Lanfrank's "Science of cirurgie". Edited from the Bodleian Ashmole ms. 1396 (ab. 1380 A.D.) and the British museum Additional ms. 12,056 (ab. 1420 A.D.) by Robert V. Fleischhacker, DR. PHIL. Part I--Text.

¶ Now begynneþ þe secunde tretys off particuler woundes of membris of office from þe hede to þe ffot, and ffirste y begynne at the Anotamye off the hed.

Al thynge breffliche y-ordeynde, aftere þe devysinge of my Symple wytt, whiche þat longith to þe firste tretys of this [folio 69a] boke whiche þat holdyth certeyne rulys & techynges off surgerye vndire general chapitelis, as we han byheyȝt. Now we wylle begynne to tretyn of certeyne cures, aftere þat þe lymes ben in mannys body. & firste y wyl begynne at þe hed & at hys anotamye, & so þe processe forþ to eueryche membre devysinge þe Anotamye of euery membre, & in ordeynynge þe cures of woundys þat beþ made in eche sengle membre, I sigge þat þe hed ys made of þre partyes: of a ffleschy party, a bony partye, and a braynie partye. Þe fflesch partye is aboue þe brayn panne, whiche þat is made of an herye skyn; & þilke skyn ys fulfylde with brawnys in euery place. Þe

herys off þe hed were for grete proffyte y-ordeynde, þat neiþere colde ne hete ne scholde noȝt sodeynliche entre þe pores of þe skyn, & neuere þe lattere þat þe fumosyte of þe hed myȝte go out be þe pores þere as þe here growyth, and þat þe hed myȝte be þe more semlykere, and þat þe coloure of þe herys myȝte schewe þe complexioun of þe hed. Þe skyn þat is abouen þe breyne panne ys lacertos & ful of þykke flesch, þat he myȝte wreyen þe breyn panne, þat he scholde noȝt fele to sodeynlyche neiþere to grete hete ne to cold. Þe whiche skyn ys made of sotyll þredys of synwes þat comeþ from þe brayn & of veynis & of arteryes sotylliche y-mad; and so þe skyn of þe hed ys sotylliche y-Ioyned with þe skyn off alle þe bodye, and also þe skyn of þe hed ys more þykkere þenne þe brayne scolle, þat it scholde be more rare & more porose þat is to sigge more ful of holys. Þe lacertes of þe skyn proceden after þat þe goynge procedyth of þe herys, þe brayn panne ys mad of manye bonys. Þe fyrste summe, whiche þat wiþholdyth þe profites þat longyth to þe brayn panne, haþ tweye helpynges; on helpynge ys, þowȝ þat an hurtynge come to on bon, neuere þe latere he scholde noȝt fallen to alle þe bonys; þe secunde helpe is þat on bon þat is to harde in on partye, ne scholde noȝt be so [folio 69b] hard in an oþere

partye. Secunde summe, whiche þat withhalt helpynges, þat beþ vnder þe brayn panne, haþ with hym iiij helpynges; þe whiche helpynges beþ ful mad be þe semys þat beþ of þe breyn panne. Ne þo helpynges ne myȝte noȝt be mad, but ȝif þat þere were manye bonys. Þe firste helpe ys, þat þe veynes myȝte go doun by the semys of [of above line.] þe brayn panne, berynge norosschynge to þe same brayn.

Secunde helpe ys þat þe synwes, þat comyth out of þe brayn, myȝte habbe wey in goynge out. Þe þridde helpe ys, þat þe fumes of þe brayn myȝte habbe wey of smokynge out. Þe ffourþe ys, þat neiþere dura mater ne pia mater, þere as þey ben y-hongyde, ne myȝte noȝt greue þe brayn. Sytthe þat þe breyne panne ys made of two smeþe lyȝte tablys, þat one ys aboue & þe oþere byneþe, & þey be sumwhat spongyouse in þe myddel & rare, þat þe smokys of þe hed myȝte þe bettyre passen out, & þey be smeþe þat þey myȝte noȝt greue þe brayn. Dyuerse men þat makyth dyuerse Anotamye devydeþ þe breyn panne dyuerslyche. Somme nowmbryth mo bonys. þenne summe oþere spekyn of; but soþenesse ys that þere ben sixe; & one whyche þat susteyneþ þo sixe. Þe ffyrste bon ys clepyde þe bon of þe [þe above line.] fforhed oþere ellys coronale, & he bygynneþ from þe browys, & lastyth vnto þe seme þat departyth þe hed

twarte offere. And þylke bon is y-clepyde coronale: þis bon hath in some manere of men a smal seme in þe ffoldynge of þe fforhed, & þere fore sum men siggeþ þat þere beþ tweye bonys. Tweye oþere bonys beþ y-Ioyned wiþ þylke bon coronale in þe myden of þe hed twarte offere, & þey ben y-bounde togedyre by one Iucture, þe whiche þat strecchiþ from tofore to byhynde, by the lengthe of þe hed, þe whiche ys y-clepyde sagyttalis by as myche as he ys schapyde lyke an arwe. And þese tweye bonys beþ y-clepyde Nerualia, by cause of þe ffigure of the seme þat ys wiþ þe coronale, [folio 70a] ys þe ffigure of a synwe oþere of a corde. And þese bonys ben in þe heyest coppe of the hed, and behynde in þe nolle þere ys a bon whyche þat is y-clepyde Alauda, & ys y-made to þe Symilitude of þis cyffre of Augrym

[figure]

, whiche þat ys Ioynede with þe bonys nerualibus tofore seyde, by þe mene of on ȝem y-mad to þe lyknesse of þe bon tofore seyde. & þese þre ȝemes whiche þat Ioyneþ togedyre þe foure bonys to fore seyde, ben y-made as yt were tweye [MS. tweye twice.] ȝawes, whos teth joyned eche of hem in oþere in thys manere /

[figure]

& þis ioyninge togedire of on bon with an oþer was y-made by-cause Iuvamentes þat y haue tolde beforn; þere nys no bon y-ioynede with an oþere as þese bonys ben. Undire þe bon þat ys

y-clepyde Alauda, þere ys a ful harde bon & y-holyde in þe myddle, þe whyche bone susteyneth alle þe bonys of þe hed. Þe whiche bon ys y-clepyde Passilus, & he ys ioynede byneþe wiþ þe fyrste bon of þe nekke. Þe schappe of þe coniuccioun of þe fife bonys of þe hed ys in þis manere

[figure]

. Bothe on þe ryȝte syde & on þe lefte syde of þe forseyde bonys whiche þat beþ y-clepyde nerualia,* whiche þat beþ in lengthe in þe heyest place of þe hed, þere ben twey bonys on eiþere syde*; þe whiche þat beþ vndiresetterys to þo bonys þat beþ y-clepyde nerualia; & þo bonys þat vndire setten, ben y-clept ossa mendosa. And þese bonys in one partye ben ful harde, þere as þe hole of þe ere passyth þorwȝ, & þey ben y-clepede [MS. petotra.] petrosa & sum men siggen þat þere ben foure bonys, two on eythere syde. & whanne þat alle bonys of þe hed be Ioynede togedire þou schalt fynde in sotfastnesse, þat þere ben but sixe bonys whanne þat þou reknyste os [MS. as.] coronale ffor on bon, & tweye bonys þat beþ y-clepyde mendose tweyne þat beþ þre, and o bon þat ys y-clepyde Alanda, & tweye bonys þat is y-clepyde nerualia—þat beþ sixe, and þe vij bon ys y-clepyde passillare, þe whiche ys nought of þe bonys of þe hed, but he susteyneth alle þe oþere bonys of þe hed. And þre maner of semys makyth coniuccioun of alle þe bonys on þis

manere

[figure]

, & with tweye semys mendose in þis manere

[figure]

. And whanne þat þe corone of þe hed ys perfyt, þe hed [folio 70b] ys mad in þis manere

[figure]

. Þis ys þe forme of an hed wel proporcionede, þat he be ronde because þat he myghte þe more withholde, & þat he myȝte þe lasse be y-hurt, and þat he be longewarped havynge tofore & behynde eminence þat is to sigge aperynge, þat þe synwes þat comyth out of þe brayn, myghte haue a porose place of goynge out. And naþelese as ypocras & galyen, whiche þat exponeþ ypocras, tellyn: it is possible to fynden þre oþere manere makynge of hedys. On manere is, ȝif eminence be noȝt in þe partye of þe hed tofore; for ȝif þat he be pleyn in þe partye tofore, by þat pleynnesse þe seme is y-lost þat is y-clepyde coronalis. Secunde ys ȝif þe hed haff non eminence behynde, but þat þe hyndore party be playn, and by þat playnnesse þe seme ys y-lost þat ys y-clepyde Alauda. [MS. Abauda.] Þe þridde ys ȝif þere be non eminence tofore ne behynde in þe hed, but alle þe hed ys rounde as a cercle. And þenne þere nys but on sem in þe myddel of þe breyn panne, ffor it is vnpossible þe hed to habben enye oþere schappe wiþouten lesyng of some party of þe brayn; & þat were contrariouse aȝeyne lyf. By þe myddele seme, whiche þat is in þe hed, þere dissendyth a veyne comynge

from þe lyffere, by þe breyn ponne, of a bon whiche þat is y-holyde. þat is y-clepyde pasillaris. And by þe same weye þere arysith an Arterye comynge fro þe herte, and þey ben Ioynde togedire, & of þe weffynge of þo tweyne þere is y-mad an hard pannycle þat is to sigge a cloth þat is vndir þe brayn panne, and he is hongyde wiþ sum smale ligamentys to þe brayn panne in some of þe semys, þe whych pannycle byndeþ þe bonys togedire, & it is clepyde dura mater. And yt is ryȝtful þat an Arterye scholde arysen vpwarde from byneþyne, for þe blod þat ys in hym þat is sotyll, & hys meffynge þat ys pulsatyff [MS. prilsatyff.] ; and he hadde discendyde from aboue dunwarde, he scholde han discendyde wiþ to gret [folio 71a] an hastynesse, but þe ascendynge temprith þulke fflux. And yt is couenable þat þe veyne discende, bycause þat þe blod þat ys in þe veynes ys more þykkore, & þe blod þat is in þe veyne geþ doun softliche. & boþe þese veynes þat buþ [buþ, above line.] pulsatyf & nouȝt pulsatyf beþ y-Ioynede wiþ dura matre. And also þowȝ þe veyne streche more lowere, & of hem ys engendryde pia mater. Afterward þey descenden doun to þe brayn. & þey bryngen lyf & dywe norysschynge & cordyal spirites, þe whiche is in þe brayn and þere is diffyede, & þere resseyueþ naturel forme of vnderstondynge. Pia mater environeþ al þe brayn, & departyth hym into þe þre celoles [MS. cololes.] þat beþ chaumbres:

