The Frenche chirurgerye, or all the manualle operations of chirurgerye , vvith divers, & sundrye figures, and amongst the rest, certayne nuefovvnde instrumentes, verye necessarye to all the operationes of chirurgerye. Through Iaques Guillemeau, of Orleans ordinarye chirurgiane to the Kinge, and sworen in the citye of Paris. And novv truelye translated out of Dutch into Englishe by A.M.

The Frenche Chirurgerye THE THIRDE TRE∣ATISE OF THE OPERATI∣on of Chyrurgerye, wherin is discoursede and handelede of the sovvinge or suture of vvoundes. Contayninge sixe Chapters.

• VVhat the suture, or sovvinge together of avvounde is and the vse therof. Chap. 1.
• VVherone vve must note in the sovvinge of a vvounde. Chap. 2.
• VVhat is needfulle, to the sovvinge, and of the meanes, hovv to doe the same. Chap. 3.
• Of the species, or differences of sovvinge, and of the time to remove the same. Chap. 4.
• Hovv vve ought to repose agayne the guttes, vvith the net, vvhenas they hange out of the bo∣dy. Chap. 5.
• Of the Gastroraphia, or sovvinge of the bellye- Chap. 6.

❧ What sowinge is, and the vse therof, and in what impedimentes she is necessarye, and in what partes. Chap. 1.

THe Chyrurgiane ought to con¦sider sixe especialle thinges, vvhich concerne the sovvinge of vvoundes: First the vse ther∣of, that is, in vvhat impedimēts it is necessarye, & in vvhat par∣tes: vvhat vve must therin consider: vvhat ther is vvantinge to effecte the foresayed sovvinge: after vvhat manner vve ought to doe it, & ho∣vve manye fashions, & differences ther are of the same. Therfore sovvinge of a vvounde is nothinge els, but a vnitinge, and couplinge to¦gether of the dissevered partes: vvhich vveare contrarye to nature, separated and parted one frō the other, vvhich fore sayed vnitinge must be effected vvithe a threded needle.

The occasione, vvhy vve in anye vvounde, or separated parte, vse this sovvinge, is to vni∣te agayne, & ioyne them together, vvherof the convenientest meanes is, this sovvinge, & the vse of this combinatione, and that especiallye in all such partes, vvhich vve can not conve∣niently oraptlye binde together, even as vve may playnlye see, in the greate vvoundes of the armes, & legges, vvhich are overthvvart∣lye vvounded, in like manner alsoe in the bo∣dye vvvich happen in the length therof, for the lippes or edges of the same, are soe much separated one from the other and causeth the vvoūde soe to gape, that shee coulde not vvit∣hout great daunger be cured, vnlesse that in anye place vve sovved it, to bring them toge∣ther and vnition: because that all incarnate, or fleshye partes of the bodye, are dravvne throughe vvith certayne sinnuishe fibers or filamētes, the vvhich beinge overthvvartlye, or contradictorylye separated the one, from the other, the one lippe of the vvoūde is dra∣vven opvvarde, & the other dovvnevvard or the one on the right syde, & the other one the left, all accordinge as the vvoūde or the sepa∣ratione is more or lesse, overthvvarte, cōtra∣dictorye, lōge, deepe, or vndeepe. In like sorte is the sovvinge, verye necessarye in a vvoūde, vvherin a peece or parcell of fleshe hangeth one the one syde, and one the other end as yet connexed, even as it commonlye chaunceth most commonlye, in a great hevve or slashe, throughe the vvhich the eare, hangeth by the heade, or in any other parte, as in the nose, the vvhich helde fast but at one end onlye.

It happeneth alsoe some times, that the vvhole parte is cleane cut of, vvherin the sovv¦inge is nothinge profitable, vvherfore therin vve must not vse anye sovvinge at all, to cure thē agayne, for then in the separated par∣te is noe more life, & therfore can noe more be nourished of the bodye, by the vvhich the curinge ought to come.

And althoughe that all those partes, vvhich agaynst the course of nature are separated frō the other, might behove to be healed agayne, cā not beare or suffer to be vnited or coalited, even as are the synnues, Tendones, & Cartila∣ges or grissells, because after the opinione of aunciente professors, and as alsoe the vse and practise teacheth vs, ther must consequentlye follovve of one pricke, or thrust vvith a nedle, in the synnues, or tendones, great payne of all sortes, inflāmatione, convulsione of synnues, and some times alsoe death it selfe, throughe the sympathye, or compassione, vvhich they have vvith there firste originalle, the vvhich Galenus, hath shevved vnto vs, in a vvoūde, be∣lovve the Hockes in the vvhich, consideringe the greatnes therof, it vvas verye needefull that there shoulde be a profounde suture, & that not onlye to bringe the supersituated places, together, but alsoe the profoūde lyin∣ge partes of the vvounde: the vvhich he ende∣vourīge to effecte, hath separated the tēdones frō the muscles: for because ther is great daū∣ger consisteth in the hurtinge of the synnues, even in like sorte is ther daunger in hurtinge

of the tendones, & that consideringe the syn∣nuishe fibers vvhervvith the muscles of the bellye are connectede, vvhich in time chaūge themselves into a tendone, vvhich vve com∣monlye call the great synnue.

What we ought to consider in the suture, and so win∣ge of a wounde. Chap. 2.

