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 SEAVENTH TREATISE OF THE OPE∣ratione of Chyrurgerye, Contayninge sixe Chapters. (Book 7)

• Of the Caries, or of the corruptione & rottinge of bones. Chap. 1.
• Of the fistles of the Privityes or fundamente. Chap. 2.
• Hovv vve ought to dravve forth Childrene out of their mothers bodye, vvhich of themselves can not be borne. Chap. 3.
• VVherfore the externalle partes or ioynctes of the bodye, must be extirpatede, as Armes and Legges & vvheraboutes the same must in the fore sayed ioynct be done. Chap. 4.
• Hovv vve ought to effect, the extirpation, or dissection of any ioynct, & restraynge the bloode after vve shalle have layed dovvne the patient. Chap. 5.
• Hovv vve ought to extirpate the spoylede, & superflvous fingers, & hovv vve shall separat those fingers vvhich are combinede, & grovven together. Chap. 6.

Of the Caries, and corruptione of the bones. Chap. 1.

* 1.1THe bones, not being spoylede & corrupt, are of natur vvhyt smooth, & solide. They are accordinge to the sayinges of aunciente Chyrurgianes and our dayly experience, subiect∣ed vnto all evell dispositions, vvhich the flesh is subiected vnto, yea allso vnto apostematiōs. Celsus avouchethe, that all bones vvhich have any impedimēt, are ether hurte, corrodede, corrupted, burst, broken, crushed, plettered, or out of ioyncte. VVe may praeiudice the bones to be altered,* 1.2 or polluted, throughe our sight feelinge, matter, and impuritye, vvhich ther∣out issueth: vvhē vve perceave it to be yellovv or purple, and at the last blacke, & as verye le∣arned lye, & discretlye the sayed Author, vvri∣teth, first the corrupted bone vvaxeth fattye then blacke,* 1.3 or putilaginous, that is corroded: vvhen as in touchinge vvith the privet or se∣archinge irō, vve feele the bone to be rugged, and not playn, and the privet, entereth therin, as if it vveare a peece of corrupted, & vvorme eaten vvoode, & especially vve knovvinge the same not to have binn bared of his fleshe, ne∣ther hath binn of the ayre illuminated: becau∣se that sometimes the altered bone, for that it hath a longe vvhile lyen bare, is grovvē to be soe harde, & thicke, thar vvithout greate pay∣nes, vve can not fasten therō vvith the grating iron, through the matter, vvhich is thinne,* 1.4 & subtile, cleere, faetide, stinckinge, & blackishe: vvhen as rovvnd aboute the vlceration especi∣allye, is regenerated a tender & viscouse flesh vvher through the vlceration can not, be cica∣trized, & although shee be cicatrized, therafter redubleth herforces, & breacketh open agay∣ne.* 1.5 Such alteration procedeth of some cōcur∣rēt humors, that descēde on the bared bones, as appeareth vvhen they are through soackede vvith any pestiferouse humors, or els because they are of their flesh & pellicle, or mēbrane Periostio, denudatede and barede vvherthrough

they corrupte & vvaxe drye for vvant of blood vvhervvith they shoulde be nourished, or els because they are to full of humiditye, & moy∣sture, throughe the purulēt matter, vvhich cō∣tinuallye theron distilleth, & corrodeth: ether because they are to much ānoyncted vvith oy∣le, & to much fatty salves therō applyed, vvher∣by the vlceration is corrupted, & putrified: Or because she is polluted, vvith the matter of the vlceratione, vvhich supernaturallye, & from a∣bove is descēded & theron distilled.

VVhēas therfore for certaynty vve knovve that ther is putrefactiō, & rottēnes in the bone vve must then doe our devoyr to knovv hovv lardge, & profovvnd the same is, because ther∣by vve may the surer knovv, hovv vvith moste conveniēce vve shoulde remove & abolishe the same & cause therin a separatione, because it is necessarye that the vivificēt parte, expelle & drive from it the mortified, or els the mor∣tifiede allso cause mortificatione in the vivi∣ficent partes.

* 1.6Concerninge the magnitude thereof, vve may discerne it through the sight, vnlesse it be operted vvith any viscoufe or slimye flesh, & vve supposing & doubtinge to be more putre∣factione of bones, that is patefiede & evidente vnto vs, throughe the circumiacent partes of the vlceraration, vvhich as then are purple co∣loured through the spongiouse flesh, through the elevatione of the edges of the vlceratione & throughe the diuturnalle continuāce of the same in one estate:* 1.7 For as Hippocrates affirmeth: In the venomouse vlcerations, vvhich for the space of a yeare have continuede, or longer, it can not othervvise be, but necessarilye in the bone vnder the fleshe of the vlceratione, must needes be a corruptione, putrefaction & a cor∣rosione, & some peeces therof come out, the Cicatrises also vvill continually be cōcavouse, & hollovve.* 1.8 VVe therfore certaynlye knovv∣inge this, vve muste as then dilate the vlceratiō denudate the bone, & dilligentlye marck hovv large the foresayede putfactiō is: vvhich muste be effectede vvith causticke medicamentes, by the vvhich the spongiouse fleshe, mvst be cō∣sumede, accordinge as the foresayede vlceratiō reqvireth. Celsus councelleth vs that firste vve make an inscisione in the skīne, to denudate the bone, if so be the putrefaction of the bone, be greater then the vlceratione, discidinge & cuttinge of all the flesh rovvnde aboute, vnto the sovvnde bone: touchinge the depth of the putrefactione of the bone, vve may knovve it throughe the privet or searchinge iron, vvhen as vve feele theron, the vvhich pearcinge deep or not deep in the same, shevveth vnto vs that the foresayede corruptione of bone is great or smalle. But if vv see the bone to be blacke & dry as it happeneth bereft of blood the privet thē vvill not enter therin, vvherfore the depth of such a corruptione, can so certaynly be kno∣vven, as through the perforative Trepane, or els through the little groūd dravver, vvhere∣vvith vve must perforate the foresayede bone through vvhich perforatione of bone, vve ea∣sily shalle perceave, vvhether the bone be bla∣cke, vvhyte, or redde, & vvhether ther issuethe bloode out or not if it be so, it is then a signe that the putrefaction, of the bone is not deep. And if so be vve perceave, the perforated bone to be blacke, it is then a token, that the putre∣factione is deepe, because the corruptione of the bone, pearceth so deepe, & vvhen vve per∣ceave that the bone is vvhyte, & redde, so farre is it then incorruptede.

To the vvhich Caries, or corrupting of bōes vve muste vse the actualle Cauterye, or els allso the potentialle or the Raspatorium: If so be the corruptione of the bone penetrateth not verye deepe,* 1.9 vve muste then grate the foresayed bone vvith a peculiare Raspatorye, & in raspinge of the same, stifly crush therō, that vve may qvick∣lye penetrate through the corruptione, & the operatione, vvih all festinatione be effectede & done. All daūger beinge novv passed, & vve perceavinge the bone to be vvhyte, smooth pu∣re, & solide, it is then sufficient: For it is impos∣sible, that the foresayede corruptione of bones may have an end, as long as vve doe not liberat, & free the same, by one meās or other, from all daūger, & corruptiō. VVhen vve perceave, in raspinge the bone to give bloode from it, it is then a signe that all corruptione is therout, and that the bone is vvell disposed, because that no corrupte or alterede bones vvill give from thē any bloode. This beinge done, vve as then vse the poulder of Aristolochiae of Mirrha of Ireas & of Aloe to liberate the foresayed bone frō al cor¦ruption & praevente the same to be anye more putrefacted and corrupted. If vve suppose, that the Raspatorium, be not sufficient enough, to re∣move the foresayed corruption, as vvhē she is deeply corroded invvardes,* 1.10 & vvhen as ther is a peculiare corruptiō imprinted in the bone, the same alsoe being fatt, & oylye, & if so be the pa∣tient vveare not timorouse of the fyer, the af∣suredest remedye as then is, that vve cauterize the foresayed coruption, vvith an actuall Cau∣terye, vvhich conforteth that parte, and consu∣meth all venoumouse humors, & vvith all fes∣tinatione causeth the corrupted bones to sepa∣rate, & causeth little, or noe payn at all, because the foresayed bone is insensible, and doth not communicate his vnhemence vnto the other circumiacent partes.

VVhen as therfore,* 1.11 vve desire to vse it accor∣dinge to the depthe, & greatnes of the corup∣tion, or Caries, vve must therin vse a meane, of applyinge the foresayed Cauteriū on the bone,

to vvitt vntill through the porositye of the bo∣ne ther commeth out, a frothye matter, & noe lōger: for if vve helde it lōger theron, it should through his great callidity, & throughe the ex∣siccatinge vertues therof, not onlye consume, the humeditye of the putrefaction of the bone but alsoe the naturall humiditye, & moysture through vvhich occasiō, the fleshe ingendreth & increaseth betvveene the sovvnde & the cor∣rupte bones: This doinge, nature in a certayne time therafter, vvill separate the corrupted bo∣ne, frō the sovvndebone, engendringe betvveē them bothe, a tenerouse fleshe, vvhich by little & little hardeneth, as if it vveare Pomgranate-kernelles, vvhich foresayed fleshe, vve oftenti∣mes may see, grovve cleane throughe the cor∣rupted bone, & that in such sorte, as the smalle tender grasse, grovveth through the grovvnde, & as thē is the suppuration, & matter goode & laudable, vvhyte, or reddishe coloured, and vvithout stincke. And vve must heere alsoe far∣ther note, that the Chyrurgian, may somtimes gentlely move, the corrupted bone being cau∣terized, & stirre it, because nature ther through may be opitulated, vnto the separatione of the cauterised bone, and the foresayed bone lyinge sōvvhat raysed, may be lifted on highe, because as thē it houldeth fast noevvhere, but vve may not vvith any violēce take the same therof, for in soe doing, the sovvnde, bone, before cōplet∣lye it be covered vvith fleshe might chaunce of the ayre, to be agayne infected, and corrupted.

