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

OF PARTICULAR TVMORS AGAINST NATVRE. THE EIGHT BOOKE.

The Preface.

BEcause the Cure of diseases must be varied according to the variety of the temper, not onely of the body in generall, but also of each part thereof; the strength, figure, forme, site, and sence thereof being taken into consideration: I thinke it worth my paines, having already spoken of Tumors in Gene∣rall, if I shall treate of them in particular which affect each part of the body, beginning with those which assayle the head. Therefore the Tumor either affects the whole head, or else onely some particle thereof, as the Eyes, Eares, Nose, Gumms and the like. Let the Hydrocephalos, and Physocephalos be examples of those tumors which possesse the whole head.

CHAP. I. Of an Hydrocephalos or watry tumor which commonly affects the heads of Infants.

THe Greekes call this disease Hydrocephalos, as it were a Dropsie of the Head, by a waterish humor; being a disease almost peculiar to Infants newly borne. It hath for an externall cause the violent compression of the head by the hand of the Midwife or otherwise at the birth, or by a fall, contusion and the like. For hence comes a breaking of a veine or Artery, and an effusion of the blood under the skinne. Which by corruption be∣comming whayish, lastly, degenerateth into a certen waterish humor. It hath also an inward cause, which is the abundance of serous and acride blood, which by its tenuity and heat sweats through the Pores of the vessells, sometimes betweene the Musculous skinne of the head and the Pericranium, sometimes betweene the Pericra∣nium and the skull, and sometimes betweene the skull and the membrane called Dura mater, and otherwhiles in the ventricles of the braine.

The signes of it, contained in the space betweene the Musculous skinne and the Pericranium, are a manifest tumor without paine, soft, and much yeeelding to the

pressure of the fingers. The Signes, when it remayneth betweene the Pericrani∣um and the skull, are for the most part like the forenamed, unlesse it be that the Tumor is a little harder, and not so yeelding to the finger, by reason of the parts betweene it and the finger; And also there is somewhat more sence of paine. But when it is in the space betweene the skull and Dura mater, or in the ventricles of the Braine or the whole substance thereof, there is dullnesse of the sences as of the sight and hearing; the tumor doth not yeeld to the touch, unlesse you use strong impression, for then it sincketh somewhat downe, especially in infants newly borne; who have their sculls almost as soft as waxe, and the junctures of their Sutures laxe, both by nature, as also by accident, by reason of the humor conteined therein moistening and relaxing all the adjacent parts; the humor con∣teined here lifts up the Scull somewhat more high, especially at the meetings of the Sutures, which you may thus know, because the Tumor being pressed, the humor flyes backe into the secret passages of the braine.

To conclude, the paine is more vehement, the whole head more swollen, the forehead stands somewhat further out, the eye is fixt and immoveable, and also weepes by reason of the serous humor sweating out of the braine.

Vesalius writes that hee saw a girle of two yeares old, whose head was thicker than any mans head by this kinde of Tumor, and the Scull not bonie, but membranous, as it useth to be in abortive birthes, and that there was nine pound of water ran out of it.

A••ucrasis tells that he saw a child whose head grew every day bigger by rea∣son of the watery moisture conteined therein, till at length the tumor became so great, that his necke could not beare it neither standing nor sitting, so that hee died in a short time. I have observed and had in cure foure children troubled with this disease, one of which being dissected after it died, had a braine no bigger than a Tennis Ball. But of a Tumor and humor conteined within under the Cranium, or Scull, I have seene none recover; but they are easily healed of an externall Tumor.

Therefore whether the humor lye under the Pericranium, or under the muscu∣lous skin of the head, it must first be assailed with resolving medicines, but if it can∣not be thus overcome, you must make an incision, taking heede of the Temporall Muscle, and thence presse out all the humor, whether it resemble the washing of flesh newly killed, or blackish blood, or congealed or knotted blood, as when the tumor bath beene caused by contusion; then the wound must be filled with dry lint, and co∣vered with double boulsters, and lastly bound with a fitting ligature.

CHAP. II. Of a Polypus, being an eating disease in the Nose.

THe Polypus is a Tumor of the Nose against nature, commonly arising from the Os Ethm••ides of spungye bone. It is so called, because it resembles the fect of a Sea Polypus in figure, and the flesh thereof in consistence. This Tumor stops the Nose, intercepting and hindering the liberty of speaking and blowing the Nose. Celsus saith the Polypus is a caruncle or Excrescence one while white, another while reddish, which adheres to the bone of the Nose, and sometimes fills the Nosthrils hanging towards the lipps, sometimes it descends backe through that hole, by which the spirit descends from the Nose to the throtle; it growes so that it may he seene behinde the Vvula, and often strangles a man by stopping his breath. There are five kinds thereof, the first is, a soft membrane, long and thin like the relaxed and depressed Vvula, hanging from the middle gristle of the nose, being filled with a Phlegmaticke and viscide humor. This in exspiration hangs out of the Nose, but is drawne in and hid by inspiration; it makes one snaffle in their speech and snort in their sleepe. The second, hath hard flesh, bred of Melancholy blood without adustion, which obstructing the nosthrils intercepts the respiration made by that part. The third, is flesh hanging from the Gristle, round, and soft, being the off-spring

of Phlegmaticke blood. The fourth is an hard Tumor, like flesh, which when it is touched yeelds a sound like a stone; it is generated of Melancholike blood dryed, being somewhat of the nature of a Scirrhus confirmed and without paine.

The fifth is as it were composed of many cancrous ulcers spred over the trans∣verse surface of the gristle.

Of all these sorts of Polypi, some are not ulcerated, others ulcerated, which send forth a stinking and strong smelling filth. Such of them as are painefull, hard, resisting, and which have a livide, or leaden colour, must not be touched with the hand, because they savour of the Nature of a Cancer, as into which they oft de∣generate; yet by reason of the paine which oppresses more violently, you may use the Anodyne medicines formerly described in a Cancer, such as this fol∣lowing.

℞. Olei de vitell. ovorum ℥ij, Lytharg. auri, & Tuthiae praep. an. ℥j. succi plant. & solani an. ℥ssj. Lapid. haematit. & camphorae, an ℥ss. Let them be wrought a long time in a leaden mortar, and so make a medicine to be put into the nosethrills. Those which are soft, loose and without paine, are sometimes curable, being plucked a∣way with an instrument made for that purpose, or else wasted by actuall cauteries put in through a pipe, so that they touch not the sound part; or by potentiall cau∣teries, as Agyptiacum composed of equall parts of all the simples with vitrioll which hath a facultie to waste such like flesh. Aquafortis and oyle of vitrioll have the same facultie, for these take away a Polypus by the rootes; for if any part thereof re∣mayne it will breede againe. But Cauteries and acride medicines must be put in∣to the nostrills with this Caution, that in the meane time cold repelling and astrin∣gent medicines be applied to the nose and parts about it to asswage the paine, and hinder the inflammation. Such as are Vnguentum de bolo, and vnguentum nutri∣tum, whites of Egges beate with Rose leaves, and many other things of the like nature.

CHAP. III. Of the Parotides that is, Certaine swellings about the Eares.

THe Parotis is a Tumor against nature, affecting the Glandules and those parts seated behinde and about the Eares, which are called the Emun∣ctories of the braine; for these because they are loose and spungy, are fit to receive the excrements thereof. Of these some are criticall, the matter of the disease somewhat disgested being sent thither by the force of nature. Others Symptomaticall, the excrements of the braine increased in quantity or quality rushing thither of their owne accord. Such abscesses often have great inflammation joyned with them, because the byting humor which flowes thither is more vitiated in quality than in quantity. Besides also they often cause great paine, by reason of the distention of the parts indued with most exquisit sence, as also by reason of a Nerve of the fifth Conjugation spread over these parts; as also of the neighbouring membranes of the braine, by which meanes the patient is troubled with the Head-ach and all his face becomes swolne. Yet many times this kinde of Tumor useth to be raysed by a tough, viscous, and grosse humor.

This disease doth more grievously afflict young men than olde; it com∣monly brings a Feaver and watching. It is difficult to be cured, especi∣ally when it is caused by a grosse, tough, and viscide humor, sent thither by the Crisis.

The cure must be performed by diet, which must be cōtrary to the quality of the hu∣mor in the temper & consistence of the meates. If the inflāmation & rednesse be great,

which indicate abundance of bloud, Phlebotomie will be profitable, yea very neces∣sary. But here we must not use the like judgement in application of locall medi∣cines as wee doe in others tumors, as Galen admonisheth us; that is, wee must not use repercussives at the beginning, especially if the abscesse be criticall; for so, we should infringe or foreflow the indeavors of nature forcibly freeing it selfe from the morbi∣fique matter. But wee must much lesse repell or drive it backe if the matter which hath flowed thither be venenate, for so the reflow thereof to the noble parts would prove mortall. Wherefore the Chirurgion shall rather assist nature in attracting and drawing forth that humor. Yet if the defluxion shall be so violent, if the paine so fierce that thence there may be feare of watchings and a Feaver, which may deject the powers, Galen thinks it will be expedient with many resolving medicines to mix some repelling. Wherefore at the beginning let such a Cataplasme be applyed.

℞. Far. hord. & sem. lin. ana. ℥ij. coquantur cum mulsa aut decocto cham. addendo but. recen. & olei cham. ana ℥j fiat Cataplasma. And the following oyntment wil also be good.

℞. But. recen. ℥ij, oles cham. & lilior. an ℥j. unguen. de Althea ℥ss. cerae parum: make an oyntment to be applyed with moist and greasie wooll to mitigate the paine, also somewhat more strong discussing and resolving medicins will be profitable, as:

℞. Rad. altheae & bryon. an. ℥ij. fol. rutae, puleg. orig. an. m. j. flo. chamaem. melil. an. p. j. coquantur in hydromelite, pistentur, traijciantur, addendo farin. faenugraec. orobi, an. ℥j. pal. Ireos, cham. melilot. an. ℥ij. olet aneth. rutac. an. ℥j. fiat cataplasma. But if you deter∣mine to resolve it any more, you may use Emplastrum Oxycroceum & Melilot-Plaister. If the humor doth there concrete and grow hard, you must betake you to the medicines which were prescribed in the Chapter of the Scirrhus; but if it tend to suppuration, you shall apply the following medicine.

℞. Rad. liliorum & ceparum sub cineribus coct. an. ℥iij. Vitell. over. num. ij. axung. suilla & unguent. basilicon, an. ℥j. far. sem. lini ℥iss. fiat Cataplasma. But if the matter doe so require, let the tumor be opened as we have formerly prescribed.

