The whole course of chirurgerie wherein is briefly set downe the causes, signes, prognostications & curations of all sorts of tumors, wounds, vlcers, fractures, dislocations & all other diseases, vsually practiced by chirurgions, according to the opinion of all our auncient doctours in chirurgerie. Compiled by Peter Lowe Scotchman, Arellian, Doctor in the Facultie of Chirurgerie in Paris, and chirurgian ordinarie to the most victorious and christian King of Fraunce and Nauarre. Whereunto is annexed the presages of diuine Hippocrates.

The first Chapter, of bleeding and thinges therein to be obserued.

BLeeding which the Greekes call Phlebetomia and the Latins venaesectio or an incision of the veine arificially done, to euacuate, retaine and diuertise the blood & other humors cōtained with it in the body, of the which there is gret differēce acccording to the veines & blood as in the head, leggs or feete com. ap hori••. 25. et 47.* 1.1 Is a thing most ne∣cessarie to be knowne of all Chirurgians not onely for the healing of maladies, but also for conseruation of the bodie from sicknes, sometime both for healing & preseruing, for the which it is most nenessarye to knowe the number of the veines, also the true situation, to the end he take not one for an other, because sometime the situation is va∣riable, and in partes not accustomed verie vneasie to be opened, wee must also knowe the waye to open them

and what it is to consider afore and after, for the effectes, that followe thereupon wtich are these. It quickneth the spirrits, helps memorie, maketh the senses more sub∣till, clarifieth the voyce and sight, causeth digestion, e∣uacuates the euill blood and is an euacuation naturall of the humors of our bodies, by the which infinite mala∣dies are cured as is ample prooued by Gualterus and Ru∣fus.* 1.2 The number of the veines which wee open ordina∣ly, for Maladies is 41. to wit, 17. in the heade, 6. in the armes, 3 in ech one, 6 likewise in the hands, 4 in the fun∣dament, 2 in each side, 8 in the legges, and must be ope∣ned 3 wayes, the great long waies, the little ouerthwart, in the typ of the nose in pricking it, not lifting the skin.

Rules to be obserued in bleeding.

SOmtime bleeding is vsed for the preseruation of the bo∣die [ 1] from sicknes as yee haue hearde,* 1.3 which is not commonlye done in Children afore Fouretenth yeares of age, nor in old people after Fourescore, because the abun∣dance of blood is not great, nor the forces strong, neuer∣thelesse for the healing of sicknesses, which is the seconde commoditie of bleeding,* 1.4 wee let blood both Chil∣dren and old folk, and sometime rather the olde than the yong, as one of Threescore, will sometime better endure bleeding, than one of Thirtie, and a Chi••••e of a yeare olde twise in one day, and one of Thirtie Ten times in a daye. Secondlye wee must weigh the strength, for in strong [ 2] people wee bleede largely,* 1.5 those that are feeble and extinuat not so much, although Gaelen & others coūsell in vehement dolor & carbuncles,* 1.6 to draw blood vsque ad a∣nimae defectū, the which come great accidēnts, so not to be done.* 1.7 If the blood be euil & intēperate aduise for the cor∣rectiō hereof, with some l••arned Phisitiā, & also with Hen∣ricus.* 1.8 If the body be of good habitud nourished with good [ 3] iuyce, the veines great & full of blood, we drawe largely,

