae, sem. cydon, etc. and after I had cleansed it of its crusty matter (with which some bones came forth) I daily injected some of the Lotions prescribed in the method of Cure. I bathed him five or six times, and the while kept his body soluble by Clysters, or by a lenitive Electuary, and allowed him boiled Mutton, Veal or Chicken for his Dinner, and a couple of new laid Eggs for his Supper, a small Ale for his drink. I also prescribed him a grain of Laudanum, or some anodyne draught to appease his nocturnal pains. After I had done bathing him, I caused his Legs Arms, Shoulders, Spine, and Hips to be anointed daily, and sweated him in a warm bed with a draught of Posset-drink. After he began to spit I anointed him more sparingly, only his Legs and Arms, and when I saw his Chaps swollen sufficiently, I forbore the anointing, and kept him to his Posset-drink and Broth, washing his mouth with decoct. hordei, rad. althaeae, liquiritiae, etc. He salivated very well near a month, but before he had spit fourteen days the pains diminished, and the Nodes lessened, and that filthy matter ceased to discharge out of his Nose: Also a Gumma which seemed ready to burst dried up. In the declination of the flux I put him into a strong decoct. sarsae etc. with Milk, and nourished him with good medicated Broths. As his strength increased, I purged him with the bitter decoction some days, and after his Chaps healed I kept him strictly to the Sarsa-drinks without the Milk, and sweated him with antimon. diaphoret. gum. guaiaci, bezoard. orient. and ordered his Diet as drying as he was capable of, purging him as customary once in four or five days. Thus in the space of eight weeks the Ozaena was perfectly cured, and all the Nodes resolved: but notwithstanding he complained of pain in all his Limbs, and was so weak that he was scarce able to go, and bemoaned his condition, supposing he should never be cured. I was of an Opinion that he was cured, and that those pains proceeded merely from the emaciation of the muscles; but I referred it to a consultation, where it was declared positively, that he was not Cured, and that he aught to salivate again. These proposals dismayed the Patient, and disturbed me not a little, for in truth he was too weak to salivate. I persisted in my former Opinion, and prevailed with the Patient to retire two or three miles into the air, and there to drink a decoction of Sarsa, etc. with Milk, and to give himself liberty to feed upon meats of good nourishment, and advised him to bathe in milk and water sometime. He did so, and I supplied him with papers of ingredients to make the decoction, also with a lenitive Electuary of Cassia, tamarinds, manna, etc. to keep his body soluble. In a few weeks he grew fleshy, his pains wasted, and from that time he enjoyed a good health many years.  
One about twenty eight years of Age was afflicted with an Ozaena of an old date. 
58. Observation.  It had perforated the septum, and cast forth some rotten bones, one whereof he shown me. He had also Nodes on both his legs and on his right arm. He was emaciated by reason of his continual pains, and the much Physic he had unsuccessfully taken. I injected a decoct. hordei, etc. into his nostrils, and after the crusty matter separated I prescribed him an Errhine to snuff up his nostrils often in a day. And having resolved to salivate him by Unction I disposed his body thereto by Clysters, Lenitive Bolus', (to which latter I added calomel. to take of his pains) and prescribed him decoct. sarsaes, etc. with milk, also a liberty in diet, and bathed him the while. Having thus somewhat recruited his spirits, I caused him to be anointed, legs, arms, hips, and shoulders, till I had raised a Salivation. Than I kept him to Posset-drink and Broth. I also allowed him a pint of Ale daily, sometimes burnt Wine or other Cordials by which he was enabled to salivate near a month. During that time the Ozaena cured, and some of the Nodes resolved. As the Salivation declined I purged him with the bitter decoction, and than put him into a decoct. sarsaes, and sweated him with diaphoreticks, and purged him once in four or five days, he observing the while a strict diet. After all I bathed him again a week or ten days, and permitted him a nourishing diet, and kept his body soluble cum elect. nost. laxativo ex cassia, pulp. tamarind. manna, etc. Some of his Nodes remained till I bathed him; but if they had not than resolved, yet I should not have doubted of his being well cured. For it doth sometimes hap that great Nodes dry and harden into such an exostisis as will not yield to any remedy. And indeed they being without pain we need not be so solicitous in their removal, for beyond Sea I have seen some well cured, the Nodes continuing upon their legs knotted like a Crab-tree-stick.  
A woman of about 50 years of age, 
59 Observation of Lues Vener. compl. with Caucer, etc.  of an ill habit of body, having passed through various courses of Physic, was brought to me complaining of pain in her arms, and nodes on the back of both her hands; also a cancerous tumour on her right breast. She importuned me to put her in a course of Salivation by Unction, and took a lodging near me. I thought it necessary enough for her, and told her I would prepare her body for it, and consult her Physician in the manner of salivating her. Accordingly I let her blood, than purged her with a solution of manna and cremor tartari in posset-drink, and bathed her four or five times; than gave her alternately two or three doses of calomel. to try how the Flux would rise. But she growing impatient in the delay sent for a Physician, to whom she related the original of her Disease, and that she had taken the spitting Pills formerly unsuccessfully, therefore desired to salivate by Unction. Some objection was made against it, as doubting her viscera were naught. But he complied, and promised to visit her as occasion should require. I sent her a pot of Unction the next day, wherewith her legs and arms were anointed, and she returned to her warm bed and was disposed to a breathing sweat by a draught of Posset-drink. By this method the Salivation was raised and she fluxed moderately about 20 days, during which her pains remitted, the Nodes resolved, and she recovered the use of her hands. The Cancer lay also quiet. The Salivation declining she was purged with the bitter decoction, and some days after drank a sarsa drink, and sweated. In the going of of her Flux she complained of a shortness of breath, and was afterwards subject to fainting. Whereupon her Physician was consulted, who supposing it hysterical prescribed as followeth: ℞ Galbani, sagapeni an.ʒj. asae. foetid. ℈ ss. castor. ℈ j balls. Peruv. q. s. f. pill. quarum capiat ℈ j omni nocte. ℞ Galbani ʒuj. fiat empl. pro umbilico. Superbibat post pilulas julapii sequ. ℥ iij. ℞ Aq. brion comp. ℥ ij. pulegii, mirabilis, hyssopi, an. ℥ iij. tincturae crociʒij. sacchar. albis. ℥ ss. ms. f. julapium. After she had proceeded in this course eight or ten days, she complaining of her stomach and of an offensive smell she thought arose from thence, her Physician prescribed her as followeth: ℞ Salis vitrioli ℈ iij. capiat statim in possetalâ: si semel tantùm vomuerit, capiat ℈ j ejusdem in eadem posset alâ, and so to repeat it the third time if her strength would bear it. She did so, and was laid to rest with this following draught: ℞ Landani gr. j aq. menthae ℥ jss. cinamomis pulveriz. ʒss. diascordiiʒij. f. haustus horâ somni. The day following the Physician found her much relieved, and prescribed her this decoction: ℞ Sarsae ℥ iij. santali albi ℥ ij. chinae ℥ jss. guaiaci ℥ j digere horas sex in aq. come. lbviij lbviij. vase clauso, dein decoqu. ad medias, addendo sub finem ingredientia decoct. pectoralis. Bibat copiose & frequenter, addendo singulis haustibus mixturae sequentis cochl. j vel. ij. ℞ Aq. limac. brion. comp. an. ℥ ij. tinct. croci ℥ ss. sp. castores ℥ jss. ms. This potion was also prescribed her 3 or 4 days after: ℞ Tamarind. ℥ ss. coqu. in aq. come. sub finem addendo senaeʒiij. rhab. ʒij. sem. anisiʒss. cape colaturae ℥ iv. mannaeʒuj. syr. de rhab. ℥ j syr. de spina cervinaʒj. f. potio. By these prescriptions she somewhat recovered, and removed from those lodgings to others more airy in the same street. And there another Physician was consulted and joined with the former: he approved of what had been done, and gave hopes of her recovery; and together they prescribed as followeth. ℞ Gum. galbani, ammoniaci, myrrhae, balls. Tolut. an.ʒj. croci gr. iv. cum opobals. Giluadituiʒss. f. pill. quadruplo deaur andae: cap. bis térve quotidie. ℞ Gum. guaiaci catharticiʒj. syr. è capil. Veneris q. s. fiat mixtura mollis, quam capiat tertie quoque manè ad quatuor vices. ℞ Aq. ceras. nigr. ℥ vj. è flor. paralies. aq. cinam. hoard. an. ℥ ij. margar. praeparat. ʒij. sacchar. crystal. ʒij. ms. f. julapium, de quo bibat ad placit. Some while after she removed nearer the Country for the benefit of fresh air, and to drink Ass' milk, which she had already begun to do, and might have recovered if her viscera had not been all rotten.  
A poor fellow aged about 50 years had grievous pains in his head, 
60. Observation of Nodes and pains.  and divers nodes and gummata in several parts of his body. He had lately come out of a course of Physic, and was so wasted as he could scarce stand, and had lost the nails of his fingers and toes. I directed him a Clyster, and that night sent him an opiate to calm his pains and dispose him to rest, viz. of laudan. merchant dull. gum. guaiaci, etc. as is set down in the method of cure, and repeated it as occasion offered; and prescribed him a sarsa drink with milk. But after 2 or 3 days observing that he was much oppressed in his stomach nauseating all that he took, I gave him a vomit of infus. croc. metallor. with oxymel. scillit. by which I emptied it of much viscous phlegm. From that time he recovered his appetite, and by good nourishment and mitigation of his pains he recovered a tolerable measure of strength. I than caused him to be anointed legs, arms, hips and shoulders, and repeated the anointing daily till I had raised a swelling in his chaps. He salivated well, and was kept to warm Broth, Posset-drink, and sometime Ale and  Wine. During the Salivation he fainted often, and was seized twice with Convulsions, and with much difficulty I kept up his Spirits: but he got through it by the help of good Cordials, aq. theriacalis, etc. In the declining of the Flux I purged him with the bitter decoction, and finished the cure with decoct. sarsaes, sweeting and drying diet and purging. Passing by this man's house one day in the company of D Walter Needham, we went in, he was working in his trade, he shown us his legs and arms, there was not a node left; he also shown us new nails thrusting out, the Patient than declaring himself well, and indeed so he continued a month or two, and than pains began, nodes and gummata also arose. I attempted the cure by crude Mercury as it is usually given by some under the name of the Blue Pills with a strong decoction of sarsa, rad. bardanae, fol. saponariae, and with laureola. Indeed I consulted several that pretended great matters in the cure of this Disease, and omitted nothing whereby I could hope to relieve him, applying also Emplasters, and caustical Medicaments to the Nodes, by which I did resolve the biggest and most painful of them: but the malignity increasing, the Patient made it his request to me to salivate him again by unction. Whereupon I let him blood, and directed a Clyster, than bathed him four or five times, and raised a salivation by only anointing his Legs and Arms according to his desire. He salivated very well, and during the salivation he was freed of his Pains and Nodes, and by the prosecuting the Course by diet-drink, sweeting and purging, he seemed perfectly well; but yet he relapsed. I afterwards perceived his Wife had been all the while infected with the same disease; but whether he got it from her, or through neglect of observing this latter Course, his necessity in following of his Trade constraining him to be daily abroad and in his Shop, (and without a strict observance in that Course you will scarce cure. the lesser Species of the Lues) I contented myself in the expenses I had been at, 
61. Observation of Ozaena and Nodes.  and left him to others.  
A Man of about thirty years of Age, came out of a long Course of Physic to me, having an old Ozaena whereon some bones had cast of: he had also pains in divers parts, and several Nodes. I resolved to salivate him by unction, to which purpose I let him blood, purged him, and anointed him, Legs, Arms, Hips, Shoulders, etc. by which in few days I raised a salivation, kept him to Posset-drink and Broth, and took care of his mouth. His Nose was also dressed daily, as hath been showed in the like case. In the declination of the Flux, I purged him with the bitter decoction, and prescribed a strict drying Diet, decoct. sarsaes, purging and sweeting, and dismissed him cured of the Ozaena, and the Nodes and Pains resolved. But some months after he relapsing came to me again, and acknowledged that he had not been so regular in his Diet as I had directed (and in truth I had heard he had bragged of it) and that he would enter into a new Course of Physic. I let him blood, and purged him six or seven days with the bitter decoction, than vomited him with turbith minerale three or four times, prescribing Clysters between while. After I had thus heated his Chaps, and disposed the matter for Sudorificks, I put him into a decoction of sarsa, and with merc. diaphoret. sweated him twice a day, and kept him to a strict drying diet, and by this method I cured and secured him from relapse; and so shall do as many as will submit to it: an instance whereof may be seen in many of these Observations. 
62. Observation of an Ozaena and Ulcers in the Tonsils, and Nodes.   
A Man of about thirty six years of Age came to me with an Ozaena, Ulcers in both the Tonsils, and Nodes, with pains in several parts of his Body, which together had extremely emaciated and weakened him. I syringed his Nose with a lenient Lotion according to my custom, and afterwards prescribed some of the other Errhina for daily detersion. I also dressed the Tonsils with lac sublimati. In order to his Cure, I let him blood, and prescribed a Clyster, and that very night sent him ℈ j merc. praecipitat. albi, which he took in a spoonful of white bread and milk, and repeated the giving of it three or four nights after one another, carrying it of by Clysters daily. During which I allowed him medicated Broths, Posset-ale, and a Pearl julep. After I had thus disposed his Ulcers to digestion, so as that he was in a capacity to eat meat, I permitted him to eat such as was of good nourishment, and prescribed him a decoction of Sarsa, etc. with an addition of Milk to drink daily, and every other morning gave him a few grains of Theriac metaltor. in ʒss. cons. melissae, and thereby vomited him moderately, And purged him once or twice, and continued the use of Clysters accordingly as I saw cause, and bathed him often, I suppose eight days. Thus I removed his pains, and cured the Ulcers, and purposed to have put him into a strict Diet, and to have finished the course by Sudorificks, etc. but some of the Nodes remaining, and the Patient having long before met with great difficulty in his Cure, earnestly importuned me to salivate him by unction, alleging it the sure way to prevent relapse. I seeing his desire, and supposing it might be reasonable, did comply with him, and caused his Legs and Arms to be anointed daily till his cheeks swelled. Than I kept him to Posset-drink and Broth, and took care in the washing his mouth. He salivated well about sixteen or seventeen days, but than growing weak and faint, I caused his feet and legs to be bathed with warm water, and fresh linen to be put on, and by Clysters disposed the matter downwards, and kept up his Spirits with Cordials. Having thus refreshed him I purged him proportionably to his strength, and finished the Cure by a course of drying diet, decoct. sarsaes, Sudorificks, etc. in three weeks. But he being extremely pained in all his Limbs suspected his Cure, but the Nodes being resolved, and the Ulcers so long before cured, I encouraged him to take his wont nourishment, supposing these proceeded from the emaciation of the muscles; yet I prescribed him a medicated Ale, and advised bathing a few days: he did so, and found as his strength recovered so his pains lessened. He removed afterwards to Paris, where he enjoyed his health and a quiet mind, till one night upon change of lodgings he was bitten with Musketoes, and seeing his face next morning so swelled, he consulted Physicians and Surgeons, who would needs persuade him it was Venereal, but it proving otherwise he escaped the grand Course, but was bathed often.  
A Woman of about forty six years of Age was commended into my hands, 
63. Observation of a Gumma,  The hairy scalp on the os frontis had been some while ulcerated, and the bone corrupted the compass of a broad shilling. I laid it open by a circular incision, and dressed it up dry. The second day after I took of the dress, and saw the bone full of a lose flesh arising out of the cavities. I scraped the bone, and dressed it up with unguent. Aegyptiac. warm, and digested the lips the while, Having thus disposed the bone to exfoliate, I began the internal Cure by bleeding and purging, and prosecuted it by salivating her with Turbith mineral. and in the declination of the flux I purged her with the bitter decoction, and finished the course by a decoct. sarsaes, drying diet and sweeting, and in the while exfoliated the cranium, and cicatrized the Ulcer.  
A young Woman came to me with an inflamed Tumour upon the Fibula of her right Leg; it seemed to have matter in it, 
64. Observation of a Gumma resolved.  but upon a farther enquiry I discovered it a Gumma. I applied an Emplaster è bolo to defend it from fluxion, and caused her to be let blood. The next day I purged her with decoct. senae, etc. and prescribed her an anodyne draught that night. The day after I purged her with extract. nost. mag. & calomel. and the next day sent her 10 grains Turbith min. in a Pill, which vomited her five or six times. The next day a Clyster was administered, and the fourth day after Turbith again; and so repeated the Turbith with Clysters proportionably: and in the interval purged her sometimes with the bitter Apozeme to avoid salivating. By this means I resolved the Gumma, and perfected the Cure by Diet and Diet-drink, Sudorificks, etc.  
A poor Fellow came to me with a Carious Ulcer on the os frontis, 
