The method of curing vvounds made by gun-shot Also by arrowes and darts, with their accidents. Written by Ambrose Parie of Laual, counsellor and chiefe chirurgean to the French King. Faithfully done into English out of the French copie, by Walter Hamond chirurgean.

CHAP. XV. An Apologie touching wounds made by Gun-shot.

THere hapned into my hands not many dayes past,* 1.1 a certaine Book written by a Physitian; wherin he very openly contradicteth that which I haue written heretofore, as concerning wounds made by Gunshot and their curations. I protest that if there were no other cause, or that there were no other interest heerein then the contem∣ning of me and my Book, I would let these things alone, and passe them away vnder silence; know∣ing well, that all answers and replies whereby we striue to stop the Mouths of euill speakers, do of∣tentimes

rather giue them a further occasion of speaking then otherwise; and that there is no bet∣ter way to stay such Controuersies, then by not answering one word. Euen as we see that the fire is extinguished when the combustible matter ceaseth, by taking away the wood. But when I did consider the euident danger that many wold fall into, if they came to follow those rules and instru∣ctions that the saide Physitian setteth downe for the cure of the saide wounds, I therefore thought it my duty to preuent this euill, and to hinder it as much as lieth in mee, in regard of my professi∣on. The which beyond that common affection which all men owe to the publike weale, doeth binde me particularly to this, in such manner, that I could not with a good conscience become deaf and dumbe, when both my particular and gene∣rall duties, do binde and constraineime to speake. This therefore was the true cause that did solicite me to make this Apologie, rather then any passi∣onate or boyling desire in me, to haue my reuēge of him who hath truly assaulted me.

Now in this booke, he pretendeth to despise & contemne the application of suppuratiue Medi∣cines, as Bassilicon, and others of that nature.* 1.2 Al∣so of those that are sharpe, as Egyptiacum, and such like. For (saith he) such remedies haue beene the cause of the deathes of an infinite number of men, whereunto they haue beene applyed; yea, although that their wounds were but superficiall, and in fleshy parts. And that heerein the counsell

of Hippocrates ought not to be followed,* 1.3 who sai∣eth, that all contused wounds ought to be broght to suppuration, because (sayth he) this is a new di∣sease, and vnknowne to the Ancients, and there∣fore it requireth new remedies. Also that thunder and the violent effect thereof, ought not to bee compared to the reports of Artillery.

Now seeing that he striueth to contradict all that I haue written before in my book of wounds made by Gunne-shot, Arrowes▪ and Dartes, I am constrained for my defence, to repeate somewhat of that which I haue heeretofore divulged, to re∣proue all these points (as I hope) one after ano∣ther.

First of all, that suppuratiue Medicines are not proper in such wounds, it is against reason, autho∣rity, and experience: for euery one knoweth that the Bullet being round and massiue, cannot make any entrance into our bodies, without great con∣tusion and bruising; the which cannot bee cured without suppuration, according to the authority not onely of Hippocrates, but also of Galen, and all other Authors both Ancient and Moderne. And what doth it serue him to call such new woundes, to derogate from the saying of Hippocrates whom we hold to be the Father, Author, and Founder of the Lawes of sacred Medicine, which are wor∣thy of all esteeme and praise aboue all others, be∣cause they are not subiect to change, as all others that are established by Kings and Princes, ney∣ther are they tied to the prescription of times, nor

the customes of Regions. Therfore if I haue here∣in followed the Hippocratick Doctrine, which is alwayes found true and st••ble, I perswade my self to haue done well. And therein I haue not bene in that conceit alone; for Mounsieur Botall, Phy∣sitian in ordinary to the King, and Mounsieur Iou∣bert Physitian to the King also, and his Lecturer in ordinary in the vniuersity of Mont-pellier, men well experimented both in Physicke and Chirur∣gery, haue lately written of this matter. Com∣mending, and commanding the application of Bassi••ic••n & other suppuratiues in the beginning of such wounds.

These men, because they haue followed the warres, haue seene more wounded by shot, then our Physitian hath done all his life time. As for experience, there is an infinite number of other good Chirurgians, and greatly experimented, who haue and do vse of these remedies in the be∣ginning, to bring those wounds to suppuration, if there be no Indication that doth contradict it. I know moreouer that an Empericall Chirurgean, a neighbour of his called Doublet,* 1.4 hath many and sundry times done meruailous cures, by applying onely in those woundes a suppuratiue Medicine, composed of melted Bacon, the yolke of an Egge, terebinthinae, with a little Saffron, and this he held for a great secret.