those that are of a weake and ill temperature and haue the veines small,* 1.9 and little blood, are to bleede lesse. Those [ 4] who are brought vp in hot countries, nourished with hot meates endure more bleeding,* 1.10 then those in cold coun∣tries▪ and their blood is more hot, so much more subiect [ 5] to hot apostemes and feuers, nor to cold as the other blee∣ding,* 1.11 which is vsed for preseruation of health, ought nos ••o be done, neither in winter, nor in sommer, but in the spring time▪ in which time many sicknesses are cured, as also the goute as testifieth Galen,* 1.12 and must bee done rather in the mornimg, than any othe•• time: yet that which is vsed for the healing of sicknesses may be done at all times and ho∣wers according as the sick requireth.* 1.13 If we are ordinarily accustomed to let blood when the hemorroides, & purga∣tions in women are retained otherwise, then they ought, [ 6] to eschewe great maladies, and is done sometime in the arme,* 1.14 otherwhiles in the legge and foote, as it shalbe fond expedient: and being accustomed to let blood for preuen∣ting of certaine diseases, doe it afore the disease come. The Astrologians are of the opinion, that the starrs, planets and [ 7] signes haue power in mans body and that euery humor of the body is gouerned by certaine signes,* 1.15 as the sanguine by Taurus virgo and Capricornus, the phlegmatick humor by Aries & Sagittarius, the chollerick by Cancer & Pisces, the melancholick by Libra and Aquarius. According to their opinion and sometime Phisitians also, also Constan∣tinus Aefricanus, wee must not let blood that part where the signe is, which things are not obserued of the most lear∣ned Phisitians and Chirurgians, as Hipp. Gaelen, Oribasius, Sardinius, Aetius, Paulus, Rasis, Auicen, Haly abbas, and diuers others Latins Greekes and Arabes. For when the body is greuously oppressed with maladie, wee must not stay for the course of the celestiall signes. There are some, who obserue the course of the Moone, except in greate necessitie, and the new Moone is better, than the old, yet it must bee considered, by reason of some other

euacuation, for the which olde women must bee bledde in the olde of the Moone, and young women in the newe: as noteth Gordonius in these wordes.

Luna vetus veteres, Iuuenes noua Luna requirit.

If hee whome wee would bloudde, be constipat, giue [ 8] him a clyster remollient, and consider,* 1.16 if the meate he hath eaten, be digested, and if the bloud be grosse, vse frictions to subtilize it and make it runne,* 1.17 if any great maladie hath preceded, or great euacuation, either of hemerroihdes or monethly course, fluxe of the belly or vomiting, waking, or great vsing of women, in these cases bleeding shoulde bee defeerred, except for great occasions, and then it must be moderately done. The sicke must haue his minde free from passions, chiefely feare, which retireth the bloud to the cen∣ter of the bodie: if he feare fainting, hee must eate an egge before, or a toste in wine and lie in his bedde.

Of the scituation of the 17. veines in the head, the way to open them, and their effectes.

THe first is called vena frontis preparata or recta, and proceedeth of the Iugular interne, scituated in the [ 1] middest of the Forehead, for the opening of the which, thou must binde the necke with a napkin, till the veine appeare, doing the like in all other veines of the head: nexte, drawe the lancet on the veine, open it aslope, take heede ye goe not too deepe, for feare of the Pericrane: and it is good for all inueterate dolors of the head, chiefly of the hinder parte of the head, for all diseases in the face, as rednesse, euill sauoured vlcers, inflamation on the eyes, phrensie. The second is called venapuppis scituated in the [ 2] hinder part of the head, open it in the same manner, as the other, and it is good for dolors in the head and sleepienesse. The third is called temporalis▪ acotheres or sterilis & taketh his origine from the Iugulars, scituated on the temples, and [ 3]

hath many braunches, and is opened for the Migrim, do∣lors of the eares, and Opthalmie and watering of the eyes. [ 4] The fourth is called auricular, scituated behinde the eares, open it as the others, shaue the haire and rubbe the parte with a hotte clo••h••,* 1.18 till the veine appeare, and it is good for deafenesse, paine in the eares, olde Catarres, Hemicranes, all vlcers maligne:* 1.19 if these veines be cutte, they cause a man to be sterile, as saith Hippo, Which thing was practised a∣mongst the Schites to effeminate them, and serue them like [ 5] women. The fift is called occular, and proceedeth of the interne Iugulars, scituated betwixt the eyes and nose, in o∣pening it: beware to goe to deepe, for feare of the muscle that moueth the eye, which being offended, often draweth the eye aside, as also Fistula. All the veines of the head should be opened with Flambettes, for feare of going too deepe. The opening of this is good for maladies of the face,* 1.20 affections of the eyes and eyeliddes, scabbes and red∣nesse [ 6] of the eyes. The sixte is called nasall, scituated on the tippe of the nose, betwixte the Cartilages opening it, goe deepe with the lancet, and it is good for heauinesse of the head, fluxions on the eyes and all rednesse of the face, yet it is not vsuall, neither was it opened by Galen, nor any [ 7] of the Greekes. The seuenth is called labier, scituated in the inner side of the lippe, the opening thereof is good for corruption of the gummes, fissures in the lippes, vlcers in [ 8] the nose or about it. The eightis the ra••••ull vnder the tongue, proceeding of the interne Iugular, and is opened ouerthwart, not going deepe, for feare to make the tongue immobill, because of some nerue motiue, which is neere to these veines, it is good for the Squinancie, inflamation of the Amigdalles,* 1.21 Vula and other affections of the mouth and throate, also for such as become dumbe and loose their [ 9] speach. The ninth is the Iugular, taking the origine from the veine caue, good for the Squinancie, fluxions on the throate, Suffocation, Leprosie, melancholicke Maladies,

