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. XXII. Of the Dracunculus.

* 1.1I Cannot chuse, but explain in this place those things which may be spoken of that kind of Tu∣mor against Nature, which by the Ancients is called Dracunculus. The matter and reason of these hath been variously handled by divers Authors, so that hitherto we have nothing writ∣ten of them, to which we may by right and with good reason adhere as a firm foundation of their essence.

For first, for Galen's opinion, Lib. 6. de Loc. affect. cap. 3. The generation, saith he, of those hairs which are evacuated by the Urin is worthy no less admiration than the Dracunculi, which, as they say, in a certain place of Arabia breed in the Legs of men, being of a nervous nature, and like worms in colour and thickness.

Therefore seeing I have heard many who have said they have seen them, but I may self never saw them, I cannot conjecture any thing exactly neither of their original nor essence.

* 1.2Paulus Aegineta writes that the Dracunculi are bred in India, and the higher parts of Aegypt, like worms in the musculous parts of Mans Body, that is, the arms, thighs, and legs, and also creep by the intercostal muscles in children with a manifest motion.

* 1.3But whether they be creatures indeed, or only have the shape of creatures, they must be cured with a hot fomentation, by which the Dracunculus raised to a just tumor, may put forth it self, and be pluckt away piece-meal with the fingers: also suppurating Cataplasms may be applyed, com∣posed of Water, Hony, Wheat, and Barly-Meal.

Avicen being various, having no certainty whereon to rest, inclineth one while to this, and another while to that opinion:* 1.4 for now he speaketh of the Dracunculi, as of creatures, then pre∣sently of a matter and humor shut up in a certain place; for the rest, he rightly delivers the cure and essence of this disease, as we shall afterwards shew.

* 1.5Aetius saith, the Dracunculi are like Worms, and that they are found sometimes great, some∣times small, and that their generation is not unlike to that of flat Worms, which are bred in the Guts, for they move under the skin, without any trouble, but in process of time, the place be∣comes suppurate about the end of the Dracunculus. The skin openeth, and the head thereof is thrust forth.

But if the Dracunculus be pulled, it causeth great grief; especially, if it be broken by too vio∣lent

pulling. For that which is left causeth most vehement pain.* 1.6 Wherefore that the creature may not run back, the arm must be bound with a strong thred, and this must be done every day, that the Dracunculus going forward by little and little, may be intercepted by this binding, but not broken off.

The place must be bathed with Aqua Mulsa, and Oyl in which Wormwood or Southern-wood hath been boyled, or some other of those medicines which are prescribed for the worms of the Belly.

But if the Dracunculus going forward of its one accord, may be easily drawn forth, we must do nothing else: but if it be turned to suppuration, we must not leave off the Cataplasms, the Aqua mulsa, and anointing with Oyl: It was usual with him after the taking away of the Cataplasms, to apply Emplastrum è Baccis Lauri: but when it is come to suppuration, the skin must be opened long-ways, and the Dracunculus so laid open must be taken away, but the skin must be filled with lint, and the rest of the suppurative cure used, so that the creature being suppurated and drawn forth, the wound may be incarnated and cicatrized.

Rhasis writeth, that when the part is lifted up into a blister, and the vein hastneth its egress,* 1.7 it is good for the Patient to drink the first day half a dram of Aloes, the next day a whole dram, the third day two drams; and in like manner the place affected must be fomented with Aloes, for so that which lies hid will break forth: that which shall come forth must be rolled in a pipe of lead, which may equal the weight of a dram, so that it may hang down, for the vein drawn by the weight will come more forth; and when that which shall come forth is grown much and long, it must be cut off, but not by the root, but so that a portion thereof may remain and hang forth, to which the leaden Pipe may be fastened, for otherwise it would with-draw its self into its skin and its lurking hole, and so cause a putrid and malign Ulcer.