CHAP. IIII. Of the Epulis, or overgrowing of the flesh of the Gums.

THe Epulis is a fleshy excrescence of the Gums betweene the teeth, which is by litle and litle oft times encreased to the bignes of an Egge, so that it both hinders the speach and eating; it casts forth salivous and stincking filth, and not seldome degenerates into a Cancer, which you may understand by the propriety of the colour, paine and other accidents; for then you must by no meanes touch it with your hand. But that which doth not torment the Patient with paine, may be pluckt away; and let this be the manner thereof.

Let it be tyed with a double thred, which must be straiter twitched untill such time as it fall off; when it shall fall away, the place must be burnt with a cautery put through a trunke or pipe, or with Aqua fortis, or oyle of Vitrioll, but with great care that the sound parts adjoyning there to be not hurt, for if so be that it be not burnt, it usually returnes.

I have often by this meanes taken away such large tumors of this kinde, that they hung out of the mouth in no small bignes, to the great dissiguring of the face, which when as no Chirurgion durst touch, because the flesh looked livide, I ventured upon because they were free from paine; and by taking them away and cauterizing the place, I perfectly healed them; not truly sodainly and at once; for although I b•…•… the place after dissection; yet neverthelesse they sprung up againe, because a certaine por∣tion of the bone and sockets in which the Teeth stand fastened, were become rotten I have often observed such like flesh by continuance of time to have turned into a gristlely & bony substance. Wherfore the cure must be begun as speedily as may be; for being but litle, and having fastened no deepe roots, it is more easily taken away, being then only filled with a viscide humor, which in successe of time is hardened, and makes the taking away thereof more difficult.

CHAP. V. Of the Ranula.

THere is ofttimes a tumor under the tongue, which takes away the liber∣ty of pronuntiation, or speech; wherefore the Greeks call it Batrachi∣um, the Latines Ranula, because such as have this disease of the tongue, seeme to expresse their minds by croaking rather than by speaking. It is caused by the falling downe of a cold, moiste, grosse, tough viscide and Phlegmaticke matter, from the braine upon the tongue, which matter in colour and consistence resembles the white of an egge, yet sometimes it lookes of a Citrine or yellowish colour.

That you may safely performe the cure, you must open the Tumor rather with a cautery or hot Iron, than with a Knife, for otherwise it will returne againe. The manner of opening of it must be thus. You shall get a bended hollow and perfora∣ted iron plate with a hole in the midst, and making the patient to hold open his mouth, you shall so fit it, that the hole may be upon the part which must be opened. Then there you must open it with an hot Iron, for so you shall hurt no part of the mouth which is whole; but when you are ready to burne it, by thrusting your thumbe under the Patients Chin, you may somewhat elevate the Tumor, whereby you may open it with more certainty; when it is opened you must thrust out the matter conteined therein, and then wash the patients mouth with some barly water, hony, and Sugar of Roses; for so the ulcer will be safely and quickly healed.

[illustration]

The deliniation of the Iron plate and crooked actuall Cautery.

CHAP. VI. Of the swelling of the Glandules, or Almonds of the Thro ate.

NAture at the jawes neare the roots of the Tongue, hath placed two Glandules opposite to one another; in figure and magnitude like to Almonds, whence also they have their name, Their office is to re∣ceive the spittle falling downe from the braine, both least that the too violent falling downe of the humor should hinder the tongue in speaking, as also that the tongue might alwayes have moisture, as it were laid up in store, lest by continuall speaking it should grow dry and faile. For thus this spittle be∣ing consumed by feaverish heats, the patients are scarse able to speake, unlesse they first moisten their tongue by much washing of their mouth.

These Glandules because they are seated in an hot and moist place, are very sub∣ject to inflammations; for there flowes into these ofttimes together with the blood, a great quantity of crude, phlegmaticke and viscous humors, whence arises a tumor;

which is not seldome occasioned by drinking much and that vaporous wine, by too much Gluttony, and staying abroad in the open aire.

Swallowing is painfull and trouble some to the Patient, and commonly hee hath a Feaver. Ofttimes the neighbouring Muscles of the Throtle and necke are so swolne together with these Glandules, that (as it usually happens in the Squinzye) the passage of the breath and aire is stopped, and the Patient strangled.

We resist this imminent danger by purging and blood-letting, by applying Cup∣ping-Glasses to the Necke and shoulders, by frictions and ligatures of the extreme parts, and by washing and gargling the mouth and throte with astringent gargaris∣mes. But if they come to suppuration, you must with your incision Knife make way for the evacuation of the Pus, or Matter; but if on the contrary, these things perfor∣med according to art, defluxion be encreased, and there is present danger of death by stopping and intercepting the breath, for the shunning so great and imminent danger, the top or upper part of the Aspera arteria or Weazon must be opened, in that place where it uses to stand most out; & it may be done so much the safer, because the jugu∣lar veines, and arteryes are furthest distant from this place, and for that this place hath commonly litle flesh upon it. And that the incision may be the fitlyer made, the pati∣ent must be wished to bend his head backe, that so the Artery may be the more easily come to by the instrument; then you shal make an incision overtwhart with a crooked knife betweene two rings (not hurting nor touching the Gristlely substance) that is to say, the membrane which tyes together the Gristlely rings being onely cut; you shall then judge that you have made the incision large enough, when you shall perceive the breath to breake out by the wound; the wound must be kept open so long, untill the danger of suffocation be past; and then it must be sowed up not touching the Gristle. But if the lipps of the wound shall be hard and callous, they must be lightly scarified, that so they may become bloody for their easier agglutination and union, as we shall shew more at large in the cure of Hare lips. I have had many in cure, who have reco∣vered, that have had their Weazon together with the Gristlely rings thereof cut with a great wound, as we shall note when wee shall come to treate of the cure of the wounds of that part.

CHAP. VII. Of the inflammation and relaxation of the Vvula, or Columella.

THe Vvula is a litle body, spongy and somewhat sharpened to the forme of a pine apple, hanging even downe from the upper and inner part of the palat, so to breake the force of the Aire drawn in, in breathing and carryed to the Lungs, and to be as a quill to forme and tune the voyce. It often growes above measure by receiving moysture falling downe from the braine, becom∣ming sharpe by litle and litle from a broader and more swolne Basis. Which thing causes many Symptomes; for by the continuall irritation of the distilling humor the Cough is caused, which also hinders the sleepe, and intercepts the liberty of speech; but also by hindring respiration the patients cannot sleepe unlesse with open mouth: they are exercised with a vaine endeavoring to swallow (having as it were a morsell sticking in their jawes) and are in danger of being strangled.

This disease must be resisted and affailed by purging, bleeding, Cupping, taking of chysters, using astringent Gargles, and a convenient diet; but if it cannot thus be over∣come, the cure must be tryed by a causticke of Aqua fortis, which I have divers times done with good successe. But if it cannot be so done, it will be better to put to your hand, than through idlenesse to suffer the patient to remaine in imminent and deadly danger of strangling; yet in this there must very great caution be used; for the Chirur∣geon shall not judge the Vvula fit to be touched with an instrument or caustick, which is swolne with much enflamed, or blacke blood after the manner of a Cancer; but hee shall boldly put to his hand if it be longish, grow small by litle and litle into a sharpe, loose & soft point; if it be neither exceeding red, neither swolne with too much blood

but whitish and without paine. Therefore that you may more easily and safely cut away, that which redounds and is superfluous, desire the patient to sit in a light place, and hold his mouth open; then take hold of the top of the Vvula with your sizers, and cut away as much thereof as shall be thought unprofitable. Other-wise you shall binde it with the instrument here under described; the invention of this instrument is to be ascribed to Honoratus Tastellanus that diligent and learned man, the Kings Physition in ordinary, and the chiefe Physition of the Queene mother; Which also may be used in binding of Polypi and warts in the necke of the Wombe.

[illustration]

The Deliniation of constrictory rings fit to twitch, or binde the Columella, with a twisted thred.

A. Shewes the ring whose upper part is some-what hollow.

B. A double waxed thred, which is couched in the hollownesse of the ring, and hath a run∣ning, or loose knot upon it.

C. An iron rod, into the eye whereof the fore-mentioned double thred is put, and it is to twitch the Columella when as much thereof is taken hold of, as is unprofitable, and so to take it away without any fluxe of blood. When you would straiten the thred, draw it againe through this iron rod, and so straine it as much as you shall thinke good, letting the end of the thred, hang out of the mouth. But every day it must be twitched harder than other, untill it fall away by meanes thereof, and so the part and patient be restored to health. I have deliniated three of these instruments, that you may use which you will, as occa∣sion shall be offered.

[illustration]

A Figure of the Speculum oris, by which the mouth is held and kept open, whilest the Chirurgion is busied in the cutting away or binding the Vvula.

But if an eating ulcer shall associate this relaxation of the Vvula, together with a

fluxe of blood, then it must be burnt and seared with an hot iron, so thrust into a Trunke, or Pipe with an hole in it, that no sound part of the mouth may be offended therewith.

[illustration]

A hollow Trunke with a hole in the side, with the hot iron inserted, or put therein.

CHAP. VIII. Of the Angina, or Squinzy.

THe Squinancy, or Squinzy, is a swelling of the jawes, which hinders the entring of the ambient aire into the weazon, and the vapours and spirit from passage forth, and the meate also from being swallowed. There are three differences thereof. The first torments the patient with great paine, no swelling being outwardly apparent, by reason the morbificke humor lyes hid behinde the almonds or Glandules at the Vertebrae of the necke, so that it cannot be perceived, unlesse you hold downe the tongue with a spatula or the Speculum oris, for so you may see the rednesse and tumor there lying hid. The patient can∣not draw his breath, nor swallow downe meate, nor drinke; his tongue, (likes Gray-hounds after a course,) hangs out of his mouth, and he holds his mouth open that so hee may the more easily draw his breath; to conclude, his voyce is as it were drownd in his jawes and nose; he cannot lye upon his backe, but lying is forced to fit, so to breathe more freely: and because the passage is stopt, the drinke flyes out at his nose; the eyes are fiery and swollen, and standing out of their orbe. Those which are thus affected are often suddainely suffocated, a foame rising about their mouthes.

The second difference is said to be that, in which the tumor appeares inwardly, but litle or scarse any thing at all outwardly, the tongue, Glandules, and jawes ap∣pearing some what swollen.

