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

OF DIVERS OTHER PRETER NATURALL AF∣FECTS, WHOSE CURE IS COMMONLY PERFORMED BY SURGERY. THE SEVENTEENTH BOOKE. (Book 17)

CHAP. I. Of an Alopecia, or the falling away of the haires of the head.

AN Alopecia is the falling away of the haire of the head, and sometimes also of the eye-browes, chin and other parts; the * 1.1 French commonly call it the Pelade. Phisicians terme it the Alopecia, for that old Foxes subject, by reason of their age, to have the scab, are troubled oft times with this disease. This affect is caused either through defect of nourishment fit to * 1.2 nourish the haires, as in old age through want of the radicall humidity, or by the corruption of the alimentary matter of the same, as after long fevers, in the Lues venerea, leprosie, the corruption of the whole hody and all the humours, whence followeth a corruption of the vapours and fuliginous excrements; or else by the vitious constitution of the pores in the skin in rarity, and constriction or density, as by the too much use of hot oyntments made for colouring the hair, or such as are used to take off haire, therefore called Depilatoria, or by the burning of the skin, or losse thereof, having a scarre in stead thereof, by reason of whose density the haire cannot spring out, as by too much laxity the fuliginous matter of the haire stayes not, but presenly vanisheth away. The Alopecia which comes by old age, a consumption, burne, baldnesse, leprosie and * 1.3 a scald head, is uncurable: that which admits of cure, the cause being taken away, is helped. Wherefore, if it proceed from the corruption of humours, let a Phisician bee called, who as hee shall thinke it fit, shall appoint diet, purging and phlebotomie. Then the Surgeon shall shave off that haire which is remaining, and shall first use re∣solving fomentations, apply Leaches and Horns to digest the vicious humour which is under the skin, then shall he wash the head to take away the filth with a lye where∣in the roots of Orris and Aloes have been boyled. Lastly, hee shall use both attra∣ctive fomentations and medicines for to draw forth the humour which is become laudable in the whole body by the benefit of diet fitly appointed. But if the Alope∣cia shall happen through defect of nourishment, the part shall bee rubbed so long

with a course linnen cloth, or a figge leafe, or onions, untill it waxe red; besides also the skin shall bee pricked in many places with a needle, and then ointments applied made of Labdanum, pigeons dung, stavisager, oile of bayes, turpentine and waxe, to draw the bloud and matter of the haires. If the haire be lost by the Lues venerea, the patient shall be annointed with quicksilver to sufficient salivation. To conclude, as the causes of this disease shall be, so must the remdies be fitted which are used.

CHAP. II. Of the Tinea, or scalde Head.

THE Tinea (let me soterme it in Latine, whilst a fitter word may be found) or a scald head, is a disease possessing the musculous skin of the head or * 1.4 the hairy scalpe, and eating thereinto like a moth. There are three diffe∣rences thereof, the first is called by Galen scaly or branlike, for that whilst it is scratched it casts many branlike scales: some Practitioners terme it a dry scall, because of the great adustion of the humour causing it. Another is called ficosa, a fig-like scall, because when it is dispoyled of the crust or scab which is yellow, there ap∣peare graines of quick and red flesh, like to the inner seeds or graines of figges, and casting out a bloudy matter. Galen names the third Achor, and it is also vulgarly ter∣med the corrosive or ulcerous scall, for that the many ulcers wherewith it abounds are open with many small holes flowing with liquid sanies like the washing of flesh, stinking, corrupt and carrion-like, somewhiles livid, somewhiles yellowish. These holes, if they be somewhat larger, make another difference which is called Cerion or Favosa (that is, like a hony combe) because as Galen thinks, the matter which floweth * 1.5 from these, resembleth hony in colour and consistence. They all proceed of an hu∣mour which is more or lesse vicious, for a lesse corrupt humour causeth a scaly, a more corrupt, the fig-like, but the most corrupt produceth the ulcerous. If it shall happen to an infant by reason of the fault and contagion of the nurse, or else presently after it is borne, it scarce admits of cure; neither must we attempt that be∣fore the child come to that age, that he may be able to endure the cure & medicines. But you may in the meane while apply the leaves of Colworts or beets besmeared with fresh butter, or other gentle medicine having a faculty to mollifie and open the passage for the shut up matter. Those who are of sufficient age to away with medi∣cines, * 1.6 may bleed, purge, bathe, according to art by the advice of a Phisician. For lo∣call medicines in a scaly scall, softning and discussing fomentations shall bee appoin∣ted, * 1.7 made of the roots of marsh-Mallowes, Lillies, Docks, Sorrell boyled in lye with a little vineger added thereto. The head shall bee twice in a day fomented with such a decoction, and on the sixth day the haire being shaven off, it shall bee sca∣rified, and then leaches and hornes put to it so scarified. Then it shall be forth with annoynted with oyle of stavisager mixed with blacke sope, both to draw & represse the malignity of the humour impact in the part. You may also use the following medicine even to the perfect cure of the disease, as that which is much commended in this kind of disease by Vigo, Gordonius, and Guido; it is thus made. ℞. elleb. albi & * 1.8 nigri, uttrament. auripigmenti, lithargyri auri, calcis viva, vitriol. alum. galla. fulig. ci∣ner. faecis vini usti, an ℥ ss. argenti vivi extincti, ℥iii. aeruginis aeris ʒii. fiat pulvis qui in∣corporetur cum succo boraginis, scabiosae, fumariae, oxylapathi, aceti, an. quart. i. olei anti∣qui lib. i. bulliant usque ad consumpt succorum, in fine decoctionis cineres ponantur, adden∣do picis liquidae ℥ ss. cerae quantum sufficit, fiat unguentum: These authors testifie that this will heale any kind of scall. Certainely none can dislallow of it who well consi∣dereth the engredients and composure thereof.

A crusty also or fig-like scall shall bee so long fomented with the prescribed fo∣mentation, untill the crusts or scabs fall off, yet there is nothing so good and effectu∣all * 1.9 as Cresses beaten or fryed with hogs suet. For it will make it fall off in the space of foure and twenty houres, besides, if it be continued it will heale them throughly, * 1.10 as I have knowne by experience, and reason also stands therewith; for according to

Galen, Cresses are hot and dry. When the crusts shall bee fallen away, the parts af∣fected * 1.11 shall bee annoynted with the formerly prescribed ointment. I have cured ma∣ny with a little oyle of vitrioll, and sometimes also with Aegyptiacum made some-what more strong than ordinary. But if the root of the haires appeare rotten, they shall bee plucked out one by one; yet if such putrefaction shall possesse the whole hairy sculpe, and trouble all the roots of the haire, that you may plucke them out the more readily, & with lesse paine, you may besmeare a cotten cloth on the rougher side with this following medicine. ℞. picis nigrae ℥vi. picis res. ℥ii. pul. viridis aeris, * 1.12 & vitriol. rom. an. ℥i. vel ℥ ss. sulphur. viv. ʒ ss. coquantur omnia simul in aceti acerrimi quantitate sufficiente, fiat medicamentum ad usum: let it be applyed to the head, and re∣maine on for two dayes; then let it bee quickly and forcibly plucked away against the haire, that so the haires sticking to the plaister may by that meanes be plucked a∣way therewith: you shall use this medicine so long as need shall seem to require.

For the third kind of scall which is termed a Corrosive or ulcerous, the first indi∣cation * 1.13 is to cleanse the ulcers with this following ointment. ℞. unguenti enulati cum mercurio duplicato, aegyptiaci, an. ℥iii. vitriol. albi in pulverem redacti ℥i. incorporentur si∣mul, fiat unguentum ad usum; also you may use the formerly described ointment. But if any paine or other accident fall out, you must with stand it by the assistance and dire∣ction of some good Phisitian; verily these following medicines against all kinds of Scalls have been found out by reason, and approved by use. ℞. Camphur. ℥ss. alum. roch. vitriol. vir. aeris, sulph. vivi, fulig. forn. an. ʒvi. olei amygd. dulcium & axungiae por∣ci, aii. ℥ii. incorporentur simul in mortario, fiat unguentum. Some take the dung which lyeth rotting in a sheep-fold; they use that which is liquid, & rub it upon the ulcera∣ted places, & lay a double cloth dipped in that liquor upon it. But if the patient can∣not be cured with all these medicines, & that you find his body in some parts therof troubled in like sort with crusty ulcers, I would wish that his head might be anointed with an ointment made of Axungia, argentum vivum, & a little Sulphur, & then fitsom emplastrum Vigonis cum mercurio into the fashion of a cap; also some plaisters of the * 1.14 same may be applyed to the shoulders, thighs and legs, and so let him be kept in a ve∣ry warme chamber, and all things done as if he had the Lues venerea. This kinde of cure was first (that I know of) attempted by Simon Blanch the Kings Surgeon, upon a certaine young man, when as he in vaine had diligently tryed all other usuall me∣dicines. A scalled head oft-times appeareth very loathsome to the eye, casting forth virulent and stinking sanies; at the first it is hardly cured, but being old, far more dif∣ficultly. For divers times it breaketh out afresh, when you thinke it kild, by reason of the impression of the maligne putrefaction remaining in the part, which wholly corrupts the temper thereof. Moreover, oft-times being healed, it hath left an Alo∣pecia behind it, a great shame to the Surgeons. Which is the reason, that most of them judge it best to leave the cure thereof to Empericks and women.

CHAP. III. Of the Vertigo, or Giddinesse.

THE Vertigo is a sudden darkening of the eyes and sight by a vapo∣rous * 1.15 & hot spirit which ascendeth to the head by the sleepy arte∣ryes, and fils the braine, disturbing the humours and spirits which are conteyned there, & tossing them unequally, as if one ran round, or had drunk too much wine. This hot spirit oft-times riseth from the heart upwards by the internall sleepy arteryes to the Rete mi∣rabile, or wonderfull net; otherwhiles it is generated in the brain, its selfe being more hot than is fitting; also it oft-times ariseth from the stomack, spleen, liver and other entrals being too hot. The signe of this disease is the sudden * 1.16 darkening of the sight, and the closing up as it were of the eyes, the body being light∣ly turned about, or by looking upon wheeles running round, or whirle pits in wa∣ters,

or by looking downe any deepe or steep places. If the originall of the disease proceed from the braine, the patients are troubled with the head-ach, heavinesse of the head, and noyse in the eares, and oft-times they lose their smell. Paulus Aegine∣ta for the cure bids us to open the arteries of the temples. But if the matter of the * 1.17 disease arise from some other place, as from some of the lower entrals, such ope∣ning of an artery little availeth. Wherefore then some skilfull Phisitian must be con∣sulted, with who may give directions for phlebotomie, if the original of the disease proceed from the heat of the entrals; by purging, if occasioned by the foulenesse of the stomack. But if such a Vertigo be a criticall symptome of some acute disease af∣fecting the Crisis by vomit or bleeding, then the whole businesse of freeing the pati∣ent * 1.18 thereof must be committed to nature.

CHAP. IV. Of the Hemicrania, or Megrim.

THE Megrim is properly a disease affecting the one side of the head, right, or left. It sometimes passeth no higher than the temporall mu∣scles, otherwhiles it reacheth to the toppe of the crowne. The cause of such paine proceedeth eyther from the veynes and externall arte∣ryes, or from the meninges, or from the very substance of the braine, or from the pericranium, or the hairy scalpe covering the pericranium, or lasty, from putride vapours arising to the head from the ventricle, wombe, or other inferiour member. Yet an externall cause may bring this affect, to wit, the too hot or cold constitution of the encompassing ayre, drunkennesse, gluttony, the use of hot and vaporous meates, some noysome vapour or smoake, as of Antimony, quick-silver, or the like, drawne up by the nose, which is the reason that Goldsmythes, and such as gilde mettals are commonly troubled with this disease. But whence foever the cause of the evill proceedeth, it is either a simple distemper, or with matter: with matter, I say, which againe is either simple or compound. Now, this affect is either * 1.19 alone, or accompanied with other affects, as inflammation and tension. The hea∣vinesse of head argues plenty of humour; pricking, beating and tension shewes that there is plenty of vapours mixed with the humours, and shut up in the nervous, ar∣terious, or membranous body of the head. If the paine proceed from the inflamed meninges, a fever followeth thereon, especially, if the humour causing paine doe pu∣tresie. If the paine be superficiary, it is seated in the pericranium. If profound, deepe and piercing to the botome of the eyes, it is an argument that the meninges are affe∣cted, and a feaver ensues, if there be inflammation, and the matter putresie: and then oft times the tormenting paine is so great and grievous, that the patient is affraid to have his head touched, if it be but with your finger, neither can hee away with any noise, or small murmuring, nor light, nor smels however sweet, no nor the fume of Vine. The paine is sometimes continuall, otherwhiles by fits. If the cause of the pain * 1.20 proceed from hot, thin & vaporous bloud, which will yeeld to no medicines, a very necessary, profitable & speedy remedy may be had by opening an artery in the tem∣ples, whether the disease proceed from the internall or externall vessels. For hence alwayes ensueth an evacuation of the conjunct matter, bloud and spirits. I have ex∣perimented this in many, but especially in the Prince de la Roche sur-you. His Phy∣sitians, * 1.21 when hee was troubled with this grievous Megrim, were Chapaine, the Kings, and Castellane, the Queenes chiefe Phisitians, and Lewes Duret, who not∣withstanding could helpe him nothing by bloud-letting, cupping, bathes, fictions, diet or any other kind of remedy either taken inwardly or applyed outwardly. I be∣ing called, said, that there was onely hope one way to recover his health, which was to open the artery of the temple in the same side that the paine was; for I thought it probable, that the cause of his pain was not contained in the veins, but in the 〈◊〉〈◊〉, in which case by the testimony of the ancients, there was nothing better than the

opening or bleeding of an artery, whereof I had made tryall upon my selfe to my great good. When as the Physitians had approved of this my advice, I presently betake my selfe to the work, and choose out the artery in the pained temple, which was both the more swolne and beat more vehemently than the rest. I open this, as wee use to doe in the bleeding of a veine, with one incision, and take more than two sawcers of blood flying out with great violence, and leaping; the paine presently ceased, neither did it ever molest him againe. Yet this opening of an Artery is sus∣pected by many, for that it is troublesome to stay the gushing forth bloud, and ci∣catrize the place, by reason of the density, hardnesse, and continuall pulsation of the artery, and lastly, for that when it is cicatrized there may be danger of an Aneu∣risma. Wherefore they thinke it better first to divide the skin, then to separate the artery from all the adjacent particles, and then to binde it in two places, and lastly divide it, as we have formerly told you must be done in Varices. But this is the opini∣on of men who fear all things where there is no cause; for I have learnt by frequent * 1.22 experience that the apertion of an artery, which is performed with a Lancet, as wee doe in opening a veine, is not at all dangerous; and the consolidation or healing is somewhat flower than in a veine, but yet will bee done at length, but that no flux of bloud will happen, if so bee that the ligation be fitly performed, and remaine so for foure dayes with fitting pledgets.

CHAP. V. Of certaine affects of the eyes, and first of staying up the upper eye-lidde when it is too laxe.

OF the diseases which befall the eies, some possess the whole substance thereof, as the Ophthalmia, a Phlegmon therof: others are proper and peculiar to some parts thereof, as that which is termed Gutta ferena to the opticke nerve. Whence Galen made a threefold difference of the * 1.23 diseases of the eyes, as that some happened to the eye by hurting or offending the chiefe organ thereof, that is, the crystalline humour; others by hin∣dering the animall faculty, the chiefe causer of sight, from entring into them; and lastly, other some by offending the parts subservient to the prime organ or instru∣ment. Now of all these diseases, the eye hath some of them common with the other parts of the body, such as are an ulcer, wound, phlegmon, contusion and the like: other some are peculiar and proper to the eye, such as are the Aegilops, Cataracta, Glaucoma, and divers others of this kinde. Some have their upper eie-lid fall down, * 1.24 by reason that the upper skin thereof is relaxed more than is sufficient to cover the eye, the gristle in the meane while not relaxing it selfe together therewith. Hence proceeds a double trouble; the first, for that the eye cannot bee easily opened; the other, because the haires of the relaxed eye-lid run in towards the eye, and become troublesome thereto by pricking it. The cause of such relaxation is either a particu∣lar * 1.25 palsie of that part, which is frequent in old people, or the defluxion or falling downe of a watrish humour, and that not acride or biting; which appeares by this, that those who are thus affected have a ranke of haires growing under the naturall ranke, by reason of the aboundance of heaped up humour, as it is most probable. For thus a wet and marish ground hath the greatest plenty of grasse. Now if this same humour were acride, it would cause an itching, and consequently become trouble∣some to the patient, and it would also fret insunder and destroy the roots of the other haires, so farre it is from yeelding matter for the preternaturall generation of new. It is fit, before you doe any thing for the cure, that you marke with inke the portion * 1.26 thereof which is superfluous, and therefore to be cut away, lest if you should cut off more than is requisite, the eye-lid should remaine turned up, and so cause another kinde of affect, which the ancients have called Ectropion. Then the eye being cove∣red, take and lift up with your fingers the middle part of the skin of the eye-lid, not taking hold of the gristle beneath it, and then cut it athwart, taking away just so much

as shall be necessary to make it as it were naturall; lastly, joine the lips of the wound together with a simple future of three or foure stiches, that so it may bee cicatri∣zed; for the cicatrization restraines the eie-lid from falling downe so loosly, at least some part thereof being taken away. There ought to be some measure, and heed ta∣ken in the amputation, otherwise you must necessarily run into the one or other in∣convenience, as if too much be cut away, then the eye will not bee covered, if too little, then you have done nothing, and the patient is troubled to no purpose. If there shall bee many haires growne preternaturally, you shall plucke them away with an instrument made for the same purpose; then their roots shall be burned with a gen∣tle cautery, the eye being left untoucht, for a scar presently arising will hinder them from growing againe.

CHAP. VI. Of Lagophthalmus, or the Hare eye.

SUch as have their eie-lids too short, sleep with their eyes open, for that they cannot be covered by the too short skin of the eye-lids: the Greekes terme this affect, Lagophthalmos. The cause is either * 1.27 internall or externall: internall, as by a Carbuncle, Impostume, or Ulcer: externall, as by a wound made by a sword, burn, fall, & the like. If this mishap proceed by reason of a cicatrization, it is cureable, if so that the short eye-lid be of an indifferent thicknesse. But if it have bin from the first conformation, or by some other meanes, whereby much of the sub∣stance is lost, as that which happens by burning and a carbuncle, then it is uncu∣reable. For the cure, you shall use relaxing and emollient fomentations, then the skinne shall be divided above the whole scarre, in figure of an halfe moon, with the * 1.28 hornes looking downewards. Then the edges of the incision shall bee opened, and lint put into the middle therof, that so it may hinder the lips from joyning together againe. Then shall you apply a plaster upon the lint, and so bind up the part with a fitting ligature that may somewhat presse upon the whole eye, lest it should lift it selfe somewhat upwards againe, and so returne into its ancient, but not naturall fi∣gure. But in cutting the skinne, you must take care that your incision harme not the gristle; for if it be cut, the eie-lid falls downe, neither can it be afterwards lifted up. But now for the lower eye-lid: it is subject to sundry diseases, amongst which there is one which answereth in proportion to that, which we late mentioned, which is, when as it is lifted upwards little or nothing, but hangs and gapes, and cannot bee joyned with the upper, and therefore it doth not cover the eye, which affect is fami∣liar * 1.29 to old people; it is called Ectropion, and it may be helped by the means former∣ly delivered.

CHAP. VII. Of the Chalazion, or Haile-stone, and the Hordeolum or Barly-corne of the eye-lids.

THe Chalazion is a round and cleere pimple which growes upon the upper * 1.30 eie-lid, it is also moveable and may be stirred this way and that way with your fingers: the Latines call it Grando, for that it resembles a Hail-stones Another pimple not much unlike this growes somtimes upon the verges of the eye-lids above the place of the haires. It is termed Hordeolum, by reason of the similitude it hath with a barly corne. The matter of these is contained in its pro∣per * 1.31 cist or skin, and therefore is hardly brought to suppuration. At the first begin∣ning it may be resolved and discussed. But when as it is once growne and concrete into a plaster or stone-like hardnesse, it is scarce cureable. Wherefore it is best to

performe the cure by opening them, that so the contained matter may flow, or bee pressed forth. If the pimple or swelling bee small, then thrust it through with a nee∣dle and thread, and leave the thread therein of such length that you may fasten the ends thereof with a little of the emplaster called Gratia Dei like glew to the fore-head, if it be on the upper eye-lid; or to the cheeks, if on the lower. You must draw through a fresh one every second day, as is usually done in chirurgicall setons. For thus at length the swelling will be destroyed and made plaine.

CHAP. VIII. Of the Hydatis or Fatnesse of the Eye-lids.

THe Hydatis is a certaine fatty substance like a peece of fat seated and ly∣ing * 1.32 under the skinne of the upper eye-lid. It is a disease incident to chil∣dren, who are of a more humid nature: wherefore it is a soft and loose tumour making the whole eye-lid, which it possesseth, oedematous; so that, as if depressed with a weight, it cannot be lifted up. It hath its name, for that it hath as it were a bladder distended with a whayish humour, which kinde of fault is observed by Galen in the liver. Those, who are thus affected, have their eyes looke * 1.33 red, and flow with teares, neither can they behold the sun, or endure the light. The cure is performed by cutting off the superfluous substance, not hurting the neigh∣bouring * 1.34 parts; and then presently put some salt into the place whence it was taken out (unless the vehemency of paine hinder) that so the place may bee dryed and strengthened, and the rest of the matter (if any such be) may be consumed, and hin∣dred from growing againe. Lastly, you shall cover the whole eye with the white of an Egge dissolved in rose-water, or some other repercussive.

CHAP. IX. Of the Eye. lids fastened or glewed together.

SOmetimes it commeth to passe that the upper eye-lid is glewed or faste∣ned to the under, so that the eye cannot be opened, or so that the one of them may sticke or bee fastened to the white coat of the eye, or to the * 1.35 horny. This fault is sometimes drawne from the first originall, that is, by the default of the forming faculty in the wombe (for thus many infants are born with their singers fastened together, with their fundaments, privities and eares un∣perforated) the eye in all other respects being well composed. The cause of this af∣fect somtimes proceeds from a wound, otherwhiles from a burn, scald or impostu∣mation, * 1.36 as the breaking of the small pox. It is cured by putting in a fit instrument, & so opening them; but with such moderation, that you touch not the horny coat, for otherwise it would fall out. Therefore you must put the end or point of your probe * 1.37 under the eye-lids, and so lifting them up (that you hurt not the substance of the eie) divide them with a crooked incision knife.

The incision made, let the white of an egge beaten with some rose-water be put into the eye; let the eye-lids be kept open, yea let the patient himself be carefull that he often turne it upwards, and lift it up with his fingers, not onely that the medicine may bee applyed to the ulcer, but also that they may not grow together againe. In the night time let a little pledget dipped in water, and that either simple, or where∣in some vitrioll hath bin dissolved, bee laid thereon. For thus you shall hinder the eye-lids from joyning together againe. Then on the third day the parts or edges of the eie-lids shall be touched with waters drying without biting or acrimony, that so they may be cicatrized. But if the eye-lid adhere to the horny coate at the pupilla or apple of the eye, the patient will either bee quite blind, or very ill of sight. For the scarre which ensues will hinder the shapes of things from entring to the crystalline

humour, and the visive spirits from passing forth to the objects. For prognostickes, you may learne out of Celsus, that this cure is subject to a relapse, so that it may bee * 1.38 shunned neither by diligence nor industry, but that the eye-lid will alwayes adhere and cleave to the eye.