and maligne Vlcers, and corrodent Hemicrane and Reume. Remember that all veines of the head must bee opened after rest. Auicen is of the opinion, that the veines of the head beeing opened, letteth generation, be∣cause of the animall spirites which dissippe.

Of the scituation of the three Veines in the arme, the way to open them and their Effectes.

THe first of the three Veines in the arme is called ce∣phalica, spatulina or capitalis, or humeralis as saith Ga∣len, [ 1] which is most hihh and externe in the arme, and hath neither veine, arter, nerue nor tendon vnder it,* 1.22 in ope∣ning of the which make a good issue, otherwise it is in danger to apostume, because that oft there remaineth lap∣pered bloud, for the thickenesse of the fleshe, it is good for all dolors and paine of the head, eyes, eares, throat and E∣pilepsie. The second is called mediana, or vena matricis or matricalis, mediastina, cardiaca, or purpurea, it is compo∣sed [ 2] of the basilicke and cephalicke scituated betwixt them,* 1.23 in the middest of the arme, vnder it is a nerue, or tendon of the muscle biceps, sometime both, for the which we must be warie and take good heede in opening it, for feare of Gan∣gren or conuulsion, or dolor, it must be opened athwart, and is good for all diseases that happen to the bodie, both supe∣rior and inferior. Once I saw in opening of this the nerue pricked, of the which within the space of foure dayes after there came a soft tumor in the omoplat, with a relaxation of the ioynt, as also all the ioyntes of the body, for the which the deepe perfounding is forbidden by Auicen and Rasis. The third is called basillica, or hepatica, venainterna, iecori∣na, regia, or vena axillaris and is scituated lowe downe in [ 3] the arme, accompanied with a great Arter vnder it,* 1.24 for the which you must haue a great care & beware of Auen••••isme.

Rasis forbiddeth to bleed in this veine, but in great necessi∣tie. It is opened for the obstructions of the lyuer, inflama∣tions in all the bodie,* 1.25 as also partes vnder the head, hardnes of the lyuer, dolor of the stomacke, pleuresie, difficultie of breath.

Of the three veines in the handes, their scituation, the way to open them & their effects.

THe first of the three veines is called cephalica, or ocularis, [ 1] and is scituated betwixt the thombe and formost finger, and is opened longwise, because it is little, good for dolors in the head and affections of the eyes.* 1.26 Galen saith, that the veines in the handes giue not much bloud, because they are but little braunches and therefore were not opened by the [ 2] mediciners Greeks. The second is called saluatella, titula∣ris or asellaris,* 1.27 and is onely a braunch of the basilicke, it is scituated betwixt the middle finger called medius and the third finger, called auricularis, and is good for the Iaundise and maladies of the lyuer, being bledde in the right hand, and the other in the lefte hande, called splenetica, for the affections of the milte. The third is called, funus brachij, [ 3] and is a braunch of the cephalicke, scituate on the finger medius, opened in default of the other two. These veines must be bathed in hotte water▪ in opening of them, as those in the feete.

Of the foure veines in the Funda∣ment and their Effectes.

IN each side of the Fundament are scituated two veines hemerroihdalles, and are opened for affections, or me∣lancholicke maladies.

Of the foure veines in the legges their situation and effectes.