WE must not at anye time sovve vp a vvounde, least in the first shee be vvell purifyed, & cle∣ansed, as vvell externallye, as internallye, if at the least vvith out any great daunger or per∣rill it may be effected: extractinge and takinge therout all that is contrarie vnto the sayed vvounde, as is congealed bloode, vvhich com∣minge to corruptione, might cause greate in∣flāmatione, & oftē times alsoe a convulsione in that parte, throughe vvhich the sovvinge breaketh, & teareth, & soe conseqventlye hin∣derethe the vnitinge & healinge of the vvoū∣de: vvherfore in the resovvinge of a vvoūde, vve must deligentlye note, that vve doe not contracte & dravve together on all sydes) the lippes or edges of the forsayed vvounde (ex∣cept it vveare in the haremouth, & in the cle∣aved or severed lippes of the mouth) but must leave some distance betvveene the one & the other lippe or in anye place some or other a∣pertione, because the matter which gathe∣reth it selfe together, in the bottome of the vvounde, may issue therout, and by that mea∣nes the medicamentes may be therone appli∣ed. In like sorte the Chirurgiane must in sovv¦inge consider, & vse medicoritye, and not ta∣ke to great a qvantitye, ether in the length, or in the depthe of the fleshe, and of the skine, throughe the vvhich there might ensue and follovve great payne, vvhich vve ought not to esteeme for smalle, & therof allsoe vvoulde remayne an illfavored & vnseemlye cicatrice or scarre: As to the contrarye the not deepe sovvinge of the vvounde, myght easylye brea∣ke and burst agayne, & then in vayne it vvea∣re sovvede. For if soe be, that the needle, be to neere thrust throughe the edges of the vvoū∣de, thē the threde because of his tenuitye tea∣reth throughe the skinne or fleshe, & vvhen as vve thruste the needle to deepe and farre, from the lippes or edges of the vvounde, then there resteth and remayneth a greate parte of the skinne, vvhich vvill not be vnited: vvher∣fore indifferentlye vve ought to pearce toge∣ther as much of the skin as of the fleshe, be∣cause the fleshe farre sooner and easyer com∣meth to heale and cure, vvith the fleshe then the skinne vvith the skinne, and that is consi∣deringe the naturall temperatenes of the fo∣resayed fleshe, vvhich is vvarme, and moyste. And as touchinge the distance of the stitches, and soovvinge, vve ought not to laye them to close one by the other, nether to farre separa∣te & sequestred one frō the other, as thē they can not retayne the vvounde: And vvhen all to nye the other they are layed, cause payne, through all the stitches, and dravvinge to∣gether of the same, through the vvhich payne is caused a concursione of Humors vnto that place: vve must therfore vse a meane therine vvell consideringe, the largenes, and length of the vvounde: but above all vve must marke, that vve thrust not, throughe or in anye syn∣nues or tendones, consideringe the payne, the Spasmus and manye other fearfull accidentes, vvhich therof might ensue, as allreadye vve have sayed. Sovving of a vvounde may not be effected vvith anye violence, in those partes vvhich vve endevoure to vnite and bringe to¦gether, but thē is sovvinge laudable, vvhen as the skinne stretcheth it allmost together, of it ovvne accorde, & vvheras in this sorte it vvill not be effected or brought to passe easylye, & that the lippes of the vvound vvith violence must be ioyned, it is as then most convenient, that vve relay the stitches some distāce one frō the other, & lettinge them be somvvhat loos∣lye sovved: for if it chaunced vve drevve them somvvhat stiflye together, the skinne might then easylye rente or teare, & soe burst a sun∣der throughe the tumefactione vvhich therof ensueth: If that therefore, vve disire perfectlye to cure a vvounde, vve ought as thē soe to dis∣pose of the sovvinge, because that in thus doin¦ge, the humors, bloode, matter, and the exter∣nall ayre might be repelled, from the lippes, or edges of the vvoūde, because such thinges, may hinder, or at the leaste deferre, the curin∣ge of the same: and in soe much, as the lippes of the vvounde are not vvell vnited the one vvith the other, and kept in that stature, & vni∣tinge, the vvound can verve badlye & hardlye be cured.

And alsoe if the lippes of the vvounde, doe greatlye chaunce to svvell, & inflame, & theye shrinck in themselves, or els if they be to much brused or plettered, vve must not thē in anye sorte resovve it agayne: for the suture vvould strayght vvaye breake, and soe conse∣quentlye the inflammatione increased, but must delay it soe longe vntill the foresayed in∣flammatione be seaced & the vvounde be co∣me to goode suppuratione and matter, and is prepared and readye, to be vnited & brought together.

What is necessarye vnto the sowinge of a wounde, and howe we ought convenientlye to doe it Chap. 3.

WHen as the Chyrurgiane desi∣reth aptlye & convenientlye to sovve a vvounde, he must first of all have in his hande a needle, & therto a threde, and a canulle: Cōcerninge the nee∣dle, shee must be of a reasonable length, som∣times right, & sometimes croocked, accordin∣ge as the partes reqvire, nether must shee be made of to harde a steele or mettle, vvher of they easylye might chaunce to breake, but of gentle steele, because they might rather ben∣de then breake: althoughe shee ought to be stiffe, smooth, & infrangible, havīge a sharpe triangled poyncte, because that in her entrin∣ge she might both cut & pricke, & soe the ea∣syer perce or goe ther through, & because that in her govvinge throughe, she might make a longe little vvound or hole, & not rounde, be¦cause those little rovvndes, are more difficulte to be cured, then the longe holes. In the heade she must be one both sydes hollovve, in form of a gutture, because the threde might therin∣ne be hidden & buried, & not hinder the per∣cinge or entrance of the needle, in the dravvī∣ge throughe therof, because shee then touch∣eth the bodye in that sort more easyer and sof¦ter: It vvill not alsoe hinder accordinge to the sayīge of Avicenna, that vve somvvhat anoynt the needle vvith oyle, vvherbye the payne of the pricke night be somvvhat easyed, & the fo¦resayed needle enter the easyer.