CHAP. X. Of the itching of the Eye-lids.

MAny have their Eye-lids itch vehemently by reason of salt phlegme, which often times excoriating and exulcorating the parts themselves, yeelds a sanies, which joynes together the eye-lids in the night time as if they were glewed together, and maks them watry and bleared. This affect doth so torment the patients, that it oft times makes them require the Physitians helpe. Wherefore generall medicines being premised, the Ulcers shall be washed with the following Collyrium. ℞. aquae mellis in balneo mariae destilla∣tae ℥iii. sacchari candi. ʒi. aloës lotae & in pollinem redactae ʒss. fiat collyrium. Which * 1.39 if it doe no good, you may use this which followes. ℞. Ung. Aegyptiac. ʒi. dissolve in aquae plantaginis quantitate sufficienti. Let the ulcerated eie-lids betouchd with a soft linnen rag dipped therin, but with care that none therof fall upon the eye. But when the patient goes to bed, let him cause them to be anointed with the following oint∣ment, very effectuall in this case. ℞. axungiae porci et butyri recentis, an. ℥ss. tuth. prae∣par. ʒss. antimon. in aquae euphrasiae praeparati, ℈ii. camphor aegra. iiii. misce, et in morta∣rio plumbeo ducantur per tres horas, conflatum indeunguentum, servetur in pyxide plum∣bea. Some commend and use certaine waters fit to cleanse, dry, binde, strengthen, and absolutely free the eye-lids from itching and rednesse; of which this is one.

℞. aquae euphrag. faeniculi, chelidon. an ℥ss. sarcocal. nutritae ℈ii. vitriol. rom. ʒi. mis∣ceantur simul & bulliant unica ebullitione; postea coletur liquor, & servetur ad usum di∣ctum. Or else. ℞. aquaeros. & vini alb. boni an. ℥iiii. tuth. praepar. aloës an. ʒi. flor. aeni ℈ii. camphor. gra. ii. Let them bee boyled according to art, and kept in a glasse to wash the eye-lids. Or else, ℞. vini albi lbss. salis com. ʒi. let them be put into a cleane barbars bason and covered, and kept there five or six dayes, and bee stirred once a day, and let the eye-lids bee touched with this liquor. Some wish that the patients urine be kept all night in a barbers bason, and so the patients eie-lids be washed ther∣with. Verily in this affect we must not feare the use of acride medicines, for I once * 1.40 saw a woman of fifty yeares of age, who washed her eye-lids when they itched with the sharpest vinegar she could get, and affirmed that she found better successe of this than of any other medicine. Vigo prescribes a water whose efficacy above other me∣dicines in this affect, hee saith, hath bin proved; and that it is to bee esteemed more worth than gold, the description thereof is thus. ℞. aq. ros. vini albi oderiferi medio∣cris vinosit atis an. ℥iiii. myrobalan. citrini trit. ʒiss. thuris ʒii. bulliant omnia simul usque ad consumptionem tertiae partis; deinde immediatè addantur floris aris ℈ii. camph. gr. ii. Let the liquor be kept in a glasse well stopped for the foresaid use.

CHAP. XI. Of Lippitudo, or Bleare-eyes.

THere are many whose eyes are never dry, but alwaies flow with a thinne, acrid and hot humour, which causeth roughnesse, and upon small occasi∣ons inflammations, blear or blood-shot eies, and at length also Strabismut or sqinting. Lippitudo is nothing else but a certaine white filth flowing * 1.41 from the eyes, which oft times agglutinates or joynes together the eye-lids. This disease often troubles all the life time, and is to be cured by no remedy: in some it

is cureable. Such as have this disease from their infancy, are not to be cured, for it remaines with them till their dying day. For large heads, and such as are repleate with acride or much excrementitious phlegme, scarce yeeld to medicines. There is much difference whether the phlegme flow downe by the internall vessels under the scull, or by the externall which are betweene the skull and the skin, or by both. For if the internall veines cast forth this matter, it will be difficultly cured, if it bee cured at all. But if the externall vessels cast it forth, that cure is not unprofitable, which having used medicines respecting the whole body, applyes astringent medi∣cines to the shaved crown, as Empl. contra rupturam, which may streighten the veines, and as it were suspend the phlegme, useth cupping, and commands frictions to bee made towards the hinde part of the head, and lastly, maketh a Seton in the necke. There are some who cauterize the toppe of the crowne with a hot iron, even to the bone, so that it may cast a scaile, thus to divert and stay the defluxion. For locall * 1.42 medicines, a Collyrium made with a good quantity of rosewater, with a little vitrioll dissolved therein, may serve for all.

CHAP. XII. Of the Ophthalmia, or inflammation of the Eyes.

AN Ophthalmia is an inflammation of the coate Adnata and consequently * 1.43 of the whole eye, being troublesome by the heate, rednesse, beating, renitency, and lastly paine. It hath its originall either by some primi∣tive cause or occasion, as a fall, stroake, dust, or small sand flying into the eyes. For the eye is a smooth part, so that it is easily offended by rough things, as saith Hippocrates, lib. de carnibus. Or by an antecedent cause, as a de∣fluxion falling upon the eyes. The signes follow the nature of the materiall cause, * 1.44 for from blood especially cholerike and thin, it is full of heat, rednesse and paine; from the same allayed with phlegme all of them are more remisse. But if a heavinesse possess the whole head, the original of the disease proceeds therfrom. But if a hot pain trouble the forehead the disease, may be thought to proceed from some hot distem∣per of the Dura water, or the pericranium; but if in the very time of the raging of the disease the patient vomit, the matter of the disease proceeds from the stomacke. But from whence soever it commeth there is scarce that paine of any part of the body, which may be compared to the paine of the inflamed eyes. Verily the greatnesse of the inflammation hath forced the eyes out of their orbe, and broken them asunder in divers. Therefore there is no part of Physicke more blazed abroad than for sore eyes. For the cure, the Surgeon shall consider and intend three things, diet, the eva∣cuation * 1.45 of the antecedent and conjunct cause, and the overcomming it by topicke remedies. The diet shall bee moderate, eschewing all things that may fill the head with vapours; and those things used that by astriction may strengthen the orifice of the ventricle, and prohibite the vapours from flying up to the head; the patient shall bee forbidden the use of wine, unlesse peradventure the disease may proceed from a grosse and viscide humour, as Galen delivers it. The evacuation of the mat∣ter flowing into the eye, shall bee performed by purging medicines, phlebotomy in * 1.46 the arm, cupping the shoulders and neck with scarification, and without: and lastly, by frictions, as the Physitian that hath undertaken the cure shall thinke it fit. Galen * 1.47 after universall remedies for old inflammations of the eyes, commends the opening of the veines and arteryes in the forehead and temples, because for the most part the vessels therabouts distended with acride, hot and vaporous blood, cause great & vehement paines in the eye.

For the impugning of the conjunct cause, divers topick medicines shall be apply∣ed, according to the four sundry times or seasons that every phlegmon usually hath. For in the beginning, when as the acride matter flowes downe with much violence, repercussives doe much conduce 〈◊〉〈◊〉 and tempred with resolving medicines, are good also in the encrease. ℞. aq. ros. et plantag. an. ℥ss. mucagin. gum. Tragacanth. ʒii. al∣bum.

ovi quod sufficit, fiat collyrium, let it bee dropped warme into the eye, and let a double cloth dipped in the same collyrium bee put upon it. Or, ℞. mucag. sem. psil. * 1.48 & cydon. extractae in aq. plant. an. ℥ss. aq. solan. & lactis muliebris, an. ℥i. trochise. alb. rha. ℈i. fiat collyrium, use this like the former. The veins of the templesmay be streigh∣tene•• by the following medicine. ℞. bol. arm. sang. drac. & mast. an. ℥i. ss. alb. ovi, aquae ros. & acet. an. ℥i. tereb. lot. & ol. cidon. an. ℥. ss. fiat defensivum. You may also use ung∣de * 1.49 Bolo, empl. diacal. or contrarupturam dissolved in oyle of myrtles, and a little vine∣ger. But if the bitternesse of the paine be intolerable, the following cataplasme shall be applyed. ℞. medul. pomor. sub. ciner. coctorum. ℥iii. lactis muliebris ℥ss. let it be ap∣plyed to the eye, the formerly prescribed collyrium being first dropped in. Or, ℞. mu∣cag. * 1.50 sem. psil. & cidon. an. ℥ss. micae panis albi in lacte infusi, ℥ii. aquae ros. ℥ss. fiat cataplasma. The bloud of a turtle Dove, Pigeon or Hen drawne by opening a veine under the wings, dropped into the eye, asswageth paine. Baths are not onely anodine, but also stay the defluxion by diverting the matter thereof by sweats; therefore Galen much * 1.51 commends them in such defluxions of the eyes as come by fits. In the state when as the paine is either quite taken away or asswaged, you may use the following medi∣cines. ℞. sarcocol. in lacte muliebri nutritae, ʒi. aloës lotain aq. rofar. ℈ii. trochis. alb. rha. ʒss. sacchar cand. ʒii. aquae ros. ℥iii. fiat collyrium. Or, ℞. sem. faeniculi, & fanug. an. * 1.52 ʒii. flo chamae. & melil. an. m. ss. coquantur in aq. com. ad ℥iii. colaturae adde tuthiae praep. & sareoc. nutritae in lacte muliebri. an. ʒi. ss. sacchari cand. ℥ss. fiat collyrium ut artis est. In the declination the eye shall be fomented with a carminative decoction, and then this collyrium dropped thereinto. ℞. sarcoc. nutritae ʒii. aloës & myrrh. an. ʒi. aq. ros. & euphrag. an. ℥ii. fiat collyrium, ut artis est.

CHAP. XIII. Of the Proptosis, that is, the falling or starting forth of the eye, and of the Phthisis, and Chemosis of the same.

THe Greekes call that affect Proptosis, the Latines procidentia or Exitus ocu∣li, when as the eye stands, and is cast out of the orbe by the occasion of a matter filling and lifting up the eye into a greater bignesse, and largenesse of substance. The cause of this disease is sometimes externall, as by too violent strayning to vomit, by hard labour in child-birth, by excessive and won∣drous * 1.53 violent shouting, or crying out. It sometimes happeneth that a great and cru∣ell paine of the head, or the too strait binding of the forehead and temples for the easing thereof, or the palsie of the muscles of the eye, give beginning to this disease. Certainely sometimes the eye is so much distended by the defluxion of humors, that it breakes in sunder, and the humours thereof are shed, and blindenesse enfues there∣of, as I remember befell the sister of Lewis de Billy merchant, dwelling at Paris near S. Michael's bridg. The cure shall be diversified according to the causes. Therefore universall medicines being premised, cupping glasses shalbe applyed to the originall * 1.54 of the spinall marrow, and the shoulders; as also cauteries, or Setons: the eye shall be pressed or held downe with clothes doubled and steeped in an astringent decocti∣on made of the juice of Acacia, red roses, the leaves of poppy, henbane, roses and pomegranate pills: of which things poultisses may bee made by addition of barly meale and the like.

There is sometimes to bee seene in the eye an affect contrary to this, and it is ter∣med Atrophia. By this the whole substance of the eye growes lanke and decayes, and * 1.55 the apple it selfe becomes much lesse. But if the consumption and emaciation take hold of the pupill onely, the Greekes, by a peculiar name and different from the ge∣nerall, terme it a Phihisis, as Paulus teacheth. Contrary causes shall bee opposed to each affect; hot and attractive fomentations shall be applyed; frictions shall be used * 1.56 in the neighbouring parts, and lastly all things shall be applyed which may without danger be used to attract the bloud and spirits into the parts.

There is another affect of the eye, of affinity to the Proptosis, which by the Greeks

is termed Chemosis. Now this is nothing else than when both the eye-lids are turned * 1.57 up by a great inflammation, so that they can scarce cover the eyes, and the white of the eye is lifted much higher up than the blacke. Sometimes the Adnata changing his wont, looketh red; besides also, this affect may take its originall from externall causes, as a wound, contusion and the like. But according to the variety of the cau∣ses, and the condition of the present affect fixed and remaining in the part, divers re∣medies shall be appointed.

CHAP. XIV. Of the Ungula, or Web.

THE Ungula, Pterygion or Web is the growth of a certaine fibrous and membranous flesh upon the upper coate of the eye called Ad∣nata, arising more frequently in the bigger, but sometimes in the lesser corner towards the temples. When it is neglected, it covers not onely the Adnata, but also some portion of the Cornea, and comming to the pupill it selfe hurts the sight thereof. Such a Web sometimes adheres not at all to the Adnata, but is onely stretched over it from the corners of the eye, so that you may thrust a probe betweene it and the Adnata: it is of severall colours, somewhiles red; somewhiles yellow, somewhiles duekish, & other-whiles white. It hath its originall either from externall causes, as a blow, fall, and the like; or from internall, as the defluxion of humours into the eyes. The Ungula * 1.58 which is inveterate, and that hath acquired much thicknesse and breadth, and besides doth difficultly adhere to the Adnata, is difficultly taken away, neither may it bee helped by medicines whereby scars in the eyes are extenuated. But that which co∣vereth the whole pupill must not bee touched by the Surgeon, for being cut away, the scar which is left by its density hindereth the entrance of objects to the cristal∣line humour, and the egresse of the animall spirit to them. But oftentimes it is ac∣companied with an inflammation of the eyes, a burning itching, weeping defluxion, and swelling of the eye-lids. That the cure may rightly and happily proceed, hee * 1.59 must first use a spare diet, purging medicines shall be given, and bloud taken away by opening a veine, especially, if there be great inflammation. For particular remedies, this excrescence shall be eaten away, or at least kept from growth by dropping into the eye collyrium of vitrioll described in wounds of the eyes. But if that wee profit nothing by this meanes, it remaineth, that wee take it away with the hand after the following manner.

You shall set the patient upon a forme or stoole, and make him leane much backe, * 1.60 and be so held firmely, that he may not fall nor stirre; then must you open his sore eye, putting therein the speculum oculi formerly described in treating of the wounds of this part, and then must you lift up the Web it selfe with a sharpe little hook, with the point turned a little in, and put under the midst of the Web; when you have lif∣ted it a little up, thrust a needle threaded with a smoth threed between it & the Adna∣ta, then taking hold of the hooke, and the two ends of the threed drawne through with the needle, and lifting up the Web by them, you shall gently begin to separate it from the substance of the eye lying there-under, beginning at the originall thereof with a crooked incision knife, and so prosecute it even to the end, yet so as you hurt no part of the Adnata, nor Cornea.

[illustration]

The figures of little hookes, a needle, and crooked incision knife. Little Hookes. A needle. A crooked incision knife.

Then must it bee cut off with a paire sissers, and the white of an egge beaten with some Rose-water laid thereon, and often renewed. Afterwards the eye must every day be opened, lest comming to cicatrization, the eye-lids shall be glewed together in that part whereas the Web is taken away, which also shall bee hindred by putting of common salte, sage and cummin seeds into the eye, being first champed and chaw∣ed in the mouth. There are some who in stead of the crooked knife separate the Web from the Adnata with a horses haire, others do it with a goose quill made rea∣dy for the same purpose, taking heed that they hurt not the caruncle at the corner by the nose, for it will follow if that you draw the Web away too violently; and if it be cut, there will remain a hole, through which during the rest of the life a weeping humour will continually flow, a disease by the Greeks termed Rhyas. If after the cutting, there be fear of inflammation, linnen rags moystned in repelling medicines, formerly prescribed in wounds of the eye, shall bee layd thereupon.

CHAP. XV. Of the Aegilops, fistula lachrimosa, or weeping Fistula of the eye.

AT the greater corner of the eye there is a glandule, made for the recei∣ving * 1.61 and contayning the moysture which serveth for the lubricating and humecting the eye, least it should dry by continuall motion. This Glandule sometimes by a sanguine or pituitous defluxion falling violent∣ly from the brain, swels, impostumates & ulcerates with an ulcer, not seldome dege∣nerating * 1.62 into a fistula, so that in successe of time it rotteth the bone that lyeth under it: of such fistulaes, some are open outwardly, and these usually have their origi∣nall from a phlegmon; other some are inwardly, and those are such as at first swel∣led by the defluxion or congestion of a phlegmaticke matter, so that there appeareth no hole outwardly, but onely a tumor of the bignesse of a pease; this tumor being pressed, floweth with a sanious, serous and red, or otherwise with a white and viscide matter, and that either by the corner of the eye, or by the inside of the nose. Some have this matter flowing continually, others have it onely monethly, which is pro∣per * 1.63 also to some fistulaes. Such weeping fistulaes if they become old, cause an Atro∣phia of the eye, & sometimes blindnesse, & a stinking breath. Therefore wee must di∣ligently and speedily by phisicall and chirurgicall meanes resist the breeding disease. Wherefore, having used generall medicines, we must come to particulars. Therefore if the ulcer be not sufficiently wide, it shall bee inlarged by putting tents of spunge

therein. The flesh of the Glandule encreasing more than is fit, shall be corrected by * 1.64 putting therein the cathaereticke pouders of Mercury, calcined vitrioll, or some aqua fortis, or oyle of vitrioll, and lastly, by a potentiall cautery. If you cannot prevaile by these meanes, and that the bone begins to rot, and the patient bee stout hearted, then use an actuall cautery whose use is far more effectuall, ready, certaine and excel∣lent * 1.65 than a potentiall cautery, as I have tryed in many with happy successe. In my opinion it makes no matter, whether the cautery be of gold, silver or iron; for the efficacy it hath, proceedeth not from the matter, but from the fire. Yet if wee must religiously observe and make choise of mettals, I had rather have it of Iron, as that which hath a far more drying and astringent faculty than gold, for that the element of earth beareth the chiefe sway thererein, as appeareth by the waters which flow through iron mines. Wherefore you shall cause to be made a triangular Iron, sharpe at the end, that it may the more speedily penetrate. And then the sound eye and ad∣jacent parts being well covered and defended, and the patients head firmely holden in ones hands, lest the patient being frighted, stirre himselfe in the very instant of the operation. But a plate of iron somewhat depressed in the midst, for the cavity of the greater corner, shall be applyed and fitted to the pained eye. This plate shall be perforated that the hot Iron may passe thereby to the fistula lying thereunder, and so may onely touch that which is to be cauterized.

[illustration]

The figure of a cautery, and a plate with a hole therein.

After the bone is burnt with the cautery, a collyrium made of the whites of egges * 1.66 beaten in plantaine and nightshade waters must be poured into the hole it selfe, the eye and all the neighbouring parts; but the patient shall bee layd in bed, with his head somewhat high, and the collyrium shall be renued as often and as soone as you shall perceive it to grow dry. Then the fall of the Eschar shall be procured by an∣nointing it with fresh butter; when it is fallen away, the ulcer shall be cleansed, fil∣led with flesh, and lastly cicatrized.

CHAP. XVI. Of the Staphiloma, or grape. like swelling.

STaphiloma is the swelling of the horney and grape-like coat, bred * 1.67 through the occasion of an humor flowing downe upon the eye, or by an ulcer, the horney coat being relaxed, or thrust forth by the violence of the pustule generated beneath. It in shape resem∣bleth a grape, whence the Greekes stile it Staphyloma. This tumor is sometimes blackish, otherwhiles whitish. For if the horney coat bee ulcerated and fretted in sunder, so that the grapie coat shew it selfe, and fall through the ulcer, then the Staphyloma will looke blacke like a ripe grape, for the ut∣ter part of the Uvea is blackish. But if the Cornea bee onely relaxed and not broken, then the swelling appeares of a whitish colour like an unripe grape. The Ancients * 1.68 have made many kindes or differences thereof. For if it bee but a small hole of the

broken Cornea by which the Uvea sheweth or thrusteth forth its selfe, they then ter∣med it Myocephalon, that is, like the head of a fly. But if the hole were large, and also callous, they called it Clavus, or a naile; If it were yet larger, then they termed it A∣cinus, or a grape. But in what shape or figure soever this disease shall happen, it brin∣geth * 1.69 two discommodities, the one of blindnesse, the other of deformity. Wherefore here is no place for surgery to restore the sight, which is already lost, but onely to a∣mend the deformity of the eie; which is by cutting off that which is prominent. But you must take heed that you cut away no more than is fit, for so there would be dan∣ger of pouring out the humors of the eye.

CHAP. XVII. Of the Hypopyon, that is, the sappurate or putrefied eye.

PUS, or Quitture is sometimes gathered between the horny and grapy coate from an internall, or externall cause; From an internall, as by a * 1.70 great defluxion, and oft times after an inflammation, but externally, by a stroake, through which occasion a veine being opened hath poured forth blood thither, which may presently be turned into Quitture. For the cure, universall remedies being premised, cupping-glasses shall bee applied, with scarification, and frictions used. Anodine and digestive collyria shall be poured from above downewards. Galen writes that he hath sometimes evacuated this matter, the Cornea being opened at the Iris, in which place all the coats meet, concurre and are * 1.71 terminated. I have done the like, and that with good successe, James Guillemeau the the Kings Surgeon being present, the Quitture being expressed and evacuated after the apertion. The Ulcer shall be clensed with Hydronel, or some other such like me∣dicine.

CHAP. XVIII. Of the Mydriasis, or dilatation of the pupill of the eye.

MYdriasis is the dilatation of the pupill of the eye; and this happeneth ei∣ther by nature or chance: the former proceedeth from the default of * 1.72 the first conformation, neither is it curable; but the other is of two sorts; for it is either from an internall cause, the off-spring of an humour flow∣ing downe from the braine, wherefore Phisicall meanes must bee used for the cure thereof. Now that which commeth by any externall occasion, as a blow, * 1.73 fall or contusion upon the eye, must bee cured by presently applying repercussive and anodyne medicines, the defluxion must be hindred by diet skilfully appointed, phlebotomie, cupping, scarification, frictions, and other remedies which may seeme convenient. Then must you come to resolving medicines; as the bloud of a Turtle Dove, Pigeon, or Chicken reeking hot out of the veine, being poured upon the eye and the neighbouring parts. Then this following cataplasme shall be applyed there∣to. ℞. farinae fabar. & hordei an. ℥iiii. ol. rosar. & myrtillor. an. ℥i. ss. pul. ireos flor. ʒii. cum sapa fiat cataplasma. You may also use the following fomentation. ℞. rosar. rub. * 1.74 & myrtill. an. m. i. florum melil. & chamam. an. p. i. nucum cupress. ℥i. vini austeri lb. ss. aq. rosar. & plantag. an. ℥iii. make a decoction of them all for a fomentation to be used with a sponge.

CHAP. XIX. Of a Cataract.