Therefore we must gently meet with this disease, and the vein must be drawn by little and lit∣tle out of the Body, until it be all come forth, that no worse thing happen: but if by chance it shall happen that as much of the vein as shall be come forth shall be cut off by the roots, then the Ulcer must be opened long-ways with an Incision-knife, and that so that whatsoever remains thereof may be wholly taken away. Then for some days the part must be anointed with Butter until whatsoeuer of such a substance adheres, being consumed with putrefaction shall flow away. Then the Ulcer must be cured with sarcotick things.

Therefore Rhasis thus in the same Text expresseth the same thing by divers names,* 1.8 and armed with Iron and Lead, he comes to the cure thereof, as if he meant to encounter with some fierce Beast.

Soranus the Physitian, who lived in the times of Galen, was of a quite contrary opinion,* 1.9 as Paulus Aegineta in the place being before-cited, relates of him; as who denyes the Dracunculus to be a living-creature, but only a condensation of a certain small Nerve, which seems both to the Phy∣sitian and Patients to have some motion under the skin.

Wherefore Soranus seems to have come neerer the truth than the rest, but yet not so, as throughly to understand, and know the Essence of this Disease, as we shall demonstrate here∣after.

Manardus writes, that the Dracunculi are generated of evil and unlaudable Bloud, gross, hot,* 1.10 and melancholick; or of adust phlegm very much dryed.

Gorraeus a most learned Physitian of our time, Lib. de Definitionib. medic. denyes any of our Phy∣sitians to be able to say any thing of the Dracunculi, because it is a disease so unfrequent in these our Regions, that it is scarse ever met withall in practise.

The Author of the Introduction, and Medicinal definitions, defines the Dracunculus to be a dis∣ease very like the Varices; then causing great pain, when increasing by little and little, it begins to be moved? Therefore to be cured after the same manner, and by the same method of Section and Incision, as the Varices are. Which thing seems chiefly to have moved Guido to refer this kind of disease to the Varices in his Tractate of Imposthumes, because it hath the same cause, and is healed with the same remedy as the Varices.

But seeing that divers names have been imposed upon this disease by several Writers, yet they have all expressed it by the name of a Vein, for it is called by Avicen and Guido, Vena Meden, be∣cause it is disease frequent in the City Medina: by Albucrasis, vena civilis. Haliabas hath called it vena samosa; others have called it Vena Cruris, or the Leg-vein. Truly, the contrariety of so ma∣ny opinions repugnant not only amongst themselves, but also with themselves, easily argueth how little certainty they had of the Essence of this disease, who have written of it unto us: To which also this may be added, that none of the latter Physitians have written any thing thereof. For al∣though Jacobus Dalechampius, a man most conversant in every part of Physick, hath written much of this matter in his Book of the French Surgery which he set forth some years ago: Yet he hath left us no amplier testimony of his industry, than that he was very diligent in collecting the wri∣tings of the Ancients concerning this thing, interposing no judgment of his own, the better to as∣sure us of a thing so controverted.

But my modesty cannot so contain me, but that I shall chuse rather to undergo the censure of being thought too daring, than (as much as in me lyeth) to suffer this question of the Dracunculi, to remain longer ambiguous and undecided. Therefore for the present, I will thus order it, that refuting the opinions of the Ancients, I may strengthen by certain reasons, my opinion of the Es∣sence and cure of this disease.

* 1.11For first, that Dracunculi are no living things, nor like unto worms, nor of like generation as the flat worms of the belly, which was the opinion of Aetius, is easie to disprove both by his writings, as also by reason it self. For he writes, that the broad worm which he cals Taenia, is as it were a certain Metamorphosis, or transmutation, of the inner tunicle of the smal guts into a quick living and movable body.

But no man ever said, neither will he confess that the Dracunculi hath the material causes of their beginning from the Tunicle of the vein, in which they are closed, or from the fibers of a nervous body, to which often they are adjoined; but much less from the skin under which they lie, may they draw the material causes of their original.

Moreover, neither can there be any generation of worms, nor of any other living creatures whatsoever, who have their original from putrefaction, unless by the Corruption of some mat∣ter, of whose better and more benign part, nature by the force of the vital heat, produceth some animate Body,* 1.12 as Aristotle teacheth. Wherefore to produce this effect, it is fit the matter should have such a disposition to putrefaction as is required for the generation of such a creature as they would make the Dracunculus to be: It is fit the helping causes should concur as assistants to the principals in the action. And it is meet the place should be opportune or fit.