* 1.12Nether is it sufficiēt, that once vve apply the Cauterye theron, but must divers & sundrye ti∣mes doe the same, nether must it be glovvinge or red hott, but reasonable hott, removinge of the forsayed cautery frō one place of the bone to the other, or houldīg of the same in one pla∣ce, vntill the place be throughlye vvarmed.

* 1.13The corruptiō, therfore or Caries being very deep, vve must them trepane or boare it vvith a perforative Trepane, vnto the sovvnd bone, or vvith the small grounde dravver, make divers hoales therin, the one close to the other, of an aeqvall depth also, as the corruption of the bo∣ne is, in vvhich trepaned hoales, vve must as thē apply some little hott actuall cauteryes be∣cause the foresayed bone, ther by may be thro∣ughlye dryed: By this operation, the corrupted bone vvill separate it selfe frō the sovvnde bo∣ne, as heertofore vve have sayed. If soe be that the vvhole substāce of the bone be corrupted, & corroded, vve must then vvholye remove, & take the same a vvay.* 1.14 As Albucasis, to this pur∣pose, reciteth a memorable history of on vvho∣me at three sūdry times he tooke avvay allmost the vvhole shinne bone, dividing also the ope∣ration, in thre sundrye & aeqvall times, because the patient vvas not able, to tollerate soe greate payne, because of his great imbicillitye, & alsoe because Albucasis feared least that vnder his hā∣des he should have diede, because through cer∣tayne evacuations, he allvvayes fell into great fayntnes, but in the end vvas perfectlye cured: and in place of bone, ther ingendred in the pla∣ce, a harde carnositye, vvhich so miraculouslye fortifyed from day to day, that he during some continuance of time therafter, coulde agayne couragiouslye goe one that legge.

VVhē as therfore it is reqvisite, to applye the foresayed actuall Cauterye one anye certayne place, vve must dilligentlye consider, hovv vve might liberate, & defende,* 1.15 the circumiacēt par∣tes of the Vlceratione, least they be touched of the cautery, vvhich vve may vvith most conve∣niēce doe, vvith some certayne plasters, becaus nether the fatt nor any other ebullient humi∣ditye, vvhich through the calliditye or heate of the cauterye might chaunce to runne therout, one the selfe same circumiacēt partes, of the vl∣ceratiō, & that therby they chaunced not to be burned, & seared, vvhich vvould be the cause of greate payne and doloure.

Novv therfore to correct & cure the Caries, or corruptiō of bones, ther are divers Chyrur∣gianes of our times & age, in place of the actu∣all Cauterye vse the potentialle:* 1.16 amongest the vvhich the oyle of vitrioll is in the most chee∣fest, in like sort alsoe the oyle of franckinsēce, vvhich of divers Chyrurgians is highlye com∣mended, and esteemed.

Of the Fistel of the Fundament. Chap. 2.

ANd because vve have not heer intended generally to vvrite of al fistles, & to discours of thei∣re matter, & conditions, vvhat partes be therof polluted, of their occasiones, signes, prog∣nosticationes, & of the remedyes, of theire cu∣res, it seemed expedient vnto me, breefelye to shevve, the meanes, to cure those vvhich reve∣ale, & demōstrate thēselves in the Fundament, & that especiallye through a convenient hand∣linge,* 1.17 or operatione of Chyrurgerye vvhen as shortlye and breeflye I shall have taught, in vvhat sorte vve may best and easyest knovve them.

Those Fistles vvhich are ingēdred in the fun∣dament, are of divers & sundry sortes: for some of thē are occulte, others patefyede, the occul∣ted are soe called, because vve noe vvher exter∣nally espye them, and internally in the foresay∣ed fundament,* 1.18 or excrementall gutt have thei∣re apertiō, & issue in the muscle Sphincter, vvhe∣ther they be situated vpvvardes or dovvnvvar∣des, or any vvher one the syde, adioninge vnto any of the tvvo buttockes. VVhich allthoughe

vve can not evidentlye perceave them, yet may iudge, that the foresayed partes, are hurte or hī∣dered, throughe the payne and throughe the stinckinge matter, and humiditye, vvhich issu∣eth out of the foresayed fundament, & through the vvhich commonlye, the shirtes of the pati∣ent are polluted, & throughe certayne vlcerati∣ons also, vvhich before times in that parte they have hadde, or through certayne internall he∣morrhodes, or through any inveterate vvoūd, vvhich vvas badly cured. VVe may also somti∣mes see them vvithe our eyes, through the Spe∣culum Ani.

* 1.19The patefyed Fistles, are therfore soe called, because immediatlye vvithout any daūger vve may evidentlye see them: Of the vvhich ther a∣re some vvhich lye croocked, and curved, & al∣though they have but one apertion, vvhich vi∣siblye vve may see, yet they have divers vvayes, branches, or cubicles, like Conyeburrovves, vvhich of theire patent Orificium, in the bodye, runne this vvay and that vvay, vvhich vvith the searchinge iron somtimes vve may finde, vvhē as vve thrust it this vvay or that vvay, vvher vve feele it of his ovvne accorde to enter, together also, out of the great qvantity of matter, vvhich daylye issueth therout, vve may easylye iudge, that the foresayed Fistle, must needes have mo∣re concavityes, then by the externall fistulouse apertione vve can iudge, vvhich at somtimes is not greate.

Ther are alsoe some Fistles, vvhich external∣lye have but one issue, and doe not passe throu∣ghe the concavitye of the externall, or arsegutt, or through the muscle Sphincter, as easyly thro∣ughe the privet or searchinge vve may percea∣ve vvhen vve thrusting the same therin, vve cā not anye vvher perceave it agaynst our fingers, to the vvhich intent vve must thrust the same middle finger of the left hand in the fundamēt, for if it soe be that vve betvveen our finger, and the privet feele anye thinge it is then a signe that it doth not pearce throughe but if vve fee∣le it agaynst our finger, it the pearceth throu∣ghe.

And novv as concerning the curation of the same,* 1.20 vve vvill not heere treate of anye thinges belonging vnto the medicamentes, but onlye speake of the Chyrurgerye to the curing of this dissease: the vvhich on a threefoulde manner is taught vnto vs, as vvell in the curatione of the internalle, as externalle Fistles: to vvitt, ether throughe ligature, inscisione, or through Cau∣terye.

Although Avicenna, vvith more others are of opinione, that vvith anye of these foresayed remedyes vve ought in noe sort to meddle ther vvith vnles, they vveare too intollerable, and molestiouse vnto the patiēt, but that vvith cle∣ane linnen, vvith Cotten, and vvith decent and convenient lavamentes, vve ought to sustayne them. But for all this not vvithstanding, I vvill heere discribe vnto you, our vse and customes of the auncient Chyrugians.

Novv therfore as vvell to cure the publiqve, and patent Fistles, as the occult and hidden, vve must cause the patient conveniently to lye, na∣melye that the patient must lye one his backe, vvith his legges on highe, retayning and houl∣dinge the foresayed legges, close vnto his belly, and this is the maner, and customes of ayn∣cient Chyrurgians. But vve novve a dayes, cau∣se the patiēt to stande on both his legges, vvith his heade, lyinge on a bedde, disioyninge & se∣paratīge the foresayed legges vvyde the one frō the other, vvhich alsoe of tvvo servantes or stā∣ders by must soe be helde, least that he agayne might chaunce to shut them. The patient be∣ing thus situated, tovvardes the light, vve shall then thrust the middlemost finger of the left hande into the fundamente, havinge vvith so∣me certayne oyle anoyncted your finger, and pared close your nayles: and in our right hande vve must have a privet or searchinge irō, in for∣me of a needle, in the vvhich at the on end ther of must be a threde, vvhich foresayed needle, or Privet vve must thrust into the Orificium of the Fistle vntill vve sensibly feele the same on our finger, and then vvith our finger recurvate, the end of the foresayed needle, & neatlye, & con∣veniently reduce the same vnto the fundamēt, and then dravve the same therout, dilligentlye observinge, that internally vve hurte or vvoū∣de nothinge,* 1.21 and the threde alsoe beinge passed throughe the fundament vve must then cut of the foresayed needle from the threde, & tye the endes of the foresayed threde both together, dravvinge the same reasonable fast, and close together, and vvith a slidinge knott binde the same together, because daylye vve might knitt the same closer, and continuinge this same soe longe in this sorte, vntill such time as vve shall have cutt avvay all the thred vvhich vvas remayninghe betvveene, both the Orificia, and both the apertions become to one, and the threde conseqventlye, vvithout anye mo∣re dissectione of the same, shalbe taken there∣out.

