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.

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Title
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.
Author
Paré, Ambroise, 1510?-1590.
Publication
London :: printed by E: C: and are to be sold by John Clarke at Mercers Chappell in Cheapeside neare ye great Conduit,
1665.
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Subject terms
Medicine -- Early works to 1800.
Surgery -- Early works to 1800.
Anatomy -- Early works to 1800.
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"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." In the digital collection Early English Books Online 2. https://name.umdl.umich.edu/A55895.0001.001. University of Michigan Library Digital Collections. Accessed April 30, 2024.

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CHAP. XVI. Of the Golden Ligature, or the Punctus Aureus, as they call it.

IF the Rupture will not be cured by all these means, by reason of the great solution of the continuity of the relax'd or broken Peritonaeum, and the Patient by the consent of his friends there present, is ready to undergo the danger in hope of recovery; the cure shall be at∣tempted by that which they call the Punctus aureus, or Golden tie.

For which purpose a Chirurgeon which hath a skilful and sure hand, is to be imployed. He shall make an Incision about the Share-bone, into which he shall thrust a Probe like to the Cane, a lit∣tle before described; and thrust it long-ways under the Process of the Peritonaeum, and by lifting it up, separate it from the adjoyning fibrous, and nervous bodies, to which it adheres; then pre∣sently draw aside the spermatick vessels, with the Cremaster, or hanging muscle of the testicle; which being done, he shall draw aside the process it self, alone by it self: And he shall take

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as much thereof, as is too lax, with small and gentle mullets, perforated in the midst, and shall with a Needle, having five or six threds, thrust it through as near as he can to the spermatick vessels, and Cremaster muscles. But the Needle also must be drawn again in to the midst of the remnant of the process, taking up with it the lips of the wound; then the thred must be tyed on a strait knot, and so much thereof must be left after the Section, as may be sufficient to hang out of the wound. This thread will of it self be dissolved by little and little by putrefaction: neither must it be drawn out before that nature shall regenerate and restore flesh into the place of the li∣gature, otherwise all our labour shall be spent in vain.

And lastly, let the wound be cleansed, filled with flesh, and cicatrized, whose callous hardness may withstand the falling of the gut or kall.

There are some Chirurgeons who would perform this golden ligature after another manner. They cut the skin above the share-bone where the falling down commonly is, even to the process of the Peritonaeum, and they wrap once or twice about it, being uncovered, a small golden wire, and only straiten the passage as much as may suffice to amend the loosness of this process, lea∣ving the spermatick vessels at liberty; then they twist the ends of the wire twice or thrice with small mullets, and cut off the remnant thereof; that which remains after the cutting, they turn in, lest with the sharpness they should prick the flesh growing upon it. Then leaving the golden wire there, they cure the wound like to other simple wounds, and they keep the Patient some fifteen or twenty dayes in his Bed, with his Knees something higher, and his head something lower.

Many are healed by this means; others have fallen again into the disease by reason of the ill twisting of the wire.

[illustration]

  • A, Shews a crooked Needle having an eye not far from the point, through which you may put the golden wire.
  • B, B, The golden wire put through the Eye of the Needle.
  • C, The Mullets or Pincers, to cut away the wast or superfluous ends of the wire.
  • D, The spring of the mullets.
  • E, The mullets to twist the ends of the wire together.

There is also another manner of this golden tie, which I judg more quick and safe, even for that there is no external body left in that part after the cure. Wherefore they wrap a leaden wire in stead of the golden, which comes but once about the process of the Peritonaeum, then twine it as much as need requires; that is, not too loosly, lest it should leave way for the falling down of the Body, neither too straitly, lest a Gangrene should come by hindering the passage of the spi∣rits and nourishment. The ends thereof are suffered to hang out; when in the process of time, this contraction of the Peritonaeum seems callous, then the wire is untwisted and gently drawn out. And the rest of the cure performed according to Art. But let not the Chirurgeon thrust himself upon his work rashly, without the advice of the Physitian, for it divers times comes to pass, that the Te∣sticles are not as yet fallen down into the Cod by the two great sluggishness of Nature, in some of a pretty growth; but remains long in the groins, causing a tumor with pain, which thing may make a good Chirurgeon believe that it is an Enterocele. Therefore whilst he labours by repelling me∣dicines & trusses to force back this tumor, he encreaseth the pain, and hinders the falling down of

