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

CHAP. XXII. Of Indications.

THe knowledge and exercise of Indications befits that Chirurgion, whom no blinde rashnesse of fortune, but reason; no chance, but counsell directs * 1.1 in the undertaking and performing the workes of his Art. For an Indica∣tion is a certaine safe and short way, which leades the Physition, as by the hand, to the attainement of his purposed end, of preserving the sound, or curing the sicke.

For Galen doth define an Indication to be a certaine insinuation of what is to be done, * 1.2 or a quick & judicious apprehension of that which may profit or hurt. And as Faulco∣ners,

Mariners, Plowmen, Soldiers, & all manner of Artizans, have their peculiar termes and words, which are neither knowne, nor used by the vulgar; so this word Indicati∣on is proper and peculiar to Philisitions and Chirurgeons, as a Terme of Arte not vulgar; by consideration of which, as by some signe, or secret token, they are admo∣nished what is to be done to restore health, or repell an imminent danger.

There are three prime and principall kinds of Indications, every of which is subdi∣vided * 1.3 into many other. The first is from things naturall. The second from these things which are termed not naturall. The third from those things which are contrary to na∣ture. Things naturall shew they must be preserved by their like, and in the compasse of these are contained all the Indications which are drawne from the nature of the Patient, that is, from his strength, temper, age, sexe, habit, custome, diet.

Things not naturall may be doubted as uncertaine, for one while they indicate the same things with things naturall, that is, they coindicate with the strength, temper and the rest; otherwhiles they consent with things against nature, that is, they coindi∣cate * 1.4 with the disease. Wherfore Galen when he saith, that Indications are drawn from three things; The disease; The nature of the Patient, and the encompassing aire, by proposing the familiar example of the aire, hee would have us to understand the o∣ther things not naturall; because wee may shun, or embrace them more or lesse as we will our selves, but we must, whether we will or no, endure the present state of the aire. Therefore the aire indicates something to us, or rather coindicates; for if it nourish the disease, as conspiring with it, it will indicate the same that the disease, that is, that it must be preserved in the same state.

Things contrary to nature indicate they must be taken a way by their contraries; * 1.5 Therefore that we may more accurately and fully handle all the Indications drawne from things naturall, we must note, that some of these are concerning the strength of the Patient, by care to preserve which, we are often compelled for a time to forsake the cure of the proper disease: for so a great shaking happening at the beginning of an ague or feaver, we are often forced to give sustenance to the Patient, to strengthen the powers shaken by the vehemency of the shaking, which thing notwithstanding lengthens both the generall and particular fitts of the ague. Other pertaine to the temper, other respect the habite, if the Patient be slender, if fat, if well flesht, if of a rare, or dense constitution of body. Other respect the condition of the part affected in substance, consistence, softnesse, hardnesse, quicke or dull sense, forme, figure, mag∣nitude, site, connexion, principallity, service, function and use, From all these, as from notes the skilfull Chirurgion will draw Indications according to the time and part affected: for the same things are not fit for sore eyes, which were conveni∣ent for the eares, neither doth a Phlegmon in the jawes and throat admit the same forme of cure, as it doth in other parts of the body. For none can there outwardly apply repercussives, without present danger of suffocation. So there is no use of re∣precussives * 1.6 in defluxions of those parts which in site are neere the principall. Nei∣ther must thou cure a wounded Nerve and Muscle, after one manner. The tempe∣rature of a part, as Moisture, alwayes indicates its preservation, although the disease be moist and give Indication of drying, as an ulcer. The principallity of a part al∣wayes insinuates an Indication of astringent things, although the disease require dissolving, as an Obstruction of the Liver; for otherwise unlesse you mixe astringent things with dissolving, you will so dissolve the strength of the part, that hereafter it cannot suffice for sanguification. If the texture of a part be rare, it shewes it is lesse apt, or prone to obstruction; if dense, it is more abnoxious to that disease; hence it is that the Liver is oftener obstructed than the Spleene. If the part be scituate more deepe, or remote, it indicates the medicines must be more vigorous and liquid, that they may send their force so farre. The sensiblenesse, or quicke-sense of the part, gives Iudication of milder medicines, than paradventur the signes, or notes of a great disease require. For the Phisition which applies things equally sharpe to the Horny tunicle of the eye being ulcerated, and to the Legge, must needs be accounted either * 1.7 cruell, or ignorant. Each sexe and Age hath its Indications, for some diseases are curable in youth, which we must not hope to cure in old age; for hoarsenesse and great distillations in very old men, admit no digestion, as Hippocrates saith; * 1.8

Nunquam decrepitus Branchum coquit, atque Coryzam.