But vve perceavinge the Fistle to have no issue in the concavitye the arsegutt, and the needle doth not come out agaynst our finger beinge in the foresayed arsegutt, and that ther as yet is some pellicle, or membrane betvveene them both, the needle havinge a reasonable sharpe acuitye or poyncte, vve must thrust the foresayed threded needle, or Privett, bo∣uldlye, and audaciouselye therthroughe, into the foresayed concavitye of the Arsegutt, be∣cause vve might also dravv the foresayed thred therout, as alreadye above vve have mētioned.

VVe must alsoe heere farther note, that this privet, or needle, must ether be of goulde or sil∣ver, because shee may the easyer internallye in the foresayed gutt be recurved. VVe vse heer∣vnto a silver plate, vvhich thervnto expressely, vve caused to be made, as this same plate, & the foresayed Privett, or needle, before amōgst the figures of the instrumentes, are also defigured, and sett dovvne vnto vs.

The threde must be of course thred, the same being tvvisted thre or foure times dubble. And because that vnto some, the dissectione of this simple threde, falleth somvvhat tediouse, they annoyncte the same vvith some Causticke me∣dicamētes. Gvido,* 1.22 effecteth this dissection, vvith a rescindent actuall Cauterye, & to praevent the same that it pearce noe deeper, then it ought, he thrusteth in the fiistle a hollovv Privett, on the vvhich concavitye, he vvith the foresayed Cau∣terye pearceth the skinne, and in like sort alsoe cutteth throughe the fistle, bringeth, & dirima∣teth avvay vvith it the callositye, & praeventeth also the fluxione of bloode.

* 1.23Others vvil not in anye sorte, have the fistle cauterized, nor bovvnde, & tyed, but vvill only have that same to be inscided vvith a croocked lancett, vvhich is betvveene both the Orisicia, to vvitt of the fistle, and the excrementall, or arse∣gutt, & that alsoe vvhich internallye is grovven callouse, they vvill have it to be crudifyed and made ravv, or excoriated, as vve are vsed to doe in the haremouthes: yet daylye experience tea∣cheth vs, that the ligature is more certayne, thē the inscisione, vvherin vve neede not to take avvaye the callosity, because it oftētimes chaū∣ceth, that vve endevoringe to remove, and take avvay this callositye, vve discide, and cutt of any of the Fibres, of the muscle Spincter, vvhich beinge vvounded, or hurte, the patient ther af∣ter can in no sorte restraygne his stooles, or ex∣crementes.

It may seeme admiraculouse, & strange vnto some, that I vvrite that, the fistle may be cured throughe the ligature onlye, vvithout remo∣vinge the callositye, because it seemeth oppug∣nant vnto reason, because all combinatione, & healinge together, is caused throughe the ioy∣ninge or touching of vveake thinges together: yet I dare affirme, that all those, vvhich I have seen tyed, have bin perfectlye and sovvnd∣lye cured vvithout in any sort to have touched, or removed the callositye.

Novv to come to the operation of the hid∣den fistles, havinge situated the patient as be∣fore is sayed, vve must then applye therin, the Speculum Ani, opening the fundamēt thervvith, vvith the least payn vve cā, as vvyde as is possi∣ble, allvvayes annoynctinge the foresayed Spe∣culum vvith oyle, throughe the vvhich sayed a∣pertione, the Orisicium, of the vlceratione may appeare & be apparēt vnto vs, be-tvvixt vvhich concavityes or braunches, vve must thrust in a privet, vvhich must be of a reasonable thicke∣nes, or crasitude, like vnto a small & little need∣le vvherevvith vve are vvonted to make our stit∣ches, vvhich must be blunte, & in the one end must vvith a threede be threded, vvhich fore∣sayed needle, or privet, vve must thrust vnto the bottome, or grovvnde of the fistle, vvhich penetrateth vnto the skinne, as vve easily may feele vvith our finger, on the vvhich, vvith the croocked lancet vve must make an inscision, & the needle beinge in this sorte passed through, & the Speculū Ani beinge taken avvay, vve must then dravve out the needle, and cutt her from the thred, and tye bothe the endes therof toge∣ther.

Other say vve ought besides the privett, in∣ternallye to make an inscisione throughe the vvhol Fistle, vnto the other hole, vvhich is ma∣de on the other syde: but there is most certayn∣tye in the ligatione, to avoyde the effluxion of bloode, vvhenas ther is sufficient flosh enough betvveene.

Ther have binne certayn auntient Chyrur∣gianes, vvhich coulde not agree vnto the Specu∣lum Ani, but have onlye thrust there finger into the fundament, to dilate the same, and besydes the same a thinne and pusille privett, vvher∣vvith they have soe longe felt thervvith this vvay and that vvay & vp, and dovvne, till such time as they have fovvnde the Orificium, of the fistle, vvhich is felt as if it vveare a thinge rent, or torne, and novv hauinge fovvnde the fore∣sayed Orificium,* 1.24 they then close to ther finger thrust in the privett, conducinge the same a∣longe the finger supernallye, or vpvvardes, or thether vvher they suppose the bottome, or ground of the fistle to desiste, and end: vvhich throughe feelinge of the finger of the other hand vve may easylye discerne: and havinge fovvnde the end therof, and perceavinge the skinne or the fleshe not to be verye thicke, in stede of ligatione, vve violentlye thrust the pri∣vett ther throughe, vpvvardes, the privett bei∣nge passed therthroughe, they then cutt open all that vvhich is situated betvveen the tvvo O∣rificia of the Vlceration, or els they thrust a threde ther throughe, and soe binde it thro∣ughe.

Amongst those vvhich are of opinione, that vve ought to cure the fistle throughe an actuall Cauterye Albucasis discribeth vnto vs the meanes,* 1.25 vvillinge vs to vse a Cauterye of iron thervnto, vvhich must be verye subtile, and glovvinge, or redhott, and that it be pro∣portioned accordinge to the greatnes of the fistle, thrustinge the same tvvice, or thrice therin, vntill such time as all the callositye is taken avvay ther from, laudinge the fervent, &

glovvinge Cauterye, above the cuttinge or re∣scindent Cauterye, because the glovvinge Cautery, as he sayeth correcteth and amendeth the vntēperatnes of that parte & ther follovv∣eth noe effluxione of blood the callosity ther∣of is burned avvay, & the superfluouse humidi∣ty is exsiccated, vvhich vvas concursed, and as∣sembled together vnto that patte.

❧How we ought to extracte, & drawe forthe little infantes out of theire mothers bodye, which of them∣selves can not be borne. Chap. 3.

* 1.26BEfore vve offer to imploy our hādes, on such on operatione: it seemed expediēt vnto me to admonishe the Chyrurgiane vvhat vvoemē may escape this daūger, because vve should ob¦tayne great blame and discredite, vnto our sel∣ves, if so be the vvoman being in childebearth, should chaunce vnder our handes to dye, she supposinge, by our helpe, & councell to be re∣leased out of this daunger,* 1.27 VVherefore those vvhich vve suppose to be in daunger of death, vve must not in any sorte laye hādes on them▪ because the countenance and cheare of those vvoemen vvhich are in laboure, or childebe∣arthe and also ther face, administreth sufficient knovvledge vnto vs, vvhat event, or successe the matter shall have: for those vvhich are in any great daūger, of their lives, have a straūge & vvonderfull behaviour over them, to vvitt that shee troubleth, or molesteth her self vvith nothing, hath a fearfull sight, vvhich is cleane contrarye to her naturalle beinge, is debilita∣ted, hath hollovve eyes, a sharpe nose, a feeble Puls, vvhich beateth obscurely, and vvithout ti∣me: Shee is vvholy cōvicted, as if she hadde the soporiferouse dissease, vvith out all strēgth, cle∣ane layed alonge, & although vve speake vnto her, yet vve can not avvakē her, & if vve doe lōg trouble, & plucke her, shee speaketh verye fee∣blelye, & vvith noe strength, and then agayne lyeth, as it vveare in a great sleep: the ayre alsoe flyeth out of her throte. Those in the vvhich is anye strength left, they fall into Spasmo, or con∣vulsion of synnues. Others after they haye con¦tinued a long time in theire labors, as are those vvhich have bin troubled & molested thervvith the space of five, or sixe monethes, they are vvholye decayed, grovvē leane, & vvholy con∣sumed, for vvant of foode, & because alsoe that vvhich shee hath eaten, is not chaūged into any nouriture, the vvhol boodye beinge thorough soacked vvith humidity, & especiallye the face, vvherof her svveat most commonlye, is fattye, & axungiouse, and smearye.

