[2.] Of þe apostemeȝ in þe lure causyng þe fistule, and þe cure of tham.

2. [T]hof-al þe principal entent was for to trete de fistula in ano, Neþerles it spedeþ first for to touche somwhat of aposteme bredyng þer-in or niȝe,*. [vel exterius prope anum.] siþe oft tyme apostemeȝ bredyng þer bene cause of fistule or of cancre. ffor, after auctours, Aposteme y-bred in any place of þe body, if it be not y-helid by þre or four moneþes, it is turned into a fistule or a cancre. Therfore when ther falleth ane aposteme in þe lure or niȝe1 þou shalt knowe it by þese signes; þat is by bolnyng, akyng, brynnyng, ȝekyng & prikkyng.*. [per tumorem et dolorem, ardorem atque pruritum et puncturam.] And the pacient for akyng and anguissh may nouþer sitte ne ligge ne slepe. Whiche apperyng, ffirst it is to labour to þe slakyng or esyng of the akyng and brennyng and of oþer accidenteȝ without repercussione. ffor in þe lure ow noȝt to be repercussion, siþe it is ane emunctory, and in emunctorieȝ ow it noȝt to be done; þese bene emunctorieȝ:—þe armeholes, þe þeholes, þe chawelleȝ,*. ["axillæ inguina et fauces," says the Latin text.] &c. And witte þou after Gilbertyne þat ane aposteme beyng within þe lure is cured with þe infusion of oile roset in which is ceruse distempred, or led brent, or litarge, or all þise if þai be hadde, or with þe ȝolk of an ey. And he be euermore warre of paynyng of egestion. And ȝif his wombe be costyue*. [et si venter constipetur.] be it softned þat þe hardnes of þe ordure bryng noȝt in anguissh in egestion doyng. And be it softned with ane emplastre of malueȝ & swynes grese; Or with water of decoccioun of malueȝ and branne, with oile or butter fressh, or suche other, and be it ȝette in by a clisterye. Therfore take oyle roset and medle it with þe ȝolke of a rawe ey in euen porcion. Aftir putte it in a little bleddere, þan take a Nastar of tree*. [tunc accipe unum instrumentum ligneum, concavum per medium, quod Nastare ligneum vocatur.] and putte it in þe bladder and bynde it aboute wiþ a strong þrede, and enoynt þe for ende wele with oyle roset, and softly putte it in þe lure and presse þat is in þe bleddre with þi fyngres in-to þe lure. Þis, forsoþe, swageþ and softeneþ þe brynnyng, þe prikkyng, smertyng & akyng, and comforteþ þe membre in boþe cause,*. [in omnibus membris corporis.] þat is Page  12boþe in hote and colde. ffor, after auctores, Oile roset coldeþ ane hote membre and hoteþ ane colde membre*. [oleum ros. membrum supercalescens infrigidat et super infrigidatum calefecit.]; and it doþ many oþer profites þere and in al þe membres of þe body. And þerfore a gode leche puruey*. ["provideat."]hym þat he want neuer oyle roset, siþe þer procedeþ of it many helpyngis to mannes body; for why; after Galien to euery akyng hote oile roset is mytigatif. Vpon þe aposteme, forsoþe, vtward be putte a gode emplastre and riȝt maturatif of diaquilon resolute with oile roset, or oile of lilieȝ, or of camamill, or dialtred,*. [dialthæa.] or comon oyle, þat is oyle of olyue, or swyne grese, or gandres,*. [anatis.] or maulerdes,*. [mallardes.]or hennes grese. ffor whi; diaquilon þus y-ordeyned and put-to matureþ colde materieȝ & resolueþ & mollifieþ hard materies. Also be þer made suche a vntment þat is riȝt mitigatiue. Recipe: tame comon malueȝ*. ["Malvas domesticas communes."] M. i or M. ij,& brisse þam in a morter, and put þam in a quart of oyle of olyueȝ and lat þam putrifie þerin 7 dayes or 9. After boile þam long at þe fire vnto þe oile be wele grene; after cole it and [leaf 145, back] kepe it: þis oyntment is ryȝt mitigatiue of akyng of apostemeȝ, and mollifieȝ þan if it be put vpon [tham] hote with lana succida. Lana succida is wolle þat groweth atuix þe leggeȝ of ane ewe about þe vdder, ful of swet,*. [sudore imbuta.] noȝt y-wasshe, and it opneþ strongly and consumeth; oyle, forsoþe, of propirte holdeþ opne and draweth and swageþ akyng. If, forsoþ, þou haue noȝt lanam succidam þan dippe a lyn clout in þe forseid oyntement and putte it hotte vppon and bynde it warly þat it fal not away. Also ane emplastre of þe forseid