65. Observation of an Ulcer, with Caries of the os frontis.  which had been of a long continuance: the bone was white, yet corroded much, and filled with an Hypersarcosis, as most of these sort of Venereal Ulcers are. He was let blood, and purged four or five days with the bitter decoction, and took every other night ℈ j calomel. After I had thus purged him, I laid open the Ulcer by a circular abscission, and dressed it up dry. The second day I opened it again, and scraped the bone and lose flesh of, and applied dossils pressed out of the tincture of Vitriol, and dressed up the recent lips with the digestive ex terebinth. cum vitello ovi. After I had thus digested the Ulcer, and disposed the bone to exfoliation, I raised a salivation by a few doses of Turbith minerale; during which his Landlady discovering his Disease would not permit him to lodge longer in her house. Whereupon he removed unknown to me to a Common Alehouse some distance of. Walking thither in a cold winter day to a Lodging as cold, the salivation checked, and a shortness of breath with frequent fainting followed, and increasing upon him he died in spite of my endeavours, and those I consulted.  
A Man aged forty four years, 
66. Observation of a Caries in the Os frontis.  of a Plethoric Body, half a year after he had been Cured of a Chancre, began to complain of a pain in the sore-part of his Head. A Tumour appearing in that part some time after, he consulted a Chirurgeon, who opened it by incision, and dressed it with a dossil of lint, and left him to his Chirurgeon to cure: But in progress of time the Ulcer enlarging, and the bone growing more carious, the Patient consulted another Chirurgeon, who told him it was the work of Nature, and that in time the bone would cast of. The poor Man believing what was said, took care to have it dressed accordingly by the same young Chirurgeon, till the Caries had infected the bone almost the whole length from the coronal suture to the brows. And than he came to me for Cure, and having lodged himself near me, I went to dress him, and saw a great discharge of a setid matter, and the lips of the Ulcer lying hollow over the rotten bone. I cut them of round so far as the bone lay carious under them, than dressed up the wound and bone with dossils of dry lint, etc. Than knowing that there was no hopes of curing him without the use of Antivenereals, I ordered a Clyster that evening, and began the next morning to purge him with an infusion of sena, rhab. etc. (for I had permitted him to bleed sufficiently in the extirpation of the callous lips.) The third day I renewed dressing, and saw a pulsation of the dura mater through several small apertures in the carious bone. Upon sight whereof I had thoughts of setting on a Trepan, but there being no immediate danger, I proceeded with Mercurials, and gave him ℈ j Calomel. that night, and purged it of the next morning with a draught of the bitter decoction, and repeated the same Apozem four or five days, giving him Calomel. every other night. Whilst I was purging him the matter abounded much, and flowed downwards into a remaining sinus between his brows, to prevent which, I made a bandage with good compression on that part, and dressed the rotten bone with dossils pressed out of sp. vini, and continued that method of dressing daily. And that I might hasten the exfoliation and cure of this Ulcer, I gave him the morning after Turb. min. gr. xij. which both vomited and purged him. I repeated it once in two or three days till I had raised a salivation, during which the sinuous Ulcer healed by agglutination, and the matter accordingly lessened daily, and lost it's fetid smell; the bone also cast of in its circumference, and loosened in the middle, so that I broke those forementioned apertures into one another, and raised up one piece of the cranium consisting of both tables, and made way for the Callus to thrust of the remaining sides of the bone, part whereof cast of soon after, and the Ulcer incarned, and is now cicatrizing. There was a Node upon the right jaw, which is partly resolved. The Patient is yet in a Course of Diet-drink, sweeting and purging, in order to the confirmation of the Cure, which I think there is no doubt of.  
A Man of about thirty four years of Age was commended to my Care. 
67. Observation of Ulcers and Nodes, with the ill consequences.  He had several Nodes on his Legs and Arms, one whereof upon his right Leg was big and much inflamed. He had also some break out about several parts of his body, and Caries in both his jaws. He had passed through many hands, and came than out of a salivation raised by some Mercurial Pill, and (as he said) had spit between 4 and 5 quarts a day the space of three weeks. I designed salivation by unction. In preparation thereto I let him blood, purged and bathed him, than caused his Legs and Arms to be anointed till his Chaps swelled, and the salivation arose moderately; than I put him to the drinking Posset-ale and Broth, and took care of his mouth. All things thus likely to succeed well, I having a Command to make a Journey of four or five days into the Country, recommended him into careful hands, purposing at my return to raise the salivation higher, if there were occasion. About the sixth day after, at my return, I found my Patient much indisposed with a shortness of breath, and frequent fainting. The swelling in his Face was sunk, yet was his mouth much ulcerated, and his jaws so contracted, that he could scarce open them to take in a spoonful of broth. His spitting checked, his body costive, and the urine he made was little and high coloured. I caused a Clyster presently to be administered, and sent for a quart of aq. antisyph. of which I gave him some, and advised the taking it once in two or three hours. I syringed his mouth with decoct. hordei, liquiritiae, & mel. magist. and put a folded rag between his jaws, which I had before advised his Nurse; but she was one of his choosing, and ignorant in this work.  
I also advised him to hold some of the gargoyle often in his mouth as hot as he could endure it, and made up a mixture of some mel magistralis with sp. vitrioli to dress some other of the Ulcers which required detersion. I also prescribed him a Lambitive of ol. amygd. dull. etc. to help expectoration. The next day I purged him with a decoct. tamarind. cassiae fistul. senae, etc. to which was added sir de ros. solut. manna, sir de sp. cervina, and repeated it the second and third days. It wrought moderately, and somewhat relieved him. In the washing his mouth with a syringe forcibly, I put him upon excreating a great quantity of a filthy matter, amongst which there seemed somewhat like that we call purulent. I not imagining whence it should come, indeed never having seen the like, consulted Doctor Denton, who advised me to purge him with Barnet-water a quart or more at a time, with a spoonful or more of syr. de spina cervina in the first draught, and so to proceed accordingly as it passed. I did so, and observing it to pass both by urine and stool; I repeated the use of it five or six days, and the while kept up his strength with good Broths, etc. After I had thus emptied his bowels, that discharge of matter ceased, and he recovered. Than I bathed him, and prescribed him medicated broths, etc. also decoct. sarsaes, and kept his body soluble by lenient purgatives once in three days.  
By the frequent syringing and gargling his mouth, and dressing the Ulcers I healed that, but by reason of the contraction of his Jaws, the ulceration and Caries increasing upon the old diseased parts of the Jaws some of his teeth dropped out, and at last I was forced to cut the contracted Callus, and that way enlarged his Jaws. Whilst these various accidents affected the Viscera internally, his Nodes and Pains discussed, his skin also was freed of its foulness, and he seemed perfectly cured; yet to secure him from relapsing, I prevailed with him to continued his Diet-drink, and to sweated with autimon. diaphoret. etc. and to purge between while. To which purpose I supplied him with Materials, and he retired a few miles out of Town, and prosecuted the Course, and came from thence to Town well fleshed, and enjoys a good health to this day.  
A Man aged forty eight years, having been long diseased in the Country, 
68 Observation of Lues Venerea, with complication of Diseases.  and taken much Physic unsuccessfully, was afterwards advised to the Bath, whither he went; but those waters not being suitable for his Disease, he returned to London much emaciated, and very sick and weak, and consulted two Physicians and myself. He had Nodes upon his Arms, Hands, and Fingers, and indeed had no use of them. His other Limbs were affected with pain. He had an ozaena of an old date, whence several rotten bones had cast of. His Jaws were also carious. There was small hopes of his recovery, yet we were obliged to attempt it some way, and in order thereto Lodgings were provided for him near me, and we began his course of Physic with an infus. senae, rhab. etc. but his stomach was so weak that he had of long time nauseated all sorts of sustenance, and vomited this potion. Upon notice whereof we prescribed him sal vitrioli, and emptied his stomach of much viscous phlegm. A Clyster was administered that evening, and we laid him to rest that night with an anodyne draught. The next morning he was let blood in the Arm, and purged the day after with a soulution of manna, crem. tartar. in a draught of Posset-drink, and the next day we bathed him in water lukewarm: he fainted in it, and was seized with a shortness of breath after he was in bed, which lafted about an hour; yet we proceeded in the bathing him daily the space of a week, and relieved him in those fits with Cordial-waters, and kept his body soluble by Clysters. Having thus prepared him for other remedies, we prescribed him calomel. but which way soever he took it, he vomited it soon after. We than sent a pot of unguent. Neapolit. by a servant who rubbed part of it on his Arms, Thighs and Legs, and disposed him afterwards to a breathing sweat with a draught of Posset-drink: Thus he was anointed several mornings, till his chaps swelled and his mourth ulcerated. Than we took care in washing his mouth with lenient decoctions, and nourished him with medicated Broths and Posset-ale, permitting him sometime to take a little  Wine, aqua theriacalis mag. to support his spirits. By which method he salivated 26 days, and was freed of his pains; the nodes also resolved, and he recovered the use of his hands, and the rotten bones cast of from the eithmoides, etc. The Salivavation declining, the bitter apozeme was prescribed him. Decoctions of sarsa with an addition of a little aqua mirabilis was also allowed: But our Patient had been obstinate and ungovernable in the whole course, and was now at last so averse to every thing was prescribed him, that in truth he neither purged, drank his diet-drink or sweat as he aught; and through that omission the serous humours abounded, and began first to swell his Legs, than his Thighs, and somewhat his Belly. His Arms and Hands afterwards swelled, and at last his Eyelids and Face, and an Itch broke out over all his body, which by his rubbing and scratching excoriated the skin in several parts, and was very vexatious to him. At the first appearance of these anasarcous swell, various internals were prescribed, but he only took Cordial-waters, in which we infused sometimes purgatives, whereof this following was one: ℞ Spec. diamosch. amariʒjss Aloesʒj. sp. vini lb j. eliciatur tinctura s. a. capiat cochlear. iij. pro vice, repetend. ad placitum. Some such like tincture was also added to aq. lumbricor. etc. We having no other way of purging him, the serosity increased, and overcoming the natural heat he died.  
One of a strong constitution having been diseased seven years with the various species of this Lues, 
69. Observation of the Tonsils, Ozaena and Nodes.  and had passed through many hands beyond Sea and here, and hath been taken notice of by me in one of the former Observations for his irregularity in that course of Physic, came to me again within a year after lamentably afflicted with Ulcers in his Tonsils, Palate and Nose, etc. (I being than imprisoned by the fanatics in Lambeth house) he consulted others, but came afterwards to me, desiring my opinion of his Disease, and what hopes I had of restoring those ulcerated parts to their former use and shape. The Ulcers in the Tonsils and Nose were large, and accompanied with inflammations and tumour, and thereby occasioned a great difficulty in swallowing his drink, the most part of it running out at his Nostrils. On the ridge of his Nose there was a herpes exedens with a caries in that bone, and upon the left side of his Nostril another, which had penetrated through that cartilege, and an ozaena within which had corrupted part of the ethmoides and the lower part of the septum, insomuch as there only remained the exterior skin to divide the Nostrils, and that being ulcerated could not defend itself long from being eaten in pieces. He had also some Nodes upon his Legs, but the Ulcers in his Nose were they which threatened the danger, yet there were hopes of curing them if a course were speedily taken. He returned somewhat satisfied, and the next day sent for two eminent Physicians, and procured leave for me of my Keeper to meet them. I representd the condition of the Ulcers to the Physicians, and proposed to them the raising a Salivation by unction as the speediest way to prevent the farther erosion. They had no great opinion of Salivating, but did comply with me, and promised the Patient to visit him often during course.  
The Patient had been let blood, and purged by their prescriptions; upon which consideration I prescribed him ℈ j Calomel. in a spoonful of white bread and milk to take that night, and advised them to bathe him the next day; also to repeat the Calomel. for some nights, hoping thereby to check the corrosive quality in the Ulcers; and I also advised to repeat his bathing in order to the salivation I intended by the unction. Care was also taken to keep his body soluble by Clysters, or lenient Bolus'. I directed one of my Servants to dress the Ulcers, some with lenients, and others with detersives.  
Whilst the Ulcers were thus disposing to Cure, my liberty was procured, and I again attended the Patient; and having prepared all things ready, began to raise the salivation by anointing his Legs, Arms, Shoulders, Spine and Hips, and repeated it daily, and afterwards put him into a warm bed, and disposed him to a breathing sweat, with a draught of buttered Ale to gratify his palate. The rest of the day he drank Posset-drink, etc. During the anointing, some of the Lotions were syringed twice or thrice a day into his nostrils. Gargles were also used to wash his throat, and the Ulcers of the Tonsils and uvula touched with lac sublimati. Those Ulcers without were deterged and smoothed fit to heal, as Nature should be disposed thereto. And that little bit of skin which served to divide the nostrils likewise healed.  
I continued anointing this Patient till I had wasted near three pounds and a half of the unction, yet his Chaps would not swell, nor did he spit a quart in 24 hours. But during this anointing he was freed of his pains, and the Ulcers cured as well as I could desire. But how far this would serve to eradicate such an inveterate Lues, I much doubted. The Physicians seemed also to distrust my undertaking, considering I did not salivate him as I had proposed. The Patient also became weary of the frequent anointing. Upon which considerations I was somewhat troubled, and endeavoured by Clysters to move it downwards, wishing it would end in a Diarrhoea; but it not moving that way, nor any other way disturbing him, I concluded his not salivating to proveed from the quantity of Mercury he had formerly taken, and that possibly it was become habitual to him. Supposing it might be so, I caused some Mercurial Emplasters to be applied to his Feet, Legs and Arms, and sweated him again in his Bed moderately. And after these, seeing the Salivation not yet arise, I gave him Turbith min. gr. xuj. in a Pill with cons. boraginis. It vomited him twice or thrice inconsiderably. But from that time he began to be sevourish and faint, and the matter much indisposed, by which I judged it necessary to purge of. To which purpose a Clyster was administered, and the Plasters taken of, and fresh linen put on. He took the bitter decoction five or six days, making large evacuation that way. During which his mouth was frequently washed, and disposed to Cure; and I put him into a decoct. sarsaes, and strict diet, sweeting him with antimon. diaphoret. etc. as before hath been prescribed in such like cases. I continued him a month in this Course, and being than satisfied that he was well Cured, and secured from further relapse, the Physicians were sent for, and saw the several Ulcers cicatrized; that on the ridge of his Nose where the bone had been bore was healed smooth without any visible exfoliation. If the Cartilege on the side of the Nostril did exfoliate, it was cast of into the Nostril, for the cicatrix lay close and transverse as a small seam. Within his Nose there was a great vacuity, but nothing of Caries or bore bone, nor did he blow any thing of filth as formerly he had done. And that his Palate and Tonsils were as well, appeared both by his voice, eating and drinking. His Legs were also as free from Nodes as pains. The Physicians judged him Cured, yet would not yield the Cure to the Salivation: but in other cases of that kind, where I afterwards proposed Salivation, they would reply upon me, that I did not Salivate such a one, meaning this Patient: To which I always answered, The Cure consists not so much in the spitting a great quantity, as in putting the matter upon such a ferment as might fit it to be carried of by the Sudorificks, Purging, etc.  
This Person retired afterwards into the Country, and returned to London at the end of two years, and acknowledged to me his Cure by settling Thirty Pounds a year upon me during his Life, and paid me Sixty Pounds for the two years passed.  
I am not ignorant that there are a people who pretend to Cure all the forementioned Species of Lues Venerea without running such long Courses, or keeping their Chamber: But it is their undertake which make us so much work; yet truly, I do believe, that all those who are of a fleshy and strong Constitution, may be Cured without Salivating by Unction, if they would patiently submit to so strict a Course of Diet, etc. as that way requireth.    

