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 NINTHE TRE∣ATISE OF THE OPERATI∣one of Chyrurgerye, wherin is discoursede and handelede of the Ligatures, or vvindinges, & circumvolutions, & of the conve∣nience or the situation of the partes, Contayning sixe Chapiters.

• VVhat the Ligamentes, or Circumvolutiones are, theire matter, qualitye, forme, and quanti∣tye. Chapit. 1.
• The Kindes, and differences of the Ligamentes. Chap. 2.
• Rules, and generall instructions, vvherone vve must consider, in all circumvolutiones, and Liga∣mentes. Chap. 3.
• Hovve vve ought to tye the Ligament, and agayne make loose the same. Chap. 4.
• Hovve vve must ligate, and tye, the broken Armes, Legges, and Hippes. Chap. 5.
• Of the placinge, and situatione of those partes, one the vvhich the operatione, is set one vvorke. and imployed. Chap. 6.

❧ What the Ligamentes or Circumvolutiones are their matter, quallitye, forme, and quanti∣tye. Chap. 1.

HAvinge therfor spoken, & trea∣ated of the combinationes, and sutures, vvherthrough al vvoū∣des, & divisione, or separatiō of the vvhole is inserted & com∣bined together agayne, and the lippes or edges of the foresayed vvoundes are kept close together & shutt, vve vvil novve tre∣acte, and handle of the Ligamentes, or bindin∣ges, of the vvounded partes vvherin vve ought to consider, vvhat their matter, theire qualitye, forme, quantitye, & differences are, hovve vve ought to vvind, and agayne vnvvinde the same.

The vvindinge therfore, or dressinge of a vvounde is nothing els, then a vvindinge abou∣te, or circumvolution, of the Ligatures, vvhich is as much to say, vvith a broade and longe liga∣mēt, vvhervvith not onlye, the vvounded par∣te, butt allsoe the fin itimate, and circumia∣cent partes, are involved, and circumvestede

by this meanes to restore them to theire For∣mer estate, and naturall beinge.

Those Ligamētes accordinge to the affirma∣tions of aunciēt Chyrurgiās, are of divers mat∣ter, as of Linnen, vvoolle, or Lether: the linnen Ligamentes are the most commonest of all the other, vvhich at that time they vsed, vvhen as they vvoulde stifflye compresse, & bringe close together anye parte: they vsed vvoollen rovv∣lers, in the fractures vvith vvoundes, gentlye in that sort to retayne together the broken bones, & to cause noe payne, or inflammatione at all. Hippocrates vsed the Ligamentes of lether, in the fractures of the Nose, & the nethermost chavv bone: But of vvhat matter soever vve make thē they must not be too much vvorne out, becau∣se that they may be strōge enough, to be dravvn close together, & stretche stifflye out: Farther more they must be even and smoothe, nether must they have any silvages, nether must it ha∣ve anye harde seames, & must be cut aright the threde, accordinge the length of the linnen, & not cōtradictorily: because they may tye smoo∣the and evenlye, vvithout the one syde beinge hardre tyed then the other, as oftentimes it chaunceth, vvhen the rovvler is cutt contradi∣ctorryelye: It is right trevve, that the ligature vvhervvithe after Phlebotomye vve tye the ar∣me, yeeldeth it selfe better beinge so cutt, but it chaunceth heerin, because in that place it yeel∣deth it selfe better for the bending of the arme.

Touching their qvallity, they must be cleane & vvhyte, leaste that throughe their impuritye they be a hinderance, or interruption vnto the parte, & because by that meanes they may the better receave the humidityes, as Oxicrate, & vvyne, or any such like, vvherin vve chaunce to madifye, & vvett them. They must allso be fine & light because throughe their ponderousnes, they doe not overburthen the parte, suscitate, & provoke payne, & cause inflāmation. Third∣ly they must be softe, & flexible because throu∣gh the obduratnes therof, they might chaunce to hurte that parte. Fourthlye, of līnen, vvhich must be verye vvhyte, & not to closely vveaved because so they ar more better to be placede, & the matter, & the evaporationes might the easi¦er therthroughe transpire, vvhich being therin occluded, cause inflāmatione, & itchinge.

Concerning their forme, & figure, vve muste knovve, that these foresaede Ligamentes, or rovvlers, are ether rovvled vp, or involved, sī∣plelye, or dubblelye, vnto the middest of the foresayed ligature & of an aeqvalle latitude in all places, as are those vvhich vve vse in the frac¦tures of the Armes, Hippes, & Legges: In like sorte allso in the vvoundes, & vlcerations of the same partes. The dubble ligament or rovv∣ler is ether of on peece of linnen, on the endes beinge diverselye cutte, or on an other place, in other endes, as are the ligamēts of the Head, vvhich are cutte into foure, or sixe endes: And in foure endes for the Scrotum: Or in the liga∣ment, vvhich is sovved together, & made of di∣vers peeces, as are those vvhich are vsed for the flancks, for the Brestes, for the Testicles, & for the Fundament, & that especiallye vve desirīge to spare, & be chairye of the linnen. And as much as concerneth their longitude, & latitud that cosisteth on the consideratione, & iudge∣ment of the Chyrurgiane, vvhich before hand must see the figure, & knovve it, & must therby allso be able to knovve, the conformatione, & sitvatione of the parte, & the diversitye of the dissease: for vvhen as vve are vrgede to make a greate circumvolutione, vve must then consi∣der on the length, & make it as long as is reqvi∣red: cōsideringe the breadth, vve must make thē accordinge to the longitude, & latitude of the dissease, so that the foresayde ligament must be greater thē the dissease, because vvith on circū∣volutione doe not onlye involve the vvounde but allso both the endes therof as vvell on the one syde as the other: for if so be the ligamente vveare smalle, he must thē crushe the dissease, vvherthrough greate payne, and inflammati∣one might becausede.