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the testicles into the Cod. I observed this not long ago in a Boy, which an unskilful Chirurgeon had long, and grievously troubled, as if he had had a rupture: for when I had observed that there was but one Stone in the Cod, and knew the Boy was never gelt; I bid them cast away the Plai∣sters and Trusses, and wisht his Parents that they should suffer him to run and leap, that so the idling Stone might be drawn into the Cod, which thing by little and little, and without pain, had the event as I fore-told.

That the reason of this affect may be understood, we must know a man differs from a woman, only in efficacy of heat; but it is the nature of strong heat to drive forth, as of cold to keep in. Hence it is that the Stones in men hang forth in the Cod, but in women they lie hid in the lower Belly. Therefore it happens that in some males more cold by nature, the Testicles are shut up some certain time, until at length they are forc't down in the Cod by youthful heat. But that we may return to our former Treatise of the Cod, although that way of Curing Ruptures wants not pain & danger, yet it is safer than that which is performed by Gelding, which by the cruelty there∣of exposes to the to Patient manifest danger of death. For the Gelders whilst they fear lest when the cure is finished, the relaxation may remain, pull with violence the process of the Peritonaeum from the parts to which it adheres, & together with it a nerve of the sixth conjugation which runs to the Stones; they offer the same violence to the spermatick vessels; by which things ensue great pain, convulsion, efflux of bloud, inflammation, putrefaction, and lastly, death, as I have obser∣ved in many whom I have dissected, having died a few dayes after their gelding. Although some escape these dangers, yet they are deprived of the faculty of generation for all their life after; for performance whereof, Nature hath bestowed the Testicles, as parts principally necessary for the conservation of mankind. Through which occasion Galen hath not feared to prefer them before the Heart; because the Heart is the beginning of life, but the Testicles of a better life; for it is far more noble to live well, than simply and absolutely to live; therefore Eunuches de∣generate into a womanish nature; for they remain without beards, their voyce is weak, their courage fails them, and they turn cowards; and seeing they are unfit for all humane actions, their life cannot but be miserable. Wherefore I will never subscribe to the cutting out of the Stones, unless a Sarcocele or Gangrene invade them. But that the way of performing the Punctus aureus may be better known, I have thought good (in the fore-going Page) to set down the Instruments, by which this operation is performed, before your view.

Another more easie and safe way to restore the Gut and Kall.

THeodorick and Guido have invented another way of performing this operation. They put back into their places the Gut and Kall being fallen down, the Patient being so placed, that his thighs are high and his head is somewhat low; then they draw aside the lower portion of the pro∣duction of the Peritonaeum, and also the spermatick vessels, and cremaster-muscle to the Ischium; then by applying a caustick fitted to the age and disease, they burn the other part of the process, directly perpendicular to the Sharebone, where the Gut did fall down. Then they pull off the Es∣char thus made with a Knife even to the quick, then they apply another caustick in the same place, which may go even to the Bone, then procure the falling of this Eschar made on the foresaid pro∣cess. And afterwards they heal the ulcer which remains; which presently contracting somewhat a thick Callus, so keeps up the guts and kall, that it binds them from falling down into the cod. This way of restoring the Gut and Kall, though it be safer and more facile; yet the Chirurgeon must not attempt it, if the Guts or Kall stick so fast, agglutinated to the process of the Peritonaeum, that they cannot be severed, nor put back into their places (for from the Guts so burnt and violated, greater mischief would ensue) if by the broken and too much dilated process, the Bodies there∣by restrained, make an exceeding great Tumor by their falling down; if the Testicle yet lying in the Groin as in a Bubonocele, a kind of Enterocele, being not yet descended in the Scrotum, or Cod, if the Patients be not come to such age, as they can keep themselves from stirring, or hold their excrements while the operation is performed.

Notes

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