The threede must be smooth, soft rovvnde, and vvithout anye knott, all eqvivalent vvith the thicknes, & greatnes of the needle, but not in any sorte to thinne, least he chāce to breake or cut through the lippes of the vvoūde. VVe may rather take a threde, thē silke, because the knott of the silke easylye vnlooseth, throughe his vveaknes: it is right true that the foresayed threde, must not be to harde, because there throughe he might hurt, the vvoūde, & not to softe least he breake nor chaūce to corrupte, before the time the vvounde be fullye healed, vvherthrough the lippes of the vvoūd, might agayne dissolve & vvaxe loose yet notvvithstā¦dinge novve a dayes vve had rather vse a thred of carmosyne silke, thē a hempen threde, or of flaxe, vvhich Galenus disprayseth & misliketh, in his third booke of methode, vvhere he best liketh of a threde of vvollen vvhich may be likened vnto, a brovvne threde, or a vvhyte silke threde ravve, vvithout beinge dyede, or coloured: because that in the dyinge someti∣mes is entermingled poysen, as in the scarlet dye ther cōmethe Arsenicū. The fore sayed Gale¦nus vseth stringes made of smalle guttes, as are lutestringes, but cōsideringe there moysture, they quicklye beginne to svvell, & rotte, vvher¦fore vve had rather vse a stronge brovvne thre¦de, vvhich vve must dravve throughe vvaxe & vvaxe it because soe much the lesse he might corrupt & rott, & houlde the faster. And to ef∣fect this & surelye to sovvea vvoūde vve must have a Canulle vvhich one the one end must be roūde, splitte, & vvith a hole, partlye becau∣se the edge or lipp of the vvoūde, vvhich vvith the needle vve vvoulde pearce, & because that the fore sayed lippe may stay, & rest it selfe, on the pype, vvithout stirringe this vvay or that vvay, & throughe the vvhole to espye, vvhen the needle is halfe perced throughe as then to dravve her through vvith her threde, vvithout ether the nedle, or the thred to dravve the lip∣pes of the vvounde tovvard, them, & because throughe the splitte of the pype, it might the the easyer frō thence be removed, to rest therō the other edge therafter, vvhē she allsoe must be thrust throughe. And convenientlye to ef∣fect this sovvinge of a vvounde, vve must first thrust through the vpper lippe of the same, si∣tuatinge at the first the holed ende of the pype vvith the left hande, internallye vvithin the lippe of the foresayed vvounde, because she may rest therone, and not stirre this vvay or that vvay, then vvith the right hande vve must thruste the needle throughe the externalle par¦te of the lippe, invvardes, & then set the Can∣ulle on the externall parte, of the nether lippe of the vvounde, & thrust the needle internal∣lye outvvardes, of the foresayed lippe, & gent∣lye dravve throughe, the threde, because as then vve may couple & ioyne agayne the lip∣pe together: & if it be needfull to lay more stit¦ches, vve must lay them as is a fore sayed: some mē hould the lippes vvith ther fingers in stee∣de of a Canulle.

The kindes and differences of sowinge, or sutures, the the time, and the methode, or rule to take thē away. Chap. 4.

THe aunciēt Chyrurgianes ha∣ve invented & fovvnde out di¦vers & sundrye vvayes of sovv¦inge of a vvounde, cōsiderin∣ge, & markinge one the vvoū∣ded parte, & nature or qvally∣tye of the disseases: for the vvoundes of the ar∣mes, or legges, as in those places vve may bet∣ter & vvith more cōvenience vse the dry sutu∣re: the vvoūdes of the bellye, are alsoe on an o∣ther fashone sevved, then the vvoundes of the guttes. The profounde & deepe vvoundes are sovved, on an other fashon, thē the not deepe vvoūdes: Alsoe are the debile & imbicille per∣sōs sovved one an other fashō, as are vvoemē, thē those vvhich are robuste & stronge, & by great paynes takinge and labour have a harde skine, ther in to eschevve & flye the deformi∣tye vvhich after the sovvinge vvilbe seene.