But those vvhich can suffer the manuall o∣peratione, & are fitt, to have the child dravven out of their bodye, have none of these fore re∣hearsed accidentes, vvherfore vvithall festina∣tiō alsoe they must be opitulated, & helped, on this māner as heerafter follovveth notvvitstā∣nding vvithout rashlye, or temorously to be∣ginne the same, vvithout beinge certifyede, of the Midvvyfe, vvhat the reason or occasione might be, vvhye the vvoman can not be delive∣red, or bringe forth her childe,* 1.28 beinge certifyed heereof, as vvell of the parturinge vvomā, as of the Midvvyfe, in as much as is possible, dilliggēt∣ly considering the same, & having vvell perpē∣ded it, therout to knovve the iust occasione of this heavines & sorrovv, considering, vvhether it taketh his occasion of the parturiēt vvomen, or els out of the childe, because therby vve might knovv hovv to rule, & govern our selves

If so be this daūger consisteth in the mother,* 1.29 it happeneth then, ether because of her mistru∣ste or smalle hope, or because shee is fearfulle, and fayntharted, havinge the vvombe, and the necke or entrance of the sam, small & anguste, because shee is yonge & small of body, tender, and delicate: Or els because the entrance of the foresayed VVombe, lyeth recurved, or is occlu¦ded vvith some tumor, or els there is som Apo∣stematione vlceration, or any Carnositye ther in, vvhich oppugne themselves agaynst the be∣arth of the infant: Ether because that the mo∣ther, hath a stone in her Bladder, vvhich therin alsoe beinge oppressed, seeketh by all meanes possible to come therout, and beinge come in∣to the mouth, or entrance of the Bladder, crus∣heth there the entrance of the VVombe, vvher throughe she is angust, or els because therin is som cicatrice, vvher through she is narrovver, then she ought to be, vvher through she cā not in any sorte stretch forth her selfe.

Childe bearth alsoe in some vvoemē is hin∣dered above all these foresayed accidentes, be∣cause they ar to fearfull, & are to much affrigh∣ted, of the parture, or Childbirth, as yet not beinge vsed vnto the labouring of childe, & doe not yet knovve therafter to governe thēselves, as vveare condecent, and needfulle. Others are grovvne impotent, throughe anye praecedente sicknesses, and having noe strength at all to de∣liver the conceptione or fruicte from them.

The childe alsoe may be occasion heerof,* 1.30 be∣cause it is to feeble, and cā not helpe it selfe, in the deliverance of his mothers labors, and that especiallye vvhen it is deade, and svvollē: in like sorte also the same beinge to grosse, and greate, ether in any parte of his body, as havinge tvvo heades, four armes, beinge dubble, or els if ther be moe, then one, to vvitt, tvvo, three, or four, vvherof the one might praesent his arme, & an other his legge, or anye other part, all at one time.

Afther the infāt praesenteth himselfe, the

childebirth falleth easye, or difficulte: because, that follovvinge the naturall Childebirth, the childe allvvayes praesenteth first his heade, ha∣vinge his armes stretched out alōgest both his sydes: or vvhē it praesēteth it selfe vvith both the legges forvvarde, vvherby it may easylye be plucked & dravven out: & vvhen it praesen∣teth him one anye other manner, it is as then not naturall, but verye daungerouse, vvherin vve must vse our remedyes as herafter shalbe shevved.

* 1.31Touchinge the externall occasiones, they are violēt heate, vvherthrough the strengthe & forces of our bodyes are convicted: contra∣rilye, ther is great could, vvherthrough, all the conduictes are stopped as allsoe are those per∣sons vvhich vve feare, or hate.

The childe alsoe as longe as it lyeth drye, & the vvater as yet is not brokē out, vvherthrou∣ghe it can have no passage, because the vvayes & passages are drye, & not slippery, not smoo∣the, as in the vvater streames vve may see, that the stones, through the slipperishenesse of the vvater,* 1.32 are carryed avvay. In like sort alsoe all sorrovve, & tribulatiō, stoppeth & occludeth the entrance of the vvombe: as cōtrarilye the meane, & reasonable iucunditye, openeth the same.

All these foresayed occasions, must be cōpa∣red, vnto ther cōtraryes, as if soe be that thro∣ughe the imbicilitye of the mother it be occa∣sioned, she must thē be conforted, givinge her a little vvyne, or Hipocras, conforting, & ioy∣inge her in her necessitye, as much as is possi∣ble: & if soe farr forth as the passage, be to nar∣rovve, or anguste, to exsiccate, or dry, or els to much shrūcke, vve must then, endevore vvith decoctiones, vvith vvarme infusions, & vvith pingvefactiōs, to soften, moystē, & make sup∣ple the same: If then ther be anye carnositye, vvhich in terrupteth the passage therofe, vve must depose, & detrude the same one the one syde: or if ther be a stone in the entrāce of the bladder, vve must thrust the same on highe: & if soe be the Childe othervvise praesent it selfe thē it should, as first vvith the heade, vve must then turne it in the best sorte vve maye: or if it thrust one arme, or legge out, vve must not thervvith dravve it out, but must gentlelye re∣trude it backe agayne, & agayne bringe it into his place: or if ther, be more thē one child, vve must dilligently consider hovve vve ought to take hould therone, notinge that vve doe not take the one by the foote and the other by the foote, & soe both at once plucke thē, vvherfo∣re vve must thrust one foote on highe, & dra∣vve tovvardes him the foote of that vvhich is next,* 1.33 & most rediest vnto the passage.

But before vve come to the manuall opera∣tiō, vve must first of al situate the vvomā con∣venientlye: & although ther be divers māners of situationes, (for some sett thē in a stoole, o∣thers set thē leanīge, on a table, or one the ed∣ge of a bedd, vvith the legges separated the o∣ne from the other: others set them one theire knees) yet the best & fittest vvay is one a bed∣de, causinge the vvomā to lye one her backe, thvvarte over the bedde, close to the edge ther of, vvith cushēs or pillovves vnder her backe, to rest her heade therō, layinge her heeles clo∣se to her buttockes, vvhich must lye alsoe som¦vvhat exalted, and the hippes spanned the one frō the other, vvhich of tvvo vvoemē must so & in that sorte be helde, least that she doe not chaūce to dravve, & shutt them together: the vvomā lyinge in this sorte, the Chirurgian as then may the easyer obtayn his vvill, and com close vnto her, to drive, & detrud the child to∣vvarde the entrance of the vvombe.

The vvomā beinge thus setled, or layed, the Chyrurgiā must lay one the knees, & one the belly of the vvomā a cleane linnē clothe, par∣tly to be an opercle, or coveringe to the vvo∣man, & partlye ther through to be freed from the externall ayre: thē he must gentlely thrust his hande being annoyncted vvith freshe but∣ter vvith Sallatoyle, or vvith hogges suct, in to the entrance of the vvombe, first of all cōside∣ringe vvhether the childe be alive, or deade, & hovv it is thereī disposed, or turned, vvhether also ther be more thē one, tvvo, or thre child∣ren a fore hādes: & hovve soever it be situated,* 1.34 or disposed, ether alive, or deade, curved, or croocked, if it be possible vve must dravve the heade first out, but if not, vvith both the leg∣ges, dravvinge the same aeqvally dovvnevvar∣des, & cause, one of the armes, to be stretched out, alōgest the syde of the heade, because ther throughe may be hindered, that the bodye be∣inge therout the vvombe doe not chaunce to shutt, & the necke of the Childe be not therin inclosed, vvhich through the arme vvhich ly∣eth stretched out by his heade shalbe praeven∣ted & hindered. If so be the one foote praesen∣teth it selfe, & the other tarrye therī, vve must tye the foresayed foote vvith a ribbon & gen∣tlye thrust in agayn the foresayed foote, suffe∣ringe the end of the ribbon to hange out, and inqvire, & seeke after the other foot, thrustin∣ge the hande, alongst by the foresayed foote, & legge vntill such time, as vve feele the buttoc∣ke of the other foote, & then reducinge your hande close to the buttok shall immediatlye finde the other foote, vvhich gētlely you must bring forevvardes, & dravvinge by the ribbō, the other foote, vvil come forth agayn, vvhich having thē both aeqvally together must gētly dravvē thē out vvith, the rest of the vvhole bo¦dye of the child: by this means vve may knovv vvhether they be both the legges of one child,

on this māner dravving out the same, first the one & then the other.