þe firste, þe myddle, & þe laste. And þowȝ þat alle þese ben diffyede senglerlyche by hem selffyn, yt semeþ þat þe celele þat is tofore in þe brayn ys departyde in two parties, & by þat cause sum men siggen, þat þere ben foure ventricles of þe brayn. Þe furþere part of þe brayn ys gret & brod, by cause þat he scholde resseyue manye spirites þat ben y-sende to hym for þat place is propre instrement of y-maginacion, þe whiche resceyueþ þynges þat buþ comprehendide of fantasie; and þo þynges comen vndirstondynge resceyueþ by propre Instrementys þat longyth to hym, and þawȝ þat al þe brayn, in comparson of þe herte & of alle oþere membres of þe body, be y-demyde colde & moist, þis celule hauynge comparson to oþere celules ys y-demyde hot & dryȝe. Þe myddel part of þe brayn ys lasse þen eny of þe oþere two partyes, & here forme ys pyneat, brod towarde þe furþere syde of þe hed and scharpere towarde þe hyndor syde, þat he myȝte be þe more able to resceyue y-maginatyf þynges & þo þynges to ȝefe to þe ynnere partye & þo þynges þat beþ y-ȝefe to with holde. Þis ventricle ys y-sette bytwene tweyne additamentes of þe brayn, þe whiche additamentes ben y-liche þe two buttokkes of a man þat beþ y-Ioynede togedre, and þey beþ to *þis ventricle as yt were a syttynge place

oþere a couche, vpon . þe whyche he ys drawyne abrode, whenne þat he resseyueþ [folio 71b] y-maginatyff þynges. And afterwarde he ys y-drawe togedire as a worme, whenne þat he resceyueth y-maginatyff þynges; and whenne þat þe sentence of þilke y-magynacioun ys y-brought forth, þenne þilke ventricle ys y-drawe alonge. And also þe smallere ende of þis ventricle entrith into þe ventricle þat ys behynde in þe hed, and þis ventricle ys myche lasse þenne þe oþere tweyne bycause þat non synwes procedent not out of hym, and þat manye þynges myghte be endyde in litel* place, þat vertue of wytt myghte þe sonnere be y-gedryde togedre to taken hys counseyll. And thys ventrycle to comparson of oþere ventricles ys y-demyde hot & drye. After þat ys þe hyndere ventricle, whiche ys grattere & hardere þenne thys; þe whiche in *comparson of þe oþere tweyne ys y-demyde colde & drye, þe whiche is brod towarde þe fore partye of þe hed & scharpe bachwarde, þe whyche resseyuyth sentense þat beþ schewyde & kepyth hem priuyliche as a chest kepyth tresore. And out of hym goth out [in þe a, struck through after goth out.] nucha [nucha on margin.] þrowe þe hole of þe bon þat ys y-clepyde passilarys. And þilke nucha ys y-clothyde [MS. ys y-clothyde twice.] wiþ tweye pannycles þat goth out of þe brayn. And alle þe brayn ys y-demyde colde & moyst. bycause þat he scholde

atempren spirituel ffumosites þat comyth of þe herte, and þat he scholde noȝte ben y-dreyȝede fforto myche meffynge þat he haþ in worchynge of vertues. And þe brayn is whit bycause þat scholde resceyue þe bettere resoun & vnderstondynge. Ffor þese peyntores, whenne þey schulle peynten a table, firste þey maken yt whyte, for þere nylle none coloure lasten but yt be leyde vpon whyt; & it is þenne oþere rare, because þat vndirstondynge myȝte þe sonnere passe þorwe hym; & yt is nessche þat þe meffynges off vertues myghte þe betyre habbe place; & þe brayn ys towȝ, þat þe synwes þat goth out of hym, myȝte be þe [folio 72a] more towȝere, and þe more þat þey ben enlongyde from here bygynninge, þe more hardere þey scholde be; and also that þey scholde be bowable y-nowȝ nought aȝeynestondynge here hardnesse. And yt is necessarye þat þe brayn scholde be cloþed with tweye clothys, þat in hys meffynge as *y haue seyde tofore he scholde nought ben y-hurt of þe brayn panne.

Also þe brayn ys departyde into þre celules with þe additamentes of þe pannycles of pie [MS. pie, twice.] matris, þat þe spirites myȝt þe lengore dwellen in þe ventricles, to reseyfen by ordre, digestioun, forme & perfeccion, more þanne þey hadden fyrst of þe hert, and þat euery vertue myghte fulfylle hys accioun in hys ventrycle, ere

þanne þe foys þat ys comprehendyde myghte passe to þe ventricle þat ys sywynge. Nowȝt aȝeynestondynge þese propretes, þe brayn haþ sum substaunce of marie whiche fulfilleþ þe voydenesses of þe forseyde pannycleres. And þilke marye envyrownyth þe foreseyde pannycles, of þe whyche marye þere may sum partye in þe hurtynge of þe hed ben y-lost; and noȝt ageynestondynge þe goynge out of sum partye of þilke marye, a man schal noȝt deye. Ffor þis marye is nought of þe substaunce of þe ventricles of þe brayn, of whiche mynde ys y-mad; ffor þey ben of so grete noblete, ȝif þere be neuere so litel infectioun oþere ellys þat þere falle neuere so lytel a lesynge of hem, þey ben depreffyde of alle here helthe, in so myche þat on celele may noȝt ben y-lost, and a man ben saffyde, as manye ydyotes supposen. Anothomye of eynen, neose, erne, chekelappes, mouþ, tonge & teþ, we deferren to ordeynen in þe þridde tretys, in þe distyncioun whiche ȝif god wol, we þynkeþ forto treten of oþere syknesse of þe lymes, outsepte woundes. And þo hurtynges þat beþ y-mad in þe hed, oþere þey ben mad withouten wounde, oþere with wounde. & wheþere þat it be wyth wounde oþere wiþouten wounde, oþere þey ben with brekynge of þe brayn panne, oþere

without brekynge of þe breyn panne. And wheþer [folio 72b] þat yt be mad wiþ þe breche of þe brayn panne oþere withouten breche of þe breyn panne, some ben with hurtynge of þe brayn, some without hurtynge of þe brayn. And ryȝte as þilke hurtynges habben dyfference in toknes, so þey hauen differens in pereles & pronosticaciouns & maners, with þe whiche þey most ben y-holpen. And ȝif an hurt be in þe hed withouten wounde, as with fallynge, oþere with smytinge of a ston, oþere a staff, oþere with sum oþere thynge þat brusyth, and ȝif þat yt be withouten breche of þe brayn panne, & with outen hurtynge of þe brayn panne, it nedyth nouȝt but schaffynge of þe hed, & anoyntynge wiþ hote oyle of roses, and abofen þe vncture* to strawyn on þe poudre of þe seed of myrtylles, & streyne þe place with a band tyl al þe place be y-fastnyde & þe swellynge be y-vanschyd aweye. In þis manere þou schalt fastne al þe place, þat noþyng schal be corumped, oþere ellys þere schall dwelle a lytel corupcioun. And ȝif enye þynge of corumpcion abyde, þe place schal ben y-opnyde with an Instrument, & so alle þe quyter schal be excludyd, & he schal ben y-curyd ryȝt as oþere empostemys þat beþ y-woundyde. And ȝif þat þe brayn panne were y-broke withoute enye wounde of þe hed, þe whiche may ben y-knowe by dysposicioun of þe cause & eke of þe syke man, in byholdynge ȝif þat þat smyt