The third being least dangerous of them all, causes a great swelling outwardly, but litle inwardly.

The Causes are either internall, or externall. The externall are a stroake, splin∣ter or the like things sticking in the Throat, or the excesse of extreme cold, or heat. The internall causes are a more plentifull defluxion of the humors either from the whole body or the braine, which participate of the nature either of blood, choler or flegme, but seldome of Melancholy. The signes by which the kinde and commixture may be knowne, have beene declared in the generall treatise of tumors. The Squincy is more dangerous, by how much the humor is lesse appa∣rent within and without. That is lesse dangerous which shewes it selfe outwardly, because such an one shuts not up the wayes of the meate, nor breath. Some dye of a Squincy in twelue houres others in two, foure or seven daies. Those (saith Hippocrates) which scape the Squincy, the disease passes to the lungs, and they dye within seven

dayes; but if they scape these dayes, they are suppurated; but also often times this kind of disease is terminated by disappearing, that is, by an obscure reflux of the humor into some noble part, as into the Lungs (whence the Empyema proceeds) and into other principall parts, whose violating brings inevitable death; sometimes by resolution, otherwise by suppuration.

The way of Resolution is the more to be desired; it happens when the matter is small, and that subtle, especially if the Physition shall draw blood by opening a veine, and the patient use fitting Gargarismes. A Criticall Squincy divers times proves deadly by reason of the great falling downe of the humor upon the throtle, by which the passage of the breath is sodainely shut up. Brothes must be used made with Capons, and Veale, seasoned with Lettuce, Purslaine, Sorrell, and the cold seeds.

If the Patient shall be some what weake, let him have potched Egges, and Barly Creames, the Barly being first boiled with Raisons in water and Sugar, and other meates of this kinde. Let him be forbidden wine, in stead where of he may use Hydro∣melita, and Hydrosachara (that is, drinkes made of water and Hony, or water and Sugar) as also the Syrupes of dryed Roses, of Violets, Sorrell and Limons, and others of this kinde. Let him avoide too much sleepe. But in the meane time the Phy∣sition must be carefull of all, because this disease is of their kinde, which brooke no delayes. Wherefore let the Basilica be presently opened, on that side the tumor is the greater; then within a short time after the same day, for evacuation of the con∣junct matter, let the veine under the tongue be opened; let cupping-Glasses be ap∣plyed, sometimes with scarification, sometimes without, to the necke and shoulders, and let frictions and painefull Ligatures be used to the extreme parts. But let the humor impact in the part be drawne away by glisters and sharpe suppositories. Whilest the matter is in defluxion, let the mouth without delay be washed with a∣stringent gargarismes to hinder the defluxion of the humor, least by its suddaine falling downe it kill the Patient, as it often happens, all the Physitions care and dili∣gence not withstanding. Therefore let the mouth be frequently washed with Oxy∣crate, or such a gargarisme: ℞ Pomorum silvest. nu. iiij. sumach, Rosar. rub. an. m. ss. berber. ʒij. let them be all boyled with sufficient quantity of water to the consump∣tion of the halfe, adding thereunto of the wine of soure Pomegranats ℥iiij. of dia∣moron ℥ij, let it be a litle more boyled and make a gargle according to arte. And there may be other Gargarismes made of the waters of Plantaine, Night-shade, Verjuice, Iulep of Roses and the like. But if the matter of the defluxion shall be Phlegmaticke, Alume, Pomgranate pill, Cypresse nuts, and a litle Vinegar may be safely added. But on the contrary, repercussives must not be outwardly applyed, but rather Lenitives, where by the externall parts may be relaxed and rarified, and so the way be open either for the diffusing or resolving the portion of the humor. You shall know the humor to begin to be resolved, if the Feaver leave the patient, if he swallow, speake and breathe more freely, if he sleepe quietly, and the paine begin to be much aswaged. Therefore then natures endeavor must be helped by apply∣ing resolving medicines, or else by using suppuratives inwardly and outwardly, if the matter seeme to turne into Pus. Therefore let gargarismes be made of the roots of March-Mallowes, Figgs, Iujubes, damaske Prunes, Dates, perfectly boyled in water. The like benefit may be had by Gargarismes of Cowes milke with Sugar, by oyle of sweete Almonds, or Violets warme, for such things helpe forward sup∣puration and aswage paine; let suppurating cataplasmes be applyed outwardly to the necke and throate, and the parts be wrapped with wooll moistened with oyle of Lillyes. When the Physition shall perceive that the humor is perfectly turned into pus, let the patients mouth be opened with the Speculum oris, and the abscesse opened with a crooked and long incision knife; then let the mouth be now and then washed with clensing gargles; as ℞. Aquae hordej lib. ss. mellis ros. & syr. rosar. sic. an ℥j. fiag gar∣garisma. Also the use of aenomel, that is wine, and Hony will be fit for this purpose. The ulcer being clensed by these means, let it be cicatrized with a litle roch-Alume added to the former gargarismes.

[illustration]

The Figure of an incision knife opened out of the hafte, which serves for a sheath thereto.

CHAP. IX. Of the Bronchocele, or Rupture of the throate.

THat which the French call Goetra, that the Greeks call Bronchocele, the La∣tines Gutturis Hernia, that is, the Rupture of the throate. For it is a round tumor of the throate, the matter wherof comming from within outwards, is conteined betweene the skin and weazon; it proceeds in weomen from the same cause as an Aneurisma.

But this generall name of Bronchocele undergoes many differences, for sometimes it retaines the nature of Melicerides, other whiles of Steatom'as, Atheroma's or Aneuris∣ma's, in some there is found a fleshy substance having some small paine; some of these are small, others so great, that they seeme almost to cover all the throatt; some have a Cyste, or bagge, others have no such thing; all how many so ever they be, and what end they shall have, may be knowne by their proper signes; these which shall be cureable, may be opened with an actuall or potentiall cautery, or with an incision knife. Hence if it be possible, let the matter be presently evacuated, but if it cannot be done at once, let it be performeed at diverse times, and discussed by fit remedies, and lastly let the ulcer be consolidated and cicatrized.

CHAP. X. Of the Pleurisie.

THe Pleurisie is an inflammation of the membrane, investing the ribbes, caused by subtile and cholericke bloud, springing upwards with great violence from the hollow veine into the Axygos, and thence into the intercostall veines, & is at length powred forth into the emptie spaces of the intercostall muscles, and the mentioned membrane. Being con∣tained there, if it tend to suppuration, it commonly infers a pricking paine, a Feaver and difficulty of breathing. This suppurated bloud is purged and evacuated one while by the mouth; the Lungs sucking it, and so casting it into the Weazon, and so into the mouth, otherwhiles by urine, and sometimes by stoole.

But if nature being too weake, cannot expectorate the purulent blood poured forth into the capacity of the Chest the disease is turned into an Empyema, wherefore the Chirurgion must then be called, who beginning to reckon from below upwards, may make a vent betweene the third and fourth true and legitimate ribs; & that must be done either with an actuall or potentiall cautery, or with a sharpe knife drawne up∣wards towards the backe, but not downwards, lest the vessells should be violated which are disseminated under the rib. This apertion may be safely and easily per∣formed by this actuall caurtry; it is perforated with foure holes, through one where∣of there is a pin put higher or lower according to the depth & manner of your incision:

then the point thereof is thrust through a plate afiron perforated also in the midst, into the part designed by the Physition, lest the wavering hand might peradventure touch, and so hurt the other parts not to be medled withall. This same plate must be somewhat hollowed, that so it might be more easily fitted to the gibbous side, and bound by the corners on the contrary side with foure strings. Wherefore I have thought good here to expresse the figures thereof.

[illustration]

The Figure of an actuall cantery with its plate fit to be used in a pleurisie.

But if the patient shall have a large body, Chest and ribs, you may divide and per∣forate the ribs themselves with a Trepan; howsoever the apertion be made, the pus or matter must be evacuated by little and litle at severall times; and the capacity of the Chest clensed from the purulent matter by a detergent injection of vj ounces of Barly water, and ℥ij hony of Roses, and other the like things mentioned at large in our cure of wounds.

CHAP. XI. Of the Dropsie.

THe Dropsie is a Tumor against nature by the aboundance of a wate∣rish humor, of flatulencies, or Phlegme, gathered one while in all the habite of the body, otherwhiles in some part, and that especially in the capacity of the belly betweene the Peritonaeum and entrailes. From this distinction of places and matters there arise divers kinds of Dropses. First that Dropsie which fils that space of the belly, is either moist or dry. The moist is called the Ascites, by reason of the similitude it hath with a leather bottle, or Borachio, because the waterish humor is contained in that capacity, as it were in such a vessell.

The dry is called the Tympanites, or Timpany, by reason the belly swolne with winde, sounds like a (Tympanum) that is, a Drum. But when the whole habit of the body is distended with a Phlegmaticke humor, it is called Anasarca or Leucophleg∣matia. In this last kinde of Dropsie the lower parts first swell, as which by reason of their site are more subject to receive defluxions, and more remote from the foun∣taine of the native heate; wherefore if you presse them downe, the print of your finger will remaine sometime after; the patients face will become pale and puffed up, whereby it may be distinguished from the two other kinds of Dropsie. For in them first the belly, then by a certaine consequence the thighes and feet doe swell. There are besides also particular Dropsies contained in the strait bounds of certaine places, such are the Hydrocephalos in the head; the Bronchochele in the throat; the Pleurocele in the Chest; the Hydrocele in the Scrotum, or Cod; and so of the rest. Yet they all arise from the same cause; that is, the weaknesse or defect of

the altering or concocting faculties, especially of the liver, which hath beene caused by a Scyrrbus, or any kinde of great distemper, cheifly cold, whether it happen pri∣marily, or secondarily by reason of some hote distemper dissipating the native and inbred heate, such a Dropsie is uncureable; or else it comes by consent of some o∣ther higher or lower part; for if in the Lungs, Midriffe, or Reines there be any distemper, or disease bred, it is easily communicated to the gibbous part of the Liver by the branches of the hollow veine, which runne thither. But if the mis∣chiefe proceed from the Spleene, Stomacke, Mesentery, Guts, especially the Iejunum and Ileum, it creeps into the hollow side of the Liver by the meseraicke veines, and other branches of the Vena porta or Gate-veine. For thus such as are troubled with the Asthma, ptisicke, Spleene, Iaundise, and also the Phrensie, fall into a Dropsie.

