The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

CHAP. XII. Of the cure of the Dropsie.

THe beginning of the cure must be with gentle and milde medicins; neither must we come to a Paracentesis unless we have formerly used and tried these. Therefore, it shall be the part of the Physitian to prescribe a drying diet, and such medicines as carry away wa∣ter,* 1.1 both by stool and urine, Hippocrates ordains this powder for Hydropick persons. ℞ Canthar. ablatis capitib. & alis ℥ ss. comburantur in furno, & fiat pulvis; of which administer two grains in white wine; for, nature, helped by this, and the like remedies, hath not seldome been seen to have cured the Dropsie. But that we may hasten the cure, it will be available to stir up the native heat of the part by application of those medicines which have a discussing force; as bags, baths, oint∣ments,* 1.2 and Emplaisters. Let bags be made of dry and harsh Bran, Oats, Salt, Sulphur, being made hot; or, for want of them, of Sanders or Ashes often heated.

* 1.3The more effectual baths are salt, nitrous, and sulphurous waters, whether by nature or art, that is, prepared by the dissolution of salt, nitre, and Sulphur; to which if Rue, Marjoram, the leaves of Fennel,* 1.4 and tops of Dill, of Stoechas, and the like, be added, the business will goe bet∣ter forwards.* 1.5 Let the ointments be made of the oyl of Rue, Dill, Baies, and Squills, in which some Euphorbium, Pellitory of Spain, or Pepper, have been boiled. Let Plaisters be made of Frankincense,* 1.6 Myrrh, Turpentine, Costus, Bay-berries, English Galengall, hony, the dung of Ox∣en, Pigeons, Goats, Horses, and the like, which also may be applied by themselves. If the di∣sease continue, we must come to Sinapisms and Bhoenigms, that is, to rubrifying and vesicatory medicines. When the blisters are raised, they must be anointed again, that so the water may by little and little flow so long untill all the humor be exhausted, and the patient restored to health.

* 1.7Galen writes, the Husbandmen in Asia, when they carried wheat out of the Country into the City in Carrs, when they would steal away and not be taken, hide some stone-jugs fill'd with water in the midst of the wheat; for that will draw the moisture through the jugs into it self, and encrease both the quantity and weight. When certain pragmatical Physitians had read this, they thought that wheat had force to draw out the water, so that if any sick of the Dropsie should be buried in a heap of wheat, it would draw out all the water.

* 1.8But if the Physitian shall profit nothing by these means, he must come to the exquisitly chief remedy, that is, to Paracentesis. Of which because the opinions of the ancient Physitians have been divers, we will produce and explain them.

Those therefore which disallow Paracentesis, conclude it dangerous for three reasons. The first because by pouring out the contained water, together with it, you dissipate and resolve the spirits, and consequently the natural, vital, and animal faculties. Another opinion is, because the Liver wanting the water by which formerly it was born up, thence-forward hanging down by its weight, depresseth and draweth downwards the midriffe and the whole Chest, whence a dry cough, and a difficulty of breathing proceed. The third is, because the substance of the Perito∣naeum, as that which is nervous, cannot be pricked or cut without danger, neither can that which is pricked or cut be easily agglutinated and united, by reason of the spermatick and bloudlesse nature thereof. Erasistratus moved by these reasons condemned Paracentesis as deadly: also, he perswaded that it was unprofitable for these following reasons, viz. Because the water powred forth,* 1.9 doth not take away with it the cause of the Dropsie, and the distemper and hardness of the Liver, and of the other Bowels, whereby it comes to pass that by breeding new waters they may easily again fall into the Dropsie. And then the feaver, thirst, the hot and drie distemper of the bowels, all which were mitigated by the touch of the included water, are aggravated by the ab∣sence thereof, being powred forth: which thing seemeth to have moved Avicen and Gordonius that he said none, the other said very few, lived after the Paracentesis: but the refutation of all such reasons is very easie.

* 1.10For, for the first; Galen inferrs that harmful dissipation of spirits, and resolving the faculties hap∣pens, when the Paracentesis is not diligently, & artificially performed. As in which the water is pre∣sently powred forth; truly, if that reason have any validity, Phlebotomy must seem to be removed far from the number of wholsome remedies, as whereby the blood is poured forth, which hath far more pure and subtil spirits, than those which are said to be diffused and mixed with the Dropsie waters. But that danger which the second reason threatens shall easily be avoided; the patient be∣ing desired to lie upon his back in his bed, for so the Liver will not hang down. But for the third reason, the fear of pricking the Peritonaeum, is childish: for those evils which follow upon wounds of the nervous parts, happen by reason of the exquisit sense of the part, which in the Peritonaeum ill affected & altered by the contained water, is either none or very small. But reason and experience teach, many nervous parts, also the very membranes themselves being far remo∣ved from a fleshy substance, being wounded admit cute; certainly much more the Peritonaeum, as that which adheres so straitly to the muscles of the Abdomen, that the dissector cannot separate it from the flesh, but with much labor. But the reason which seems to argue the unprofitableness of Paracentesis is refelled by the authority of Celsus.* 1.11 I, saith he, am not ignorant that Erasistratus did not like Paracentesis; for he thought the Dropsie to be a disease of the Liver, and so that it must be cured; and that the water was in vain let forth, which, the Liver being vitiated, might grow again. But first, this is not the fault of this bowel alone, and then although the water had his ori∣ginal