were stronge, oþere ellys þat þe syke haue y-fallen from hye place, oþere ellys þat he was y-smyte with stronge smytynge; and also ȝif þat he fel & myght nought hastlye aryse, and ȝif þat he hadde scotomye: þat ys to sugge a manere seknesse, whenne þat þere semyth as flyeȝes, oþere smale blake gnattys vleyȝen tofore hys eyȝen, oþere ellys he spyweþ hys mete, oþere he felyth to grete akþe in hys hed, and ȝif þat he may nought breken a knotte of a strawȝ with hys teth, and ȝif þe hed be smyten with a lyȝt dreyȝe staff, as of salwe oþere ellys pyne, and þenne leye þyn [folio 73a] ere to hys hed; & ȝif þat þe bon be hol. þou schalt heren an hol soun after þe comparsoun of þe soun of an hol belle & a bloke belle; also ȝif þat þou makyste þe syke man to holde bytwene hys teþ a þrede y-twyned & y-waxed, & þenne begynne to harpen with þy naylles vpon þe þrede faste be þe seke mannes mouth, & so harpe with þyne naylles vpon þe þred alle wey streyned, in makynge soun to þe ende of þe þred, & þilke þred schal ben of lengþe from þe mouth be þe space of a Kubyte; and þou schalt harpe so ofte tymes, & ȝif þat þe pacient mowe susteyne þe soun, he haþ noȝt hys brayn panne y-broke; ffor ȝif hys breyn panne were broke, þe seke man myghte nought susteyne þe soun of þe þred. Alle þese signes oþere ellis manye of hem betokne þat þe breyn panne is broken. And to þe

laste signes beþ more serteyne þenne enye of þe oþere. And vnderstonde þat þe breyn panne may ofte tymes ben to-broke, & naþeles þe brayn felyth nought in þe bygynninge none hurtynge. But afterwardys ofte tyme of hurtynge of þe brayn panne þe brayn ys y-hurt, Galien wytnessynge; the brekynge of þe bonys of þe hed ys dyuers in perelys from brekyng of oþer bonys of þe body, for þe accidentes whiche þat fallyth ofte tymes to þe breche of þe brayn panne. Ne þere nys no man, ne neuere ne was, þat myȝte euyre more helpen to alle accidentes whenne þat þe brayn was meffyde in þe bygynninge, þat nouȝt ageynestondynge his helpe, be he neuere so gode a leche, þat þe syke ne moste deye. Euyle accidentes whiche þat *comyth to þe accidentes of þe brayn & of hys pannycle, ben alwey dwellynge: as constipacioun of þe wombe, oþere ellys flux of þe wombe, oþere ellys crokydnesse, oþere ellys lokynge a-squynte of þe eyȝen, oþere ellys wepynge of þat on eyȝe, oþere ellys an hard scotomye, oþere ellys ffebylnesse of alle þe vertues & chaungynge. And noȝt only anymal vertues, þat beþ vertewys of þe brayn, beþ noȝt y-chaungyde, but also naturell vertewys, & lyfy vertewys sensyble & motifes; sensible, for þat þey seen noȝt

also [folio 73b] priuye vertues ben y-trublyde as ymagenatyff, ffor þey beleffe þat þey seen, *þat þey seen nouȝt; also resonable vertue, for þey speken in deveyn, & þey answeren whanne þey beþ nouȝt y-askyde; also memoryal, þat þey þynke nouȝt on here owne name; also meffable vertue ys so myche y-greuyde, þat vnneþe þey mowe nouȝt mefen hem namlyche aboute þe nekke. Þey syken greuouslye, and a scharpe ffeuere fallyth, þe whiche a rigoor goth tofore. A rigoor nys nothynge ellys but as yt were a prikynge of nedlys oþere of nettlys in þe flesch, and ȝif þis rigoor come with a ffeuyre oþere ellys with outen ffeuyre, yt is worst signe, and ȝif the crampe folwen, yt ys dedlye. Also þese beþ yuele accidentes: blaknesse of þe tonge, bleynesse [bleynesse, leady colour. See N. E. Dict. s. v. bley; mistake for bleynes, blains.] aboute þe chyn oþere þe chekenesse, oþere in enye oþere partye of þe hed þenne in* þe wounde, ys an yuele signe, and sum tyme blod comyth out at þe erys & noseþrylles. And ȝif þe more partye of þese toknys, oþere ellys alle comen, þe syke man moste nedys deyȝen, namlye & þo Accidentes contynewen, and specialy ȝif þat þe syke man haue y-be tofore manye daies in gode disposicioun, & after þilke disposicioun þese yuele accidentes fallen;

ryȝtfullyche, for boþe herynge & oþere comyn wyttes ben y-trublyde; but sumtyme in þe bygynninge euyle accidentes comyth, afterwarde, by good gouernayle & by gode helpe of the leche, þese euyle accidentes ben departyde & good comyth, & þenne yt is a good* signe, for it betoknyth strengþe off kynde, hauynge non drede of þe syknesse & konyngnesse of þe leche. O holy gost, al thynge fulfyllynge, al þinge sanctifyinge, lytnynge & gouernynge, opyne þe eyȝen of hem þat redyn in thys booke, þat þey mowen vndirstonde þat þynge þat is wel seyde, & þat þey mowe demen þorwe þy clernesse þat þat [MS. at.] ys euyle seyde, specyaliche in pas where þat only nouȝte y þat am vnwys & vnkunnynge, but also grettere maistryes & more kunnynge han y-writen dotousliche. & haþ y-sett in þis cas [folio 74a] dyuerse vnderstondynges. Ne þey ne y ne fonde non wey in þis [Heading of the page: Cure of symple Wounde off þe hed.] werke þat myȝte maken vs sykere, specialiche in grefynges of þe breyne panne, in whose cure dyuerse men han wrought dyuerslye; y wyll begynne at a symple wounde of þe flesch & of þe hed, in þe whiche þat þere ys non hurtynge of þe brayn ne of þe brayn panne. Byholde whar þilke wounde be mad with a swerde oþere enye þynge semblable to hit, & þan sowen þylke wounde, & caste abofen þe

poudre of lym tofore seyd, and do alle þynge be ordre as yt is conteynede aboue in þe chapitell off wounde of þe flesch; and ȝif þat a wounde be mad in þe hed with a brusynge, as with a mace oþere a staf, oþer with enye þynge þat brusyth, þanne it is necessarie to leggen abofe þe brusynge a maturatyf, y-mad of foure partyes of water, & on partye of comyn oyle & floure of whete, þat suffiseþ to maken yt þikke, tyl þat þe matere þat is brusyde be matured; þe whiche maturatyff schal be do abrode on a cloþ & y-leyde to þe wonde, & þou schalt fulfille þe wounde with oyle of roses & þe ȝolke of an neyȝe, [neyȝe at the beginning of a line.] & lenet of an olde lynne clout y-medlyde to gedre, tyl þat þe wounde ȝif quyter & þe akþe be aswagede. & afterwarde leye in þe wounde dreye lynet of lynne cloth, & fille þe wounde full of þe same lynet, & leye aboue þe mundificatyff of mel rosat & barlye mele, tyl þat he be perfitlye clansyde, & leye aboute þe wounde fro þe begynnynge, tyl þat þe wonde be perfitlie clansyde, a defensyf of bol armonyak, þe whiche y haue tolde of ofte tymes; afterward incarne hit—þat is to sigge, brynge ouere flesch, & afterwarde consoude yt; and ȝif þat þis wounde touchith þe pannycle þat bynde þe bonys togedre, þowȝ þat þe bon be nouȝt to-broken,

charge yt noȝt litel but take þere of gode hede, & do in þe wounde hot oyle of roses don to þe pannycle, tyl þat þere be non akþe in þe wounde. & kepe þilke wounde, as þou woldiste kepen oþer wondys of þe brayn panne & of þe brayn, fro colde & from hete; ffor colde ys most greuest to bonys & to pannycles þat beþ woundyde. [folio 74b] Þere ben some manere of men þat leggen withouten forth on alle manere wondys of þe hed, wheþere it be wiþ wounde of þe brayn panne oþere without wounde of þe brayn panne, in what manere þat þe hed ben y-hurt, a lynnen cloth y-wett in þe oignement y-made in þis manere: ℞ whit resine [pound]. [one half]., oyle of roses [dram] v., whyt wex [dram] iij., þey melten all togedres in an erthyne panne, & þey maken þere of on body, & þey boyllen yt afterward in gode wyn by þe space of an Oure; & þey leten afterwarde nyȝh colden, & þey weten þere ynne a pece of lynnen cloth, & þey schapen þilke pece with a schere aftere þe wounde ys, & þey baþen þylke pece in gode wyn, & þey leggen þilke pece on þe wounde,* and anon afterwarde þey leggen on þilke pece on eiþere syde of þe wounde a plumacyole, y-wet in good hote wyn, & þey leggen on a drye pylwe of herdes vpon þo tweye wete pylwes, þe whiche dreye pylwe schall comprehende þe tweye wete & bynden hem faste; and þey ȝeuen some men to drynken gode

wyn, & to eten gode fflessch of capouns & of hennys; & þey comaunden to drynken a drope watere; and þey gouernen on þis manere alle men þat ben woundyde in þe hed differentlyche, & þey sigge þat mo [MS. no.] men ben y-helyde by þis manere cure þen dyȝen. But by as myche as alle auttorys beþ aȝeyns þis cure, namlyche in dyetynge, y ne was neuere hardye to preuen þis manere of cure; ffor in mannys bodye a medycine schal nouȝt ben preuyde, whiche þat is noȝt acordynge to resoun; ffor alle auctores acorden, þat þere ys noþynge þat so sone greuyth þe brayn & þe synwes as wyn doþ, and vsynge of flesch ys cause of bryngynge in an hot Emposteme. Neuere þe latere ȝif a man þat vsith of custome swyche a manere dyetynge haffe a stronge hed, & in hys hele he dredyth non wyn, & þe vertue of hym þat ys seek [folio 75a] be stronge, in some manere of folk with þis manere of gouernaylle vertue ys more y-streynþed, & sunnere þey ben y-helyde. But y ne procede nouȝt wiþ swyche a manere dyetynge, by cause of drede leste an hote empostome scholde come to þe sore; but y procede in dyetynge & worche aboute þe wounde, as y haue seyde toforn. Oþere men loken* in brekynges of þe brayn panne, wheþer þat þe brekynge of þe breyne panne be with a gret wounde oþere a smal wounde, oþere without wounde; and ȝif

