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

CHAP. XVI. Of the golden Ligature, or the Punctus Aureus; as they call it.

IF the Rupture will not be cured by all these meanes, by reason of the * 1.1 great solution of the continuity of the relaxt, or broken Peritonaeum, and the Patient by the consent of his friends there present, is ready to un∣dergoe the danger in hope of recovery; the cure shall be attempted by that which they call the Punctus Aureus, or Golden tie.

For which purpose a Chirurgion which hath a skilfull and sure hand, is to be im∣ploied. He shall make an incision about the share bone, into which he shall thrust a Probe like to the Cane, a little before described; and thrust it long wayes under the processe of the Peritonaeum, and by lifting it up, separate it from the the adjoining fi∣brous, and nervous bodies, to which it adheres; then presently draw aside the sper∣matique vessels, with the Cremaster, or hanging muscle of the testicle; which being done, he shall draw aside the processe it selfe, alone by it selfe: And he shall take as much thereof, as is too lax, with small and gentle mullets, perforated in the middest, and shall with a needle, having five or sixe threeds, thrust it through as neere as hee can to the spermaticke vessels, and cremaster muscles. But the needle also must be drawne againe into the middest of the remnant of the processe, taking up with it the lipps of the wound; then the threed must be tied on a strait knot, and so much there∣of must be left after the section, as may be sufficient to hang out of the wound. This threed will of it selfe be dissolved by little and little by putrefaction: neither must it be drawne out before that nature shall regenerate and restore flesh into the place of the ligature, otherwise all our labour shall be spent in vaine.

And lastly, let the wound be clensed, filled with fiesh, and cicatrized, whose cal∣lous hardnesse may withstand the falling of the gut, or kall.

There are some Chirurgians who would performe this golden Ligature after ano∣othe manner. They cut the skinne above the share-bone where the falling downe * 1.2 commonly is, even to the processe of the Peritonaeum, and they wrap once or twice about it, being uncovered, a small golden wyre, and onely straiten the passage as much as may suffice, to amend the loosenesse of this processe, leaving the spermatique vessels at liberty. Then they twist the ends of the wyre twice or thrice with small mullets, and cut off the remnant thereof; that which remaines after the cutting, they turne in, least with the sharpnesse it should prick the flesh growing upon it. Then lea∣ving the golden wyre there, they cure the wound like to other simple wounds, and they keepe the Patient some fifteene or twenty day in his bed, with his knees some thing higher, and his head some thing lower.

Many are healed by this meanes; others have fallen againe into the disease by rea∣son of the ill twisting of the wire.

There is also another manner of this golden tie, which I judge more quicke and * 1.3 safe, even for that there is no externall body left in that part after the cure. Where∣fore they wrappe a leaden wyre in steade of the golden, which comes but once about the processe of the Peritonaum, then they twine it as much as neede requires, that is, not too loosely, least it should leave way for the falling downe of the body, neither too straitly, least a Gangrene should come by hindring the passage of the spirits and nourishment. The ends thereof are suffered to hang out; when in processe of time, this contraction of the Peritonaeum seemes callous, then the wyre is untwisted and gently drawne out. And the rest of the cure performed according to Art. But let not the Chirurgion thrust himselfe upon his worke rashly, without the advice of * 1.4 the Physition, for it diverse times comes to passe, that the testicles are not as yet fal∣len downe into the Codde by the too great sluggishnesse of nature, in some of a pret∣ty growth, but remaines long in the groines, causing a tumor with paine, which thing may make a good Chirurgion beleeve that it is an Enterocele. Therefore whilst he labours by repelling medicines and trusses to force backe this tumor, he encrea∣seth the paine, and hinders the falling downe of the testicles into the codde. I ob∣served