Lastly, all such as have the menstruall or haemorrhoidall bloud suppressed or too im∣moderatly flowing contrary to their custome, either overwhelmes, diminisheth or extinguisheth the native heate; no otherwise than fire, which is suffocated by too great a quantity of wood; or dieth and is extinguished for want thereof. We must looke for the same from the excrements of the belly or bladder, cast forth either too sparingly or too immoderatly: Or by too large quantity of meates too cold, and rashly devoured without any order; To conclude by every default of externall causes, through which occasion, error may happen, in diet or exercise.

The Ascites is distinguished from the two other kinds of Dropsies, both by the magnitude of the efficient cause, as also by the violence of the Symptomes, as the dejected appetite, thirst, and swelling of the Abdomen. And also when the body is moved or turned upon either side, you may heare a sound as of the jogging of water in a vessell halfe full. Lastly the humor is diversely driven upwards or downewards, according to the turning of the body and compression of the Abdomen; It also causeth various Symptomes by pressure of the parts to which it floweth. For it causeth difficultie of breathing and the cough by pressing the Midriffe; by sweating through into the capacity of the Chest it causeth like Symptomes as the Empyema. Besides also the Patients often seeme, as it were, by the ebbing and flowing of the waterish humor, one while to be carryed to the skies, and another whiles to be drowned in the water; which I have learnt not by reading of any author, but by the report of the patients themselves. But if these waterish humors be fallen downe to the lower parts, they suppresse the excrements of the Gutts and bladder by pressing & straitning the passages. When the patient lies on his backe the tumor seemes lesse, because it is spread on both sides; On the contrary when hee stands or sits, it seemes greater, for that all the humor is forced or driven into the lower belly, whence hee feeles a heavines in the Pecten or share. The upper parts of the body fall away by defect of the bloud fit for nourishment in quality and consistence, but the lower parts swell by the flowing downe of the Serous and watrish humor to them. The pulse is little, quicke, and hard with tention.

This disease is of the kinde of Chronicall or long diseases; wherefore it is scarce, or never cured, especially in those who have it from their mothers wombe, who have the Action of their Stomacke depraved, and those who are cachecticke, old, and lastly all such as have the naturall facultie languishing and faultie.

On the contrary young and strong men, especially if they have no Feaver, and finally all who can endure labour and those exercises which are fit for curing this disease, easily recover, principally if they use a Physition before the water which is gathered together doe putrifie and infect the bowells by its contagion.

CHAP. XII. Of the cure of the Dropsie.

THe beginning of the cure must be with gentle and milde medicines; nei∣ther must we come to a Paracentesis, unlesse we have formerly used and tried these. Therefore it shall be the part of the Physition to prescribe a drying diet, and such medicines as carry away water, both by stoole and urine. Hippocrates ordaines this powder for Hydropicke persons. ℞, Canthar. ablatis capitib. & alis ℥ss. Comburentur in furno, & fiat pulvis; of which administer two graines in white wine, for nature helped by this, and the like remedies hath not sel∣dome beene seene to have cured the dropsie. But that we may hasten the cure, it will be availeable to stirre up the native heate of the part by application of those me∣dicines which have a discussing force: as bagges, baths, ointments, and emplaisters. Let bagges be made of drie and harsh Bran, Oates, Salt, Sulphure, being made hot, or for want of them, of Sander, or Ashes often heated.

The more effectuall baths are salt, nitrous, and sulphurous waters, whether by Nature or Art, that is, prepared by the dissolution of Salt niter, and Sulphur; to which, if Rue, Marjarom, the leaves of Fennell, and tops of Dill, of Staechas, and the like be added, the businesse will goe better forwards. Let the ointments be made of the oyles of Rue, Dill, Baies, and Squills, in which some Euphorbium, Pellitory of Spaine, or Pepper have beene boyled. Let plaisters be made of Franckinsence, Myrrhe, Turpintine, Costus, Baiberies, English galengall, hony, the dung of Oxen, Pigeons, Goats, Horses, and the like, which also may be applied by themselves. If the disease continue, we must come to Synapismes and Phoenigmes, that is, to rubrifying and vesicatory medicines. When the blisters are raised, they must be annointed a∣gaine, that so the water may by little and little flow so long untill all the humor be exhausted, and the patient restored to health.

Galen writes, the Husbandmen in Asia, when they carried wheat out of the coun∣try into the city in Carrs, when they will steale away and not be taken, hidde some stone juggs fild with water in the middest of the wheat; for that will draw the moi∣sture through the juggs into it selfe, and increase both the quantitie and weight. When certaine pragmaticall Physitions had read this, they thought that wheat had force to draw out the water, so that if any sicke of the Dropsie should be buried in a heape of wheat, it would draw out all the water.

But if the Physition shall profit nothing by these meanes, he must come to the ex∣quisitely chiefe remedy, that is, to Paracentesis. Of which because the opinions of the ancient Physitions have beene divers, we will produce and explaine them.

Those therefore which disallow Paracentesis, conclude it dangerous for three rea∣sons. The first is, because by powring out the contained water, together with it, you dissipate and resolve the spirits, and consequently the naturall, vitall, and animall fa∣culties; another opinion is, because the Liver wanting the water by which formerly it was borne up; thence forward hanging downe by its weight, depresseth and draw∣eth downewards the Midriffe and the whole Chest, whence a drie cough, and a diffi∣culty of breathing proceede. The third is, because the substance of the Peritonaeum, as that which is nervous, cannot be pricked or cut without danger, neither can that which is pricked or cut be easily agglutinated and united, by reason of the sperma∣tique and bloudlesse nature thereof. Erasistratus moved by these reasons condemned Paracentesis as deadly: also he perswaded that it was unprofitable for these follow∣ing reasons, viz. because the water powred forth, doth not take away with it the cause of the Dropsie, and the distemper and hardnesse of the Liver, and of the other bowels, whereby it comes to passe that by breeding new waters they may easily a∣gaine fall into the Dropsie. And then the feaver, thirst, the hot and drie distemper of the bowels, all which were mitigated by the touch of the included water, are aggra∣vated by the absence thereof, being powred forth: which thing seemeth to have mo∣ved Avicen and Gordonius that he said none; the other said very few lived after the Paracentesis: but the refutation of all such reasons is very easie.

For, for the first Galen inferres, that harmefull dissipation of spirits, and resolving the faculties happens, when the Paracentesis is not diligently, and artificially perfor∣med. As in which the water is presently powred forth; truly if that reason have any validity, Phlebotomy must seeme to be removed farre from the number of whole∣some remedies, as whereby the bloud is powred forth, which hath farre more pure and subtile spirits, than those which are said to be diffused and mixed with the Drop∣sie-waters.

But that danger which the second reason threatens shall easily be avoi∣ded; the patient being desired to lie upon his backe in his bed, for so the Liver will not hang downe. But for the third reason, the feare of pricking the Peritonaeum, is childish: for those evils which follow upon wounds of the nervous parts, happen by reason of the exquisite sence of the part, which in the Peritonaeum ill affected and altered by the contained water, is either none or very small. But reason and experi∣ence teach, many nervous parts, also the very membranes themselves being farre re∣moved from a fleshie substance, being wounded, admit cure; certainely much more the Peritonaeum, as that which adheres so straitly to the muscles of the Abdomen, that the dissector cannot separate it from the flesh, but with much labour. But the reason which seemes to argue the unprofitablenesse of the Paracentesis is refelled by the authority of Celsus. I, saith he, am nor ignorant that Erasistratus did not like Pa∣racentesis; for he throught the Dropsie to be a disease of the Liver, and so that it must be cured, and that the water was in vaine let forth, which the Liver being vitiated, might grow againe. But first this is not the fault of this bowell alone, and then al∣though the water had his originall from the Liver, yet unlesse the water which staieth there contrary to nature being evacuated, it hurteth both the Liver, and the rest of the inner parts, whilest it either encreaseth their hardnesse, or at the least keepeth it hard, and yet notwithstanding it is fit the body be cured. And although the once letting forth of the humor profit nothing, yet it make way for medicines, which while it was there contained, it hindered. But this serous, salt, and corrupt humor, is so farre from being able to mitigate a Feaver and thirst, that on the contrary, it encreaseth them. And also it augmenteth the cold distemper, whilest by its abun∣dance it overwhelmes and extinguisheth the native heate. But the authority of Caelius Aurelianus that most noble Phisition, though a Methodicke, may satisfie Avicen and Gordonius. They, saith he, which dare avouch that all such as have the water let out by opening their belly have died, doe lie; for we have seene many recover by this kind of remedy: but if any died, it happened either by the default of the slow or negligent administration of the Paracentesis. I will adde this one thing which may take away all error of controversies: we unwisely doubt of the remedy when the patient is brought to that necessity, that we can onely helpe him by that meanes. Now must we shew how the belly ought to be opened. If the Dropsie happen by fault of the Liver, the section must be made on the left side; but if of the Splene, in the right: for if the patient should lie upon the side which is opened, the paine of the wound would con∣tinually trouble him, and the water running into that part where the section is, would continually droppe, whence would follow a dissolution of the faculties. The Section must be made three fingers bredth below the Navell, to wit, at the side of the right muscle, but not upon that which they call the Linea Alba; neither upon the nervous parts of the rest of the muscles of the Epigastrium; that so we may prevent paine and difficulty of healing. Therefore wee must have a care that the patient lie upon his right side, if the incision be made in the left, or on the left, if on the right. Then the Chirurgion both with his owne hand, as also with the hand of his servant assisting him, must take up the skinne of the belly, with the fleshie pannicle lying under it, and separate them from the rest; then let him divide them so separated with a Section even to the flesh lying under them, which being done, let him force as much as hee can the devided skinne upwards towards the stomacke, that when the wound, which must presently be made in the flesh lying there under, shall be consolidated, the skinne by its falling therein, may serve for that purpose: then therefore let him divide the musculous flesh and Peritonaum with a small wound, not hurting the Kall or Guts.