* 1.35But if so be the Childe be deade, it vvill not as then stirre it selfe, & in the feelinge also ther∣of it vvill be coulde, vvhenas vve thrust the fī∣ger in the mouth therof, it stirreth nether lip∣pes, nor tunge to suck: The mother as then hath a stinckinge breath, hollovve eyes, and a svvollen bellye: vve therfore out of all these foresayed tokens, perceavinge the Childe to be dead, vve must then dravve it out as already vve have sayed vvith the feet forvvardes: As farre forth therfore as if the Childe had one arme or one Legge hanging forth of the vvō∣be & it vveare impossibleto reduce the same agayne into his former sitvation, because that throughe the bodye of the Childe, the entran∣ce of the vvombe is stopped, vve must then plucke the foresayed arme or legge & dravve it to the ioyncte of the shoulder, or of the hip∣pe:* 1.36 & then discide, & cut of the same in the fore¦sayed ioncte. And if so be the heade did first repraesent it selfe, vve must then thrust both our fingers into the mouth therof in place of a hoocke, tovvardes the roofe, and so as gent∣lye as is possible dravve the same tovvardes you. If soe be the belly therof be svvollene, or hath to greate a heade, and the same fulle of vvater, vve must then vvith our finger, a little crush theron, because the aquosity might so∣acke therout, and the svvollen partes by this meanes be diminished and vnsvvollen: & if soe be that our handes vveare not sufficient to dravve out the Childe, or to finde the belly, to let out the sayed Aquosity, vvhich ether is re∣tayned, in the heade, in the Brest, or in the bel∣lye, vve must then gently vvith our right han∣de bringe therin, a little curved and croocked knife, vvhich vvithin the curvednes therof is sharpe, and cutttinge, the acuitye or povncte therof being closely inclosed betvvixt his fin∣gers,* 1.37 vvhich he must houlde verye close toge∣ther, vvhervvith vve must make an inscisione ether in the Heade, in the Breste, or els in the Belly, by this meanes to dravve forth the vva∣ter vvhich is therin cōtayned: And then vve must take, a hook, vvhich on the same fashon as is afore sayed vve must bring therin, vvher∣of vve must fasten the poyncte, ether in the eyes, or in the mouth, or in the Clavicles, vvheron vve must then dravve as violentlye as the cause reqvireth to be done, dilligentlye cōsideringe that the hooke breack not through & let his houlde goe, & through the violente pluckinge of the same doe not chaūce to hāge & take houlde in the VVombe, to the vvhich intēt vve must vvith as much iudgemēt, & cōsi¦deration, dravve the same as is possible, onlye vvith one hande vvhich muste be vvithin the VVombe. Novv if the Childe, be so thick, & so grosse,* 1.38 that vvholy to dravv it out is impo¦ssible for vs or els if it be a Monster, or tvvo Childrene faste together, vve must as then by parcels dravve them out, cuttinge the Heade thereof in peeces, & then plucke out first the the one peece, & then the other, then the Brest the Armes, and the legges, & allvvayes makin∣ge that it be cut in the ioynctes, vvithout brea∣kinge any bones: for although they be tender, yet the splinters therof might chaunce to hur∣te the vvombe, soe that it is allvvayes the surest vvay vve cutt of the Armes, and legges in their ioynctes.

It chaūceth also sōtimes, that vve dravvinge forthe the Childe by the legges, that onlye the head tarrieth therin vvhich therafter vvithout great difficulty vve cā not get it out, thē vvith extreame daunger, because the same rovv∣leth vp and dovvne in the concavitye of the vvōbe: this therfor being happened, ther must as then a servant, or one of the standērs bye vvhich is experimented in such affayers, sittīg one the left syde of the vvoman, crushe vvith both his handes one the bellye of the vvomā, beinge covered vvith a vvarme cloth on this manner to depresse dovvnevvardes the heade of the childe, and ther in that place to contay∣ne, and keepe the same.* 1.39 And the Chyrurgiane vvhich sitteth on the right syde of the vvoman must vvith his light hande bringe the hoocke therin, as is already sayed, vvhich he must faf∣tē in the heade, ether in the eyes, in the mouth or in the apertione of the heade, & dravve the same by little, & little therout, as if, as yet the vvhole bodye remayend therin: If soe be the foresayed head vveare to great, vve must then in like sorte alsoe cutt the same in peeces, and dravv therout the peeces first the one, & then the other.

The Childe beinge dravven therout, vve must dilligentlye consider, that vve doe not breake a sunder the navell, because it may ser∣ve for a conductor, & leader, vvhich vve must allvvayes feelinge the same, and suffering it to glide throughe our right hande must follovve vntill vve be come to the matrice vvhervvith the Childe vvas covered in the foresayed vvō∣be: & hauinge found the same, vve must gent∣lye rovvnde about separate her vvher vve fin∣de her to befastened, & then dravve her forth vvith al the cōgregrated blood therī, if therbe anye, least that there it might chaunce to pu∣trifye: havinge thus finished all this, the vvo∣man as then shall ioyne, and shutt her hippes together agayne, and must then circumligate the bellye, as is required, and necessarye.

In this forerehearsed daunger, is oftenti∣mes incident vnto the vvoman a farre more lamentable and pitiful accident, to vvitt, a dis∣cendinge, and sinckinge do vvnvvardes of the

vvombe, vvhich betvveen the hippes sincketh out, throughe the vvhich the vvoman, can not goe.* 1.40 If soe be therfore this chaunced, vve must gentlye, and easilye by degrees thrust in agayn the same, as vve have sayed of the guttes, or en∣tralles being sunck out, vvherof vve must cau∣se the disseased and sicke vvoman to keepe her bedde some certayn cōtinuance of time, vvith her buttockes a little exalted, and if soe be the Matrice in her risinge chaunced agayn to sinc∣ke out, vve must then agayn, thrust in the same.

And to praevent her that she doe not agayne sincke out of the bodye, vve must thē thrust in the Matrice a Pessarium, like a rovvnde Apple, vvhich must have a hole in the middle therofe, as heer before amongest the instrumentes vve may see it defigured vnto vs vvher vve shall al∣soe finde, the forme, the figure, & the manner of vsinge the same.

❧VPpon what occasione, the externall partes as Ar∣mes, and legges are, and must be extirpated, or cutt of and in what place it must be do∣ne. Chap. 4.

* 1.41THe externalle membres of mās bodye, as are Armes, & legges, are cutt, or savved of, vvhen as they are sqvised, plettered, and brokē, the Vaynes, Arteryes, & Synues, vvholy be lacerated, & cutt of: Or els vvhen they concerninge any ex∣ternalle occasione are hurte, or indammaged, vvherby they sōtimes vvholy come to be mor∣tifyed, & that suddaynlye, or els somtimes alsoe by degrees, so that somtimes ther ensueth such a Gangraena, or mortification, that not only the fleshe, & all the other mollifyed partes, of the foresayed ioyncte, doe mortify & corrupte, but alsoe the Bones themselves, soe that ther is noe hope at all, of any health, then onlye throughe the extirpatione of the same, fearinge least that the foresayed Gangraena, shoulde farther infect & pollute all the circumiacent partes, vvhere∣throughe the patient might suddaynlye chaūce to dye. Notvvithstandinge the Chyrurgiane may not in anye forte aproch vnto his exstrea∣me, & last remedye, before he have tryed all o∣ther remedyes, to ease & appease this forsayed mortificatione, & to save the ioyncte: because that such an operatione,* 1.42 can not be done, then throughe extreame daunger, as oftentimes the patientes themselves, doe dye vnder our hādes, because of the great effluxione of bloode, or els some greate fayntnes. Others immediatly after the extirpatione fall into a Phrensye, in extrea∣me, & intollerable payne, in Spasmo, in a coulde svveat, vvheron praesentlye, follovveth death. VVherfore first of all vve ought to admonishe the frendes, & kinsfolke of the patient, & certi∣fye vnto them that this operatiō is full of daū∣ger, and is as vvell lamentable for the Chyrur∣giane as for to patient: and that vve ought not therof the make anye greate matter of vvorth, or estimation, seinge ther is no other hope, nor anye other successe to be expected, & that it see∣meth more convenient, and necessarye, to ex∣tirpate the mortifyed ioyncte, and soe to avoy∣de & flye death, vvhich is more terrible, and fe∣arfull, then the losse onlye of one ioyncte.

And before vve beginne this operatione, & that vve must extirpate, the foresayed ioyncte, it is necessary that first of al vve knovv, the pla∣ce vvher it must be done,* 1.43 because of divers opi∣nions vvhich are hadde therof: for some are of opinione, that in the ioyncte vve ought to doe it, because in this place it vvoulde fall easyer for the Chyrurgiane to execute the same, & is alsoe more tollerable and easyer for the patient, be∣because ther it may be done vvith more festina∣tione, vvith a simple inscision of a vvell rescin∣dent and cuttinge knife, if onlye the Chyrurgi∣ane be agile, and experte, in findinge of the ioyncte.

Novv as touchinge those vvhich suppose all vvoūdes of the ioynctes, to be more subiected,* 1.44 vnto deadly, and dolorouse accidentes, thē tho∣se vvhich happē to be thre fingers above, or vn¦der the same, yet for all that they are noe lesse davngerouse, because of the Tendones, and al other sunnuish partes, vvhich as then are alsoe cutt of, vvhich are rounde more thicker there then in the ioynctes themselves: VVherfor vve neede not to feare, that ther vvill follovve mo∣re payne, or convulsione, althoughe the extir∣patione vvhich is done, three, or foure fingers belovve, or above the same, because the Tēdo∣nes, and the synnues are as vvell in the on place as in the other aequallye cutt of. And vvhich is more, if vve extirpate a membre in the ioync¦te, the marrovve, of the pipe as thē is not denu∣dated, because of the Epiphysis, vvhervvith it is covered, and contayned: But contrarilye if vve savve throughe the focille, or pipe, the marro∣vve as thē is denudated, for the praeservatione of vvhich Nature vvith greate difficultye, must have a longe time, to engēdre a Callum thervn∣to, and to cover it, because nature must separa∣te that end of the savved bone: And besydes all this, ther follovveth noe superfluous effluxion of bloode, as Hippocrates in his boocke of Hemor∣rhoidibus, vvitnesseth vnto vs.