CHAP. V Of Gonorrhoea.  
GOnorrhoea in general may signify any flux of Seed from the body; 
Gonorrhoea, what it is.  but custom hath appropriated it to that which is involuntary.  
The Ancients have confined that appellation to a loss of Seed which happens without erection or tentigo; or if you will have it in Celsus his words, sine venere vel nocturnis imaginibus. But Moderns have given a larger account of Gonorrhoea, and do found many differences of it.  
As First, That which comes from a fault of the vessels; as first, 
It's differences.  from natural coldness or great refrigeration, in which case they loose their retentive faculty; or secondly, which is more frequent, from friction and mastrubation among young boys (when they first come to puberty;) thirdly, from violent straining; fourthly, from the laxity of the seminal vessels in general; fifthly, from erosion of the caruncle in the urethra which covereth the exit of the vesiculae seminales, and vasa deferentia, and is indeed the sphincter of them; sixthly, in epileptic cases we found profluvia seminis, which seem to be caused by the strength of the Convulsion.  
Secondly, That which cometh from fault in the matter of the Seed, viz. 1. when it is too crude, thin and cold, and so weeps away insensibly; 2. when it is sharp and comes away either with titillation or pain; sometime to the erosion of the Vrethra and the excoriation of it; 3. when it is infected with a virulency in the Lues Venerea.  
It is this latter species that is the most usual employment of our profession, the diseases of those parts being most frequently gotten by the too predominant vice of the age. I shall therefore confine my discourse to that subject, not only because it is one of the first symptoms of the Lues Venerea, but also for that through the Patients slighting and neglecting its cure, many ill accidents do hap in process of time, which renders it much more difficult to cure than any other species of the Pox.  
A virulent Gonorrhoea is an involuntary emission of seed, 
Definition.  occasioned by venom contracted from an unclean woman.  
Seed thus emitted is doubly peccant, both in quantity and quality. The latter is always proportionable to the degree of the infection and to the increase of putrefaction.  
The quantity is likewise always far greater than vessels in their natural estate are able to breed or to discharge, which hath caused a great deal of contention among Physicians about the seat of this disease, or the original of it. And indeed it is very odd to consider that a man upon coition shall sometimes have nothing outwardly appear upon him, either by way of chancre, bubo, or any other evil, but shall found his urine hot, with a flux of sharp and acrimonious seed from within, the continuance of which shall spend his strength, erode the urethra, make caruncles and other mischiefs. On the contrary, if stopped, shall 'cause inflammations in the testicles, or else a bubo or chancre; and if these hap not, shall infect the whole body, breaking out in scabs and ulcers, or making nodes, intolerable pains, rotting the bones, etc.  
Where this venom should enter, what parts it should originaly infect, and how insinuate itself, and afterwards 'cause such great separations of spermatick matter, etc. is worth our while to inquire.  
The way of its entrance in a woman is intelligible enough, but in a man it can be no other than either the passage of the urethra, or the pores of the skin of the penis, pubes and inguina.  
The former seemeth not very likely, 
Manner of contracting it, 1. In Men,  because it is not suitable to many other circumstances of the disease, which doth seldom or never originaly infect the urethra itself, or the prostatae, etc. and never ascends into the bladder; whereas on the other side we found visible affections of the glans, praeputium, inguina, etc. to be the first effects of the infection.  
We have therefore reason to believe that the venom lurking in the vagina uteri of an infected woman, doth upon the friction and warmth that happens in coition fasten upon those parts which it toucheth, viz. If it lie high within the vagina, or the penis enter not far in coition, the glans and prepuce suffer to the production of a Chancre. If the coition were closer, and the venom have possessed the labia pudendi, than the whole skin of the penis is infected, and the pubes itself; where insinuating into those pores, it doth not produce so visible effects as it doth in the prepuce and glans, because the skin is thicker. But than it is transmitted not only into the mass of blood in general, but also into the spongy glandules of the inguina in particular. If these or either of these be sufficiently swelled, and nature strong, the venom may discharge here; but if this hap not, than it creeps into the blood, and there produceth fermentations suitable to its nature. The matter of the venom being originally corrupted seed, doth therefore raise seminal fermentations, but withal one that is peccant after the nature of the venom that excited it; by which means it happens that spermatick matter of a vicious sort abounds in the blood, exhausts it of its best spirits, and derives the flower of it to the seminal vessels. This matter is too much and too sharp to be long contained there, where it immediately provokes and stimulates nature to an excretion; and according to the degree of its acrimony and corruption the seed will be more or lesle, thicker or thinner, white, yellow, green, etc.  
I know Bartholinus hath made a Gonorrhoea to be nothing else, but an Ulcer of the prostatae. Which Opinion is sufficiently confuted by Doctor Wharton, who gives him the insoluble objection of the Tumour of the Testicles, which happeneth always upon the untimely stopping of it. By the pounding up of the water, it is easy to found which way the current came.  
In Women, 
2. In Women.  the manner of the Infection is much more intelligible. Where the Infection of a corrupt venomous Seed enters into an Vterus, that is heated partly by coition, and partly by its own appetite, it is greedily sucked in, and as fatally to the misfortune of the Woman. There its first attack is upon the innermost or glandulous membrane of the Womb, usually acuating its ferment, and causing a large precipitation of serum from the blood. This is at first by modest Women mistaken for a fluor albus (unless the matter have been so highly virulent as to 'cause immediate inflammations) and is so treated till worse Symptoms arise, and all is betrayed. What those are, we have already shown you in part, and more will appear hereafter.  
The preceding sign of it is heat in Urine, 
Signs of it in Men;  than succeedeth the Disease itself, viz. an issuing of white matter in small quantity, which by degrees increaseth, and groweth more corrupt and virulent, changing its colour somewhat to a yellow or green: and about this time it is accompanied with a painful erection, and for the most part with a contraction or pricking in the Vrethra under the fraenum.  
In Women also heat of Urine is felt with a dropping of matter from the Womb, at first resembling a fluor albus, but after a few days it increaseth, 
In Women.  and becometh purulent and fetid, with diversity of colours, making an inflammation with excoriation; also a bearing down of those parts, and pain in the back.  
A Gonorrhoea is more or lesle difficult of Cure, 
Prognostic.  according to the malignity from which it received its Original. Those that become suddenly virulent, and accompanied with stranguria, are most difficult to Cure. If they do stop with out any manifest cause, either a Chancre ariseth, or a hernia humoralis. If the Cure be slubbered over, or long delayed, caruncles arise in the Vrethra, and in progress of time a carnosity, etc.  
In the Cure of this Disease, 
Cure.  we aught to have a special regard to the accidents , viz. inflammation, excoriation, stranguria, etc. Therefore in the first place, we endeavour to contemperate the heat, than purge of the vicious humours; afterwards by moderate detergents and desiccants cleanse and dry the diseased parts, and restore them to their natural temper.  
In order to the contemperating of the heat, and acrimony of the humours, a cooling and moistening diet aught to be prescribed, viz. Broths of Mutton, Veal, Chicken, etc. wherein may be boiled Endive, Lettuce, Purslane, Sorrel, etc. Barly-cream, Grewels, Panadoes are also proper during the pains. Their drink aught to be Ptisans, Emulsions, Juleps, or medicated Ale: a small Ale, or white Wine diluted with water may also be permitted.  
All exercise of the Body is prejudicial to their healths, and consequently their rambling abroad prolongs their Cure.  
A quiet mind, with a patiented submission to their Physician and Chirurgeon is also required: and that they forbear Venery, as they value their own and their Mistress' healths.  
The Evacuation may begin with a Clyster of the common decoction cum electuario lenitiv. ℥ ij. butyri recentis & ol. amygdal. an. ℥ jss. cum vitel. ovi. You may afterwards let them blood in the Arm if you judge it necessary. Than purge them with elect. diacathol. diaprun. solut. diacassia cum manna, or with a decoction cassiae fistulae, tamarind. hoard. mundat. liquirit. florum trium cordial. to which may be added manna, syr. ros. solut. &c.  
After purging, it will be necessary to dispose the humours to quiet by some anodyne draught: Emulsions are also proper during the whole Course. Of which sort this may be an Example. ℞ sem. canabini ℥ jss. sem. quat. frig. maj. an.ʒj. sem. papaver. alb. ʒij. amygd. dulc. excort. n. 16. decoct. hordei q. s. fiat emulsio; dulcoretur cum sacchar. albis. aromatizetur cum aqua cinamomi: sumat ℥ vj. horâ somni, repetatur ad libitum.  
If the heat of Urine, and other accidents increase, it may be necessary to give ℈ j calomel. in a bolus, with some of the forementioned Electuaries, and to repeat it as you see cause once in two or three days.  
If by these the accidents do not remit, bathe them in a semicupium, with an emollient decoction, or milk and water, and to prevent erosion in the Vrethra, inject decoctum hordei, wherein hath been boiled sem. althaeae, cydonior. or some of the lesser cold seeds; and if you will, you may anoint those external parts with ungunet. refrigerat. Galeni. But do not insist too long in the use of lenitives, jest a Chancre arise; but purge of those vicious humours with pull. cornichini, pill. cochiae, Rudii, pulver. diagridii, troch. Alhandal. etc. with or without out calomel. and if there be required strong revulsion, vomit them with infus. croc. metallor. merchant vitae, or with a few grains of turbith minerale.  
The virulency thus removed, the use of Turpentine comes in request to deterge and heal, which would not be so reasonably admitted sooner, jest through its heat and tenuity of parts it lead down the impure matter, and burden the diseased parts. It may be given to the quantity of a drachm, two or three, washed in aq. plantag. parietariae, etc. adding a few grains of camphire to it; or you may add purgatives to it, viz. pull. rad. jalapii, trochisci Alhandal. diagridii, etc. Or, ℞ terebinth. lot. in aq. plantag. ʒj. acidi tartari ℈ j corn. cervi usti, ocul. cancror. diagridii an. ℈ ss. f. Bolus: Or ℞ terebinth. Venet. lot. in aq. ros. rub. ʒij. tartari vitriolatiʒss. salis succini, rhab. pull. an. ℈ ss. cum pull. glycyrrhiz. f. Bolus. And in its mor decrease: ℞ salis prunellaeʒiij. crem. tartariʒuj. camphorae ℈ j terebinth. Cyprae. ℥ ijss. sumat ad quant. castaneae mane & vesperi. In case of relapse, add pull. rad. jalapii to it.  
At this time, Clysters of terebinth. are proper, which in the time of its virulency would be mischievous.  
If by some of the foresaid Medicaments, the Gonorrhoea be not perfectly cured, you may prescribe astringents. The time of giving them is in the very declination of it, when there only appeareth a little thin waterish humour which glueth the entrance of the urethra. If you give them sooner, you may stifle in the matter, and raise a hernia humoralis. The astringents usually prescribed are, Bol. armen. sang. dracon. mastic. corn. cerv. usti, of sepiae, croc. mart. astringentis, troch. alkekengi, etc. made into Pills: viz. ℞ succin. mastichis anʒij. sang. dracon. lap. haematit. coral. rub. an.ʒj. ballast. sem. plantag. an. ʒjss. croci martis astring. ℥ j pulveriz. omnia, & cum balls. Peruviano & syr. cydon. f. massa pilul. does. ʒss. adʒj. After which the Patient may drink a draught of the following decoction: ℞ folior. polygon. millefoliis an. Mj. rad. althaeae, nymphaeae an. ℥ j flor. ros. rub. papaver. rhead. an. Pj. sem. quat. frig. maj. an. ʒiij. sem. plant. protulac. lactucae an.ʒj. sem. byoscyam. papaver. albi an. ʒiv. baccar. myrt. sumach, sem. halicacabi an. ʒij. f. decoctio. in ss. q. aq. fontis; colaturae add syr. cydon. de rosis siccis.  
If after the Gonorrhoea be cured, you suspect you have not enough secured the Patient from the malignity of the Disease, you may purge him with some of the forementioned Catharticks with Calomel. after which you may proceed with Sudorificks; as hath been showed in the former Observations.  
One came to me, 
1. Observation of Gonorrhoea.  complaining of a heat in his Urine, with a suspicion of a Gonorrhoea, contracted as he supposed the night before. Upon view of the penis there appeared a redness on the end of the glans, and he crushed out a moisture like matter. I concluding it a Gonorrhoea began the cure without delay. In the first place I let him blood, and some hours after administered a Clyster. I prescribed him that night a barly-cream for his supper, and in the morning purged him with manna and cremor tartar. in Whey. The next morning the Gonorrhoea appeared visibly, and his Linen was much stained with the matter. We repeated the hordeat that night, and prescribed him ℈ j calomel. cons. cichor. ʒss. ms. which he took early in the morning, and about three hours after a draught of the decoct. tamarindor. etc. as it is prescribed in the Method of Cure, and some hours after that drank so much more of the decoction, by which he was well purged. That night I laid him to rest with an anodyne draught. The next morning I found the Gonorrhoea increased with heat in Urine and painful erections. I repeated the former Apozeme, and to prevent erosion I injected the decoct. hordei, as is above mentioned, and repeated at night the anodyne draught: but finding the accidents still to increase I prescribed him the morning after calomel. gr. 15. turbith gr. 6. with cons. ros. in a bolus, with a draught of Posset-drink after it: and in case he vomited, to drink Posset-ale after each vomit. But he had formerly taken much Mercury, and this dose moved him little. A Clyster was administered that afternoon, and at night an emulsion ex sem. canabin. etc. which he had liberty to drink as often as he pleased in the night. The second day after I repeated turbith min. The next morning I perceived a remission of pain, etc. which I imputed to the mercurial dose, and would gladly have repeated somewhat of that kind: but to avoid fluxing I purged him the day after with pull. cornichini; it worked plentifully. I repeated it again the next day with ℈ j calomel. and at night he drank the emulsion as before. Thus the virulency and accidents were checked. From that time I purged him with that Electuary of sal. prunel. cum terebinth. but observing it to run again I added pull. jalapii to it; and by the repeating that, and afterwards the same Electuary as it is prescribed without Jalap, I cured the Gonorrhoea.  
I was sent for to a man grievously afflicted with a Stranguria. 
2. Observation.  He had been let blood and purged with lenients; he had also drank emulsions, and bathed often in a semicupium, but without remission of pain. Upon this information, and assurance that he had not the Stone, I suspected it might arise from some, Gonorrhoea suppressed, but he would by no means acknowledge that. However I gave him early next morning ℈ j calomel. cum cons. cicohrei in a bolus, and a Clyster that afternoon. It gave him three or four stools. That night I prescribed a draught of emulsion. The next morning I found him much relieved. I gave him alternately two doses more as at first, with Clysters in the afternoons, and continued the use of emulsions, and thereby freed him of the stranguria. A day 2 or 3 after he came to me, and shown me a Gonorrhoea weeping. It had been too soon stopped by astringents, and that caused the stranguria; which now returned again, but with no great malignity. I purged him with the Electuary ex terebinth. sal. prunellae cum pull. jalapii, and afterwards I confirmed the Cure with the same Electuary sine jalapio, and the decoct. millefoliis, etc. casting up an injection at last of a solution of mel. Aegyptiac. in aqua equiseti: by all which he was cured.  
One came to me diseased with an involuntary effusion of matter; it seemed to me a Venereal Gonorrhoea, 
3. Observation.  but he having consulted others who thought it arose from some scorbutical affection I advised him to put himself into their hands, my knowledge extending only o the cure of the venereal one: and supposing it to be so, yet I could not hope to cure it in so few days as they had promised him. Thus we parted, but after a longer trial with them than was promised, he returned to me again not better than at first. Upon which consideration I undertook to serve him as well as I could. He had been sufficiently treated with lenient purgatives. I began with a dose of pull. cornichini, which purged him at lest 15 or 16 times. That night I disposed him to rest with an anodyne draught. The next day he was lesle pained in making urine, and the running was lessened. Upon which account I purged him more moderately, but that way of lenient purging gave way to the increase of the virulency; which being also observed by the Patient, I purged him with more large doses, and those of the stronger Catharticks, viz. pill. Rudii with calomel. and sometime with pull. cornichini, or the Electuary ex terebinth. cum jalapio. By the use of this last I purged of the Gonorrhoea, and stopped the running by some few doses of pill. croci martis astringentis. He continued well about a month, than it relapsed again. Upon sight whereof I repeated the former course, and stopped it; yet it broke out afterwards seven times for the space almost of a year. I cured it as often, by purging him with the Electuary cum jalapio, so that it continued well at last. Whether it was venereal at first, I cannot affirm: Nay so far as I could judge by his habit of body and manner of living, he was not that way inclined; but what way soever it proceeded, he was perfectly cured and continueth so.  
I was commended to a Patient who lay much afflicted with a virulent Gonorrhoea accompanied with the severest accidents, 
4. Observation.  viz. Priapismus with contraction of the penis, stranguria, etc. insomuch that he was necessitated to rise often in a night to cool himself. He had been in such hands as had purged him and let him blood. I began with a Clyster, and the next morning gave him Lenitive Electuary, diaprun. etc. with the addition of calomel. and bathed him that day, and prescribed him Emulsions, and prosecuted the foresaid method of bathing and purging 4 or 5 days with little remission of the accidents. Wherhfore I left of bathing, and prescribed him gr. iij. merchant vitae in a pill, which vomited him much and purged him. I disposed the Patient to rest the following night with gr. jss. Laudan. aq. cinam. hordeat. & aq. papaver. cum syr. paralyseos. The next morning I prescribed him an emulsion made with Chicken broth, as well to nourish him as contemperate the acrimony. I also repeated emollient Clysters, such as hath been set down in the Method of Cure. Having thus somewhat refreshed him, I prescribed him calomel. ℈ j turbith min. gr. iv. which vomited him twice that day. I kept him to Chicken-broath and Clysters, and at length repeating these Mercurials, I freed him of all those accidents; and with the white Electuary ex terebinth. cum pull. jalapii I purged of the Gonorrhoea, and with the other ex terebinth. the astringent Pills, and decoct. lig. lentiscini cum rad. bistortae, consolid. tormentillae, etc. I concluded the Cure. This very man was the most severely afflicted with the foresaid Gonorrhoea I ever saw: yet some years after was again clapped, and passed under several hands till the malignity spread itself all over his head, face and body, and was at last Cured by me.  
One of about 30 years of age of a full body, came to Town diseased with Caruncles, 
5. Observation of Gonorrhoea with Chancre.  intending to be my Patient; but within a day or two after he came to me with a recent Gonorrhoea contracted the night before. I began the Cure that very instant by letting him blood, and prescribing a Clyster that afternoon, and prosecuted the course by emulsions and purging. But the Patient being irregular, the Gonorrhoea became highly virulent with all the accidents of pain, etc. and whilst he was purging with pull. cornichini and calomel. a Chancre appeared between the Prepuce and Glans very big and hard. He pretended it risen that night. I gave him the next morning a dose of turbith min. which vomited him 5 or 6 times, and purged him twice. I dressed the Chancre with a Pledget dipped in lac sublimati, I repeated the Turbith the third day, and afterwards again till I salivated him, I thinking that way the most speedy in such Libertines. During his salivating an Artery amongst the great Teeth on the right Jaw burst forth, and bled very much before I had notice of it: I stopped it by directing him to hold the yolk of hard roasted Egg between his Jaws close upon the place where I suspected the Artery to lie, and so by compression restrained the bleeding. The next day I set him in a clear light, and discovered the blood to arise by a carious tooth which I stopped with Lint dipped in ol. vitriol. so that it bled not more. During the Salivation the Chancre resolved, and the Gonorrhoea stopped. In the declination of the Salivation I purged him with the bitter Apozeme, and afterwards finished the Course with decoct. sarsaes, etc. sweeting him. Whilst he was in this course of sweeting, the Gonorrhoea appeared again weeping, but the malignity being wasted, I cured it with the white Electuary, and astringent Pills.  
One of about twenty three years of Age came to me with a Gonorrhoea, accompanied with Virulency. 
6. Observation of a Gonorrhoea with Chancre.  I advised him a Clyster that Evening, and the next morning let him blood, and prescribed him a laxative ptisan (as it is set down in the method of Cure) to purge him moderately, which he took and repeated three or four days, taking ℈ j Calomel every other night. During which I prescribed a lenient injection of summitat. malvar. violar. decoctted in aq. hordei. Those accidents of pain thus mitigated, I purged him with pull. cornichini and calomel. and after its operation, I prescribed him an emulsion ex sem. canabini, etc. and repeated the use of the purgative and emulsion, till I had taken of the virulency. Than I sent him a Pot of the white Electuary exterebinth. jalap. etc. and a draught of the emulsion after it each night. During this Course, the Patient supposing himself secure, took his liberty abroad in eating and drinking, till a great inflammation happened on the prepuce, with a swelling and excoriation of the glans, also a large Chancre between the prepuce and glans: Upon sight thereof I let him blood, and fomented the prepuce with decoct. summitat. rubi, plantag. etc. and dressed him up as is usual in such Cases, and gave him ℥ ij. of manna with crem. tartar. next day in a draught of Posset-drink. It purged him seven or eight times. The second day after I prescribed him a Dose of turbith, and a Clyster that Afternoon, and afterwards proceeded in the repeating turbith. min. and raised a light Salivation, by which the hardness was resolved, and the Chancre Cured. After which he drank a decoct. sarsaes, and observed a strict diet, and sweat, as hath been said in the like cases. After I had thus Cured him, a weeping of the Gonorrhoea appeared again; it was no more than I expected, it commonly following after such courses of Physic: but there being no malignity in it, the Cure was soon effected with that white Electuary cum terebinth. etc. and he continued well.  
A young Woman newly married, complained the second day after of a heat in her Urine, which increasing upon her with a fluor albus, I was sent for, 
7. Observation.  and heard her complaints, and saw some linen she had worn, much stained with matter. I advised her to bathe the excoriated parts with milk and water, and to dress them with unguent. refrigerant. Galeni, prescribed her an emollient Clyster, emulsions, etc. and took my leave without discovering to her the nature of her Disease. A day or two after, I took an opportunity to acquaint her Husband with what I had observed of his Wife's condition, and questioned his health. After a little demur, he told me, he had some months passed a Gonorrhoea, and supposed he had been Cured, but of late, since the complaint of his Wife, he had observed some little weeping, and shown me somewhat like the relics of Gonorrhoea. It was inconsiderable, yet seemed enough to infect her. He put himself into my hands, and recommended her also to my Care. I let them both blood, and purged her with a laxative ptisan of Cassia, tamarind. etc. and sent her an injection of a solution of lap. medicam. Crollii in aq. plantag. a dram to a pint, and continued the use of emulsions, and afterwards bathed her some days in a semicupium, and kept her body soluble with lenitive Bolus', to which I added 10 or 12 grains of praecipitat. alb. After I had thus contemperated the heat, and healed the external excoriations, I purged her with deagridium, and praecipitatus alb. some days, increasing the one or other, and sent her decoct. summitat. rub. equiset. plantag. etc. with a solution of unguent. Aegyptiac. these parts requiring powerful dryers. After I had thus purged of the malignity, I prescribed her the purging Bolus of terebinth. cum pull. jalap. and afterwards confirmed the Cure with astringents, as in the method of Cure hath been set down. Her Husband was cured by purging with the foresaid Electuary.  
They have both enjoyed their healths well since, and have Children.  
Whilst I was Curing one of a Gonorrhoea by purging, etc. and thought I had Cured him, a Tumour risen in the left Testicle. 
8. Observation.  Upon complaint of it I sent for a Truss, and the while let him blood in the Arm, and made up a Cataplasm of far. hordei & fabar. with oxycrate, mel. common, and applied it. That afternoon a Clyster was administered, and the use of the Cataplasm was repeated twice a day; during which he was purged with diagridium and calomel. by the help whereof the Tumour in the Testicle diminished daily, but by the sharpness of the acetum the scrotum was heated and blistered in several parts. Upon sight whereof I directed some Vinegar to be prepared with lethargy, and made up a Cataplasm with it instead of the Oxycrate, and applied that, defending the vesication with pledgets of unguent. album. By this Cataplasm the humour was dried up, and the Testicle restored to its natural tone; but the Gonorrhoea discovering itself in the mean time, I purged it of as is abovesaid, and concluded the Cure with the white Electuary, and astringent Pills: the Patient drinking a draught of decoct. lig. guaiaci, lentisci, etc. after it.  
One about eighteen years of Age was afflicted with a swelling in his right Testicle with inflammation and hardness. 
9 Observation.  I supposed it Venereal and risen from a suppression of a Gonorrhoea, but he denied it. I let him blood, and sent for a Bag-truss, and the while prescribed a Cataplasm ex farin. hoard. & fabar. an. ℥ vj. pull. summitat. absinth. flor. sambuci & chamaemeli decocted in oxymel: It was applied, and retained close on by a Bag-truss. By the application of this Cataplasm a few days the Tumour was removed, and restored to its natural state, but before this Tumour was quite resolved, I took occasion to look upon the Penis, and saw it running; yet the Patient persisted in the denying it: but before I prescribed him aught in order to the Cure, it was more demonstrable, and he acknowledging it, I purged him with extract. Rudii & calomel. four or five days, and afterwards with that Electuary ex terebinth. cum jalapio, by which I purged of the venomous matter, and with Clysters of terebinth. and astringent Pills I cured him.  
A young Fellow was brought to me, 
10. Observation.  having a great inflammation and swelling in his right Testicle; he acknowledging that it arose upon the Cure of a Gonorrhoea. I let him blood, and sent for a Bag-truss, and the while prescribed an Anodyne Cataplasm ex foliis hyoscyami decocted cum pull. flor. ros. rub. croco, axung. porcin. medull. panis tritic. cum vitell. ovor. which was applied, and kept on with a Truss. The next day a Clyster was administered, and the dressing repeated. The day after he was purged with ℈ j of calomel. in a lenitive Bolus. We continued the application of the Cataplasm till the inflammation and pain relaxed. Than made up a Cataplasm ex farin. fabar. hoard. etc. as in the former Observation, and from that time I purged him with pill. cochiae min. & calomel. and supplied him with a Box of the same Pills, and a Pot of that Cataplasm to dress himself: and he finding himself well mended, removed to his former lodging, and rambled about his affairs. Fifteen or sixteen days after, when I thought he had been Cured, he came to me with a Callous Chancre on one fide between the glans and fraenum, the Tumour in scroto being resolved. I confined him again to his Lodging, and purged him daily with the foresaid Pills, increasing and decreasing the Mercury or Cathartick, till I totally resolved the Chancre. Than with decoct. guaiaci and Sudorificks I concluded the Cure.  
A Man being diseased with a Gonorrhoea, put himself into some hands for Cure, 
11. Observation of a Gonorrhoea, with Hernia humoralis.  but whether through irregularity in the Patient, or that they were too hasty in the use of astringents, however so it happened, that upon the stopping of the Gonorrhoea a Tumour arose between the Testicles, but it especially affected the left Testicle, and the perinaeum with great inflammation and hardness. I let him blood, and advised a Clyster, and prescribed him a Cataplasm ex summitat. hyoscyami, cicutae, althaeae, flor. cham. sambuci, sem. lini, etc. The next day I purged him with manna & crem. tartar. in a draught of Posset-drink, and the day after prescribed him 12 gr. of turbith. min. which vomited and purged him well. By the repeating of the same Dose once in three or four days, and by the continued application of the Cataplasm, I resolved the Tumour which threatened the welfare of the Part; the suppurations in these tumors commonly leaving an opening into the Vrethra, which is difficult to agglutinate. After the resolution of the Tumour the Gonorrhoea returned. It was Cured by that white Electuary which is purging, and hath diagridium in it. During which he drank this following decoction: ℞ lig. guaiaci ℥ iij. lentisci ℥ iv. chinae nodosae ℥ ij. sassafr. ℥ j ras. C. C. eboris an. ʒ vj. santal. rubri ℥ j rad. tormentillae, bistortae, consolid. maj. Ireos' Florent. an. ℥ jss. passular. maj. enucleatar. ℥ iij. lig. cassiae, calam. aromat. an. ʒ iij. liquiritiae Hispan. ℥ j infundantur, & coquantur in suf. quant. aquae fornanae ad lbviij lbviij. colat. add sacchar. rosat. q. s. ad dulcorandum pro usu.  
A young Fellow having long suffered with a hernia humoralis, which had apostemated and broke out on the outside of the right Testicle, 
12. Observation of a sinuous Ulcer in the right Testicle.  and having passed through negligent hands, was at , as an object of Charity, recommended to me by Doctor Walter Needham. I looked upon the Tumour, and made a search into the Ulcer, and informed myself that it was not only sordid but sinuous from the production to the lower part of the Testicle. But would not acknowledge that it arose from a Gonorrhoea, or upon any Venereal accout. He was hypochondriack, and importuned me earnestly to cut of both his Testicles. Whether it was in despair of their Cure, or as a punishment for their offence I know not; but he toll me, it was to that purpose he came to me. I seeing him so resolute, advised him to come such an hour the next day, and I would prepare for him. He came and perfisted in the same resolution to have them both cut of. I having made dress ready as for the work began with the ulcerated Testicle, passing my director in the sinus, bending it downward, and cut that sinuosity open the whole length, than passed in my probe Scissors to the sinus up ward, and divided that, and by this opening he began to shrug, and being made sensible of the pain, was well contented that I should dress him up, and cure the Testicle. I complied, and dressed up the Ulcer with dossils dipped in precipitate, and applied between the wounded lips pull. Galeni cum albamine ovi. But the blood burst forth so forcibly after I had bound it, that I was necessitated to dress it again. I did so with dossils dipped in the Royal Styptic, and from that instant it bled not more. The second day after I took of the dress, and seeing the Ulcer sordid I dressed it with detersives, and having thereby in few days disposed the Ulcer to Cure, I purged him with pill. cochiae min. & calomel. and left the finishing of the Cure to my Servants, who performed it accordingly.   