Then put into the wound a trunke, or golden, or silver crooked pipe, of the thick∣nesse of a Gooses-quill, and of the length of some halfe a finger. Let that part of it which goes into the capacity of the belly have something a broad head, and that per∣forated with two small holes, by which a string being fastened, it may be bound so about the body, that it cannot be moved, unlesse at the Chirurgions pleasure. Let a spunge be put into the pipe, which may receive the dropping humor: and let it be taken out when you would evacuate the water: but let it not be powred out all to∣gether, but by little and little, for feare of dissipation of the spirits, and resolution of the faculties, which I once saw happen to one sicke of the Dropsie. He being impa∣tient of the disease and cure thereof, thrust a Bodkin into his belly, and did much re∣joyce at the powring forth of the water, as if he had bin freed from the humor and the disease, but died within a few houres, because the force of the water, running forth, could by no meanes be staied, for the incision was not artificially made. But it will not be sufficient to have made way for the humor by the meanes aforementioned, but also the externall orifice of the pipe must be stopped and strengthened by double cloathes, and a strong ligature, least any of the water flow forth against our wills. But we must note that the pipe is not to be drawne out of the wound, before as much water shall be issued forth as we desire, & the tumor requireth; for once drawne forth, it cannot easily be put in againe, and without force & paine be fitted to the lips of the wound, because the skin and fleshy pannicle cover it by their falling into the wound of the flesh or muscle. But whilest the water is in evacuation, we must have a dili∣gent care of feeding the Patient, as also of his strength, for if that faile, and he seeme to be debilitated, the effusion of the water must be staied for some dayes; which at the length performed according to our desire, the wound must be so consolidated that the Chirurgion beware it degenerate not into a Fistula.

[illustration]

The Figure of a Pipe informe of a Quill, to evacuate the water in Dropsies.

Others performe this businesse after another manner; for making an incision, they thrust through the lipps of the wound with a needle and threed: but they take up much of the fleshie sub∣stance with the needle, least that which is taken up should be rent and torne by the forcible draw∣ing of the lippes together. Then the threed it selfe is wrapped up and downe over both ends of the needle, so thrust through, as is usually done in a hare-lippe, that so the lippes of the wound may so closely cohere, that not a drop of water may get out against the Chirurgions will. Sometimes such as are cured and healed of the Dropsie, fall into the Iaundise, whom I usually cure after this manner. ℞, sterc. anser. ʒij, dissolve it in ℥iij, vini alb. coletur. make a Potion, and let it be given two houres before meate.

CHAP. XIII. Of the tumor and relaxation of the Navell.

THe Exomphalos or, swelling of the Navell, is caused by the Peritonaeum, ei∣ther relaxed or broken: for by this occasion oft-times the Guts, and oft-times the Kall, fall into the seat of the Navell, and sometimes superfluous flesh is there generated; otherwise this tumor is as an Aneurisma by too great a quantity of bloud powred forth in that place: otherwise by a flatulent matter, and sometimes by a waterish humor. If the humor be occasioned by the Kall, the part it selfe will retaine his proper colour, that is, the colour of the skinne; the tumor will be soft and almost without paine, and which will reside without noise, either by the pressure of your fingers, or of it selfe when the Patient lieth on his backe; but the

tumor caused by the guts, is more unequall, and when it is forced in by the pressure of your fingers, there is such a noise heard, as in the Enterocele; but if the tumor pro∣ceede of superfluous flesh, it will be harder and more stubborne, not easily retiring into the body, although the Patient lie upon his backe, and you presse it with your fingers.

The tumor is softer which proceeds of winde, but which will not retire into the body, and sounds under your naile like a taber. If the swelling be caused by a wate∣rish humor, it hath all things common with the flatuous tumor, except that it is not so visible, and without noise. If it be from effusion of bloud, it is of a livid colour, but if the effused bloud shall be arteriall, then there are the signes of an Aneurisme. Wherefore when the tumor is caused by the Guts, Kall, Winde, or a waterish hu∣mour, it is cured by Chirurgery: but not if it proceede from a fleshie excrescence or suffusion of bloud. The tumor of the Navell proceeding from the Kall, and Guts, the Patient must lie upon his backe to be cured, and then the Kall, and Guts, must with your fingers be forced into their due place: then the skinne with which the tu∣mor is circumscribed must be taken up with your fingers, and thrust through with a needle, drawing after it a double twined and strong threed; then it must be scatified about the sides, that so it may be the easier agglutinated. Then must it be thrust through with a needle, three or foure times, according to the manner and condition of the distention and tumor. And so twitch it strongly with a threed, that the skinne which is so bound may at length fall off together with the ligatures. But also you may cut off the skinne so distended even to the ligature, and then cicatrize it, as shall be fit. A flatulent tumor of the Navell shall be cured with the same remedies, as we shall hereafter mention in the cure of a windy rupture, but the watery may be powred forth by making a small incision. And the wound shall be kept open, so long, untill all the water be drained forth.

CHAP. XIIII. Of the Tumors of the Groines and Codds, called Herniae, that is, Ruptures.

THe ancient Phisitions have made many kindes of Ruptures, yet indeede there are onely three to be called by that name, that is, the Intestinalis, or that of the guts, the Zirbalis, or that of the kall, and that which is mixed of them both. The other kindes of Ruptures have come into this order, rather by similitude, than any truth of the thing: for in them the Gut, or Kall doe not forsake their places.

The Greekes have given to all these severall names, both from the seat of the tu∣mor, as also from their matter. For thus they have called an unperfect rupture which descends not beyond the Groines, nor falls downe into the Codds, Bubo••ocele: but the compleate which penetrates into the Codde, if it be by falling downe of the Gut, Enterocele: if from the Kall, Epiplocele; if from them both together, they name it En∣teroepiplocele: but if the tumor proceede from a waterish humor, they terme it Hy∣drocele; if from winde, Physocele, if from both, Hydrophydocele; if a fleshie excrescence shall grow about the testicle, or in the substance thereof, it is named Sarcocele. If the veines interwoven, and divaricated diverse wayes shall be swollen in the Codde and Testicles, the tumor obtaines the name of a Cirsocele. But if the humors shall be shut up, or sent thither, the name is imposed upon the tumor, from the predominant humor, as we have noted in the beginning of our Tractate of tumors. The causes are many, as all too violent motions, a stroake, a fall from a high place, vomiting, a cough, leaping, riding upon a trotting horse, the sounding of trumpets, or sackbuts, the carrying, or lifting vp of a heavy burden, racking, also the too immoderate use of viscide and flatulent meates; for all such things may either relaxe or breake the Ier∣tonaeum, as that which is a thinne and extended membrane. The signes of a Bubo••ocele are a round tumor in the Groine, which pressed, is easily forced in. The signes of an Enterocele, are a hard tumor in the Codde, which forced, returneth backe and de∣parteth

with a certaine murmour and paine; but the tumor proceeding of the Kall, is laxe and feeles soft like Wooll, and which is more difficultly forced in, than that which proceeds from the Guts, but yet without murmuring and paine: for the substance of the Guts, seeing it is one, and continued to it selfe, they doe not onely mutually succeede each other, but by a certaine consequence doe, as in a dance draw each other; so to avoide distention, which in their / membranous body cannot be without paine, by reason of their change of place from that which is naturall, into that against nature: none of all which can be fall the Kall, seeing it is a stupide body; and almost without sence, heavy, dull, and immoveable. The signes that the Peri∣tonaeum is broken, are the sudden increase of the tumor, and a sharpe and cutting paine; for when the Peritonaeum is onely relaxed, the tumor groweth by little and little, and so consequently with small paine; yet such paine returnes so often, as the tumor is renewed by the falling downe of the Gut, or Kall, which happens not the Peritonaeum being broken: for the way being once open, and passable to the falling body, the tu∣mor is renued without any distention, and so without any paine to speake of. The rest of the signes shall be handled in their places. Sometimes it happens that the Guts, and Kall, do so firmely adhere to the processe of the Peritonaeum, that they cannot be driven back into their proper seate. This stubborne adhesion happens by the intervention of the viscide matter, or by meanes of some excotiation caused by the rude hand of a Chirurgion, in too violently forcing of the Gut, or Kall, into their place. But also, too long stay of the gut in the codde, and the neglect of wearing a Trusse, may give occa∣sion to such adhesion. A perfect and inveterate rupture by the breaking of the processe of the Peritonaeum in men of full growth, never, or very seldomes admits of cure. But you must note, that by great ruptures of the Peritonaeum, the Guts may fall into the codde, to the bignesse of a mans head, without much paine and danger of life, because the excrements, as they may easily enter, by reason of the largenesse of the place and rupture, so also they may easily returne.

CHAP. XV. Of the cure of Ruptures.

BEcause children are very subject to Ruptures, but those truely not fleshy 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 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 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•• 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.

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 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 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, 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 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. 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 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.

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 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 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 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 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 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 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

[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. 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.

CHAP. XVII. Of the cure of other kinds of Ruptures.

EPiplocele is the falling downe of the Kall into the Groine, or Codde, it hath the same causes as an Enterocele. The signes have beene explained. It is not so dangerous, nor infers a consequence of so many evill symp∣tomes, as the Enterocele doth, yet the cure is the same with the other.

Hydrocele is a waterish tumor in the Codde, which is gathered by little and little betweene the membranes encompassing the testicles, especially the Dartos and Ery∣throides; it may be called a particular dropsie, for it proceeds from the same causes, but chiefely from the defect of native heate. The signes are a tumor encreasing slowly without much paine, heavy, and almost of a glassie clearenesse, which you may per∣ceive by holding a candle on the other side, by pressing the Codde above, the water flowes downe, and by pressing it below, it rises upwards, unlesse peradventure in too great a quantity it fills up the whole capacity of the Codde, yet it can never be for∣ced or put up into the belly as the Kall or Guts may, for oft times it is contained in a Cyste, or bagge; it is distinguished from a Saycocele, by the smoothnesse and equality thereof. The cure must first be tried with resolving, drying, and discussing medicines, repeated often before, and in the Chapter of the Dropsie; this which followes I have often tried and with good successe.

℞, Vng. comitissa, & desiccat. rub. an. ℥ij. malaxentur simul; and make a medicine for your ease. The water by this kinde of remedy is digested and resolved, or rather dried up, especially if it be not in too great quantity. But if the swelling, by reason of the great quantity of water will not yeeld to those remedies, there is neede of Chi∣rurgery;

the Cod and membranes wherein the water is contained, must be thrust through with a Seton, that is, with a large three square pointed needle, thred with a skeane of silke; you must thrust your needle presently through the holes of the mul∣lets made for that purpose, not touching the substance of the Testicles. The skean of thred must be left there, or removed twise or thrise a day, that the humor may drop downe, and be evacuated by little and little. But if the paine be more vehement by reason of the Seton, and inflammation come upon it, it must be taken away, and neg∣lecting the proper cure of the disease, we must resist the symptomes.