Althoughe that all these foresayed reasons,* 1.45 are sufficient enoughe, to persvvade the yonge Chyrurgian, to extirpate the members in their ioynctes and Hippocrates, allsoe commaundeth & councelleth the same, yet al PractisionerS of Chyrurgerye, doe heere in agree, & vnite their

opinions together, that vve ought to extirpate the membre,* 1.46 three, or four fingers vnder, or a∣bove the ioyncte, accordinge to the dispositiōe & reqviringe of the mo••tified ioynct: For first of all the opratione is done vvith such festina∣tion & so certayn, because of the facility ther∣of, for vve may righte vvell knovve that the vvhole infectede, & spoylede parte, most com∣monlye svvelleth, & the finitimate partes also thervnto lyinge, that vvithout greate daunger & difficultye, vve can not knovve the ioyncte or the place therof in the vvhich vve ought ve∣ry vvarily to enscide: Farther allso the ioynctes are most cōmonlye verye difficulte, cleane to cutt them of, or extirpate them, because of the bones, vvhich are placed the one in the orher.

Touchinge therfore the certayntye therof experience teacheth vs, that an inconvenience may as vvell come of the one, as of the other: And such vvoundes, are noe lesse mortalle, then the vvoundes of the ioynctcs. Secondlye, ther much sooner follovveth a cicatrice, becau¦se of the greate qvantitye of fleshe, vvhervvith the bone on all sydes is circumcinglede, & co∣vered & vvhich in that place is not of such a crassitude, & spongiousnes, as in the ioyncte. And althoughe the Cicatrice can not so soone be effectede, the patient neverthelesse needes not abstayne from going, & that vvithout pay∣ne allso, layinge his knee in a stilte, vvhervvith he shall as then abyde the time of his complet sanatione: The vvhich he in that sorte shoulde not be able to doe, before that the cicatrice vve are vvholye curede, & obduratede, if so be his legge hadde binne extirpatede in the ioyncte, because the vvhole body resting theron, throu¦ghe the confricatione, or rubbinge together of the same might chaunce to breacke open agay∣ne.* 1.47 As touching my selfe, I have allvvayes foū∣de that the cicatrice hath ever binne very diffi∣culte, yea & allmost impossible to be curede & effectede in the ioynct, but īmediatlye therafter is openede agayn, hovv little soever the bodye restede therone.* 1.48 VVherfore I also am of the same minde, & opinione, vvith all other com∣mon Chyrurgianes that as vvell consideringe the festinatione, & facilitye of the operatione, as allso the brevitye of the generatione of the cicatrice, that vve ought to doe our extirpation or savvinge of, of anye membre, three, or foure fingers breadth above, or vnder the ioynct, to vvitt, of the Legge, if it be vnder the knee: For allthoughe the Gangraena, or mortificatione of the Legge, vveare onlye belovv in the foresay∣ed Legge, & the middle of the Legge as yet illaef vnhurt, & sound, vvherfor it is all vvayes better to make the stumpe short, then longe, because vvithe his length, it is associated vvith a certay∣ne deformitye, & might cause greate impedi∣ment vnto the patiente, vvith thrustinge of the same, heer agaynste this thinge, & ther agaynste somvvhat els. VVhich in the Arme is contrary because ther it is better, that vve suffer him ••o keepe as longe a parte therof, as is possible to be by any meanes done,

It is right true, if so be the Gangraena,* 1.49 or morti∣ficatione of the Legge, doe end in the ioynct or, close thervnto, & noe higher then to the begin∣ninge of the hippe vve must then allvvayes ra∣ther doe the extirpatione in the ioyncte, then above the same, & especiallye in the hippe: Be∣cause the accidentes might allvvayes be vvorse, consideringe the greate Vaynes, Arteryes, & Synnues, vvhich by hovv much the more vve plucke, & dravve them vpvvardes, so much the greater vve finde them:* 1.50 And then the cicatrized parte, shoulde be constraynede to reste on the artificiall, fayned legge, as if vve extirpatede the same in the ioyncte: Be it therfore vvhat place you vvill chuse, vve must note, that allvvayes vve rather take avvay some of the sovvnde par∣te allso, then leave anye of the corruptede, or mortifiede parte behinde. Because that such a parte of mortificatione, might allso corrupte, & mortify, the finitimate sovvnde part, so that the patient, should have suffered all the davvnger, & payne in vayne, & for nought, & to continue his lyfe, vve shoulde be constrayned to make an other extirpatione.

How we ought to doe the extirpatione, or sawinge of, of a ioyncte and how we may stopp the bloode, after we shall have layed downe the Patient. Chap. 5.

HAvinge noted the place, vvhere vve intende to doe the extirpati∣one, vve muste situat the patient as it is reqvirede, not onlye con∣sideringe the nature, disposition & qvallitye of the parte, vvhich vve intende to extirpate,* 1.51 but allso one the Chy∣rurgiane his cōmodity, that the patient sitt not agaynst the day, & ligt of the Chyrurgian, not to highe, nor to lovve, nor on a place vvher he mig∣ht slippe as it oftentimes hath chaunced, the pati∣ent sittinge to farre in the bedde. Some are of minde that vve ought to sett the patient on a stoole because he may sitt the faster, & conveni∣enter: Others effect this operation, the patiēt sit∣tinge on the edge of a bedde, fearing least he sho∣uld grovv faynt, or syncopize, & might thē vvith more ease be gottē into his bedde & restīg place the extirpatione beingedone.. But my vse is, to cause the patiēt to ••itt in a resonable lovve chay∣re, because all beddes are not of one hight, nether are soe readye, and fitt for our purposes nether so vvell tovvardes the day, vvheras vve may set the

chayre vvheare vve our selves liste: farther the patient is more surer in such a place, & may al∣soe better, & vvith more convenience be held, and better tovvardes the Chyrurgians hande, as vvell to cutt throughe the fleshe, as to sa∣vve of the bone and restraygne the bloode: the servantes allsoe shall have more better opor∣tvnity to houlde the patient fast & in more sa∣fetye.

* 1.52Therfore to effect and finishe this opera∣tione, the Chyrurgyne must stande betvveene the legges of the patient, and must cause a ser∣vant, or stāder bye as much as is possible vvith both his handes to strippe vp the skinne & the muscles vvhich are situated above the extirpa∣tione, after he shall have caused the patient to bende the ioyncte, & that as vvell for the lon∣gatione of the skinne, as lengtheninge of the Vaynes, and Arteryes, vvhich after the extirpa∣tion of the Ioyncte, the ligature being taken a∣vvay, vvill more easyer as then demonstrate them selves, & be more easyer taken houlde of vvithe the Crovvesblil, and they tyen or caute∣rized: Then vve must immediatly one the pla∣ce, vvher vve intend to make our extirpation, lay a stronge ligatvre of stronge linnen, the sa∣me being reasonable closelye dravvne together and that because of divers occasions: First of all because the Ioynct may be praesēted the stedyer and faster to the Operator, and because the fles∣he should the better beare, and receave the ins∣cione of the croocked, or curved knife: Second∣lye, because the sensibilitye of the foresayed Ioynct, in the scissure, might partlye be ther∣through benummed, and somvvhat mitigated: Thirdlye, because after the inscision, in sovvin∣ge of the bone, the bloode might be soe longe throughe the foresayed ligature restraygned, & kept backe.

Farther more, by this meanes vve keepe the skinn & muscles on highe, vvhich after the o∣peratiō, the ligature beinge dissolved, & made loose, sinck agayne dovvnvvardes, and cover the savved bone, by vvhich meanes the Cica∣trice the sooner grovveth therover, and serveth the foresayed bone therafter, in steede of a Cushone.

* 1.53All vvhich beinge finished, vve must then vvith a croocked knife, vvhich is very sharp, cut through the fleshe close vnto the ligature roū∣de abovvte, vnto the bare bone, vvithout leavīg any thinge betvveē the bones vncutt, if ther be tvvo, scrapinge of vvith the backe of the knife the membrane Periostium, vvhervvith the bone is covered, because vve doe not chaunce to tea∣re the same, vvith the teeth of the savve, vvhich vvoulde cause an intollerable payne vnto the patient, & also in serratinge, or savvinge might be some hinderance: In like sorte also vve must remove the fleshe as much out of the vvay as is possible, & then vvith a vvell cuttinge savve, savve of the vvhole legge as close to the fleshe as may be, dilligentlye notinge, that vvith the teeth of the savve vve doe not in any sort touch the foresayed fleshe.

The legge novv beinge extirpated,* 1.54 vve must thē dissolve & make loose the ligamēts, vvhich vveare tyed above the vvound, & strippe dovv∣nevvardes the skinne, and the muscles, because the bone of al sydes may be vvel covred: vvhich beinge done, if soe be there be but little bloode issued therout, vve must not then (especiallye vvhere there is a Gangraena,) so soone restraygne the same, but as yet let it a little more bleede, & that as longe, as you suppose it may vvithout a∣nye davnger to the Patiēt be done, because that parte there throughe might the better ease her selfe, and be disburthened, and soe much the lesse be subiect vnto anye inflamationes.

The bloode havinge indifferentlye and rea∣sonably issued therout according to the strēgth of the Patient, vve must as then stoppe,* 1.55 and re∣straygne it, vvhich vve must doe throughe the imposition of the fingers one the mouthes, or apertiōs of the Vaynes, vvhich vve must ether bind or els cauterise the one or the other accor¦ding as the same shalbe needfull, and requisite, it be ether through binding, or cauterizinge, as the auncient Chyrurgians of former times ha∣ve done, & vve have cōmitted it to the memo∣ry, of those of our times.