malueȝ is a ful gode maturatif and mitigatif of akyng in apostemeȝ of þe lure and of wymmenȝ pappeȝ, and to al oþer apostemeȝ þat nedeþ maturacion. And it is made þus. Recipe: malueȝ tame M. i. or ij; seþe þam in watir to þai wax softe, þan put þam out of þe watre and presse oute þe watre of þam, and aftir hakke þam small wiþ a sharp knyf on a clene borde; þan frye þam in a panne ouer þe fire with comon oyle or butter or swynes grese, Or, if þe pacient be riche or noble, with som of þe forseid oileȝ. And aftir vpon clene stuppes be it put on þe aposteme. And witte þou here þat if þou may haue wormed it profiteþ mich in curyng if it bePage  13soden & made wiþ þe forseid malueȝ, for þat emplastre is best mitigatiue of akyng of pappes, & bryngeþ in quytour and conforteþ þe place, and makeþ þe mater for to vapour by þe poreȝ. And for certeyn it availeþ in al apostemeȝ in euery place of þe body, and also in many brissureȝ. With þis emplastre in cures of pappes I haue y-gette many worshippeȝ and benefetes, for certaynly it is soueraynly mitigatyue. But witte þou after all auctours—and I haue proued it for certayn experience— þat ane aposteme bredyng nere þe lure owe not to abide to it breste by itself, but þe leche owe bisily for to fele wiþ his fynger þe place of the aposteme, and wher-so is founden any softenes, þer, þe pacient noȝt wittyng, warly, be it boldely opned wiþ a ful sharp lancette, þat þe quitour and þe corrupte blode may gone oute. Or elleȝ, forsoþe þe gutte or þarme þat is called longaon, þat deserueþ to þe lure, shal be bristen wiþ-in þe lure, and presed byfore þat þe aposteme be bristen withoute-forþe. Whiche case byfallyng, if it al-oonly brest within it is of hard cure, and þan shal þer be ragadieȝ or frousingeȝ, fforsoþ if it briste boþe within and with-out, þan may it neuer be cured but by a ful experte cirurgien in his crafte. ffor than may it þe firste day be called a fistule; siþe a fistule is noȝt elleȝ þan ane vlcus vndesiccable,and for it is vndesiccable, þerfore by consequens it is vncurable, siþe no wonde ne vlcus may be heled but if it may be dried. Som tyme it bifalleth som men for to haue ane hole apperyng outward al-oonly, persyng þurȝ þe longaon within þe lure by þe space of ane ynche or of tuo, and bisyde þat anoþer hole with-out, noȝt persyng þe longaon with-in-forþ. And I haue sene som haue 7 or 9 holeȝ on þe tone party of þe buttokkis, and 6 or 5 on þe toþer party, of whiche noon of þam, outake oon, persed longaon. And I haue sene som haue 2 or 3 holeȝ on þe buttokke, and 2 or 3 descendyng [leaf 146] doun into þe codde of þe testiculeȝ. And I haue sene som haue oon hole or many in þe tone buttok, and oon or tuo on þe party of þe ȝerde persyng als wele longaon as þe ȝerde. And in þis case, as by my demyng, sich pacientes bene vncurable, and þat for fistulyng of þe Page  14ȝerde. And þat may be knowen, for som-tyme þe sperme goþ oute by þe hole of þe ȝerde infistulate, and som-tyme vryne or bothe. Neþerlesse I cured a preste, at lincolne in þe house of Maistre Giffray Scrope, þat had aposteme in his ȝerde, of whiche als wele vryne as quitour come doune into his codde, and sometyme blode went oute by þe hole of þe ȝerde, and his testicules war bolned out of mesure. Therfore, first, I putte on his testieuleȝ oon oyntement ruptorye, and I made an hole by whiche went out bothe vryne and quitour; þis i-do, þer shewed ane bolnyng vnderneþe in þe ȝerde riȝt be þe lure, whiche I opned wiþ a ruptorie; whiche y-opned, þer went out boþe quitour and vryne. Whom y-cured perfitely, oure lord beyng mene*. [Domino mediante.]; but for certeyne his lure & longaon war vnhurte. And witte þou þat þis cure was ful hard. Þerfore in suche þingis be a leche avised and discrete. Also a leche owe to be circumspecte in his askyngis, þat he enquere bisily of þe pacient if he fele ony tyme ventositeȝ or egestionȝ go out by þe holes of þe fistule. Also enquere he of þe pacient ȝif he fele any heuynes or greuousnes in his heued; Or if it appere to hym þat þe house some-tyme is turned vp-so-doune*. [ut si appareat ei quod