There was also another at Thurin in the yeere 1538. (I being then in the seruice of the late Mar∣shall of Monte-ian, Lieutenant Generall of the

King at Piedmont) who had the report aboue all the Chirurgeans in those partes, for his excellent cur••ng of those woundes with Oleu•• Catellorum; the description whereof, I procured of him tho∣rough my earnest intreaty. This oyle is of power to lenisie and appease the paine, and to suppurate those woundes beeing applied a little more then luke-warme, and not boyling hote, as manie will. This an infinite number of Chirurgeans haue v∣sed, after that I had described it in my Booke of wounds made by Gun-shot with good and hap∣py successe. As for that which he writeth against the Vnguent Egyptiacum, certainely I beleeue that he abideth in that opinion and heresie alone,* 1.5 because there hath not bin yet discouered a more singular remedie to correct and preuent the pu∣trifaction which happeneth most commonly in those wounds, the which doe degenerate often∣times into virulent, corrosiue, ambulatiue, and malignant Vlcers, casting forth a stinking Sanies, whereby the part salleth into a Gangrena, vnlesse it be preuented by Egyptiacum, and other sharpe medicines. And for this cause they haue bene ve∣ry much approued by the saide Botal and Ioubert, and of all good Chirurgeans; yet neuertheles our Physitian maintaineth that they are venomous, because (saith he) that being applyed in woundes by Gunne shot, they haue beene the cause of the death of many persons; which is a thing so absurd and against reason, that I will leaue the resolution thereof to the Towne-Barbers, who I am sure are

of skill sufficient to confute the grossenes of that imputation; or if their want of iudgement be such that they cannot, yet the consideration of euerie one of the ingredients of the sayde Aegyptiacum would suffice to shew, that it is so free from anie venomous quality, that it doth resist, & is directly contrary to all sorts of poisons and putrifactions which may happen in the fleshy partes, by reason of any wound or vlcer.

He saith moreouer, that the disposition of the aire cānot be the cause to infect or restore wounds more daungerous at one time then at another. Herein also he is of this opinion alone. But if hee had well read and vnderstood Hippocrates, he had not so lightly contemned the constitution of the seasons, and the infection proceeding from the aire not simple and Elementary (for being simple, it neuer acquireth any putrifaction) but by additi∣on and commixtionwith other corrupted vapors, as I haue written in my treatise of the Pestilence: For inasmuch as the aire that doth incompasse & inclose vs, is perpetually necessary vnto our liues; it followeth therefore, that according to the indis∣position thereof, our bodies also altered in manie and sundry manners, because we do draw it con∣tinually by meanes of the Lungs and other partes, seruing vnto respiration; and also by the pores & euery little inuisible hole throughout the bodye, and by the Arteries dispersed in the skinne. And this is done both for the generation of the spirite of life, and also to refresh and foment our naturall

heate. For this cause, if it be immoderately hotte, cold, moist, or dry, or otherwise distempered, it altereth and changeth the temperature of our bo∣dies vnto its owne quality. This is cleerely seene: for when it is infected by the putrified and Cada∣ueruous vapors produced from a great multitude of dead bodies that haue not bene buried soone e∣nough; as of men, of ho••ses, and other beasts. As it happeneth after any battell, or when many men haue perished by shipwracke, and haue bene cast ashore through the violence of the waues. As for example, the memory is yet f••esh, of the corrup∣tion of the aire which proceeded from deade bo∣dies at the castle of Pene, situate vpon the riuer of Lot, in which place, in the yeare 1562. in the mo∣neth of September, whiles the first troubles hap∣ned about Religion, there was a great number of dead bodies fell into a pit of an hundred fathome deepe, or thereabouts: from whence, two mo∣neths after, there was eleuated such a stinking and venomous vapor, which dispersed it selfe ouer all the countries of Agenois, and the neighbouring places within the compasse of thirty miles round, that thereby many were infected with the pesti∣lence, whereof we need not wonder; for the wind blowing▪ and driuing the exhalations and corrup∣ted vapors from one countrey to another, doeth infect them with the saide pestilence.