The feeble Sire, for age that hardly goes, Ne're well digests, the hurtfull Rheume or pose.

Moreover according to his decree the diseases of the Reines, and whatsoever paines molest the bladder, are difficultly healed in old men; and also reason per∣swades that a Quartaine admits no cure in Winter, and scarse a Quotidian, and * 1.9 ulcers in like manner are more hard to heale in Winter; that hence we may under∣stand certaine Indications to be drawne from time; and to increase the credit of the variety and certainty of Indications, some certaine time, and seasons in those times command us to make choise of Medicines; for as Hipocrates testifies; * 1.10

Ad Canis ardorem facilis purgatio non est.

In Dogdayes heat it is not good, By purging for to clense the blood.

Neither shalt thou so well prescribe a slender diet in Winter, as in the Spring, for the aire hath its Indications. For experience teaches us, that wounds of the head are farre more difficultly and hardly cured, at Rome, Naples, and Rochell in Xan∣toigne. But the times of diseases yeeld the principall Indications, for some Medi∣cines are onely to be used at the beginning and end of diseases, others at the encrease and vigour of the disease. We must not contemne those Indications which are drawn * 1.11 from the vocation of life, and manner of Diet; for you must otherwise deale with the painfull Husbandman (when he is your Patient) which leades his life sparingly and hardly, than with the Citizen who lives daintily and idlely. To this manner of life and Diet may be referred a certaine secrt and occult property, by which many * 1.12 are not onely ready to vomite at eating of some meats, but tremble over all their bodyes when they heare them but spoken of. I knew a prime Nobleman of the French Nobility, who was so perplext at the serving in of an Eele to the Table, at the middst of dinner & amongst his friends, that he fell into a swound, all his powers failing him. Galen in his booke de Consuetudine tells that Arius the Peripateticke died sodainly, because compelled by the advise of those Physitions he used, he dranke a great draught of cold water in the intollerable heat of a Feaver. For no other reason saith Galen, than that, because he knowing he had naturally a cold stomacke from his childhood, perpetually abstained from cold water.

For as much as belongs to Indications taken from things against nature; the Length * 1.13 and depth of a wound or ulcer indicates one way; the figure cornered, round, equall and smooth, unequall and rough, with a hollownesse straight or winding, indicate o∣therwise; the site right, left, upper, lower in an other manner, and otherwise the force and violence of antecedent and conjunct causes. For oftentimes the condition of the cause indicates contrary to the disease, as when abundance of cold and grosse humors cause and nourish a Feaver. So also a Symptome often indicates contrary to the disease, in which contradiction, that Indication must be most esteemed, which doth most urge; as for example sake, if swounding happen in a Feaver, the feaverish burning shall not hinder us from giving wine to the Patient.

Wherefore these Indications are the Principallest and most noble which leade us, as by the hand, to doe these things which pertaine to the cure, prevention and miti∣gating of diseases. But if any object, that so curious a search of so many Indications is to no purpose, because there are many Chirurgions, which setting onely one be∣fore their eyes, which is drawne from the Essence of the disease, have the report and * 1.14 famce of skillfull Chirurgions, in the opinion of the vulgar; but let him know that it doth not therefore follow, that, this indication is sufficient for the cure of all disea∣ses; for we doe not alwayes follow that which the Essence of the disease doth indi∣cate to be done. But chiefly then, where none of the fore-recited Indications doth resist or gainesay; you may understand this by the example of a Plethora, which by the Indication drawne from the Essence of the thing requires Phlebotomy; yet who