For as in example,* 1.56 if ther be anye member corrupted, and mortified, vvhich must be extir∣pated, after vvhich extirpatione, the fluxion of bloode, must be farre more stopped, throughe the applicatione of glovvinge cauteryes, on the appertiō, or mouthes of the vaynes, thē throu∣ghe the ligation, or binding of the same, becau∣se the glovvinge cauteryes, make one the fore∣sayed Orificia of the vaynes an Escara, vvher∣through the foresayed Orificia of the vaynes are occluded and the bloode stenched, because it cā noe more issue out, by vvhich meanes it dra∣vveth vnto it selfe, & also consumeth al the ve∣noumouse evaporations, & dampes, and brin∣geth thē to nought, vvhich as yet throughe the foresayed vaynes, have bīne retayned in the su∣persituated partes, although, it semeth not that the foresayed parte is in any sorte corrupted, or putrifyed, then onlye soacked throughe vvith some certayne venoumousenes, vvhertroughe sometimes that parte hath binne prepared as it vveare to some mortificatione, or Gangraenati∣one: that vve supposing to take houlde one the vaynes vvith the Crovvesbill, and soe to bind them, doe most commonlye chaunce to breake betvveene the Crovvesbill, or els hovv gent∣lelye soever vve knit the threde together, one that sorte to tye them, are throughe the tyinge of the threde notvvithastndinge cutt a sunder:

vvherthroughe vve are in the end constrayned to vse the actuall Cauterye.

* 1.57And not vvithout occasione, Galenus testify∣eth vnto vs, to be a thinge verye expediente, & necessarye, to stench, and restraygne the bloode throughe actualle Cauteryes, vvhich throughe anye corruptione, hath corroded throughe the vaynes, because they, nether are able to suffer the Crovvesbill, therby to be dravvne out, ne∣ther the tyinge, & bindinge. It is also the most surest vvay, to cauterize all that, vvhich throu∣ghe the Gangraena is corrupted, or els, that vve applye theron any Causticke medicamentes, as vve are vsed to doe one the originalle of al cor∣ruptions.

VVherfore if so soe be the Chyrurgian ha∣ve anye suspicione, of anye venoumousenes, vvhich after the extirpation, might be dravven invvardes tovvardes the finitimate partes ther∣aboute, it is as then the surest remedye, that to the restraygninge, and stenchinge of the blood, he have in praeparatione, and readines, three, or fovr fervent, & glovvinge cauteryes, vyhich he must applye on the Orificia of the descided vay∣nes,* 1.58 vvithout houlding, or depressing the same to harde theron, because thus doinge ther may be left behinde a goode Escara: And if it chaun∣ced that the bloode throughe the applicatione of one cautery vveare stenched, it is then suffi∣ciently cauterized, nether must vve anye more cauterize the same Vayne, prosecutinge of the same, on the other vaynes.

* 1.59Contrarilye, vve beinge constrayned to ex∣tirpate anye membre, beinge verye much plet∣tered, and broken, & vvhich throughe noe Gan∣graena,, or corruptione is putrified, it is as then most conveniēt, to restraygne the blood, throu∣ghe takinge hould of the Vaynes, or Arteryes, vvith the Crovvesbill, compraehendinge allsoe some parte of fleshe thervvith, vvhich vvith a good & stronge threede vve must binde toge∣ther, as allsoe the fleshe, vvhich vvith the thre∣de is tyed, is an occasione, that the ligature must be the more certayner, and surer.

And as Galen findeth it goode, to stench the bloode, throughe actuall cauteryes, vvherby is anye corruptione, or putrefactione, in like sor∣te alsoe he commendeth the ligature in the ef∣fluxione of bloode, vvherby is noe corruptio∣ne,* 1.60 or anye venoumousnes. VVhich right vvel may be an agreemēt betvvixt to great per∣sonages of our time, vvher of the on is a Physi∣cione, and the other a Chyrurgiane, because of a certayne dispute, vvhich they had, concernin∣ge this matter, of the meanes, vvhich vve ought to vse, in the restraygninge of bloode, as they have agitated most inmicisiously this disputa∣tione the one agaynst the other vvithout the o∣ne, vnderstandinge the other.

The bloode therfore throughe the fore∣sayed meanes beinge stenched, & restraygned, vve must as then strovve some restringēt poul∣der one that parte, and applye therone divers drye plumaciolles, or flatt tentes, and therone an ordinarye restringent, or defensive plaster, layinge rovvnde about the stumpe, a plaster of Refrigerans Galeni, because that the foresayed de∣fensive, shoulde not chaunce to cleave too fast therone, and soe binde the parte, as it requi∣reth, and then curinge the same as a simple vvounde, allvvayes dilligentlye consideringe that vve doe not take avvay the Escara, vvhich throughe the foresayed Cauteryes is made, ne∣ther the threedes allsoe vvher vvith the Vaynes have binne tyed, if soe be at least ther be anye.

It happeneth allsoe sometimes,* 1.61 that the Vaynes after that they have binne cutt of doe dravve themselves invvardes, soe that vvith the Crovvesbill in noe sorte vve can take houlde therone: It might allsoe chaunce, that the tyed Vayne, might chaunce to vntye, vvherthrough the patiente is charged vvith a nevve effluxion, of bloode.

If soe be anye of these accidentes chaunced, and come vnto your handes, and it seemed best vnto you, to Cauterize the Vayne, then to bin∣de her, or els rather to binde, then to Cauteri∣ze her, and such a mischaunce, or accident hap∣pened into your handes vnexpected, and not beinge therone provided, vvithout havinge a∣nye Cauteryes in are adines, the right vvorship∣full M^r. Pare councelleth vs very fitlye to stench the bloode. The vvhich if in tvvo or thre or four Vaynes it chaunced, or Arteryes, at one ti∣me then must the servant, of one of the cir∣cumstantes, lay the endes of his fingers, one e∣ach vayne one, gentlelye crushinge the same, one the Orificia of the Vaynes, because as Galen sayeth the Chyrurgiane may have time, to re∣straygne the bloode: And then take a needle of a fingers length, or longer, and of a reaso∣nable crassitude, vvhich is very sharpe, and res∣cindent, as heere before is defigured vnto vs, beinge threded vvith a stronge threde, vvher∣vvith the vayne after this sort follovvinge must be tyed.

Havinge first of al considered, vvhere the bleeding Vayne is situated,* 1.62 you must thē thrust your needle therthroughe, beginninge on the skinne a good fingers bredth higher then the vvounde, one the syde of the Vayne, makinge the same to come contradictorilye out of the vvoūde, to vvitt one the syde, & alsoe somvvhat lovver then the Orificium of the Vayne, because the threde may be thervnder, ther to circumcin¦gle the same, sufferinge the end of the threde to hange one the skinne, vvithout extractinge, or vvholye dravvinge out of the same: Then you must agayne, thrust the same needle inter nal∣lye in the vvounde, one the other syde of the

vayne, because in soe doinge, the threde, vvhich vvith both his endes is come forth externallye on the skinne may take houlde on the fore∣sayed vayne, vvith some certayne portione of fleshe, & soe through both the stitches of the needle, & passages of the threde, may stifflye be bovvnde together, throughe both the endes of the foresayede threde, layinge betvveen the thredes a little compresse of lether, tvvice, or thrice dubbled, as thick as a little finger, becaus ther through the payne might be praeventede, vvhich through the foresayed stiffe bindinge, might be caused, & because the knott, through the continuance of time should not cut throu∣ghe the skinne.

* 1.63VVhen as this ligature is convenietlye done, shee as then is verye certayne, vvhich allso may be done in all partes of the bodye, vvher ther is anye fluxione of bloode, as in greate vvoundes of the Armes, of the Hippes, or of the Throte. Heere before amongste my Instrumentes of Chyrurgerie, you shall finde them defigurede vnto you.

How we shoulde extirpate, the superfluous, & corrup∣tede fingers, & separate those which are growen, & conioynede together Chap. 6.

* 1.64THe hande, vvhich is an instru∣mente, of instrumentes, is divi∣dede in five fingers: And it som¦times allso chaunceth, that be∣sydes the thumbe, or the little finger, ther grovveth a sixte fin∣ger, vvhich is all carnall, or fleshye, or els com∣posede of some smalle bones: Yet is nether the one nor the other complet, vvhether ye consi∣der ether their figure, or their magnitud, & gre∣atnes, as beinge agaynst the course of nature, vvherthroughe they are an impediment to the actiones of the hand. It may allso vvell chaūce, the one finger of the hande to be pletterede, vvithout beinge able to keepe the same from Gangraenatione. Besydes this ther commethe in the endes of the fingers, somtimes a certayn vlceratione,* 1.65 vvhich is callede Panaris, or Paroni∣chia: The vvhich cause such vehemente payne, throughe the venoumouse matter, that ther∣throughe the bone corrupteth, & rotteth, yea & the inflammatione allso beginneth moste commonlye in the bone: The vvhich to reme∣dye, before that the bone be corruptede, vve muste make an inscision in the end of the fin∣ger according to the length therof, begīning at the extreameste end of the ioyncte, vnto the bare bone, because the venoumouse matter, vvhich lyeth inclosede betvvene the bone, and the pellicle, vvhich covereth the same, mighte have some or other issve. The inscisione beīg done, vve muste suffer it to bleede as longe, till it of it selfe restraygneth & stoppeth, thē thrust the finger in good Aqvavitae, vvherin vve must before dissolve a little Treackle: And if so be notvvithstandīge all these remedyes the finger as yet corrupted farther, and must be extirpated, vve may thē verye aptlye effecte the same vvith our rescindent, or cutting pinsers, vvhervvith, vvithout great payne, vve may vvith,* 1.66 one nipe clippe it of. Ther are other, vvhich lay the fin∣ger on a little blocke of vvoode, & as thē vvith a rasor hevv it of. On this manner also vve may extirpate the superfluouse finger vvherin ther is anye bone.