Some Practitioners use not a Seton, but with a Razor, or incision knife, they open the lower part of the Cod, making an incision some halfe fingers breadth long, pe∣netrating even to the contained water; alwayes leaving untouched the substance of the Testicles and vessels, and they keepe the wound open, untill all the water seemes evacuated; truly by this onely way the cure of a watery rupture whose matter is contained in a Cyste, is safe, and to be expected; as wee have said in our Treatise of Tumors in generall.

The Pneumatocele, is a flatulent tumor in the Codde, generated by the imbecility of heate residing in the part.

It is knowne by the roundnesse, lenity, renitencie and shining. It is cured by pre∣scribing a convenient diet, by the application of medicines which resolve and dis∣cusse flatulencies, as the seeds of Annis, Fennell, Faenugreeke, Agnus Castus, Rue, Origanum, other things set downe by Avicen in his Treatise of Ruptures. I have often used with good successe for this purpose, Emplastrum Vigonis cum mercurio; and Em∣plastrum Diacalcitheos, dissolved in some good wine, as Muscadine, with oyle of Bayes.

A Sarcocele is a tumor against nature, which is generated about the stones by a schyrrhus flesh. Grosse and viscide humors breed such kind of flesh, which the part could not overcome and assimulate to it selfe; whence this over-abundance of flesh proceeds, like as Warts doe. Varices, or swollen veines often associate this tumor; and it increases with paine. It is knowne by the hardnesse, asperitie, inequality, and roughnesse. It cannot be cured but by amputation or cutting it away; but you must diligently observe, that the flesh be not growne too high, and have already seazed upon the Groine, for so nothing can be attempted without the danger of life.

But if any may thinke, that he in such a case may somewhat ease the patient by the cutting away of some portion of this same soft flesh, he is deceived. For a Fungt will grow, if the least portion thereof be but left, being an evill fure worse than the former; but if the tumor be either small or indifferent, the Chirurgion taking the whole tumor, that is, the testicle, tumefied through the whole substance, with the processe encompassing it, and adhering thereto on every side, and make an incision in the Codde, even to the tumor; then separate all the tumid body, that is, the testicle from the Codde: then let him thrust a needle with a strong threed in it, through the middest of the processe above the region of the swolne testicle; and then presently let him thrust it the second time through the same part of the processe; then shall both the ends of the threed be tied on a knot, the other middle portion of the Peritonaeum being comprehended in the same knot. This being done, he must cut a∣way the whole processe with the testicle comprehended therein. But the ends of the threed, with which the upper part of the processe was bound, must be suffered to hang some length out of the wound, or incision of the Codde. Then a repercussive medicine shall be applied to the wound, and the neighbouring parts with a convenient ligature. And the cure must be performed as we have formely men∣tioned.

The Cirsocele is a tumor of veines dilated, and woven with a various and mutuall implication about the testicle and codde, and swelling with a grosse and melancholy bloud. The causes are the same as those of the Varices. But the signes are ma∣nifest.

To heale this tumor, you must make an incision in the codde, the bredth of two fingers to the Varix. Then you must put under the varicous veine, a needle having a double threed in it, as high as you can, that you may binde the rootes thereof: then

let the needle be againe put after the same manner about the lower part of the same veine, leaving the space of two fingers betweene the Ligatures. But before you binde the thread of this lowest Ligature, the Varix must bee opened in the middest; al∣most after the same manner as you open a veine in the arme to let bloud; That so this grosse blood causing a tumor in the Cod, may be evacuated as is usually done in the Cure of the varices. The wound that remaines shall be cured by the rules of Art after the manner of other wounds: Leaving the threads in it, which will presently fall away of themselves. To conclude then, it being growne callous especially in the upper part thereof; where the veine was bound, it must be Cicatrized, for so after∣wards the bloud cannot be strained, or run that way.

Hernia Humoralis is a tumor generated by the confused mixture of many humors in the Cod or betweene the tunicles which involue the testicles, often also in the pro∣per substance of the testicles. It hath like causes, signes and cure as other tumors. While the cure is in hand, rest, trusses, and fit rowlers to sustaine and beare up the testicles are to be used.

CHAP. XVIII. Of the falling downe of the Fundament.

WHen the muscle called the Sphincter which ingirts the Fundament is relaxed, then it comes to passe that it cannot sustaine the right gut. This disease is very frequent to Children by reason of the too much humidity of the belly; which falling downe upon that muscle molli∣fieth and relaxeth it or presseth it downe by an unaccustomed weight, so that the muscles called Levatores Ani or the lifters up of the Fundament, are not sufficient to beare up any longer. A great bloudy flux gives occasion to this effect. A strong endevour to expell hard excrements, the Haemor∣rhoides, which suppressed doe over-loade the right gut, but flowing relaxe it: Cold as in those which goe without breeches in winter, or sit a long time upon a cold stone, a stroake or fall upon the Holy-bone: a palfie of nerves which goe from the Holy-bone to the Muscles the lifters up of the fundament: the weight of the stone being in the bladder.

That this disease may be healed, we must forbid the Patient too much drincking, too often eating of broth, and from feeding on cold fruits. For locall medicines the part must be fomented with an astringent decoction made of the rinds of Pomegra∣netts, galls, myrtles, knotgrasse, sheapheards purse, Cypresse nutts, Alume, and common salt boyled in smiths water or red wine. After the fomentation, the gut be annointed with oyle of Roses or myrtles, and then let it bee gently put by little and little into its place, charging the childe if he can understand your meaning, to hold his breath. When the gut shall be restored, the part must bee diligently wiped least the gut fall downe againe by reason of the slipperinesse of the unction. Then let the powder prescribed for the falling downe of the wombe be put into the fundament as farre as you can: Then you must straitly binde the loynes with a swathe, to the mid∣dest whereof behinde let another be fastned which may be tied at the Pubes comming along the Perinaeum, so to hold up to the fundament; the better to containe it in its place, a spunge dipt in the astringent decoction. The Patient if he be of sufficient age to have care of himselfe, shall be wished when hee goes to stoole that he sit upon two peeces of wood being set some inch a sunder, least by his strayning hee thrust forth the gut together with the excrement; but if he can doe it standing, he shall never by strayning thrust forth the gut.

But if the gut cannot by the prescribed meanes bee restored to its place, Hippocrates bids that the Patient hanging by the heeles be shaken, for so the gut by that shaking will returne to his place: but the same Hippocrates wisheth to an∣noint the fundament, because that remedie having a drying faculty, hath also power

to resolve the flatulent humors without any acrimony, by reason of which the gut was the lesse able to be contained in his place.

CHAP. XIX. Of the Paronychia.

THe Paronychia or Panaris is a tumor in the ends of the fingers, with great inflammation, comming of a maligne and venemous humor, which from the bones by the Periostium is communicated to the ten∣dons and nerves of that part which it affecteth, whereof cruell symp∣tomes doe follow, as pulsifique paine, a feaver, restlessenesse, so that the affected through impatiencie of the paine are variously agitated like those tor∣mented with Carbuncles: for which cause Guide and Iohannes de Vigo judge this di∣sease to be mortall; wherefore you must provide a skilfull Physitian for the cure of this disease, which may appoint convenient diet, purging and Blood letting. In the meane time the Surgeon, shall make way for the virulent and venenate matter, by making incision in the inner part of the finger, even to the bone alongst the first joynt thereof; for Vigo saith there is not a presenter remedy, if so be that it be quickly done and before the maturation of the matter; for it vindicates the finger from the corrup∣tion of the bone and nerves, and asswages paine, which I have often and happily tried immediatly at the beginning, before the perfect impression of the virulea∣cie.

But the wound being made you must suffer it to bleede well, then presently let him dip his finger in strong and warme vinegar, in which some treakle being dissolved may draw forth the virulencie. But to appease the Paine, the same remedies must be applyed to the affected part as are used in Carbuncles, as the leaves of Sorrell, Henbane, Hemlocke, Mandrake roasted under the Embers and beaten in a Morter with new Vnguentum Populeon, or oyle of Roses or new butter without salt: for such like medicines also helpe forward suppuration, whilest by their coldnesse, they re∣presse the extraneous heat affecting the part; and so strengthen the native heate being the author of suppuration: which reason moved the ancient Physitians to use such medicines in a Carbuncle: but if by reason of the fearefulnesse of the patient, or unskilfulnesse of the Surgion, no incision being made, a Gangren and Sphacel shall possesse the part, it remaines that you cut off with your cutting mulletts as much of the part as shall be corrupt, and performe the rest of the cure according to Art. Yet it doth not seldome happen that there may bee no neede to cut off such a finger, because it being corrupted together with the bone doth by little and little dissolve into a purulent or rather sanious and much stincking filth. But in this affect there is often caused an Eschar by the adusti∣on of putredinous heat, and superfluous flesh indued with most exquisit sence grow∣eth underneath it, which must in like manner be cut off with the Mulletts that the part may receive comfort, the paine being aswaged by the copious effusion of blood.

CHAP. XX. Of the swelling of the knees.

AFter long and dangerous diseases there oftentimes arise Tumors in the knees, and also in plethoricke bodies and such as have evill juyce after labours and exercise. This kinde of disease is frequent because the hu∣mor easily falles into the part which hath beene heated by Labour. But if

such tumors follow long diseases, they are dangerous and difficult to cure, and therefore not to bee neglected; for bitter paine accompanieth them, because the humor falling thither distends the Membranes, which being ma∣ny involve the part; besides that this humor participateth of a certaine virulent and maligne quality whether it be cold or hot, when it hath setled into those parts, being such as wee finde in the paines of the joynts, and in the bitings of venemous crea∣tures.

For the cure, if the tumor bee caused by blood, let a slender and refrigerating diet be appointed, and phlebotomy for the revulsion of the antecedent cause; diverse locall medicines shall be used according to the variety of the foure times. But for to asswage the paine, Anodyne or mitigating medicines shall be appointed: of all which wee have sufficiently treated in the Chapter of the cure of a Phleg∣mon.

And because these parts are of exact sence, if there be necessity to open the tu∣mor, yet must we not doe it rashly or unconsiderately, for feare of paine and evill accidents.

This kinde of tumor is oft times raised by winde contained there; in which case the Chirurgion must bee very provident, that hee bee not deceived with the shew of flowing of the humor; which hee seemes to perceive by the pressure of his fingers, as if there were matter and humor contained therein, and so bee brought to open the tumor. For the winde breaking forth in stead of the humor, causeth evill symptomes by reason of the section rashly made in a part so sensi∣ble.