þat þere ben a gret wounde þey loken wheþere þey mowe seen ȝif enye pece of þe brayn panne ben to-broken, & þey don yt awey. And afterwarde þey putten bytwene þe brayn panne & duram matrem a þenne clout y-wett in þe whyte of an eyȝe, & sumwhat þe whyte compressyde out, & þey fulfyllen alle þe wounde of þe brayn panne with swiche a manere cloth. & þey leggen in þe ofere wounde whiche þat ys in þe flesch, lenyt y-wett in þe whyte of an eyȝe, tyl þat þe blode be staunchyde; & þey leggen aboue a plumacyole y-wet in an eyȝe. And whanne þat þe blode ys y-staunchyde, þey leggen a dreye cloth vndire þe brayn panne in þe wounde, and þey leggen aboue þe wounde a potage, the whiche engendryth quytere; & whenne þat þe quyter ys engendryde, þey leggen in þe wounde carp oþere lyneth of a clout; and þey anoynt [At the end of the line.] aboute þe wounde with oygnement fusco; and at þe laste ende þey leggen aboue Apostolicon. And þey assayen in þis manere: ȝif þat þe brekynge of þe brayn panne be with a rimele, þat ys to seye a chyne, oþere a creueys; & ȝif þat þilke creveys perse to wiþynne, makynge þe syke man to streynen hys mouþ & hys nese, & þey

maken hym þenne to blowen, & þey loken ȝif enye þynge exale out by þilke rymele. *& ȝif þat enye þynge exale out by þylke rymele, as blod ore enye oþere matere, þey drede noȝt to perce þilke rymele; and þenne some sigge þat þilke rymele scholde be to-broke oþere y-perced. from þat one ende to þat oþere with Rynspyndles, persynge þe braynscolle. [folio 75b] A rynspyndell ys an Instrument þat Cutlers poudren wiþ here hefftes, whose ffigure schal be schappyde [MS. scharpyde. rp for pp, like lk for kk. See p. 120.] in þe same chapitle ffolwynge. And þe worste þynge þat a man may do, ys to perce þe rymele on boþe sydes. But oþere men don bettyre whiche þat percen þe rymele at þat one ende, whyche is moste hongynge; and þey maken as many holys on bysyde an oþere, as beþ necessarie to maken an hole in þe brayn panne, be þe whiche hole ȝif enye þynge beþ [þ above line.] fallen vpon þe duram matrem myȝte ben y-clansyde; & þese in as myche as towchynge trepanacioun worchith best. And whenne þat þey haue made manye holys, þey kutten from on hole to an oþere with an spatymyne, [Lat.: cum spatumine.] þat ys an Instrument, þat þey mowe drawyne out þe bon, þat ys betwene þe ordre of holys þat was y-made & þe rymele, & þey casten hym aweye, afterwarde

þey proceden forth in oþere manere thynges, as yt is seyde tofore. And whenne þat þou desiriste þe wey of trepanynge, *þis manere trepanynge suffiseþ to þe in þe rimeles of þe brayn panne. Þis schal ben þe forme of a trepane, *with þe whiche þe brayn scolle schal be trepaned wiþ

[figure]

. And þis is þe forme off a spatimene, with þe whiche a man schal kutte with from on hole to an oþere hole

[figure]

. And þou schalt smyten with a Mal oþere an hamere vpon þe gret ende; and whenne þou haste remefed of þe bon þat schal be remeffyde, euene þe brynkes wiþ schauynge, þat þere mowe noȝt lefe non manere scharpnesse in þe brynkes. Þis ys þe manere of þy schafe

[figure]

, and þis schafe schal kutten on þe syde þat feldyth inwarde, & schal be blunt on þe syde þat ys outwarde. And þenne fulfyllen þe wounde þat is in þe flesch, wiþoutforþ as y haue seyde tofore, with cloþ expressyde of þe whyte of an eyȝe, & lynet to þat þe wounde be ful, and also tyl þat þe kynde haue regeneryd a repeyrement, þe whiche schal fulfylle þe place where þat þe bon was don awey. [folio 76a] Afterwarde þey cure þe wounde aftere comyn cure of wondys. Alle oþere manere of trepanacioun ys comprehendyde vndire on Somme, þowȝ þat sum men ordeynen partyklerliche aftere here devyse, dyuerse maners. But be as myche as y haue noȝt seyne in þis place no wey þat myȝte remefe

me fro doute, by as myche as y haue assayede longe tyme boþe by sum auctores experyment, & also by myn experyment, & þat wey is noȝt certeyn, þerefore here þey Galien, whiche þat seith: ȝif we mowe romywe quyter without doynge awey bonys þat scholde be do awey, hyt is good. And Auisene & Serapio acorden to þe same sentense of cure of hed-akþe, þat comyth off smytinge oþere ellys of fallynge, where þat he techith þe worchynge of hurtynges of þe brayn panne & of þe brayn, noȝt by trepanacioun, but by emplastres & by medycines. And also y toke gode hede þat manye mo men ben y-helyde by manere medycines & emplastres, þenne ben y-helyde by trepanes þat beþ persynge oþere þryllynge. Ffor y ne vse noȝt Instrumentes to remywe þe bon, but in tweye cases—þat on cas ys ȝif þat þe breyn panne be so myche y-scleud, þat þe part þat ys y-broke entre vndire þe partye þat ys hol, þe secunde cas ys ȝif þat enye pece be departyde from þe brayn panne, whyche þat pryketh duram matrem. In þe firste cas dura mater ys compressede. In þe secunde cas dura mater ys y-prikyde, þe whiche ys cause of akþe, & akynge ys cause of drawynge of humoures, the whiche engendrith a posteme vpon þe same pannycle, the whiche is cause of a [a, above line.] crampe, & of oþere accidentes tofore seyde, & at þe laste þey bryngen deþ

to þe pacient. In þese tweye causes y am constreynde to remefe a bon with handly Instrumentes. In alle oþere manere of breches oþere of crefeys, in what manere þat þey happen, þowȝ þat y be noȝt sykere of þe paciente, naþeles y procede in þis manere with more trest, by sechynge alweye help of god, þe whyche þat haþ y-helyde mo men [MS. m, en cut away.] be myn handys, þat am hys Instrument, þenne han be ded, nouȝt aȝeynestondynge al my cauteles & [folio 76b] helpynge. Ffor sytthe þat y haf beholde sotelyche þe resouns & þe processes of oþere auctorys, y holde þis wey lesse dredful þenne enye oþere. Ffor y folwe þe sentence of galien, which þat seiþ: ȝif þat a man hath but o wey to hys hele, hyt ys gode þat he holde þilke weye, þowȝ þat þilke wey be euell. And whenne þat y come to a Man þat is woundyde in the hed, & knowe þat hys breyn panne ys to-broke, by þe tokenys tofore seyde, ffirste y considere þe vertu of hym þat ys pacient, & also hys age & alle oþer [oþer, above line.] partyclere thynge, & namly vertue. And gladliche y leue þe cure, ȝif þat y se enye dedlye signes; but ȝif þat so be þat y be preyde wiþ the grettere Instaunce of þe frendes of þe seke man. And noȝt aȝeynestondynge here preyere, y telle hys frendys þat by resoun þe pacient scholde

deyȝe, & þenne y wirche aboute hym, as y worche in a Man in whom yuel accidentes apere. And ȝif þat þe signes be nought dedlyche, & þe breche of þe breyn panne be with a gret wounde of þe hed, & þat a grete partye of þe breyn panne be don aweye alle togedre, so þat y mowe han a gode wey to legge medycynes vpon duram matrem. ffirste y do schaffe hys hed, afterwarde y legge an olde lynnen clout & a þenne, y-wett in two partyes of oyle of rosys swote smellynge, & on partye of mel rosat colat bytwene þe duram matrem and þe brayn panne, slyȝlye & softlye, þat dura mater be noȝt compressyde with þe cloth þat ys y-wett tofore seyde, & y fulfille þe wounde of þe fflesch with lynt of olde lynnen cloþ wet in þe ȝolke of an eyȝe & oyle of roses, of boþe y-lyche myche; & y anoynte aboute þe wounde with deffensyfe of bol armonyak ofte tymes seyde, & y legge abouen þe wounde a plumacyole whiche þat schal keuere alle þe wounde, and þenne [folio 77a] abouen alle togedre y legge a grete plumacyole in-wet in gode hot wyn. And afterewarde y bynde þe wounde with a bande, in byndynge ofte tymes aboute þe hed, þat þe lynet & þe cloþ whyche þat is in þe wounde & aboute þe wounde myȝte noȝt slyde to non partye, and y bynde þe wounde in þat manere þat dura mater be no weye be compressyde. Þe