A Cataract is called also by the Greeks Hypochyma, by the Latines, * 1.75 suffusic. Howsoever you terme it, it is nothing else but the con∣cretion of an humour into a certaine thin skin under the hor∣ny coat, just against the apple or pupill, and as it were swimming upon the watery humour; and whereas the place ought to bee empty, opposing it selfe to the internall faculty of seeing, where∣by it differeth from spots and scars growing upon the horny * 1.76 coate and Adnata. It sometimes covereth the whole pupill, otherwhiles but the one halfe thereof, and somwhiles but a small portion thereof. According to this varie∣ty the sight is either quite lost, weake, or somewhat depraved; because the animall visive spirit cannot in its entire substance passe through the density thereof. The defluxion of the humour whence it proceeds, is either caused by an external occasi∣on, * 1.77 as a stroake, fall, or by the heat or coldnesse of the encompassing ayre, trouble∣some to the head and eyes; or else it is by an internall meanes, as the multitude; or else the acride hot and thin quality of the humours. This disease also sometimes ta∣keth its originall from grosse and fumid vapours sent from a crude stomacke, or from vaporous meats or drinks, up to the braine, and so it falleth into the eyes, where by the coldnesse, straitnesse and tarrying in the place, they turn into moysture, and at length into that concretion or filme which wee see: The signs may be easily drawne, * 1.78 from that we have already delivered. For when the cataract is formed and ripe, it re∣sembleth a certain thin membrane spred over the pupill, and appeareth of a different colour, according to the variety of the humour whereof it consisteth, one while white, another while blacke, blew, ash-coloured, livid, citrine, greene. It some∣times resembleth quicksilver, which is very trembling and fugitive, more than the rest. At the first when it beginneth to breed they seeme to see many things, as flyes flying up and downe, haires, nets, and the like, as if they were carelesly tossed up and down before their eyes: sometimes every thing appeareth two, and somewhiles lesse than they are; because the visive spirit is hindered from passing to the objects by the density of the skin, like as a cloud shadowing the light of the Sun. Whence it is that the Patients are duller sighted about noone, and surer and quicker sighted in the morning and evening, for that the little visive spirit diffused through the aire, is dispersed by the greater light, but contracted by the lesse. Now if this filme cover halfe the pupill, then all things shew but by halfes; but if the midst thereof bee covered and as it were the center of the Christalline humour, then they seeme as if they had holes or windowes: but if it cover it all, then can hee see nothing at all, but onely the shadowes of visible bodies, and of the Sun, Moone, Stars, lighted candles, and the like luminous things, and that but confusedly and as by conjecture.

CHAP. XX. The physicall cure of a beginning Cataract.

A Beginning Cataract is hindred from growing and concretion by * 1.79 diet conveniently and artificially prescribed, by the abstinence from wine, especially more strong and vaporous, and forbearing the use of meates, which yeeld a flegmaticke juice and vaporous, as pease, beanes, turneps, chesnuts, and lastly all such things as have the faculty of stirring up the humours, and causing defluxion in the body, such as are all salt & spiced meats, as also garlike, onions, mustard. The immoderate use of venery hurts more than all the rest, for that it more violently ex∣agitates the whole body, weakens the braine and head, and begets crude humours.

Let his bread be seasoned with some fennell seeds, for it is thought to have a faculty * 1.80 of helping the fight, and clearing the eyes, and dissipating the misty vapours in the stomacke before they can ascend to the braine. Wherefore by the same reason it is good to use marmelade of quinces, conserve of roses, and common drige powder, or any such like composed of things good to break wind, or corroborate the ventri∣cle. Phlebotomie and purging, if they be requisite, shall be fitly appointed: Vento∣ses shall be applyed to the shoulders and necke; the phlegmaticke matter shall be di∣verted and evacuated by the mouth with using masticatories in the morning. There be some which believe that a beginning cataract may be dissipated and discussed by often rubbing the eye-lids with the fingers, and in like sort by the often and earnest beholding of the Starres, and the Moone when it is at the full, looking-glasses, dia∣monds, and all other such like bright shining things. I beleeve that by beames plen∣tifully * 1.81 and suddenly brought and diffused over the eye, directly opposite against some bright shining thing, it may seeme to have a penetrating, dividing, dissolving, as also a consuming and drying faculty. Besides, also the hot breath of him who holdeth in his mouth, and chaweth fennell seeds, aniseeds, coriander-seeds, nutmeg, cinamon, cloves, and the like, hath a great faculty, the eyes being first gently rubbed with the finger, it being breathed in, neare at hand and often received, to heat, attenu∣ate, resolve, digest, and diffuse the humour which is ready to concrete. Moreover, this collyrium of John Vigo is thought very powerfull to cleare the eyes, strengthen the sight, hinder suffusions, and discusse them if at any time they concrete and beginne to gather. ℞. hepatis hircini sani & recentis lib. ii. calami aromatici & * 1.82 mellis an. ℥〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. succiruta, ʒiii. aquae chelidoniae, faniculi, verbenia cuphosiae, an. ʒiii. piperis longi, nucis moschatae, caryophyllorum an. ʒii. croci ℈ii. floris rorismarini aliquantum contriti, m. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. sarcocolla, aloës hepaticae, an. ʒiii. fellis raiae, leporis & perdicis, an. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉i. te∣rantur omnia, tritisque adde sacchari albi ℥ii. mellis rosati ʒvi. conjiciantur in alembicum vitreum & distillentur in balnco Mariae; Let this distilled liquor bee often dropped into the eyes. But if you prevaile nothing by all these medicines, and that the clou∣dy and heaped up humour doth daily encrease and thicken, then must you abstaine from remedies, and expect untill it bee no more heaped up, but thickned, yea untill it seeme to be growne somewhat hard. For so at length it may bee couched with a needle; otherwise if this same skin shall not be ripe, but more tender than is fitting, when you shall come to the operation, it will be broken and thrust through with the needle, and not couched. On the contrary, if it bee too hard, it will resist the needle, neither will it suffer it selfe to bee easily couched. Wherefore it is requisite that the * 1.83 Surgeon know when it is ripe, and he must diligently observe the signes whereby he may discerne a ripe Cataract from an unripe; and that which is cureable, from that which is uncurable. For that only which is ripe and curable is to be couched; that which is unripe, that is, such an one as is more tender, and as it were crude, and that which is more hard and dense, and lastly, that which is uncureable must not bee at∣tempted at all.

CHAP. XXI. By what signes ripe and curable cataracts may bee discerned from unripe and uncurable ones.

IF the sound eye being shut, the pupill of the sore or suffused eye, after it shall be rubbed with your thumbe, bee presently dilated and diffused, and with the like celerity returne into the place, figure, colour and state, it is thought by some to shew a ripe and confirmed cataract. But an unripe and not to bee couched, if the pupill remaine dilated and diffu∣sed for a long while after. But it is a common signe of a ripe, as also more dense and consequently uncurable suffusion, to bee able to see nor distinguish no visible thing beside light and brightnesse; for to discerne other objects sheweth that it is not yet ripe. Therefore the sound eye being shut and pressed, the pupill of the other rubbed

with your thumbe, is dilated, enlarged, swelleth and is more diffused; the visive spi∣rits by this compression being as it were forced from the sound into the fore eye. But these following cataracts are judged uncurable, that is, such as are great, such as when the eye-lid is rubbed are nothing dilated or diffused, whose pupill becommeth no broader by this rubbing: for hence you may gather that the stopping or obstruction is in the opticke nerve, so that how cunningly and wellsoever the cataract bee con∣ched, yet will the Patient continue blind; you shall do no more good in couching a * 1.84 cataract, which is in an eye consumed and wasted with a Phthisis. Also that cataract is uncurable which is occasioned by a most grievous disease, to wit, by most bitter and cruell paines of the head, or by a violent blow. Such as are of a plaister-like, green, blacke, livid, citrine and quicksilver-like colour, are usually uncurable. On * 1.85 the contrary, such as are of a Chesnut colour, or of a skye or sea-water colour, with some little whitnesse; yeeld great hope of a happy and successefull cure.

CHAP. XXII. Of the couching a Cataract.

AFter you shal know by the forementioned signes, that the Cataract is cura∣ble, * 1.86 it remains that you attempt the couching thereof, but so, that there be nothing which may hinder. For if the paine of the head, cough, nauseous∣nes or vomiting at that time trouble the patient, you shal then bestow your labour in vaine: Wherefore you must expect untill these symptomes be gone. Then make choice of a season fitting for that purpose, that is, in the decrease of the moon, when the aire is not troubled with thunder nor lightening, and when as the Sunne is not in Aries, because that signe hath dominion over the head. Then let the Surgeon consult a Physitian whether purging or bloud-letting be convenient for the Patient, so to resist plethoricke symptomes, otherwaies ready to yeeld matter for relapse. Two dayes after you must make choice of a place furnished with indifferent or com∣petent * 1.87 light, and the Patient being fasting shall be placed in a strait chaire, so that the light may not fall with the beames directly upon him, but sidewise. The eye which shall bee cured must bee made more steddy, by laying and binding wooll upon the other: Then the Surgeon shall feate and place himselfe directly against the Patient upon a seat somewhat higher, and bidding the Patient put his hands downe to his girdle, he shall hold the patients legges betweene his knees. One shall stand at the Patients backe who shall hold his head and keepe it from stirring; for by a lit∣tle stirring hee may lose his sight for ever. Then must you prepare and make rea∣dy * 1.88 your needle, and thrust it often into some strong thicke cloth, that it may bee as it were smoothe by this motion, and for the performance of the worke in hand with the lesse paine somewhat warmed. It must bee made of iron or steele, and not of gold or silver, it must be also flatted on the sides, and sharpe pointed, that so it may the better pierce into the eye, and wholly couch the Cataract once taken hold of; and lest it should slip in the Surgeons hand, and be lesse steddy, it shall bee put into a handle, as you may see by the following figure.

[illustration]

A needle inserted in a handle for the couching of Cataracts.

All things being thus in a readinesse, you must bid the patient to turne the sight of his eye towards his nose, and the needle must be boldly thrust (for it is received in a place that is voyde, and onely filled with spirits) directly by the coat Adnata, in the middle space between the lesser corner & the horny coat, just against the midst of the Cataract, yet so, as that you hurt no vein of the Adnata, & then by stirring it as it were diversly untill it come to the midst of the pupill and suffusion. When it is come * 1.89 thither, the needle must bee inclined from above downewards to the suffusion, and there to be stirred gently untill by little and little it couch or bring downe the Ca∣taract as whole as may be beneath the compasse of the pupill; let him still follow it though couched with his needle, and somewhat violently depresse, and keep it down for some short space, that so it may rest and stay in that lower place whether it is de∣pressed. The Surgeon shall try whether it firmely remaine there or no, bidding the patient presently to move his eye; For if it remaine constantly so, and doe not re∣turne * 1.90 againe, the cure is perfect. Then must the needle be lifted up by little and little, neither must it presently be taken forth, that if the Cataract should beare up, or rise againe, that it might againe, and so often (whilst the worke is yet hot, and all things in a readinesse) be couched towards the lesser corner, untill it be fully and surely hid. Then must you draw backe the needle gently, and after the same manner as you put it in; lest if you use not moderation, you bring backe the Cataract, from whence you couched it, or grievously offend the crystalline humour, the prime instrument of sight, or the pupill with danger of dilating thereof. Some as soone as the worke is done, give the patient something in his hand to looke upon: but Paulus approves * 1.91 not thereof, for hee feares lest his endeavouring or striving to see, may draw backe the Cataract. Wherefore it is more wisedome and better, presently after the draw∣ing * 1.92 forth of the needle, to put on a soft ragge the white of an egge beaten in rose-wa∣ter with a little choice alume, and so apply it to the eye and neighbouring parts for to binde and binder the inflammation; then also you must together therewith bind up the sound eye, lest by stirring to see, it might together therewith draw and move the fore eye, by reason of the sympathy and consent they mutually have by the op∣ticke nerves. After all things are thus performed, the patient shall bee laid in a solt bed, & so placed, that his head may lye somwhat high; let him be laid far from noise, let him not speake, nor eate any hard thing that may trouble his jawes, wherefore let him feed upon liquid meats, as ponado, barly cream, cullisses, gellyes, reare egs, and other meates of the like nature. At the end of eight dayes the ligature that binds up his eyes shall be loosed, and his eyes washed with rose water, and putting on spe∣ctacles, or some taffaty, the patient shall by little and little accustome himselfe to the light, lest hee should bee offended by the sudden meeting with light. But if the suffusion, after some short while after, lift it selfe up againe, it must bee couched againe, but through a new hole, for the eye is pained and tender in the former place. It sometimes happens by the touch of the needle that the Cataract is not couched whole, but is broken into many peeces; then therefore each of them must be followed, and couched severally: if there be any very small particle which scapes the needle, it must bee let alone, for there is no doubt but that in processe of time it may be dissolved by the force of the native heat. There are also some Cata∣racts * 1.93 which at the first touch of the needle are diffused & turne into a substance like to milke or troubled water, for that they are not throughly ripe, yet these put us in good hope of recovery, and it bee but for this, that they can never afterwards con∣crete into one body as before. Wherefore at the length they are also discussed by the strength of the native heat, and then the eye recovers its former splendor. If that any other symptomes come unlooked for, they shall be helped by new counsels and their appropriate remedies.

CHAP. XXIII. Of the stopping of the passage of the eares, and the falling of things thereinto.

IT sometimes happeneth that children are born without any holes in their eares, a certaine fleshy or membranous substance grow∣ing * 1.94 in their bottome or first entrance. The same may also hap∣pen afterwards by accident, they being ulcerated by some impo∣stume or wound, and the eare shut up by some fleshy excrescence or scar. When as the stopping is in the bottome of the cavity, the cure is more difficult than if it were in the first entrance. But there * 1.95 is a double way of cure; for this substance, whatsoever it be, must either be cut out, or else eaten away and consumed by acrid and catheriticke medicines; in perfor∣mance of which there is need of great moderation of the mind and hand. For it is a part endued with most exquisite sence and neare the braine, wherefore by handling it too roughly, there is feare of distension of the nerves, and consequently of death.

Sometimes also the preternaturall falling of strange bodies into this passage, maketh a stopping of the eares, such as are fragments of stones, gold, silver, iron and the like mettals, pearles, cherry-stones, or kernels, peafe and other such like pulse. Now solid and bonie bodies still retaine the same magnitude; but pease, seeds and kernels, by drawing the moisture there implanted into them, swell up, and cause ve∣hement pain by the distension of the neighbouring parts, wherefore the sooner they are drawne forth, the better it is for the patient. This shall be done with small pin∣cers and instruments made in the shape of earepicks. But if you profit nothing thus, then must you use such gymblets as are made for the drawing forth of bullets shot deep into the body. Little stones and bodies of the like stony hardnesse shall bee * 1.96 forced forth by the brain, provoked to concussion by sneesing, & by dropping some oyle of almonds first into the passage of the eare, that the way may be the more slip∣pery; for it will come to passe by this sneesing, or violence of the internall aire for∣cibly seeking passage out, that at length they may bee cast forth, the mouth and nostrils being stopped with the hand. But if wee cannot thus prevaile, it remaines, that we cut open the passage with an incision knife, so much as shall be sufficient for the putting in and using of an instrument for to extract them. If any creeping things of little creatures, as fleas, ticks, pismires, gnats and the like, which sometimes hap∣peneth, shall get therein, you may kill them by dropping in a little oyle and vineger. There is a certaine little creeping thing, which for piercing and getting into the eares, the French call Perse-oreille (wee an Eare-wigge). This, if it chance to get into the eare, may be killed by the foresaid meanes, you may also catch it, or draw it forth by laying halfe an apple to your eare, as a bait for it.

CHAP. XXIV. Of getting of little bones and such like things out of the jawes and throate.

SOmetimes little bones and such like things in eating greedily use to sticke, or as it were fasten themselves in the jawes or throate. Such bo∣dies * 1.97 if you can come to the sight of them shall bee taken out with long, slender and croked mallets made like a Cranes beake. If they do not ap∣pear, nor there be no means to take them forth, they shalbe cast forth by causing vomit, or with swallowing a crust of bread, or a dry fig gently chawed, and so swallowed; or else they shall be thrust downe into the stomacke, or plucked back with a leeke, or some other such like long and stiffe crooked body annoynted with oile and thrust downe the throate. If any such like thing shall get into the Weazon

you must cause coughing by taking sharpe things, or else sneesing, so to cast forth whatsoever is there troublesome.

CHAP. XXV. Of the Tooth-ache.

OF all paines, there is none which more cruelly tormenteth the pati∣ents * 1.98 than the Tooth-ache. For wee see them oft-times after the man∣ner of other bones to suffer inflammation, which will quickly suppu∣rate, and they become rotten, and at length fall away piecemeale; for wee see them by daily experience to be eaten and hollowed, and to breed wormes, some portion of them putrefying. The cause of such paine is either internall, or externall and primitive. The internall is a hot or cold defluxion of hu∣mours * 1.99 upon them, filling their sockets, & thence consequently driving out the teeth; which is the reason that they stand sometimes so farre forth, that the patient neither dares nor can make use of them to chaw for feare of paine; for that they are loose in their sockets by the relaxation of the gums, caused by the falling downe of the de∣fluxion. When as they are rotten and perforated even to the roots, if any portion of the liquor in drinking, fall into them, they are pained as if you thrust in a pin or bodkin, the bitternesse of the paine is such. The signes of a hot defluxion are sharpe * 1.100 and pricking paine, as if needles were thrust into them, a great pulsation in the roote of the pained tooth and the temples, and some ease by the use of cold things. Now the signes of a cold defluxion are a great heavinesse of the head, much and fre∣quent spitting, some mitigation by the use of hot remedies. In the bitternesse of paine we must not presently run to Tooth-drawers, or cause them presently to goe in hand to plucke them out. First consult a Physician, who may prescribe remedies according to the variety of the causes. Now here are three intensions of cureing. The first is concerning diet; the other for the evacuation of the defluxion or ante∣cedent * 1.101 cause; the third for the application of proper remedies for the asswaging of paine. The two former scopes, to wit, of diet, and diverting the defluxion by pur∣ging, phlebotomie, application of cupping glasses to the necke and shoulders, and fcarification, doe absolutely belong to the Phisitian. Now for proper and to picke medicines they shall be chosen contrary to the cause. Wherefore in a hot cause, it is good washing the mouth with the juice of Pomgranats, plantaine water, a little vi∣neger * 1.102 wherein roses, balaustiae and sumach have beene boyled. But such things as shall be applyed for the mitigating of the paine of the teeth, ought to bee things of very subtle parts, for that the teeth are parts of dense consistence. Therefore the ancients have alwaies mixed vineger in such kind of remedies. ℞. rosar. rub. sumach. hordei, an. m. ss. seminis hyoscyami conquassati ʒii. santalorum an. ʒi. lactucae summitatum rubi, so∣lani, plantaginis, an. m. ss. bulliant omnia in aquae lib. iiii. & pauco aceto ad hordei crepatu∣ram. Wash the mouth with such a decoction being warme. You may also make Tro∣chisces for the same purpose after this manner. ℞. sem. hyoscyami, sandarachae, cori∣andri, * 1.103 opii an. ʒss. terantur & cum aceto incorporentur, formentur que trochisci apponendi dentibus dolentibus. Or else, ℞. seminis portulacae, hyoscyami, coriandri, lentium, corticis santali citrini, rosar. rub. pyrethri, camphorae, an. ʒss. Let them all bee beaten together with strong vineger, and made into trochisces, with which being dissolved in rose water, let the gums and whole mouth bee washed when need requireth. But if the paine bee not asswaged with these, you shall come to narcoticks, which may * 1.104 stupefie the nerve; as, ℞. seminis hyoscyami albi, opii, camphorae, papaveris albi, an. quan∣tum sufficit, coquantur cum sapa, et denti applicentur. Besides, you must also put this following medicine into the eare of the pained side. ℞. opii & castorei, an. ℈i. misce∣antur cum oleo rosato: It hath sometimes availed in swolne and distended gums, be∣ing first lightly scarified, to have applied leaches, for the evacuation of the conjunct matter, as also to have opened the veines under the tongue, or these which are behind the eares. For I remember that I, by these three kindes of remedies, asswaged great

paines of the teeth. Yet there bee some who in this affect open not these veines which are behind the eares, but those which are conspicuous in the hole of the eare in the upper part thereof.

Paine of the teeth arising from a cold cause and defluxion, may be helped by these remedies; boyle rosemary, sage, and pellitory of Spaine in wine and vinegar, and adde therto a little aqua vitae, in this liquor dissolve a little treacle, and wash your teeth therewith. Others mingle Gum ammoniacum dissolved in aqua vitae with a lit∣tle sandar acha and myrrhe, and lay it to the pained tooth, after Vigoes counsaile. Mesue thinkes that beaten garlicke carryed in the right or left hand, asswages the paine, as the teeth ake upon the right or left side. But I being once troubled with grievous paine in this kinde, followed the counsaile of a certaine old woman, and laid gar∣licke rosted under the embers to my pained tooth, and the paine forthwith ceased. The same remedy used to others troubled with the like affect, had like successe. Moreover, some thinke it availeable if it bee put into the auditory passage. Others drop into the eares oile of castoreum, or of cloves, or some such other chemicall oile. It is good also to wash the teeth with the following decoction. ℞. rad. pyrethri ʒss. menthe et rutae an. p. i. bulliant in aceto, and with this decoction being warme, wash the teeth. Some like fumes better, & they make them of the seeds of Coloquintida and * 1.105 mustard, and other like; they take the smoake by holding their mouths over a fun∣nell. Other some boile pellitory of Spaine, ginger, cinamon, alume, common salt, nut megs, cipresse nuts, anise and mustard seeds, and euphorbium in oxycrate, and in the end of the decoction adde a little aqua vitae, and receive the vapour thereof through a funnell: as also they wash their teeth with the decoction, and put cotton dipped therein into the eare, first dropping in a little thereof. Some there are which affirm that to wash the teeth with a decoction of Spurge is a very good and anodyne medicine in the tooth-ach. I have oft times asswaged intolerable paines of the teeth by applying vesicatories under the eare, to wit, in that cavity whereas the low∣er * 1.106 jaw is articulated with the upper: for the veine, artery and sinew which are distri∣buted to the roots of the teeth, lye thereunder. Wherfore the blisters being opened, a thinne liquor runnes out, which doth not onely cause, but also nourish or feed the disease. But if the tooth be hollowed, and that the patient will not have it puld out, there is no speedier remedy, than to put in caustick medicines, as oile of vitrioll, a∣qua fortis, * 1.107 and also a hot iron; for thus the nerve is burnt insunder, and loseth its sense. Yet some affirm that the milky juice that flowes from Spurge made into a paste with Olibanum and amylum, and put into the hollowed tooth, will make it presently to fall away in peeces. When the Gums and Cheekes are swollen with a manifest tumour, then the patient begins to be somewhat better and more at ease. For so by the strength of nature, the tumor causing the paine is carryed from within outwards. But of what nature soever the matter which causeth the paine be, it is convenient to intercept the course thereof with Empl. contra rupturam, made with pitch and ma∣stick, and applyed to the temple on that side where the tooth aketh.

CHAP. XXVI. Of other affects of the teeth.