But if watrish humors shall tumifie the part, the body shall first be purged with medicines purging flegme: And then inciding, attenuating, rarifying, discussing and very drying locall medicines shall be used.

Of which wee have abundantly spoken in the Chapter of the Oedema. Yet this hu∣mor, divers times lyes deepe betweene the whirle bone and the joynt, which cau∣seth it that it cannot be discussed and resolved by reason of the weakenesse of the part and defect of heate, so that the adventitious humor often moves and excludes the bones from their seate. As I have observed it to have happened to many.

In which cause Irrigations of red wine falling something high, whereby the force of the medicine may enter and more easily penetrate, are much commen∣ded.

CHAP. XXI. Of the Dracunculus.

ICannot chuse, but explaine in this place those things which may bee spoken of that kinde of tumor against nature, which by the ancients is called Dracunculus. The matter and reason of these hath beene variou∣sly handled by diverse Authours, so that hitherto wee have nothing written of them to which wee may by right and with good reason ad∣here as a firme foundation of their essence.

For first for Galens opinion, Lib. 6. de Loc. affect cap. 3. The generation, saith he, of those hayres which are evacuated by the Vrine is worthy no lesse admiration than the Dracunculi, which as they say, in a certaine place of Arabia breede in the legges of men being of a nervous nature and like wormes in colour and thicke∣nesse.

Therefore seeing I have heard many who have sayd they have seene them, but I my selfe never saw them, I cannot conjecture any thing exactly neither of their origi∣ginall nor essence.

Paulus Aegineta writes that the Dracunculi are bred in India and the higher parts of Aegypt, like wormes in the musculous parts of mans body, that is, the armes, thighes and legges, and also creepe by the intercostall muscles in children with a manifest motion.

But whether they by creatures indeede, or onely have the shape of creatures, they must bee cured with a hot fomentation, by which the Dracunculus raised to a just tumor, may put forth it selfe, and be pluckt away peece meale with the fingers: also suppurating Cataplasmes may be applyed, composed of water, honey, wheate and barly meale.

Avicen being various, having no certainty whereon to rest, inclineth one while to this, and another while to that opinion: for now he speaketh of the Dracunculi as of creatures, then presently of a matter and humor shut up in a certaine place; for the rest he rightly delivers the cure and essence of this disease, as we shall afterwards shew.

Actius saith, the Dracunculi are like wormes, and that they are found sometimes great, sometimes small, and that their generation is not unlike to that of flat wormes, which are bred in the guttes, for they move under the skinne without any trou∣ble, but in processe of time, the place becomes suppurate about the end of the Dracunculus. The skinne openeth, and the head thereof is thrust forth.

But if the Dracunculus bee pulled, it causeth great greefe; especially if it bee bro∣ken by too violent pulling. For that which is left causeth most vehement paine. Where fore that the creature may not runne backe, the arme must bee bound with a strong threed, and this must bee done every day, that the Dracunculus going for∣ward by little and little, may bee intercepted by this binding, but not broken off.

The place must bee bathed with Aqua Mulsa and oyle in which wormewood or southernewood hath beene boyled, or some other of those medicines which are pre∣scribed for the wormes of the belly.

But if the Dracunculus going forward of its owne accord, may be easily drawne forth, we must doe nothing else: but if it bee turned to suppuration wee must not leave off the Cataplasmes, the Aqua Mulsa and anointing with oyle: It was usu∣all with him after the taking away of the Cataplasmes, to apply Emplaslrum E Ba••••is Lauri: but when it is come to suppuration the skinne must bee opened long wayes, and the Dracunculus so layd open must be taken away, but the skinne must be filled with lint, and the rest of the suppurative cure used, so that the creature be∣ing suppurated and drawne forth, the wound may bee incarnated and cicatri∣sed.

Rhasis writeth, that when the part is lifted up into a blister, and the veine hastneth its egresse, it is good for the patient to drinke the first day halfe a dramme of Aloies, the next day a whole dramme, the third day two drammes; and in like manner the place affected must bee fomented with Aloes, for so that which lyes hid will breake forth: that which shall come forth must be rolled in a pipe of lead, which may equall the weight of a dramme so that it may hang downe, for the veine drawne by the weight will come more forth; and when that which shall come forth is growne much and long, it must be cut off, but not by the roote, but so that a portion thereof may remaine and hand forth, to which the leaden pipe may be fastned, for otherwise it would withdraw it selfe into its skinne and its lurking hole, and so cause a putrid and maligne ulcer.

Therefore wee must gently meete with this disease, and the veine must be drawne by little and little out of the body untill it be all come forth that no worse thing hap∣pen: but if by chance it shall happen that as much of the veine as shall bee come forth shall be cut off by the rootes, then the ulcer must be opened long wayes with an in∣cision knife, and that so that whatsoever remaines thereof may bee wholy taken a∣way. Then for some dayes the part must be annointed with butter untill whatsoever of such a substance adheres, being consumed with putrifaction shall flow away. Then the ulcer must be cured with sarcoticke things.

Therefore Rhasis thus in the same text expresseth the same thing by diverse names, and armed with Iron and Lead, hee comes to the cure thereof, as if hee meant to encounter with some fierce beast.

Soranus the Physitian, who lived in the times of Galen, was of a quite contrary opi∣nion, as Paulus Aegineta in the place being before cited, relates of him; as who denies the Dracunculus to be a living creature, but onely a condensation of a certaine small nerve, which seemes both to the Physitions and Patients to have some motion under the skinne.

Wherefore Soranus seemes to have come neerer the truth than the rest, but yet not so, as throughly to understand, and know the essence of this disease, as we shall demonstrate hereafter.

Manardus writes, that the Dracunculi are generated of evill and unlaudable blood, grosse, hot, and melanckolicke, or of adust phlegme very much dryed.

Gorraeus a most learned Physition of our time, Lib. de Definitionib. medic. denies any of our Physitions to be able to say anything of the Dracunculi, because it is a di∣sease so unfrequent in these our regions, that it is scarce ever met withall in pra∣ctice.

The Author of the Introduction, and Medicinall definitions, defines the Dracun∣culus to be a disease very like the Varices; then causing great paine, when increasing by little, and little, it begins to bee moved: Therefore to bee cured after the same manner, and by the same method of Section and incision, as the varices are. Which thing chiefely seemes to have moved Guido to referre this kinde of disease to the Varices in his Tractate of Impostumes, because it hath the same cause, and is healed with the same remedy as the varices.

But seeing that diverse names have beene imposed upon this disease by severall writers, yet they all have expressed it by the name of a veine: for it is called by A∣vicen and Guido, Vena Meden, because it is a disease frequent in the Citty Medi∣na: by Albucrasis, vena civilis. Haliabbas hath called it vena famosa; others have called it Vena Cruris or the legge veine. Truely the contrariety of so many opinions repugnant not onely amongst themselves, but also with themselves, easily argueth how little certainty they had of the essence of this disease, who have written of it unto us: To which also this may be added, that none of the latter Physitions have written any things thereof. For although Iacobus Dalechamphius a man most conver∣sant in every part of Physicke, hath written much of this matter in his booke of the French Surgery which he set forth some yeares agoe: Yet he hath left us no am∣plier testimony of his industry, than that hee was very diligent in collecting the wri∣tings of the Ancients concerning this thing, interposing no judgement of his owne, the better to assure us of a thing so controverted.

But my modesty cannot so containe me, but that I shall chuse rather to undergoe the censure of being thought too daring, than (as much as in me lyeth,) to suffer this question of the Dracunculi to remaine longer ambiguous and undecided. Therefore for the present, I will thus order it, that refuting the opinions of the Ancients I may strengthen by certaine reasons, my opinion of the essence and cure of this dis∣ease.

For first, that Dracunculi are no living things, nor like unto wormes, nor of like ge∣neration as the flat wormes of the belly, which was the opinion of Aetius, is easie to disprove both by his writings, as also by reason it selfe. For he writes that the broad worme which hee calls Tania, is as it were a certaine Metamorphosis or transmutation of the inner tunicle of the small guttes, into a quicke living and moveable bo∣dy.

But no man ever sayd, neither will he confesse that the Dracunculi have the ma∣teriall causes of their beginning from the tunicle of the veine, in which they are closed, or from the fibers of a nervous body, to which often they are adjoyned; but much lesse from the skinne under which they lie, may they draw their materiall causes of their originall.

Moreover, neither can there bee any generation of wormes, nor of any other living creatures whatsoever, who have their originall from putrifaction,

unlesse by the Corruption of some matter, of whose better and more benigne part, nature by the force of the vitall heat, produceth some animate body, as Aristotle teacheth. Wherefore to produce this effect, it is fit the matter should have such a disposition to putrefaction as is required for the generation of such a creature as they would make the Dracunculus to be: It is fit the helping causes should concurre as assistants to the principalls in the action. And it is meete the place should be oppor∣tune or fit.

But there may be many causes found which may give life to the Dracunculi, for by the common consent of all those who have written of them, their generation pro∣ceedes from an humor melancholicke, terrestriall and grosse, which by its quali∣ties both by the first coldnesse and drinesse, as also by the second, that is Aciditie, is not onely thought most unfit of all others for putrefaction, but also is judged to resist putrefaction, as that which is caused by heate and superfluous heate hu∣midity. Besides, if the materiall cause of this disease should be from an humor putri∣fying and turning by putrefaction into some living creature, it was fit there should be stench also, as being an unseparable accident of putrefaction, for thus the excre∣ments in the guts of which the wormes are generated, doe smell or stinke.

Therefore that which exhales from their bodies which are troubled with the Dracunculi, should be stincking, as it happens to those sicke of the Pthiriasis or Lew∣sie-evill. But none of those who have delivered the accidents or symptomes of the Dracunculi are found to have made mention hereof. But for the efficient cause whereby so great heat may be raysed in the places next under the skin, by the effi∣cacy whereof such a creature may be formed of a matter melancholicke and most unapt to putrifie, as they make the Dracunculus to be who faine our bodies to be fruit∣full monsters; especially seeing the surface of the body is continually ventilated by the small Arteries spread under the skinne, as also by the benefit of insensible transpi∣ration, and breathed with the coolenes of the Aire incompassing us. But now the ma∣teriall and efficient causes being defective, or certainely very weake, for the genera∣tion of so laborious an effect; what coadjutory cause, can yeeld assistance? Can the humidity of meates? for those bodies which are fed with warme and moyst meates, as milke, Cheese, Summer fruits, usually breed wormes, as we are taught by experi∣ence in Children.