And to speake of the qvantitye of the fore∣sayed ligamentes, that is nothinge els then the meane, and measure vvhich vve must vse and observe ether in stifly or loosely bynding, as in respect, of the persone. For as the one man is grosser & more corpulent then the other, so ther are also disseases, vvherof the one is more paynfull then the other, vvherfore vve muste consider, that the ligament be nether too stifly nor loosely tyed, for all ligatures vvhich are too stiflye bovvnde, cause payne, & concursione of humors, vvith inflāmations, yea & somtimes allso a Gangraena: And those ligamentes vvhich are too loose, they are profitable for nothinge, & cause that the restauratede partes, vvhich are sitvatede, move therout, as the broken Legges & the dislocatede membres, yea & allso the lip∣pes of the vvoundes vvhich are insertede, and brought together throughe the loose ligature doe agayne separate the one from the other. And finallye in one vvorde to conclude, the mediocritye of ligatione, is a greate solace, and comforte to the Patient, as he vvill then vvith his ovvne mouth testifye.

VVe must note that all ligatures muste not in a vvoūd so faste be ligatede, as in a Fract∣ure & lesse in a Fracture vvhich is vvithout a vvounde, then in a simple vvounde: VVe must allso harder, & more violenter binde & ligate on the vulneratede parte, & one the fracture, thē on any of the approximate, & nexte adioy∣nīg partes, therby to repell, & drive back agayn the humors, vvhich doe theron sinck and allso

crushe out, those vvhich are suncke into the fi¦nitimate partes, vvhich is leaste shutte: for in so doinge, vve keepe those partes occludede, & li∣berate, & free from all inflammations. Farther more in the end of the ligatione vve espye a tē∣der tumefactione, out of vvhich vve may iudge that the parte is reasonablye shutte: if so be the tumor be harde, & obduratede, & blackishe, it is then a signe that the parte is too stiflye tyed. And vvheras at all vve perceave anye tumefac∣tion, it is a signe that the ligament is too loose∣lye tyede.

❧Of the kindes, & differences of the ligamentes. Chap. 2.

HIppocrates gennerally hath made tvvo sortes of Ligamēts: vvher of the firste is, that vvhich of it selfe, & by his virtues did pros∣per, & opitulate the curinge of the disseases, and vvithout the vvhich they can not be cured becaus that vvith out the same, the parte can not be contaynede in his statione, or forme, vvherin shee must be contayned, to be cured, & to be praevented that ther happen noe fluxione vnto the parte, ne∣ther the matter beinge therin congregatede, vvithout the sayede ligature coulde not be dri∣ven, & expellede therout. As vve may note on the ligamentes, vvhich in the vvoundes of the Heade vve vse, vvhich allso in all concavouse vlcerations vve vse, in Fractures, in dislocatiōs, recurvatione of Ioynctes, in the separatinge of those partes, vvhich agaynst nature lye the one above the other, in the reductione of the sepa∣ratede partes, in the apertione of the partes, vvhich are to closelye occludede, & shutte & a∣gaynste the minde of the Chyrurgiane, vvill combine themselves together.

The seconde ligament, is that vvhich is or∣daynede, not onlye because of it selfe it is com∣modiouse, & profitable, but Per accidens, & bye chaunce, & it is but onlye vsed, to contayne, & keepe the remedyes, & compresses, on the diss∣easede parte, as on a great, & dolorouse inflam∣matione, on a greate Apostematione, or on any other dolorouse parte.

And touchinge the ligature vvhich of it selfe is profitable, & commodiouse, ther of ther are tvvo kindes, vvhich of the vse, vvher vnto they are ordaynede, are taken: vvhich is ether to cō∣tayne the partes as close in their naturall being because therthroughe they may be combinede & vnitede, vvherfore this ligatione is called, the agglutinative, or incarnative ligatione: Or els to praevente, the fluxione vvhich might chaūce to come to that parte, & expell the same ther∣out, vvhich is molestiouse, & troublesom vnto him, vvherfore he is called the expulsive, or re∣pellinge ligature.

The incarnative or conglutinating ligation, is commōly vsed in this form on the vvounds. To vvitt, that vve roule vp the rovvler, or liga∣ture on both his endes, vnto the middest ther∣of, vvherof in each hāde vve must take the one end beinge rovvled vp: laying that parte of the ligamēt vvhich is not rovvled vp, on the other syde of the vvounde, reducinge both the endes of the ligatione, vvhich vve have in our hands above on the vvounde, that ther throughe, vve might adioyne, & bringe together, the separa∣ted partes, & lippes of the vvounde, crossinge the foresayed ligature, in forme of a Burgundi∣ane crosse, or in forme as in the margine is set dovvne vnto you: Then vve must reduce both the endes to the parte, bringinge one end, to∣vvardes the superiour parte of the membre, be¦cause therby the fluxione may be praevented, & the other end, on the inferior parte, that the bloode therthrough, vvhich is suncke, and dis∣cended into that parte, might be depressed, and crushed out: and the fore sayed Ligature must be of such a breadthe, that vvhen as he is rovv∣led vp, & applyed on the vvounded parte, may not onlye compraehende the vvounde but al∣soe both the endes, of the same.