In like manner, the euill constitution of the aire, whether the cause be manifest or hidden, may make wounds to become putrified, alter the spirits

and the humors, and cause death. This therefore ought not to be attributed vnto the woundes, be∣cause that they which are hurt, and those that are not, are both equally infected, and fall into the same inconueniences.

Mounsi••••r d' Alechamps in his French Chirur∣gery spea••••ng o•• these thinges which hinder the c••••••t••on of Vlcers, hath not omitted, that when either the pes••••lence, or any Epidemicall Disease reigneth in any Proui••ce through the corruption of the Aire, it ma••••th Vlcers become incureable, or of most ••••fficult curation.

The good old man Guido, in his Treatise of Vl∣cers hath also writ, ••hat the wounds of the heade were more h••r••er to cure at Paris then at Auignō, and that the Vlcers of the legges were more diffi∣cult at Auignon then at Paris, forsomuch as at Pa∣ris the aire is cold and moist, which is a contrarie thing, especially to wounds in the head. Likewise in Auignon, the heare of the aire doe liquefie and subtilize the humors: and therefore, more easilie and in greater abundance do the humors fall into the Legges, whereby the curation of the Vlcers in those partes, is more difficult at Auignon then at Paris. But if any one alledging experience shall say the contrary, that the wounds in the head are for the most part mortall in hot countreyes: To him I answere, that that proceedeth not from the aire, as it is more hot and dry, but rather because of some superfluous humidity and euil vapor com∣municated with the aire, as in the places about

Prouence, and of Italy neere vnto the Mediterrene∣an sea. Now, there is not a Chirurgean of so little vnderstanding, that knoweth not but if the aire be hot and moyst, the wounds doe easily degenerate into a Gangrena and putrifaction. As for experi∣ence, I wil giue him a familiar example. Wee see that in hot and moyst weather, and when the Sou∣therly winds blow, that flesh doth putrifie in lesse then two houres, though it were neuer so lately killed, in such fort that Butchers in those times do kill no meate but euen as they sell it. Also there is no doubt to be made but that humane bodies doe fall into affections against Nature, when the qua∣lities of the seasons are peruerted through the euil disposition of the aire: as hath bene seene, that in some yeres, wounded persons haue bin most hard to cure, and oftentimes dyed of very smal wounds, what diligence soeuer the Physitians and Chirur∣gians could vse. The which I noted well at the siedge which was planted before Roan: for the cor∣ruption of the aire did alter and corrupt the blood and humors in such sort, by the meanes of inspi∣ration and transpiration, that the wounds became so putrid and faetide, that they sent forth a Cada∣uerueous smell: and if it hapned that one day had bene omitted wherein they had not beene drest, you shall finde the next day a great companie of wormes in them, with a meruellous stench; from whence were eleuated many putrified vapours, which by their communication with the hart cau∣sed a continual F••uer, with the Liuer hinderance

of the generation of good bloode, and with the Braine they produce alienation of the spirits, fain∣ting, convulsion, vomitings, and by consequence death: and when their bodies were opened, you should finde Apostumes in many partes of theyr bodies full of a greene stinking Sanies, in such sort that those that were within the Town seeing these things, that their wounded persons coulde not be cured, saide that those without had poiso∣ned their bullets: and they without saide the like of those within: and then perceyuing that those wounds did rather turne to putrifaction then vn∣to any good suppuration, I was constrayned, and with mee the most part of all the Chirurgea••s to leaue suppuratiues, and insted of them to vse the Vnguent Aegyptiacum, and other such like reme∣dies, to preuent the said putrifaction & Gangre∣na, and other of the aforesaide accidents.

Moreouer, if the diuers courses of the heauens haue power and force to imprint a pestilence in vs thorough the influence thereof, why is it not possible that the like may be done in a wound, to infect it after many wayes? Experience it self gi∣ueth vs a good and sufficient testimony, not one∣ly in hot weather, but also in winter. For we see that euery patient whether he be wounded, or o∣therwise disposed against Nature, are tormented more of their greefes when the weather is subiect to raine, then when it is faire weather. And the reason is, because the vapour and moyst aire, and southerne winds, do inwardly mooue and agitate

the humors which afterwards do discharge them∣selues vpon the afflicted parts, & thereby increase their paines.