All auncient professors have vsed, & have

had in esteē, thre sortes of sovvinge of vvoun∣des, as naemelye, the incarnative, the bloode stoppinge, & the conservative sovvinge. The incarnative suture is soe called because that throughe her vnitinge, shee ioyneth together the separated partes, if soe be vvithout violēce & cōveniētlye they may be brought together: vve vse this māner of suture in all freshe vvoū¦des, or in these, vvhich are renued. And this sovvīge is effected after five māner of vvayes. VVher of the first is called, the knotted suture or sovvinge, because that in evetye stitche, vvhich perceth throughe both the lippes of the vvoūd, is every time cutt of, & vvith both the endes of the thred above the vvounde is knitte together: betvvixt the vvhich stitching, vve lay as yet other. This suture is done vvith a vvaxed threde, as is all readye sayed, notinge that bothe the lippes must aeqvallye be ioyned the one vvith the other, vvith out that ether the one or the other, yelde it selfe more this vvay thē that vvay, placinge the firste stich in the middle of the vvoūde, vvith a perforation of both the lippes of the vvoūd, by the vvhich the threde beinge passed, shall one the one syde of the lippe be dravven together, & abo∣ve dobblelye knitte to gether, cuttinge both endes of the threde shorte of, because they should be noe hinderāce, vnto the remydyes vvhich vve shall applye: The vvhich in the re∣nuinge of the dressinge might be the occasi∣one of payne, or brekinge of the stitches, vvhē as vvith the plasters vve chaunced to plucke them. If the vvoūde he greate, vve must as yet lay more stitches, in the middle of the Spaciū, & one both endes of the vvounde, so procee∣dinge forvvardes vntill the vvhole vvounde be layed vvith stitches or sutures, everye stich a fingers bredth the one frō the other, because at the least the lippes of the vvoūde might be brought close together, consideringe, & due∣lye perpendinge the generall observatione a∣bove mētioned, & especiallye that the stitches be not layed the one to neere to the other, or the one to vvyde frō the other because as heer tofore vve have sayed, through the great mul∣titude, and throughe soe many prickes, they bringe & are cavse of vehemēt payne: & cōtra¦ryly they lyinge to fare the one frō the other, the vvoūde as thē beinge not sufficientlye oc∣cluded, or shutt vp, doe little profite, & cōmo∣ditye, therfore they may not be layed to close by on another, nether to farre separate the on frō the other, they alsoe vvhich are layed to looselye, suffer the vvoūde to gape to vvyde, & they vvhich to fast, & strictlye dravve together the vvounde, cause inflammations, & cōpell the vvoūde burst open, vvherfore heerine vve ought te observe a mediocritye.

The seconde incarnative, or fleshe making suture, is done vvith one, or vvith more need∣les, as if soe be the vvounde be greate, & deep, as thē vve beginne to sticke & thruste the nee∣dle in the lippe or edge of the vvoūde, vvith∣out dravvinge of the foresayed needle qvite through, althoughe shee be threded, but must suffer her to continue therine, and vvinde the threde about her, in form of an S as the Tay∣lers doe, vvhē as they are mynded safely to kee¦pe there threeded needle, anye vvher one ther apparrell, as you may see in the figure or form of the haremouth: & soe put as manye needles therin as shalbe needfull, accordinge to the greatnes of the vvounde, & vvinde the threde ther about, and let them cōtinue therin vntill such time as the vvoūde shalbe healed & ioy∣ned agayne. This sovvinge or suture is vsed, in such vvoundes as stande vvyde opē, & in those in the vvhich the lippes are separated the one sōvvhat vvydlye frō the other, & they vvhich vvith the common stitchinge might not be contayned, or Kept together.

The thirde incarnative sovvinge, is called, the penned stitchinge, because most commō∣lye it is done vvith little quilles, or shaftes of a penne, not that the foresaved qvilles, doe ef∣fecte the sovvinge, but because they contayne it, & alsoe are a lett & hinderāce that the thre∣de dothe not cut the lippes of the vvoūde cle∣ane throughe, vvhich if vvith al expeditione & vvith the least payne vve desire to make thē vve must doe as heerafter follovvethe. VVe shall first of all take a stronge double threde vvhich is separated in tvvo, at the end having a knotte, vvhich vvith the needle vve must thruste throughe both the lippes or edges of the vvounde, redoinge the same soe often, & in divers places, as the greatnes of the vvoūde shall reqvire, allvvayes remēbringe that eve∣rye stitch must be a fingers bredthe the one frō the other situated & layed, or therabout.

This beinge in this sort finished we must as then one that syde of the vvound vvhere the knott lyeth of the threde, betvveen eve∣rye dubblethrede sticke a little shaft or qville, or els a little stick of vvoode, vvhich is vvounde in linnen clothe, & must be as lon∣ge in the vvounde it selfe: vvhich after∣vvardes vvith the threde, vve must dravve clo∣se vnto the lippe of the vvounde: and one the other lippe of the vvoūde, vve must through that same dubblethrede, in like sorte alsoe put a qville, or a little sticke, vvound about vvith linnē vvhich in the first must be dravvn vvith one of the foresayed thredes, and vvith a dub∣ble knott be knitted together, bringinge by this meanes the lippes of the vvounde as close together as is possible, in this vvyse proceedin¦ge vvith dravvinge together and knittinge, all the thredes vvhich ther are, in such sorte as the first vvas dravven together & knitte. Such sovvinge, is vsed, in greate, & deepe vvoūdes

in the vvhich vve feare least the cōmon sovv∣inge or stitchinge might chaunce to breake, & cut through the edges of the vvounde.

The fourth is called the drye stich, or sovv∣inge, because this may be done vvithout pear∣cinge of the skinne or fleshe: vvhich vve are vvonte to doe vvith tvvo strōge peeces of lin∣nen cloth, vvhich are cut of the syde or edge of the clothe, and vvhich in the endes are cut sharpe or picked, as heere before in the figure vve may see, on the vvhich other ende vve must spreade a verye dravvīge & fast houldin∣ge playster, vvhich qvicklye may be dryed, vvhich must thus be praepared, vve shall ap∣plye this same one both sydes of the vvound, a little higher then the foresayed vvounde, & in such sort that bothe the sharpe endes of the peeces of cloth, may be situated close vnto the edges of the vvounde. This beinge cleaved ve∣rye fast to the skinne, vve must as then so∣vve bothe ther endes close together, vvith∣out touchinge of the skinne, and dravve them together vvith the threde, through the vvhich meanes, vve may compacte the lippes of the vvounde as close together, os vve please. Such a māner of stitchinge is very vvillingelye vsed in the vvoundes of the face vvhēas vve desire to have noe great cicatrice left therin.