THe first of these foure veines is called Popletica & cō∣meth from the veine Femorall, as all the rest, it is situ∣ated [ 1] in the bending of the ham, open it for all affecti∣ons in any part contained in the inferior venter. The secōd is called Saphena, situated within the foote, nere or aboue [ 2] anckle on the inside, in opening of it, ye must not profoūd deepe because the partes are neruous, and so must mortal accidents. Note that all veines in parts neruous, must bee opened longwise, except sciatica which must be opened a little athwart, yet Gvlen saith that all veines in parts ner∣uous must bee opened longwise, and are not so much sub∣iect to euill accidents: this being opened is good for af••ec∣tions of the kidneis, matrix, gonorrhea maling that returns in againe,, and prouoketh the purgation in women. Bee circumspect in blooding the foote, for it weakeneth more than any other, as saith Auicen, therfore I vse alwaies to wommen a tablet cordiall or else they eate some-what a∣fore. The thirde is called Sciatica, situated aboue the an∣ckle, & is opened athwart as ye haue heard, good for [ 3] sciaticks, dolors in the thighes and anckles. The fourth is called Medium or renall, and is situated vnder the bending [ 4] of the foote, and is opened for such maladies, as the other. Some say that aboue euery knee about three fingers there are two great veines, which Arabes call Salsores, and say if the ••••ick be bled in them, he dyeth presently, anh Galen is not of their opinion.

Thinges which are to bee considered to bleede well.

FIrst the Chirurgian must be in a light place either natu∣rally, or with candle also his owne sight should be good as sayth Haly Abbas, and must haue a ligator,* 1.28 that goeth

twise about the arme, an inch broad, also hee must haue a tound staffe to hold in his hands, in like maner a litle oyle to rub on the veine to make it souple, also annoint the lan∣cet with sallet oyle, before the blood which will appease the paine, he must haue diuers lancets, of the which some are large▪ some round pointed, when the paine is superfi∣ciall, also when neede is to make a good issue and euacu∣ation,* 1.29 which we vse in putride feuers, and when the blood is thick and the sick strong: some must be long sharp poin∣ted to open when the veines are deepe and hidden, as al∣so to make little issues in small superficiall veines, & when neede is to make deriuation as if the person spit blood, or bleede at the nose. The issue you make, must bleede long to diuert it, we make the issue little in people, that are out of their wits, that the issue may be soone consolide, by rea∣son that such people lose the bandage,* 1.30 and oft blod much. The incision must be made one of 3 waies, to wit, in lēgth, breadth & oblique, making alwaies an incisiō in midst of the veine, not cutting it altogether which if it be, the blood cōmeth not wel, but alongst the arme, and the extremity of the veines retireth one from another.* 1.31 Then let him make the issue as it should be, & cause the blood come well out, rub first the arme, thou woldest blod gētly with a hot cloth or thy hand, thē knit it with thy legature a little aboue the elbow, let the binding be steady, & show it selfe the bet∣ter, then the sick party shall close his hand, that the veines may shew the better, thereafter if it be the right arme the Chirurgian shall take it with left hand, neare to the part, where he intendeth to make the issue, holding his thomb on the veine that it stirre not, for oftentimes it rolleth, and slydeth from the launcet, sometime it yeildeth being full of wynd. This being done he shall marke the place, with the formost finger of the right hand, making a little marke with his naile on the verine, then he shall take the launcet betwixt the thomb & the formost finger in the midst of it, and to the end that he tremble not, he shall leaue the o∣ther

three fingers on the arme and leaue the finger and thomb, that holdeth the lancet on the left thomb, which holdeth the veine, then open the veine softly slyding the poynt of it in the veine not suddenly, if the vaine be not o∣pened at the first time, prick suddenly againe a little aboue or vnder the first, ye may do the same if the hole be not great enough to let out the blood in a reasonable quanti∣ty. The veine opened in that manner,* 1.32 the party shall hold the staffe in his hand, that he may rest his hand, & the blood come out the better. Hauing drawen such quā∣tity of blood, as the cause requireth. He shall presse out that which remayneth, if there come out any fat, as oft happeneth in grosse people, thou shalt put it in agayne, that done, put a pece of c••oth in 3 or 4 fingers double on the wound, and wet it in water, bynd the arme with a band of an inch broad, that goeth 3 or 4 times about the arme, winding it about aboue the elbow, and vnder that it neyther be too straight, nor too slack. If the veins be small blood thē after meate, rather than before, for thē they are more full of blood,* 1.33 doe not eat nor drink of an ho∣wer after.

Thinges to bee considered after the veine is opened.