Our Physitian hath also written, that in the bat∣tels of Dreux and of S. Denis, which were fought in the winter time, there dyed a great number of men, that I confesse too; but I deny that it was by the application of suppuratiue medicines, or of Corrosiues, but thorough the vehemencie of their wounds, and the disorder that the Bullets made in their members, whereunto the nature of the wounded parts helped greatly, and the tempe∣rature of the patient, but aboue all the cold. For the cold causeth wounds to bee of most difficult curation; yea, sometimes it causeth a Gangrena and totall mortification, as witnesseth Hippocra∣tes. And if he had beene with me at the siedge of Metz, he should haue seen many soldiers hauing their legges eschiomened by reason of the colde, and an infinit company of others that died of the colde, although they were not wounded at all. If he will not beleeue this, I will but send him to the top of the Mount Senis in the winter time, where many haue lost their liues, and were benummed and frozen in a moment; witnesse the chappell of Transis, which from thence had that Name gi∣uen it.

He hath in like maner calumnied me, because I compared thunder with Artillery. Truly it may be saide that they haue like effectes: for this Dia∣bolical* 1.6 gun-powder doth such merueilous things

that it is easie to proue a great similitude the one with the other. And first of all, we may compare the fire that we behold to issue forth of the Can∣non to the lightning in this, because it is seen be∣fore the Thunder is heard, so is it with the other: and this happeneth, because the eare is not so quicke as the eye to receiue their obiects. Wee may also compare the dreadfulnes of the reports of great Ordinance to that of Thunder.* 1.7 For when there is made any notable battery with great Or∣dinance, their reports are heard sometimes twen∣ty leagues off, more or lesse, according as the windes carrieth the eccho of their noise. The first reports are not heard so plaine, as those that fol∣low; and the cause is, for that the multiplication of the reports following and succeeding one ano∣ther, that which is nerest doth driue or thrust for∣ward that which is next him, and that in like man∣ner thrusteth forwards the other, and that other the other, vntill it commeth to our eares. In like manner the Bullets are carried by the force of the powder, with such an inestimable swiftnesse, that they breake and batter all that they meete with;* 1.8 yea, they haue more force against hard and vnre∣sistable things then against soft things: therein al∣so they do resemble Thunder, which shiuereth the sword in the scabberd, and yet the scabberd remaining whole, melting Siluer in a purse, the purse vnburnt. In like manner (as I haue said here before) hath bene seene many whom the Bullet hath neuer touched, yet neuerthelesse thorough

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the impetuosity of the aire caused by the violence of the powder issuing out of the mouth of the ca∣non; hath broke and shiuered the bones, without any manifest apparance of solution of continuitie in the flesh; yea, to haue battered and killed them out right, as if it had beene with a thunder-clap. Gunpowder also hath a stinking smell,* 1.9 senting of Brimstone; imitating therin that odour that con∣tinueth in that place where a Thunder-bolt hath lately falne; which smell, is not onely abhorred of men, but also all Animalles are therefore con∣strained to abandon and forsake their dennes and caues when it hath fallen nere thereunto: so great is that sulphurous stinke that it leaueth b••hind it. But yet their similitudes is more manifested by the effects of the saide powder;* 1.10 the which beeing enclosed in a Mine, and conuerted into winde or aire by meanes of the fire that is put thereunto, it ouer-whelmeth peeces of earth as great as moun∣taines▪ breaketh and demollisheth strong towers, reuerseth mountaines vpside downe. This I haue already manifested by that history which I haue elsewhere written, which was that at Paris; there was seene not long since a sodaine disaster by rea∣son of the powder in the Arcenall, which taking fire, it caused such a great tempest, that it made the whole Towne to shake, ouer whelming those houses that were neere thereunto,* 1.11 vncouering & vnglasing those that were further from the furie thereof.

To be breefe, euen as the thunder doth massa∣cre

and reuerse men halfe dead here and there; ta∣king from some their sight, from others their hea¦ring, and leaueth others so torne in their mem∣bers, as if foure horses had drawne them to pee∣ces: and all this through the agitation of the aire into whose substance the saide powder was con∣uerted. The like acte happened in the Towne of Malignes, in the yeere 1546. by the fall of a thun∣derbolt, within a great and strong Tower, where∣in there was a great quantity of Gunpouder, the which did ouerthrow and reuerse almost the one halfe of the Towne, and killed a great number of persons, whereof I sawe a while since many re∣markable tokens.