The fifth incarnative sovvinge or stitchin∣ge, is effected vvith iron hoockes, vvhich one both there endes vveare crooked, vvith the vvhich vve must hould both the lippes of the vvounde, bringinge the foresayed lippes close together: but because they cōtinuallye pricke & are never vvithout causing of payne, & mo∣reover might chaunce to sticke in anye mem∣brane, vvhich might suscitate & cause payne, concurringe of humors, & inflammatione, in the vvoūded parte, it is novve a dayes noe mo¦re in vse. The seconde suture is, the bloode-stoppinge suture, soe called, because she sten∣cheth & stoppeth bloode, and hindereth that the ayre can not enter into the vvoūde, vvhen as in manner of revolutione vve turne the needle, (as the furriers are vvōte to doe, vvhen as they sovve together the skinnes, & lay the stiches, reasonable close, harde, & on by the o∣ther. Some vse this suture, or stitchinge, vvhē as the great vaynes or arteryes, are hurt or cutt of, cōsideringe the great sheddinge of bloode, through the vvhich they are compelled to doe soe, & soe the more easyer to ioyne & bringe together and shutt the lippes of the vvounde.

But this stitchinge, is nothinge to certay∣ne, because the one stitchbrekinghe, all the other breake & goe loose, moreover the bloo¦de vvhich is therin cōtayned causeth that part to svvell, and leeseth as it vveare himselfe be∣tvveen the muscles, vvhich alsoe therafter by cōtinuance of time corrupt & are mortifyed. VVherfor I vvoulde councell the yonge Chi∣rurgiane, that he should rather tye or binde the mouth of the vayne or arterye, or vvith a Cauterium cauterize it together, thē to vse such a stitchinge, vvhich is farre cōvenienter, in the vvoundes of the small guttes, or entralles, of the blather, or in the vvoūdes of the stomacke to be effected, if at the least in the tvvo last it may anye vvay possible be brought to passe.

The thirde sovvinge, or stitchinge vve call the conservative, or the praeservinge suture, because she praeserveth, & Keepeth, the lippes op the vvounde vvhich are verye vvyde sepa∣rated the one frome the other, or els because they are plettered, & crushede, or els because ther is anye parte of them lost, throughe the vvhich they cā not by any meanes be brought & ioyned agayne, the one vvith the other, re∣qviringe onlye to be defēded, & mayntayned in that estate, till such time as the vvounde be come to a goode suppuratione & incarnatio∣ne: vvher through the vvoūde, is soe much the the sooner cured & cicatrised, vvithout anye greate, or deformed cicatrice, remayninge in the place. This stitchinge is alsoe vsed vvhen vve suspecte, that ther is anye thinge cōtrarye to nature in the vvoūde, vvhich vve vvilling∣lye vvould have therout , vvherfore vve doe not bringe the lippes of the vvounde so close together, as in other sutures, contentinge our selves, that in such sorte vve may continue it.

Touchinge the time, vvhē vve ought to cut a sunder the stitchinges, ther is noe certayntye therof, because in some bodyes, the vvoūdes are sooner cured, then in others, alsoe the one parte healeth sooner then the other, vvher∣fore vve ought not to cutt loose the stitches, before the vvounde be soe far come, that she hath noe more neede of the stitches, vvhich cuttinge, must alsoe be done one divers man∣ners, as the stitchinges are divers: for the knot¦ted stitchinge, must be done, by cuttinge eve∣rye stitche aparte, right at the knott, liftinge vp the threde vvith the privette or searchinge iron, havinge in this sorte cut of the knott of everye stitche, vve shall as then vvith the pin∣cet or pinsinge iron dravve them out by there knot layinge the one finger one the stitch, to hould that fast that the one lippe of the vvoū∣de, be not dravvē out vvardes. That stitchinge vvhich happeneth to be done vvith one or more needles, as in the haremouthes, in these vve cut a sunder the vvhole threde, vvhich is vvoūde roūde about the needle, thē gentlelye takīge the same avvaye, & therafter the needle alsoe. The pēned suture, is takē avvay through the discidinge or cuttinge avvaye, as is above sayed, that vve ought to cut everye stitche abo¦ve the knotte, and ther gentlye dravve forth the thredes therout. The drye stitch is taken

avvay, vvhen as ether vvith vvater or vvith a∣nye oyle vve moysten the same. And the sutu∣re of the furriers fashone, is verye difficulte to be taken avvaye: in this stitchinge, vve must first of all beginne to cutt, the first stiche, and soe proceedinge forevvardes, vvith the scis∣sors, or sheares, vnto the end, if at the least it be to be done, and then easylye and gentlelye take every stitch out apart, allvvayes houldin∣ge fast the lippes of the vvoundes vvith pour finger, least that they in anye sorte lift vp them selves because if it soe chaūced vve coul¦de not easylye resovve them agayne.

❧How we ought to thrust in agayne the guttes, and the nett, which is suncke out of the bellye. Chap. 5.

IN the great vvoundes of the bellye, vvhich enter into the concavitye of the same, therin is vsed an other māner of sovv¦inge, vvhich the auncient pro∣fessors call Gastroraphia, that is as much to saye, as the bellye suture or sovvi∣nge. But because in such vvoūdes, most com∣monlye the guttes & the net come to sincke out, it is therfore first of all necessarye, that vve hādle of the meanes, throughe the vvhich vve might agayne restore in to ther former place the guttes, or the nett, for othervvyse can not the sovvinge be effected, or brought to passe.