CHAP. VI Of the ill Consequences of a Gonorrhoea Cured.  
IN the preceding Chapter of a Gonorrhoea, 
The Consequences of a Gonorrhoea.  I shown you the accidents that Disease is subject to in its recency; I shall now declare to you the sad consequences that attend it in its seeming declension, when it is left imperfectly Cured, and is, as some of those Blades call it, a weeping, only a weeping not worthy the keeping Chamber.  
From which neglect of Cure, those seminals from whence the Gonorrhoea issued are rendered more lax, and in progress of time the matter fermenteth upon the old Leven, and becometh much more acrid and malign, discharging a matter, as at first in the nature of a Gonorrhoea, heating and corroding the Vrethra, from whence Caruncles do frequently arise, and are attended with many ill consequences, of which I shall give you a relation, and begin it with that of a Caruncle.  
Caruncles are a sort of lose flesh, 
Caruncles.  arising in the Vethra frequently in the time of a Gonorrhoea, by reason of the erosion made by that virulent arid matter; but if that Gonorrhoea be well treated, the erosion is Cured, and those little grains of flesh dried up. However their growth is than so small, as they are rarely taken notice of till the declining of the Gonorrhoea, and than a small weeping with a few rags appearing in the Urine gives the first suspicion of them.  
If this matter be not timely dried up, the Caruncles increase, and a difficulty of Urine gradually succeedeth, and it cometh forth forked, or in a small stream dribbling: but this happens in some people not till many years after the Gonorrhoea; for they arising from a dry membranous part do grow slowly (and do sometimes waste of themselves, or are washed of by the Urine) upon which account that trouble in pissing happening sometime many years after a Gonorrhoea, gives them occasion to suspect that it ariseth from gravel; and as the Disease increaseth, it is thought the Stone, but by a searching candle a more certain discovery is made, those Caruncles being to it so many rubs in the way.  
If at this time their Cure be neglected, 
Cornosity.  some drops of Urine, or in coitu the Seed remaining amongst these Caruncles, heateth the part, and increaseth their growth, and not only renders them Callous, but at length the whole ductus, and than it is called a carnosity; which straightening the passage stoppeth the virulent matter in its motion, whereby it is forced back to the Seminals, in which case the Testicles for the most part do suffer: but if it be the vesiculae seminales, or prostates which are oppressed, they inflame, and by adhesion to the neighbouring parts pass their matter that way, sometimes through the tunicles of the Intestinum rectum, and than the matter is discharged by stool; or it may be, the matter passeth through or near the podex, and than it is supposed a fistula in ano, and this way the Urine is sometime discharged with it. These are the Ulcers which tender fistulae ani scandalous. If the matter passeth in perinaeo, for the most part it perforates the Vrethra, sometime like a Flute, and the Urine cometh thereout, othertimes it corrupteth within, and dischargeth the putrefaction into the pelvis.  
Whilst the Vrethra is straitened with a carnosity, the Urine is frequently suppressed, and than the bladder endeavouring to disburden itself becomes subject to fluxion, and groweth sometime carnous, and of a strange preternatural shape, stretching out of the pelvis. In the opening such a diseased Body, I saw the bladder adhering close to the upper part of the os pubis, and that part of the peritonaeum. In another there was frequently discharged a matter with the Urine not unlike corrupt Seed.  
One riding a Journey was hurt by the stumbling of his Horse, and became so indisposed, that he was brought back to Town. Physicians and Surgeons were consulted, and supposed him bruised internally. They let him blood, and treated him accordingly, but without success. The day after I was fetched to him, and found him labouring with great oppression, shortness of breath, fainting, etc. I viewed his body naked, and endeavoured to inform myself of his bruise, but there was no symptom of any. I seeing he was not likely to recover, took my leave, and desired a Servant of the house to give me notice of his death. He died that night, and I went the next morning and opened his Body. All the Viscera were sound, and no blood extravasated, but within the pelvis I saw a great quantity of purulent matter, like that which issues forth in a Gonorrhoea. I divided the os pubis, and opened the pelvis, and saw near the Prostates a bag broken, which I concluded to be one of the vesiculae seminales. Upon search into the Vrethra, I found he had been long diseased with the relics of a Gonorrhoea, viz. Caruncles and Carnosity.  
The Female Sex do also extremely suffer upon the same account, the corrupt seminal matter frequently excoriating the pudendum; whence excrescences of all sorts do arise, and the sharp matter dropping from the matrix, frets and ulcerates the external parts of the labies, etc. An instance of this sort you may see in some of the following Observations.  
The Vagina uteri is also sometimes excoriated, and excrescences frequently grow there of great bigness, one whereof I took of very large of the shape of a Mulberry.  
In others I have seen the vagina uteri much ulcerated, and discharging great quantity of fetid matter with pain and inflammation. The alae of the pudendum of one were gangrened, but I removed that, and cicatrized several of the Ulcers; but one Ulcer within the Vagina corroded into the bladder, and a mortification followed, and put an end to her misery.  
Another upon a suppression of that corrupt seminal matter was seized with a dysuria: the cause not being discovered, the kidneys were blamed. The disease increasing to a stranguria, a stone in the bladder was supposed. I was fetched to make a search, but felt none. The accidents of pain, inflammations, etc. increasing, she died. I opened her body, and saw the bladder, vagina uteri, & intestinum rectum all gangrened: The musculi lumbares, and those of the abdomen looked as if they had been parboiled: The rest of the viscera were reasonable sound.  
As from a suppression of that malign matter, apostemations do arise between the interior Tunicles of the vagina uteri, so I have sometimes met with scirrhous tumors, which I have sometimes palliated by Antivenereals, when they were thought Cancers. All these mischiefs increased to such height through the ignorance in them that treated them.  
Thus I have given you an account of the several symptoms as they arise one upon the neck of another, by which you may distinguish how they differ.  
The cause of them is also apparent, that they arise from a Gonorrhoea ill managed.  
The signs of Caruncles I have also shown you are discoverable by a searching candle, they lying in the way give a stop to the candle in its motion to the Bladder. Yet let not that make you over confident that there is no Stone in the Bladder, for it frequently happeneth that there is also a Stone therein; therefore you aught to inform yourself of the peculiar symptoms of that Disease before you oppose it. For so also from that Stone a dribbling of the urine is common, and in case of pain the urine cometh forth forked and in a small stream. But in Caruncles it cometh forth more forcibly than in those of the Stone, and they make much urine at a time, and are in ease after they have urined, which doth not hap in the Stone.  
A Carnosity hath the same signs that Caruncles have, but the urine being more straitened by the carnosity maketh the symptoms the more severe, insomuch as there is frequently a pain in the glans, and in straining hard to urine there accompanieth it sometimes a prolapsus ani, which are especial signs of the Stone in the Bladder. But the preceding Gonorrhoea and symptoms of the Caruncles will sufficiently guide you in making the distinction between them two. To distinguish the Abscesses and Ulcers in Ano attending this Disease from those which arise from the Hemorrhoids, the Treatise of Fistulae Any will instruct you.  
The extirpation of Caruncles is no easy work, 
Prognostic.  and if there be a Carnosity joined with it, the Cure is much more difficult. And so accordingly as there are other symptoms complicated with them, so much more is the Disease rendered deplorable and difficult to cure.  
In the cure of this Disease the same method aught to be observed in Diet which hath been delivered in the cure of a Gonorrhoea; 
Cure.  also evacuations by Lenient Purgatives: At lest you aught to begin with such to prepare the body; as ℞ hordei mundati ℥ iij. rad. graminis, polypod. querc. filicis foem. an. ℥ iv. scolopendrii utriusque, cichorei, endiviae cum toto, adiant. hepaticae an Mj. court. radic. cappar mediani fraxini, tamarisci an. Mss. passular. ma. enucleat. ℥ iv. liquiritiae ras. ℥ j sem. anisi, foenic. an. ℥ ss. coq. in sufficienti quant. aq. font. ad lb iij. colatura calida infund. per noctem fol. senae ℥ jss. agarici trochiscati, rhei electi anʒiij. santali citrini, cinamomi an. ʒij. f. iterum expressio mediocris. & clarificetur cum succo limon. & gut. aliquot vitrioli. In colaturae ℥ xviij. dissolve cremoris tartariʒiij. syr. de spina cervina ℥ ij. syr. ros. pallid. ℥ j f. apozema. With this or such like you may purge them five or six days, and let them blood if you see cause. Emulsions and contemperating Juleps may also be of use to mitigate the heat of Urine. Vomits are also of great use for revulsion, and those of Turbith I have always observed to be most efficacious. All the Antivenereals prescribed in the cure of Lues Venerea are proper here, we being indeed often necessitated to salivate by Unction. After which drying Decoctions and Sudorificks are proper as aforesaid, with purging; and after all we conclude the cure with such as have virtue to heal and fortify the relaxed seminals, of which sort these following are: ℞ Fol. menthae Miij. millefoliis, plantag. equiset. an. Mij. sem. 4. frigid. maj. confus. an. ℥ ij. sem. plantag. acetosae, agni casti, canabis, papaver. albi an. ℥ ss. terebinth. Cypr. ℥ vj. sacchari albis. lb j. lactis recent. C. ij. f. distillatio. ℞ Gum. guaiaciʒ iij. terebinth siccat. ʒij. rad. bistortae, tormentillae & nymphaeae pulv. an.ʒj. succini, coral. rub. margarit. lap. Gagati, ocul. ♋ pull. an ℈ iv. camphoraeʒss. terebinth. Cypr. q. s. f. massa pilular. capiat ℈ ij. manè & horâ somni, superbibendo ℥ iij. vel 4. aq. superscriptae. Or, ℞ rad. tormentillae, bistorti, symphyt. an. ʒiij. succini alb. coral. rub. margarit. eboris, cornu cervi usti an. ʒj gum. guaiaciʒij. sem. agni casti, canabin. papaver. albi, plantag. acetosae an.ʒj. sem. anisi, foenic. coriand. confect. an. ʒiij. f. pulv. sumatʒj. cum lact. ℥ viij. mane & vesperi. ℞ Gum. guaiaci not. ʒij. mastic. benzoin. an.ʒj. mer dull. sexies sublimat. ʒj. bragrisiaeʒss. croci ℈ j ol. absinthii gut 6. aloes rosati ad pondus omnium, & cum sufficienti quant. hals. nat. f. m●ssa pilular. de qua capiat ℈ j singul. noctibus in forma pill. iv. ℞ colophoniae ex terebinth Cypr. in aq. plantag. & ros. rub. ad duritiem coct. mastic. granot. select. an. ℥ ss. gum. animae pellucidissimae, gum. guaiaci, benzoini, succini albi an. ʒij. unguium alcisʒij. balls. Tolutaniʒjss. terebinth. è Chio accipienda reliqua, quae in pulverem subtle. redact. in mortario calido misce, addendo sub finem bragrisiae ℈ j f. massa pill. ex qualibetʒj. formentur pill. iv. & usui reserventur: harum capiat vj. quotidie manè & vesperi, superbibendo haust. sequent. decoct. ℞ rad. sarsaparillae ℥ vj. court. ligni sancti ℥ ij. sassafr. rad. tormentilaes an. ℥ jss. santali rub. citrini, ras. corn. cervi, rhinocerot. flor. anthos an. ℥ ss. fol. agrimonii Mij. thae. chinae Mj. rad. liquiritiae ℥ jss. macerisʒij. f. omnium infus. & decoct. in aq. font. lbxij lbxij. ad tertiae partis consumptionem pro potu ordinario. These were all prescribed by Sir Fra. Pruyean to several Patients labouring of these Diseases under my hands.  
Having thus offered to you Internals, we shall now proceed to show you the way of extirpating these Caruncles. The methods thereto proposed by Authors are various: I shall reduce them to two, viz. the one by medicaments, the other by mere force with wax-candles, probes of Lead, Silver, or Steel to tear and break them in pieces.  
Whilst the Caruncle is recent, you may by the compression of a well proportioned candle crush it to pieces, and by the use of moderate detergent and exsiccant injections dry and heal the part: but if there be an issuing of matter, as in virulent Gonorrhoea's, you must first remove that matter by purging, etc. before you can hope to extirpate the Caruncles. Nay, if the matter should flow much upon the use of the Candles, you must forbear further proceeding with them, and make evacuation and revulsion of that peccant matter, as hath been aforesaid, and than proceed again in the work.  
In order to the search, you may place the Patient sitting upon the side of his bed, chair or stool, with his thighs opened, and his heels drawn back, so as he do not press upon the perinaeum. He must also at the same time lean forward with his body. Than make choice of a proportionable candle, and having smoothed the end, and a little bended it, anoint it with oil (of Lilies if you please) pass it gently in, and move it easily forward, that by the warmth it gets in the ductus it may ply accordingly with it. If you meet with a stop, press moderately; if it will not go by, draw it back, and take the exact distance the Caruncle lieth of, and mark it with your nail; than anoint it with Oil, and pass it again into the urethra, and when you come at that stop, raise the penis with the other hand; if it will not pass over that Caruncle, try another candle made taper at the end: But if you be satisfied that it passeth beyond the Caruncle, it is a good sign, pull it out again; and if the parts be heated, you may inject decoct. hordei, etc. and prepare your candles for the consuming the Caruncle. The Medicaments I propose thereto are as followeth: ℞ court. mali granat. acid. in umbra siccat. & pulveriz. ʒij. aluminis pulver. ℈ j emplastri de cerussa ℥ j misce super ignem. Or, ℞ merchant praecipitat. rub. ℥ j lap. calamin. ʒ iij. vitrioli calcinatiʒjss. empl. diachalcith. ℥ vj. ad ignem liquefacti. You must scrape of the wax from the end of the candle, and dip the wick in either of the plasters whilst they are scalding hot; than after they are cold shape them and smooth the ends for your use. This following Medicament hath great credit amongst Authors: ℞ aeruginis, auripigmenti, aluminis rochae, chalcitidis an. ℥ iv. Infuse them in strong Vinegar, than grinned them upon a Marble very fine, dry it in the Sun, and temper it again with Wine-vinegar to the eighth time, drying it each time till it hath lost much of its corrosive quality. ℞ argenti spum. ℥ ij. olei ros ℥ iv. coq. ad empl. consistentiam, than add of the abovesaid powder ℥ ij. it being well mixed, and of a good consistence, you may dip the bared ends of your candles in it for the abovesaid use. Your great care in this work must be, that the emplaster be of such consistence as that it adhere as firm to the wick as the Wax, for otherwise it will 'cause vexatious work. I commonly sand a proportion of the foresaid Powder to my Wax Chandler who mixeth it with a proportionable quantity of Wax, and makes me so many dozen of Wax-Candles; which Candles being so medicated do very often serve me in wearing of recent Caruncles, and also in cicatrizing the part.  
If the Caruncles be of an older date, and be so big and tough that you cannot pass with any of the Wax-Candles, forbear farther attempting it, and endeavour by emollient Injections, Embrocations, etc. to suppling and dilate the ductus. ℞ Rad. althaeae, lilior. an. ℥ ij. sem. lini, foenugraeci contus. an. ℥ j coq. in aq. fontis ad lbij. lbij. ℞ Colaturae lb j. ol. amygd. dull. noviter extract. ℥ j ms. Inject some of it warm twice or thrice a day with a Syringe, having a thick blunt Pipe. You may also foment the Perinaeum with the residue of the said decoction; or he may sit upon a Close-stool over some of the same decoction, or ex radic. & fol. althaeae, matric. viol. sem. lini, foenugraeci, flor. cham. sambuci, meliloti, summitat. pulegii, origani, etc. When he cometh of, embrocate the Perinaeum with ol. ex pedibus bovinis, and apply over all some such like Cerote. ℞ unguent. Agripp. dialth. oesipi, butyri recentis an. ℥ ij. ol. lilior. amygd. dull. an. ℥ j sem lini. alihae. pulver. an. ʒ vj. gum ammoniaci ℥ ij. cerae q. s. To which may be added Argenti crudi extincti in terebinthina ℥ iij. or that Emplaster ad salivationem. After three or four days make trial again with a proportionable Candle, and if you can pass the Caruncle take the exact mark and pass in a medicated one upon the Caruncle, and leave it remaining there, cut of the end within an inch, and flat that end; than turn that broad end over the top of the Glans, and fasten it close with a linen rag: you aught to leave him more of the same Candles fitted for his use, that in case he urine he may take it out and put in another. Whilst he puts in the Candle he must stand somewhat straddling, and bow his Body forward, but as to his posture he will make choice of that to his own conveniency. The best time to begin this work may be at night, the Candle being than likely to stay in its place without disturbance. In the morning when you draw out the Candle inject some lenient decoction, and pass in a white Wax-Candle of a proportionable bigness to the other you drew out, to make good the way you have got, and yet to lenify the heat in the ductus; but if it be not disturbed, go on as you did to wash the Caruncle.  
But if after the use of Emollients you cannot pass the Caruncle, you may well conclude it callous. In which case you may pass a Canula into the Vrethra to that Caruncle, and whilst you hold that there steady, you may convey a grain of caustick into the Canula, and press the caustick to it; and whilst you hold it there, you will perceive its operation by the pressing forward of the Canula. The Caruncle thus consumed, cast in a Lenient injection daily; and if you take notice of his urine, you may see the separation of the sloughs as rags in it. After which you may by the common medicated Candles wear away the remainder, and with Injections cicatrize it. But if after the extirpation of one Caruncle you meet with another behind it, and cannot pass it, nor a Canula so far as where the Caruncle lieth, you may than attempt it by the Leaden Probe. Anoint it first, pass it to the Caruncle, than by pressing upon it break it of. You must expect a bleeding, and it is not done without pain, the Vrethra being of exquisite sense: that pain sometime accompanied with rigour and sevour. In order to the stopping of the flux of blood you may inject the Royal Stiptick-water with aq. plantag. ros. rub. etc. proportionably as you see cause: or in case the pain be great, beaten the white of an Egg with aq. spermatis ranar. and inject it. Externally you may apply such like defensative. ℞ boli Armen. sang. dracon. court. granat. aurant. myrtil. ballast. pull. an. ʒj. acet. ros. ℥ ij. album. ovor. succour. plantag. equiset. q. s. ms. But I never saw any inflammation or tumour arise from the use of these Probes. Fever I have sometime seen upon the use of them where there was no blood shed; in which case bleed them in the Arm presently and prescribe Clysters, and forbear the use of your Probes some days.  
After you have torn of the Caruncle, and that the fear of inflammation is over, you may make a search, and if the Caruncle be extirpated proceed in the drying it to a Cicatrix, which may be by a solution of troch. albi Rhas. in any of the forementioned distilled waters, or as I said with the Royal Styptic. A proportionable thick leaden probe of a fit length and flat head rubbed with quick-silis also effectual. Small Probes are apt to be made brittle by the Mercury and break within the Vrethra. But if you suspect some part of the Caruncle remaining, use the medicated Candle, and it will not only waste it, but dry it to a firm Cicatrix.  
If there be carnosity with Caruncles, your way is to dilate and suppling it by Emollients as above said. If a suppression of urine hap, a large Clyster suddenly injected up hath frequently forced the Urine out of the Bladder: but if that fail, a Catheter must help you, or an incision in Perinaeo through the carnosity. If a flux of virulent matter be accompanying the Stranguria, the last remedy is Salivation.  
If by reason of the long continuance of the Disease the Vrethra be so straitened with the carnosity and Caruncles, 
Abscess.  that the purulent matter cannot pass forth, which often happeneth when the Urine doth, you may well suspect an abscess will arise in some part; which if it hap within, there is danger of putrefaction. If the matter raiseth a tumour externally, and it do suppurate, yet it commonly leaves incurable Ulcers. Therefore you aught upon the lest suppression of this matter to make revulsion by Antivenereals; yea rather than to fail, raise a Salivation, and prosecute the Cure as his habit of body and greatness of the Disease requireth. And the while make way with Emollients to dilate the Vrethra, or give vent by incision in Perinoae, timely to discharge the matter.  
The female Sex are not subject to such external apostemations. The Caruncles do not 'cause suppression, nor is the Vrethra so subject to them. Sometimes they hap by a scalding of the urine, but they are of easier cure. Yet the Pudendum is subject to excrescences of all sorts and figures. The Vagina Vteri is also subject to Ulcers, Excoriation, Excrescences and scirrhous tumors, with great flux of humours, the Stranguria and Inflammation, etc. therefore require your great care timely to resist them by Antivenereals. Merchant dulcis, and those milder preparations being apt to lead the humours downwards are not so effectual here as the rougher sort which vomit. How they are farther to be treated by internals, and each disturbance removed or alleviated by external Medicaments, you may see among the Observations following.  
One of about 30 years of age, 
1. Observation of a Caruncle.  troubled with a weeping and dribbling in making urine, came to me. I suspecting Caruncles made a search, and found two little rubs in my way, and behind the Testicles in Perinaeo met a full stop, which the Candle would not pass; upon which I drew it out. He had been purged sufficiently by other hands. I began the Cure with cmollient Injections as above prescribed, and fomented and embrocated the Perinaeum, and after a day or two I carried half a dozen of medicated Candles and made another search and took a measure of the place where the great Caruncle lay which made the full stop, and left him that Candle with others, showing him how to pass them in, and encouraged him to make use of them in my absence, and to try what progress he could make; also advising him to use the Injection before and after the use of the Candle, and to continued the Embrocation and Plaster as he saw cause. During which his body was kept soluble by Clysters and healing Decoctions; also balsamic Pills were prescribed. After three or four days I returned, and found the Patient had passed over the stop, but he had a little heated the Vrethra by overdoing. I than left of the use of the Oil in the Injection. He would have injected Milk, but I strictly forbade that, in consideration of the mischief I have known it do in curdling in the Bladder. After the heat was calmed, he used the Candles with more moderation, keeping the passage open he had made. One night when he was going to bed I made him a visit and brought with me some medicated Candles, and having first flatted the upper end of one of them I passed it into the Vrethra and turned that end over the Glans, and with a soft Linen cloth over it bond it close on. He slept with it until towards morning, than pulled it out, and urined. In the morning I made a search and sound the passage open. I injected some of the emollient lotion and passed in one of the common searching Candles, and bound it on as the former, and advised him to keep his Bed, or at lest his Chamber that day, and in case of urine to pull it out and inject a collyrium of aq. plant. and syr. de ros. siccis, and to put in another Candle the same night armed as before. By this method the main Caruncle wasted, and the lesser which lay in the way to that was consumed by the passing and lying on of the same Candles. I feeling not more rubs left of the use of the Candles, and sent him an injection of aq. plantag. rubi, equiseti, wherein was dissolved a few grains of lap. medicament. Crollii, by which the relics of the Excrescences were dried up, as also the weeping, and the Patient remained cured. Thus by showing the Patients how to use the Candles, they themselves have sometimes prosecuted their Cures at a great distance from me with good success.  
One having had many Gonorrhoea's and been frequently under Cure of Caruncles came to me. 