These examples in my opinion are sufficient to content our Physitian, and to shew him that there is a great similitude betweene the effects of Gun-powder and Thunder. Neuerthelesse, I will not for all that confesse that Gunshot is accom∣panied with poyson and fire as the claps of Thun∣der: for although they do agree the one with the other, as doth appeare by the former similitudes, it is not in the substance and matter, but in theyr manner of breaking, battering, and dissipating of the obiects which they meete, that is to say, the thunder-claps by the meanes of the fire, and the stone engendred therein, and Gunne-shot by the ayre impetuously agitated, which guiding the bullet, causeth the like tempestuous disaster, that the thunder doth. These things considered, may wee not therefore confesse, that those who haue

written that the Cannon shot and Thunder to haue a great similitude together, haue had reason so to do? Finally, this Physitian hath not taken much paines to prooue that Gun-pouder was not venomous, and that the bullets are without anie burning at all. Neither in like manner to inuent and name the Instruments proper for the extra∣ction of all strange bodies, because he hath found them already digested in my booke, with manie other things which he hath written, as euerie one may know by comparing his book with mine. He hath also inriched his Book with many sentences and reasons which he hath collected from an Ita∣lian Author, named Bartholomaeus Magius, Phy∣sitian of Bolognia, who hath written sufficiently thereof in a Treatise called De Vulnerum sclopeto∣rum curatione, although he doth not acknowledg him for his guide. But hauing traduced him al∣most word for word, hath made it neuerthelesse his owne, and of a Translator, would bee called Author.

Now let vs come to his goodly practise and new method to cure wounds made by Gun-shot.* 1.12 First of all, hee would haue applyed suppuratiue Medicines, the which neuerthelesse he doeth not vnderstand to be hot and moist, nor of an empla∣sticke substance; but to the contrary, he ordaineth them to be hot and dry, because (saith hee) that this is not of the nature of an Apostume, where∣in there is required no other cure but only to sup∣purate them. But heere where the woundes are

with contusion, many and diuers Indications a∣rise from thence; for so much as the contusion would be concocted and digested, and the wound desiccated. To answer to this, I would send him to learne the nature and quality of suppuratiues in Galen in the 5. of Simples, and to take all in his way, vntill hee come to the tenth of his Method, which will teach him, that in complicated disea∣ses he ought to consider the cause, the order, and the vigent.

Moreouer, I would willingly aske of him if hee can heale that wound made by gunshot, vnlesse th•• Contusion be first suppurate? I think not: and herein I refer my selfe to the iudgment of al good practitioners; and therefore our Basi••icon and Ole∣um Catellorum, and other such suppuratiue medi∣cines, are proper to suppurate such woundes as are made by Gun-shot. Secondly, he would haue Oxycratum put into the wound to stanch the fluxe of blood: and if by that means it cannot be stop∣ped, to apply thereon a medicine made of the white of an Egge, Bole Armoniacke, Rose-vine∣gar and Salt. I leaue you to consider whither such like remedies haue power to stay the flux of bloud or no, they being put with in the wound. Truely they will rather make it flow more, because that the vinegar is of a gnawing and subtle qualitie, causing paine, defluxion, inflammation, & other euill accidents, as I haue knowne by experience: and I know no Chirurgean that hath beene exer∣cised in his Art, will follow such a kinde of pra∣ctise,

least he finde himselfe deceiued in the end. To this purpose I do remember that I had a Moor in cure, who belonged to Mounsieur the Earle of Roissy, who was hurt before Bologne by an English man, who gaue him a wound with a Lance tho∣row the backe: whereuppon, to stay the Fluxe of blood, I put into the wound a restrictiue, wherein there was Vinegar insted of another, but present∣ly after he came to me againe, telling me that he thought he had had fire in his arme, which caused me to dresse him anew, and to change the medi∣cine of his wound, and to apply the saide restric∣tiue vppon it. I beleeue that this Physitian knew not so much, otherwise I esteeme him so honest a man that I thinke he would not haue put it in his Booke for a good restrictiue.

