The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XV. Of the cure of Ruptures.

BEcause children are very subject to Ruptures, but those truely not fleshy * 1.1 or varicous, but watry, windy, and especially of the Guts, by reason of continuall and painefull crying and coughing: Therefore in the first place we will treate of their cure. Wherefore the Chirurgion, called to restore the Gut which is fallen downe, shall place the child, either or table, or in a bed, so that his head shall be low, but his buttocks, and thighes higher; the•• shall he force with his hands by little and little, and gently, the Gut into its proper place; and shall foment the Groine with the astringent fomentation, described in the falling downe of the wombe. Then let him apply this remedy. ℞, Praescript decoctionis quantum * 1.2 sufficit, farinae hordei & fabarum, an. ℥j, pulver. Aloes, Mastiches, Myrtyll. & Sarcoco. an. ℥ss, Boli Armeni ℥ij. Let them be incorporated and made a cataplasme according to Art. For the same purpose he may apply Emplastrum contra Rupturam: but the chiefe of the cure consists in folded clothes, and Trusses, and ligatures artificially made, that the restored gut may be contained in its place, for which purpose he shall keepe the child seated in his cradle for 30. or 40. dayes, as we mentioned before; and keepe him from crying, shouting, and coughing. Aetius bids steepe paper 3. dayes in water, and * 1.3 apply it made into a ball to the groine, the gut being first put up; for that remedy by 3. dayes adhesion wil keep it from falling down. But it wil be, as I suppose more effectu∣all, if the paper be steeped not in common, but in the astringent water, described in the falling downe of the wombe. Truely I have healed many by the helpe of such remedies, and have delivered them from the hands of Gelders, which are greedy o•• * 1.4 childrens testicles, by reason of the great gaine they receive from thence. They by a crafty cozenage, perswade the Parents, that the falling downe of the Gut into the Codde, is uncurable: which thing notwithstanding, experience convinceth to be false, if so be the cure be performed according to the forementioned manner, when the Peritonaum is onely relaxed, and not broken: for the processe thereof by which

the Gut doth fall as in a steepe way, in progresse of time and age is straitned and knit together, whilest also in the meane time the guts grow thicker. * 1.5

A certaine Chirurgion who deserveth credit, hath told me that he hath cured many children as thus: He beates a loadstone into fine powder, and gives it in pappe, and then hee annointes with hony the Groine, by which the gut came out, and then strewed it over with fine filings of iron. He administred this kinde of remedy for ten or twelve dayes: The part, for other things, being bound up with a ligature and trusse as was fitting. The efficacie of this remedy seemeth to consist in this; that the loadestone by a naturall desire of drawing the iron which is strewed upon the * 1.6 Groine, joynes to it the fleshy and fatty particles interposed betweene them, by a certaine violent impetuosity, which on every side pressing and bending the loosenesse of the Peritonaeum, yea verily adjoyning themselves to it, in processe of time by a firme adhesion intercept the passage and falling downe of the Gut or Kall; which may seeme no more abhorring from reason, than that we behold the loadstone it selfe through the thicknesse of a table, to draw iron after it any way. The same Chi∣rurgion affirmed, that he frequently and happily used the following medicine. Hee burnt into ashes in an Oven red Snailes, shut up in an earthen pot, and gave the powder * 1.7 of them to little children in pappe, but to those which were bigger, in broath.

But we must despaire of nothing in this disease, for the cure may happily proceede in men of full growth, as of fortie yeare old, who have filled the three demensions of the body, as this following relation testifies.

There was a certaine Priest in the Parish of Saint Andrewes, called Iohn M••ret, * 1.8 whose office it was to sing an Epistle with a loud voice as often as the solemnitie of the day, and the thing required. Wherefore seeing he was troubled with the Ente∣rocele, he came to me, requiring helpe, saying, he was troubled with a grievous paine, especially then, when he stretched his voice in the Epistle.

[illustration]

The Figure of a man broken on the side, wearing a Trusse, whose bolster must have three Tube∣rosities, two on the upper, and one on the lower part; and there must be a hollownesse betweene them in the middest, that they may not too straitly presse the sharchone, and so cause paine. The manner of such a Trusse, I found out not long agoe, and it seemed better and safer than the rest for to hinder the falling aowne of the Gut and Kall.

A. Shewes the shoulder band which is tied before and behinde to the girdle of the Trusse.

B. The Trusse.

C. The Cavitie left in the midst of the Tuberosities.

When I had seene the bignesse of the Enterocele, I perswaded him to get another

to serve in his place; so having gotten leave of M. Curio Clearke, and Deacon of Divinity, he committed himselfe unto me: I handled him according unto Art, and commanded him he should never goe without a Trusse; and he followed my directi∣ons. When I met him some five or sixe yeares after, I asked him how he did, he an∣swered very well, for he was wholy freed from the disease with which he was for∣merly troubled; which I could not perswade my selfe of, before that I had found that hee had told mee the truth, by the diligent observation of his genitals. But some sixe moneths after, he dying of a Pleurisie. I came to Curio's house where hee died, and desired leave to open his body, that I might observe whe∣ther nature had done any thing at all in the passage through which the gut fell down. I call God to witnesse, that I found a certaine fatty substance about the processe of the Peritonaeum about the bignesse of a little egge, and it did sticke so hard to that place, that I could scarce pull it away without the rending of the neighbouring parts. And this was the speedy cause of his cure. But it is most worthy of observation, and * 1.9 admiration, that Nature but a little helped by Art, healeth diseases which are thought incurable. The chiefe of the cure consists in this, that we firmerly stay the gut in its place, after the same manner as these two Figures shew.

