OF
_Chirurgical Diseases_.
CHAP. 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 s.p.a.ce of time, by the Fluidity of the Matter. {98}
_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. {99}
_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 Ma.s.s of the Blood, or else of many at once intermixt together.
_What are the four Humours contain"d in the Ma.s.s 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. {100}
_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.
CHAP. 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 {101} 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 {102} 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.