2. Observation.  Upon sight of the Penis I saw he had an issuing of much matter as in a virulent Gonorrhoea. I made a search for my own satisfaction, and met with several excrescences, and a full stop before I reached to the Perinaeum. The Vrethra was tender and did not admit the Candle without pain. I began with the letting him blood, and purged him the next morning with Whey, Manna and Cremor tartari. After which I bathed him four or five times in warm water, keeping his body soluble the while with Clysters, or a bowl of cassia, ol. amygd. dull. syr. viol. and the like. After he had done bathing I gave him 25 grains of merchant dull. at night, and a Clyster the next day, and repeated the merchant dull. every other day, and syringed him with a lotion of aq. plantag. with a solution of troch. alb. Rhas'. But afterwards observing the merchant dull. not to answer my expectation, it having as I perceived been no novelty to him, I gave him gr. 8. of turbith min. which vomited him three or four times, and gave him half a dozen large stools, by which I believed the Mercury he had taken before worked downward. I ordered him a Clyster of milk cum vitel. ovor. that night to quiet his Bowels, and another the next day, and the day after gave him 12 gr. of turbith miner. which vomited him four or five times, and purged him twice or thrice. By the repeating of this Medicament tiwce or thrice, intermitting three or four days between, I lessened that flux of matter very much, but it making his chaps sore I purged it of with the bitter Decoction, and put him into a decoct. sarsaes, lig. lentis, rad. consolid bistort. etc. and gave him of that Electuary with terebinth. sal. prunellae, etc. also Clysters of terebinth. sometimes at night going to bed. Injections of lap. medicamentosi Crollii were afterwards used, by which the running ceased. I than made a search with a Candle, and having marked the main stop I proceeded in the use of French Candles which were made Taper fashion, and passed one over the great Caruncle bound in on, and left it lying upon it, and directed the Patient to take it out upon occasion of urining, and afterwards to pass it again. By the use of that there was room made for the application of my own Candles, which I armed with that composition of merc. praecipitat. etc. and thereby did wear of that Caruncle. Afterwards I met with others, which I also extirpated the same way; and with the solution of lap. medicamentosi Crollii and the use of Leaden Probes, I smoothed and cicatrized them.  
I was sent for one night to a man that laboured of a suppression of Urine, with great pain about the os pubis. I intended to have passed a Catheter, 
3. Observation.  but saw the head of the Glans hard as a Cartilege, and the entrance into the Vrethra so narrow as I could scarce get in a small Probe. I was at a loss how to relieve him. I presently caused a large pint of milk to be warmed for a Clyster, and syringed it up quick, and of a sudden the urine forced its way out in a great quantity. The Patient supposed himself to have the Stone, but I assured him the contrary, his disease being Caruncles with carnosity, not better than the Pox in those parts, and more difficult to cure than any of the forementioned species of it. I let him blood that night and purged him the next day with a decoction of Cassia, tamarind. etc. with an addition of Manna, syr. ros. Damasc. and afterwards bathed him three or four days, and than anointed with the mercurial Unction his Legs, Arms and Perinaeum, etc. by which I raised a salivation. It lasted about thirty days, during which he made urine with more ease; yet upon search I found the Caruncles, but the carnosity in the Glans, etc. resolved. During his salivating I cast emollient Injections into the Vrethra daily, and afterwards while he was in his course of sweeting and purging I began to work with the Candles, and made way with little difficulty till I came into the Perinaeum, and there I spent some days in endeavouring to pass a small taper-candle without success. Wherhfore I attempted it by the force of a Leaden Probe, and broke the Caruncle of. It bled 3 or 4 ounces, but I stopped it by injecting aq. sper. ranar. with a few grains of lap. medicament. Crollii, than embrocated the Perinaeum and parts about with ol. ros. cum aceto, and applied an empl. è bolo over them. The next morning I found he had not urined much better. I injected again, and passed in a Candle, and perceived that Caruncle eradicated, but I met with another behind which I could not pass, I again used Injections and passed in a taper-candle, by which I gradually proceeded, and afterwards by armed ones I freed that passage, and his urine came away in a full stream. I prosecuted the cure with medicated Candles and drying Injections, and continued the use of sudorific decoctions and astringent Pills till he was cured. Yet some while after he came to me again complaining that there was a Caruncle near the end of the Bladder which hindered his passing the Candle into the Bladder, such hath been the complaint of others, but that Caruncle was natural.  
One came to me having had many Gonorrhoeas, 
4. Observation.  and in his later years much difficulty in Urine. I made a search, and found he had Caruncles, and one within half an inch of the entrance into the Vrethra. We agreed upon the Method of Cure, and I was to begin my work the next day, but heard not from him till about a year after. It seemed he had been that while in other hands, who had proposed an easier method of Cure but sailed. Yet the urinary passage was thereby more enlarged, so that the Patient could better admit of the Candles, and was also the more observant to my Rules; but than again there was a slux of matter which required to be removed. To which purpose I began with a dose of turbith miner. and by the repeating of it made revulsion and salivated him. During the Salivation I fomented and embrocated the Perinaeum and injected emollient Decoctions, and by Candles prosecuted the extirpation, passed the lesser Caruncle, and afterwards pressing upon the bigger with a proportionable big Candle I broke it, and permitted it to bleed, and than passed a medicated Candle over that broken Caruncle, and by the pressure of it wore that Caruncle of smooth. There was another Caruncle that lay behind this in Perinaeo, which I also made way over by a taper-candle, and afterwards by the pressure of my medicated Candles I wasted them. During which he passed through a course of purging, sweeting, etc. and finished the Cure by the use of Astringents as well inwardly as outwardly.  
A Man who had been long diseased with a weeping Gonorrhaea was commended to me for Cure. 
5. Observation.  By making his urine and search I found that he had Caruncles. I proceeded by Injections and Embrocations to make way for my Candles, and cleared my passage into the Vrethra to the Perinaeum, and endeavoured by taper-candles to make my way over the rest. But the Patient not keeping his Chamber made my work irksome to me. Whereupon one morning I took a Candle proportionable to the ductus, and having smoothed one end I dipped it in Oil, and passed it readily to the Caruncle, and whilst it was stiff I pressed hard upon the Caruncle to break it, and did so; but at that very instant the Patient was seized with a rigour, and in pulling it out the blood followedl. I Injected a solution of pull. bol. Armen. in aq. sperm. ranar. and stopped the bleeding; but after that rigour the Patient burned and lay distempered all night, and in the morning I found him in a Fever, yet he had no considerable pain in the urinary passage. I applied Refrigerants externally to the Perinaeum, and let him blood, and consulted a Physician. He was brought very weak by this Fever, but recovered, (as I thank God I never had one died upon this account.) From that time he would make not more use of Candles, but put me upon the use of Injections, of which I tried many sorts; the best was a solution of lap. medicament. Crollii, by which he made water better, and to this day enjoys a good health.  
One about 50 years of age who had laboured long with Caruncles, 
6. Observation.  finding his Urine to come daily much more difficultly away, sent for me. I made a search and found a rub before I had entered an inch into the ductus. I began by purging him with an opening apozem of cassia, tamarind. rad. gran. etc. and let him blood, than having relaxed the Vrethra by Emollients I proceeded with the Candles, and by degrees made way till I came to a Caruncle near the Testicles. I endeavoured to pass that with taper-candles, and after some while made way and applied armed one's for some days, and wore that Caruncle down, and passed in towards the Perinaeum, where the passage was extremely straight, and a Caruncle stopped our going forwards. In pressing upon it the Patient was immediately seized with a rigour. I pulled out the Candle whole, and without blood. The next day I found my Patient in bed without pain or Fever; yet I let him blood, and gave him a Clyster. The day after I purged him with the aforesaid Apozeme. The next day I made a search, and passing a Wax-Candle into that straight passage he began again to fall into a rigour. Whereupon I desisted, and contented myself in the making good the way I had gotten by putting in a proportionable thick Leaden Probe (which had been rubbed with Quicksilver) some days, which Probe had a flat head as broad as a threepences to retain it from slipping in. I repeated the use of Emollients and mercurial Emplasters to the Perinaeum, and withal made revulsion by a vomit of turbith mineral. and by repeating it I raised a Salivation, which lasted longer than I intended, but it served my purpose so well as I afterwards made way over that Caruncle in Perinaeo without danger, and by armed Candles wasted it. Than with detergent Injections and medicated Candles smoothed and healed the ductus, and left him a free and easy passage for his Urine, and concluded that course of Physic with purging, sudorificks, etc.  
I was fetched to a young Woman who had been long diseased with a Gonorrhoea, 
7. Observation of excrescences.  and cured thereof, but from the internal excoriation thereby the pudendum was overspread with many excrescences of a spongy soft flesh of different size and shape. Those on the more external parts were callous. I prescribed the injection of summitat. rubi, etc. and let her blood, purged her with whey and manna, and afterwards with the bitter decoction, sometime giving her a ℈ j calomel. over night in a Bolus with cons. borraginis. Having thus as I thought prepared her body, I began to proceed in the extirpating of the excrescences, but observing the fluxion great, I deferred the work, and made revulsion by a dose of turbith. mineral. which the third day after I repeated again, and between while prescribed Clysters and lenient purgatives, and added unguent. Aegyptiacum to the injections. By this method I diverted the fluxion, and began my work with the cutting of those excrescences in the most external parts, and eradicated them by caustick stone, and ol. vitrioli, and so proceeded with one after another as they lay in my way till I was prevented with the bleeding of them. Than washed the parts with oxycrate, and stopped the blood with dossils dipped in a solution of lap. medicament. some hours after; the bleeding being stopped, I rubbed the remaining roots of them which I had cut of with a vitriol stone, than with a pair of scissors or knife, according as they were seated cut of the rest, and stopped the bleeding as before, and from that time consumed the remaining roots by the help of the vitriol stone, oil of vitriol or caustick stone, and appeased the pained parts with decoct. hordei, sem. cydonior. etc. and afterwards cicatrized the ulcerations, as hath been elsewhere showed in the like cases. But it was a difficult work, and not effected without turbith mineral. which was repeated often, and afterwards decoct. sarsaes, sweeting and purging, etc. finished the Course.  
A Woman of about forty years of Age, of a full body, 
8. Observation of a scirrhous tumour in Vagina uteri.  having been some years diseased in the matrix, as was supposed with a Cancer, consulted me; I made a search, and felt a hard Tumour on the right side of the Vagina Vteri of the bigness of a Pullet's egg fixed between the Tunicles, neither ulcerated nor painful to the touch, yet there seemed to discharge much serous matter from thence. There was also a descent of the Vterus. Upon a further enquiry into the cause of this Tumour, I perceived she had been frequently subject to diseases in those parts, and that they were Venereal. Upon which account I supposed this Tumour to be so, and having well informed myself that the courses of Physic she had taken before were upon another account, I presuming a better success by Antivenereals attempted the Cure, and began with Venesection, taking about ℥ viij. of blood from her Arm. That day a Clyster was administered, and the next day I purged her with elect. diacassiae cum ℈ j calomel. and afterwards repeated calomelanos three or four times every other night ℈ j with cons. ros. rub. and prescribed her an emulsion ex sem. 4. frigid. maj. cum sem. papaver. alb. etc. in a decoct. sarsaes, aromatizing it with aq. cinamomi hordeat. and sweetened it with Sugar. I also prescribed this injection: ℞ fol. plantag. virg. aureae, alchimillae an. Mj. summit. centaur. utriusque an. Pj. rad. iridis ℥ ij. coquantur in aq. fabror. ad lb iij. colaturae add syr. de rosis siccis, and the pilosella an. ℥ ij. injiciatur manè & vesperi. Afterwards observing that the calomel. did work downwards, and rendered the pudendum more slabby, I gave her a dose of turbith. min. ℈ ss. which vomited her four or five times, and purged her as often. I repeated it the fourth day, and perceiving the revulsion it made, I increased the dose, and gave it the third day after, and again till it salivated her, and thereby took of the fluxion and pains. In the declining of her Salivation, I put her to the drinking of a decoct. sarsaes, and purged and sweated her with Bezoard. min. gum. guaiaci, etc. and by a strict diet concluded the course, and resolved that Tumour as she than thought. Whether it totally discussed I know not, but she hath continued since very well.  
A Man aged about fifty years, 
9 Observation of a Gangreen upon suppression of Urine.  by the suppression of Urine and virulent matter was gangrened on the right Testicle, and that part of the perinaeum lying next to it, the Urine passing thereforth. I scarified the gangrened parts, washed out the blood with salt water, filled the incisions with merc. praecipitat. and dressed it up with unguent. Aegyptiac. hot, with a Cataplasm over all of medul. panis triticeae, pull. summitat. absinth. scordii, etc. decocted in Brandywine. I than let the Patiented blood, prescribed him a Clyster, and a Cordial Julep. The next day I saw the Escar separating in perinaeo, and was satisfied that the Urine came all that way. I fomented with the Fotus prescribed in the Chapter of Gangreen, and dressed it with unguent. basilicon, and a few drops of ol. terebinth. mixed with it, and continued the use of the Cataplasm. By these applications the slough separating I deterged with mundif. Paracels. and purged the Patient with elect. lenitiv. and calomel. and prescribed him a decoct. sarsae. After detersion I incarned with the smae mundificative, adding to it pull. thuris, sarcocollae, myrrhae, aloes and syr. de ros. siccis, and with the Vitriol Stone dried the lose flesh, and cicatrized it with aq. calcis, etc. In the time of incarning his urine passed somewhat by the natural way, and at the last it passed better. The Cure was finished by purging, sweeting, etc. as I am accustomed to do in such cases. He is since married to a young Woman.  
In the year 1652. 
10. Observation.  at my return to London from the Battle at Worcester, I somewhile assisted that most excellent Chirurgeon the deceased Mr. Ed. Molins in dressing his Patients; amongst which I saw his Practice in the most difficult cases of this Disease, whereof I shall give you one of his Operations.  
An Old Fornicator, hoaving been long diseased with a Carnosity, which had resisted all endeavours, and in a manner totally suppressed his Urine, sent for him; he went, and caused the Patient to be taken out of Bed, and placed upon a Table, with his Legs drawn up, as in cutting for the Stone; be cut into the Vrethra near the neck of the Bladder, it was hard as a gristle. His knife did not readily divide it, but so soon as he had, the Urine gushed out, which being discharged, he put his finger into the Vrethra, and afterwards enlarged the incision upward more to the Scrotum, than dressed it up with his green Balsam warm, by which in few days it digested, and the Patient was relieved: the lips grew also daily softer, and the wound healed apace, but all this while the Urine had no other passage, the common ductus being so closed up by reason of the Carnosity, that we could not make any way into it with our smallest probes or candles. Upon which consideration it was thought necessary to keep this opening in perinaeo for the discharge of Urine, and in order thereto it was dressed up with a Dossil, an Emplaster and Compress, which the Patient took of at times to ease Nature. But this not satissying him, he frequently complained of his unhappy condition; insomuch that Mr. Ed. Molins being wearied with the Patient's solicitation, took me one morning along with him, where again he placed the Patient as before, and attempted to make a way from the Apex into the Vrethra, but it was in vain. Whereupon he caused one of his Servants to hold the one leg, and myself the other while he took up the Testicles, and put the one into my hand, and the other he placed in the hand of his Servant; than with his knife divided the Scrotum in the middle (we holding each Testicle the while in our hands) and cutting into the Vrethra slit it the whole length to the incision in perinaeo; than with a needle and thread stitch the skin over the Vrethra, as also the Scrotum, leaving the Testicles covered, as before, and dressed them with agglutinatives, by which they were cured in few days: But the Urine nevertheless continued to flow by the opening in perinaeo.  
A lean withered old Man, near seventy years of Age, 
11. Observation  having in his younger years had many Gonorrhoeas, complained in his later years of difficulty in making his urine, and that he vioded much matter. He sent for me, and would needs have his disease to be the Stone, and that matter to proceed from an ulcer in his bladder. I endeavoured to inform him better, but observing him so wise, I was well enough contented he should report it so, and concerned myself not further with him, than by the prescribing him an emulsion. About a year after, his urine being in a manner suppressed he sent for me again; I made a search, and found the entrance into the Vrethra eaten away below the fraenum with part of the prepuce, and the passage there into the ductus difficult to found; and after I got in, it was so straight and stuffed with Caruncles, that I could make no way either by probe or wax-candle. I ordered him presently a Clyster, supposing thereby to force the Urine out; but it would not. I than proposed the cutting into the ductus below, but he would not. The retention of the matter in the seminals soon after raised a Tumour beneath the Scrotum, which being exceeding painful, he was contented I should make an opening to let his Urine out. I placed him in a clear light, with his legs drawn up, as in the former Observation hath been said, and made incision into the Vrethra near the neck of the bladder: which having done, and satisfied myself by my finger, and discharge of his Urine, that I had made opening enough, I dressed him up with the Spanish Balsam, there being no blood lost in the work, save what came from the skin, the Vrethra itself being cartilagineous. From that time I only dressed the wound with a dossil dipped in the smae Balsam, and applied a pledget over it, with an emplast. diachalcith. and bandage to retain it on. To the swelling above I applied a Cataplasm ex ra. & fol. hyoscyami, cicutae, etc. by which the Tumour resolved, the matter indeed discharging with the Urine by the opening. There was not much care taken in dressing this Ulcer, for in seven or eight days it contracted, and being callous could not unite, if the Urine would have permitted it, but it had no other passage. The Patient was hereby greatly relieved, and had no other trouble but to Urine this way, which I thought he would have been well pleased with, and rejoiced in the having such an easy discharge: Yet after some months he made me many visits, maundering as if I had done him a discourtesy in leaving such an opening. Whereupon to quiet him, I gave him some searching candles, and wished him to go home, and try if he could found any passage from the Apex into the Vrethra to the Bladder; if he could, I would readily heal that Ulcer in perinaeo, otherwise I wished him to consider how he would Urine: upon which he became more satisfied. He lived some years after, and died of Old Age.  
One having been long troubled with a difficulty in Urine, 
12. Observation.  was at last seized with a Tumour in perinaeo hard and painful. I was fetched, and seeing it would tend to suppuration, I dressed it with a Cataplasm ex rad. althae. lilior. etc. and having suppurated it, I opened it by incision, and discharged a quantity ofmatter. In the dressing of it daily I observed much gleet, which I discovered after a while to be Urine mixed with the matter, and upon search found Caruncles in his Vrethra. I perceiving the cause of the abscess proceeded in the Cure with candles, etc. as hath been set down in the method of Cure; and having cleared that passage, and made a free way for the Urine, I made search into the abscess, and laid it open by incision according to the length of the perinaeum, and from that time hastened the incarning and agglutination of the Ulcer as well by internals as externals, and in few weeks cicatrized it smooth and firm.  
One having contracted a Gonorrhoea beyond Sea, 
13. Observation.  and not being well Cured thereof, in progress of time Caruncles arose, and a difficulty of Urine followed. After he had spent some time in endeavouring his Cure abroad, he returned toward England; but in his journeying through those hot Countries, an abscess arose amongst the seminals, and discharged its matter under the pubis, and afterwards between the Testicles, and in three or four places of the perinaeum, and on both sides of it, by reason of which the Patient lay long by the way, and was at last with much difficulty brought to London. Sir Fr. Pr. and myself were sent for. We saw the Patient miserably emaciated, and so diseased as I have said. Decoctions of sarsa, with Pectorals, Emulsions, Cordial Juleps, Balsamicks, also lenient purgatives with calomel. were prescribed, and much pains was taken in the Chirurgery, but he not being capable of the great Remedies our work proved unsuccessful, and he removed into some of the neighbouring Villages to drink Ass' milk, and to try how he could nourish himself in the fresh Air, where I think he died.  
Another who had spent his younger days loosely, 
14. Observation.  languished in his old age with a carnosity, whereby the Urine was straitened in its passage forth, and the seminal vessels within the pelvis corrupting inflamed the neighbouring tunicles of the rectum intestinum, and passed its matter into that gut and discharged it by stool; yet not so entirely, but that it afterwards made a way lower out between the anus and perinaeum, by which ways he had also pollutios. His case was deplorable, but the way to cure him if possible had been to have made revulsion and evacuation of that matter by Salivation, and afterwards by laying open those sinus' as in fistula ani: but his was a poor man and not governable. He lived some years by the charitable assistance of Mr. Ed. Molins and myself, and at last was found dead in the street.  
The same year I came from the Wars to London, I was sent for to one who laboured of an abscess in ano. 
15. Observation.  He discharged a purulent matter in great quantity. I consulted the late deceased Mr. Ed. M. who upon search with his finger in ano concluded it to arise from some abscess in the prostates, and to be the effects of a Gonorrhoea ill cured. Which being confessed, we dressed the Ulcer, and prescribled some little remedies. A day or two after we met again, made a search with a Candle into the Vrethra, and discovered Caruncles, which was also apparent by his pissing. The Patient was much pained by the searching, and desired that work might be forborn till this Ulcer in ano was better disposed. Upon which my friend declined his visits. The discharge of that virulent matter fretted the parts without, and enlarged the opening into the rectum intestinum, so as upon passing my finger in ano I felt it, and by a curved Probe, found the sinus tend to the perinaeum. Upon which part I applied a caustick, and afterwards made incision into the lower part of the sinus, whereby the matter was partly discharged. But the had little advantage thereby, his disease being Venereal required a severe course of phsick: but he not submitting to it, the matter afterwards apostemated that buttock, and discharged itself through many orifices. He lived seventeen years thus and followed his employment abroad.  
One having been many years afflicted with the relics of a Gonorrhoea, it at length broke its way downward and raised an abscess under the pubis, 
16. Observation.  and through want of sufficient vent corroded the Vrethra, so that his Urine came thereout. He had also a continual weeping of a virulent matter by the penis, and passed his urine in a small stream and frequently forked. I began the Cure with a purging decoct. of cassia and tamarind, etc. than let him blood, and afterwards purged him with pull. cornichini and merchant dull. and repeated it once in three days: all which time he continued his own way of dressing the Ulcer with precipitate. But after I had a while purged him with Mercurials I scraped of the crusted precipitate, and dressed it up with Pledgets dipped in tinctura vitrioli, and applied a compress over them with good bandage, and renewed the dress once in three or four days, during which I gave him 10 grains of turbith mineral. by which I made revulsion of that peccant matter. The second day I repeated the turbith, and gave him another dose of the same the third day after, and purposed to have raised a Salivation; but finding the Patient not able to bear any thing of that kind I forbore the further proceeding thereby, and by Clysters and lenient purgers carried the matter downward. The Ulcer being cicatrized and the callus resolved, I threw of the bandage, and concluded him well thereof. Whilst I purged him to carry of the Salivation he spit the more, and his mouth grew sore, which put me upon indulging him the longer, but as his mouth healed I purged him again, and kept him to the drinking a decoction of sarsaparilla, etc. and began to make way with Candles to extirpate the Caruncles; but the fistulous Ulcer being cured, he would not believe the extirpating the Caruncles necessary. Wherhfore I submitted to his pleasure, and finished that course of Physic.   
FINIS.   

