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.

Of the swellinge of the Almondes, and of the vl∣cerations of the same. Chap. 6.

ONe both sydes of the pallate, and in the hīder partes therof, in the angustnes of the throte, vvhich of the Greeckes is cal∣led Isthmos, hath nature crea∣ted and formed, tvvo Almon∣des, the one right opposite agaynst the other, vvhich are therfore called Paristmia: vvhich be cause of the forme, figure, and qvantitye ther∣of, are vvholye likened to an Almonde, & are for that occasione called Almōdes: ther func∣tione, and office is, that they retayne in them, a certayne sputaminous humiditye, vvhich sincketh & descendeth out of the heade, ther∣bye not onlye to refreshe & moystē the mou∣the, & the circumiacent partes of the same but alsoe the throte, and the entrance of the sto∣macke, because the tunge in speakinge might not vvholye be exsiccated and dryed, and that the cōtinuall speech might not therby be hin∣dered, and interrupted.

These foresayed Almondes, are situated, in a moyste, and vvarme place, and consideringe ther spongious, nature, are subiected to all cō∣cursions of humors, and all inflammations, vvherthroughe oftētimes they vvaxe harder, and greater, thē naturally theyought to be out of the vvhich, procedethe an vlceratiō or tu∣mefactione, called of vs Antiades, vvherthrou∣ghe the passage of eatinge, drinckinge, & brea∣thinge is stopped, & interrupted, soe that tho∣se afflicted patientes, can not vvithout great difficultlye, svvollovve, or respire & breathe, & even as the patiētes, heere throughe are co∣me into great perill, & daunger, soe they must

immediatlye be succoured vvith excellent & good remedyes.

The assuredest and most convenient reme∣dye is, that vve cause thē praesentlye to be phle¦botomised, after that they shall at the first ha∣ve vsed a glister: and thē in like sort cause him to be lett bloode vnder the tūge: that vve boxe thē behinde in the necke, that they vse gargri∣ses, vvhich are indifferentlye frigifyinge, and astringent.

This tumefactione oftentimes is of such a magnitude, that it exvlcerateth: vvhich easilye vve may espye, vvhen as vve perceave it to be rumpeled, and vvhytishe, and vvhen as before ther hath binne any prickīge therin. VVhich havinge espyed to be soe, vve must vvith an in¦strument, vvhich onlye to that intent, & pur∣pose vvas made, open the foresayed vlceratiō, or els vvith a lancett, vvhich rounde about vn∣to the poyncte is vvounde vvith linnen. The apertion must be reasonablye dilated, because theris noe especiall greate vayne situated in that place, vvhich vve might hurt, except it vveare in the bottome or roote of the foresay∣ed Almondes. VVe are sometimes cōstrayned to opē this vlceratione, before it be fullye ma∣ture, and ripe, to vnburthen, and release that parte therof, because the bloode vvhich issu∣eth out of the foresayed vlceratione, diminis∣heth & intercepteth the payne, and inflamma¦tione therof, adminestreth better passage vn∣to the meate, and drincke, and finallye, prolō∣geth the breathe. It is right true, that vve all¦vvayes in the first, ought by all meanes ende∣voure to mitigate the payne, and coole the caliditye of the vlceratione as much as is pos∣sible.

If soe be these sayed Almōdes, are groovvē soe longe & harde, vvith out anye hope to re∣duce them agayne to ther former & naturall estate, & beinge, vve must as then vse the ma∣nuall of Chyrurgerye thervnto, ether by cut∣tinge of the same, or els throughe inscisione: if soe be there be nothinge to hinder or be a let heere vnto, then the ligature vveare most convenient thervnto, and especiallye, vvhē as vve feare anye superfluous bleedīge. VVhich verye conveniētlye may be done, vvith an in∣strument, one the same forme and fashon, as before vve have rehearsed, in the tyinge of the pallate, ever observinge, that vve cutt therof noe more, then is needfull, contentinge our selves thervvith, not to cut therof anye more, then that vvhich surpasseth his naturall mag∣nitude, & greatnes: because that throughe the largenes and romthe of the throte vvhich by this dissectione might chaūce, there be not ir∣ritated and occasioned to follovve, all such ac∣cidentes and inconveniēces, as before vve ha∣ve discribed, of the pallate vvhich is to shorte cut of, or anye daungerouse bleedinge, if soe vve descide and cutt it of vnto the naturall, & sovvnde fleshe, of the forerehearsed almon∣des, because of the greate vaynes vvhich there vnder lye dispearsed.