But there may be many causes found which may give life to the Dracunculi; for by the common consent of all those who have written of them, their generation proceeds from an humor melan∣cholick,* 1.13 terrestrial and gross, which by its qualities both by the first coldness and dryness, as also by the second, that is Acidity, is not only thought most unfit of all others for putrefaction, but also is judged to resist putrefaction, as that which is caused by heat and superfluous hu∣midity. Besides, if the material cause of this disease should be from an humor putrefying and tur∣ning by putrefaction into some living Creature, it was fit there should be stench also, as being an unseparable accident of putrefaction; for thus, the excrements in the guts of which the worms are generated, do smell or stink.

Therefore that which exhales from their bodies who are troubled with the Dracunculi, should be stinking, as it happens to those sick of the Pthiriasis or Lowsie-evill. But none of those who have delivered the accidents or symptoms of the Dracunculi are found to have made mention hereof; but of the efficient cause whereby so great heat may be raised in the places next under the skin, by the efficacy whereof such a creature may be formed of a matter melancholick and most unapt to putrefie, as they make the Dracunculus to be, who fain our bodies to be fruitful monsters; especially seeing the surface of the body is continually ventilated by the small Arte∣ries spread under the skin, as also by the benefit of insensible transpiration, and breathed with the coolness of the air incompassing us. But now the material and efficient causes being defec∣tive, or certainly very weak, for the generation of so laborious an effect; what coadjutory cause can yield assistance? Can the humidity of meats? for those Bodies which are fed with warm and moist meats,* 1.14 as Milk, Cheese, Summer fruits, usually breed worms, as we are taught by ex∣perience in children.

But on the contrary Avicen in the place before cited writeth, that meats of a hot and dry temper chiefly breed this kind of disease, and that it is not so frequent to moist bodies and such as are accustomed to the Bath, moist meats and wine moderately taken. But whether may the con∣dition of the air of those regions in which it is, as it were, an Endemiall disease, confer any thing to the generation of such creatures? Certainly, for this purpose in a cloudy, warm and thick air, such as useth to be at the beginning of the Spring when all the places resound with frogs, toads and the like creatures breed of putrefaction.

But on the contrary Jacobus Dalechampius by the opinion of all the Physitians that have written of the Dracunculi,* 1.15 writes, that this disease breeds in the dry and Sun-burnt regions of India and A∣rabia; but if at the least that part of our body which is next under the skin should have any op∣portunity to ingender and nourish such creatures, they may be judged to have written that the Dracunculus is a living creature with some probability. But if there be no opportunity for ge∣neration in that place, nor capacity for the nourishment of such like creatures as in the guts, if that region of the body be breathed upon with no warmness and smothering heat, if it be defiled with none of those gross excrements, as the guts usually are, but only by the subtiller exhala∣tion, which have an easie and insensible transpiration by the pores of the skin, which may seem to be a just cause of so monstrous and prodigious an effect: but we shall little profit with these en∣gines of reason unless we cast down at once all the Bulwarks, with which this old opinion of the Dracunculi may stand and be defended.

For first they say, Why have the ancients expressed this kind of disease by the name of a living thing, that is, of a Dracunculus or little Serpent? I answer, because in Physick, names are often imposed upon diseases rather by similitude than from the truth of the thing; for the confirmati∣on whereof, the examples of three diseases may suffice, that of the Cancer, Polypus, and Elephas. For these have those names not because any Crab, Polypus, or living Elephant may breed in the Body by such like Diseases, but because this by its propagation into the adjacent parts re∣presents the feet and claws of a Crab; the other represents the flesh of the Sea-Polypus in its substance; and the third, because such as have the Leprosie have their skin wrinckled, rough, and horrid with scales and knots,* 1.16 as the skin of a living Elephant. So truly, this disease of which we now enquire seems by good right to have deserved the name Dracunculus, because in its whole conformation, colour, quality and production into length and thickness it expresseth the image