A TABLE Of the several OBSERVATIONS In the Eight foregoing TREATISES.  

TREATISE I. Of tumors. 

CHAP. III. Of Inflammation, or Phlegmon.  
Observation 

1. OF the beginning of a Phlegmon in the right Hip Page 17  
2. the beginning of a Phlegmon in the right Breast, occasioned by the biting of a Coach-horse ibid.  
3. a Phlegmon beginning in the Thigh Page 18  
4. a Phlegmon beginning in the Thigh with Herpes' ibid.  
5. a Phlegmon in the Thigh discussed ib.  
6. a Phlegmon in the Arm discussed ib.  
7. a Phlegmon in the Arm suppurated Page 19  
8. a Phlegmon in the Breast of a maid suppurated Page 20  
9 a Phlegmon in the Hip ibid.  
10. a Phlegmon in the Hip gangrened by improper applications Page 21  
11. a Phlegmon gangrened after opening ibid.  
12. a Phlegmon beginning in the Arm by too strict Bandage ib.  
13. a Phlegmon by over-strict Bandage Page 22  
14. a Phlegmon by over-strict Bandage gangrened ibid.  
15. Phlegmon erysipelatodes Page 23  
16. the like ibid.  
17. a Phlegmon by Translation ib.  
18. casûs non vulgaris de Sarcomate in arteria axillari reperto Page 24     

CHAP. iv Of tumors from Milk.  
Observation 

1. Of Apostemation in the Breast after Childbed Page 27  
2. the like ibid.  
3. the like ib.  
4. the like Page 28  
5. the like in both Breasts Page 29     

CHAP. V Of Abscesses, etc. arising from Distempers of the Vterus in Childbed.  
Observation 

1. Of an Abscess in Inguine, etc. after Childbed Page 30  
2. an Abscess in planta pedis after Childbed ibid.  
3. an Abscess in Abdomine after Childbed Page 31  
4. an Abscess in the Thigh after Childbed Page 32  
5. the like Page 33  
6. several Abscesses after Childbed ibid.     