from the Liver, yet unless the water which stayeth there contrary to nature be evacuated; it hurteth both the Liver, and the rest of the inner parts, whilst it either encreaseth their hard∣ness, or at the least keepeth it hard, and yet notwithstanding it is fit the body be cured. And al∣though the once letting forth of the humor profit nothing, yet it makes way for medicines, which while it was there contained, it hindered. But this serous, salt, and corrupt humor is so far from being able to mitigate a feaver and thirst, that on the contrary it increaseth them. And also it augmenteth the cold distemper, whilst by its abundance it overwhelms and extinguisheth the na∣tive heat. But the authority of Celius Aurelianus that most noble Physitian, though a Methodick, may satisfie Avicen and Gordonius. They, saith he, which dare avouch that all such as have the water let out by opening their belly have died, do lie;* 1.12 for we have seen many recover by this kind of remedy: but if any died, it happened either by the default of the slow or negligent ad∣ministration of the Paracentesis. I will add this one thing which may take away all error or contro∣versie: we unwisely doubt of the Remedy when the Patient is brought to that necessity, that we can only help him by that means. Now must we shew how the belly ought to be opened. If the Dropsie happen by fault of the Liver, the section must be made on the left side;* 1.13 but if of the Spleen, in the right: for if the patient should lie upon the side which is opened, the pain of the wound would continually trouble him, and the water running into that part where the section is would continually drop, whence would follow a dissolution of the faculties. The Section must be made three fingers breadth below the Navell, to wit, at the side of the right muscle, but not upon that which they call the Linea Alba; neither upon the nervous parts of the rest of the muscles of the Epigastrium; that so we may prevent pain and difficulty of healing.* 1.14 Therefore we must have a care that the Patient lye upon his right side, if the incision be made in the left, or on the left, if on the right. Then the Chirurgion both with his own hand, as also with the hand of his servant assisting him, must take up the skin of the belly, with the fleshy pannicle lying under it, and separate them from the rest; then let him divide them so separated with a Section even to the flesh lying under them; which being done, let him force as much as he can the divided skin upwards towards the stomach, that when the wound, which must presently be made in the flesh lying there-under, shall be consolidated, the skin, by its falling therein, may serve for that pur∣pose: then therefore let him divide the musculous flesh and Peritonaeum with a small wound, not hurting the Kall or Guts.

Then put into the wound a trunk, or golden, or silver crooked pipe, of the thickness of a Goo∣ses-quill, and of the length of some half a finger. Let that part of it which goes into the capacity of the belly have something a broad head, and that perforated with two small holes, by which a string being fastened, it may be bound so about the body, that it cannot be moved, unless at the Chirurgeons pleasure. Let a spunge be put into the pipe, which may receive the dropping humor: and let it be taken out when you would evacuate the water: but let it not be poured out altoge∣ther, but by little and little for fear of dissipation of the spirits, and resolution of the faculties, which I once saw happen to one sick of the Dropsie.* 1.15 He being impatient of the disease and cure thereof, thrust a Bodkin into his belly, and did much rejoice at the pouring forth of the water, as if he had been freed from the humor and the disease, but died within a few hours, because the force of the water running forth, could by no means be staied, for the incision was not artificially made. But it will not be sufficient to have made way for the humor by the means aforementioned,* 1.16 but also the external orifice of the pipe must be stopped and strengthned by double cloaths, and a strong ligature, lest any of the water flow forth against our wills. But we must note that the pipe is not to be drawn out of the wound, before as much water shall be issued forth as we desire, and the tumor requireth; for once drawn forth, it cannot easily be put in again, and without force and pain be fitted to the lips of the wound, because the skin and fleshy pannicle cover it by their falling into the wound of the flesh or muscle. But whilst the water is in evacuation, we must have a diligent care of feeding the patient, as also of his strength; for if that fail, and he seem to be debilitated, the effusion of the water must be staied for some daies, which at the length perfor∣med according to our desire, the wound must be so consolidated that the Chirurgeon beware it degenerate not into a Fistula.

[illustration]

The figure of a Pipe in form of a Quill, to evacuate the water in Dropsies.

Others perform this businesse after another manner; for,* 1.17 making an incision, they thrust through the lips of the wound with a needle and thred: but they take up much of the fleshie substance with the needle, lest that which is taken up should be rent and torn by the forcible drawing of the lips together. Then the thred it self is wrapped up and down over both ends of the needle, so thrust through, as is usually done in a hare-lip, that so the lips of the wound may so closely cohere, that not a drop of water may get out against the Chirurgeons will. Sometimes such as are cured and healed of the Dropsie, fall into the Jaundise,* 1.18 whom I usually cure after this manner. ℞ sterc. anser. ʒij, dissolve it in ℥ iij, vini alb. coletur: make a Potion, and let it be given two hours before meat.

Notes

• * 1.1

  Hip. lib. 4. de acut. & lib. de intern.
• * 1.2

  Bags.
• * 1.3

  Bathes.
• * 1.4

  Liniments.
• * 1.5

  Emplaisters.
• * 1.6

  Vesicatories.
• * 1.7

  Gal. lib. de fa∣cul. natur. 1.
• * 1.8

  Divers opini∣ons of Para∣cent••sit, or ope∣ning of the belly. Reasons a∣gainst it.
• * 1.9

  Erasistratus his Reasons a∣gainst it.
• * 1.10

  Reasons for it.
• * 1.11

  Lib. 3. cap. 21.
• * 1.12

  Lib. de morb. Ch. cap. de Hydrope.
• * 1.13

  The places of the apertion must be divers according to the parts chie∣fly affected.
• * 1.14

  The manner of making aperti∣on.
• * 1.15

  A History.
• * 1.16

  A caution for taking out the pipe.
• * 1.17

  Another man∣ner of evacua∣ting the water after the aper∣tion.
• * 1.18

  A medicine for the Jaundise.