[illustration]

Another Figure of a man having a Rupture on both sides, shewing by what meanes, what kinde of Trusse, and what shoulder-band he must be bound on each groine.

A. Sheweth the shoulder-band di∣vided in the middest for the put∣ting through of the head.

B. The Trusse, with two bolsters, betweene which is a hole for put∣ting through the yard. The forme of both bolsters ought to be the same with the former.

In the meane time we must not omit diet. We must forbidde the use of all things, which may either relaxe, dilate, or breake the processe of the Peritonaeum, of which I have already treated sufficiently. Sometimes, but especially in old men, the guts can∣not be restored into their place by reason of the quantity of the excrements hardened in them: In this case they must not be too violently forced, but the Patient must be kept in his bed, and lying with his head low, and his knees higher up; let the fol∣lowing Cataplasmes be applied.

℞. rad. alth. & lil. ana. ℥ij. seminis lini. & foenug. an. ℥ss, sol. malva, viol. & pariet∣an. * 1.10 m. ss. Let them be boiled in faire water, afterwards beaten, and drawne through a

searse, adding thereto of new Butter without falt, and oyle of Lillies, as much as shall suffice. Make a Cataplasme in the forme of a liquid pultis. Let it be applied hot to the Codde, and bottome of the belly; by the helpe of this remedy when it had beene applied all night, the guts have not seldome beene seene of themselves, without the hand of a Chirurgion, to have returned into their proper place. The windinesse being resolved, which hindered the going backe of the excre∣ments into another gut, whereby they might be evacuated and expelled. But if the excrements will not goe backe thus, the flatulencies, yet resisting and undiscussed, an emollient and carminative Clyster is to be admitted with a little Chymicall oyle of Turpentine, Dill, Iuniper or Fennill. Clysters of Muscadine, oyle of Wallnuts and * 1.11 Aqua vitae, and a small quantitie of any the aforesaid oyles, are good for the same purpose.

It often happens that the guts cannot yet be restored, because the processe of the Peritonaeum is not wide enough. For when the excrements are fallen downe with the gut into the codde; they grow hard by little and little, and encrease by the accesse of flatulencies caused by resolution, which cause such a tumor as cannot be put up through that hole, by which a little before it fell downe: whereby it happens that by putrifaction of the matter there contained, come inflammations, and a new accesse of paine; and lastly, a vomitting and evacuation of the excrements by the mouth being hindered from the other passage of the fundament. They vulgarly call this affect Miscrere mei. That you may helpe this symptome, you must rather assay extreame remedies, than suffer the Patient to die by so filthy and loathsome a death. And we must cure it by Chirurgery after this manner following. We will binde the Patient lying on his backe, upon a Table or Bench; then presently make an incision in the upper pard of the codde, not touching the substance of the guts; then we must have a silver Cane or Pipe, of the thicknesse of a Goose quill, round, and gibbous in one part thereof, but somewhat hollowed in the other, as is shewed by this follow∣ing Figure.

[illustration]

The Figure of the Pipe or Cane.

We must put it into the place of the incision, and put it under the production of the Peritonaeum being cut together with the codde, all the length of the production; that so with a sharpe knife we may divide the processe of the Peritonaeum, according to that cavity separated from the guts there contained, by the benefit of the Cane in a right line not hurting the guts. When you have made an indifferent incision, the guts must gently be put up into the belly with your fingers, and then so much of the cut Peritonaeum must be sowed up, as shall seeme sufficient, that by that passage made more straight, nothing may fall into the Codde, after it is cicatrized.

But if there be such abundance of excrements hardned, either by the stay or heate of inflammation, that that incision is not sufficient to force the excrements into their place, the incision must be made longer, your Cane being thrust up to∣wards the belly: so that it may be sufficient for the free regresse of the guts into the belly. Then sow it up as is fit, and the way will be shut up against the falling downe of the guts or kall; the processe of the Peritonaeum being made more straight, by reason of the future; for the rest, the wound shall be cured according to Art. But before you undertake this worke, consider diligenly whether the strength of the Patient be sufficient, neither attempt any thing before you have foretold, and decla∣red the danger to the Patients friends.

Notes

• * 1.1

  To what rup∣tures children are subject.
• * 1.2

  An astringent cataplasme.
• * 1.3

  Ser. 1. Cap. 24.
• * 1.4

  The craft and coveto usuesse of Gelders.
• * 1.5

  Another way to cure Rup∣tures.
• * 1.6

  The reason of this cure.
• * 1.7

  Another me∣dicine.
• * 1.8

  A notable History.
• * 1.9

  We must never despaire in dis¦seases if so be nature be associated by Art.
• * 1.10

  A Cataplasma to soften the excrements.
• * 1.11

  Chymicall oyle.