is it, that will draw blood from a child of three monethes old? Besides, such an Indi∣cation is not artificiall but common to the Chirurgion with the common people. For who is it that is ignorant, that contraries are the remedies of contraries? and that broken bones must be united by joyning them together? but how it must be perfor∣med and done, this is of Arte and peculiar to a Chirurgion, and not knowne to the vulgar. Which the Indications drawn from those fountaines we pointed at before, aboundantly teaches, which, as by certaine limits of circumstances, encompasse the Indication which is taken from the Essence of the disease, lest any should thinke, we must trust to that onely. For there is some great and principall matter in it, but not all. For so the meanest of the common people is not ignorant, that the solution of continuity is to be cured by repairing that which is lost. But in what parts we may * 1.15 hope for restitution of the lost substance, and in which not, is the part of a skilfull Chirurgion to know and pronounce. Wherefore hee will not vainly bestow his labour to cure the Nervous part of the Diaphragma, or Midriffe being wounded, or the Heart, small Gutts, Lungs, Liver, Stomacke, braine or bladder; and that, I may speake in a word, Emperickes are not much more skilfull than the common people, although they do so much extoll themselves above others by the name of experience. For although experience be another instrument to find out things with reason, yet * 1.16 without reason, it will never teach, what the substance of the part in which the disease lyes, may be; or what the action, use, site, connexion, from whence speciall and proper Indications are drawne; With which the Chirurgion being provided and instructed shall not onely know by what meanes to finde out a remedye, but also, lest he may seeme to mocke any with vaine promises, he shall discerne what diseases are uncure∣able, and therefore not to be medled withall.

But implicite, or intricate diseases require each to be cured in their severall order, * 1.17 except some one of them be desperate, or so urge and presse that the Physition think it necessary after a preposterous order, to begin with it, although often he be forcedto make some one of these diseases incureable, or give occasion of causing some new one, into which straits we are necessarily compelled to fall, when, (for example) we deter∣mine to pull, or take away some extraneous body; for the performance whereof we are compelled to enlarge the wound. So we are forced by necessitie to open the necke of the bladder, (that so we may draw forth the stone therein contained) with a wound which often degenerates into an uncurable Fistula. For that disease which threatens danger of present death is of such moment, that to shun that, it may be counted a smal matter, and commodious for the sicke to bring in other diseases, though uncureable. For if a convulsion happen by pricking a Nerve which we cannot heale by any re∣medies, then by cutting the Nerve asunder wee end the convulsion, but deprive the part into which that Nerve did goe, of the use of some voluntary motion. So if in any great joynt there happen a Luxation with a wound, because there is danger of convulsion by trying to restore and set right the Luxated part, wee are forcte for shunning thereof, to attend the wound onely, and in the meane time to let alone the Luxation. Otherwise in implicite diseases if there be nothing which may urge, or call us from the ordinary cure, we must observe this order, that beginning with that af∣fect, which hinders the cure of the principall disease, we prosecute the rest in the same and their proper order, untill all the diseases being overcome we shall restore the part affected to its integrity. Therefore let us take for an example, an ulcer in the Leg, a * 1.18 Varix (or big swollen veine) and a Phlegmonous tumor round about it; and lastly, a body wholy plethoricke and filled with ill humors; order and reason require this, that using the advise of some learned Physition we prescribe a convenient diet, and by what meanes we may, bring him to an equality by purging and blood-letting, and then we will scarifie in divers places the part where it is most swollen, then presently apply Leaches that so we may free it from the burden of the conjunct matter; then use Cauteryes to helpe the corruption of the bone, and in the meane time change the circular figure of the ulcer into an ovall, or triangular; then at the length we will un∣dertake the cutting of the Varix, and cure the ulcer which remaines according to Arte, and so at the length cicatrize it. In all this whole time the Patient shall neither walke, nor stand, nor sit, but lye quietly, having his Leg orderly and decently rowled up. But

if (as it often happens) the temper of the hurt part, be different from the temper of the whole body, the manner of curing must be so tempered, that we increase the * 1.19 Dosis of hot or Cold medicines, according to the ratable proportion of the Indica∣tions requiring this, or that. Therefore imagine the part ulcerated to be such, as that it is two degrees dryer than the just temper; but the whole body to exceed the same temper in one degree of humidity: reason and Arte will require, that the medicine applyed to the ulcer be dryer by one degree than that which the part would other-wise require if it were temperate; but on the contrary let us suppose thus. The whole body to be one degree more moist than the temper requires, & the ulcerated part to be one degree dryer, truly in this case the medicine that is applyed to the ulcer by reason of the part it selfe, shall not be encreased in drynesse, but wholy composed and tempe∣red to the Indication of the ulcer, because the force of the moisture exceeding in the like degree, doth counterpoise the superfluous degree of drynesse. But it is more easie by an artificiall conjecture to determine of all such things, than by any rules or * 1.20 precepts.