THe teeth are also troubled with other preternaturall affects. For some∣times they shake by relaxation of the gums, or else become corrupt and rotten, or have wormes in them, or else are set on edge. For the first, the gummes are relaxed either by an externall or primitive cause, as a fall or * 1.108 blow: or else by an internall or antecedent, as by the defluxion of acrid or waterish humours from the braine, or through want of nourishment in old bodies. If the teeth grow loose by the meanes of the decaying gums, the disease is then incurable: but you may withstand the other causes by the use of such things as fasten the teeth, shunning on the contrary such as may loosen them. Therefore the patient must not speake too earnestly, neither chaw hard things. If they become loose by a fall or

blow, they must not bee taken forth, but restored and fastened to the next that re∣maine firme, for in time they will be confirmed in their sockets, as I tryed in Antho∣ny de la Rue a tailour, who had his jaw broken with the pommell of a dagger, and three of his teeth loosened and almost shaken out of their sockets; the jaw being re∣stored, * 1.109 the teeth were also put in their places, and bound to the rest with a double waxed thread; for the rest, I fed the patient with broths, gellyes, and the like, and I made astringent gargarismes of cypresse nuts, myrtle berries, and a little alum boyld in oxycrate, and I wished him to hold it a good while in his mouth: by these means I brought it so to passe, that hee within a while after could chaw as easily upon those teeth, as upon the other. I heard it reported by a credible person, that he saw a Lady of the prime nobility, who instead of a rotten tooth she drew, made a sound tooth, drawne from one of her waiting maids at the same time, to be substituted and inser∣ted, which tooth in processe of time, as it were taking roote, grew so firme, as that she could chaw upon it as well as upon any of the rest. But as I formerly said, I have this but by heare-say.

Now the teeth are corroded or eaten in by an acride and thinne humour pene∣trating * 1.110 by a plenteous and frequent defluxion even to their roots, and being there conteined, it putrefies, and becomming more acride, it doth not only draw the teeth into the contagion of its putrefaction, but also perforats and corrodes them.

The putrefaction may bee corrected, if after generall medicines, you put oile of vitrioll or aqua fortis into the hole of the eaten tooth: or else, if you burne the tooth * 1.111 it selfe to the roote with a small iron wyar being red hot: you shall thrust this hot i∣ron through a pipe or cane made for the same purpose, lest it should harm any sound part by the touch therof, and thus the putrefaction, the cause of the arrosion, may be stayed. But if the hole bee on the one side between two teeth, then shall you file a∣way so much of the sound tooth as that you may have sufficient liberty to thrust in your wiar without doing any harme.

[illustration]

The formes of Files made for filing the teeth.

Wormes breeding by putrefaction in the roots of the teeth, shall be killed by the use of causticks, by gargles or lotions made of vinegar wherein, either pellitory of * 1.112 Spain hath bin steeped, or Treacle dissolved also; Aloes and Garlike are good to be used for this purpose.

Setting the teeth on edge happens to them by the immoderate eating of acride or tart things, or by the continuall ascent of vapours endued with the same quality, * 1.113 from the orifice of the ventricle to the mouth, or by a cold defluxion, especially of a∣cride phlegme, falling from the braine upon the teeth, or else by the too excessive use of cold or stupising liquors. This affect is taken away, if after generall medi∣cines and shunning those things that cherish the disease, the teeth bee often washed with aqua vitae, or good wine wherein sage, rosemary, cloves, nutmegs and other things of the like nature have bin boyled.

CHAP. XXVII. Of drawing of teeth.

TEeth are drawne, either for that they cause intolerable paines, which will not yeeld to medicines, or else for that they are rotten and hollowed, so that they cause the breath to smell; or else for that they infect the sound and whole teeth, and draw them into the like corruption, or be∣cause they stand out of order. Besides, when they are too deep and strongly rooted, so that they cannot be plucked out, they must oft times be broken of necessity, that so you may drop some caustick thing into their roots, which may take away the sense, and consequently the paine. The hand must be used with much mo∣deration in the drawing out of a tooth; for the Jaw is sometimes dislocated by the * 1.114 too violent drawing out of the lower teeth. But the temples, eyes and braine are shaken with greater danger by the too rude drawing of the upper teeth. Wherefore they must first be cut about, that the gums may be loosed from them, then shake them with your fingers, and doe this untill they begin to be loose; for a tooth which is fast in, and is plucked out with one pull, oft-times breaks the jaw, and brings forth the piece together therewith, whence follow a feaver and a great fluxe of bloud not easily to be stayed (for bloud or pus flowing out in great plenty is, in Celsus opinion, * 1.115 the sign of a broken bone) & many other maligne and deadly symptoms: some have had their mouthes drawne so awry, during the rest of their lives, so that they could scarce gape. Besides, if the tooth be much eaten, the hole thereof must be filled ei∣ther with Lint, or a corke, or a piece of lead well fitted thereto, lest it be broken un∣der your forceps, when it is twitched more straightly to be plucked out, and the root remain, ready in a short time to cause more grievous paine. But judgement must be used, and you must take speciall care lest you take a sound tooth for a pained one; for oft-times the patient cannot tell, for that the bitternesse of paine by neighbour-hood is equally diffused over all the jaw. Therefore for the better plucking out a * 1.116 tooth, observing these things which I have mentioned, the patient shall be placed in a low seat, bending back his head between the Tooth-drawers legs; then the Tooth-drawer shall deeply scarifie about the tooth, separating the gums therfrom with the instruments marked with this letter A. and then if spoyled as it were of the wall of the gums, it grow loose, it must be shaken and thrust out by forcing it with the three-pointed levatory noted with this letter B. but if it sticke in too fast, and will not stirre at all, then must the tooth be taken hold of with some of these toothed forcipes mar∣ked with these letters C. D. E. now one, then another, as the greatnesse, figure, and site shall seeme to require. I would have a tooth-drawer expert and diligent in the use of such toothed mullets; for unlesse one know readily and cunningly how to use them, he can scarce so carry himself, but that he will force out three teeth at once, oft-times leaving that untoucht which caused the paine.

[illustration]

The effigies of Forcipes or mullets for the drawing of teeth.

[illustration]

Instruments for scraping the teeth, and a three-pointed levatory.

[illustration]

The forme of another Instrument for drawing of teeth.

After the tooth is drawn, let the blood flow freely, that so the part may be freed * 1.117 from pain, and the matter of the tumor discharged. Then let the tooth-drawer presse the flesh of the gums on both sides with his fingers whereas hee tooke out the tooth, that so the socket that was too much dilated and oft times torne by the violence of the plucke, may be closed again. Lastly, the mouth shall be washed with oxycrate; and if the weather bee cold, the patient shall take heed of going much in the open aire, lest it cause a new defluxion upon his teeth.

CHAP. XXVIII. Of cleansing the Teeth.

PEices of meat in eating sometimes sticke between the teeth, and becom∣ming corrupt by long staying there, doe also hurt the teeth themselves, * 1.118 and spoile the sweetnesse of the breath. Hee that would eschew this, ought presently after meate to wash his mouth with wine mixed with water, or oxycrate, and well to clense his teeth that no slimy matter ad∣here to them. Many folkes teeth by their owne default gather an earthy filth of a yellowish collour, which eates into them by little and little, as rust eates into iron. This rusty filthinesse, or as it were mouldiness of the teeth, doth also oft times grow

by the omitting of their proper duty, that is, of chawing. Whence soever this sli∣my * 1.119 filth proceeds, wee must get Dentifrices to fetch it off withall, and then the teeth must be presently rubbed with aqua fortis and aqua vitae mixed together, that if there be any thing that hath scaped the Dentifrices, it may bee all fetched off; yet such a∣cride washings are hurtfull to the sound teeth, for that they by little and little con∣sume * 1.120 and waste the flesh of the gums.

Dentifrices shall be made of the roote of marsh mallowes boiled in white wine & Alume; and as when the teeth are loose wee must abstaine from such things as are hard to be eaten and chawed, but much more from breaking of such things as are of a bony consistence, also here we must shunne all things that by their toughnesse stick to the teeth. Many for the cleansing of the teeth, commend a powder made of scut∣tle bones, purple shells, pumice stone, burnt alume, and harts horne, and a little ci∣namon, which is a singular remedy for the teeth howsoever affected. Many other are content with bread only tosted & beaten; but this following water is very effectuall to whiten the teeth. ℞. sal. ammon. & gemmei, an. ℥i. alum. roch. ℥ss. aquae ros. quod * 1.121 sufficit, destillentur. And let the teeth be cleansed with this distilled liquor.

CHAP. XXIX. Of the impediment and contraction of the Tongue.

THe tongue is sometimes tyed and short from the nativity; as when the * 1.122 liberty of the tongue is restrained by the subject and neighbouring as well membraines as muscles, being either too short or too hard. Some∣times this disease happens after they are borne by some accident or pre∣ternaturall affect, as by too hard a scarre left by the healing of an ulcer under the tongue. The patient at his beginning to speake, is too slow in speaking, but present∣ly leaving his slownesse hee becomes too quicke, so that he stammers. If the disease * 1.123 proceed from the astriction and shortnesse of the ligamentall membrane lying under the tongue, then the in incision shall bee made broadwise, having great care that the veines and arteries which are there, be not violated, for feare lest they should cause a haemorrhagy not easily to be stayed: Then the mouth shall be presently washed with oxycrate, and some lint dipped in syrupe of dryed roses, or honey of roses put into the midst of the incision, lest the part of the ligament, especially on the night time when the tongue is silent and at rest, should grow to the rest of the ligament. For the same purpose the finger shall be often thrust this way, and the tongue more violent∣ly rowld up and down, & thrust out of the mouth. Yet sometimes this ligament is so thick & short, and therfore holds down the tongue so close, that you cannot come to cut it with a knife or lancet without great and manifest danger of death by bleeding: Therefore in such a case a needle and thread shall bee thrust through it, and so the * 1.124 thread shall bee tyed straiter and straiter every day, untill by little and little this liga∣mentall tye of the tongue, which by its immoderate shortnesse intercepts the liber∣ty of the motion shall be consumed and broken.

CHAP. XXX. Of superfluous Fingers, and such as sticke together.

EAch hand hath naturally five fingers onely; whatsoever is more or lesse * 1.125 is against nature: and if there be fewer, it is a fault not to be helped by art. But if there be more, that for the most part may be helped by art: superfluous fingers usually grow by the thumbe, or the little finger, but seldome otherwise, These are either wholly fleshy, or have bones of their kind and nailes upon them. Those which are of a bony nature doe either arise from the joints of the naturall fingers, and are joynted like them, and so are oft times

moveable, or else from some middle space of a joint, and these have not power to stirre or move. Now they are sometimes equall in magnitude to the naturall fingers to which they grow, yet more frequently they are shorter. Those which are onely fleshy, are easily amputated and made even with a razour; but such as are also bo∣ny cannot be cut off, unlesse with the cutting mullets herafter described, and this is a disease of the fingers in number. There is also another disease in figure, for they som∣times sticke together, and otherwhiles they are very little separated. This fault happens either from the first originall by the error of the formative faculty; or else it happens afterwards by accident, as by a wound or burne ill cured. For neighbou∣ring fingers being ulcerated do easily grow together, unlesse they be kept a sunder by a linnen ragge. And if they by chance shall grow together by a little and thin skinne and flesh, they shall forthwith be divided with a sharp razour; but if they be joyned by the interposition of a more grosse and dense substance, to wit, the nerves, ten∣dons, and vessels, being knit together on each side, it will be best not to meddle at all with the dividing them.

[illustration]

Cutting Mullets neatly made for the cutting off superfluous Fingers.

Neither must wee omit, that many have their nailes run with such bony sharpe∣nesse * 1.126 into the flesh of their fingers lying under them, that they cause most cruell pain; neither commonly do you availe any thing by paring them; for growing up with∣in a while after, they presse downewards againe with the more violence. Therefore the Surgeon is often forced to cut away all the flesh whereinto the sharpenesse of the naile runs. Which I have done in many with happy success. Many have corns grow∣ing upon their fingers in divers fashions: They are taken off by paring away by lit∣tle * 1.127 and little the callous hardnesse, and then laying a head of garlicke beaten there∣on. Yet the cure is more quick and certaine which is performed by caustickes, as a∣qua fortis, or oile of vitrioll.

CHAP. XXXI. Of the too short a Praepuce, and of such as havebin circumcised.

WHen as the Praepuce or foreskin is too short, it cannot cover the glans. This happens either by nature, to wit, by the first conformation, or af∣terwards by some accident, as to those whom religion and the custome * 1.128 of their nation bids to be circumcised. The cure is thus. The Praepuce is turned up, and then the inner membrane thereof is cut round, and great * 1.129 care is had, that the veine and artery which are there betweene the two membranes

of the Praepuce, be not cut in sunder. Hence it is drawn downward by extension, un∣till it cover the glans, a deficcative emplaster being first put between it and the glans, lest they should grow together. Then a pipe being first put into the urinary passage, the praepuce shall be there bound untill the incision be cicatrized. This cure is used to the Jewes, when having abjured their religion full of superstitions, for handsom∣nesse sake, they would cover the nut of their yard with a praepuce, and so recover their cut off skinne.

CHAP. XXXII. Of Phymosis and Paraphymosis, that is, so great a constriction of the praepuce about the Glans or Nut, that it cannot be bared or uncovered at Pleasure.

THe prepuce is straitened about the Glans two waies; for it either co∣vers the whole nut, & so straitly encompasses the end therof, that it cannot be drawne upwards, and consequently the nut cannot be uncovered; or else it leaves the Glans bare under it, being fastened so stiffely to the roots thereof, that it cannot bee turned up, nor drawn down, or over the Glans. The first manner of constriction is termed Phymosis, the latter Paraphymosis. The Phymosis happens either by the fault * 1.130 of the first conformation, or else by a scarre, through which occasion the praepuce hath growne lesser, as by the growing of warts. Now Paraphymosis is often occasio∣ned by the inflammation of the yard, by impure copulation; for hence ulcers breed betweene the praepuce and Glans, with swelling, and so great inflammation, that the praepuce cannot bee turned backe. Whence it is that they cannot bee handled and cured as you would, and a gangrene of the part may follow, which may by the con∣tagion * 1.131 bring death to all the body, unless it be hindred & prevented by amputation: but if a scar be the cause of the constriction of the praepuce, the patient being plac'd in a convenient site, let the praepuce be drawne forth and extended, and as much as may be stretched and enlarged, then let the scarre be gently cut in three or foure places on the inner side with a crooked knife, but so, that the gashes come not to the outside, and let them be an equall distance each from other. But if a fleshy excrescence or a wart shall be the occasion of this straitnesse and constriction, it shall be consumed by the same remedies, by which the warts of the wombe and yard are consumed or ta∣ken off. But when as the praepuce doth closely adhere to the Glans on every side, the cure is not to be hoped for, much lesse to be attempted.

CHAP. XXXIII. Of those whose Glans is not rightly perforated, and of the too short or strait ligament, bridle, or Cord of the yard.

SOme at their birth, by evill conformation, have not their Glans perfora∣ted in the middle, but have only a small hole underneath, toward the bri∣dle * 1.132 & ligament of the yard, called the cord. Which is the cause, that they do not make water in a strait line, unlesse they turn up their yard toward their belly, neither by the same reason can they beget children, because through this fault of conformation, the seed is hindred from being cast directly in∣to the wombe. The cure is wholly chirurgicall, and is thus performed. The prae∣puce * 1.133 is taken hold of and extended with the left hand, but with the right hand, the extremity thereof, with the end of the Glans, is cut even to that hole which is under∣neath. But such as have the bridle or ligament of the yard too short, so that the yard cannot stand straight, but crooked, and as it were turned downewards; in these also the generation of children is hindred, because the seed cannot be cast directly and

plentifully into the wombe. Therefore this ligament must be cut with much de xte∣rity, and the wound cured after the manner of other wounds, having regard to the part.

Children also are sometimes borne into the world with their fundaments unper∣forated, * 1.134 for a skinne preternaturally covering the part, hinders the passage forth of the excrements; those must have a passage made by art with an instrument, for so at length the excrements will come forth: yet I have found by experience, that such children are not naturally long lived, neither to live many dayes after such section.

CHAP. XXXIV. Of the causes of the stone.

THE stones which are in the bladder have for the most part had their first originall in the reines or kidneys, to wit, falling down from thence * 1.135 by the ureters into the bladder. The cause of these is twofold, that is, materiall and efficient. Grosse, tough, and viscide humours, which crudities produce by the distempers of the bowels and immoderate exercises, chiefly immediately after meat, yeeld matter for the stone; whence it is that chil∣dren are more subject to this disease than those of other ages. But the efficient cause is either the immoderate heate of the kidneys, by meanes whereof the subtler part * 1.136 of the humors is resolved, but the grosser and more earthy subsides, and is hardened as we see bricks hardened by the sun and fire; or the more remisse heat of the blad∣der, sufficient to bake into a stone the faces or dregges of the urine gathered in great plenty in the capacity of the bladder. The straightnesse of the ureters and urenary passage may be accounted as an assistant cause. For by this meanes the thinner por∣tion of the urine floweth forth, but that which is more feculent and muddy being stayed behind, groweth as by scaile upon scaile, by addition and collection of new matter into a stony masse. And as a weeke often-times dipped by the Chandler into melted tallow, by the copious adhesion of the tallowy substance presently becomes a large candle; thus the more grosse and viscide faeces of the urine stay as it were at the barres of the gathered gravell, and by their continuall appulse are at length wrought and fashioned into a true stone.

CHAP. XXXV. Of the signes of the stone of the Kidneys and bladder.

THE signes of the stone in the reines, are the subsiding of red or yellow sand in the urine, a certaine obscure itching at the kidneys, and the sense of a weight or heavinesse at the loynes, a sharp and * 1.137 pricking paine in moving or bending the body, a numnesse of the thigh of the same side, by reason of the compression caused by the stone, of the nerves discending out of the vertebrae of the loynes of the thigh. But when the stone is in the bladder, the fundament and * 1.138 whole perinaeum is pressed as it were with a heavie weight, especially if the stone be of any bignesse, a troublesome & pricking pain runs to the very end of the yard, and there is a continuall itching of that part, with a desire to scratch it: hence also by the paine and heat there is a tension of the yarde, and a frequent and needlesse desire to make water, and sometimes their urine commeth from them drop by drop. A most grievous paine torments the patient in making water, which he is forced to shew by stamping with his feet, bending of his whole body, and the grating of his teeth. He * 1.139 is oft times so tormented with excesse of paine, that the Sphincter being relaxed, the right gut falleth downe, accompanied with the swelling heate and paine of the Haemorrhoid veines of that place. The cause of such tormentis, the frequent striving

of the bladder to expell the stone wholly contrary to the nature thereof, whereto by sympathy the expulsive faculty of the guts and all their parts of the belly come as it were for supply. The sediment of the urine is grosse & viscid, and oft-times like the whites of egs, which argueth the weaknesse of the native heate not attenuating the juices. The patient looketh of a pale and yellowish complexion and hollow eyed, by reason of the almost continuall watching which is caused by the bitternesse of paine; yet may it more certainely be knowne by putting in, or searching with a Ca∣thaeter. * 1.140 Which to doe, the patient shall bee wished to stand with his body somewhat stooping, leaning against somewhat with his backe, and holding his knees some foot asunder. Then the Cathaeter being bigger or lesser as the body shall require, and a∣nointed with oyle or butter, shall bee thrust with a skilfull hand into the passage of the urine, and so into the capacity of the bladder. But if the Cathaeter cannot come to that capacity, the patient shall be placed in such a posture; then shall he be layd up∣on his backe on a bench, or the feet of a bed, with his knees bended, and his heeles drawn to his buttocks, after which manner he must almost lie when he is to be cut for the stone, as shall be shewen hereafter. For thus the Cathaeter is more easily thrust in∣to the bladder, and shewes there is a stone by the meeting and obscure sound of the obvious, hard and resisting body. You must have sundry Cashaeters, that they may serve for every body bigger and lesser, and these must be crooked, smooth and hol∣low. When being thrust into the urenary passage (which before unawares I omit∣ted) they come to the necke of the bladder, they must not be thrust streight into the bladder, but taking hold of the yard with the left hand, they must bee gently thrust with the right directly into the bladder, especially in men, by reason of the length and crookednesse of the way, which trends in the forme of this letter S. It is not so in * 1.141 women by reason of the shortnesse and straitnesse of the necke of the bladder. It is fit your Cathaeters bee hollow or fistulous in manner of a pipe, that they may receive a silver wiar or string, that may hinder the grosse and viscide humour, clotted blood, or the like, from stopping the further end of the Cathaeter, through which the sup∣pressed urine ought to passe & be made. But now assoon as we perceive that the Ca∣thaeter is come into the capacity of the bladder, the wiar must be drawn forth, that so the urine may the freelier flow out by the hollownesse of the Cathaeter. You may per∣ceive the shapes of these instruments by this following figure.

[illustration]

The figure of Cathaeters, and of a silver string or wiar.

CHAP. XXXVI. Prognostickes in the stone.

WHen the stone is cast forth of the kidney (whereas it bred by little and little) and is so driven into one of the ureters, that it wholly stop it, yet thereupon there followeth no suppression of the urine; for seeing nature hath made divers parts of our body double, all the urine floweth into the other ureter. But if they shall bee both stopped with stones, there is no doubt but the urine will bee whol∣ly supprest, and death ensue by the suffocation and extinction of the native heat, by * 1.142 the urine flowing back by the rivelits of the veines over all the whole body. Such as have a small stone cast forth of their reines into the cavity of the ureters, these, un∣till this stone be fallen into the bladder, have cruell paine with gripings, with often desire to go to stoole and make water, but oft-times do neither. For such oft-times have their bellies distended with flatulencies: an argument hereof is their continuall belching, or breaking of wind. But by sneesing & coughing, or any other concussion of the whole body, a pricking paine is forthwith felt, whereas the stone stops, espe∣cially if it be either rough, or have sharpe points like hornes. This paine is commu∣nicated to the hip and thigh by sympathie, and some have the stones drawne up as it were with great violence. To these may bee added the Colicke, cholericke vomi∣ting, and almost a generall sweat. The stone in the kidnies is most commonly bred in such as are ancient, by reason of the weaknesse of the expulsive faculty. But the stone in the bladder happeneth to such as are more young, because the native heat is more vigorous in such, and strong and inordinate motions increase the strength of the expulsive facultie. When the stone is in the bladder, and the urine appeareth bloody, it is the signe of a small, as also a prickly and rough stone, for thus it more casily entreth into the neck of the bladder, and exulcerateth it being fleshy, whence the blood commeth away with the urine, and most cruell paine as of needles thrust into the flesh, especially after labour and much exercise: on the contrary, a larger and more smooth stone will not cause such tormenting paine, and it causeth a milkie water. The shapes of stones bred in the kidnies are various, according to the varie∣ty of the strainers through which they passe whilst they are bred. Verily I have seen * 1.143 stones which represented the figure of grayhounds, hogs and other creatures, and things wholly contrary to mans nature, by the production of their prickles and as it were branches. Some are foure square, others longish and like a finger, other some of a round figure with many protuberancies like a pine apple kernell; neither is the variety lesse in magnitude, number and colour: for some are yellowish, others whi∣tish, red, ash-coloured or some other like, according to the various temper of the af∣fected bodies. The stones of cholerick and leane men usually concrete by preterna∣turall heat and drinesse; but those of phlegmaticke or fat bodies, of a certaine as it were congelation and obstruction of the passages. A stone falling sometimes from the bottome of the bladder into the passage of the urine quite stops it up, and thence followeth a totall suppression of the urine. Therefore then the patient shall be pla∣ced upon his backe and his legs being lifted up on high, he shall be shaken and tossed up and downe, just as one would shake up a sacke to fill it; for thus it is forced back into the bladder from whence it came, from the passage of the urine whereinto it was got; yet it may also bee forced backe by thrusting in a Cathaeter. The paine which afflicteth such as have the stone is some whiles continuall, yet more frequent∣ly it commeth by fits and returnes, sometimes monethly, other whiles yearely. Such as have the stone in the kidnies make for the most part waterish urine. Women are * 1.144 not so subject to the stone as men, for they have the neck of their bladder more short and broad, as also more straight; wherefore the matter of the stone by reason of the shortnesse of the passage is evacuated in gravell, before it can be gathered and grow into a stone of a just magnitude; yet stones breed in some women and those equally as big as in men, and therefore they are to be cured by section and the like remedies.