If soe be the vvoūde vveare ample, & greate, and the ligature, cōsidering his latitude, coulde not be accommodated, vve must as then com∣praehende but the one halfe of the vvounde, & the other halfe therafter.

Such a Ligament therfore must be reasona∣ble closelye vvounde, but allvvayes a little stif∣fer one the vvounded parte, as Hippocrates vvil∣leth vs to doe, yea also, in the vvoundes vvith Fracture, because there throughe might be ex∣pressed, and crushed out, the bloode, vvhich in that parte is suncke, least that there shoulde happen anye inflammatione thervnto, & then an Apostematione.

The expulsive, or repellinge ligamente, is ve∣rye much vsed in Fistles, & in concavouse vlce∣rations, thervvith to expell the matter, vvhich is discending to the grovvnde or bottome of the same, & vvhich throughe the longe retenti∣one, internallye corrodeth that part. This liga∣ture is allso verye commoeiouse in the Varices or bursten vaynes, & in tumefacted Legges, but vve may not vse it in Fistles, nor in any conca∣vouse vlcerationes, vnlesse first of all they be putrifyede, & their callositye taken therout, ne∣ther in inflammationes:

This ligamente is imposed, vvith the one end being revolvede, & rovvled vp, begīning vvith the sovvnde part, vvhich is sitvated close to the bottome of the Sinus, vvhere he muste be som∣vvhat more dravven together, & shutt, & then is reduced agayne tovvard the vvounded parte,

& tovvarde the mouth, or apertion of the con∣cavitye, vvith out bindinge the same to stiffe, & consideratione, of the inferiour parte.

As if the Sinus be in the legge, & the bottome of the same vnder the Knees, & is alsoe higher, & hath his issu in the crassitude of the calfe, vve must them beginne to binde, one the Knees, & finishe in the inferiore partes therof. Contra∣rilye if soe be the inferior parte of the Legge, & the issue therof be by the Knees, vve must thē beginn the ligatiō by the foote, & end the same close to the Knees. But if vve desire to vse this Ligature in greate Armes, and great Legges, vvhich are Varicouse, vve must then beginne from belovv the legge, or Arme, vpvvardes, vvhich is the most farthest, from the originall of the Vaynes and supernallye end the same, to vvitt, about the Harte, & the Liver, vvhich are the originalls of all Vaynes, & Arteryes, heerby to repell the humors vvhich are in that parte, & to praevent that there concurre noe more vnto that place.

As farre forth therfore, as if that parte be rug¦ged, and vnsmoothe, as is that Legge, vvhich is farre more thicker in the Calfe therof, then in the lovvermost partes therof, vve must thē frō palme, to Palmebreadthe, a little more thē half throughe cutt the same, and fovvlde both sydes cōtradictorilye the one to the other, & soe loos∣lye sovve the same, by vvhich meanes the sayed Ligament, is made to be recurvated, and crooc∣kedlye vvounde, like a Bovve. Having therfore stifflye rovvled op this foresayed ligature, or rovvler, vve may thervvith as smoothlye vvind & involve a Legge, vvithout makinge, therin a∣nye inaeqvalitye, or furrovves causing that syde vvhich vvas cut of, & thē agayn sovved, aeqval∣lye to agree vvith the thīnest parte: & the vvhol parte vvhich is the longest, to agree vvith the greatest parte. Above these tvvo foresayed Kin∣des, & differēces of Ligamentes, vve may as yet adde thervnto a thirde Kinde: The vvhich vve call an attractive Ligamēt, vvhich vve may vse vvhen vve desire to retracte, anye bloode, nou∣rishment, or anye other vitall Spirites into that parte, the vvhich, the parte of it selfe can not dravve, & attracte vnto it, because her attracti∣ve forces are debilitated, & very much feebled.

VVe vvill somvvhat alsoe speake of that liga∣ment, vvhich of it selfe is for noe vse profitable but accidentallye cureth, throughe his conti∣nuāce of the remedyes, vvhich are applyed vn∣to the dissease, vvherfore vve may call it the re∣tentive Ligament: vvherin vve must consider thre especiall thinges. First in vvhat disseases it is commodious: Secondly on hovve manye fashones, it may be composed, & made: Third∣ly, & lastelye, hovve vve ought to vse the same.

Touchinge the first, vve ether vse the same, consideringe the parte, or the Dissease, vvhich can tollerate noe other: Consideringe the Dis∣sease, as anye vvounde, or vlceratione, accom∣panied & associated, vvith anye great payne, or inflammatione, or vvhen vve disire an Aposte∣matione to be matured: Consideringe the par∣te, as vvhen a vvounde is in the Heade, in the Necke, in the Bellye, or in the Testicles, vvhich partes cā not indur to be stiffly tyed, or bovvnd, & therfore neede noe ligatione, but only to re∣tayne the remedyes therone, because that the other stiffe ligatures, bringe vvith them great discommoditye.