But on the Contrary, Avicen in the place before cited writeth, that meats of a hot and drie temper chiefely breed this kinde of disease, and that it is not so fre∣quent to moyst bodies and such as are accustomed to the Bath, moyst meats and wine moderatly taken. But whether may the condition of the Aire of those regions in which it is as it were, an Endemiall disease, conferre any thing to the generation of such creatures? Certainely for this purpose a cloudy warme and thicke ayre, such as useth to be at the beginning of the Spring when all places resound with frogges, toades and the like creatures bred of putrifaction.

But on the Contrary Iacobus Dalechampius by the opinion of all the Phisitions that have written of the Dracunculi, writes that this disease breedes in the drie and Sun burnt regions of India and Arabia; but if at the least that part of our body which is next under the skinne should have any opportunity to engender and nourish such creatures, they may be judged to have written that the Dracuuculus is a living crea∣ture with some probability, But if there bee no opportunity for generation in that place, nor capacity for the nourishment of such like creatures as in the guts, if that re∣gion of the body be breathed upon with no warmenesse and smothering heat, if it be defiled with none of the grosse excrements, as the gutts usually are, but onely by the subtiller exhalation, which have an easie and insensible transpiration by the pores of the skin, which may seeme to be a just cause of so monstrous and prodigious an effect: but we shall little profit with these engines of reason unlesse we cast downe at once all the Bulwarkes, with which this old opinion of the Dracunculi may stand and be defended.

For first they say, why have the ancients expressed this kind of disease by the name of a living thing, that is, of a Dracunculus or little Serpent? I answere, because in Phy∣sicke names are often imposed upon diseases rather by similitude than from the truth

of the thing; for the confirmation whereof, the examples of three diseases may suf∣fice, that of the Cancer, Polypus, and Elephas. For these have those names not because any Crabb, Polypus, or living Elephant may breede in the Body by such like di∣seases, but because this by its propagation into the adjacent parts represents the feete and clawes of a Crabbe: the other represents the flesh of the Sea-Polypus in its sub∣stance; and the third because such as have the Leprosie have their skinne wrinckled, rough, and horrid with scales and knots, as the skinne of a living Elephant. So truely this disease of which wee now enquire seemes by good right to have deserved the name Dracunculus, because in its whole conformation, colour, quality and producti∣on into length and thicknesse it expresseth the image of a Serpent. But whence, will they say (if it be without life) is that manifest motion in the matter? We reply that the humor the cause of this disease is subtill and hot, and so runnes with violence into the part whence it may seeme to move. But when the Dracunculi are separated, why doe they put their heads as it were out of their holes? we answer, in this the ancients have beene very much deceived, because after the suppuration the ulcer being ope∣ned, some nervous body being layde bare, thrust forth and subjected it selfe to the sight, which by the convulsive and shaking motion might expresse the crooked cree∣ping of a Serpent. But they will say, paine happens not unlesse to things indued with sence and life, but this Dacunculus when he is drawne too violently especially if hee be broken, thereby will cause extreame paine: we doe answer, that the conclusion doth not follow and is of no consequence, for these paines happen not unlesse when the un∣provident Surgeon drawes or pulls insteed of the Dracunculus some nervous or mem∣branous body swolne and repleate with an adust humor, whence there cannot but be great paine that part being pulld which is the author ofsence. But it is childish to say that the Dracunculus feeles, for that it causeth sharpe paines to the living body in which it is. Therefore that at last we may determine something of the nature, essence and generation of these Dracunculi, I dare boldly affirme it is nothing else but a tu∣mor and abscesse bred from the heat of the bloud in a venenate kinde. Such bloud dri∣ven by the expulsive facultie through the veines to the Externall parts, especially the limits, that is the Armes and Legges, causeth a tumor round and long often stretched from the joynt of the shoulder even to the wrist, or from the groine even to one of the Anckles with tension, heat, renitency, pricking paine, and a feaver. But this tu∣mor is some whiles stretched forth straight, otherwhiles into oblique and crooked tumors, which hath beene the cause that many taken with this kind of disease, and ha∣ving their limbes so infolded as with the twinings of a Serpent would say they had a Serpent. I have thus much to say of the Dracunculi, especially of those of our owne country.

For the cure, it is not unlike to the cure of a Phlegmon arising from a defluxion, for heere also in like manner the remedies must bee varied according to the foure times of the disease, and the same rule of diet, phlebotomy and purging must be ob∣served which is before prescribed in the cure of a Plegmon.

The mention of the Dracunculi calls to my memorie another kinde of Abscesse, altogether as rare. This our French men name Cridones, I thinke a Crinib us. i. from hayres: it chiefly troubles children and prickes their backes like thornes. They tosse up & downe being not able to take any rest. This disease ariseth from small haires which are scarce of a pins length, but those thicke and strong. It is cured with a fomentation of water more than warme, after which you must presently apply an oyntment made of honey and wheaten flower; for so these haires lying under the skin are allured and drawne forth; and being thus drawne, they must be plucked out with small mullets. I imagine this kinde of disease was not knowne to the ancient Phisitions.

The End of the Eighth Booke.

Notes

• What it is.
• The causes.
• Differences by reason of place
• Signes.
• A History.
• The reason of the name.
• Lib. 6. Cap. 8.
• The differen∣ces thereof.
• Which of them admit no ma∣nuall operati∣on.
• An Anodyne.
• Why it must be taken cleare away.
• What it is.
• The differen∣ces. Their signes and Symp∣tomes.
• Prognosticke.
• The cure.
• Lib. 3. de comp∣med. see. Locol. Hip. aph. 21 lib. 1.
• Gentle resol∣ving medicines
• Stronger re∣solvers.
• A Ripening medicine.
• What it is.
• The Sympu∣tomes.
• The Chirut∣gicall cure.
• Why the eure must not be deferred.
• The Reason why it is so called.
• The Cause.
• The Cute.
• Why the Glandules are called Almonds.
• Their use.
• The Cause of their tumor.
• Symptomes.
• Cure.
• Extreme di∣seases must have extreme remedies.
• How you must open the Wearon.
• What the Vvula is, and what the use therof. The Cause of the swelling thereof.
• Symptomes
• The Cure.
• The Cure by Chirurgery.
• What it is.
• The differen∣ces. The first kind.
• The Sym∣ptomes.
• The second kinde.
• The third.
• The Causes:
• Hip. sect. 3. prog. z. Aphor. ••0. sect. 5.
• Dict.
• Cure.
• Repelling Gargarismes.
• Ripening Gargarismes.
• Detergent Gargarisma.
• The reason of the name.
• The differen∣ces.
• The Care.
• What it is.
• Of a Pleurisie comming to suppuration.
• Of the change there of into an Empyema.
• Of the aper∣tion of the side in an Empyema
• What the Dropsie is.
• The differen∣ces thereof.
• The Symp∣tomes.
• The Causes.
• How divers diseases turne into Dropsies.
• The signes of an Ascites.
• The Symp∣toms.
• Prognostickes.
• Hip. lib. 4. de acut. & lib. de intern.
• Bagges.
• Bathes.
• Liniments
• Emplaisters.
• Vesicatories.
• Gal. lib. defa∣cul. natur. 〈◊〉〈◊〉.
• Divers opini∣ons of Para∣centesis, or ope∣ning of the belly. Reasons a∣gainst it.
• Erasistratus his Reasons a∣gainst it.
• Reasons for it.
• Lib. 3. Cap. 21.
• Lib. de morb. Ch. cap. de Hydrope.
• The places of the apertion must be divers, according to the parts chiefely affe∣cted.
• The manner of making apertion.
• A History.
• A Caution for taking out the Pipe.
• Another man∣ner of evacus∣ting the water after the ap••r∣tion.
• A medicine for the Iaundies.
• The diuers causes thereof.
• Signes hereof occasioned by the Kall.
• By the guts:
• By flesh.
• By winde.
• By a waterish humor. By bruised blood. Which may be cured by Chi∣rurgery, which not.
• The cure by Chirurgery.
• There are onely 3. sorts of Ruptures.
• Bubo••ocele.
• Enterocele and Epiplocele.
• Hydrocele. Physocele.
• Sarcocele.
• Cirsocele.
• The Causes.
• Thesignes.
• What rupture is uncurable.
• To what rup∣tures children are subject.
• An astringent cataplasme.
• Ser. 1. Cap. 24.
• The craft and coveto usuesse of Gelders.
• Another way to cure Rup∣tures.
• The reason of this cure.
• Another me∣dicine.
• A notable History.
• We must never despaire in dis¦seases if so be nature be associated by Art.
• A Cataplasma to soften the excrements.
• Chymicall oyle.
• The Chirur∣gicall cure by the golden Tye.
• Another man∣ner thereof.
• The third manner there∣of.
• A thing to be noted.
• A History.
• Lib de arte medic••.
• Lib. de sem.
• Lib. 3, Cap. 33.
• what a Hydro∣cele is.
• The signes.
• The cure.
• A medicine 〈◊〉〈◊〉 draw forth the contained mat∣ter.
• What a Pneu∣matocele is.
• The Cure.
• What a Sarco∣cele is.
• The signes. Prognosticks.
• The signes.
• What a Cir∣socele is.
• The Cure.
• Hernia Hu∣moralis.
• The causes.
• The cure.
• Hippocrates his cure.
• What the Pa∣ronychia is.
• Lib. 2. cap. 4. tract. 8.
• Gal. comm. ad sent. 1. ser. 4. lib. 6 E••••. Gal. Com ad sect, 67. sect. 2. prog.
• The cure.
• It is not as yet sufficiently knowne what Dracunculs are.
• Lib. 4. cap. ult.
• The cure out of Egineta.
• Cap 21. lib. 4. sent. 3 tract. 3.
• Lib. 14. cap. ult.
• The cure out of Aetius
• Tract. at 〈◊〉〈◊〉. cap. 31. The cure our of Rhasis.
• His opinion of them.
• Soranus his opinion.
• Epist. 2. lib. 7.
• Aetius opinion confuted. Tract. 3. ser∣me. 1. cap. 40.
• 4. Meteorolog.
• Naturall Me∣lancholicke humor is most unapt to pu∣trifie.
• Stinke an un∣separable companion to putrifaction.
• What things usually breed wormes.
• Cap. 83. Chir. Gallic.
• Why they are called Dacun∣culi.
• The Cure.
• So the Malu••∣pilate in Ari∣stotle cap. 11. lib. 7. hist. ani∣mal.