When the stone exceedeth the bignesse of an egge, it can scarce be taken away with∣out the tearing of the bladder, whence happeneth an unvoluntary shedding of the water, curable by no art, because the bladder, seeing it is nervous and without bloud, being once torne admitteth no consolidation, adde hereto that inflammation and a * 1.145 gangrene often following the rending of the bladder bring inevitable death. The patient runs the same hazzard, if along stone be pulled out sidewise with your instru∣ment, or if it be inclosed in a membrain (which kind of stone can scace be found with a Cathaeter) and so bee fastened to the bladder, or otherwise if the stone it selfe bee fastened into the substance of the bladder, or lastly if by any chance the Surgeon be∣ing about to plucke out the stone shall hurt the body of the bladder with his instru∣ments. Yet stones of an indifferent bigness are more safly extracted out of the blad∣der than those which are lesse, and the patient more frequently and happily reco∣vereth. For they doe not scape from the instrument, and the patient being used a long while to endure pain, as that which hath been a long time a growing, doth more easily and constantly away with the inflammation, paine and other symptomes, which happen after cutting, yea in cutting. Having thus spoken of the causes, signs, places, symptomes and prognosticks, we must come to the cure, beginning with that part which is termed Prophylactice, that is, the preventing part.

CHAP. XXXVII. What cure is to be used when we feare the stone.

DIet must first bee appointed, which by the convenient use of the sixe * 1.146 things not naturall (as they terme them) may heape up small store of grosse, tough and viscide humours in our bodies. Therefore cold and cloudy aire is to be shunned. They must abstaine from fish, beefe, porke, water-foule, pulse, cheese, milke meates, fryed and hard egges, rice, cakes and all pastry, unleavened bread, and lastly all manner of obstructing meats. Also garlike, onions, leeks, mustard, spices, & lastly all things which overheat the bloud and humors must be shunned, especially if you feare that the stone is con∣crete by the heat of the reines. Standing and muddy waters, thicke and troubled wines, beare, and such kind of liquors must be eschewed. Saciety in meats and drinks is to be shunned, as that which breeds crudities. Also long watching and continuall labour because they inflame the bloud, cause crudities, and preternaturall heat must carefully be eschewed, as also all more vehement passions of the minde. If the body be plethoricke, then it must bee evacuated by phlebotomie, purging and vomiting, which is accounted for a singular remedy for the prevention of this disease. For the performance of all which things a Physician shall be consulted. But because Phy∣sicians are not in every place and alwaies at hand, I have thought good to set downe these following medicines; yet we must first remember this counsell of Galen; The * 1.147 use of diureticks, and strong purging medicines is hurtfull, as often as there is in∣flammation in the reines and bladder, for so the confluxe of the humors to the affe∣cted parts is the greater, whence the inflammation and paine are increased.

Wherefore first using relaxing medicines, as sixe drams of Cassia newly drawne, with ℈iv. of Rubarbe in powder mixed therewith; then lenitive and refrigerating medicines shall bee inwardly and outwardly used, such as is this following syrupe. ℞. summitatum malv. bismal. & violar. an. m. ss. rad. alth. ℥i. glycyr. ℥ss. 4. sem. frigid. * 1.148 major. an. ʒi. fiàt decoctio. ℞. pradict. decoctionis lb. ss. in colatura dissolve sacch. albiss. ℥ii. mellis albi ℥iss. fiat syrupus secund. artem; let the patient use this often. This following apozeme is also very effectual for the same purpose. ℞. rad. aspar. gramin. polyp. quer∣cini, * 1.149 passul. mund. an. ℥ss. betonic. herniar. agrimon. omnium capill. & pimpinell. an. m. ss. 4. sem. frigid. major. & sem. f••nic. an. ʒi. folior. sen. ʒvi. fiat decoct. ad lb. ss. incolatura dissolve syrupi de Alth•••• & de ••erniar. an. ℥iss. Make a cleare apozeme and let it be aromati∣zed with a little cinamon, for two doses; let him take the first dosis in the morning two houres before meat, and the other at foure of the clock in the afternoone. More∣over

this following broth hath an excellent and certain power to prevent the stone. ℞. hordei integr. p. i. radic. petroselini, acetos. foenicul. cichor. brusci an. ℥i. 4. sem. frigi∣dorum * 1.150 conquassatorum. an. ℥ss. fol. acetos. portul. lactucae, summitatum malvae, & violar. an. m. ss. bulliant in aqua fluviatili cum gallo gallinaceo & crure vitulino; let the broth bee kept, and let the Patient take thereof sixe ounces for foure daies; in the morning two houres before meat, with an ounce of the juice of Citrons gently warmed with the same broth at the time of the taking thereof; for thus, much urine will be made in a short while after, full of a sandy sediment and a grosse viscide humour. Whereby you may certainly gather that this kind of broth is very effectuall to cleanse the pas∣sages of the urine, neither in the interim, doth it any harme to the stomacke and o∣ther parts by which it passeth: so that it may be rightly esteemed a medicinall nou∣rishment. You may also profitably use this following powder. ℞. nucleorum mespi∣lorum * 1.151 ℥i. pul. elect. diamarg. frig. ʒii. 4. sem. frigid. majorum mund. glycyrhizae rasae, ʒi. sem. saxifrag. ʒii. sem. milii solis, genist. pimpinel. brusci & asparag. an. ℈i. sem. altheae, ʒiss, succh. albiss. ℥vi. fiat pulvis; let him take a spoon full in the morning three houres before meat. Also some thinke that lye made of the stalkes and huskes of beanes is * 1.152 a good preservative against this disease. Besides the use of this following glyster hath done good to many. ℞. fol. lactuc. scariol. portul. an. m. i. flor. viol. & nenuph. an. p. i. fiat decoctio. ad lib. i. in colatura dissolve cassiae fistulae ℥i. mellis viol. & sacch. rub. an. ℥iss. olei viol. ℥iiii. siat clyster. This which followeth is the fitter to asswage the paine. ℞. flo. cham. melil. summitat. aneth. berul. an. p. ii. fiat decoctio in lacte vaccino; in colatura dissolve cassiae fistul. & sacchar. alb. an. ℥i. vitellos ovorum num. ii. olei anethini, & cha∣maem. an ʒii. fiat clyster. In the interim let the kidneys bee annointed on the outside with unguentum rosatum, refrigerans Galen. and populeon used severally, or mixed to∣gether, laying thereupon a double linnen cloth dipped in oxycrate. But if the con∣cretion of the stone be of a cold cause, the remedies must bee varied, as follows; ℞. terebinth. venet. ʒi. cort. citri ʒii. aquae coct. ʒii. fiat potio. Or else, ℞. cassiaerecent. ex∣tract. ʒvi. benedict. lax. ʒiii. aq. foenicul. ℥ii. aq. asparag. ℥i. fiat potio; let him take it * 1.153 three houres before dinner: this following apozeme is also good. ℞. rad. cyper. bar∣dan. & gram. an ʒiii. bismal. cum toto, beton. an. m. ss. sem. milii solis, bardan. urtic. an ʒii. sem. melon. glycyrhiz. ras. an. ʒiiss. ficus num. 4. fiat. decoct. ad quart. iii. in express•• colatu∣ra, dissolve syrup. de caphan. & oxymilitis scillitici an. ℥i. ss. sacchar. albis. ℥iii. fiat apoze∣ma pro tribus dosibus, clarificetur & aromatiz. cum. ʒi. cinam. & ʒss. sant. citrin. let him take foure ounces three houres before dinner. Or else, ℞. rad petrosel. foenicul. an. ℥i. saxifrag. pimp. gram. & bardan. an. m. ss. quatuor seminum frig. major. mundat. & milii. solis an. ʒii. fiat decoctio, cape de colatura lb. ss. in qua dissolve sacch. rub. & syrup. capill. ven. an. ℥i. ss. Let it be taken at three doses, two houres before meat. The following powder is very effectuall to dissolve the matter of the stone. ℞. sem. petrosel. & rad. ejusdem mundat. an ℥ss. sem. cardui, quem colcitrapam vocant, ℥i. let them be dryed in an oven or stone with a gentle fire, afterwards let them be beaten severally and make a powder, whereof let the patient take ℈i. ss. or two scruples with white wine, or chick∣en broth fasting in the morning by the space of three daies. Or, ℞. coriand. praep. ℈iv. anis. marathri, ganor. alkakengi, milii solis, an ʒii. zinzib. & cinam. an. ℈ii. turbith. electi ʒi. cari ℈ii. galang. nucis moschat. & lapid. judiaci an. ℈i. fol. senna mund. ad duplum omnium, diacrydi•• ʒii. ss. misce, fiat pulvis: the dosis is about ʒi. with white wine three houres before meate. Against the flatulencies which much distend the guts in this kind of disease, glisters shall be thus made; ℞. malv. bismal. pariet. origani, calament. * 1.154 flo. chamaem. sumitat. anethi, an. m. ss. anisi, carvi. cumini, foenic. an. ℥ss. baccar. laur. ʒiii. semin. rutae ʒii. fiat decoctio, in colatura, dissolve bened. lax. vel diaphaenic. ℥ss. consect. bac. lauri ʒiii. sacchar. rub. ℥i. olei aneth. chamaem. & rutar. an. ℥i. fiat clyster. Or, ℞. olei nu∣cum & vini mal. an. lb. ss. aq. vitae. ℥ss. fiat clyster; let it be kept long, that so it may have the more power to discusse the winde.

CHAP. XXXVIII. What is to be done, when the stone falleth out of the Kidney into the Ureter.

OFt-times it falleth out that the reines using their expulsive faculty force downe the stone (whose concretion and generation the Physi∣cians * 1.155 by the formerly prescribed meanes could not hinder) from themselves into the ureters; but it stayeth there either by reason of the straightnesse of the place, or the debility of the expulsive faculty. Therefore then cruell paine tormenteth the patient in that place whereas the stone sticketh, which also by consent may be communicated to the hippe, bladder, ••esti∣cles and yard, with a continuall desire to make water and goe to stoole. In this case it behooveth the Physician that he supply the defect of nature, and assist the weake indeavours.

Therefore let the patient if he be able mount upon a trotting horse, and ride upon * 1.156 him the space of some two miles, or if hee can have no opportunity to doe, so, then let him run up and downe a paire of staires untill he be weary, and even sweat again; for the stone by this exercise is oft-times shaken into the bladder; then presently shall be given or taken by the mouth such things as have a lenitive and relaxing fa∣cultie, as oyle of sweet almonds newly drawne and that without fire, and mixed with the water of pellitorie of the wall and white wine. Let frictions of the whole body be made from above downewards with hot clothes; let Ventoses with a great flame be applyed one while to the loynes, and another while to the bottome of the belly, a little below the grieved place; and unlesse the patient vomit of his owne ac∣cord, or by the bitternesse of his paine, let vomiting bee procured with a draught of water and oile luke warme; for vomiting hath much force to drive downe the stone, by reason of the compression of the parts, which is caused by such an endea∣vour: lastly, if the stone descend not by the power of these remedies, then the pati∣ent must bee put into a Semicupium, that is, a Halfe-bath, made of the following de∣coction. ℞. malvae, bismal. cum toto an. m. ii. beton. nasturt. saxifrag. berul. parietar. vio∣lar. * 1.157 an. m. iii. semin. melonum, milii solis, alkekengi an. ʒvi. cicer. rub lb. i. rad. appii, gram. faeniculi, & eryngii, an. ℥iiii. in sufficienti quantitate aquae pro incessu; coquantur ista om∣nia inclusa sacco; herein let the patient sit up to the navell: neither is is fit that the patient tarry longer in such a bath than is requisite, for the spirits are dissipated, and the powers resolved by too long stay therein. But on the contrary, if the patient re∣maine as long as is sufficient in these rightly made, the paine is mitigated, the exten∣ded parts relaxed, and the passages of urine opened and dilated, and thus the stone descendeth into the bladder. But if it be not moved by this meanes any thing at all out of the place, and that the same totall suppression of urine do as yet remaine, nei∣ther before the patient entred into the bath the putting of a Cat••aeter into the blad∣der did any thing availe, yet notwithstanding he shall try the same againe after the patient is come out of the bath, that hee may bee throughly satisfied whether perad∣venture there may bee any other thing in these first passages of the yard and neck of the bladder, which may with-hold the urine; for the Cathaeter will enter farre more easily, the parts being relaxed by the warmenesse of the bath: then inject some oyle of sweet almonds with a syringe into the Urethra or passage of the yarde; whilst all these things are in doing, let not the patient come into the cold aire. But here I have thought good to describe a chaire for a bath, wherein the patient may fitly sit.

[illustration]

The figure of a chaire for a Semicupium.

A. Sheweth the whole frame of the Chaire.

B. The hole wherein the patient must sit.

C. The Cisterne that holds the water.

D. A Cocke to empty the water when it groweth cold.

E. A Funnell whereby to poure in warme water.

There may also be another decoction made for the bath, as thus: ℞. rad. raph. alth. an. lb. ii. rad. rusc. petrosel. & asparag. an. lb. i. cumin. foenicul. ameos an. ℥iiii. sem. lini, faenug. an. ʒvi. fol. marub. parietar. florum chamaem. melil. anethi, an. m. ii. bulliant omnia secundum artem in aquae sufficienti, & vini albi odoriferi exigua quantitate ad consump∣tionem tertiae partis pro Semicupio. Also the same decoction may bee used for glisters, adding thereto two yolkes of egges, and foure ounces of oyle of lillies, with ʒi. of oile of Juniper, which hath a certaine force to asswage the paine of the stone and co∣lick. But a farre lesse quantity of the decoction in a glister must be used in these dis∣eases, than usually is appointed in other diseases; otherwise there will be danger lest the guts being distended should more presse upon the kidneys and ureters, troubled in some sort with inflammation, and so increase the paine and other symptomes. This following cataplasme shall be profitably applyed to the grieved place, to wit, the loynes or flankes and bottome of the belly, for it is very powerfull to asswage paine, and help forwards the falling downe of the stone. ℞. rad. alth. & raphani, an. ℥iiii. pariet. foenic. senecionis, nasturt. berul. an. m. i. herniariae m. ss. omnibus in aquasuffi∣cienti * 1.158 decoctis, & deinde contritis, adde olei aneth. chamaem. & pingued, cuniculi, an. ℥ii. fa∣rin. cicer. quantum sufficit, fiat cataplasma ad usum praedictum. After by these means the * 1.159 stone forced out of the ureter is fallen into the bladder, the paine presently (if there be but one stone, for sometimes more with much gravell do againe fall into the ure∣ter) is mitigated, and then the patient is troubled with an itching and pricking at the end of his yard and fundament. Therefore then unlesse he bee very weake, it is fit that he ride and walk a foote, and take ʒiv. of species Lithontribon in foure doses with white wine, or the broth of red Cicers three houres before dinner and supper. Be∣sides, let him plentifully drink good wine, and after he hath drunke, let him hold in

his urine as long as he can; that so it being gathered in greater plenty, it may present∣ly thrust the stone out of the bladder with the more force: for which purpose you may also inject the following liquor into the bladder. ℞. syrupi capill. ven. ℥i. aquae alkekengi ℥iii. olei scorpionum. ℥ss. Let it bee injected into the bladder with a syringe.

CHAP. XXXIX. What must be done the stone being fallen into the necke of the bladder, or passage of the yard.

AFter the stone is fallen out of the capacity of the bladder, and stops in the necke thereof, or passage of the yard, the Surgeon shall have a speciall care that he do not force or thrust backe the stone from whence it came, but rather that he press it gently with his fingers to the end of the yard, the passage being first made slippery by injecting some oyle of sweet almonds. But if it stop in the end of the Glans, it must bee plucked out with some crooked instrument; to which if it will not yeeld, a Gimblet with a pipe or case thereto, shall be put into the passage of the yard, and so it shall be gotten out, or else broken to pieces by the turning or twining about of the Gimblet, which I remember I have divers times at∣tempted and done; for such Gimblets are made with sharpe screwes, like ordinary Gimblets.

[illustration]

The delineation of a Gimblet made to breake the stones in the passage of the yard, together with its pipe, or case.

[illustration]

The effigies of another lesser Gimblet.

Verily what Gimblets soever are made for this businesse, their body nor point must bee no thicker than a small probe; lest whilst they are forced or thrust into the urethra, or urinary pas∣sage, they might hurt the bodies next un∣to them by their violent entrance.

CHAP. XL. What course must be taken, if the stone sticking in the Urethra or urinary passage, cannot be gotten out by the fore-mentioned arts.

BUT if the stone be more thicke, hard, rough and remote from the end of the yard, than that it may be gotten out by the meanes formerly men∣tioned in the precedent chapter, and if that the urine be wholly supprest * 1.160 therewith; then must you cut the yard upon the side with a streight wound: for you must not make incision on the upper part for feare of a fluxe of blood, for a large veine and artery lyeth thereunder; nor in the lower part,

for so it would scarce ever heale againe, for that it is a bloodlesse part, and be∣sides, the continuall and acride falling of the urine would hinder the agglutinati∣on: wherefore the incision must be made on the side, on that part whereas the stone most resists and swels out. For that part is the more fleshie; yet first the end of the skin of the prepuce must be much drawn up so to cover the Glans, which being done, the Urethra shall be tyed with a threed a little above the stone, that so the stone may be stayed there, and may not fall back againe. Therefore then, incision being made, the stone must be taken forth, and the skin which was drawne more violently to co∣ver the Glans is to be let goe backe againe; for so it will come to passe that a whole part of the skin may cover the cut yard, and so it may be the more speedily united and the urine may naturally flow out. I have by this meanes oft-times taken forth the stone with the instruments here delineated.

[illustration]

Instruments fit to take the stone forth of the opened Urethra, or ure∣nary passage of the yard.

Then for the agglutination, if need require, it will be requisite to sew up the lips of the wound, and apply this agglutinative medicine following. ℞. tereb venet. ℥iiii. gum. elemi, ℥i. sang. dracon & mastic. an. ʒss. fiat medicamentum ut dictum est: then the * 1.161 whole yard must be covered over with a repercussive medicine made of the whites of egges, with the pouder of bole armenick, aloes, farina volatilis, and oyle of roses. Lastly, if need so require, a waxe candle, or leaden string annoynted with Venice tur∣pentine shall be thrust into the Urethra to hasten the agglutination, and retaine the naturall smoothnesse and streightnesse of the urenary passage, lest peradventure a ca∣runcle * 1.162 grow therein.

CHAP. XLI. What manner of section is to be made when a stone is in a boyes bladder.

HItherto we have shewed, by what means it is convenient to draw small stones out of the ureter, bladder and passage of the urine; now will we briefly shew the manner of taking of greater stones out of the blad∣der, which is performed by incision and iron instruments, and I will deliver the practice thereof first in children, then in men, and lastly in * 1.163 women. First therefore let the Surgeon take the boy (upon whom it is determi∣ned the worke shall be performed) under the arme holes, and so give him five or sixe shakes, that so the stone may descend the more downewards to the neck of the blad∣der. The must you cause a strong man sitting upon a high seat to lay the child upon his backe with his face from himward, having his hips lying upon his knees. The * 1.164 child must lye somewhat high that he may breathe the freelier, & let not the nervous parts be too much stretched, but let all parts be loose and free for the drawing forth of the stone. Furthermore, it is fit that this strong man, the childs legges being ben∣ded backe, wish the child, that putting his legs to his hams, that he draw them up as much as he can, & let the other be sure he keep them so; for this site of the child much

conduceth to well performing of the worke. Then let the Surgeon thrust two of the fingers of his left hand as farre into the childs fundament as hee is able; but let him with his other hand presse the lower belly, first wrapping a cloth about his hand, that so the compression may be the lesse troublesome, and lest inflammation should happen rather by this meanes than by the incision. Now the compression hath this use, to cause the stone descend out of the bottome of the bladder into the neck there∣of under the os pubis, whither after it is arrived, it must be there kept, & as it were go∣verned by the command of your hand, lest it should slide from that place whereto you have brought it. These things thus done, nothing now remaineth, but that the Surgeon, with a wound some two fingers breadth distant from the fundament, cut through all the flesh even to the stone on the left side of the perinaeum. But in the in∣terim, * 1.165 let him beware that he hurt not the intestinum rectum; for it may, and usually doth happen, that whilest the stone is brought out of the bottome of the bladder to the neck thereof, this gut is doubled in: now if it bee cut with your incision knife, it commeth to passe that the excrements may sometimes come out at the wound, and the urine by the fundament, which thing hath in many hindred the agglutination and consolidation of the wound; yet in some others it hath done little harme, be∣cause * 1.166 in this tender age many things happen, which may seeme to exceed nature: the incision being made, the stone must bee plucked forth with the instrument here expressed.

[illustration]

Hookes to pull stones forth of childrens bladders.

The stone being drawne out, a small pipe shall be put into the wound, and there kept for some space after, for reasons hereafter to bee delivered; then his knees shall bee bound together, for thus the wound will the sooner close and bee agglutinated. * 1.167 The residue of the cure shall be performed by reducing the generall cure of wounds, to the particular temper of the childs age, and the peculiar nature of the child in cure.

CHAP. XLII. How to cut men, for the taking out of the stone in the bladder.

SEing wee cannot otherwise helpe such men as have stones in their bladders, we must come to the extreme remedy, to wit, cutting. But the patient must * 1.168 first be purged, and if the case require, draw somebloud; yet must you not immediately after this, or the day following hasten to the work, for the patient can∣not but be weakened by purging & bleeding. Also it is expedient for some daies be∣fore to foment the privities with such things as relaxe and soften, that by their yeel∣ding, the stone may the more easily be extracted. Now the cure is thus to be perfor∣med; The patient shall be placed upon a firm table or bench with a cloth many times * 1.169 doubled under his buttocks, and a pillow under his loynes & back, so that he may lie halfe upright with his thighs lifted up, and his legs and heels drawn back to his but∣tocks. Then shall his feet be bound with a ligature of three fingers breadth cast about his ankles, and with the heads thereof being drawn upwards to his neck, and cast a∣bout

it, and so brought downewards, both his hands shall bee bound to his knees, as the following figure sheweth.

[illustration]

The figure of a man lying ready to be cut for the stone.

The patient thus bound, it is fit you have foure strong men at hand; that is, two to hold his armes, and other two who may so firmely and straightly hold the knee with one hand, and the foot with the other, that he may neither move his limmes, nor stirre his buttocks, but be forced to keep in the same posture with his whole body. Then the Surgeon shall thrust into the urenary passage even to the bladder, a silver or * 1.170 iron and hollow probe, annoynted with oyle, and opened or slit on the out side, that the point of the knife may enter thereinto, and that it may guide the hand of the workman, and keep the knife from piercing any farther into the bodies lying there-under. The figure of this probe is here exprest.

[illustration]

Probes with slits in their ends.

