Mikrokosmographia a description of the body of man. Together vvith the controuersies thereto belonging. Collected and translated out of all the best authors of anatomy, especially out of Gasper Bauhinus and Andreas Laurentius. By Helkiah Crooke Doctor of Physicke, physitian to His Maiestie, and his Highnesse professor in anatomy and chyrurgerie. Published by the Kings Maiesties especiall direction and warrant according to the first integrity, as it was originally written by the author.

QVEST. VIII. Of a new kinde of compunction of dropsie bodies through the Nauell.

IT shall not be amisse in this place, to annexe a kinde of Compunction of the Nauell, by which the water is safely let out of dropsie bodies. The an∣cient Physitians called all apertions of dropsie bodies 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. In the administration of which Paracentesis, there arise foure Questions. Whe∣ther it be feasible; when, where, and how it is to bee performed. That it may be done safely, remaineth vnder the Testimony of many witnesses, all beyond exception; and beside, it may by reason be demonstrated. Hippocrates first of all o∣ther, prescribes it both in his Aphorismes, and also in diuers other places. Galen in the 14. of his Method, Paul•••• of Aegina, Albucasis, and in a word, almost all Physitians. Besides Authorities, reason also addeth her suffrage to this attempt. For when these restagning or gathering waters, can neyther by outward nor by inward Medicines bee euacuated, why

should we not proceede to Section in these, as well as in other watery and Flegmatick tu∣mors: especially seeing the parts wherein the Section is to bee made, are all ignoble and base.

The time fit for this apertion, Hippocrates elegantly describeth, where he sayth, Dropsie bodies must presently be cut, and those that are Empui, presently burnt. This presently, Hippo∣crates himselfe interpreteth to be out of hand, or in the beginning of the disease: Galen saieth, it must be before the inward parts are corrupted; for the water is in vaine let out, if the entrals be vitiated, especially any thing notably; because it wil instantly and continually gather againe: so then it is a foule error in a deplorate or desperate dropsie to vndertake this kind of cure, because (as Celsus very well saith,) it is a kinde of impiety in Art rashly or inconsi∣derately to prophane such remedies, as being rightly vsed may be of great auaile. The third question is concerning the place for this apertion. Paulus and all Physitians after him, euen to these times, administer this Section a little below the Nauell towardes the sides, because of the Tendons or chordes of the Muscles: and that on the side that is opposite to the part affected; as if the liuer be affected on the left side, if the Spleen on the right. That kind of section is not to be discommended, yet Laurentius thinketh, it may bee more com∣modiously done through the very Nauell, and for his opinion bringeth very rare obserua∣tions, and strong reasons.

Antonius Benneuenius recordeth, how a certaine Dropsie Patient being giuen ouer by the Physitians, by a rash and casuall aduenture recouered his health. For, when hee was exceedingly dry (as is vsuall in that disease) and in despaire of recouery, hee powred in an abundance of water, wherupon his Nauell suddenly opened whence issued so great quan∣tity of the dropsy Lie, that his body fell to the wonted scantling, and he being assisted by a discreete Physitian, recouered his health.

I saw (saith Laurentius) at Monpelier, a dropsie Woman, whose Nauell in a tempestu∣ous night, when she thought little of it, opened, whereout flowed a great streame of wa∣ter: earely in the morning I was sent for, together with Bartholmew Cabrolius a skilfull A∣natomist: we found her spirits almost spent by reason of the sudden and immoderate eua∣cuation; those we presently gaue order to refresh and re-establish, which being done, she perfectly recouered through Gods helpe; and yet continueth in good health.

Ludouteits Villonouanus a verie learned Physitian, tolde me at Gratianopolis, (saith Lau∣rentius, that he knew a Countrey peasant perfectly cured by this kinde of section. Bal∣thazar Garielus my friend, and a learned Chyrurgion of Mompelier, at my appointment, saith the same Laurentius, opened after this manner a dropsie patient, who was very im∣portunate vpon vs; his Belly fell almost vnto the accustomed extent, and he seemed to bee past all feare of death. The tenth day after his Section, without any knowledge, hee ate a pound of Cherries, heereupon he fell into a scowring, by which the frame of Nature was vtterly ouer hrowne, and so within two daies he dyed.

It is manifest therefore by experience, that this way section may be safely administred: neyther doth reason disswade from it. For, as Hippo. sayth, The way that Nature inclineth the Physitian must follow; but Nature oftentimes findeth this way through the Nauel. Be∣side, this kinde of apertion of the nauell, excuseth the section of many parts. For, about the nauell, do meete the foure nauell vessels, which if they chinke or cleaue, as they vse to do by the forcible confluence of water to that part in dropsie bodyes, then there remai∣neth nothing to cut, but onely the skinne, and then the water will yssue foorth. But it will bee obiected, that the Chords or Tendons of all the Muscles of the Abdomen, do meete a∣bout that place, and therefore if that place bee wounded, it is a venture but Convulsions will follow. Wee confesse indeede, that all the extreamities of the Muscles do determine in the white line, but these extreamities about the nauell are perforated, to make way for the vmbilicall Vesselles, and therefore are not wounded in this kinde of apertion. More∣ouer, those which labour of that kinde of Dropsie which is called Ascites, almost all haue strutting or swollen nauels, the tumour growing by reason of the confluence of water to that part, so that if but the skinne bee pierced with a snarpe instrument, then presently fol∣loweth a flood of waters. Againe, when the section is thus made in the middest, the pati∣ent may with ease lye vpon either side, which he cannot do if the other kinde of section be administred.

The last question, was mooued about the manner of this kinde of Paracentesis, which is on this sort. You must first cast a bought or running knot round about the nauell, that at

your pleasure you may streighten the hole or passage, if the water should yssue out with too great violence; next, with a sharpe poynted Nall or Bodkin, you must pierce the skinne in the verie middle of the knot of the Nauell, against which as wee haue said, the Vesselles doe chinke or cleaue in Dropsie bodyes; and then put a Brazen or Siluer pipe into the wound, through which the water may passe, which also may bee stopped at your pleasure: for all the water must not at once bee drawne out, but some and some by degrees. For Hippocrates saith, That if the Dropsie water, or the purulent Matter of an empyeme in searing or cutting do all at once yssue foorth, the Patient will dye: For, it is a rule, That all plentifull and sudden euacuations are dangerous. And in another place, Dropsie Waters must be by degrees euacuated. Finally, it may seeme, that Hip∣pocrates had some knowledge of this kinde of apertion, because hee saith in one place, Apply your actuall Cauterie about the Cir∣cumference of the Nauell, to let out the dropsie water, but burne not the part too deepe. Haply least they should not be able to mo∣derate the effluxion.

(:{inverted ⁂}:)

Notes

• Paracentesis.
• That it is fea∣sible.
• Hippocrates. Galen.
• The time for this worke.
• The place.
• Aponcurosis.
• Laurentius his new conceite established,
• By Histories.
• Gratianopolis.
• By reasons.
• Obiection.
• Answere.
• The manner how to admi∣nister this kind of aper∣tion.
• Caution.
• Aphor. 27. sect. 6 Apho 51. sect. 2
• De morbis in∣ternis.

  De locis in ho∣mine.