But before vve proceede unto this operati∣one, vve must consider, vvhether they be not of some canckerouse nature, because those vvhich are canckerouse may not by the ma∣nualle, operation of Chyrurgerye be cured: they are most easyest knovvne, vvhen as they are harde, of a purple coloure, rugged, full of payne, and have a great roote. But if they be pale rovvnde, tender, smoothe, and belovve thinne, vve may as then vvithout daūger tye, and cutt them of. And in as much as concer∣neth this operatione, the historye of Albucasis shall at this time suffice, to instructe the yon∣ger Chyrurgian, to imitate the same, vvhich affirmethe to have had a vvoman in handes, vvith such an vlceratione vvherbye her thro∣ate vvas allmost occluded and stopped, that vvith great difficultlye shee respired, & brea∣thed, nether coulde shee anye more eate, or drincke, beinge in greate perill, & daunger of death, if soe be that in that estate she had con∣tinued but one day longer, in vvhome this vl∣ceratione vvas soe extreamlye svvollen, that it had yet spreade it selfe abroade into tvvo branches more, into the nostrelles. In vvhich greate necessitye, and perplexitye, vvith al ex∣peditione he tooke, a little hooke, vvhervvith he layed houlde one the one branche therof, vvhich vvas come into the nostrelles, vvher∣vvith he drevve forth therof a reasonable qvā¦titye, and then as deepe as he coulde, he cutt it of, & havinge done the same, in the other no∣strell allsoe he hath aperted and opened her mouth & depressinge the tunge dovvnevvar∣des, hath taken houlde on the svvellinge and tumefactione, vvith a hooke, & allsoe cutt a great qvantitye therofe, vvithout anye greate store of bloode issuinge out of it: This beinge finished, the miserable & poore vvomā hath immediatlye opened her mouthe & beganne to eate, & drincke vvater. At other seasons al∣soe therafter he hath cut avvay ther frō other peeces, but yet notvvithstādinge, as oftē & as much as he descided & cut therof, is increased agayne & grovvne thervnto: vvhich vvhē he had marked, he cauterised the same, & by this meanes in the end hath praevented the excre∣scence of this tumefactione: but beinge con∣strayned to take his iourny to some other pla¦ce, coulde never heare, or by any man vnder∣stande, hovv it happened therafter vvith her: & it may right vvell be thought, that the cau∣terisinge of this dissease vnto his roote, could not in anye sorte increase agayne, as before it had done.

It happeneth allsoe sometimes, that the Al∣mondes soe chaūce to svvelle, that ther is noe hope left, that vve shoulde perforate, or thrust them throughe, or to binde & tye thē, because somtimes it is impossible for the patient to o∣pen his mouthe, & not beīge able in any sorte to respire, must of necessitye dye: vvhich per∣ceavinge to be in such an estate, vve are then constrayned in our extreame necessitye, to ta∣ke our last refuge, vnto the makīge of an insci∣sione in the throte, or Trachea arteria, rather thē vvith our eyes behoulde the patiēt to smother & choake. VVhen as therfore vve vvoulde effect this, vve must cause the patient to lye, & leane on his backe, and hange his heade back∣vvardes, because the throte, or Trachea arteria, may evidentlye shevve it selfe, then vve must vvith our fingers, take hould on the skinn, of the third, or fourth ringle of the throat, vvher vvith the foresayed, circles, or rovvndes of the throate are covered, & lifted vp, novv this be∣inge, soe heaved vp, vve must accordinge vnto the lōgitude therof make the inscisiō, vvhiche beinge cut throughe, & agayn let fall, vve shal as then perceave the throte bared, & if soe be therone vve espyed any vayn, vve must detru∣de it one the one syde & eschevve, or avoyde the same. VVhich beinge effected, vve must vvith the poyncte of a croocked lancet, make our inscisione thvvarte over, betvveē the thir∣de or fourth rotūditye or circle, qvite through the mēbrane, vvhervvith both the foresayed cartilages, or circles are the one vvith in other vnited, & holden together, of vvhich betvveen thē both is situated, vvithout touchinge ether of both these cartilages, or rovvndes, into the concavitye of the foresayed Trachea arteria, or throate, vvhich easyly vve may perceave vvhē as the breath issueth forth of the vvounde: in the vvhich vvound, immediatlye therone, vve must impose a silvern, or gouldē pipe, because ther throughe duringe some shorte space the patient may breathe. This sayed pipe must in the one end be somvvhat broade, vvith a thre∣de theron fastened, because that through the dravvinge of breath, it doe not chaunce to be dravvne into the throate. Novve the daunger of choakinge beinge passed, vve must as then take it therout agayne, because that the vvoū∣de, vvith convēnient remedyes may be cured.

Notes

• The vse, situatione & compo¦sitione, of the Al∣mondes.
• A tume∣factione called Antiades.
• Reme∣dyes a∣gaynst the tumefac∣tion An∣tiades.
• Signes hovve to knovv vvhē the tumefac∣ted Almō¦des, exvl∣cerates and ther remedyes
• Ligature, or inscisi∣on in the almōdes, vvhē they are gro∣vven to longe & harde.
• The canc¦kerouse almondes may not be tyed, not cut of.
• Historye of Albu∣casis.