CHAP. VI Of an Erysipelas.  
Observation 

1. Of Erysipelas in the Arm after venaesection Page 37  
2. Erysipelas upon a fontanel, and its consequences Page 38  
3. Erysipelas in an Asthmatick person ibid.  
4. Erysipelatodes in the Leg Page 39  
5. Erysipelatodes with a small Phlegmon ibid.  
6. Erysipelas' repelled Page 40  
7. Erysipelas in the Face ibid.  
8. Erysipelas on the Head suppurated ib.  
9 Erysipelas in the Face Page 41  
10. Erysipelas on the Ear ibid.  
11. Erysipelas in the Face, and suppurated in the lower Eyelid ib.     

CHAP. VII. Of a Furuncle or Boil.  
Observation 

1. Of a Furuncle on the Wrist Page 42  
2. a Furuncle on the Thigh Page 43  
3. a Furuncle on the Nose ibid.     

CHAP. VIII. Of Epinyctis and Terminthus.  
Observation 

1. Of Epinyctis on the Arm Page 44  
2. Epinyctis on the Wrist ibid.  
3. Terminthus on the Knuckle Page 45     

CHAP. IX. Of Inflammatory tumors of the Glandules.  
Observation  
Of Phyma. 

1. Of Phyma under the right Jaw Page 46  
2. the like ibid.    
Of Phygethlon ib.  
Of Bubo. 

Of tumefaction of the Glands' in Inguine, occasioned by a Fontanel in the Leg Page 47  
1. Of a Bubo in the right Axilla Page 48  
2. a Bubo in inguine with its consequences ibid.    
Of Parotis. 

1. Of a Parotis after a fall. Page 50  
2. a Parotis behind the right Ear ibid.  
3. the like ib.  
4. a Parotis behind the left Ear Page 51  
5. a Parotis behind the right Ear ibid.  
6. a Parotis behind the left Ear ib.     

CHAP. X. Of a Carbuncle.  
Observation 

1. Of a Carbuncle on the Back Page 53  
2. a Carbuncle on the right Breast Page 54     

CHAP. XI. Of Paronychia.  
Observation  
Of Paronychia benigna. 

1. Of Paronychia about the inside and root of the Nail Page 56  
2. Paronychia on one side the Nail ibid.  
3. Paronychia on the pulp of the Thumb ib.  
4. Paronychia under the forepart of the Nail and Finger ib.    
Of Paronychia maligna. 

1. Of Paronychia in the pulp of the Forefinger ib.  
2. the like ib.  
3. Paronychia in the pulp of the Thumb Page 57  
4. Paronychia in the Forefinger ibid.  
5. the like ib.  
6. the like Page 58  
7. Paronychia on the first joint of the Finger ibid.  
8. Paronychia in the Forefinger ib.     

CHAP. XII. Of Pterygion.  
Observation 

1. Of an Excrescence about the nail of the Forefinger Page 60  
2. Excrescence on the Thumb-nail ibid.  
3. ulceration about the nail of the great Toe Page 61  
4. the like ibid.  
5. the like ib.  
6. the like Page 62     

CHAP. XIII. Of Pernio.  
Observation 

1. Of Chilblains and Kibes Page 63  
2. Chilblains in Face, Ears and Hands ibid.  
3. Kibes Page 64     

CHAP. XV. Of an Ecchymosis.  
Observation 

1. Of Ecchymosis on the Shin Page 68  
2. Ecchymosis on the left Leg Page 69  
3. Ecchymosis on the Arm ibid.  
4. Ecchymosis on the left Thigh ib.  
5. Ecchymosis on the left Side, Hippolito and Arm Page 70     

CHAP. XVI. Of an Aneurisma.  
Observation 

1. Of Aneurisma near the trachea arteria Page 73  
2. Aneurisma on the inside of the Leg ibid.  
3. Aneurisma on the forepart of the Thigh Page 74  
4. Aneurisma in the Arm Page 75  
5. the like; with the deligation of the Artery Page 76     

CHAP. XVII. Of an Herpes'.  
Observation 

1. Of an Herpes' behind the Ear Page 79  
2. an Herpes' on the Breast, etc. ibid.  
3. an Herpes' on the right Hand ib.  
4. an Herpes' on the right Leg Page 80  
5. Herpes' miliaris in the palm of the Hand ibid.  
6. Herpes' miliaris in the sole of the Foot. ib.  
7. Herpes' miliaris and simple Herpes' ib.     

CHAP. XVIII. Of Oedema.  
Observation 

1. Of a pituitous swollen Hand Page 83  
2. an oedematous swollen Leg Page 84  
3. oedematous swelled Legs and Feet Page 85  
4. an oedematous swollen Thigh ibid.  
5. an oedematous swelling with Apostemation Page 86  
6. an Oedema in the Thigh Page 87  
7. the like ibid.  
8. phlegmatic tumors in the Thigh and Ischion ib.  
9 an Oedema in the Belly Page 88  
10. another Tumour in the Belly ibid.     

CHAP. XIX. Of a Scirrhus.  
Observation 

1. Of Scirrhus in the Legs Page 93  
2. Scirrhus' under the lower Jaw caused by a Fracture ibid.  
3. Scirrhus' on the outside of the right Thigh Page 94  
4. Scirrhus' on the Breast, etc. ibid.     

CHAP. XX. Of Warts and Corns.  
Observation  
Of Warts. 

1. Of a Wart extirpated Page 96  
2. the like ibid.  
3. a Wart on the joint of the Finger, with the ill consequences of it ib.    
Of Corns. 

1. Of a soft Corn Page 97  
2. the like ibid.  
1. Of Apostemation from a Corn ib.  
2. the like Page 98  
3. the like ibid.  
4. the like; with the ill consequence of it ib.     

CHAP. XXI. Of a Cancer.  
Observation 

Of varieties of Cancers Page 99, 100, 101 

1. Of a cancerous Gland in the Breast Page 105  
2. a cancerous Gland in the left Breast ibid.  
3. a cancerous Gland in the right Breast Page 106  
4. a cancerous Gland behind the Ear ibid.  
5. a cancerous Gland in the left Breast ib.  
6. a cancerous Gland in the Breast, the extirpation attempted by Caustick ib.  
7. a Cancer in the right Breast Page 107  
8. a cancerous Breast cut of Page 108  
9 a cancerous Breast cut of ibid.  
10. a Cancer in the left Breast Page 109  
11. a Cancer on the right Side near the Breast Page 110  
12. a cancerous Tumour on the Breast Page 111  
13. a cancerous Tumour on the Head ibid.  
14. a Cancer on the left Cheek Page 112  
15. a cancerous Excrescence of the lower Jaw ibid.  
16. a Cancer on the Jaw Page 113  
17. a Cancer under the Tongue Page 115  
18. a Cancer on the Tongue Page 116       

CHAP. XXII. Of Noli me tangere.  
Observation 

Of a Noli me tangere on the Cheek Page 118     

CHAP. XXIII. Of Waterish tumors.  
Observation 

1. Of Ascites Page 122  
2. the like ibid.  
3. the like Page 123  
4. Anasarca in the Legs and Feet ibid.  
5. Anasarca in the Legs Page 124  
6. a watery Tumour in the Back ibid.    
Of Hydrocele. 

1. Of Hernia aquosa with Anasarca and Ascites Page 126  
2. Hernia aquosa with Anasarca Page 127  
3. an Ascites with anasarcous Swell in Scroto, etc. ibid.  
4. Hydrocele Page 129  
5. the like ibid.  
6. the like ib.  
7. the like Page 130  
8. Hydrocele returned Page 130  
9 Hydrocele with Sarcomata of both Testicles ibid.  
10. the like Page 131    
Of Hydrocephalus. 

1. Observation of it Page 133  
2. of the same ibid.  
3. of the same ib.  
4. of the same Page 134     

CHAP. XXIV. Of Scabs and Itch.  
Observation 

1. Of Itch and Scabs Page 136  
2. the like ibid.  
3. the Itch ib.  
4. the like ib.  
5. the like Page 137  
6. Scabs and Itch ibid.     

CHAP. XXV. Of Lepra, or Elephantiasis.  
Observation 

1. Of Elephantiasis on the left Brow Page 138  
2. Elephantiasis in the Arms, etc. Page 139  
3. Elephantiasis from Head to Foot ibid.     

CHAP. XXVI. Of Gutta Rosacea.  
Observation  
Of Flushing in the Face with read Pimples Page 142   

CHAP. XXVII. Of Flatuous tumors.  
Observation 

1. Of a flatuous Tumour on the right Thigh Page 145  
2. a flatulent Tumour on the outside of the Thigh ibid.  
3. the like ib.  
4. a flatulent Tumour on the Knee ib.  
5. a flatulent Tumour round the Rotula ib.  
6. a flatulent Tumour on the Knee Page 146  
7. a flatulent Tumour near the Toes ibid.     

CHAP. XXVIII. Of Hernia.  
Observation 

1. Of Bubonocele and Hernia ventosa Page 154  
2. Hernia intestinalis Page 155  
3. Hernia intestinalis by Relaxation ibid.  
4. Hernia intestinalis Page 156  
5. the like ibid.  
6. the like ib.  
7. Hernia ventosa ib.  
8. the like ib.  
9 the like Page 157  
10. the like ibid.  
11. Bubonocele ib.  
12. the like ib.  
13. the like Page 158  
14 the like ibid.  
15. the like ib.  
16. Hernia intestinalis Page 159  
17. the like ibid.  
18. the like ib.  
19 Hernia umbilicalis ib.  
20. four several Herniae ib.  
21. Hernia umbilicalis Page 160      
TREATISE II. Of ULCERS. 

CHAP. II. Of a Simple Ulcer.  
Observation 

1. OF a Simple Ulcer in the Leg Page 170  
2. the like ibid.     

CHAP. III. Of Ulcers with Intemperies.  
Observation 

Of an Ulcer with hot Intemperies Page 172  
an Ulcer with cold Intemperies Page 173  
an Ulcer with moist Intemperies Page 174  
an Ulcer with dry Intemperies Page 175     

CHAP. iv Of Ulcers with Pain.  
Observation 

1. Of an Ulcer on the Shin Page 177  
2. an Ulcer on the Arm with Pain from Sordes ibid.  
3. an Ulcer on the Thigh with Pain from Putrefaction Page 178  
4. an Ulcer in the Arm with Pain from a fontanel dried up ibid.     

CHAP. V Of Ulcers with Fluxion.  
Observation 

1. Of an Ulcer on the right Leg with Fluxion Page 180  
2. an Ulcer on the left Leg with Fluxion ibid.     

CHAP. VI Of Ulcers with Hypersarcosis.  
Observation  
Of an Ulcer with lose Flesh Page 182   

CHAP. VII. Of Ulcers with Caries in the Bones.  
Observation 

1. Of an Ulcer in the Thigh with Caries Page 185  
2. an Ulcer with Caries in the Tibia and Fibula of the right Leg Page 186  
3. an Ulcer with rotten Bones in the Hand Page 187  
4. an Ulcer in the Jaw Page 188     

CHAP. VIII. Of Ulcers with Callous Lips, etc.  
Observation 

1. Of an Ulcer on the Ankle with callous Lips Page 189  
2. the like Page 190     

CHAP. IX. Of Putrid Ulcers.  
Observation 

1. Of a putrid Ulcer on the Leg Page 191  
2. a putrid Ulcer on the Calf of the Leg ibid.     

CHAP. X. Of Phagedaena, Nomae, Dysepulota.  
Observation 

1. Of an Ulcer on the Ankle hard of cure Page 194  
2. an ulcer on the Leg hard of cure Page 195  
3. the like ibid.  
4. a phagedaenous corrosive Ulcer Page 196  
5. the like Page 197  
6. the like Page 198  
7. an Herpes' exedens Page 199     

CHAP. XI. Of Ulcers with Varices.  
Observation 

1. Of an Ulcer in the Leg Page 200  
2. Ulcers with Varices in both Legs ibid.  
3. a varicous Ulcer on the left Leg Page 201  
4. a Varix in the right Breast ibid.  
5. a varicous Ulcer with great tumefaction ib.     

CHAP. XII. Of Sinuous Ulcers.  
Observation 

1. Of a Sinuous Ulcer in the Leg Page 203  
2. a Sinuous Ulcer penetrating the right Breast Page 204  
3. an Ulcer penetrating the Breast ibid.  
4. Sinuous Ulcers on the left Side penetrating Page 105  
5. a Sinuous Ulcer in the Breast ibid.  
6. a Sinuous Ulcer penetrating the left Kidney ib.  
7. a Sinuous Ulcer penetrating the right Side Page 206      
TREATISE III. Of DISEASES of the ANUS. 

CHAP. I. Of Haemorrhoids.  
Observation 

OF caecae or blind Haemorrhoids. 

1. Observation of them Page 216  
2. of the same ibid.  
3. of external Haemorrhoids Page 217  
4. the like ibid.  
5. the like Page 218    
Of apertae or bleeding Haemorrhoids. 

1. Observation of them ibid.  
2. of the same ib.  
3. of the same ib.       

CHAP. II. Of Procidentia Ani.  
Observation 

1. Of a Procidentia Any Page 220  
2. the like ibid.  
3. the like ib.  
4. the like Page 221  
5. the like ibid.     

CHAP. III. Of Condyloma, Ficus, etc.  
Observation 

1. Of Rhagades, Ficus, Thymi Page 223  
2. a preternatural Body growing from the Os coccyx extirpated Page 224     

CHAP. iv Of Phyma.  
Observation 

1. Of an external Phyma Page 225  
2. the like ibid.  
3. Phyma Page 226     

CHAP. V Of Sinuous Ulcers and Fistulae in Ano.  
Observation 

1. Of a Sinuous Ulcer Page 229  
2. the like Page 230  
3. the like ibid.  
4. a Fistula in Ano Page 231  
5. an Ulcer in Ano ibid.  
6. a Fistula in Ano Page 232  
7. the like Page 233  
8. the like ibid.  
9 the like Page 234  
10. a putrid and fistulous Ulcer in Ano Page 236  
11. an Ulcer in Intestino recto with stricture of the Anus Page 237  
12. a Sinuous Ulcer near the Anus Page 239  
13. an ill-conditioned Ulcer in Ano Page 240  
14. a Cancer in Ano Page 241      
TREATISE iv Of the KING's EVIL. 

CHAP. IU. Of the method of Curing the Evil.  
Observation  
Of Discussion. 

1. OF Strumae discussed Page 264  
2. the like Page 265  
3. Vitiligo and Strumae ibid.  
4. Strumae ib.  
5. the like ib.  
6. the like Page 266  
7. Discussion and Suppuration mixed ibid.  
8. the effects of Merc. dulcis in Children ib.    
Of Suppuration. 

1. Of Struma suppurated Page 267  
2. the like ibid.  
3. the like ib.    
Of Incision. 

1. Of Incision of a Meliceris Page 268  
2. Incision of an Atheroma ibid.  
3. Incision of a Steatoma ib.  
4. the like ib.  
5. a Struma on the Eyebrow incised ib.  
6. the like Page 269  
7. a Struma on the right Jaw ibid.  
8. a Struma on the Os frontis ib.  
9 the like ib.  
10. a Struma on the Neck ib.  
11. Sarcoma cured by Excision ib.  
12. Noli me tangere cured by Excision Page 270  
13. a Struma on the right Cheek ibid.  
14. Atheroma on the left Cheek ib.  
15. a Tumour on the right Cheek Page 271  
16. the like ibid.  
17. a Tumour by the upper Lip ib.  
18. a complicated Tumour taken out by Incision ib.  
19 a preternatural Tumour on the left Breast Page 272  
20. a complicated Tumour in Inguine taken out by Incision ibid.    
Of Eradication by Caustick. 