OFtentimes chanceth after the veine is wel opened, that the blood commeth well forth and afterwards suddē∣ly doth cease, hapneth through too straight ligature saith Auerrois, or else for an apprehēsion & somtime through wrong & euill situatiō of the arme, in these points ye must slack the ligature, comfort the party & situat the arme right somtime the cause is in the thicknes & grossnes of the blod for the which rub the place incised with a litle oyle. If the party be weake, which shalbe knowne by the chang∣ing his coulor and the blood running alongst the arme, in this yee shall loose the legature, close the wound, lay the sick on his back, cast water in his face & vineger to

smell to giue him a little wine, within a while after loose the band and let him blede, till yee haue got such quanti∣tie of blood, as shal bee requisite, stirre not nor labour thy arme that carrie it in figure triangulare sleepe not two ho∣wers after. Let the blood stand, to know the nature of it, for in our bodie, there are diuers sorts very vatiable, accor∣dinh to the diuersitie of the age, the complexion, country, kinde of the sicknes and partes of the bodie.* 1.34 Wee shall iudge the nature and qualitie of the blood three waies, first by coulor, by the tast, and substance. As for the color good naturall blood should be red, sweete as phlegme naturall, and me••ne substance, when it congealeth not, it is a signe that some of the other humors are with it, when it is redde cleare and gluttering, it signifieth abundāce of choller, whē it is blackish, abundance of melancholy naturall or adust which stoppeth it to congeale, the fatnes of the blood kee∣peth it also from congealing.

Of Arteriotemie or in incision of the Arter.

LIke as for diuers maladies we blud the veines, so we do in some arters. Arteriotomia is a detractiō of blood by the diuisiō of the arter,* 1.35 which was not vsed by our auntiēts saue onely Menodotus, but is greatly in vse now, chiefly those in the tēples & behind the eares, for great fluxion of of catarrs on the eies, brest, & maladies of the head ingē∣dred of a hot fluxion inueterated, & vaparous spirrits, as are cōtained in these arters. In opening them, first I shaue the haire & rub the part the necke with a napkin as the veine, making a little incision in the bodye of the arter, as in the veine, not cutting it altogether, draw such quātity of blod, as is needefull, then stay it, and put on the wound an em∣plastrum of mastick, or halfe a beane clouen, with a com∣presse & bandage. Some feare this kind, for that the blood is ill to stay and also for an Aneufrisme, it is good in long dolors of the side,* 1.36 & all dolors, that procede frō a hot pitu∣itous substāce, also for swining giddines & long defluxion on the eyes.

Notes

• * 1.1

  Hippocrrates.
• * 1.2

  Heliogabilus •• serm. parti•• ••.
• * 1.3

  Age.
• * 1.4

  Rasu••.
• * 1.5

  Strength.
• * 1.6

  Hip. li 1. apho.
• * 1.7

  Lib. 2
• * 1.8

  Habitude
• * 1.9

  Gal le sangui. missione.
• * 1.10

  Countrie. Lanf••an. Gal. li. de arthritide.
• * 1.11

  Time. Hip. 7. apho.
• * 1.12

  Oribasi. arnold
• * 1.13

  Gal. de curandi ratione per san¦guine m••ssion. cap. 21.
• * 1.14

  Vse & custome
• * 1.15

  Signes.
• * 1.16

  afore bleeding.
• * 1.17

  Lanfrancus.
• * 1.18

  Albucrasis.
• * 1.19

  Lib. de aere et aqua.
• * 1.20

  Auice••. Haly Abbas.
• * 1.21

  H••ly Abbas.
• * 1.22

  Albucrasis. li. 4
• * 1.23

  Rafis. Oribafi∣us. Auicen. Ha∣ly Abbas.
• * 1.24

  Gal. Ra••••s.
• * 1.25

  Lib. 28
• * 1.26

  Lib. de sangui∣nis miss.
• * 1.27

  Gal. de secti-
• * 1.28

  Lib. 9.
• * 1.29

  Rasis.
• * 1.30

  ••asis. ••••tapallia.
• * 1.31

  Aetius lib. 3. Haly Abbas lib. 1.
• * 1.32

  Guliel. de salu••¦to.
• * 1.33

  Gal. Auic Aue∣rois.
• * 1.34

  Arist. lib. 2. de partis anmal. cap. 4. Gal. lib. de atra bile et de simp. med.
• * 1.35

  Caelicis.
• * 1.36

  Gal lib. 1. chro. Paul. lib. 6.