Moreouer, hee commendeth aboue all other things his Balme made of the oile of wax & myrth beaten together with the yolke of an Egge, or ra∣ther the naturall Balsome which is brought from Peru, and saith, that they do consume the super∣fluous humidity of those wounds, whereby they preuent the happening of any perillous accident. Neuerthelesse, he saith, that they do vnite & con∣solidate those kinde of wounds, as they do which are incised. Truly it seemeth very strange to mee, to see that any would go about to dresse and cure contused wounds, as simple woundes which de∣mand nothing but vnion. Ouer and besides, these Balmes cānot be proper in wounds made by gun∣shot, because that by reason of their siccitie they

doe hinder suppuration, without the vvhich they cannot be cured. And if they be needfull at all, it is onely after that the contusion is suppurated, & the wound mundified: and then I know not wher we should finde so many extractors of quintessen∣ces to extract and prepare so many Balmes as shal be needfull to dresse those souldiers which shalbe hurt in the assault of a Town,* 1.13 or a skirmish in bat∣tell? Neither vvhere they shall get mony suffici∣ent to counteruaile the charge thereof.

Let vs come to the rest. He ordaineth that these Balmes should be instilled into the vvounds with∣out Tents, yet afterwards remembring himselfe, he saith, that it would be very good to put within them a little short one, onely to keepe the Orifice of the wound open. How is it possible that these Balmes and Vnguents should bee conueyed into the bottome of the wound without Tents or Se∣tons, whose vse is principally to carry medicines vnto the bottome of wounds, and to keepe them open to giue issue vnto all strange bodies? All good practisers will neuer agree with him in this point, nor those which know what it is to handle such wounds.

Now there is yet another thing worthy to bee well noted, and that is this: After that he had re∣proued the Vnguent of Egyptiacum, hee neuer∣thelesse forgetting himselfe, commandeth it to be applyed from the beginning vntill the wound bee altogether suppurated, and to be thus vsed. Take (saith he) of Egyptiacum dissolued in a decocti∣on

on made of the tops of VVormwood, and of Hy∣pericon, and of the lesser Centaury and Plantan, and this to be iniected into the wound. H•• descri∣beth after that another, made of Plantane water, and hony of Roses boiled togither vnto the thick∣nesse of hony, and then scumming of it wel, there∣wi••hall mixe Egyptiacum in equall parts: & (saith he) this vnguent doth suppurate those VVoundes which are made by Gun-shot, I leaue the experi∣mented Chirurgicall Readers to iudge whether such remedies be suppuratiue or not. As for me I do esteeme them to bee proper to mundifie and clense, and not to suppurate. He finally writeth, that the wound ought not to be dressed but once in foure dayes, and where there shall bee fracture of the bones once in eight dayes. He saith more∣ouer in another place, that it is conuenient to in∣still euery day ten or twelue drops of balme into the wound. Truely this doctrine serueth rather to confound the yong Chirurgean, as not knowing what manner of practise hee should followe:* 1.14 for whosoeuer should follow his, I am well assured he will open often both the heauens and the earth; the heauens to receiue their soules, and the earth their bodies.

But wee haue spoken enough of this matter for this time, inasmuch as I am well assured, that these small caui••lations shall nothing at all diminish the reputation of my Booke, which is by strangers so much esteemed, that they haue translated it into their owne mother tongues, therby to haue com∣munication

therewith. Therefore now we wil bid our Physitian farewell, but first would pray him to re∣view and correct his Booke as soone as he could, to the end that the yong Chirurgean bee no lon∣ger retained in those errours which they may ap∣prehend by reading therein: for the shortest fol∣lioes are the best.

Notes

• * 1.1

  A iust occa∣sio•• of the Author for his Apology
• * 1.2

  Basilicon li∣quefied into an oyle, is proper in al woundsthat ••equire sup∣puration.
• * 1.3

  Hyp. in his ••••••ke of vl∣••e••s.
• * 1.4

  Doubles an Empirick.
• * 1.5

  Answer•• t•• th•• 〈◊〉〈◊〉 of I∣gyptia••um.
• * 1.6

  1 Similitude
• * 1.7

  2 similitude
• * 1.8

  3 similitude
• * 1.9

  4 ••imi••itude
• * 1.10

  5 similitude
• * 1.11

  Hor••ible ef∣fects of gun-powder.
• * 1.12

  A new kind of suppura∣tiue.
• * 1.13

  A pleasant answer, and to the pur∣pose.
• * 1.14

  Euill p••acti∣sers do open both the heaue•••• and the ea••th.