Concerninge the seconde poyncte: The re∣tentive Ligamēt, must have tvvo, three, or four endes, accordinge to the forme, & situatione of the parte vvhich vve vvoulde dresse. Touching the thirde poyncte, that must be begunne in the dissease, & ended on the other syde of the same.

❧ Of the Rules, & generall Instructions, wheron we must consider, in all Rowles, & Ligatures Chap. 3.

THerfore convenientlye, & de∣centlye to vvinde, or involve anye parte, or mēbre, vve must note, & cōsider on tvvo espe∣ciall thinges, vvherof the first is, the vvounded parte, vvhich vve vvill vvinde: the seconde is the aegritude, or dissease. Touching therfore the disseased parte, vve take this for a generall Rule, that shee must be tyed, & that in such a forme, & figure, as vve vvil have her to cōtinue, & lye: For if soe be vve vvind a foulded, & curvated parte, vvhich ther∣after must be situated right, and extented, ther vvill as then conseqventlye insue such or the like Accidentes: to vvitt, that the Ligature vvill dissolve, & loosen, that ther vvilbe caused great payn, & doloure in the parte, because the Mus∣cles, Vaynes, Arteryes & Synnues, & the verye bones alsoe have an other situatione, beinge erected, & extended, then vvhen as they are re∣curved, and croocked.

As in exāple: If soe be a broken Legge, being recurved, & soe on that manner be circumliga∣ted, & vvounde vvhich ought othervvyse to be tyed, beinge stretched & extended right forthe, vvithout doubte all the Ligature vvill goe loo∣se, vvhen as vve desire to extende the same, out of the vvhich vvill follovve great payn, because the brockē Bones, Vaynes, Arteryes, Synnues, & Muscles, doe not as thē keepe the same place, as they have done, the parte beinge bovvnde, & tyed.

Contrarilye, vve desiringe to dresse a fracture in an Arme, he must then be shutt, & foulded together, for if soe be vve dresse him beinge ex∣tended, vvhē as therafter he shalbe recurved & bended, then the Bones in therre lyinge, vvith the other partes, be turned into some other fas∣hone,

vvherthroughe the Ligature, vvil in one place be loosened, & in another spāned, vvhich also suscitateth payne in that parte: For it must necessarilye follovve, that vvhen as a tyed parte be chaunged, and then ether shutt & bended, or extended, thē there are some of the Muscles ex∣tended, & crushed, as in the rotunditye, in the abbreviatione, & others vveackened, & vnited: And vvhē they are exrected, they must needes then be crushed throughe the Ligature, out of the vvhich must necessarily follovve intollera∣ble payne, because of the Compresse, vvhich in ferreth vvith it in that parte great fluxiones, & other accidentes, & mischaunces.

Novv for as much as cōcerneth the dissease, vve must circumligate, & involve an Arme or a broken Legge vvith a vvounde, on an other manner, and fashon, then a Fracture vvith out vvoūde: & on an other fashon a Legge, vvhich hath but a simple Vlceratione, then a Legge, vvhich hath a concavouse, or Fistulouse vlce∣ratione: And a Ioyncte vvhich is full of payne, must one an other manner be tyed, then that vvherin is noe payne.

Therfore cōvenientlye, & decentlye to ligate or vvinde, the Ligature must be right, & close∣ly rovvled vp, because vve may houlde him the faster, & stedyer in the hāde, vvithout stirring, or glidinge this vvay or that vvaye, as he might chaunce to doe the same not being stiffly rovv∣led vp, because that throughe his hardenes he may the better be handled, & conduced, so that all ligationes, farre cōvenienter, & more decēt & to more contentment of the Patient, and the circumstantes, or standers by may be effected, then other vvyse, vvhē as the Ligature is layed dubble, croocked, curved, & vneven.

❧Howe we ought to tye the Ligament & agayne make loose the same. Chap. 4.

THe Chyrurgiane must cōsider, & note, that ther be no seames knottes, or anye vnevennes, in the Ligament, vvhich might chaūce to crushe the vvound: and the Ligatione alsoe being finished, consideringe that the end of the Liga∣ture, be not fastened, one the vvounde, nether one anye place vvher ther is any payne, for vn∣les vvith a pinne, vve fasten it, or els vvith a Needle sovve it, it allvvayes inferreth payne vvith it: vvherfore vve must fastē the sayed Li∣gature, ether higher, or lovver, or one the syde of the same, one the end of the rovvler, & one such a place of the Ligature, vvherone the Pa∣tient doth not lye, as behinde one the Heade, in the Temples of the Heade, one the Backe, & on the Buttockes, nether one the Flanckes, or Ar∣mepittes,