He shall gently wrest the probe, being so thrust in, towards the left side, and also * 1.171 he who standeth on the patients right hand, shall with his left hand gently lift up his Cods, that so in the free and open space of the left side of the perinaeum, the Surgeon may have the more liberty to make the incision upon the probe which is thrust in and turned that way. But in making this incision, the Surgeon must be carefull that he hurt not the seame of the perinaeum and fundament. For if that seame bee cut, it will not be easily consolidated, for that it is callous and bloudlesse, therefore the u∣rine would continually drop forth this way. But if the wound be made too neare the fundament, there is danger, lest by forcible plucking forth of the stone he may break some of the haemorrhoide veins, whence a bleeding may ensue, which is scarce to be

stopped by any meanes, or that hee may rend the sphincter muscle, or body of the bladder, so that it can never be repaired. Therefore it must be made the space of two fingers from the fundament, according to the straightnesse of the fibres, that so it * 1.172 may be the more easily restored afterwards. Neither must the incision thus made, exceed the bignesse of ones thumbe, for that it is afterwards enlarged by putting in the Crowes beake and the dilater, but more by the stone as it is plucked forth. But that which is cut, is neither so speedily nor easily healed up, as that which is torne. Then presently put into the wound some one of these silver instruments delineated * 1.173 here below, and called by the name of Guiders, for that they serve as guides to the o∣ther instruments which are to be put into the bladder; these are made with a round & prominent head, whereby it may bee put into the described cavity of the probe, and they are noted by these letters A. A. then there are others marked with the letters B. B. and called by the like name, and are to be put under the former, being made forked at the end, that so it may, as it were, embrace the end of the former.

[illustration]

The figures of Guiders of two sorts.

Now the probe is to be drawne forth, and the Guiders to be thrust and turned up and downe in the bladder, and at length to be stayed there by putting in the pin; yet such Guiders as want a pin are fitter for the hand, and are by some called spathoe. Then must they be held betwixt the Surgeons fingers. It will be also necessary for the Surgeon to put another instrument called the Ducks bill between the two Gui∣ders into the capacity of the bladder, hee must thrust it in some what violently, and dilate it so thrust in with both his hands, turning it every way to enlarge the wound as much as shall be sufficient for the admitting the other instruments which are to be put into the bladder; yet it is farre better for the patient, if that the wound may with this one instrument be sufficiently dilated, and the stone pulled forth with the same without the help of any other.

[illustration]

The effigies of an instrument called a Ducks bill.

Which if you have not in a readinesse, and the largeness of the stone require more dilatation, then must you put in this Dilater, for being put into the bladder, and the handle pressed together, it will dilate the incision as much as you desire.

[illustration]

The figure of a Dilater shut and opened.

The wound by the helpe of this instrument being dilated as much as is sufficient' then put in the streight Ducks-bill before described, or the crooked here express.

[illustration]

Crooked Forcipes like a Ducks-bill.

The stone may be sought & taken hold of with these instruments, and being taken hold on, the branches of the instrument shall bee tyed together, lest they should suf∣fer that to slide away which they have once taken hold of. Neither shall the stone be suddenly plucked out, but easily shaken too & again, and at the length gently drawn forth. Yet you must beware that you doe not presse it too straightly in the forcep••, lest you should breake it in pieces: Some, lest it should slip away, when they have once taken hold thereof, put their two fingers into the fundament, and put them a∣bove the stone that it may not fall out, nor slip backe againe, which I thinke condu∣ceth much to the easie extraction of the stone. There are others who strengthen this comprehension by putting in on each side above and below these winged instru∣ment, so that the stone can slip forth on no side.

[illustration]

Winged instruments to hold the stone with the Ducks-beake.

[illustration]

The figure of another.

[illustration]

The figure of another winged instrument, the end of whose handle is fastned by a screw, as also a bended iron plate which is marked with this letter A. for the firmer holding thereof.

After the stone is by these meanes drawne forth, observe diligently whether it be worne on any side, and as it were laevigated; for that happeneth by the wearing or * 1.174 rubbing of one or more stones upon it, yet there is no surer way to know this, than by searching with a Cathaeter. The one end of the following instrument may supply the want of a Cathaeter or probe, and the other may serve for a scoop or Cleanser.

[illustration]

A cleanser or scoop whereby you may search whether there be any more stones behind, as also cleanse or purge the bladder from gravell, clots of bloud, and other such bodies, as use to remaine behind after the drawing forth of the stone.

For if other stones remaine behinde, they shall bee drawne forth as the former, * 1.175 which being done, the end of the instrument, which is crooked and hollowed like a scoop or spoone, shall bee thrust by the wound into the bladder, and therewith you shall gather together and take out what gravell soever, clotted bloud, and the like refuse as shall be there, for that they may yeeld matter for another stone. But if you find that the stone which is in the bladder be too great, so that it may not be plucked * 1.176 forth without great and fearfull rending of the bladder, it will be better to take hold thereof with this Crowes bill and so break it to peeces.

[illustration]

The effigies of a toothed Crowes-bill made neatly to breake greater stones, with a screw to force it together.

This Crowes bill hath onely three teeth, and those sharpe ones on the inside, of which two are placed above, and one below, which is the middle-most, so that it fal∣leth between the two upper. When the stone is broken, all the peeces thereof must be taken forth, and we must have a speciall care, lest any piece thereof lye hid; for that in time, increased by the accesse of a tough and viscous matter, or conjoyned with other fragments by the interposition of the like matter as glew, may rise to a stone of a large bignesse.

CHAP. XLIII. What cure must be used to the wound, when the stone is taken forth.

THE stone being drawne out, if the greatnesse of the wound so require, it * 1.177 shall have one or two stiches with a needle and threed, leaving onely so much space as shall be sufficient to put in a pipe for the use we shall here∣after shew, your threed must be of crimson silke waxed, and let it not be too small, lest it by binding should cut asunder the fleshy lips of the wound, or rot in a short time, either by the moysture of the urine, or matter flowing from the ulcer. Therefore you shall take up much flesh with the skin in sewing it, lest the lips of the wound being torne, your labour prove in vaine, and so you are forced to trouble the patient with making a new one. Things being thus performed, a silver pipe shall be put through the wound into the bladder, wherof I have here given you divers forms, that you may take your choice, and so fit them to the wounds, and not the wounds

to them, which oft times in want of instruments the Surgeons are forced to doe, to the great harme of the patient.

[illustration]

Silver pipes to be put into the bladder when the stone is drawne out.

These must have no holes in their sides (as those here expressed) but only in their ends, that all the matter of the wound, and the filth gathered and con∣crete in the bladder may flow and bee carryed forth this way. When cleere urine shall beginne to flow out of the wound, there shall be no more need of a pipe; therefore if you continue it, & keepe it longer in the wound, there is some danger lest nature accustomed to that way, may afterwards neglect to send the water through the urethra, or urenary passage. Neither must you forget to defend the parts neare to the wound with the following repercussive medicine, to hinder the defluxion and inflammati∣on, which are incident by reason of the paine. ℞. album. ovorum. nu. iii. pul. boli arme∣ni, sanguinis dracon. an. ℥iii. olei ros. ℥i. pilorum leporinorum quantum sufficit, make a * 1.178 medicine of the consistence of honey.

CHAP. XLIV. How to lay the patient after the stone is taken away.

ALL things which we have recited being faithfully and diligently per∣formed, the patient shall be placed in his bed, laying under him as it were a pillow filled with bran, or oate chaffe, to drinke up the urine which floweth from him. You must have divers of these pillowes, that they may bee changed as neede shall require. Sometimes after the drawing forth of the stone, the bloud in great quantity falleth into the Cod, which unlesse * 1.179 you be carefull to provide against, with discussing, drying, and consuming medicines, it is to be feared, that it may gangrenate. Wherefore if any accidents happen in cu∣ring these kinde of wounds, you must diligently withstand them. After some few daies a warme injection shall be cast into the bladder by the wound, consisting of the waters of plantain, night-shade & roses, with a little syrupe of dried roses. It wil help to temper the heat of the bladder caused both by the wound and contusion, as also by the violent thrusting in of the instruments. Also it sometimes happens, that af∣ter the drawing forth of the stone, clots of bloud and other impurity may fall into the urenary passage, and so stop the urine that it cannot flow forth. Therefore you must in like sort put a hollow probe for some daies into the urethra, that keeping the passage open, all the grosser filth may flow out together with the urine.

CHAP. XLV. How to cure the wound made by the incision.

YOu must cure this wound after the manner of other bloody wounds, * 1.180 to wit, by agglutination and cicatrization, the filth, or such things as may hinder, being taken away by detergent medicines. The patient shall ha∣sten the agglutination if hee lye crosse-legged, and keep a slender diet untill the seventh or ninth day be past. Hee must wholly abstaine from

wine, unlesse it bee very weak; in stead thereof let him use a decoction of barly and licorish, or mead, or water and sugar, or boyled water mixed with syrups of dryed roses, maidenhaire, and the like. Let his meat bee ponado, raisons, stewed prunes, chickens boiled, with the cold seeds, lettuce, purslaine, sorrell, borage, spinage, and the like. If he be bound in his belly, a Physitian shall be called, who may helpe it, by appointing either Cassia, a glister, or some other kind of medicine, as he shall thinke good.

CHAP. XLVI. What cure is to be used to Ulcers, when as the urine flowes through them, long after the stone is drawne out.

MAny after the stone is drawneout, cannot have the ulcer consolidated, therefore the urine flowes out this way continually by little and little, and against the patients will during the rest of his life, unlesse the Sur∣geon helpe it. Therefore the callous lippes of the wound must be am∣putated, so to make a green wound of an old ulcer; then must they bee * 1.181 tyed up, and bound with the instrument wee terme a Retinaculum or stay; this must be perforated with three holes, answering to three other on the other side, needles shall be thrust through these holes, taking hold of much flesh, and shall be knit about it: then glutinative medicines shall be applyed, such as are Venice Turpentine, gum Elemi, sanguis Draconis, bole armenick, and the like; after five or sixe dayes the nee∣dles shall bee taken out, and also the stay taken away. For then you shall finde the wound almost glewed, and there will nothing remaine but onely to cicatrize it.

[illustration]

The figure of a Retinaculum or Stay.

A. shewes the greater. B. the lesser, that you may know that you must use divers ac∣cording to the different bignesse of the wound.

If a Retinaculum or stay be wanting, you may conjoyne the lippes of the wound af∣ter * 1.182 this following manner. Put two quilles somwhat longer than the wound, on each side one, and then presently thrust them through with needles having thread in them, taking hold of the flesh between, as often as need shall require, then tying the thread upon them. For thus the wound shall be agglutinated, and the fleshy lips of the wound kept from being torne, which would be in danger if the needle & thread were onely used.

CHAP. XLVII. How to take stones out of womens bladders.

WEE know by the same signes that the stone is in a womans bladder as we do in a mans, yet it is far more easily searched by a Cathaeter, * 1.183 for that the necke of the bladder in the shorter, broader, and the more streight. Wherfore it may not onely be found by a Cathaeter put into the bladder, but also by the fingers thrust into the necke of the womb, turning them up towards the inner side of the Os pu∣bis, and placing the sicke woman in the same posture as we menti∣oned in the cure of men. Yet you must observe that maides yon∣ger than seven yeares old, that are troubled with the stone, cannot bee searched by the neck of the wombe, without great violence. Therefore the stone must be drawne from them by the same meanes as from boyes, to wit, by thrusting the fingers into the fundament; for thus the stone being found out, and the lower belly also pressed with the other hand, it must be brought to the necke of the blad∣der, and then drawn forth by the forementioned meanes. Yet if the riper yeares of the patient permit it to bee done without violence, the whole worke shall be more easily and happily performed, by putting the fingers into the necke of the wombe, for that the bladder is nearer the neck of the womb, than it is to the right gut. Wher∣fore the fingers thus thrust in, a Cathaeter shall bee presently put into the necke of the bladder. This Cathaeter must bee hollow, or slit on the outside like those before described, but not crooked, but streight, as you may perceive by the following figure.

[illustration]

A Cathaeter upon which, being put into the Bladder, the necke thereof may be cut, to draw out a stone from a woman.

Upon this instrument the neck of the bladder may be cut, and then with the Di∣later made for the same purpose, the incision shall bee dilated as much as need re∣quites; yet with this caution, that seeing the necke of a womans bladder is the shor∣ter, it admits not so great dilatation as a mans, for otherwise there is danger that it may come to the body of the bladder, whence an unvoluntary shedding of the wa∣ter may ensue and continue thereafter. The incision being dilated, the Surgeon putting one or two of his fingers into the necke of the wombe, shall presse the bot∣tome of the bladder, and then thrust his crooked instruments or forcipes in by the wound, and with these he shall easily pluck out the stone, which he shall keepe with his fingers from slipping backe againe. Yet Laurence Collo the Kings Surgeon, and both his sunnes (than whom I doe not know whether ever there were better cutters for the stone) doe otherwise performe this operation; for they doe not thrust their fingers into the fundament or necke of the wombe, but contenting themselves with putting in onely the Guiders (whereof we formerly made mention) into the passage of the urine, they presently thereupon make a streight incision directly at the mouth of the neck of the bladder, and not on the side, as is usually done in men. Then they gently by the same way thrust the forcipes hollowed on the outside formerly deline∣ated, and so dilate the wound by tearing it as much as shall be sufficient for the draw∣ing of the stone forth of the bladder. The residue of the cure is the same with that formerly mentioned in men: yet this is to be added, that if an ulcer grow in the neck of the bladder by reason of the rending it, you may by putting in the speculum matri∣cis, dilate the neck of the womb, that fitting remedies may be applyed with the more ease.

CHAP. XLVIII. Of the suppression of the Urine by internall causes.

BEsides the formentioned causes of suppressed urine, or difficulty of ma∣king of water, there are many other, lest any may thinke that the urine is stopt onely by the stone or gravell, as Surgeons thinke, who in this * 1.184 case presently use diuretickes. Therefore the urine is supprest by exter∣nall and internall causes. The internall causes are clotted bloud, tough phlegme, warts, caruncles bred in the passages of the urine, stones, and gravell; the urine is sometimes supprest, because the matter thereof, to wit, the serous or whay∣ish part of the blood, is either consumed by the feavourish heat, or carryed other wayes by sweats or a scouring; somtimes also the flatulencie there conteined, or in∣flammation arising in the parts made for the urine and the neighbouring members, suppresses the urine. For the right gut if it be inflamed, intercepts the passage of the urine, either by a tumour whereby it presseth upon the bladder, or by the commu∣nication of the inflammation. Thus by the default of an ill affected liver, the urine is oft times supprest in such as have the dropsie; or else by dulnesse or decay of the attractive, or separative faculty of the reines by some great distemper, or by the de∣fault of the animall faculty, as in such as are in a phrensie, lethargy, convulsion, apo∣plexie. Besides also a tough and viscide humour falling from the whole body into the passages of the urine, obstructs and shuts up the passage. Also too long holding the water somtimes causes this affect. For when the bladder is distended above mea∣sure, the passage thereof is drawn together and made more strait: hereto may be ad∣ded that the too great distension of the bladder is a hinderance that it cannot use the * 1.185 expulsive faculty, and straiten it selfe about the urine to the exclusion thereof; here∣to also paine succeeds, which presently dejects all the faculties of the part which it seazeth upon. Thus of late a certaine young man, riding on horsebacke before his Mistresse, and therfore not daring to make water, when he had great need so to doe, had his urine so supprest that returning from his journy home into the city, he could * 1.186 by no meanes possible make water. In the meane time he had grievous paine in the bottom of his belly and the perinaeum, with gripings and a sweatall over his body, so that he almost sowned. I being called, when I had procured him to make water by putting in a hollow Cathaeter, and pressing the bottom of his belly, whereof he forth∣with made two pints; I told them that it was not occasioned by the stone, which not∣withstanding the standers by imagined to bee the occasion of that suppression of u∣rine. For thence forward there appeared no signes of the stone in the youth, neither was he afterwards troubled with the stopping of his urine.

CHAP. XLIX. A digression concerning the purging of such things as are unprofitable in the whole body by the urine.

IThink it not amisse to testifie by the following histories, the pro∣vidence of nature in expelling by urine such things as are unpro∣fitable in the whole body. Mounsieur Sarret the Kings secretary was wounded in the right arme with a pistoll bullet; many and * 1.187 maligne symptomes happened thereupon, but principally great inflammations, flowing with much sanies and pus or quitture: it somtimes happened that without any reason this purulent and sa∣nious effluxe of matter was stayd in the inflammation; wherof while we solicitously enquired into the cause, wee found both his stooles and water commixed with much purulent filth, and this through the whole course of the disease, whereof notwith∣standing by gods assistance he recovered, and remaines whole and sound; we obser∣ved

that as long as his arme flowed with this filthy matter, so long were his excre∣ments of the belly and bladder free from the sanious and purulent matter: as long on the contrary as the ulcers of the arme were dry, so long were the excrements of the guts and bladder sanious and purulent. The same accident befell a Gentleman called Mounsieur da la Croix, who received a deadly wound with a sword on the left * 1.188 arme, though German Chavall, and Master Rasse most expert Surgeons, and others, who together with me had him in cure, thought it was not so for this reason, because the pus cannot runne so long a way in the body, neither if it were so, could that bee done without the infection and corruption of the whole masse of blood, whilest it flowes through the veines; therefore to be more probable that this quantity of filth, mixed with excrements and urine, flowed by reason of the default of the liver, or of some other bowell, rather than from the wounded arme: I was of a contrary opini∣on * 1.189 for these following reasons. First for that which was apparently seen in the pa∣tient; for as long as the excrement and urine were free from this purulent matter, so long his arme plentifully flowed therewith; this on the contrary being dry, much purulent matter was voided both by stoole and urine. Another was, that as our whole body is perspirable, so it is also (if I may so terme it) confluxible. The third was an example taken from the glasses which the French terme Monte-vins (that is, Mount-wines) for if a glasse that is full of wine be set under another that is fill'd with water, you may see the wine raise it selfe out of the lower vessell to the upper through the midst of the water, & so the water descend through the midst of the wine, yet so, that they do not mixe themselves, but the one take & possess the place of the other. If this may be done by art, by things only naturall, & to be discernd by our eyes, what may be done in our bodies, in which by reason of the presence of a more noble soule, all the works of nature are far more perfect? What is it which we may despair to be done in the like case? For doth not the laudible blood flow to the guts, kidneyes, spleen, bladder of the gall, by the impulse of nature together with the excrements, which presently the parts themselves separate from their nutriment? Doth not milke from the breasts flow sometimes forth of the wombes of women lately delivered? Yet that cannot bee carryed downe thither, unlesse by the passages of the mamil∣lary veines and arteryes, which meete with the mouthes of the vessels of the wombe in the middle of the streit muscles of the Epigastrium. Therefore no marvaile if ac∣cording * 1.190 to Galen the pus unmixt with the bloud flowing from the whole body by the veines and arteryes into the kidneyes and bladder, bee cast forth together with the urine. These and the like things are done by nature, not taught by any counsell or reason, but onely assisted by the strength of the segregating and expulsive faculty; and certainely we presently dissecting the dead body, observed that it all, as also all the bowels thereof, were free from inflammation and ulceration, neither was there any signe or impression of any purulent matter in any part thereof.

CHAP. L. By what externall causes the urine is supprest; and prognostickes concerning the suppression thereof.

THere are also many externall causes, through whose occasion the urine may be supprest. Such are bathing and swimming in cold water; the too long continued application of Narcoticke medicines upon the Reines, pe∣rinaeum and share; the use of cold meats and drinkes, and such other like. Moreover, the dislocation of some Vertebra of the loines to the inside, for that it * 1.191 presseth the nerves disseminated thence into the bladder; therefore it causeth a stu∣pidity or numnesse of the bladder. Whence it is, that it cannot perceive it selfe to bee vellicated by the acrimony of the urine, and consequently it is not stirred up to the expulsion thereof. But from whatsoever cause the suppression of the urine proceeds, if it persevere for some dayes, death is to bee feared, unlesse either a fea∣ver, * 1.192 which may consume the matter of the urine, or a scouring or fluxe, which may divert it, shall happen thereupon. For thus by stay it acquireth an acride and vene∣nate

quality, which flowing by the veines readily infecteth the masse of blood, and carryed to the braine much molests it by reason of that similitude and sympathy of condition which the bladder hath with the Meninges. But nature, if * 1.193 prevalent, easily freeth it selfe from this danger by a manifest evacuation by stoole, otherwise it must necessarily call as it were to its aide, a feavourish heat, which may send the abounding matter of this serous humidity out through the skinne, either by a sensible evacuation as by sweat; because sweate and urine have one common matter: or else disperse and breath it out by transpiration, which is an insensible ex∣cretion.

CHAP. LI. Of bloody Urine.

SOME pisse pure blood, others mixt, and that either with urine, & then * 1.194 that which is expelled resembles the washing of flesh newly killed; or else with pus, or matter, and that either alone or mixed with the urine. There may be divers causes of this symptome, as the too great quantity * 1.195 of blood gathered in the body, which by the suppression of the accustomed & perio∣dicall evacuation, by the courses or haemorrhoids, now turns its course to the reins & bladder; the fretting asunder of some vessell by an acride humour, or the breaking thereof by carrying or lifting of some heavie burden, by leaping, falling from high, a great blow, the falling of some wait upon the loins, riding post too violently, the too immoderate use of venery, & lastly, from any kind of painful & more violent exer∣cise, by a rough & sharp stone in the kidneys, by the weaknesse of the retentive facul∣ty of the kidneys, by a wound of some of the parts belonging to the urine, by the too frequent use of diureticke and hot meats and medicines, or else of things in their whole nature contrary to the urenary parts; for by these and the like causes, the reins are oft times so enflamed, that they necessarily impostumate, and at length the im∣postume being broken it turnes into an ulcer, casting forth quitture by the urine. In so great variety of the causes of bloody urine, we may gather whence the causes of * 1.196 this symptome may arise, by the depraved action of this, or that part, by the condi∣tion of the flowing blood, to wit, pure or mixt, and that either with the urine alone, or with pus. For example, if this bloody matter flow from the lungs, liver, kidneies, dislocated Vertebrae, the streight gut, or other the like part: you may discerne it by the seat of the paine and symptomes, as a feaver; and the propriety of the paine, and other things which have preceded, or are yet present. And we may gather the same by the plenty and quality, for if, for example, the pus flow from an ulcer of the arm, the purulent matter will flow by turnes, one while by the urine, so that little is cast forth by the ulcer; then presently on the contrary the urine becomes more cleere. That purulent matter which flows from the lungs by reason of an Empyema, or from the liver, or any other bowell placed above the midriffe, the pus which is cast forth with the urine, is both in greater plenty and more exactly mixed with the urine, than that which flowes from the kidneyes and bladder. It neither belongs to our purpose, or a Surgeons office, either to undertake, or deliver the cure of this affect. It shall suf∣fice * 1.197 onely to note that the cure of this symptome is not to bee hoped for so long as the cause remaines. And if this blood flow by the opening of a vessell, it shall bee stayed by astringent medicines; if broken, by agglutinative; if corroded or fretted asunder, by sarcoticke.

CHAP. LII. Of the signes of ulcerated Kidneyes.

I Had not determined to follow or particularly handle the causes of bloody urines, yet because that which is occasioned by the ul∣cerated reines or bladder more frequently happens, therefore I have thought good briefly to speake thereof in this place. The signes of an ulcer of the reines are, pain in the loines, matter how∣soever mixt with the urine, never evacuated by it selfe, but alwaies flowing forth with the urine, and residing in the botome of the chamberpot, with a sanious and redde sediment, fleshy and as it were bloody fibres swimming up and * 1.198 downe in the urine, the smell of the filth is not so great as that which flowes from the ulcerated bladder, for that the kidneyes, seeing they are of a fleshy substance, doe farre better ripen and digest the purulent matter than the bladder which is nervous and bloodlesse.