herys of þe hed schul be remywede awey on þis manere: clippe hem firste with scherys, afterwarde take two partyes of colde water & on partye of oyle of roses in somere, & make hot þe same watyr & þe oyle in wyntere & wassche þe hed softliche, takynge hede þat non watere ne oyle entre into þe wounde, & þenne schaffe yt with a rasoure. & whenne þat y haue seruyde þe pacient on þis manere, y lete hym resten tyl on þe morwe; and afterwarde y serfe þe wounde on þe same manere tyl þat þe wounde be hol. Naþeles y consydere ȝif þat þe pacient be replet of blod, & hys vertue be stronge; & ȝif þat he be ȝonge, & lytel blod haue nouȝt go out of hys wounde, & whanne alle þese þynges acorde, y make hym to by leten blod on þe coral veyne of þe arme; & but ȝif he mowe schiten, y helpe hym onys a day, oþere wiþ suppositorye oþere wiþ clisterye; and y procede in dyetynge as y haue seyde in þe chapytell of dyetynge. And whenne makyth sufesentlyche quyter, y legge in þe wounde of þe brayn panne & vpon þe brayn panne as y haue don toforn, & above þe wounde y legge a mundyficatyff of mel rosat colat & barlye mele, tyl þat þe wounde ben y-clansyde, & þat þe dura mater be y-soudyde wiþ þe breyn panne; & þenne y caste in þe wounde of þe hed, poudre y-mad on þis manere: ℞ ffrank Ensence, ciperi, þe

note of cypresse, sede of mirtylles, mirre ana. ȝ. i., oreby. ȝ. j., mak poudre & leye þis poudre in þe wounde, & aboue þe poudre leye þe þredys of lynne cloþ oþere ellys lynet; and aboffe al togedire y-legge an entrete [folio 77b] y-made of two partyes of whyte resyn & on party of wex y-molten togedre, & vpon stronge Vynegre, & y-colyd þorwe a þenne streynoure vpon [MS. o pound.] colde water; & whenne þat þyne hondys ben anoyntede with oyle of roses, & malaxe yt longe tyme togedyre. In somere take euene porcioun of whyt resyn & of wex; in wyntere take foure partyes of —* & þe ffifte partye of wex, & y-drawe abrode þilke tret on a cloþ & legge yt.on þe wounde, tyl þat he be perffitliche cycatrysede. And ȝif þat þere were anye —* of a bon. whiche þat prekyde duram matrem, þenne y aforce me to remeffe þilke partye þat prykeþ with pynsones ȝif y may. And ȝif þilke partye þat prikeþ ys y-ioynede so faste to þe hol bon þat he nyl nouȝt be remeffyd awey, þenne y remeffe hym aweye wiþ rugenynge. from þe partye þat halt, in makynge an hole, oþere two, oþere mo, after þe quantyte of þe bon þat scholde be don awey,* þat halt with þe hole bon; & afterwarde y kutte with a spatymene from on hole

to anoþere tyl al þe bon be remeffyde aweye.* And whenne þe bon ys remefyde awey, y procede in þe cure, as yt is seyde in þis same chapytell. But whanne þat y remeffe a bon with Instrumentes of þe brayn panne, þenne y stoppe þe syke mannys eres, þat he mowe noȝt here þe sonn of þe eyren þat trepanyth. And y remeffe þe same manere, þe partye þat is broke, whiche þat goþ vndire þe partye þat ys hol, & compressyth þe dura mater; and ȝif þat a gobbet oþere a pece of a bon helde sumwhat in þe wounde, & myȝte noȝt lyȝtlye be remeffyde awey, and he prikyde nouȝt ne compressyde nouȝt duram matrem, þenne at þe bygynninge y do on þe bon hot oyle of rosys, and y fulfylle þe wounde with oyle of roses & þe ȝolke of an eyȝe y-medled togedire, tyl þat þe bon be y-nesschyde, and mowe lyȝtlyche be remywede aweye; þenne y remeffe þe bon, & y procede in worchynge bytwene þe bon & duram matrem, as it is seyde tofore. & ȝif þat þe breche of þe breyn panne [folio 78a] were as a cerfes, oþere ellys y-sclend, & neiþere party of þe bon were lowere þenne oþere, þen y consydere ȝif þilke sclendynge parten alle þe breyn panne, & þat þou schalt y-knowe by þe toknys tofore seyde, oþere ellys þou schalt y-knowe by þis signe þat neuere faileþ: make a plastre of þe poudre of mastyk & þe

whyte of an eyȝe, y-medlyde togedyre as þykke as hony, & distende it on a cloþ, & leye it on þe place þat ys hurt from morwe tyl euene, oþere ellys from euene tyl þe morwe. And whenne þat þe plastre ys remefyd awey, ȝif þat þe crefeys persith þorwe þe breyn panne, þou schalt se þe plastre more drye anonde [Over an erasure.] þe crefeys þen in enye oþer place, for þe gret hete þat comyth from þe brayn;* & ȝif þe breyn panne* be noȝt y-sclend þorwe, þe plastre schal be namore rye abouen þe creffeys þenne on an oþere place. And ȝif þe crefeysd perse nouȝt þe brayn scolle, þe cure is as yt is seyde in þe bygynnynge of þis chapytell, þere as y tolde of þe cure of wounde of hed, where þat þe breyn panne oþere þe brayn ys noȝt y-hurt. Ffor ȝif þat þilke ryemele persyth þe breyn panne, þere ys a gret doute in þe cas, ffor some seyne þat yt ys vnpossible swyche a wounde to ben y-helyde, but ȝif þe rymele be y-trepanyd & þat a quantyte of þe bon be y-don awey, þat þe superfluyte þat ys y-caste vpon duram matrem mowe be done awey, ellys þe dura mater scholde putrefien & be corupt, & by þat skylle þe pacient scholde deye, whiche þat myȝte be helyde by remywynge of þe bon. Naþeles y þat haue y-seye in trepanynge grete peryle, namlyche whanne þat

þe crefeys ys bysyde þe semys, where þat trepanynge ys dedlyche, and y haue seye manye þat wiþouten trepanynge almyȝtie god haþ delyuerede be myn handys, without touchynge enye brayn scolle with trepane oþere with eyren; but y helde into þe crefeys hote oyle of roses, and y legge aboue cloþes y-wett in mel rosat colat, & oyle rosat colat y-medlyde togedyre aftere þe doctryne tofore seyd, ffulfyllinge all þe [folio 78b] wounde wiþ swyche manere clothys, & afterwarde y legge aboue þe ȝolke of an eyȝe & oyle of roses y-medlyde togedres, and aboue þe wounde a defensiff of bol armonyac tofore seyd, tyl þat þe quyter be engendryd. & afterwarde y contynwe mel roses & oyle rosarum in þe wounde, & aboffe a mundificatyf of mel rosarum & barly mele, tyl þat þe ligament be fulliche engendrede on þe breyn panne, & þat þou schalt y-knowe whenne þat þou seste þe bonys Ioynyde togedre, as yt were tweye bordys Ioynede to gedre wiþ colle oþere wiþ glewȝ; & þenne y fulfylle þe wounde with drye þredys of lynnen cloþ, and abouen a mundificatyf tyl þat þe bon be keffride aboue. & þenne y strawe on aboue þe capytale poudre tofore seyde, & y legge on þe schaffynge oþere ellys þe rasure of lynnen cloþ, and abouen al þis y legge on a Tret of resyne; & y do alle þynges þat y haue seyde tofore tyl þe wounde be consouded.

And ȝif me maken an obiectioun how þat yt myȝte withouten arerynge of þe bon, þe blod & þe quyter be dreyede whiche þat fel doun by þilke sclendynge vpon þe duram matrem, I answere: ryȝte as þe matere of þe frenesie & þe matere of þe litargie þat is more doutes, by emplastres withouten forth leyd is desolfed, and þere nys none sclyndynge of þe breyn panne ne no wounde in þe skyn, myche more lyȝtlokere & more bettere þe blod þat is lyȝt & able to ben reselfyde, whiche þat wende done be þe forseyde sclendynge, may be þe forseyde sclendynge beter ben exaled. Ne þilke blod ys noȝt inviscat in þe substaunce of dure matris as þe matere ys in apostemys, wherfore he ys more obeyssaunt to* þe expulcioun of kynde, & also ys more obeyssaunt to the attractioun of medycine. And ȝif þe brayn panne be hurte wiþout wounde of þe skyn, þe whiche þou schalt y-knowen by þe toknys tofore seyde, þenne sum men kutten aboue þe hurtyng in þe manere of a cros, & þey areryn þe foure quarters, & þey kytten & flen þe pannycle þat keferith þe bonys, & afterwardes þey vsen trepanys & here oþere comyn cures, as [folio 79a] yt ys schewyde tofore. But y kytte noȝt þe skyn in manere of a cros, but in þe manere of a Schelde oþere ellys of a thynge þat ys tryangle in þis manere

[figure]