And concerninge the dissolutione, or vn∣tyinge, therine vve must cōsider tvvo thinges: Namelye one the time, vvhen the Patient must be dressed, & one the cōvenience of doinge the same: and heerin disagreethe the practise of the aunciente Chyrurgianes, from vs: For touching the dressinge of vvoundes (Celsus vvilleth) that vve ought not to dresse the vvoūde, but in thre dayes once, suffering it tvvo dayes▪ to continue vvithout dressing: And then vvilleth he vs, that vve dresse it but once in five dayes. And as tou∣chinge the simple fractures, Hippocrates coun∣celleth vs, that in thre dayes once vve dresse thē But novve adayes, vve doe not observe this mā∣nes, for vve dresse the Patiēt after the first dres∣singe 24, hovvres, vnles vve feared anye greate fluxione of bloode, vvherfore vve suffered the Patient to lye lōger vvith out dressing, to vvitt, tvvo, three, foure, or five dayes longe: It is right true, that vve sometimes make loose the liga∣mēt in tvvo, or three dayes once, vvithout tou∣chinge of the playster, onlye to give ayre to the parte, & to note, vvhether there be nether In∣flāmatione, nor any other Accident come ther vnto: But vvhen as the vvounde is come to ve∣rye great suppuratiō, & that ther is much mat∣ter, payne, or Inflammatione at hande, vve as then dresse the vvounde tvvo, or three times in the space of 24 houres, to vvitt, all eight hovve∣res once, if it be possible.

And touching the simple Fractures, vve keep thē sometimes, sixe, or seaven dayes vndressed, vnles that ther vveare anye Accidentes, at hād, but allvvayes vve tarrye as longe as is possible: for hovv little soever vve touch a brokē legge, the endes of the bones, of the fracture are ne∣verthelesse, stirred, & dislocated, & the on rub∣bed agaynst the other, vvherthroughe is caused payne, and the combinatione, or together hea∣linge is hindered, because that all conglutina∣tione, can not be vvith out cōtinuall coniunc∣tione of the one parte vvith the other.

The redressinge, or dressinge, must be done one this manner: to vvitt, that vve easilye make loose the bande, or rovvler, novv vvith the one hande and then vvith the other looseninge of the same, alvvayes houldinge the vvhole Liga∣ment in the hande. But because most commō∣lye the first dressinge of the vvounde, cleaveth soe fast, as if vvith glevve it vveare theron faste∣ned, because of the bloode & matter, vvhich is therone dryed, and baked, vve must first of all therfore, madefye, & moysten the same vvith a little vvarmed vvyne, and thervvith soacke the same because the ligament may be taken, & re∣volved therof vvithout payne, yea or els also in the vvindinge of, of the same comming on the vvounde, vve might ther everye time cutt it of, because in soe doing, vve might by peecemeale take avvay the same, vvithout in any sorte hur∣tinge

of the Patient.

❧How we shall dresse the broken Armes, hippes, and legges. Chap. 5.

AL thoughe that our common practise, of the dressinge of all broken Legges, seemeth to be alienate, and to differ, from the manner of doinge, of the anti∣que, & auncient professors, & Chyrurgiās, it is notvvithstanding in such sor∣te, that vve easyly can compare them together. All the auncient physitions, & Chyrurgianes, have binne of opiniō that in the Fractures vve ought to vse a dubble kinde of Ligament: Na∣melye inferiore ligamentes, vvhich they called Hypodesmidas, & superior ligatures, vvhich they called Hypodesmous: they have these names be∣cause of their situatione, because some of them are tyed, and bovvnd vnder & some agayn abo∣ve. And as touchinge the inferioure ligamētes, Hippocrates maketh mention of tvvo sortes.

VVherof the first, & the shortest, beginneth one the fracture, layinge alvvayes the one end contradictorilye therone because it should not vvholy lye, on the place of the payn, vvhich li∣gament must be tyed round about the fracture, & then be reduced vpvvardes, vvhere he as thē endeth: This ligament must closelye be vvoun∣de together, because so the fluxiō, vvhich might chaūce to sincke into the disseased parte, might the better be kept therout. The seconde liga∣ment, vvhich allmost, must be as longe agayne as the first, is allso begunne one the same man∣ner, to vvitt, on the fracture, layinge onlye ther∣one, a turne, or tvvo, vvinding dovvnevvardes, to crushe therout the bloode vvhich might chaunce to sincke into the fracture, vvith cir∣cumvolutiōs, vvhich must be layed a little mo∣re a parte the one frō the other, then in the first ligament they vveare: for vve must take heede of makinge to greate expressiones of bloode, in the endes of the Armes, or legges, that vvithout imflammatiō they can not receave much ther∣of, and the ligament being come dovvne, must vvinde the same vpvvardes agayne, to come a∣gayn to that place vvher vve did beginn, becau∣se both these ligamentes might hould fast, and the muscles be brought into theire naturall si∣tuation, vvhich through the tvvo formost liga∣tiones might be brought therout.

Other auncient Chyrurgianes make of this nethermost ligature, tvvo ligationes, vvherof the one is the surest the seconde for the fractu∣res, vvhich beginneth one the brokē parte: ha∣ving therafter, made one, or tvvo circumvolu∣tiones, then is the foresaved ligature reduced dovvnevvardes. The other vvhich may be the thirde for the fractures, must be begunne, on the beginning of the parte, endinge supernally vvher the first ligatiō is ended passing over the Fracture: Soe that they impose therone thre li∣gationes all vvhich three vve may call inferior ligamētes. The first vvhich ascendeth from the fracture one highe, as from the middle of the legge tovvarde the knee. The seconde vvhich descēdeth from the fracture dovvnevvardes, as from the middle of the legg tovvardes the foo∣te. The third, vvhich from the extreameste part of the Ioyncte, ascendeth superiorlye as frō the the soule of the foote tovvardes the knees.