VVhen as therfore it chaunceth, that the guttes are suncke out of the bellye, vve must then first of all dillygentlye consider, vvhether in noe place they are vvounded, or hurte, se∣condly, vvhether as yet they retayne the natu∣rall coloure, for if soe be the small guttes are cleane cutt of, & especiallye that emptye one, vvhich vve call Ieiunum, it is then impossible that he may be healed agayne, because of a great companye, and divers greate vaynes, vvhich are therin, allsoe consideringe his sub∣tyle and synuishe tunicle or koate, and becau∣se he continuallye receaveth the Cholera, and is situated more neerer the liver, then anye o∣ther. But the great guttes beinge hurte, vve may rightvvell sovve them, yet not vvithout a stedfast hope that vve are able to cure them, althoughe in respecte of the smalle guttes, by the great ones, vvhich are hurte, it is allvvayes better to have a doubtfull confidence then a certayne dispayre, as much as belongeth vnto ther curinge. If soe be anye of thē be blacke, or pale, (vvhich is a certayne signe they have lost ther feelinge) there is nothinge to be do∣ne vnto them, or at the least verye little. But if soe be as yet they retayne the vitalle colou∣re, vve must by all meanes endevoure to brin¦ge them in agayne, and that vvith all possible expeditione, because the externall ayre, in the vvhich they are not vvōte to be, doth straight vvayes change and spoyle thē. And first of all if they be vvounded, vve must stitch thē vvith the furriers suture, vvhich above vve have di∣scribed, & vvhē they are sovved, bringe them into there naturall place or situatiō, dilligent∣lye notinge that vve doe not let the end of the threde hange in the vvoūde, because vvhen as they are cured, vve may dravve the threde ther out, & not let it sincke into the bellye, for the vvhich occasione he ought be reasonable lon¦ge, vvithout cuttīge of him from the sovvīge.

But vvhen as vve vvill beginne or take such a thinge in hand, vve must as then conveniēt∣lye set, or lay the patient: even as if the vvoun∣de vveare in the bottome of his bellye, vve then laye the patient one his backe, vvith his thighes & his buttockes alofte: if soe be the vvounde vveare in the vpper parte of his bel∣lye, the patiēt must lye one his backe hyghlye situated all most sittinghe, because that the vvoūded partes may suspend & hange in the bellye: if soe be the vvoūde be in the right sy∣de, vve must thē situat the patient one his left syde, and if in the left syde he be vvounded, he must then lye one his right syde: vvhen as the vvoūde is soe narrovve, & soe smalle, that the svvollē gutt, vvhich hāgeth out, cānot agayne be put therin, it is then necessarye, ether that by arte vve drive avvay, & consume the vvyn∣des vvhich cause the tumefactione and svvel∣linge, or that vve dilate the vvounde: but it is allvvayes best that vve trye first of all to repell the svvellinghe of the guttes, vvhich must be effected vvith some resolvinge and strengtheninge medicamentes, amongst the vvhich must be entermingled some mollify∣inge and softeninge medicamentes: as vvhen the guttes are to drye, vve must then bath thē, in vvarme vvater, in the vvhich must be done a little quantitye of oyle of roses, or els vvith some grosse blacke vvyne, because it streng∣theneth and vvarmeth the guttes more then vvater: & if soe be the guttes vvith these reme∣dyes, vvill not as yet relaye ther svvellinge, & tumefactione, it vvas then the vse of Mr Pa∣re, chiefe Chyrurgiane to the kinge, in divers places to pricke them throughe, vvith a need∣le, through the vvhich the vvyndes as then de∣parte. Havinge thus finished all this, if soe be there be such a quantitye of guttes suncke out of the bellye, that they can not in anye sorte be put in agayne at the same entrāce, or vvoū∣de, because shee is to little, vve must as then dilate it vvith a crooked Lācet, vvhich cutteth but one the on syde, dilligētlye notīge that in any sort vve doe not hurt the entralls, vvhich beinge finished, a cōveniēt persone thervnto shall vvith his fingers, hould a sunder the ed∣ges of the vvoūde, & the Chirurgiane impose

foresayed guttes agayne into ther places, first of all intrudinge of those vvhich vveare last, in the comminge or sinckinge out, exactlye notinge, that everye circumvolutione of the guttes, or everye revolutione of the same, may obtayne ther ovvne place, intrudinge the sa∣me therin vvith the fingers, and one such a manner that the one may follovve the other: othervvyse that vvhich is allreadye thruste in, the finger beinge taken avvaye, might chaun∣ce retire and come forth agayne, vnlesse that vvith anye other finger vve retayned the sa∣me, vvhylest that the other finger is finishin∣ge his operatione or vvorke, vvith bringinge an other portione or parte, into his place, and vsinge this manner,they may easylye be redu¦ced into ther former places. VVhich beinge done, (imposing or layinge the hande one the vvounde) vve must as then a little stirre and iogge the bodye of the patient, vvhere throu∣ghe the entralles, vvill situate, settle, or place them selves everye one in his naturall & pro∣pre place, even as they vveare, before they vve∣are removed out of the same. If the net, issu∣eth out of the vvounde, and the same be not hurt, or vvithout anye vvounde, and as yet sovvnde, vve must genttlelye cause it to sincke one the guttes, but if soe be anye parte ther of or portione is become blacke or leadishe co∣loured, vve must as thē a little above the blac∣kenes bynde it, to praevent the bleedinge, and cutt it of vnder the foresayed succincture, and immediatelye reduce that into the bellye a∣gayne vvhich is not as yet blacke, & is yet soū∣de, layinge the end of the threde hanginge out of the vvounde, because therafter vve might easylye extracte and dravve it forth, vvhen as it shalbe therof loosened, and the vvounde be come te goode suppuratione and voydinge of matter.