To these so many and various Indications, I thinke good to add two other; the One from similitude; the Other of a certaine crafty device, and as the latter Physitions terme it, of a certaine subtile stratageme. We draw Indication from similitude, in diseases which newly spring up and arise, as which cannot be cured by Indications * 1.21 drawne from their contraries, as long as their Essence is unknowne and hid; wherfore they thinke it necessary to cure them by a way and Arte like those diseases, with which they seeme to have an agreeing similitude of Symptomes and Accidents; Our Ancestors did the same in curing the French Pockes, at the first beginning thereof, as long as they assimulated the cure to that of the Leprosie, by reason of that affinity, which both the diseases seeme to have. But we follow crafty devices and subtile coun∣sells, * 1.22 when the Essence of the disease wee meet with is wholy secret and hid, either because it is altogether of a hidden and secret nature, and which cannot be unfolded by manifest qualities, or else resides in a subject which is not sufficiently knowne to us, nor of a Physicall contemplation, as the Minde. For then we being destitute of Indications taken from the nature of the thing, are compelled to turne our cogitations to impostures and crafty counsells; and they say this Arte and Craft is of cheife use in Melancholy affects and fictions, which are often more monstrous and deformed than the Chimera so much mentioned in the fables of the Ancients; to which purpose, I will not thinke much to recite two Examples. A certaine man troubled with a Melan∣cholike * 1.23 disease, I know not by what errour of opinion, had strongly perswaded himself that he was without a head; the Physitions omitted nothing, by which they might hope to take this madd opinion out of his minde. But when they had in vaine tryed all medicines, at length they devised this crafty, but profitable device, they fastened and put upon his head a most heavy helmet, that so by the paine and trouble of his head nodding and drawne downe by that weight, he might be admonished of his error.

It is reported, another molested by the obscurity and darknesse of the same disease, did verily beleeve, that he had hornes upon his head; neither could he be drawne or diverted from that absurd and monstrous opinion, untill that binding up his eyes, they miserablely bruised and scratched his forehead with the bony roughnesse of the lower parts of an oxes hornes, that so he begun to beleeve by the painefull drawing of the blood that ran downe his face, that those bloody hornes, were forciblely plucked from him. Ingenious Chirurgions in imitation of these examples may in like cases doe the * 1.24 like. For that case requires a man of a quicke apprehension and advice, who may give manifest proofe of his diligence and skill by medicinall stratagems, as who forth∣with can politikly device stratagems of divers sorts.

But, now comming to the end of this our tract of Indications, we must cheifly and * 1.25 principally observe; That of Indications some are Indicative; which absolutely and of themselves command this to be done; other coindicative, which indicate the same with the Indicative, and joyntly shew it to be done, but in some sort secun∣darily * 1.26 and not primitively; some are repugnant, which of themselves and their owne nature perswade quite contrary to that the indicative primitively did; or which dis∣swade * 1.27 us from doing that, to performe which the indicative did perswade us; other

correpugnant, which give their voyce after the same forme and manner with the re∣pugnant * 1.28 against the indicative, as the coindicative consent to and maintaine them. Let this serve for an example of them all.

A Plethora, or plenitude of humors of its owne nature, requires and indicates blood-letting, the Spring-time perswades and coindicates the same, but to this counsell is quite opposite and repugnant, a weake faculty, and childhood is correpugnant.

Wherefore these foure must be diligently waighed and considered when we deli∣berate what is to be done, and we must rather follow that which the indicative, or repugnant shew and declare, as what the disease and strength of the Patient require, than that which the coindicative, or correpugnant shall perswade, becausethey have a weaker and but secundary power of indicating, and not essentiall and primitive. But because the kinds of Indications are so many and divers, therfore that the knowledge of them may be more perspicuous and lesse confused, I have thought good to describe and distinguish them by this following scheme.

A Table of Indications.