But novveadayes & folovving our common practise, vvhich vve vse before these three liga∣mentes, vve applye first of all, one the place of the fracture an astringent Plaster, vvhich is ma∣de of Bolus, of flovver, or volatill meale, of vvhy∣tes of Egges, of Oyle of Roses & of a little Tere∣bentine, (in steade of Cerotū Galeni, vvhich the aunciēt Chyrurgians vsed:) After the first dres∣sing vve vse the Plaster of Diacalcitheos, or of Di∣apalma, liquefacted in oyle of Roses, vvith vi∣neger. The ligature novv being decētly vvoūd, because the legges, the hippes & the Armes, are thinner belovve then above they are, vve must therfore one such slendernes apply some certayn cōpresses because the foresayed ioync∣te may be in all places of an aequall crassitude, & thickenes, & the splinter, vvhich must be ma∣de of stiffe paper, of lattinn, or of any other sub∣stance, be verye evenlye, & smoothlye applyed therone, & tyed vnder the inferior ligatures, or rovvlers.

These splinters must be three in numbre, vvhich must be excavated like a gutter, vvherof the first must be a little broader, then the other to by applyed vnder the fracture, & to comprae∣hende all that, vvhich is belovve the fracture, & be as it vveare a fundament, or foundatiō ther∣vnto. The other tvvo one both the sydes of the fracture, being somvvhat separated the one frō the other, least that in the ligatiō they chaūced to glide the one over the other. They must also be of such a longitude, as the broken parte re∣quireth.

These thre foresayed splintes being thus im∣posed, one the inferior rovvlers, vve must then tye the fracture that it may lye fast and steadye & the part be cōtayned in a goode quallitye & disposione. VVith the first of these tvvo ligatu∣res, vve must beginn, at the extreamest parte of the membre, frō vnder vpvvardes. The seconde must beginn frō above & end belovv: vve must allsoe note that the one of those rovvlers, must take his beginninge internally in the membre, & must proceed from the left to the right syde, becaus they may crosse the one over the other, in such a forme as in the margine you may see, or in forme of a S^t. Andrevves Crosse, because it may be involved verye closelye theron.

It seemeth that Hippocrates hath vsed noe o∣ther ligature, in the Fractures vvith vvounde, but that he rovvled the same somvvhat loose.

But in those fractures vvhich vveare shott, or vvith anye other such like instrument, or engi∣ne, be done, vvherin is great crushinge of bo∣nes, because vve should little neede to handle this parte, vvhich is thus broken, and crushed, least the acute, and sharpe ossicles, or bones, & frustles, the vvhich in the pertractatione of the same, might chaunce to pricke the Flo••he, Tē∣dones, Synnues & the Peritoneum, vve must ther fore vse heervnto great Cōpresses, beinge foul∣ded three, or foure on the other, and soe sovved together in the midle, beinge in tvvo places cut throughe, the compresse beinge of the bredth of a palme, of ones hāde, or theraboute, vvhich vve revolve the one tovvardes the other parte, as if vve desired to circumligate the parte. The∣se, or such like Compresses, vve must by little & little shove vnder the crushed parte, or mē∣bre: & the same being immūdifyed, & impure, and vve desire to lay an other thervnder, vve as then sovve a cleane vvhite Compresse, one the impured Compresse, & as then vve dravv avvay the impure compresse from vnder the Fracture & then subseqvētly follovveth the mundifyed, & cleane compresse thervnder, in the steade of the immundifyed. I have constituted the defi∣guratione, of these Compresses, heere before a∣mongest the figures of the Instrumentes, in the table of the Glossocomium, vvhich of Hippocratis is called Ambi, on vvhich place, & in the forsay∣ed leafe, is defigured vnto you, a broken legge, vvith the Ligamentes of the same.

Of the situation, and of the constitutione or collocatione of those partes, one the which the forsayed Opera∣tione must be effected. Chap. 5.

NOe man is ignorāt, hovv neces∣sarye, & requisite these operati∣ones are, to the resanatiō, of the disseases, vvhervvith mās body is daylye, & continually oppug∣ned & opressed: and indeed, this operation shoulde in vayn be vsed, if so be that not onlye the vvhole body, but also the forsay∣ed disseased partes, vvherō vve effecte our Ope∣ration, vveare not therafter, constituted & situ∣ated, and vvith most convenience colloca∣ted.

Therfore decentlye, & vvith most couveni∣ence to collocate the same, the Patiēt must first of all lye on his bedde, (if soe be at the least the magnitude, and largenes of the dissease require the same,) & that in such a form, that the vvoū∣ded, or vulnerated parte; may be vvith most ea∣se, & cōveniēce collocated, as it is reqvisite, for they are not al together situated in one fashō, & manner: It is right true, that there are some cer∣tayne rules, as are in the ligatures, vvhich must only be vsed one disseases.

First of al therfore, & generally, to collocate & rightlye situate al vvounded partes, vve must consider thre especiall thinges: to vvitt, that the situation, be Softe, Smooth & Highe: Softe, be∣cause a hard situatiō, somtimes might chaunce to disturbe, and irrequiate, not only the vulne∣rated part, but also the approximate partes ther vnto, by the vvhich meanes great payn, inflam∣mation, & consequentlye also an attractione, & a fluxion must necessarily follovve in that par∣te: & vvhich is more, the Patient is constrayned not being able to tollerate the obdurate collo∣catiō, to ease and yeelde solace to that parte, by oftentimes turninge, and revertinge of himsel∣fe, vvhich is very vnprofitable for him, because that parte, requireth nothinge els then quietu∣de, vvithout beinge much disturbed, and mole∣sted.