❧ Of the stitchinge of the bellye which we call, Gastroraphia Chapter. 6.

THe guttes or entralles, and the nett, beinge brought into ther severall places, vve must as thē sovve, & stitch vp the vvoun∣de: but because such suture, accordinge vnto the opinions & sayinges of divers, may not be done in that sorte, as other stitchinges, or sovvinges, to vvit the ioyninge together of that, vvhich is of one nature and dispositione, the one vvith the other, as the Peritoneum, vvith the Peritoneo, (& soe forth of the skinne and the muscles) but vve are vvilled and councelled that vve ioyne and stitch the Peritoneum, vvhich is a membra∣ne, vvith the muscles, and vvith the skinne E∣pigastri, because the same beinge verye synuis∣he, vvill verye difficultlye be cured or healed, vvith the other parte Peritonei, vvhich opposi∣telye is situated agaynst it vvhich is allsoe of the same synnuishe substance. In fine vve are councelled, to sovve vp the edges of the vvoū∣de vvhich is in the right syde Peritonei, vvith the muscles, vvhich are in the left lippe of the vvounde, soe that one this manner the muscu¦lous fleshe, of the right lippe Peritonei, vvhich healeth vvith the left lippe of the foresayed Peritoneum, vvith the musculous fleshe one the one syde, and the muscvlous fleshe vvith the Peritoneo on the other syde. Because that Peri∣toneum, vvith the Peritoneo, can not be healed, vvherthroughe the vvounde onlye above in the fleshye parte might chaunce to heale, out of the vvhich might ensue a tumefactione, as if it vveare a roushing, or issuinge forth of the navel, consideringe the foresayed Peritoneum, vvhich throughe erectione & heavinge vp of the guttes, could not in anye sorte conioyne together: and such a meaninge muste be done one this manner. The vvounde beinge grea∣te, vve must have a convenient minister or servāt, vvhich must vvith his hand one the ex∣terior parte of the vvoūde depresse it dovvne, because as then shee may be shutt & closed, & nether the guttes, nor the nett, roush therout sufferinge only a small portione of the vvoū∣de vncovered for the Chyrurgian, vvho vvith his threded needle, must begīne his first stitch in the end of the one lippe of the vvounde, thrustinge through the externall skinne, and the musculous fleshe of the vvounde, vvith∣out touchinge the Peritoneum, vvhich is there vnder situated, dravvinge the needle frō out∣vvardes, invvardes vvith her threde, & thrust the secōde stitche, cleane throughe the vvho∣le lippe of the vvounde, vvhich oppositelye is situated agaynst the first stiche, to vvitte, the Peritoneum, the muscles and the skinne, first bringinge the stitch cleane through the Peri∣toneum, and dravvinge the foresayed needle, from invvarded, outvvardes: And the same beinge dravvē out, vvith her threde, he must then lay his thirde stitche, as he did the first, beginninge the stitch in the skinne, & in the musculous fleshe, of the first lippe, vvithout touchinge the musculous fleshe, of the first lippe, vvithout touchinge the Peritoneum, dra∣vvinge the needle from out vvardes, invvar∣des, thē he must bringe his fourth stitch, as he hath done the seconde, thrustinge cleane throughe the Peritoneum, all the musculous fleshe, & the skinne, dravvinge out the need∣le from invvardes, outvvardes, & in this sorte he must proceede, and goe forvvardes, vntill the vvhole vvounde from end to ende be cle∣ane sovved vp, thrustinge throughe on the

one syde, onlye the skinne & the musculous fleshe, and one the other syde the Peritoneum, the musculous fleshe, & the skinne: because the sovvinge of the Peritoneum onlye, vvith the other part Peritonei, is not sufficiente, nether the suture of the fleshe onlye, but this suture must as vvell be done in the one as in the o∣ther, endevouringe allvvayes to vnite the Peri¦toneum vvith the musculous flesh.

Some there are vvhich effect this suture on this manner, follovvīge, beinge of opinione, that those partes, vvhich are of one nature & propertye, verye easylye vnite them selves the one, vvith the other, as the skinne vvith the skinne, the fleshe vvith the fleshe, and the membranes vvith the membranes, vvherfore they bringe ther first stitch, quite, and cleane throughe the skinne and the musculous fles∣he, from the first lipp, vvithout touchinge the Peritoneum, vvhich is thervnder situated, dra∣vvinge there needle from outvvardes, invvar∣des, vvith her thred, layinge ther seconde stit∣che, in the lipp right opposite agaynst that, thrustinge then onlye throughe the Peritone∣um, & throughe a little fleshe, dravvinge the needle, from invvardes, outvvardes, thē they bringe there thirde stitch, in the first lippe of the vvounde, thrustinge throughe the Perito∣neum, & a little fleshe, vvithout ether thrustin∣ge through the muscles, or the skinne, dra∣vvinge there needle from invvardes, outvvar∣des, & then they bringe there fourth stitch in the opposite lyinge lippe, & thrust throughe the skinne, and throughe the musculous fles∣he, vvithout touchinge the Peritoneum, and in that sort proceede forevvardes, vntill the vvhole vvounde be sovved, soe that throughe one edge of the lippe, but yet at divers times they thrust throughe the skinne and the mus∣ous fleshe, and allsoe the Peritoneum.