And soe farre forth as if the fingers, vveare from the nativitye, and birth, or through com∣bustione, or els throughe anye vlceratione, he∣aled and ioyned together, vve must then vvith a rasor, separate them the one from the other, and accordinge to the length ther of cutt them asunder, and then vvith an exsiccating plaster, being separated cure thē, and soe skinne them, by vvhich meanes every finger vvill separatlye heale. If soe be that there came anye vlceration in the finger, after the vvhich there follovveth a deformed Cicatrice, vvherthroughe the fin∣ger, grovveth croocked: VVe must then trye theron some mollifying remedyes, to cause the finger thervvith to rectifye, & grovve straight:

And if soe be by noe meanes it vvilbe soe, as it sometimes chaunceth, vvhen the foresayed Cicatrice is great, and inveterated, & ether the sinnues, tendones or skinne have binne hurt, vve must not therfore proceede vvith the same as a thinge vvhich is incurable, for if soe be vve cutt, ether the one or the other, the finger ther∣after should nether be able to bende, nor stret∣ch out, yet is it necessary that the bendinge, pro∣ceede before the stretchinge out, and the stret∣ching out, or rectifying of the same, before the recurvatione, soe that he shoulde allvvayes be right, and verye inconvenient, as beinge better that he be reasonable croocked, then right, be∣cause of the inconvenience, vvhich ther throu∣ghe vve receave: For vve supposinge to shut, & close the hande, and to fasten on any thing, this finger as then should stand right out: But vvhē it is onlye the skinne vvhich maketh the Cica∣trice, throughe the vvhich the finger is recur∣ved, vve must then cleane cutt of the same for as it beinge harde, & callouse, can not be throu∣ghe the finger erected, and stretched forth.* 1.67 Ha∣vinge therfor novv rectified this finger, by this meanes, vve as thē make a nve Cicatrice ther∣one, & must note that in the generation of the foresayed Cicatrice, the finger doe not chaunce to be agayn recurved, or shrincke vp agayne:* 1.68 to the praevētīg of the vvhich, I knovve noe better meanes, after he be cured, that ther one vve vve∣are a finger case, of lattinne, or of silver, one the plaster, & one the combustion. This fingercase

must be covered vvith Taffatye, or vvith anye other decent substance, & conveniently, vvith a bande, fastened above on the hande, vvhich fingercase shall doe more commoditye, & hel∣pe, thē all the splintes vvhich vve might applye theron.

* 1.69Ther happeneth alsoe a dissease, cleane con∣trarye, vnto all other disseases of the fingers, e∣speciallye in the thumbe, having receaved the∣rone a blovve on the Tendones, vvherby the same is erected, & agayne the foresayed Tendo∣nes beinge cutt of, can in noe sort be agayne e∣levated, nether stretched forth, vvherthroughe he lyeth in the hande immoveable, and can not be stirred. The same chaunceth alsoe in the hande, havinge receaved anye vvounde in the hande one the Tendones, or alsoe above the hande, vvhere throughe the hande hangethe & falleth dovvnevvardes, as is she vveare parali∣ticke, and of her selfe is not able to be lifted vp. As touchīg therfore the thumbe, & the fingers: vve must ether have a thumbcase, or a finger case vvherthroughe they must be heaved vp: And for the hande, a glove, vvherthroughe the hand may be helde vp. VVhich in the boocke of M^r. Pare, are discribed.

Notes

• * 1.1

  Disctip∣tion of the natu∣rall bones The bo∣nes are as vvell sub∣iected vn∣to all mā∣ner of dis∣seases, as is the fleshe.
• * 1.2

  To knovv the cor∣rupted bones throughe sight.
• * 1.3

  Through feelinge.
• * 1.4

  Through the mat∣ter.
• * 1.5

  Occasion of the cor¦ruption of the bones
• * 1.6

  Magni∣tude of the pu∣trefactiō.
• * 1.7

  Hippo∣crates.
• * 1.8

  To cure the pu∣trefacted bones.
• * 1.9

  Hovv lōg vve ought to raspe.
• * 1.10

  The fyer is the su∣rest reme¦dye to re∣pel all cor¦ruptions out of the bōes.
• * 1.11

  Māner hovv to apply the Cauterye.
• * 1.12

  The Cau∣terization must be reiterated
• * 1.13

  What vve ought to doe in a deep Ca∣ries.
• * 1.14

  A historye of Albu∣casis.
• * 1.15

  The cir∣cumiacēt partes of the vlce∣ration must be freede.
• * 1.16

  Divers re∣medyes a∣gaynst the Caries.
• * 1.17

  Intention of the Aucthor.
• * 1.18

  The fistles of the fū∣dament, are ether-hidden or aperte.
• * 1.19

  The pate∣fyed Fist∣les of the sudamēt.
• * 1.20

  A thre foulde meanes to cure the Fistles of the fun¦dament.
• * 1.21

  Hovv vve must bind a pu¦blique, or patent Fistle.
• * 1.22

  Opinion of Gvido.
• * 1.23

  It is surer to make an inscisi∣on in the fistle, thē to tye it.
• * 1.24

  An other practice or inven∣tione.
• * 1.25

  Albucasis
• * 1.26

  Admoni∣tion for the Chy∣rurgiane.
• * 1.27

  The sig∣nes vvher throughe the Chy∣rurgian is hindered, to dravve forth the child out of his mo∣thers bo∣dye, vvhic of it selfe cā not be borne.
• * 1.28

  Ther are thre thin∣ges vvhich make Childe birth diffi¦culte.
• * 1.29

  The mo∣ther.
• * 1.30

  The chil∣de.
• * 1.31

  The exter¦nall occa∣sions.
• * 1.32

  The ope∣ratione.
• * 1.33

  Hovv vve ought to situate the vvo∣man.
• * 1.34

  The child must vvith his heade be dravvne out or vvith the feete if it be possi∣ble.
• * 1.35

  Signes of a deade Childe in his mo∣thers bo∣dye.
• * 1.36

  Hovv vve ought to dravve forth a deade Childe.
• * 1.37

  After vvhat fort vve may dravve forth the aquositye out of a deade Childes bodye.
• * 1.38

  A mon∣struouse Childe.
• * 1.39

  Hovv vve may dra∣vve forth the hea∣de of the deade childe as yet remay¦ninge in the vvōbe
• * 1.40

  The mā∣ner to ele∣vate a∣gayn the suncke & discēded Matrice.
• * 1.41

  When, & vvhye the externall part, must be saved of.
• * 1.42

  Extirpa∣tione of any ioync∣te, is effec∣ted vvith great daunger.
• * 1.43

  Reason, hovv to make choyse of the place, vvher vve shoulde extirpate the ioync¦te.
• * 1.44

  Reason for those vvhich extirpate any mē∣bre in the ioyncte.
• * 1.45

  Reason, for those vvhich extirpate the mem∣bre above or belovv the ioync¦te.
• * 1.46

  Reason, for those, vvhich ex¦tirpate the mem∣bre above or belovv the ioync¦te.
• * 1.47

  Experiēce of the Author.
• * 1.48

  Conclu∣sione.
• * 1.49

  Exceptiō.
• * 1.50

  Nota.
• * 1.51

  Situation of the pa∣tient in the extir∣pation of a Ioyncte
• * 1.52

  Hovv vve may vvel & conve∣nientlye extirparte a Ioynct.
• * 1.53

  Ther may not be a∣nye fleshe one the bone vvhē vve intēde to savve it of.
• * 1.54

  The Ioynct beinge extirpa∣ted, vve must thē make loo¦se the li∣gature.
• * 1.55

  Instructi∣on hovv vve shal koovv vvhe∣ther it must be stenched, or let bleede.
• * 1.56

  Virtves of the actu∣all Cau∣teryes.
• * 1.57

  Galenus.
• * 1.58

  Hovv throughe cauterisa∣tione vve should restrayg∣ne, & stē∣che bloo∣de.
• * 1.59

  Instructiō hovv to restrayg∣ne bloode throughe ligature.
• * 1.60

  Accorde to agree, the right vvorship∣full M^r. Gourme∣len, & M^r. Pare.
• * 1.61

  Of the dressinge after the bloode is stopped.
• * 1.62

  Hovv vve should doe this li¦gature to stenche the blood
• * 1.63

  A certay∣ne ligatu∣re.
• * 1.64

  The hand is an in∣strument, of instru∣mentes.
• * 1.65

  Curation of the Pa¦naris, or Paroni∣chia.
• * 1.66

  Hovv vve may re∣move the super∣fluous fingers.
• * 1.67

  Curation of a crooc¦ked fin∣ger.
• * 1.68

  A finger-case of lattinne, or of sil∣ver.
• * 1.69

  The thū∣be or the finger beinge vvholely lamed.