of a Serpent, But, Whence, will they say, (if it be without life) is that manifest motion in the matter? We reply, that the humor the cause of this disease is subtill and hot, and so runs with violence into the part whence it may seem to move. But when the Dracunculi are separated, Why do they put their heads as it were out of their holes? We answer, in this the Ancients have been very much deceived; because after the suppuration the ulcer being opened, some ner∣vous body being laid bare, thrust forth and subjected it self to the sight, which by the convul∣sive and shaking motion, might express the crooked creeping of a Serpent. But they will say, Pain happens not unless to things indued with sense and life, but this Dracunculus when he is drawn too violently, especially if he be broken, thereby will cause extream pain: We do answer, that the conclusion doth not follow, and is of no consequence; for these pains happen not, unless when the unprovident Surgion draws or puls in stead of the Dracunculus some nervous or membranous body swoln and repleat with an adust humor, whence there cannot but be great pain, that part be∣ing pull'd which is the author of sense. But it is childish, to say that the Dracunculus feels, for that it causeth sharp pains to the living body in which it is. Therefore that at last we may deter∣min something of the nature, essence, and generation of these Dracunculi, I dare boldly affirm; It is nothing else but a tumor and abcess bred from the heat of the blood in a venerate kind. Such blood driven by the expulsive faculty through the veins to the External parts, especially the limits, that is, the Arms and Legs, causeth a tumor round and long often stretched from the joynt of the shoulder even to the wrist, or from the groin even to one of the Ankles with tension, heat, re∣nitency, pricking pain, and a feaver. But this tumor is some while stretched forth streight, otherwhiles into oblique and crooked tumors, which hath been the cause that many, taken with this kind of disease, and having their limbs so infolded as with the twinings of a Serpent, would say, they had a Serpent. I have thus much to say of the Dracunculi; especially of those of our own country.

For the cure, it is not unlike to the cure of a Phlegmon arising from a Defluxion;* 1.17 for here al∣so in like manner the remedies must be varied according to the four times of the disease, and the same rule of diet, phlebotomy, and purging must be observed, which is before prescribed in the cure of a Phlegmon.

The mention of the Dracunculi cals to my memory another kind of Abscesse, altogether as rare.* 1.18 This, our French men name Cridones, I think á Crinibus. i. from hayrs: it chiefly troubles children and pricks their backs like thorns. They toss up and down being not able to take any rest. This disease ariseth from small hairs which are scarce of a pins length, but those thick and strong. It is cured with a fomentation of water more than warm, after which you must presently apply an oyntment made of hony and wheaten flower; for so these hairs lying under the skin are allured and drawn forth; and being thus drawn, they must be plucked out with small mullets. I imagine this kind of disease was not known to the ancient Physitians.

Notes

• * 1.1

  It is not as yet sufficiently known what Dracunculi are.
• * 1.2

  Lib 4. cap. ult.
• * 1.3

  The cure out of Aegineta.
• * 1.4

  Cap. 21. lib. 4. sent. 3, tract. 3.
• * 1.5

  Lib. 14. cap. ult.
• * 1.6

  The Cure out of Aetius.
• * 1.7

  Tractar. 7. c. 34. The cure out of Rhasis.
• * 1.8

  His opinion of them.
• * 1.9

  Soranus his o∣pinion.
• * 1.10

  Epist. 2. lib. 7.
• * 1.11

  Aetius opinion confuted. Tract. 3. sermo. 1 cap. 40.
• * 1.12

  4 Meteorolog.
• * 1.13

  Natural Me∣lancholick hu∣mors is most unapt to putre∣fie.

  Stink, an unse∣parable com∣panion to putrefaction.
• * 1.14

  What things usually breed worms.
• * 1.15

  Cap. 83. Chir, Gallic.
• * 1.16

  Why they are called Dracun∣culi.
• * 1.17

  The Cure.
• * 1.18

  So the Malum pilate in Ari∣stotle cap. 11. lib. 7. hist. ani∣mal.