Amonge all other sortes of sovvinge the vvoundes of the bellye, or stitchinge of them this vvhich vve have taken out of Celsus is the least daungerous and the best alsoe, & easyest to be done. That vve must have tvvo threded needles, vvith one threde, the one needle at the one end, and the other needle at the other end of the threde, vvher of vve must take the one needle in the right, & the other in the left hande, vve must beginne in the end, of the su∣perior parte of the vvounde one the left sy∣de, first of all pearcinge throughe the Peritone∣um, then the musculouse fleshe, and the skin∣ne, dravvinge the needle vvith the threde out, vnto the one halfe, from invvardes, outvvar∣des, then vve must vvith the other needle of the left hande, make the seconde stitch, right opposite agaynst the first, in the right syde of the vvounde, beginninge vvith Peritoneo, as vve have sayed of the first stitch, on this sorte the acuitye or poyncte of the needle is farre e∣noughe frō the entralles or guttes, & yet not∣vvithstandinge the heade close vnto the fora∣sayed guttes: VVhen as therfore the needles have pearced & passed throughe from the one syde to the other, vve must as thē chāge hāds, in receavinge agayne of the needles aforesay∣ed, & take the needle, of the right hand, in the left hand, & the needle of the left hand in the right this permutatione or changinge beinge in this sorte effected, vve must then agayne thruste throughe the lippes of the vvoūde, as al readye hath binne done, to vvitt, from the internall parte, tovvardes the externall, & soe proceedinge forevvardes, as much as is suffici∣ent, and allvvayes consideringe that the one stiche be allvvayes layed right opposyte a∣gaynst the other, in this sort proceedinge, vn∣till the vvoūd be vvholye sevved vp, allvvayes remembringe to leave a little apertione, in the bottome of the vvoūde, throughe the vvhich the congealed bloode, and the threde may be avoyded, vvhich apertione, vve must alvvayes keepe aperte or open vvith a little leaden hol∣lovve pipe, vvhich in the end must be tyede & bovvnde vvith a threde, because that by chaū∣ce it doe not come to slippe into the bellye of the patient. And vve must vvel and dilligent∣lye note, that this suture or sovving allvvayes bedone vvith a goode strōge threde, & vvith a needle, somevvhat crooked at the poynct, lay∣inge the stitches, somvvhat closer the one by other, then in other vvoundes of the bodye, because the stirrīge of the bellye, farre sooner causeth the stitches to burst and breake a sun∣der, then in anye other partes of the bodye, & because alsoe the vvoundes of the bellye, are not so subiecte vnto inflammation or incen∣sions, as other althoughe that often times the bellye is thrust throughe.

Notes

• Sixe thinges vvhich in sovvinge must be cōsidered
• Descripti¦one of so∣vvinge.
• Inventio∣ne & vse of sovv∣inge.
• Sovvinge in a sepa∣rated pla∣ce, is vn∣profitable and nee∣deles.
• The tēdo¦nes are daunge∣rous to sovve and vvhy.
• Why vve may not in the re∣sovvinge of a vvoū¦de dravve the lipps or edges close toge¦ther.
• Fleshe vvith Fles¦he com∣meth far∣re sonner to vnite, thē skin∣ne vvith skinne.
• Sovvinge may not by anye violence be done in the lip∣pes of the vvounde.
• We may in noe vvi¦se sovve the lippes of an in∣flamed vvounde.
• What for∣me the needle must ha∣ve.
• What for∣me the threde must ha∣ve.
• Why the threede may not be dyed or colou∣red.
• Hovv to sovve a vvounde conveniēt¦lye.
• Divers formes of sovvinge, accordige vnto the diversitye of the vvounde.
• Three sor¦tes of so∣vvinge by the aunci¦ent pro∣fessors.
• Incarna∣tive sutu∣re, & her vse five manner of vvayes.
• Incarna∣tive or knotted sovvinge.
• The se∣cōd incar∣native su∣ture.
• The thir∣de incar∣native su∣ture.
• The fourth in¦carnative suture.
• The fith kind of sovvinge is noe more in vse.
• The secō∣de gene∣rall suture
• The thir∣de Stit∣chinge.
• Sovving of hare∣mouthe.
• The pen∣ned sutu∣re.
• The fur∣riers fas∣honed su¦ture.
• Gastrora∣phia or bellye su∣ture.
• The small guttes beinge hurte, & cleane cut a sun∣der, can not by anye me∣anes be∣cured.
• After vvhat mā¦ner vve must set the patiēt
• What vve ought te doe vvhē the descē¦ded and svvollen gutt can not be put in ag∣ayne or restored into his place.
• The en∣tralls must eve∣rye one be brought into his naturall statione.
• After vvhat sort vve ought to put in the net.
• The sovv¦inge of the bellye must not be done as the o∣ther sutu∣res.
• An other fashon of sovvinge of the bel¦lye, accor∣dinge to some mēs sayinges.
• The man¦ner of sovvinge of the bel¦lye out of Celsus-
• By the left lippe vve must not onder¦stāde the left syde of the pa∣tient for it is the right syde of the vvounde, but rather the left syde of the Chy∣rurgiane.
• What mā¦ner of threde & needle vve must haue.