, & y make but on quartere & y vnwreye þe bon, þat þe oyle of roses may persen yn,

and þat þe vertue of þe medycine, þat ys y-mad of honye of roses & oyle of roses, may drawe fro byneþe þe brayn-panne; and y do in þis cas al þynge, as yt declarith nexte aboffe. And ȝif men make obiectioun aȝeyns me by constantine oþere ellys by hym, þat seyth þat by alle oure myght we enchewyn þat neþere oyle ne non vncomys [Corrupt, probably for vnctouys.] þynge falle noȝt withynne þe brayn-panne, I answere with Avecene, þat seyth: þat he wircheþ ryȝtfulliche þat vsith certeyne oyles, & þe same telliþ galien & serapion, and also y seye þat oyle of roses, whiche þat be mad of grapes of Olyue tres þat beþ noȝt ripe, is noȝt vnctuose, but is dreyȝe; & it is clepyde oyle Omfacinum, & namlye whanne þat roses ben y-medlyde with þat oyle, þilke oyle hath y-gete to hym a swete smellynge & a dreyȝinge, cumffortynge animal spirites; and also þilke oyle hath a vertue expressif, as galien tellyth in the bok of symple medycines, by þe whyche þe brayn ys conffortyde & akþes ben aswagede, & ȝif þere be mad enye gret blod, yt is y-made Sotyll; & whenne alle þese þynges ben y-gadryde togedyre & leyde abouen, dura mater ys clansed. Sumtyme þe brayn ys meffyde of sum gret hurt oþere of sum fallynge, oþere of sum smytynge withouten eny wounde ore enye

breche of eny bon, þan do þou as dyde y to a Chanoun of þe ordre of seint Austyn. Whanne þat he wolde haue lopyn vpon an hye hors and haue seten in þe sadyll, þe hors areryde vpon hys two [folio 79b] hyndere fete, & þilke chanoun fel doun bakwarde vpon þe erthe on hys hed; & alle hys bodye was y-brusyde, and namlye aboute þe hed þat anon he lost þe ffelynge & þe meffynge of alle his bodye. Þanne a lewyde leche þat was frende to þilke Chanoun was y-clepyde, & he couþe helpe hym noȝt, for he had neuere seyne þe same cas, ne he ne couþe noȝt on lettre. And at þe laste y was clepte, & y fonde hym noȝt herynge ne spekynge ne nothynge mevynge, I demyde hym for ded, and naþeles sauyde, ȝif þat he were my broþere y nolde nouȝt for an hundrede mark, but y sayede in hym þe godnesse & þe helpynge of medycines; ffor ofte tymes kynde with gode werkys helpith preueliche þat semyth vnpossible to a leche. And þenne þey preyede me with gret Instaunce, and y made the herys of hys hed to be schaffen and þenne y anoynt all þe hed with þre partye of oyle of roses, & on partye of vyneger hot y-medlyde togedyre, & y caste abouen þe poudre of mirtylles, and y leyde abouen a sotyll þenne cloth y-wet in þe same oyle & vynegre,

& aboue þat towȝ smale y-tosyde, & y bonde alle þe hed with a band, & abouen y leyde a lambys skyn, & so y chaungede yt twyes euerye day; in anoyntynge þe nolle & þe nekke into þe myddell of þe rygge-bon byhynde wiþ hote oyle of Camamylle. In þe secunde day he opnyde a lyte his eyȝen, & he bygan to loken aboute hym as it hadde be a deff man, oþere ellys a man þat were in a wondrynge; and þenne some wolden haue assayede ȝif þat he wolde eten, & y wolde nouȝt [folio 80a] Suffren hym to eten, & y seyde þowȝ þat he wolde eten he scholde noȝt. In þe þridde day y spak to hym, & he answerde me bablynge as a childe þat begynneþ to speke, but he myȝte formen non worde. [Lat.: verbum non potuit formare.] In þe fourþe day he spak bostynglyche, and þenne y gaf hym to drynke hot ydrosacre, þat ys y-mad of Sugre & of watyre. In þe ffyfte day he toke þikke [MS. þilke.] tysan. In þe sixe day y gaf hym þe broth off a chykne, & þenne he gan to strengþe litel & lytel & lytel, & lytel to meffen, & neuere þe latere he myȝte noȝt walkyn by manye dayes. And whanne þat he myȝte take Suffisauntlye mete, y comaundyde hym to take Pylulas Cochias, for to

resolfe by evacuacioun þe matere þat was y-gadrede togedire in þe hed by þilke fallynge. And y comaundyde hym to eten ofte þe braynes of briddys hedys, as of hennys & of smale bryddes, & also of kyddes; and in þis manere he was hol; naþeles he was neuyre so sotyl of wyt as he was tofore. In þis cas buþ yuele signes: as þe face to be crokyde, & þat on eyȝe to loken asquynt oþer crokydlyche, apoplexie, crampe, to schyte wiþout felynge, & vnmevablete of alle þe membris outsepte þe lacertes of þe brest þat mowe be saff. He þat redith þis bok may chesen after hys owne wyl, one of þre weyes whiche þat beþ now y-vsyde, þat on ys þe wey whiche þat ys seyde in þe bygynninge of þis chapitell, þe whiche weye many vsen, and a leche o Ianewe þat is y-clepyde Anselme vsith þis weye, & þereby he gat myche moneye, naþeles y wyste wel þat manye men dyȝeden in his handys by þis wey. Þe [folio 80b] secunde weye is in alle manere hurtynges of hed to vsen terebracioun, oþere ellys remeffynge of þe bon with handlyche Instrumentes; þe þridde ys my weye whiche þat y haue tolde opynlye in

alle manere of cas; and y beleue ȝif þat he wyl take hede to alle þese weyes, & þat he wyll wyslye dyscussen þe opyniouns of Auctores, þat he schal se fewere dyȝe be my þridde weye þenne by enye oþere. Almyȝtie god lede þe redere of þis werk in þe beste wey, þorwe whose myȝte, wordes takyth sentence & echyn vnderstondynge. Þowȝ þat we han behoten to treten of Anotamye of membres þat ben componed, in þe bygynninge of euery chapytell of this secunde tretys, naþeles we leuen yt for þe bettire for to treten of þe Anotamye of þe vysage, to þe þridde tretys, where we schulle tretyn of seknesse þat comyth to þis membres, whyche seknesse beþ non woundes.

¶ Cap. off woundes of þe face & Anotamye of þe same.

Woundes þat ben made in þe face, oþere þey beþ mad with a swerde, ore wiþ sum thynge ellys þat woundeþ, oþere þey ben mad wiþ prikynge of a knyf, arwe, oþere spere. Yt is necessarye, þat a surgyne haue more diligence in þe woundes of þe face, for it is a place þat is myche y-seyne, & yt ys wel y-do to make a sotyll cicatryce. A wounde þat ys mad with a swerde oþere with sum þynge

semblable þat is alweye in lengthe, a man moste sotylliche sowyn & gedre þe parties of þe wounde. And for þat many men lyȝen [folio 81a] of þe wounde of þe nese, þey seyȝen þat on bare hys nose y-kytte of in hys hande, þe whiche nose was afterwarde y-sette aȝeyne in hys owne kynde; þe whiche ys an opyn lesynge, for þe spiryt of lyf of felynge & of meffynge passith aweye, whanne a membre is departyde from þe body. I wylle begynne at þe wounde at þe nese þat is y-kutte in lengthe, wose cure ys lyȝt to hele; brynge þe parties togedre of þe wounde & sowe hem, & wirche aboute the wounde as y haue seyde tofore in þe chapitle of wondes. And ȝif þat þe nese were y-kutte twarte offere doun to þe ouere lippe, & naþeles þat þe ouyre lippe & þe nose were noȝt kutte al awey, but þat it helde faste at boþe þe endys of þe wounde, þanne sette aȝeyne þe nose in his propre place, þe noseþrellys yche aȝeyns oþere as þey were tofore, & make two smale tentys of wex, & putte in boþe þe noseþrellys aboue þe wounde, ȝif þat þou maist, & þenne make a poynt by þe space of a litel fyngere from þat on ende of þe wounde, & an oþere poynt at þe oþere ende of þe wounde, and an oþere poynt in þe myddel of þe nose anentys þe forhede; & afterwarde a poynt on eiþere syde of þe nose, afterwarde make a poynt* betwene evyry poynt, so þat þou haue in noumbre of alle þe poyntes,

whenne þey ben ful mad, .IX. Caste þe poudre þat is tofore seyde vpon þe wounde, þat is y-mad of lym, ffrank ensence, sancdragoun, & take whyte of an ey & oyle of roses and bete hem togedire, & leye þereynne a lynne cloþ & leye abouen þe wounde, aftirwarde [bynde]* þereto þre plumaciolus, one [folio 81b] vndireneþe, & on on þat o syde, an oþere on þe oþere syde; & þanne bynde þe nose wiþ tweye bandys, þat on schall holden vp þe nose þat he may nouȝt discendyn dunward, þat oþere schal be leyde aboffe þat he mowe kepyn þe plumacyolus, poudere, & þe sowynge. And þilke bande þat ys vnder þe nose þat halt þe nose vpwarde, schal be knett abouen on þe hed, and aftirwarde he schal be turnyde twarte offere þe forehed, þat he mowe holde þe bande, & þe nose declyne to neiþere syde. And þe bande þat ys leyde aboffe þe nose, schal be bounden behynden in þe nolle; and afterwarde he schal turnen aȝeyne aboffe þe nose, holdynge þe plumacyoles þat þey mowe noȝt wagge on neythere syde aboute þe sewynge; & aboute þe forhed þou schalt legge þe deffensif of bol, and aftirwarde þou schalt worche on þe wounde of þe nose as y haue seyde in a wounde of flesch in þe firste tretys. Þe woundes þat beþ y-mad in oþere partye of þe face as with a swerd ore oþire þynge semblable, brynge hem togedire, sowe hem, & cure hem, as yt ys conteyned in generall chapitle of woundys, takynge

