OF
Chirurgical Diseases.
C H A P. I.
Of Tumours in general, Abcesses or Impostumes, Breakings out, Pustules, and Tubercles.
What is a Tumour?
A Tumour is a rising or bloated Swelling rais'd in some part of the Body by a Setling of Humours.
How is this setling of Humours produc'd?
Two several ways, viz. by Fluxion and Congestion.
What is the Setling by Fluxion?
It is that which raiseth the Tumour all at once, or in a very little space of time, by the Fluidity of the Matter.
What is the Setling by Congestion?
It is that which produceth the Tumour by little and little, and almost insensibly, by reason of the slow Progress and thickness of the Matter.
Which are the most dangerous Tumours, those that arise from Fluxion, or those that derive their Original from Congestion?
They that proceed from Congestion, because their thick and gross Matter always renders 'em obstinate, and difficult to be cur'd.
Whence do the differences of Tumours proceed?
They are taken, first, from the Natural Humours, Simple, Mixt, and Alter'd: Simple, as the Phlegmon, which is made of Blood, and the Erysipelas of Choler; Mixt, as the Erysipelas Phlegmon, which consists of Blood mingl'd with a Portion of Choler; or the Phlegmonous Erysipelas, which proceeds from Choler intermixt with a Portion of Blood: Alter'd, as the Melia which is compos'd of many Humours, that can not be any longer distinguish'd by reason of their too great Alteration. Secondly, the difference of Tumours is taken from their likeness to some other thing, as the Carbuncle and the Talpa, the former resembling a burning Coal, and the other a Mole, according to the Etymology of their Latin Names. Thirdly, From the Parts where they are situated; as the Ophthalmy in the Eye and the Quinsey in the Throat. Fourthly, from Disease that causeth 'em, as Venereal and Pestilential Buboes. Fifthly, from certain Qualities found in some, and not in others; as the Encysted Tumours, which have their Matter clos'd within their proper Cystes or Membranes, and so of many others.
How many kinds of Tumours are there that comprehend at once all the particular Species?
They are four in Number, viz. the Natural Tumours, the Encysted, the Critical, and the Malignant.
What are natural Tumours?
They are those that are made of the four Humours contain'd in the Mass of the Blood, or else of many at once intermixt together.
What are the four Humours contain'd in the Mass of the Blood?
They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth its particular Tumour: Thus the Blood produces the Phlegmon, Choler the Erysipelas, Phlegm the Oedema, and Melancholy the Scirrhus. The Mixture of these is in like manner the Cause of the Erysipelatous Phlegmon, the Oedomatous Phlegmon or Phlegmonous Erysipelas, and the Phlegmonous Oedema, according to the quality of the Humours which are predominant, from whence the several Tumours take their Names.
What are the Encysted Tumours?
They are those the Matter whereof is contain'd in certain Cystes, or Membranous Bags; as the Meliceris, and the Struma or Kings-Evil.
What are Critical Tumours?
They are those that appear all at once in acute Diseases, and terminate them with good or bad Success.
What are Malignant Tumours?
They are those that are always accompany'd with extraordinary and dreadful Symptoms, and whose Consequences are also very dangerous; as the Carbuncle in the Plague.
What are Impostumes or Abcesses, Breakings out and Pustules?
Indeed, it may be affirm'd, that all these kinds of Tumours scarce differ one from another, except in their size or bigness; nevertheless, to speak properly, by the Names of Impostumes or Abcesses are understood gross Tumours that are suppurable, or may be dissolv'd, and by those of Breakings out and Pustules, only simple Pusteal Wheals, or small Tumours, that appear in great Numbers, and which frequently do not continue to Suppuration; some of them consisting of very few Humours, and others altogether of dry Matter.
What difference is there between a Tumour and an Impostume or Abcess?
They differ in this particular, that all Tumours are not Impostumes nor Abcesses; but there is no Impostume nor Abcess that is not a Tumour: As for Example, Wens and Ganglions are Tumours, yet are not Abcesses nor Impostumes; whereas these last are always Tumours in regard that they cause Bunches and Elevations.
C H A P. II.
Of the general Method to be observ'd in the curing of Tumours.
What ought a Surgeon chiefly to observe in Tumours, before he undertake their Cure?
He ought to know three things, viz. 1. The Nature or Quality of the Tumour. 2. The
time of its formation and 3. Its situation: The Quality of the Tumour is to be known, because the Natural one is otherwise handl'd than that which is Encysted, Critical or Malignant. As for the time of its Formation, it is four-fold, viz. the Beginning, Increase, State, and Declination, wherein altogether different Remedies are to be apply'd. The Situation of the Tumour must be also observ'd, because the dressing and opening of it ought to be as exact as is possible, to avoid the meeting with an Artery or neighbouring Tendon.
How many ways are all the Tumours that are curable, terminated?
They are terminated after two manners, viz. either by dissolving 'em, or by Suppuration.
Are not the Scirrhus and the Esthiomenus or Gangrene, two means that sometimes serve to terminate and cure Impostumes?