this not long agoe in a Boy, which an unskilfull Chirurgion had long, and * 1.5 grievously troubled, as if he had had a rupture: for when I had observed that there was but one stone in the Codde, and knew the Boy was never gelt, I bid them cast away the plasters, and trusses, and wisht his Parents that they should suffer him to run and leape, that so the idleing stone might be drawne into the Codde, which thing by little and little, and without paine, had the event, as I foretold. That the reason of this af∣fect may be understood, we must know a man differs from a woman, onely in effica∣cie of heat; but it is the nature of strong heat to drive forth, as of cold to 〈…〉〈…〉 Hence it is that the stones in men hang forth in the codde, but in women they 〈…〉〈…〉 in the lower belly. Therefore it happens that in some males more cold by nature, the testicles are shut up some certaine time, untill at length they are fore'st downe into the codde by youthfull heat. But that we may returne to our former treatise of the codde, although that way of curing ruptures wants not paine and danger, yet it is safer than that which is performed by gelding, which by the cruelty thereof exposes the Patient to manifest danger of death. For the Gelders whilst they feare least when the cure is finshed, the relaxation may remaine, pull with violence the processe of the Peritonaeum from the parts to which it adheres, and together with it a nerve of the sixth conjugation which runnes to the stones; they offer the same violence to the spermaticke vessels; by which things ensue great paine, convulsion, effluxe of bloud, inflammation, putrefaction, and lastly death, as I have observed in many whom I have disfected, having died a few dayes after their gelding. Although some escape these dangers, yet they are deprived of the faculty of generation for all their life after, for performance whereof nature hath bestowed the testicles, as parts principally ne∣cessary for the conservation of mankinde. Through which occasion Galen hath not * 1.6 feared to preferre them before the heart; because the heart is the beginning of life, but the resticles of a better life; for it is farre more noble to live well, than simply and absolutely to live; therefore Eunuches degenerate into a womanish nature, for they * 1.7

[illustration]

A. Shewes a croked needle, having an eye not farre from the point, through which you may put the golden wyre.

B. B: The golden wyre put through the eye of the needle.

C. The mullets or Pincers, to cut a∣way the wast or superfluous ends of the wyre.

D. The springe of the mullets.

E The mullets to twist the ends of the wyre together.

remaine without beards, their voice is weake, their courage failes them, and they turne cowards; and seeing they are unfit for all humane actions, their life cannot but be miserable. Wherefore I will never subscribe to the cutting out of the stones, un∣lesse a Sarcocele or Gangrene in vade them. But that the way of performing the Pun∣ctus anreus may be better knowne, I have thought good here to set the instruments, by which this operation is performed, before your view.

Another more easie and safe way to restore the Gut and Kall.

THeodoricke and Guido have invented another way of performing this operation. * 1.8 They put backe into their places the Gut and Kall being fallen downe, the Pati∣ent being so placed, that his thighs are high and his head is somewhat low; then they draw aside the lower portion of the production of the Peritonaeum; and also the spermaticke vessels, and cremaster muscle to the Ischium; then by ap∣plying a causticke fitted to the age and disease, they burne the other part of the pro∣cesse, directly perpendicular to the share-bone, where the Gut did fall downe. Then they pull off the eschar thus made with a knife even to the quicke, then they apply an∣other causticke in the same place, which may go even to the bone, then procure the falling of this Eschar made on the foresaid processe. And afterwards they heale the ulcer which remaines, which presently contracting somewhat a thicke Callus, so keeps up the Guts and Kall, that it bindes them from falling down into the Cod. This way of restoring the Gut and Kall, though it be safer and more facile; yet the Chirur∣gion must not attempt it, if the Guts or Kall sticke so fast, agglutinated to the processe of the Peritonaeum, that they cannot be severed, nor put backe into their places (for from the guts so burnt and violated, greater mischiefe would ensue) if by the broken and too much dilated processe, the bodies thereby restrained, make an exceeding great tumor by their falling downe; if the testicle yet lying in the groine as in a Bubo∣nocele, a kinde of Enterocele, being not yet descended into the Scrotum or Codde; if the Patients be not come to such age as they can keepe themselves from stirring, or hold their excrements whiles the operation is performed.

Notes

• * 1.1

  The Chirur∣gicall cure by the golden Tye.
• * 1.2

  Another man∣ner thereof.
• * 1.3

  The third manner there∣of.
• * 1.4

  A thing to be noted.
• * 1.5

  A History.
• * 1.6

  Lib de arte medic••.
• * 1.7

  Lib. de sem.
• * 1.8

  Lib. 3, Cap. 33.