Even, and smooth, becavse that the vnevē, & implanitude collocation, inferreth payn & re∣curvatiō in the Ioyncte, to vvitt, the one parte resting on somvvhat, & the other parte, depen∣dinge vvithout restinge one anye thinge.

On Highe, because that therbye, al concursi∣one of humors is praevented, vvhich othervvise through the lovv situatiō of the Iovncte, might be therthervvardes dravvne.

Considering this occasion, have the Chyrur∣gians alvvayes caused the broken or vvounded Arme to be dependently vvorne one the breste & the legg to be collocated on highe, to vvit sō∣vvhat higher then the bodye, the Patient lyinge on bedde, because he may nether be erected, nor sitt.

Nether is it onlye necessarye that the mem∣bre, or parte be collocated softlye, smoothly, & highlye, but it is also requisite, (if soe be ther be anye vvounde, or vlceration, vvhich especially is fistulouse) that the apertiō therof, if so be it is possible, recurvate it selfe dovvnevvardes, be∣cause that the matter, might have the liberater a passage, to enter forth at, vvithout makinge a∣ny greater cōcavityes, & doe not chaunce to in∣cēce, or inflame the approximate partes, nether to corrode them, vvhich vvould bringe vvith it divers, & sundry accidentes: & praeposterate the resanatione of the same.

Secondarilye, the Ioyncte must be situated in such a forme, and fashone, vvhich is agreinge vvith the naturalle disposione of the Ioyncte, and alienated from all payne: vvhich tvvo ob∣servationes, are vvell agreinge the one vvith the other: For all fashons vvhich cause noe payne, that is the naturalle, and accustomed figure, and collocatione therof: Euen as the

paynefull, and vnnaccustomed figure is agaynst nature, so that the naturall, and accustomed fi∣gure, or fashō, is vvholy vvithout payn: vvhich happeninge, the Patient must a longe continu∣ance keepe his Ioyncte in that beinge, because soe he shall feele noe, or at the least verye small payne at all vvhich is verye cōmodiouse, to the resanation of all vvoundes, vlceratiōs, Fractures & also for all dislocatiōs, as it is in like sort pro∣fitable for all other disseases vvhatsoever,

The aunciente Chyrurgians, have called, this forme of situatione, the right and true colloca∣tione, because all the Vaynes, Arteryes, Synnu∣es, & muscles, as then are right, nether are they extended, nether lye they recurved.

And althoughe that the Arme have binn an∣glevvyse collocated, notvvithstāding vve estee∣me it as then to lye right, because that all the fo∣resayed partes, are accounted to lye right, & not extended, nether recurved, & that this colloca∣tion of the Arme is naturalle, as heere after vve vvill more largelye speake of.

And by degrees to specifye, the situatione of each, & sundry parte, vve vvil heere discribe so∣me of them for an example: vvhē as ther is any vvounde, Apostemation, or dislocation in any Ioyncte, vve must then vvith all dilligence note the situation there of: for through a badde situ∣atione, not onlye immediatly are caused many accidentes, but after the sanatione therof, the Ioynct sometimes tarryeth right out extended, vvhich ought to have binne croocked, or els a∣bideth croocked vvher it oughte to be extēded or els combineth it selfe, & ioyneth vvith some other thinge, vvhich ought to have binn sepa∣rated, & seioyncte. VVherfore if the vvoun∣de be in the vppermost parte of the shoulder, vve must then impose vnder the Armepites of the Patient, a great linnē balle, & hange the ar∣me one the Brest, & somvvhat beare, out his el∣bovve, because that the heade of the arme, may be somvvhat elevated, & the separated partes, may agayne be inserted the one vvith the other and so much the better be cured together agay∣ne: The contrarye vvherof must be observed, if soe be that in the inferior parte be anye vvoun∣de, as vnder the Armepittes: for the vvound be∣inge cured, & vve doe not lift vp somtimes, the Arme & let him fall dovvne agayn, & stirre him othervvayes, vvithout causinge any payne, and that the Arme is not helde from the Breste, the Patient therafter, because of the Cicatrice shall not be able to lift vp his Arme because through the same the Arme is grovven stiffe. As therof vve have an example, exemplifyed vnto vs of the throte, & in the Necke also of many and di∣vers, vvhich beinge vvounded, or burned, the cicatrice hath remayned so obdurated, that they ther through have ether helde their Heades, to much on high or to much stoupinge, or hāging backvvarde, or to much dependinge ether on the right, or one the Leftsyde.

If so be that ther be an Apostemation, in the Elbovve, or els that the same be dislocated, or vvounded, vve must thē situat the Elbovve an∣gle, or cornervvyse: for such aforme is very ne∣cessarye for the same, & natural, & accustomed vnto hī: & although, the cornervvyse figure is that vvhich maketh an accute corner, notvvith¦stāding vve meane therby through the anguled figure▪ vvith the auncient Chyrurgians, that vvhich hath his corner right but yet not so cle∣ane, and vvholy erected, but that vvhich attayg∣neth somvvhat tovvard the rectitude, so that it commeth somvvhat bluntlye, and such a figure is not as yet truelye the meane, betvveene the inflexione, and the extensione, but is the same vvhich yeeldeth her selfe, tovvarde the extensi∣one: If soe be the Arme be inserted and combi∣ned, vvith being able to be recurved, or extēded vve may yet as then better, and vvith more faci∣litye helpe him selfe, then if he vveare vvholye recurved, or vvholye extended.