• An Indication is a certaine plaine and compendious way which leades the Chirurgion to a certaine, de∣terminate and proposed end for the cure of the present disease; of which there are 3. kinds,
  • The first is drawne from things natural which in∣dicate their preservation by their like; of this kind are many other which are drawne, either
    • From the strength and faculties of the patient.
      • For whose preservation, oftentimes the proper cure of the disease must be neglected; for where these faile, it is impossible the Chirurgion should per∣forme what he desires and expects.
    • From the tēpera∣ment, as if the Patient shall be—
      • Sanguine,
      • Cholericke,
      • Flegmaticke
        • Of preservatiō of which the Chi∣rurgion must have care, and if they swarve from equallitie, to reduce them to that which for∣merly they naturally were.
      • Melancholicke
    • From the habite of the body, as the patient shall be
      • Dainty and delicate,
      • Slender and weake.
      • Low of stature.
      • Rare, or else dense and compacte.
    • From the native condition of the hurt or affected part, in which we cōsider, either
      • The substance therof, as for as much as it is simular' we connider whether it be hot, cold, moist, dry, or as it is organicall, and then whether it be a principall and noble part, or a subordinate and ignoble part.
      • Or, the sense whether quicke, or dull, by reason wherof the eye cannot endure such sharpe & acrids medicines, as simple flesh can.
      • Or the forme, figure, magnitude, number, site, con∣nexion, action, use.
    • From the Age, for each age yeelds his peculiar Indications, hence you may observe most diseases to be incureable in old men, which are easily cured in yong, others which in youth admit of no cure, un∣lesse by the change of age and th'ensuing temperament.
    • From Sexe, for medicines work upon weomen farre more easily than upon men.
    • From the time of the yeare, for some meats and medicines are fit in Winter, some in Summer.
    • From the Region, for as there are diversities of situations and habits of places, so also there are motions of humors, and manners of diseases: hence it is that wounds on the head at Paris, & sore shinns at Avig∣nion are more difficult to be cured.
    • From the times of diseases, for some things in the beginings, others in the encrease, state and declining of the disease, are more conve∣nient.
    • From the manner of diet, for this, as the proper temper, must be pre∣served. Wherefore such must be fed otherwise who live daintily, than those who leade their lives sparingly and hardly. Hereunto adde certaine peculiar natures, which by a certaine hidden pro∣perty are offended at this, or that kinde of meate. For there are some which not onely, cannot concoct Ptisane, Apples, Soles, Pertrige, Water and such like, but can scarse behold them without Nauseousnes.
  • The second is drawne from things not naturall, which one while in∣dicate their preservation by their like, another while their change by their contraries; for so
    • If the Aire, have as it were conspired with the disease by a certaine similitude of qualities to the destruction of the Patient, it must be corrected by its contraries according to Arte.
    • But if by the disagreement of qualities it resist the disease, it must be kept in the same temper.
  • The third from things contra∣ry to nature which shew they must be taken away by the use of their contra∣ries, as
    • The disease, the Indica∣tion being drawne from these
      • The great∣nesse The com∣plication or com∣mixtion with other; so
        • In impli∣cite, or mixed di∣seases we may draw Indicati∣ons from these 3. heades.
          • From that which is most urgent
          • From the cause
          • and From that, without which the disease can not be ta∣ken away
            • such are
              • Bitternesse of paine, a defluxion into a part, a Varix, or bigge swollen veine, a distempe∣rature if they be joyned with a di∣sease.
    • Cause of the disease
      • which two oftē indicate & require medicines contrary to the disease.
    • Symp∣tomes

Notes

• * 1.1

  What an In∣dication is.
• * 1.2

  See. method. Cap. 7. lib. de opt. secta, Cap. 11.
• * 1.3

  The kinds of Indications.
• * 1.4

  Lib. 9. Method. cap. 9.
• * 1.5

  Indications drawne from things natural.
• * 1.6

  What the con∣ditions of the parts affected do indicate.
• * 1.7

  Indications from the ages.
• * 1.8

  Aphor. 40. li. 2.
• * 1.9

  Aphor. 6: sect. 6.
• * 1.10

  Ap hor. 5. sect. 4.
• * 1.11

  From our Diet.
• * 1.12

  Hatred arising from secret properties.
• * 1.13

  Indications taken from things against nature.
• * 1.14

  We do not al∣wayes follow the Indication which is from the disease.
• * 1.15

  In what parts we cannot hope for re∣storing of so∣lution of con∣tinuity.
• * 1.16

  Exherience without rea∣son, is like a blind man without a guide.
• * 1.17

  Indications in implicite diseases.
• * 1.18

  An example of Indications in implicite diseases.
• * 1.19

  What we must do when the temper of the part is diffe∣rent from the temper of the whole body.
• * 1.20

  An artificiall conjecture is of much force in Indications.
• * 1.21

  Indication from simili∣tude.
• * 1.22

  Indication of a subtle device.
• * 1.23

  Examples.
• * 1.24

  A Physition should be of a quicke appre∣hension.
• * 1.25

  Indications in∣dicative.
• * 1.26

  Coindicative.
• * 1.27

  Repagnant.
• * 1.28

  Correpugnant