domus subvertatur.]as it shuld falle, and þe pacient may noȝt for drede of fallyng enclyne to þe erthe; And if þe pacient fele akyng and heuynes or greuousnes in his lendeȝ*. ["et si sentiat gravitatem in lumbis."] and feblenes in his stomake. Also sey he to þe pacient þus: 'I wote þat þe kynde of þe fistule is soche þat somtyme it is opned by itself and putteþ out quitour, somtyme þikke and somtyme þynne, somtyme watery and somtyme blody. And somtyme it is closed be itself, & so by a moneþ or more þer renneþ no-þing out; and eft-soneȝ it bigynneþ to ake or þat it caste out quitour. And aftirward it is opned by itself, and renneþ as it is seid afore, and aftirward it is sperred.'*. [et postea clauditur.] ffor suche pronosticacions sheweþ and tokneth to þe pacient þat þe leche is experte in þe knowyng of þe fistule, and so þe pacient wil better trist vnto hym. And witte þou, aftir Bernard of Gordon, þat þe synoweȝ closyng and openyng þe lure haþe festnyng with þe stomake and wiþ þe ventriculeȝ of þe brayne, And for this cause suchePage  15pacienteȝ ar som tyme vexed in þe heued*. [in capite.] and in þe stomak. When þe leche, forsoþe, haþ talked þus to þe pacient, as it is seid, and þe pacient aske & persew for to be cured of hym, aske þan first þe siȝt of þe sekenes; Whiche y-sene, be þe leche war þat he put noȝt his fynger in þe lure of þe pacient, ne shewe no pryue instrumenteȝ wher-of þe pacient myȝt wonder or be aferd; or if perauenture þe pacient haue wilyly broȝt in with hym any leche for to aspye, as I haue oft tyme sene. But considere þe leche bisily þe maner of þe fistule, & perceyue if it be curable. Ȝit*. [Nihilominus.] a leche ow for [leaf 146, back] to feyne perileȝ and hardenes of curyng, and for to make pronosticacions wilely þat þe sikenes askeþ long tyme of curyng, for þat þat þe medicyneȝ y-putte to may not abyde long for purgyng of þe wombe, and for moche moystenes goyng out of þe lure, and for many oþir lettyngis, as for þe lure is to streyte, or þe buttokkes be to grete or hard, or for þe pacient is waike of herte or vnobedient for to persew his cure or for to kepe his diete, and for many oþer þat hym ow for to feyne on his owne heued þat he supposeth be necessarye.*. [quæ debet capite proprio figere quæ sibi constiterit fore necessaria.] And þise pronosticated, if þe pacient stond stedfastly þat he be cured, or aske if he may be cured, þan sey þe leche þus: 'I dout noȝt, oure lord beyng mene,*. [Domino mediante.] and þi gode pacience folowyng, ȝif þou wilt competently make satisfaccion to me, as sich a cure—noȝt litle to be commended—askeþ, þat ne þingis y-kept þat ow to be kepte, and y-lefte þat ow to be lefte, as it is seyde, I shal mow bryng þis cure to a loueable ende and heleful.' And þan acorde þay of couenant, of whiche couenaunt—al excusacione y-put abak—take he þe half byfore handeȝ*. [Quo peracto medium pretii præ manibus capiat omni excusatione propositâ.]; And þan assigne a day to þe pacient when he will bygynne. In þe mene tyme, forsoþe, ordeyne þe leche redy his medicynes and his instrumentis; þat is to sey þat he haue first two spongieȝ or þre at þe lest, & a rasour or a ful sharp launcet, and oþer instrumentis named afore, as Sequere me, Acum rostratam, Tendiculum; And silke þredes, and lyn cloutes, and girdelleȝ, and oþer þat ar seid afore and to be seid here-after. Haue he also redy a medicyne restrictyue of blode, and warme or leuke watre, and all Page  16oþir necesarieȝ, þat no-þing wante þat the leche may nede in his wirchyng. And ouer al this it is best & most sikir þat he kutte noȝt in þe lure ne do no violence ne greuousnes to it in þe tyme þat þe mone is in Scorpion, or Libra, or sagittarius, for þan of astronomyeȝ is forbede þer kuttyng. ffor as wille souerayne astronomieȝ and astrologiens, þat is to sey Ptholomeus,*. [Ptolomæus,] Pictagoras,*. [Pythagoras.] Rasis, and Haly, &c. A cyrurgien ow noȝt for to kutte or brenne in any membre of a mannes body, ne do fleobotomye whiles þe mone is in a signe gouernyng or tokenyng þat membre.

^* The Latin texts contain a chapter headed