VVe may alsoe observe the same in the han∣de, for vve must keepe the fingers shutt, & halfe bended, and if soe be the dissease vveare in one finger only, it vveare then better that the same continued ether inflected, or incurved, thē that he vveare strayght, for the property of the han∣de is to gripe and take houlde, the vvhich shee can not effecte, and bringe to passe, then throu∣ghe the recurvatione of the same.

If soe be above in the Hippe ther chaunce to come, an Apostemation, or vvovnde, vve must then in the consolidatinge of the same, observe that vvhich in the shoulder vve have seene, as beinge necessarye to stirre the foresayed parte, on divers fashons, because the heade of the bo∣ne, doe not insert it selfe, and grovve fast in the panne.

VVe observe in the Ioyncture of the knees the contrarye, for if so be, that ther be a vvoun∣de, or an Apostemation, or els in the finitimate parte, the Patiēt must thē hould his legge right, vvithout havinge the heeles dravven in tovvar∣des his buttockes, as it in divers persons happe∣neth, and that to the hinderance of the Patien∣tes, vvhen they are cured.

And vve must dilligentlye note, that the leg∣ge be collocated as right, as is possible, and if so be by chaunce it laye recurved, vve must then as gentlelye, as is possible stretche and exten∣de the same agayne, othervvyse the patient be∣inge cured, might chaunce to be mutilate, and vvithout greate indecorū, or deformity should not be able to goe, as vve have knovvene the sa¦me to happē vnto tvvo great personages, of our times.

Novv as concerninge the foote, & the Toes, they must allsoe be extended, and not recur∣ved,

or inflected, as vve have spoken of the hād, & fingers: For if soe be they cōtinued soe crooc¦ked, the bodye as then shoulde not be able to rest, or stayede theron: Soe that the situation of the Arme, is cōtrarye to the Hande, to the Leg∣ge, and to the Foote: because the one must be recurvede, or croocked, and the other extended right out.

The end of the Frenche Chyrurgerye, contayninge the manuall O∣perations.

Notes

• What Li∣gamen∣tes are.
• Matter of the Liga∣mentes.
• Hippocra∣tes.
• Forme & figure of the Liga∣mentes.
• The Liga¦mēt must bē broa∣der then the dissea∣se.
• Quanti∣tye of the Ligamē∣tes.
• Wherone in Ligati∣one vve ought to consider.
• Tvvo sor¦tes of liga¦ments in generall.
• First kind of ligatu∣re.
• The se∣cōd sorte of Liga∣ment.
• Redivisiō of the first kind of Liga∣ture.
• Icarnati∣ve Liga∣ment.
• Nota.
• Hippocra¦tes.
• Expulsive Ligamēt.
• Admoni∣tione.
• Hovv vve may ma∣ke the expulsive ligament.
• An at∣tractive Ligature.
• The secō∣de kinde of Liga∣ment a¦bove re∣hearsed.
• Ligamēt for the dissease.
• Ligamēt for the parte.
• Tvvo thinges to be con¦sidered, vvhen as decentlye vve desi∣re to vvin¦de anye parte.
• Example.
• The dis∣sease.
• Decētlye to vvind.
• Wherone vve ought to, consider in the fa∣steninge of the li∣gature.
• Tvvo thinges vvherone vve must consider in the dressinge of a vvounde
• Celsus.
• Hippocra¦tes.
• For sim∣ple frac∣tures.
• Hovv vve may gēt∣lelye take of the Li∣gament.
• Our mā∣ner of dressinge of al bro∣kē legges may be assimila∣ted, and compa∣ted, vvith the man∣ner of the auncient Chyrur∣gianes.
• Tvvo sor∣tes of in∣ferior, or vnderli¦gamētes.
• Subdivi∣siō of the seconde inferior ligature.
• An astrin∣gent pla∣ster on the frac∣ture.
• Applyca∣tione of the infe∣rior Li∣gatures.
• Ligamē∣tes for shott vvoūdes, vvith crushing of bones.
• Vitilitye in consti∣tution of the parte.
• Thre thin¦ges to be cōsidered in the col¦locatiō of a parte, or membre.
• Playn, & smoothe situation.
• Highe si∣tuatione.
• The aper∣on of a vvound must all vvayes be recurva∣ted dovv∣nevvar∣des if it be possi∣ble.
• The situ∣atione of the Ioync¦te must be natu∣rall, & ac∣custo∣med.
• The na∣tural situa¦tiō vvhich of the aū∣cient pro∣fessors, is called the right si∣tuation.
• An exam∣ple of the situatiō of any disse∣ased part.
• An excel∣lent ob∣servation
• The an∣glevvyse figure, is the natu∣rall forme of the Arme.
• The hand must be shutt.
• The hip∣pe must be stirred.
• The leg∣ge must be kept right.
• Discom∣moditye of having the Legge croocked