CHAP. LIII. Of the signes of the ulcerated Bladder.

ULCERS are in the bottome of the bladder and the necke thereof. The signes of an ulcer in the bladder are, a deepe paine at the sharebones; * 1.199 the great stinch of the matter flowing therefrom; white and thin skins swimming up and downe in the water. But when the ulcer possesseth the necke of the bladder, the paine is more gentle, neither doth it trou∣ble before the patient come to make water, but in the very making thereof, and a lit∣tle while after.

But it is common both to the one and the other, that the yard is extended in ma∣king of water, to wit, by reason of the paine caused by the urine fretting of the ulce∣rated part in the passage by: neither is the matter seen mixed with the urine, as is u∣suall in an ulcer of the upper parts, because it is powred forth not together with the urine, but after it.

CHAP. LIV. Prognosticks of the ulcerated Reines and Bladder.

ULCERS of the kidneies are more easily and readily healed than those of * 1.200 the bladder; for fleshy parts more speedily heale and knit, than blood∣lesse and nervous parts. Ulcers which are in the bottom of the bladder, are uncurable, or certainely most difficult to heale, for besides that they are in a bloodlesse part, they are daily vellicated and exasperated by the continuall affluxe of the contained urine; for all the urine is never evacuated: now that which remaines after making water, becomes more acride by the distemper and heat of the part, for that the bladder is alwaies gathered about it, & dilated & straitned accor∣ding to the quantity of the conteined urine: therfore in the Ischuria, that is, the sup∣pression or difficulty of making water, you may somtimes see a quart of water made at once. Those which have their legs fall away, having an ulcer in their bladder, are near their deaths. Ulcers arising in these parts, unlesse they be consolidated in a short time, remaine uncureable.

CHAP. LV. What cure must be used in the suppression of the Urine.

IN curing the suppression of the urine, the indication must be taken from the nature of the disease, and cause thereof, if it bee yet present or not. * 1.201 But the diversity of the parts, by which being hurt, the Ischuria hap∣pens, intimates the variety of medicines, neither must we presently run to diuretickes, and things breaking the stone, which many Empericks doe. For hence grievous and maligne symptomes often arise, especially if this sup∣pression * 1.202 proceed from an acride humour, or blood pressed out by a bruise, immo∣derate venery, and all more vehement exercise, a hot and acride potion, as of Can∣tharides, by too long abstaining from making water, by a Phlegmon, or ulcer of the urenary parts. For thus the paine and inflammation are encreased, whence followes a gangrene, & at length death. Wherfore attempt nothing in this case without the ad∣vice of a Physitian, no not when you must come to Surgery. For ••iureticks can scarce have place in another case, than when the urenary passages are obstructed by gravell, * 1.203 or a grosse and viscide humour, or else in some cold countrey, or in the application of Narcoticks to the loines, although we must not here use these before we have first made use of generall medicines: now Diuretickes may be administred sundry waies, as hereafter shall appeare.

℞. agrimon. urtic. parietar. surculos rubros habentis, an. m. i. rad. asparag. mundat. ℥iiii. gran. alkekengi, nu. xx. sem. malvae ℥ss. rad. acor. ℥i. bulliant omnia simul in sex li∣bris aquae dulcis ad tertias, deinde coletur. Let the patient take ℥iiii. hereof with ℥i. of sugar candy, and drinke it warme fasting in a morning, three houres before meat. Thirty or forty Ivie berries beaten in white wine, and given the patient to drink some two houres before meate, are good for the same purpose. Also ʒi. of nettle seeds made into fine pouder and drunke in chicken broth, is good for the same purpose. A decoction also of Grummell, Goats saxifrage, pellitory of the wall, white saxifrage, the rootes of parsley, asparagus, acorus, bruscus, and orris drunke in the quantity of some three or foure ounces, is profitable also for the same purpose. Yet this follow∣ing water is commended above the rest to provoke urine, & open the passages there∣of, from what cause soever the stoppage thereof proceed. ℞. radic. osmund. regal. cyp. * 1.204 bismal. gram. petrosel. foenic. an. ℥ii. raph. crassior. intaleol. ℥iiii. macerentur per noctem in aceto albo acerrimo, bulliant postea in aquae fluvialis lb. x. saxifrag. crist. marin. rub. tinct. milii solis, summitat. malvae, bismal. an. p. ii. berul. cicer. rub. an. p. i. sem. melon. ci∣trul. an. ℥ii. ss. alkekengi, gra. xx. glycyrhiz. ℥i. bulliant omnia simul ad tertias: in cola∣tura infunde per noctem fol. sen. oriental. lb. ss. fiat iterum parva ebullitio, in expressio∣ne colata infunde cinam. elect. ʒvi. colentur; iterum colatura injiciatur in alembicum vitreum, postea tereb. venet. lucid. lb ii. aq. vitae ℥vi. agitentur omnia simul diligentissi∣me. Lutetur alembicum luto sapientiae, fiat destillatio lento igne in balneo mariae. Use it after the following manner. ℞. aq. stillatitiae prescriptae ℥ii. aut iii. Accor∣ding to the operation which it shall performe, let the patient take it foure houres be∣fore meat. Also raddish water destilled in balneo mariae is given in the quantity of ℥iiii. with sugar, and that with good successe. Bathes and semicupia, or halfe bathes artificially made, relaxe, soften, dilate, and open all the body; therefore the prescri∣bed * 1.205 diuretickes mixed with halfe a dram of Treacle may be fitly given at the going forth of the bath. These medicines following are judged fit to cleanse the ulcers of the kidneyes and bladder. Syrupe of maiden haire, of roses, taken in the quantity of ℥i. with hydromel, or barly water: Asses or Goats milke are also much commen∣ded in this affect, because they cleanse the ulcers by their ferous or whayish portion, and agglutinate by their cheeselike. They must bee taken warme from the dugge, with honey of roses or a little salt, lest they corrupt in the stomacke; and that to the quantity of foure ounces, drinking or eating nothing presently upon it. The fol∣lowing Trochisces are also good for the same purpose. ℞. quatuor sem. frigid. major. * 1.206 seminis papaveris albi, portulac. plantag. cydon, myrtil, gum. tragacanth. et arub. pinear.

glycyrrhi. mund. hordei mund. mucag. psilii, amygdal. dulcium, an. ℥i. boli armen. san∣guin. dracon. spodii, rosar. mastich. terra, sigil. myrrhae, an. ℥ii. cum oxymelite, confician∣tur secundum artem trochisci. Let the patient take ʒss. dissolved in whay, ptisan, bar∣ly water, and the like; they may also be profitably dissolved in plantaine water, and injected into the bladder. Let the patient abstaine from wine, and instead thereof let him use barly water, or hydromel, or a ptisan made of an ounce of raisins of the * 1.207 sun, stoned and boyled in five pints of faire water, in an earthen pipkin well leaded, or in a glasse, untill one pinte be consumed, adding thereto of liquorice scraped and beaten ℥i. of the cold seeds likewise beaten two drams. Let it, after it hath boyled a little more, be strayned through an hypocras bagge, with a quarterne of sugar, and two drams of choice cinamon added thereto, and so let it be kept for usuall drinke.

CHAP. LVI. Of the Diabete, or inabilty to hold the Urine.

THe Diabete is a disease, wherein presently after one hath drunke, the u∣rine is presently made in great plenty, by the dissolution of the reten∣tive * 1.208 faculty of the reines, and the depravation of immoderation of the attractive faculty. The externall causes are the unseasonable and immo∣derate use of hot and diureticke things, and all more violent and vehe∣ment * 1.209 exercises. The internall causes are the inflammation of the liver, lungs, spleen, but especially of the kidneyes and bladder. This affect must be diligently distingui∣shed from the excretion of morbifick causes by urine. The loines in this disease are molested with a pricking and biting pain, and there is a continuall & unquenchable thirst: and although this disease proceed from a hot distemper, yet the urine is not co∣loured, * 1.210 red, troubled, or thick, but thin, and white or waterish, by reason the matter * 1.211 thereof makes very small stay in the stomacke, liver, and hollow veine, being pre∣sently drawn away by the heat of the kidneyes or bladder. If the affect long endure, the patient for want of nourishment falleth away, whence certaine death ensues. For the cure of so great a disease, the matter must be purged, which causes or feedes the inflammation or phlegmon, and consequently blood must be let. We must abstain * 1.212 from the foure cold seedes, for although they may profit by their first quality, yet will they hurt by their diuretick faculty. Refrigerating and astringent nourishments must bee used, and such as generate grosse humours, as Rice, thicke and astringent wine mixed with much water. Exceeding cold, yea Narcotick things shall be apply∣ed * 1.213 to the loins, for otherwise by reason of the thickness of the muscles of those parts, the force, unless of exceeding refrigerating things, will not be able to arrive at the reins; of this kind are oile of white poppy, henbain, opium, purslain, and lettuce seed, mandrage vinegar, and the like: of which, cataplasmes, plaisters, and ointments, may be made, fit to corroberate the parts, and correct the heat.

CHAP. LVII. Of the Strangury.

THe Strangury is an affect having some affinity with the Di••be••e, as that wherin the water is unvoluntarily made, but not together at once, but by drops, continually and with paine. The externall causes of a strangury * 1.214 are, the too abundant drinking of cold water, & all too long stay in a cold place. The internall causes are, the defluxion of cold humours into the urenary parts, * 1.215 for hence they are resolved by a certain palsie, and the sphincter of the bladder is re∣laxed, so that he cannot hold his water according to his desire: inflammation also & all distemper causeth this affect, and whatsoever in some sort obstructs the passage of the urine, as clotted blood, thick phlegme, gravell, and the like. And because, ac∣cording to Galens opinion, all sorts of distemper may cause this discase, divers me∣dicines

shall be appointed according to the difference of the distemper. Therfore a∣gainst a cold distemper fomentations shall be provided of a decoction of mallows, * 1.216 roses, origanum, calamint, and the like, & so applied to the privities: then presently after let them be anointed with oile of bayes, and of Castoreum, and the like. Strong and pure wine shall be prescribed for his drinke, and that not onely in this cause, but also when the Strangury happens by the occasion of obstruction, caused by a grosse and cold humor, if so be that the body be not plethoricke. But if inflammation toge∣ther with a Plethora or fulnesse hath caused this affect, wee may, according to Galens advice, heale it by blood-letting. But if obstruction bee in fault, that shall be taken * 1.217 away by diuretickes either hot or cold, according to the condition of the matter ob∣structing. We here omit to speake of the Dysuria, or difficulty of making water, be∣cause the remedies are in generall the same with those which are used in the Ischuria, or suppression of urine.

CHAP. LVIII. Of the Cholike.

WHensoever the Guts being obstructed, or otherwise affected, the excrements are hindred from passing forth, & if the fault bee in the small guts, the affect is termed Volvulus, Ileos, & miserere mei, but if it be in the greate rguts, it is called the Cholick, from the part af∣fected, which is the Colon, that is, the continuity of the grea∣ter * 1.218 guts; but especially that portion of the greater guts, which is properly and especially named Colon, or the cholicke Gut. There∣fore Avicen rightly defines the Cholicke, A paine of the Guts wherein the ex∣crements are difficultly evacuated by the fundament. Paulus Aegineta reduceth all the causes of the Colicke how various soever to foure heads, to wit, to the grosse∣nesse, or toughnesse of the humours impact in the coates of the guts: flatulencies hindred from passage forth: the inflammation of the guts: and lastly, the collection of acride and biting humors. Now we will treat of each of these in particular. Al∣most the same causes produce the grossenesse of humors, and flatulencies in the guts, to wit, the use of flatulent, and phlegmaticke, ••ough, and viscide meats, yea also of such as are of good nourishment, if sundry thereof, and of sundry kinds be eaten at the same meale, and in greater quantity than is fit. For hence crudity and obstructi∣on, and at length the collection of flatulencies, whereon a tensive paine ensues. This kind of Cholick is also caused by the use of crude fruits, and too cold drink, drunken especially when as any is too hot by exercise, or any other way: for thus the sto∣macke and the guts continued thereto, are refrigerated, and the humours and excre∣ments therein conteined are congealed, and, as it were, bound up. The Cholicke * 1.219 which is caused by the inflammation of the kidneyes, happens by the Sympathy of the reines pained or troubled with the stone or gravell conteined in them or the ure∣ters. Therefore then also paine troubles the patient at his hips and loynes, because the nerves, which arising from the vertebrae of the loins, are oppressed by the weight of the stones and gravell, about the joint of the hippe are disseminated into the muscles of the loines and thigh. Also the ureters are pained (for they seeme nothing else but certaine hollow nerves) and also the cremaster muscles, so that the patients testicles may seeme to be drawne upwards with much violence. Hence great, phleg∣maticke, and cholericke vomiting, and sweat of the whole body, all which doe not surcease before that the stone, or gravell shall bee forced downe into the bladder. Now vomiting happens in this affect, for that the ventricle by reason of its continu∣ity and neighbourhood which it hath with the guts, suffers by consent or sympathy. For the stomacke is of the same kind or matter as the guts are, so that the guts seeme nothing else but a certaine production of the stomacke. Therefore if at any time na∣ture endeavour to expell any thing that is troublesome in the kidneyes, ureters, coats * 1.220 of the guts, mesentery, pancreas, and hypochondryes, it causeth a Colicke with pain and vomiting. A hot and dry distemper also causeth the Colicke, producing a prick∣ing

and biting paine by drying the excrements shut up in the guts, as also by wasting as it were the radical humours of that place provided for the lubricating of the guts. Acride, viscide, and tough phlegme causeth the same. There is also another cause of the Collicke which is not so common, to wit, the twining of the guts, that is, when * 1.221 they are so twined, folded, and doubled, that the excrements, as it were, bound in their knots, cannot be expelled, as it manifestly happens in the rupture called Ente∣rocele, by the falling of the guts into the cod. Likewise also wormes generated in the Collicke Gut, whilest that they mutually fold or twine themselves up, doe also twine the Colon it selfe and fold it with them. Also the too long stay of the excre∣ments in the guts, whether it shall happen by the peculiar default of the too hot and dry body of the patient, or by his diet, that is, the use of too dry meats, or exerci∣ses and paines taken in the heate of the sunne, or by the greatnesse of businesse, the minde being carryed away, causeth the Collicke, with headache, and plenty of va∣pours flying upwards.

I remember I once dissected the body of a boy of some twelve yeares old, who * 1.222 had his guts folded with many as it were tyes or knots, of the restrained, too hard & dry excrements, the which he cast out by his mouth a little before his death, which brought him to his end, being not helped in time by fitting medicines. Now these are the causes of the Collick, according to the opinion of the ancient and moderne Physicians, of whose signes I judge it not amisse here to treat in particular. You shall * 1.223 know the patient is troubled with the stone collick by the paine which is fixed and as it were kept in one place, to wit, of the kidnies; by his former manner of life, as, if the patient hath formerly voyded stones or gravell together with his urine; by the paine of the hips and testicles for the formerly mentioned causes, & lastly, by that the pati∣ent casts forth by stoole or urine, for that the great & laborious endeavour of nature to cast forth the stone which is in the kidnies, is propagated by a certaine sympathy, & like study of the neighbouring parts stirring up the expulsive faculties each to his work. The signes of a flatulent collick are, a tensive pain, such as if the guts were rent or torne in pieces, together with a noise or rumbling in the belly. The force of the shut up wind is sometimes so great, that it rendeth or teareth the guts in sunder, no o∣therwise than a swines bladder too hard blown up. Which when it happens, the pati∣ent dyes with much vomiting, because the stomack opprest with wind, can conteine nor imbrace no meat. The collick which is occasioned by the too long keeping in of the excrements, is accompanied with the weight and pain of the belly, the tension of the guts, headach, apparent hardness of the belly, & the complaint of the patient that he hath not gone to stoole in a long time. That which proceeds from a cholerick in∣flammation, yeelds a sense of great heat & pulsation in the midst of the belly, by rea∣son of the veins and arteries which are in the pancreas and coats of the guts, and there are the other signes of a Phlegmon, although also this as it were inflammation may a∣rise also from salt, acride & viscous phlegme, which nature can neither expel upwards by vomit, nor downewards by stool, this sundry times is associated with a difficulty of making water, for that when as the right gut is inflamed the bladder is pressed by reason of their society or neighbourhood. The collick which proceeds from the con∣torsion of the guts shews it selfe by the excessive cruelty of the paine, arising for that the guts are not in their due site and place, and because the excrements by their too long detension acquire a preternaturall heat; & this is the cause of the death of many such as have Ruptures, for that the gut falling down from the naturall place into the Cod, being a preternatural place, is red oubled & kept thereas it were bound, where∣by the excrements being baked becomming more acridly hot cause inflammation, and by raising up flatulencies encrease the distension through all the guts, untill at length a deadly Ileos or collick arising, they come forth at the mouth. For progno∣sticks; it is better to have the paine in the collick to wander up and down, than to be * 1.224 fixed; it is good also that the excrements are not wholly supprest. But the evill signes that here appeare pronounce the affect either difficult or deadly. Now these shew that it is deadly, intolerable tormenting paine, continuall vomiting, cold sweat, cold∣nesse of the extreme parts, hickiting by reason of the sympathy the stomack hath with the guts, a Phrensie by the consent of the braine with the stomacke, and oft-times a

convulsion by drawing the matter into the nerves. But such as have griping and pain about their navil and loines, which can neither be helped by medicine nor otherwise, it ends in a Dropsie. The cure must be diversified according to the variety of the cau∣ses, * 1.225 for the stone collick is cured by medicines proper to the stone; that which is caused by an Enterocele, is cured by the onely restoring the gut to its place; that which is occasioned by wormes, requires medicines fit to kill and cast forth the wormes. But that which proceeds from the weaknesse and refrigeration of the guts and stomack, is cured by neating and strengthening medicines aswell applyed out-wardly as taken in inwardly by the mouth, or otherwaies. The beginning of the cure of that which is occasioned by tough flegme and flatulencies, is by the mitigation of the paine, seeing there is nothing which more dejects the powers than paine. To this * 1.226 purpose shall you provide bathes, Semicupia, fomentations of mallowes, marsh-mal∣lowes, violet leaves, penyroyall, fennell, Origanum, the seeds of time and faenugreek, flowers of camomill, melilore, and other such like, which have power to heat, dry, attenuate, and rarifie the skin, so to dissipate the wind. But all such must be actually hot. Also the belly may be anointed with this following ointment. ℞. olei cham••m. * 1.227 aneth. butyr. recent. an. ℥i. sem. apii, petros. & galang. an. ʒss. aq. vitae, ol. salviaaut thy∣mi chimice extract. q. s. The following liniment is much commended by Hollerius. ℞. olei rut. & nardi, an. ʒvi. galbani cum aq. vit. dissoluti ʒii. liquefactis simul adde Z••be∣taegr. iv. croci, gr. vi. fiat linimentum. Also little bags made with millet, oates and salt fryed with a little white wine in a frying pan, shall be applyed hot upon the belly & flankes, and renewed before they grow cold. You may, in stead of these bags, use oxe * 1.228 bladders halfe filled with a decoction of resolving things; as salt, rosemary, thime, lavander, bay-berries and the like: then inject a glyster being thus made. ℞. quatuor re∣mol. an. m. i. orig. puleg. calamenth. an. m. ss. anisi, carui an. m. ss. flor. aneth. an. p. 1. bulliant in hydromele ad lib. i. in qua dissolve bened. laxat. mellis anthosati, sacc. rub. an. ℥i. olei aneth. & chamaem. an. ℥iss. Let a glyster be made to bee injected at twice; for the guts being stretched out cannot conteine the accustomed dosis of a glyster: also this following glyster is much approved. ℞. vini malvat. & olei nucum, an. ℥iii. aqua vitae, ℥i. olei juniperi, & rut. per quintam essent. extract. an. ʒiii. Let this be injected as hot as the pati∣ent can endure. I have oft-times as by miracle helped intolerable paine caused by the wind collick and phlegme with this glyster. Avicen prescribes a carminative glyster made of hysope, origanum, acorus, aniseeds and English galengall. Let the patient feed upon meats of good juice & easie digestion, as broths made with the yolks of egs, saf∣fron, hot herbes and a nutmeg; let him drink good wine, as Muskedine, or Hypocras made with good wine so to heat the stomack & guts. For in Galens opinion, all win∣dinesse is generated by a remisse heat. But if the pain shall continue, a large Cupping-glasse shall bee applyed to the navill to draw and dissipate the windinesse; the belly shall be bound with strong and broad ligatures, to strengthen the guts, and discusse the matter of flatulencies. The patients taught by nature, use this remedy, whilst none admonishing them, they presse the belly with their hands in the bitternesse of paine. But if the paine cannot be thus appeased, we must come to such medicines as worke * 1.229 by an occult propertie, as the dryed gut of a Wolfe, for a dram thereof made into pouder is given in wine with good successe. That collick which is caused by a cho∣lerick * 1.230 inflammation requires contrary medicines, to wit, bloodletting and a refrige∣rating diet; potions made of Diacatholicon and Cassia dissolved in barley water, al∣so cooling glysters. Avicen prescribes narcoticks, for that being cold, they are con∣trary to the morbi••ick cause which is hot and dry; such are pils of Philonium. Also pils of Hyerapicra in the quantity of ℈iv. with opium and saffron, of each one graine, may be used. Also baths are appointed, made of water wherein mallowes, marsh-mallowes, violet leaves, flowers of white lillies, lettuce, purslaine, have bin boyled, to correct the acrimonie of the cholericke and hot humours, whence the disease and symptome ariseth. That collick which is like to this, and proceeds from salt, acride, thick and tough phlegme, is cured, the humour being first attenuated and diffused, and at length evacuated by medicines taken by the mouth and otherwise according to the prescription of the learned Phisi••ian. But Avicen cures that which is occasio∣ned by the suppression of the hardened excrements, and twining of them by meates

which have an emollient faculty, such as humecting broths, as that which is made of an old cock tired with running, & threshed to death, & so boyled with dill, polypo∣dy and a little salt, untill the flesh fall from the bones; also he useth detergent glysters such as this which followes. ℞. betae, m. i. furfuris, p. i. ficus, nu. x. alth. m. i. fiat de∣coctio a•• lb. i. in qua dissolve nitri & muriae an. ʒii. sacch. rub. ℥i. ol. sesamini, ℥ii. But if the obstruction be more contumacious, you must use more powerfull ones made ex cyclamin. centa••rio, & hiera diacolocinth. ad ʒii. But if the obstruction do notwithstan∣ding remaine, so that the excrements come forth at the mouth, Marianus Sanctus wisheth (by the counsell of many who have so freed themselves from this deadly symptome) to drink three pounds of quicksilver with water onely. For the doubled and as it were twined up gut is unfolded by the weight of the quicksilver, and the * 1.231 excrements are deprest and thrust forth, and the wormes are killed which gave occa∣sion to this affect. John of S. Germaines that most worthy Apothecary hath told me that hee saw a Gentleman who when as hee could not bee freed from the paine of the colliok by any means prescribed by learned Physitians, at length by the coun∣sell of a certaine Germane his friend, drank three ounces of oile of sweet almonds drawne without fire, and mixed with some white wine and pellitory water, and swal∣lowed a leaden bullet besmeared with quicksilver, and that bullet comming present∣ly out by his fundament, he was wholly freed from his collick.