hede hereto, þat þe sowynge þat ys y-mad in þe face, schal be more sotyl & fairere, þanne in enye oþere party of þe body. And þou maiste maken a sowyng in þe face, ȝif þat þe wounde be nouȝt to myche, on þis manere. ℞ mastyk & sangdragoun & poudre hem & tempre hem togedire wiþ þe whyte of an eyȝe to þe þyknesse of hony, & wete þereynne tweye pecys of lynnen cloþ as longe as þe wounde, & leye one on þat o syde of þe [folio 82a] wounde, & þe oþere on þat oþere & lete hem dreyȝen, and afterwarde make þe wounde sum what to blede, & þenne brynge þe partyes of þe wounde togedires; & sowe þilke two pecys togedres, & caste aboue þe poudre of lym, ffranc ensence, sancdragoun tofore seyd, & wete a cloþ in þe whyte of an eyȝe & oyle of roses, & leye abofe al togedyre, and kepe þe partyes with ligature, & procede forþ in alle þynges as y haue tofore seyd. And ȝif þat þe wounde be y-mad with a dart oþere with an arwe, & þe arwe ben y-drawe out and þe wounde be myche y-sene, þenne þe cure ys þe same þat was seyde in þe same chapytell oþere ellys in þe firste tretys, wheþere þat þere be a synwe prikyde oþere none. But ȝif þat þe arwe-hed were entrygede in enye privy place of þe face, so þat yt myȝte nouȝt ben seyȝen, þenne euerye man bysie hym be his wyt, to knowe how þe seke man stod, whanne he was y-smete, & whennys þat þe arwe come, & to what party þe wounde strecchith, þat he mowe loke ȝif þat he mowe fynden enye manere

wey, how he may drawen out þilke arwe-hed; and þenne drawe hym out þe beste manere þat he may. And ȝif he may nouȝt, helde into þe wounde oyle of roses, & medle he oyle of roses & þe ȝolke of an eyȝe togedre, & helde into þe wounde, & wiþ þis medycine worche in þe wounde, tyl þat kynde schewe sum manere wey. Manye men han born an arwe-hed in þat partyes of here face by longe tyme; and aftere kynde haþ cast out þilke arwe-hed, oþere ellys haþ schewyde sum weye by whom þilke arwe-hed myȝte be taken out. And þou moste taken hede be al þy myght þat whanne þat þou sowyste þe woundes of þe face þat þe mouþ be noȝt crokyde, but make so slylye þy sowynge þat þylke accident may noȝt [folio 82b] ffallen; & þat þou maiste do wel, ȝif þat þou couþest ordeyn wel þy sowynge & ȝif þou couþest kepen wel þy sowynge wiþ plumacyolus & wiþ byndynges.

¶ Cap. iij. tretis ij is off woundes of þe nekke & Anotomye of þe same.

¶ By the nekke is contynwede alle þe place þat is bytwene þe hed & þe schuldres, whose Anotamye y wyll tellen as y haue behyght. ¶ Some men makyth dyfference bytwene þe nekke & þe

wesant & þe þrote-bolle, and alle þese be conprehendyde vndire þe name of þe nekke. In þe nekke þere ben vij spondiles—þat is to say, whirle bonys of þe rigge. Þe furste of þe bonys ys y-bounde wiþ a bon of þe hed þat ys y-clepyde passilare wiþ manye smale feble ligamentys; & þey weren feble bycause þat þilke Iuncte nexte þe hed myȝte meffe manye weyes. And þe cause why þat þere were manye smale lygamentes multeplyede in þat Iuncte, þat manye smale myȝte susteyne a grete burthyne as wel as a fewe grete; & ȝif þat þere were a fewe grete, þey were nouȝt so able to be meffyde. The firste spondyle ys y-bounden to þe secunde, þe secunde to þe þridde, þe þridde to þe fourþe, þe iiij. to þe v., þe v. to þe vi., þe sixte to þe sevenþe, þe vij. ys y-bounden loselyche to þe fyrste spondile [MS. Whenne þat þou reknyst from þe hed, struck through, after spondile.] of þe rugge, þat þe nekke myȝte more lyȝtlyche meffen, whiche ys clepyde þe viij. spondile, whenne þat þou reknyste from þe hed dunwarde.* vij. peire off synwes growiþ out by þese .vij. spondelis. Þe firste peire of synwe procedeþ out* bytwene þe fyrste spondile [folio 83a] & þe bon of þe hed þat ys y-clepyde passilare; þe secunde peire of synwes ys y-bore bytwene þe firste spondile & þe secunde, & so euery peire passith out bytwene euery spondile.

Þese Synwys buþ devyeded manye weyes by þe hed, & þe nekke, & þe face, & þe breste, schuldres, & þe armes; þe braunches of þe synwes of the hed in some place beþ contynwede & Ioynde with þese synwes. And þese synwes buþ y-clepyde meffynge ryȝte as þe synwes þat comyth of þe fore partye of þe brayn beþ y-clepyde felynge & þese habbiþ also felynge. Of þese Synwes þat comyth of þe spondlis of þe nekke þere beþ mad brawnys, þe whiche beþ instrumentes of mevynge of þe partyes. In þe nekke behynde, þere ben y-ordeynde opyn veynes comynge from þe lyffere whiche þat ascendyn to þe hed, and vndire þo Veynes þere ben Arteryes y-hud priuelyche, comynge ffrom þe herte & goynge to þe hed for notable profetes. And whanne þat þey han do al here office in þe hed, þey descenden doun by þe place þat beþ behynde þe erys & þey bryngen materie spermatice, þat is to say mater of sperme, don to þe ballokes, & þerefore it ys y-seyde: ȝif þat þo Veynes weren y-kutt, a man scholde neuere engendre. On þe ryȝt syde & eke on þe lefte syde of þe nekke þere ben y-ordeynde tweye nolles, þe whyche beþ of lygamente mater, þe whiche procedeþ out of þe bonys

of þe hed & of þe spondiles, & þey strecchen doun to þe ers in lengþe besydes þe spyne bon, & þey ben a couche & a restynge place to þe synwes þat comyth out of þe nucha. In þe fore partye of þe nekke þere ys gula whiche þat strecchiþ from þe chyn doun to þe furcle of þe brest; and bytwene þe nekke & þe gulam wiþynneforþ þere ys [folio 83b] y-ordeyned mery—þat ys to seye þe wesand; þe whiche þat discendiþ of a smal schyn environynge alle þe mouth withynneforþ, & so goynge doun to þe Stomak, & he ys hol & conteynde wiþ þe Stomak, & ys of Substaunce of þe same stomak, & he dissendiþ doun by þe hyndere partye of þe nek clevynge to þe spondelis; tyl þat he come to þe .v. spondile of þe rugge, & þere he ys departyde from þe spondelis and declyneþ into þe Innere partye tyl þat he perce þorwe þe mydryff, & he ys componed of twey pannycles, and in þe Innore cloþ þere ben brawnys in lengthe, by þe whiche drauȝte ys made of mete & drynke, and in þe vtter cloþ þere bene brawnys in brede by whom ys made castynge out of superfluyte; and he haþ non transversarye, þat ys to seye goynge twartoffere, ffor wythholdynge ys nouȝt nedfful to hym. And in þe fore partye of þe brest þere is y-set þe canne of longes, þe whiche ys componed off grustlye

rynges y-bounde togedire wiþ panycleris ligamentes, habbynge in þe Innore partye a ful smeþe pannicle Ioynynge togedire þilke grustly rynges. And þilke rynges, whenne þat þey ben ioynede with mery, þey ben defautyf anonde þe mery. And þe forme of þe canne of þe longes [is]* as yt were þe forme of a cane—þat is to say a reed, of þe whiche reed þe fourþ part were kutt away in lengthe, & aftereward þe canne ys y-wreye wiþ a sotyl cloth, þat whanne þat a grete mossell of mete passe doun be þe mery, he scholde han non lettynge, but þilke pannicle of mery ȝeuyth stede to þe grete mete passynge doun to þe stomak. Þe þrotbolle þat is mad of þre grustlys, ys y-sette aboue þese [folio 84a] two weyȝes. And boþe on þe ryȝte syde & eke on þe lefte syde of þe cane of þese longes, þere beþ tweye grete veynes þat beþ y-clepyde organice oþere ellys guydes. & vndire þe veynes þere ben grete arteryes, and of þe kyttinge of þilke Veynes & Arteryes þere comyth ofte tymes gret peryle & sumtyme sodeyne deþ; for þe grete afynite [a, above line.] þat þey han in þe herte & þe grete noyenesse þat þey han to þe lyffer, sennore by hem blod ys evacued, wherefore spirites exaleþ whyche þat buþ frendys, boþe to þe body &

eke to þe soule. Þe ligamente of þe þrote ys y-clepyd þe [þe, above line.] eminence oþere þe hekþe of þe epiglote, & in þe sydes of þe þrote þere is y-set gula. & þe goynge of brawnys, cordys, synwes, veynes, arteryes & here braunchys by parties of þe hed proceden aftyre þe ordre of heres, & þey ben ordeynde in þe nekke & in þe gula aftire here lengþe. And hereby þou maiste ysene, how þat yt is necessarye a surgyn to maken hys kuttynges, & hys brennynges by lengþe of þe nekke & of þe þrote, and þat þe woundys þat ben y-mad twarte offere beþ more perylose, þen þo þat bene in lengthe.