1. Of a Struma so eradicated ib.  
2. the like Page 273  
3. the like ibid.  
4. the like Page 274  
5. the like Page 275  
6. the like Page 276  
7. a strumous Tumour above the right Scapula ibid.  
8. Strumae and Sarcoma eradicated Page 277  
9 Struma with a Fungus of an Artery ibid.  
10. Bronchocele Page 279  
11. the like Page 280    
Observation 

1. Of an Ulcer on the Head Page 281  
2. Ulcers about the Chaps ibid.  
3. Ulcers in the Neck, and Atheroma in the Arm Page 282  
4. Ulcers in the Neck ibid.  
5. strumous Ulcers on both sides the Neck Page 283  
6. strumous Ulcers on the Axilla and Arm Page 284  
7. Ulcers on the Head, Neck, Lips, etc. ibid.  
8. an Ulcer with Caries in Cranio Page 285  
9 Atheroma with Caries on the Cranium ibid.  
10. the like Page 286  
11. Spina ventosa in Cranio ibid.  
12. Struma with Caries in the Os zygoma ib.  
13. strumous Ulcers with Caries in the Os zygoma Page 287  
14. an Ulcer with Caries behind the Ear ibid.  
15. external Ulcers from a Spina ventosa Page 288  
16. a Spina ventosa in the left Jaw ibid.  
17. Spina ventosa in the inferior Maxilla Page 289  
18. the like ibid.    
Observation 

1. Of Gumma on the Tendons Page 291  
2. a strumous Swelling on the Ankle Page 292  
3. a strumous Tumour by Congestion ibid.  
4. the like, and a strumous Tumour in the Thigh Page 293  
5. an Abscess on the Elbow ibid.  
6. an Abscess on the Hip ib.  
7. the like ib.  
8. the like Page 294  
9 the like Page 295  
10. a Protuberance in the bone of the Knee ibid.  
11. a Tumour on the inside of the Knee Page 296  
12. a Tumour on the Knee Page 297  
13. the like ibid.  
14. the like Page 298  
15. tumors on the right Knee ibid.  
16. a strumous Ulcer on the Ankle ib.  
17. several strumous Ulcers with Caries Page 299  
18. a Struma on the right Foot Page 300  
19 a Struma on the Thigh, and several other tumors Page 301  
20. a Tumour on the Foot Page 302  
21. a strumous Tumour on the Heel Page 303  
22. Strumae on the Arms, Leg, and Heel ibid.  
23. an Abscess in the Foot with rotten Bones Page 305  
24. strumous Ulcers on the Foot, Arms, etc. ibid.  
25. a strumous Tumour on the Thumb Page 307  
26. strumous Ulcers on the back of the right Hand ibid.  
27. an Ulcer on the left Hand ib.  
28. Ulcers on the Thumb and great Toe Page 308  
29. strumous Ulcers on the Wrist and great Toe ibid.  
30. strumous Ulcers on the Foot with rotten Bones Page 309  
31. strumous Ulcers with rotten Bones Page 311     

CHAP. V Of Ophthalmia.  
Observation 

1. Of Inflammation and Fluxion in the Eyes Page 316  
2. the like ibid.  
3. the like, with Ozaena Page 317  
4. Defluxion in both Eyes, etc. ibid.  
5. the like, with Strumae on the Neck Page 318  
6. soar Eyes with a Pustula ibid.  
7. the like ib.  
8. Defluxions upon the Eyes, Catarrhs, etc. ib.  
9 the like, with Strumae about the Neck Page 319  
10. Inflammation and Pustula in the Eye, and a Struma on the Foot ibid.  
11. soar Eyes and a swollen Lip Page 320  
14. soar Eyes, etc. ibid.    
Of Lippitudo. 

1. Of Lippitudo humida Page 321  
2. the like with Hypersarcosis ibid.  
3. Lippitudo sicca ib.     

CHAP. VI Of Aegilops.  
Observation 

1. Of Aegilops with Inflammation Page 322  
2. the like Page 323  
3. Fistula lacrymalís Page 324  
4. the like ibid.  
5. the like Page 325  
6. the like ibid.  
7. the like ib.  
8. Anchylops ib.  
9 the like Page 326  
10. Anchylops with a Polypus ibid.  
11. Ozaena ib.  
12. Hordeolum Page 327  
13. the like ibid.  
14. Sarcoma upon the supercilia Page 328  
15. an Excrescence upon the lacrymal Gland ibid.  
16. Thymus ib.     

CHAP. VII. Of the tonsils.  
Observation 

1. Of both the tonsils extirpated Page 330  
2. the right Tonsill extirpated Page 331  
3. the like ibid.  
4. both tonsils extirpated ib.  
5. the left Tonsill extirpated Page 332  
6. both tonsils extirpated ibid.  
7. the like Page 333  
8. the Uuula elongated ibid.     

CHAP. VIII. Of Ranula.  
Observation 

1. Of Ranula under the Tongue Page 334  
2. the like Page 335  
3. a Tubercle in the Tongue ibid.      
TREATISE V Of WOUNDS. 

CHAP. I. Of Wounds in general.  
Observation 

OF a Leg pricked with a Thorn Page 347  
a double Wound by a Rapier Page 350     

CHAP. II. Of Wounds of the Veins and Arteries.  
Observation 

1. Of a Wound of the internal Jugular Page 354  
2. an Artery wounded ibid.  
3. the like Page 355  
4. an Aneurisma broken open ibid.  
5. a Wound of the sural Artery ib.  
6. an Artery pricked in letting blood Page 356     

CHAP. III. Of Wounds of the Nerves, Tendons and Ligaments.  
Observation 

Of a Tendon pricked Page 359 

1. Of a Wound in the inside of the Wrist ibid.  
2. the like into the Joint Page 360  
3. a Finger bitten of by a horse ibid.       

CHAP. IU. Of Wounds of the Face.  
Observation 

1. Of Wounds in the Forehead and Eyebrow Page 361  
2. a Wound in the right Cheek Page 362  
3. a Dutch Hamburger marked with a Cross on the right Cheek ibid.     

CHAP. V Of Wounds penetrating the Oesophagus and Aspera arteria.  
Observation 

Of a Wound in the Gullet Page 363     

CHAP. VI Of Wounds of the Limbs.  
Observation 

1. Of a Puncture of the Arm Page 364  
2. a Wound in the Thigh ibid.  
3. the like ib.  
4. a Wound in the Arm Page 365  
5. a Wound in the Leg ibid.     

CHAP. VII. Of Wounds of the Breast.  
Observation 

1. Of a penetrating Wound in the Breast Page 367  
2. a Wound in the right Breast Page 368  
3. the like ibid.  
4. a Wound in the left Side ib.  
5. Wounds in the Breast and right Arm ib.  
6. a Wound through the Body Page 369  
7. a Wound in the Breast Page 370     

CHAP. VIII. Of Wounds of the Belly.  
Observation 

1. Of a Wound in the Abdomen Page 372  
2. a Wound in the Belly Page 373     

CHAP. IX. Of Wounds of the Head.  
Observation 

Of an incised Wound transverse the Temporal Muscle Page 378  
a Wound by a Sword between the Sagittal and Coronal Sutures Page 382 

1. Of a Contusion without Wound or Concussion Page 386  
2. a Contusion with an Ecchymosis opened ibid.  
3. a contused Wound Page 387  
4. a Wound betwixt the Sagittal and Coronal Sutures ibid.  
5. a large Wound of the Calvaria Page 388  
6. the Calvaria torn of ibid.  
7. a contused Wound ib.  
8. a great contused Wound Page 389  
9 Concussions on the Forehead and Face ibid.  
10. a Concussion, with a broken Leg Page 390  
11. a Fracture with a long Fissure and depression of the Cranium Page 392  
12. a contused Wound by a Puncture in the Crown Page 393  
13. a Concussion of the Brain Page 394  
14. a large Fissure, the Dura matter putrefied Page 395  
15. Caries through the Cranium, wherein the Pericranium and Dura matter were grown together Page 396  
16. a large Fissure by Contusion without a Wound Page 397  
17. a Fissure with a Fracture and depression of the Cranium under the Temporal Muscle Page 398  
18. a Soldier wounded in the Head Page 399       

An Additionall Discourse of Wounds of the Brain.  
Observation 

Of a Wound upon the Forehead with a Cudgel Page 400  
a Fracture with depression of the Soul Page 401  
a Wound between the Brow and Ear ibid. 

1. Of a Fracture of the Cranium by Musket-shot ib.  
2. a fractured Scull Page 402  
3. a fractured Face, Nose, etc. ibid.        
TREATISE VI Of GUN-SHOT-WOUNDS. 

CHAP. I. Of Gun-shot Wounds in general.  
Observation 

OF a Wound through the Jaw and Tongue Page 408  
a Wound on the outside of the Leg ibid.     

CHAP. II. Of Extraction of Bullets, etc.  
Observation 

Of an Haemorrhage relieved by actual Cautery Page 409  
a Bullet, etc. extracted in the Thigh Page 410  
a Bullet extracted above the left Clavicle Page 411  
a Bullet taken out of the Back by Incision ibid.  
one run through with a Rapier cured ib.  
a Slug extracted near the Cheekbone, shot in at the Canthus of the right Eye Page 412     

CHAP. III. Of Dressing after Extraction.  
Observation 

Of a Wound in the Hand Page 413     

CHAP. iv Of Accidents befalling Gun-shot Wounds, and of Sinuous Ulcers.  
Observation 

1. Of a wounded Thigh Page 417  
2. a Shot in the Face ibid.     

CHAP. V Of Gun-shot Wounds with Fracture.  
Observation 

Of a Wound in the Elbow-joint with Fracture Page 420  
an Arm run through, and a Shoulder fractured Page 420  
an Arm shot of Page 421  
a Leg shot of ibid.  
1. Of a fractured Arm Page 425  
2. an Arm fractured by a Splinter ibid.     

CHAP. VI Of Gun-shot Wounds in the Joints.  
Observation 

Of a shot through the Knee Page 430     

CHAP. VIII. Of Gun-shot Wounds in the Thorax.  
Observation 

Of a Wound through one side of the Sternon Page 436  
several wounded in the Breast Page 437     

CHAP. IX. Of Symptoms of Gun-shot.  
Observation 

Of a Hand torn with a Rammer Page 437      
An Appendix to Gun-shot Wounds. 

CHAP. I. Of Burns with Gunpowder, etc.  
Observation 

1. Of Hands, Arms, Breast, etc. burned with Gun powder Page 441  
2. a Hand, Arm, Side, etc. burnt with Gunpowder ibid.  
3. the Right-hand Fingers burnt Page 442     

CHAP. II. Of Gangrene and Sphacelus.  
Observation 

Of an Arm sphacelated Page 443 

1. Of a Gangrene from strict Bandage Page 445  
2. a Gangrene on a contused Wound Page 446  
3. a gangrened Leg Page 446  
4. a gangrened Elbow Page 447  
5. a sphacelated Leg ibid.  
6. a Gangrene through old age Page 448  
7. a gangrened Arm ibid.  
8. a gangrened Knee ib.  
9 a gangrened Toe Page 449    
Of the ill consequences of a Wound in the Elbow joint Page 454  
of a Hand torn by a Musket breaking Page 455     

CHAP. III. Of Fisiulae.  
Observation 

Of a Fistula with Caries in the Os tibiae Page 459.      
TREATISE VII. Of FRACTURES and LUXATIONS. 

CHAP. I. Of Fractures.  
Observation 

OF a fractured Thighbone Page 469 

1. Of a fractured Face Page 472  
2. a fractured Clavicle, etc. Page 473  
3. a fractured Leg Page 475  
4. both the Focills of the Leg fractured ibid.       

CHAP. III. Of Luxation of the lower Jaws.  
Observation 

1. Of a Luxation of both Jaws Page 483  
2. a Luxation of the right Jaw ibid.     

CHAP. IU. Of Luxation of the Clavicle.  
Observation 

1. Of a Clavicle luxated Page 485  
2. the like ibid.     

CHAP. V Of Luxation of the Shoulder.  
Observation 

1. Of the right Shoulder luxated Page 488  
2. a luxated Shoulder reduced by the Foot Page 489  
3. Reduction by the Hand ibid.  
4. Reduction by the Coulstaff ib.  
5. Reduction by a Pulley and Coulstaff Page 490  
6. Reduction by Glossocomium ibid.  
7. a Luxation by Congestion Page 491  
8. the like ibid.     

CHAP. VI Of Luxation of the Elbow-joint.  
Observation 

1. Of the right Elbow luxated Page 493  
2. the Elbow luxated ibid.     

CHAP. IX. Of Luxation of the Knee.  
Observation 

Of a luxated Knee Page 496      
TREATISE VIII. Of LVES VENEREA. 

CHAP. IU. Of the Cure of the Symptoms.  
Observation 

1. OF inflammation and excoriation of the Penis Page 21  
2. an inflammation of the Prepuce ibid.  
3. the like of the Glans and Prepuce ib.  
4. the Prepuce gangrened Page 22  
5. a Chancre on the Prepuce with callus ibid.  
6. a Chancre between the Glans and Prepuce ib.  
7. a Chancre on the side of the Glans ib.  
8. Ulcers on the Fraenum and Chancre on the Urethra Page 23  
9 a Chancre with Inflammation ibid.  
10. Chancres and ulceration ib.  
11. a Chancre on the Prepuce Page 24  
12. a Chancre, and Glands' in both Groins ibid.  
13. Inflammation and Chancre in pudendo Page 25  
14. Chancre with carnosity of the Prepuce ibid.  
15. Chancre with Callosity Page 26  
16. a Bubo ibid.  
17. the like Page 27  
18. the like ibid.  
19 the like ib.  
20. Bubones, Chancres and pains in the Shoulders Page 28  
21. Heat, Pustulae, etc. ibid.  
22. a Woman with Child venereal Page 29  
23. the like ibid.  
24. a Nurse infected ib.  
25. an Infant infected Page 30  
26. the like ibid.  
27. an Herpes' exedens in the Face ib.  
28. sweetening the Blood Page 31  
29. Herpes', Ulcer in the Tongue and various pains Page 32  
30. Ulcers on the Uuula, tonsils and Nose ibid.  
31. Pustulae and a Node on the back of the Hand Page 33  
32. Herpes' exedens, Verrucae, etc. ibid.  
33. Herpes' in the Breast, etc. ib.  
34. Herpes', Pustulae in several parts ib.  
35. Herpes' and serpiginous Ulcers Page 34  
36. ulcerous Scabs, Serpigo, etc. ibid.  
36. Herpes' exedens overspreading the Body Page 35  
37. Herpes' exedens, Eruptions, etc. ibid.  
38. Pustulae, Ulcers, and nocturnal pains Page 36  
39 an Ophthalmia ibid.  
40. the like ib.  
41. a Fistula lacrymalis Page 37  
42. a Phagedaena on the Leg ibid.  
43. Herpes' miliaris in planta pedis Page 38  
44. Herpes' exedens and Nodes Page 39  
45. Ulcers on the Arm and Leg with Caries ibid.  
46. a Node laid open, with the consequence Page 40  
47. Ozaena, Ulcer in the Palate, Nodes, etc. ibid.  
48. the Uuula and Palate eaten away Page 41  
49. Ulcers in the tonsils, Palate, etc. with a Node on the Leg Page 41  
50. a Relapse, with Nodes, etc. Page 42  
51. Ulcers on the Fauces, Gumma on the Musc. mastoïdes ibid.  
52. an Ozaena Page 43  
53. a Node, and Ulcers in the tonsils Page 44  
54. an Ozaena Page 45  
55. Nodes, Gumma and Ulcers in osse palati ibid.  
56. Nodes and pains in several parts Page 46  
57 Ozaena, Nodes, and Gummata Page 47  
58. Ozaena Page 48  
59 Lues Venerea complicated with Cancer, etc. ibid.  
60. Nodes, Gummata, and various pains Page 49  
61. Ozaena and Nodes Page 50  
62. Ozaena and Ulcers in the tonsils, etc. ibid.  
63. a Gumma Page 51  
64. a Gumma resolved ibid.  
65. an Ulcer with Caries on the Os frontis ib.  
66. a Caries on the Os frontis Page 52  
67. Ulcers and Nodes, with the ill consequence ibid.  
68 Lues Venerea with a complication of Diseases Page 53  
69. Ulcers in the tonsils, Ozaena, etc. Page 54     

CHAP. V Of Gonorrhaea.  
Observation 

1. Of Gonorrhaea Page 60  
2. the like Page 61  
3. the like ibid.  
4. a virulent Gonorrhaea Page 62  
5. Gonorrhaea with Chancre ibid.  
6. the like ib.  
7. a Gonorrhaea, and the Wife infected by it Page 63  
8. Gonorrhaea, and Tumour in the left Testicle ibid.  
9 the like Page 64  
10. the like ibid.  
11. Gonorrhaea, with Hernia humoralis ib.  
12. a sinuous Ulcer in the right Testicle Page 65     

CHAP. VI Of the ill consequences of a Gonorrhaea.  
Observation 

1. Of Caruncles Page 72  
2. the like ibid.  
3. the like Page 73  
4. the like ibid.  
5. the like Page 74  
6. the like ibid.  
7. Excrescences on the Pudendum Page 75  
8. a scirrhous Tumour in vagina uteri ibid.  
9 a Gangrene upon suppression of urine Page 76  
10. a Carnosity cut ibid.  
11. Caruncles Page 77  
12. a Tumour in perinaeo ibid.  
13. Caruncles Page 78  
14. a Carnosity ibid.  
15. an Abscess in Ano ib.  
16. an Abscess under the Pubis, and the Urethra corroded ib.       
Those Chapters that are omitted have no Observations in them.  
FINIS.