CHAP. LIX. Of Phlebotomie, or Blood-letting.

PHlebotomie is the opening of a veine, evacuating the blood with the rest of the humours; thus Arteriotomie, is the opening of an Artery. * 1.232 The first scope of Phlebotomie is the evacuation of the bloud offen∣ding in quantity, although oft-times, the Physicians intention is to draw forth the blood which offends in quality, or either way by ope∣ning * 1.233 a veine. Repletion which is caused by the quantity is two-fold, the one ad vi∣res, that is, to the strength, the veines being otherwise not very much swelled; this * 1.234 makes men infirme and weake, nature not able to beare this humour, of what kinde soever it be. The other is termed ad vasa, that is, to the vessels, the which is so called comparatively to the plenty of bloud, although the strength may very well away therewith. The vessels are oft-times broke by this kind of repletion, so that the pa∣tient casts and spits up blood, or else evacuats it by the nose, wombe, haemorrhoids, or varices. The repletion which is ad vires is knowne by the heavinesse and weari∣somnesse of the whole body; but that which is ad vasa is perceived by their distensi∣on * 1.235 and fulnesse, both of them stand in neede of evacuation. But bloud is onely to bee let by opening a veine, for five respects: the first is to lessen the abundance of * 1.236 bloud, as in Phlethorick bodies, and those who are troubled with inflammation without any plenitude. The second is for divertion, or revulsion, as when a veine of the right arme is opened to stay the bleeding of the left nosthrile. The third is to allure or draw downe, as when the saphena is opened in the ankle to draw downe the courses in women. The fourth is for alteration or introduction of another quali∣ty, as when in sharpe feavers we open a veine to breathe out that bloud which is hea∣ted in the vessels, and cooling the residue which remaines behind. The fift is to pre∣vent imminent diseases, as when in the Spring and Autumne we draw bloud by ope∣ning a veine in such as are subject to spitting of bloud, the squinancie, pleurisie, fal∣ling sicknesse, apoplexie, madnesse, gout, or in such as are wounded, for to prevent the inflammation which is to be feared. Before bloud letting, if there bee any old excrements in the guts, they shall bee evacuated by a gentle glyster, or suppository, lest the mesaraicke veines should thence draw unto them any impuritie. Bloud must, * 1.237 not be drawne from ancient people unlesse some present necessity require it, lest the native heat which is but languid in them should be brought to extreme debility and their substance decay; neither must any in like sort be taken from children, for feare

of resolving their powers by reason of the tendernesse of their substance, & rareness of their habit. The quantity of bloud which is to be let, must bee considered by the strength of the patient, and greatnesse of the disease: therefore if the patient bee weake, and the disease require large evacuation, it will bee convenient to part the let∣ting of bloud, yea by the interposition of some dayes. The veine of the forehead * 1.238 being opened is good for the paine of the hind part of the head; yet first we foment the part with warme water, that so the skin may be the foster, and the bloud drawne into the veines in greater plenty. In the squinancie the veines which are under the tongue must be opened assant, without putting any ligatures about the neck for feare of strangling. Phlebotomie is necessary in all diseases which stop or hinder the breathing, or take away the voice or speech, as likewise in all contusions by a heavie stroake, or fall from high, in an apoplexie, squinancie, and burning feaver, though the strength be not great, nor the bloud faulty in quantity or quality, bloud must not be let in the height of a fever. Most judge it fit to draw bloud from the veines most remote from the affected and inflamed part, for that thus the course of the humours may be diverted, the next veines on the contrary being opened the humours may be the more drawne into the affected part, and so increase the burden and paine. But this opinion of theirs is very erroneous, for an opened veine alwaies evacuates and disburdens the next part. For I have sundry times opened the veines and arteries of the affected part, as of the hands & feet in the Gout of these parts; of the temples in the Megrim; whereupon the paine alwayes was somewhat asswaged, for that to∣gether with the evacuated bloud, the malignitie of the Gout, and the hot spirits (the causers of the head-ach or Megrim) were evacuated. For thus Galen wisheth to open * 1.239 the arteries of the temples in a great and contumacious defluxion falling upon the eyes, or in the Megrim or head-ach.

CHAP. LX. How to open a veine, and draw bloud from thence.

THE first thing is, to seat or place the patient in as good a posture * 1.240 as you can, to wit, in his bed if he be weak; but in a chaire if strong, yet so, that the light may fall directly upon the veine which you intend to open. Then the Surgeon shall rub the arme with his * 1.241 hand, or a warme linnen cloth, that the bloud may flow the more plenitfully into the vein. Then he shall bind the veine with a liga∣ture * 1.242 a little above the place appointed to be opened, and hee shall draw back the bloud upwards towards the ligature from the lower part; and if it be the right arme, he shall take hold thereof with his left hand, but if the left, then with his right hand, pressing the veine in the meane time with his thumbe a little below the place where you meane to open it, lest it should slip away; and that it may bee the more swolne by forcing up the bloud. Then with his naile hee shall marke or designe the place to be opened, and shall annoint it being so marked with butter or oyle whereby the skin may be relaxed, and the lancet enter more easily, and therefore the section may be the lesse painefull. He shal hold his lancet between his thumb and fore finger, nei∣ther too neer, nor too far from the point; he shall rest his other three fingers upon the patients arme, that so his hand may be the more steddy & lesse trembling. Then shall he open the vein with an incision agreeable to the magnitude of the vessell, & the in∣different thicknesse of the conteined bloud somewhataslant, diligently avoiding the artery which lies under the basilica, & the nerve, or tendon of the two-headed muscle, * 1.243 which lyes under the Median veine. But for the Cephalicke it may be opened with∣out danger. As much bloud as is sufficient being drawne, according to the minde of the Physician, he shall loose the ligature, and laying a little boulster under, hee shall with a ligature bind up the wounded part to stay the bleeding; the ligation shall be * 1.244 neither too strait, nor loose, but so that the patient may freely bend and extend his arme; wherefore whilest that is in doing he must not hold his arme streight out, but gently bended, otherwise he cannot freely bend it.

[illustration]

The figure of a Lancet to let bloud withall.

CHAP. LXI. Of Cupping-glasses, or ventoses.

CUpping-glasses are applyed especially when the matter conjunct and impact in any part is to be evacuated, and then chiefly there is place for * 1.245 sacrification after the cupping-glasses: yet they are also applyed for revulsion and divertion; for when an humour continually flowes down into the eyes, they may be applyed to the shoulders with a great flame, for so they draw more strongly and effectually. They are also applyed under wo∣mens breasts, for to stop the courses flowing too immoderately, but to their thighes for to provoke them. They are also applyed to such as are bit by venemous beasts, as also to parts possessed by a pestiferous Bub•• or Carbuncle, so to draw the poyson from within outwards. For (as Celsus saith) a Cupping-glasse where it is fastned on, if the skin be first scarified, drawes forth bloud, but if it bee whole, then it draws spi∣rit. * 1.246 Also they are applyed to the belly, when any grosse or thick windinesse, shut up in the guts, or membraines of the muscles of the Epiga••trium, or lower belly causing the Collick, is to bee discussed. Also they are fastned to the Hypocondry's, when as flatulency in the liver, or spleene swels up the entraile lying thereunder, or in too great a bleeding at the nose. Also they are set against the Reines in the bottome of the belly, whereas the ureters run downe to draw downe the stone into the bladder, when as it stops in the middle or entrance of the ureter. You shall make choice of greater and lesser Cupping-glasses according to the condition of the part, and the conteined matter. But to those parts whereto these cannot by reason of their great∣nesse be applyed, you may fit hornes for the same purpose.

[illustration]

The figures of Cupping-glasses of different bignesse, with little holes in their bottomes, which shall be stopped with waxe when you apply them to the part; but opened when you would take them off, that so the aire may enter in with the more ease.

[illustration]

A Lancet.

[illustration]

Hornes which without fire, by onely sucking at the upper hole, draw from the part lying under them.

CHAP. LXII. Of Leaches, and their use.

IN those parts of the body whereto Cupping-glasses and hornes cannot be applyed, to those Leaches may for the most part be put, as to the fun∣dament * 1.247 to open the coat of the haemorrhoide veines, to the mouth of the wombe, the gums, lips, nose, fingers. After the Leach being filled with bloud shal fal off, if the disease require a large evacuation of bloud, and the part affected may endure it, Cupping-glasses, or hornes, or other Leaches shall be substituted. If the Leaches bee handled with the bare hand, they are angred, and become so stomackfull as that they will not bite; wherefore you shall hold them * 1.248 in a white & clean linnen cloath, & apply them to the skin, being first lightly scarifi∣ed, or besmeared with the bloud of some other creature, for thus they will take hold of the flesh, together with the skin more greedily & fully. To cause them fall off you * 1.249 shall put some powder of Aloes, salt or ashes upon their heads. If any desire to know how much bloud they have drawne, let him sprinkle them with salt made in∣to powder, as soone as they are come off, for thus they will vomit up what bloud so∣ever they have sucked. If you desire they should sucke more bloud than they are a∣ble to containe, cut off their tailes as they suck, for thus they will make no end of sucking, for that it runs out as they suck it. The Leaches by sucking draw the bloud not onely from the affected part whereto they are applyed, but also from the adja∣cent and distant parts. Also sometimes the part bleeds a good while after the Lea∣ches be fallen away, which happens not by scarification after the application of Cupping-glasses or hornes. If you cannot stop the bleeding after the falling away of the Leaches, then presse the halfe of a beane upon the wound, untill it stick of it self, for thus it will stay; also a burnt rag may be fitly applyed with a little boulster and fit ligature.

The end of the seventeenth Booke.

Notes

• * 1.1

  Gal. c. 2. lib. 1. de comp. med. secur∣locos.
• * 1.2

  The cause.
• * 1.3

  What Alopecia uncurable. What curable, and how.
• * 1.4

  Lib. 1. de comp. med. sect. locos.
• * 1.5

  Cap. 8. lib. citati.
• * 1.6

  The cure.
• * 1.7

  For a scaly scall.
• * 1.8

  An oyntment for a scalled head.
• * 1.9

  The cure of a crusty scall.
• * 1.10

  A poultis of Cresses.
• * 1.11

  Lib. 7. simpl.
• * 1.12

  A plaister to pluck away the haire at once,
• * 1.13

  The cure of an ulcerous scall.
• * 1.14

  A contumaci∣ous scall must be cured as we cure the Lues Venerea.
• * 1.15

  What the Verti∣go is, and the causes thereof.
• * 1.16

  The signe••.
• * 1.17

  Lib. 6.
• * 1.18

  A criticall Ver∣tigo.
• * 1.19

  The differen∣ces.
• * 1.20

  In what kind of Megrim the o∣pening of an Artery is good.
• * 1.21

  A historie.
• * 1.22

  No danger in opening an ar∣tery.
• * 1.23

  Differences.
• * 1.24

  Paul. Aegin. lib. 8. cap. 6.
• * 1.25

  The cause.
• * 1.26

  The cure.
• * 1.27

  Paulus Aegin. lib. 6. cap. 10.
• * 1.28

  The cure.
• * 1.29

  Ectropion, or the turning up or out of the Eye-lid.
• * 1.30

  Paul. cap. 16. lib. 6.
• * 1.31

  The cure.
• * 1.32

  What Hyda∣tis is.
• * 1.33

  Com. ad aphor. 55. sect. 7.
• * 1.34

  The cure.
• * 1.35

  Paulus cap. 15. lib. 6.
• * 1.36

  The cause.
• * 1.37

  The cure.
• * 1.38

  A disease sub∣ject to relapse.
• * 1.39

  A detergent collyrium.
• * 1.40

  You need not feare to use a∣cride medi∣cines in the it∣ching of the eye-lids. Lib. 2. cap. 4. fract. 3.
• * 1.41

  What lippitudo is.
• * 1.42

  A Collyrium of vitrioll to stay the defluxions of the eyes.
• * 1.43

  What Ophthal∣mia is, and the causes thereof.
• * 1.44

  Signes.
• * 1.45

  The cure.
• * 1.46

  Com. ad aphor. 31. sect. 6.
• * 1.47

  Lib. 13. meth. cap. ult.
• * 1.48

  An percussive medicine.
• * 1.49

  Astringent em∣plasters.
• * 1.50

  An anodine ca∣taplasme.
• * 1.51

  The efficacy of Bathes in pains of the eyes. Adaphor. sect. 7.
• * 1.52

  Detergent Col∣llicia.
• * 1.53

  The cause.
• * 1.54

  The cure.
• * 1.55

  The Atrophia of the eye.
• * 1.56

  The Phihisis thereof. Lib. 3. cap. 22.
• * 1.57

  The •…•…sis. Paulus li. 3. cap.
• * 1.58

  What Web cu∣rable, and what incurable.
• * 1.59

  The cure.
• * 1.60

  The cutting of the Web.
• * 1.61

  The use of the glandule at the greater corner of the eye.
• * 1.62

  The differen∣ces.
• * 1.63

  Periodicall and Typicall Fi∣stulaes.
• * 1.64

  The cure.
• * 1.65

  The efficacy of an actuall cau∣tery.
• * 1.66

  Things to be done after the cauterizing.
• * 1.67

  What a Staphi∣loma is, and the causes thereof?
• * 1.68

  Paulus and Aetim.
• * 1.69

  Every Staphilo∣ma infers incu∣rable blindness.
• * 1.70

  The cause.
• * 1.71

  Lib. 4. method. cap. ult.
• * 1.72

  The cause.
• * 1.73

  The cure.
• * 1.74

  A digesting Cataplasme.
• * 1.75

  A Cataract.
• * 1.76

  The differen∣ces.
• * 1.77

  Causes.
• * 1.78

  Signes.
• * 1.79

  Diet for such as are troubled with a Cata∣ract.
• * 1.80

  Bread seasoned with fennell seeds.
• * 1.81

  How bright shi∣ning things may dissipart a be∣ginning Cata∣ract.
• * 1.82

  A Collyrium dis∣sipating a begin∣ning Cataract.
• * 1.83

  A Cataract must not be couched unless it be ripe.
• * 1.84

  Uncurable Ca∣taracts.
• * 1.85

  Curable Ca∣taracts.
• * 1.86

  When to couch a Cataract.
• * 1.87

  The place
• * 1.88

  The needle
• * 1.89

  Gal. lib. 10. de usts partium. cap. 5. Cels. lib. 7.
• * 1.90

  The signe of a Cataract well couched.
• * 1.91

  Lib. 6. cap. 21.
• * 1.92

  What to be done after the couching of a Cataract.
• * 1.93

  Of a Cataract which is broken to pieces.
• * 1.94

  The cause.
• * 1.95

  The cure.
• * 1.96

  The concussive force of snee∣sing.
• * 1.97

  The cure diffe∣rent according to the places where they sticke.
• * 1.98

  The Tooth ach a most cruell paine.
• * 1.99

  The cause thereof.
• * 1.100

  Signes of this or that de∣fluxion.
• * 1.101

  Three scopes of curing.
• * 1.102

  A cold & reper∣cussive lotion for the mouth.
• * 1.103

  Trochisces for a hot defluxion.
• * 1.104

  Narcoticks.
• * 1.105

  Hot fumes.
• * 1.106

  Vesicatories.
• * 1.107

  Causticks.
• * 1.108

  Causes of loos∣nesse of the teeth.
• * 1.109

  A History.
• * 1.110

  The causes of hollow teeth.
• * 1.111

  The cure.
• * 1.112

  Causes of wormes in the teeth.
• * 1.113

  Causes of set∣ting the teeth an edge.
• * 1.114

  A caveat in drawing of teeth.
• * 1.115

  Lib. 7. cap. 18.
• * 1.116

  The maner of drawing teeth.
• * 1.117

  What to be done when the tooth is plukt out.
• * 1.118

  Causes of foule or rusty teeth.
• * 1.119

  The cure.
• * 1.120

  A caution in the use of a∣cride things.
• * 1.121

  A water to whi∣ten the teeth.
• * 1.122

  The cause of being tongue∣tied.
• * 1.123

  The cure.
• * 1.124

  Another way to cut it.
• * 1.125

  The differen∣ces.
• * 1.126

  The cure of nailes running into the flesh of the fingers.
• * 1.127

  How to take off the cornes of the fingers.
• * 1.128

  The cause.
• * 1.129

  The cure.
• * 1.130

  The causes.
• * 1.131

  The cure.
• * 1.132

  The cause.
• * 1.133

  The cure.
• * 1.134

  Such as are borne without a ho•…•… their fund•…•… are not long lived.
• * 1.135

  Why children are subject to the stone in the bladder.
• * 1.136

  The cause.
• * 1.137

  Why the thigh i•…•… ••umme in the stone of the reines.
• * 1.138

  Signes of the stone in the bladder.
• * 1.139

  Why such as have a stone in the bladder are troubled with the falling of the fundament.
• * 1.140

  How to sear••n for the stonein the bladder with a Cathaeter.
• * 1.141

  The figure of the necke of the bladder is different in men and women.
• * 1.142

  How death may ensue by the suppression of the urine.
• * 1.143

  Why stones of the kidneys have sundry shapes.
• * 1.144

  Why men are more subject to to the stone than women.
• * 1.145

  What stones ca•…•… ta∣ken out of the bladdes with∣out killing the patient.
• * 1.146

  What diet such must use as fear the stone.
• * 1.147

  Lib. 13. method.
• * 1.148

  A lenitive and lubricating syrupe.
• * 1.149

  A diuretick Apoz••me.
• * 1.150

  A di••••etick and •…•…h.
• * 1.151

  A diu••etick powder.
• * 1.152

  The lye made of the ashes of beane stalkes a diu••etick. Anodine gli∣sters in the stone.
• * 1.153

  Remedies a∣gainst the stone of the kidnies comming from a cold cause.
• * 1.154

  Carminative glisters.
• * 1.155

  Signes of the stone stopping in the ureter.
• * 1.156

  Remedies 〈…〉〈…〉 force ••own the stone sticking in the ureter.
• * 1.157

  A decoction for a bath.
• * 1.158

  An Anodine Cataplasme.
• * 1.159

  Signes of the stone fallen out of the ureter in∣to the bladder.
• * 1.160

  When the yard may besafely cut.
• * 1.161

  An agglutina∣tive medicine.
• * 1.162

  how to hasten the agglutina∣tion.
• * 1.163

  Why the boy must be shaken before cutting.
• * 1.164

  How to place the child be∣fore dissection.
• * 1.165

  Where to divide the perinaeum.
• * 1.166

  Nature very powerfull in children.
• * 1.167

  Generall rules must be redu∣ced to particu∣lar bodies.
• * 1.168

  What to bee done before dissection.
• * 1.169

  How to lay the patient.
• * 1.170

  Why the probe must be ••it on the out-side.
• * 1.171

  Why the s••ame of the perinaeum must not be cut.
• * 1.172

  Where to make the wound to take forth the stone.
• * 1.173

  That which is torne is sooner healed than that which is cut.
• * 1.174

  A note of more stones than one.
• * 1.175

  How to cleanse the bladder.
• * 1.176

  How to break a stone that can∣not be taken out whole and at once.
• * 1.177

  Of sewing the wound when the stone is ta∣ken forth.
• * 1.178

  A repercussive medicine.
• * 1.179

  Remedies for the Cod, lest it gangrenate.
• * 1.180

  What things hasten the union.
• * 1.181

  How to make a fresh wound of an old ulcer.
• * 1.182

  What to doe in want of a stay.
• * 1.183

  How to search for the stone in women.
• * 1.184

  In suppression of the urine we must not pre∣sently fly to diureticks.
• * 1.185

  Why the too long holding the urine cau∣seth the sup∣pression therof.
• * 1.186

  A history.
• * 1.187

  A history.
• * 1.188

  A history.
• * 1.189

  How the pus may flow from the wounded arme, by the urine and ex∣crements.
• * 1.190

  〈◊〉〈◊〉. de ••ac. affect. •• cap. 4.
• * 1.191

  Why the dislo∣cation of a ver∣tebra of the loins may cause a suppression of urine.
• * 1.192

  Why the sup∣pression of the urine becomes deadly.
• * 1.193

  A feaver fol∣lowing thereon helps the sup∣pression of u∣rine.
• * 1.194

  The differences
• * 1.195

  Causes.
• * 1.196

  Signes of what causes they proceed.
• * 1.197

  Cure.
• * 1.198

  Why the mat∣ter which flows from the kid∣neyes is lesse stinking than that which flowes from the bladder.
• * 1.199

  Differences.
• * 1.200

  Why ulcers of the bladder are cured with more difficulty.
• * 1.201

  Scopes of cu∣ring.
• * 1.202

  To what sup∣pression of the urine diureticks must not be u∣sed.
• * 1.203

  To which and when to be u∣sed.
• * 1.204

  A diureticke water.
• * 1.205

  Why the use of diuretickes is better after bathing. To cleanse the ulcers of the kidneyes and bladder.
• * 1.206

  Trochisces to heale the ulcers of the kidneies.
• * 1.207

  Drinke in stead of wine.
• * 1.208

  What Diabete is.
• * 1.209

  The causes.
• * 1.210

  Signes.
• * 1.211

  Why the urines are watrish.
• * 1.212

  The cure.
• * 1.213

  Narcoticke things to be applyed to the loines.
• * 1.214

  What the Strangury is.
• * 1.215

  The causes.
• * 1.216

  Com. ad aphor. 15. sect. 3.
• * 1.217

  Adaphor. 48. sect. 7.
• * 1.218

  What Ileos, or iliaca pass••o is. What 〈◊〉〈◊〉 passio or the Cholick••••s. Lib. 3. Lib. 3. c. 43.
• * 1.219

  The manner of the Stone chol∣licke.
• * 1.220

  How a hot di∣stemper cau∣seth the Cholicke.
• * 1.221

  The folding of the guts the cause of the collick.
• * 1.222

  A history.
• * 1.223

  Signs whereby we know that the collic•• pro∣ceeds from this or that cause.
• * 1.224

  Avicen li. 3. Hip. aphor. 10. sect. 4.
• * 1.225

  The cure.
• * 1.226

  Baths and ano∣dine fomenta∣tions.
• * 1.227

  An oyntment.
• * 1.228

  Why glysters in the col••ick must be given in lesse quan∣tity.
• * 1.229

  Specifick medi∣cines.
• * 1.230

  The cure of a cholerick col∣lick.
• * 1.231

  The force of quicksilver in the unfolding of the guts. A history.
• * 1.232

  What Phlebo∣to••ie is.
• * 1.233

  The•…•….
• * 1.234

  Repl••tion twofold.
• * 1.235

  The signes.
• * 1.236

  〈◊〉〈◊〉 scopes in letting blood.
• * 1.237

  From whom we must not draw blood.
• * 1.238

  When and for what it is neces∣sary.
• * 1.239

  13. meth. cap. ul••.
• * 1.240

  How to place the patient.
• * 1.241

  Rubbing the arme.
• * 1.242

  Binding it be∣fore we open the veine.
• * 1.243

  Why the basilica & median may not be opened so safely as the cephalick.
• * 1.244

  The bindingup after blood-let∣ting.
• * 1.245

  The use of cup∣ping-glasses.
• * 1.246

  Lib. 2. cap. 1.
• * 1.247

  The use of Leaches.
• * 1.248

  How to apply them.
• * 1.249

  How to cause them to fall off.