Wonde of þe nekke. ¶ Now we wyl tretyn of woundes þat beþ mad in þis place wiþ a swerd oþere with sum þynge semblable to hym, oþere wiþ an arwe, oþere with sum þynge semblable to hym. And ȝif it be wyth a swerde, oþere yt ys twarte offere ore in lengthe; and ȝif it be twart offere, and þere ben y-kutt grete Veynes oþere arteryes, hit ys gretly to dreden. Naþeles þou schalt helpe to staunche þe blod & to consoude þe veyne, aftere þe techynge tofore asygned in þe chapytle off fflux of blod. And ȝif þere be a synwe kutte, brynge þe parties of þe synwe togedyre, & sowȝ þe pellykles of þe synwe with þe sowynge of þe wounde, as y haue tauȝt tofore in þe [folio 84b] place of sowynge of synwes, and leye aboffe lumbricus of þe

erthe þat beþ erthe wormes y-stampyde & boylled wyth oylle of roses, & kepe þe sowynge with byndynge, and so procede forþ in alle þynge in þe cure, as yt is tolde in the chapitle tofore schewyde. And ȝif þat þe wonde were in lengþe, yt ys noȝt necessarie but forto sowe þe wounde & to casten aboue, þe poudre of lym, ffrank ensence & sank dragoun, & to kepe þe sewynge & þe poudre with byndynge, tyl þat þe wounde be ful consouded. And ȝif þat þe wounde were y-mad in þo parties with an arwe oþere a knyff, oþere a spere, oþere sum þynge semblable to hem, and ȝif þere be an arwe, drawe hym out, and ȝif þe arwe be drawen out, loke ȝif þere folwe emorosogie, þat ys to seye, a gret flux of blod, & þenne staunche hym aftere þe doctryne y-told tofore. & ȝif þere be non flux of blod, loke ȝif þere be akþe; & ȝif þere be akþe, put into þe wounde a lytel tente þat may holde þe wounde opyn al day, þat þou may se þat þe wounded man schal han non akþe. And ȝif he haue non akþe, lete þe wounde be consoudyde; ffor sum tyme it happith, þat an arwe, oþer sum thynge semblable passith þorwe þe nekke & þe þrote, & ȝit he touchiþ noȝt veyne, arterye, ne synwe, & þenne it nediþ noȝt but þat þe wonde be consouded. And ȝif þere were akþe oþere ellys a bygynnynge of swellynge, þan yt were necessarie to fulfylle þe wounde wiþ hot oyle of roses & to put in a tente noȝt to grete,

y-wett in þe ȝolke of an eyȝe & oyle of roses hot, & so holde þe wounde open to þat he ȝyfe quyter, & afterwarde clanse hym & afterwarde consoude hym. Nota: vndirstande þe peryles þat comeþ from wondys* þat ben mad in þis place. Þe firste [folio 85a] Perel ys: ȝif þat þe nekke be kutte twarte offere with a swerd, so þat þe nekke-bon & þe marye of þe nekke-bon be y-kut al atwo, yt is dedlyche; and ȝif þat nucha, þat ys þe marye of þe nekke-bon, is noȝt y-kut al atwo but ys y-hurt, yt is peryle of leosynge, ffelynge & meffynge, & at þe laste to be ded, but ȝif þe medycines þat y schal tellen afterwarde mowe helpen. And ȝif þat enye Veynes oþere enye gret synwe be y-kut twart offere, y suppose þat he be helyde, þe nekke schal neuere haue hys fre meffynge; and ȝif enye of the veynes organyk whiche þat beþ clepyde guydes, oþere ellys enye of þe arteries þat beþ vndire hem beþ y-kut, yt ys drede of sodeyne deþ, ffor sodeyne exalacioun of þe spirites & also for Afynyte of þe herte; & also ȝif þat þe canne off þe longes be y-kut twarte offere al atwo, for þe more partye it is dedlyche; & so it ys seyde ȝif þat þe veynes þat beþ behynde þe eres be y-kut al atwo, he schal nevire engendre. Also sum tyme ys y-kut oþere y-prekyde þe synwe þat is clepyde reuersiff, þat ys vndire boþe þe sydes of þe ere, of whose kuttynge oþere prekynge euere more ys mad horsnesse. And ȝif

þat place ben y-perced with an arwe, & þowȝ þat trachea arteria be y-percyde oþere ellys ysophage, so þat Nucha be noȝt þrillede be þe mydle, þey mowe ben y-helyde with gode medycines & acordynge. Þou schalt helpe Nucha þat ys y-hurt in þis manere: þou schalt helden into þe wounde in þe bygynninge oyle of roses & afterwarde leye aboffe oyle of roses & þe ȝelke of an eyȝe, and þou schalt be busy in alle manere to aswage akþe; & whenne þat quyter ys y-mad, þenne leye a mundificatyff wiþ medicynes confortatyff and [folio 85b] Incarnatyfes y-mad in thys manere: ℞. oyle of rosis colat .ȝ. iiij, with [wiþ for wex.] resyne ana. ȝ. ij, terbentyne ȝ. iij, frank ensence, mastyk ana. ȝ. i, mirre, sarcocolle, [MS. sarcticolle.] mumie ana .ȝ. [one half], barly mele .ȝ. [one half]; streyne it on a cloþ & leye yt on þe nucha þat is hurt. And þawȝ þat hereof euere more pronosticacion scholde go tofore whiche scholde sownen to yuele, naþeles by þis medicine þere comyth rectificacioun to þe nuca, & amelioracioun off mevynge of lymes þat beþ beneþe þe place of þe nuca þat ys y-hurt, more helpynge, þenne semyth possible to þe leche. For þere ys noþynge vnpossible to Stalworth nature; namlyche whanne þat yt is holpen wiþ a gode leche & wiþ þynges, þat beþ

helpynge & acordynge to a gode entencioun. Here vndirstande þat alle manere wounde þat persith to þe substaunce of þe brayn oþere ellys to þe nuca, so þat by þe hurtynge of þe nuca þe meffynge & þe ffelynge of some lymes ben y-lost, namlyche from þe whirlebonys of þe rugge, of þe reynes vpwarde, & alle manere wounde þat ys mad in þe extremites of þe lacertes as þre fyngremele brede in þe schuldres, oþere þre fyngre mele brede aboue þe elbowe oþere byneþen, oþere þre fyngre mele aboue þe kne oþere byneþene, & euery wounde þat ys in a synwye place with strengest akþe & hardnesse, schal be demyde dedlyche: ffor þe noblete of þilke brayn, & for þe Affynite of nuca wyth þe brayn, of þe whiche nuca passith as þe Ryuere from a welle, & for þe Afynite of þilke Synwes wiþ þe brayn, by mene of þe Nuca, of whom þey passen out as of a flod, wherefore [folio 86a] þou schalt euyre more in swiche manere woundes pronostiken deþ, and euere more fle as myche as þou mayst from vnresonable cures, but ȝif þou be wiþ þe more Instaunce y-preyȝede. Naþeles sumtyme nature with gode helpynges worchith þat semeþ to the leche vnpossible. Neuere þe latere loue non swiche cures* but ȝif þou be gretliche y-preyede, and þenne entyremete of þe cure of þe syke man.

¶ Capit. iiij. tretis .ij. is of woundes of þe spaude, schuldre, arme, handis, ffingres, brawnes, veynes, and here Anotamye.

Þe spawde ys one of þe iiij bonys whiche þat makiþ þe forme of þe schuldre, & þe spawde-bon is þenne & brode towarde þe schuldres & in hys endys grustly. On þe vppere syde of hym he haþ an egge sumwhat gret & towarde þe arme in þe place of þe schuldre he ys grete & rounde. And þilke ende ys holwe as a box, and þis bon ys lyche to a pele, þe whiche men settyth brede into þe ovyne, and on þe hyndere partye of þe schuldre he haþ an emynense. & in þe box of þis bon — —* whiche ys y-clepyde adiutorium þe whiche ys a bon sumwhat crokyde, gret & holowȝ. Þis bon ys gret for necessite of strengthe, & of schappe holwe, þat he were lyȝte, þat he scholde nouȝt þrowen his hevynesse lette þe wirchynge of lacertes, and þe rounde extremite of þis bon entreþ into þe holwenesse of the spaude. & þey beþ y-bounde togedre with a bowable ligament. Þe canel-bon of þe brest ys in this manere

y-made, habbynge an additamente sumwhat [folio 86b] rounde in þe neþere partye, þe whiche entryth a manere box, þe whiche ys in þe offere partye of þe ovyre bon of þe vij. bonys of þe brest. And euerye extremyte of þilke vij. bonys beþ y-Ioyned wiþ þe spawde, þat þe schuldre myghte be þe more strenger; and forto make þis place þe more strengere, þere beþ sette two smale bonys whiche beþ y-clepyde rostralis to þe lyknesse of þe byle of a crowe, & forto fastne þe schuldres, þis bon rostrale ys y-put in þe manere of a wegge. But þe bon of þe adiutorie haþ in þe neþere partye towarde þe elbowe tweye emynences, and þe on of þe emynence ys more herre þenne þe othire; and boþe þese emynence beþ as yt were half a bokett wiþ þe whiche men drawiþ water; and þilke tweye Additamentis beþ y-Ioyned with þe bonys of þe arme. Þe Arme from þe Elbowe dunwarde, haþ two bonys, and þe offere bon whiche þat strecchiþ from þe þowmbe þat ys clepyde adiutorium is smallere bon, and þe neþere bon þat strecchith from þe lytel fyngere to þe elbowe is þe grettere bon. & he haþ in þe offere ende towarde the elbowe an additament like to a byle oþere a pyk, and þilke pyk makyth þe elbowe scharpe, whenne þat þe arme ys y-folden, and it letteþ þat þe arme may noȝt ben y-bowyde bakwarde.* Þese tweye bonys beþ

so y-Ioynede togedire, þat it semyth as on bon. And þe neþere ende of þese bonys beþ y-Ioyned wiþ þe bonys of þe hande, whiche beþ y-clepyde rasceta þat beth viij bonys.