Yes, but it is done imperfectly, in regard that a Tumour or Impostume cannot be said to be absolutely cur'd, as long as there remains any thing of the Original Malady, as it happens in the Scirrhus, where the Matter is harden'd by an imperfect dissolving of it, or when the Impostume degenerates into a greater and more dangerous Distemper, as it appears in the Esthiomenus or Gangrene that succeeds it.
Which is the most effectual means of curing Impostumes, that of dissolving, or that of bringing them to Suppuration?
That of dissolving 'em is without doubt the most successful, and that which ought to be us'd as much as is possible; nevertheless some Cases are to be excepted, wherein the Tumours
or Abcesses are Critical and Malignant; for then the way of Suppuration is not only preferable, but must also be procur'd by all sorts of means, even by opening; which may be done upon this occasion, without waiting for their perfect Maturity.
What are the Precautions whereto a Surgeon ought to have regard before he undertake the opening of Tumours?
He must take care to avoid cutting the Fibres of the Muscles, and in great Abcesses, to cause all the corrupt Matter to be discharg'd at once, to prevent the Patient's falling into a Swoon.
Ought the opening of Tumours always to be made longitudinally, and according to the direct Course of the Fibres?
No, it is sometimes necessary to open 'em with a Crucial Incision, when they are large, or when a Cystis or Membranous Vehicle is to be extirpated.
How many sorts of Matter are there that issue forth in the Suppuration of Tumours?
There are four sorts, viz. the Pus, Ichor, Sanies, and Virus.
What isPus?
It is a thick Matter, and white as Milk.
What is Ichor?
It is a thick Matter like the Pus, but of divers Colours.
What is Sanies?
It is a watery Matter that riseth up in Ulcers, almost after the same manner as the Sap in Trees.
What is Virus?
It is a kind of watry Matter, being whitish, yellowish, and greenish at the same time; which issueth out of Ulcers, very much stinking, and is endu'd with corrosive and malignant Qualities.
How many general Causes are there of Tumours?
There are three, viz. the Primitive, the Antecedent, and the Conjunct: The Primitive is that which gives occasion to the Tumours; as for Example, a Fall or a Blow receiv'd. The Antecedent is that which supplies it with Matter, such is the Mass of Blood that thickens and maintains the Phlegmon. Lastly, the Conjunct Cause is the overflowing Blood or Matter, which immediately forms the Tumor.
What regard ought to be had to these three sorts of Causes in the Cure?
The Primitive Cause may be prevented by avoiding the Falls, Blows, or other Hurts, and the Antecedent by diminishing the Plethory of the Blood, and cooling the whole Mass by Phlebotomy. The Conjunct Cause, which is the overflowing of the Blood, may be also remov'd in dispersing it by dissolving, or else in discharging it by Suppuration.
What is a Crisis?
It is a sudden setling of Humours, which happens in Diseases, whereby they are usually terminated.
How are these Critical Setlings effected?
By the Strength of Nature, which either expels the peccant Humours thro' the Belly, or carries them to the Habitude of the Body; for in the former she causeth Fluxes of Humours, Urine and Blood; as in the other she excites Sweatings, Tumours, and even a Gangrene it self.
In what Parts do the Critical Tumours usually arise?
In the Glandules, which the Ancients call'd the Emunctories of the Brain, Heart, and Liver; for they gave the Name of Emunctories of the Brain to the thick Glandules which lie under the Ears, that of the Emunctories of the Heart to those that are under the Arm-Pits; and that of the Emunctories of the Liver to those under the Groin. Now Malignant Tumours may arise in all these parts, but the Venereal happen only in the Groin.
C H A P. III.
Of Natural Tumours.
A R T I C L E I.
Of the Phlegmon and its Dependancies.
What is a Phlegmon?
It is a red Tumour occasion'd by the Blood diffus'd in some part, wherein it causeth extension, pain, and heat with beating.
Are Aneurisms and Varices, which are Tumours, made by the Blood, to be reckon'd among the Phlegmons?
No, because the Blood that forms the Aneurisms and Varices is not extravasated nor accompany'd with Inflammation, but only a Tumour of Blood proceeding from the Dilatation of the Arteries and Veins.
May Echymoses or Contusions consisting of extravasated Blood, be esteem'd as Phlegmons?
By no means, in regard that it is not sufficient that the Blood be extravasated for the producing of a Phlegmon; it must also cause Pain, Heat, and a Beating, with Inflammation, which is not to be found in the Echymoses, except in great ones, after they have been neglected for a long time; where the corrupted Blood ought to be let out immediately, to prevent the Inflammation, overmuch Suppuration, and many other ill Consequences.
Is the Phlegmon always compos'd of pure Blood?
No, it may happen sometimes to partake of Choler, Phlegm, or Melancholy; on which account it is nam'd an Erysipelatous, Oedomatous, or Scirrhous Phlegmon, always retaining the Name of the predominant Humour, which is the Blood; and so of the others.