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.

The Preface.

BEcause the Cure of Diseases must be varyed according to the variety of the temper, not only of the body in general, but also of each part thereof; the strength, figure, form, site, and sense thereof being taken into consideration: I think it worth my pains, having al∣ready spoken of Tumors in general, if I shall treat of them in particular, which affect each part of the body, beginning with those which assail the head. Therefore the Tumor either affects the whole head, or else only some particle thereof, as the Eyes, Ears, Nose, Gums, and the like. Let the Hydrocephalos, and Physocephalos be examples of those tu∣mors which possess the whole head.

CHAP. I. Of an Hydrocephalos or watry tumor which commonly affects the heads of Infants;

THe Greeks call this Disease Hydrocephalos, as it were a Dropsie of the Head,* 1.1 by a waterish humor; being a disease almost peculiar to Infants newly born. It hath for an external cause the violent compression of the head by the hand of the Midwife, or otherwise at the birth, or by a fall, contusion, and the like. For hence comes a breaking of a vein, or artery, & an effusion of the bloud under the skin. Which by corruption becoming whayish, lastly, degenerateth into a certain waterish humor. It hath also an inward cause, which is the abundance of serous and acrid bloud, which by its tenuity and heat sweats through the pores of the vessels, sometimes between the Musculous skin of the head, and the Pericranium; sometimes between the Pericranium and the skull; and sometimes between the skull and membrane called Dura mater,* 1.2 and otherwhiles in the ventricles of the Brain.

The signs of it, contained in the space between the Musculous skin and the Pericranium,* 1.3 are a ma∣nifest tumor without pain, soft, and much yielding to the pressure of the fingers. The Signs when it remaineth between the Pericranium and the skull, are for the most part like the fore-named, un∣less it be that the Tumor is a little harder, and not so yielding to the finger, by reason of the parts between it and the finger; And also there is somewhat more sense of pain. But when it is in the space between the skull and Dura-mater, or in the ventricles of the Brain, or of the whole substance thereof, there is a dulness of the senses, as of the sight and hearing; the tumor doth not yield to the touch, unless you use strong impression, for then it sinketh somewhat down, espe∣cially in Infants newly born; who have their skuls almost as soft as wax, and the junctures of their Sutures lax, both by nature, as also by accident, by reason of the humor contained therein moisten∣ing and relaxing all the adjacent parts; the humor contained here lifts up the skull somewhat more high, especially at the meetings of the Sutures; which you may thus know, because the Tu∣mor being pressed, the humor flies back into the secret passage of the Brain.

To conclude, the pain is more vehement, the whole head more swollen, the fore-head stands somewhat further out, the eye is fixt and immoveable, and also weeps by reason of the serous hu∣mor sweating out of the Brain.

Vesalius writes, that he saw a Girl of two years old,* 1.4 whose head was thicker than any man's head by this kind of Tumor, and the skull not bony, but membranous, as it useth to be in Abortive-births, and that there was nine pound of water ran out of it.

Abucrasis tells, that he saw a child whose head grew every day bigger by reason of the watery moisture contained therein, till at length the tumor became so great, that his neck could not bear

it neither standing nor sitting, so that he died in a short time. I have observed and had in cure four children troubled with this disease, one of which being dissected after it died, had a Brain no bigger than a Tennis Ball. But of a Tumor and humor contained within under the Cranium, or Skull, I have seen none recover, but they are easily healed of an external Tumor.

Therefore whether the humor lye under the Pericranium, or under the musculous skin of the head, it must first be assailed with resolving medicines, but if it cannot be thus overcome, you must make an Incision, taking heed of the Temporal Muscle, and thence press out all the humor, whether it resemble the washing of flesh newly killed, or blackish bloud, or congealed or knotted bloud, as when the tumor hath been caused by contusion; then the wound must be filled with dry lint, and covered with double boulsters; and lastly, bound with a fitting ligature.

CHAP. II. Of a Polypus being an eating disease in the Nose.

* 1.5THe Polypus is a Tumor of the Nose against Nature, commonly arising from the Os Eth∣moides, or Spongy-Bone. It is so called, because it resembles the feet of a Sea-Polypus in figure, and the flesh thereof in consistence. This Tumor stops the Nose, intercepting and hindering the liberty of speaking and blowing the Nose.* 1.6 Celsus saith, the Polypus is a caruncle of excresence one while white, another while reddish, which adhere to the Bone of the Nose, and sometimes fills the Nostrils hanging towards the lips, sometimes it descends back through that hole, by which the spirit descends from the Nose to the Throttle; it grows so that it may be seen behind the Uvula,* 1.7 and often strangles a man by stopping his breath. There are five kinds thereof: the first is, a soft membrane, long and thin like the relaxed and depressed Uvula, hanging from the middle gristle of the Nose, being filled with a phlegmatick and viscid humor. This in ex∣spiration hangs out of the Nose, but is drawn in and hid by inspiration; it makes one snaffle in their speech, and snort in their sleep. The second hath hard flesh, bred of Melancholy bloud with∣out adustion, which obstructing the nostrils, intercepts the respiration made by that part. The third, is flesh hanging from the Gristle, round, and soft, being the off-spring of Phlegmatick bloud. The fourth is a hard Tumor, like flesh, which when it is touched, yields a sound like a stone; it is generated of Melancholy bloud dryed, being somewhat of the nature of a Scirrhus confirmed, and without pain. The fifth is, as it were, composed of many cancrous ulcers spred over the transverse surface of the gristle.

* 1.8Of all these sorts of Polypi some are not ulcerated, others ulcerated, which send forth a stink∣ing and strong smelling filth. Such of them as are painful, hard, resisting, and which have a livid, or leaden colour, must not be touched with the hand, because they savour of the Nature of a Can∣cer, as into which they often degenerate; yet by reason of the pain which oppresses more violent∣ly, you may use the Anodyne medicines formerly described in a Cancer, such as this following.

* 1.9℞ Olei de vitell. ovorum ℥ ij, Lytharg. auri, & Tuthiae praep. an. ℥ i, succi plat. solani an. ℥ i ss, La∣pid. haematit. & camphorae, an. ℥ ss. Let them be wrought a long time in a Leaden Mortar, and so make a medicine to be put into the nostrils. Those which are soft, loose, and without pain, are sometimes curable, being plucked away with an Instrument made for that purpose, or else wasted by actual cauteries put in through a pipe, so that they touch not the sound part; or by potential cauteries, as Egyptiacum composed of equal parts of all the simples with Vitriol which hath a fa∣culty to waste such like flesh.* 1.10 Aqua fortis and Oyl of Vitriol have the same faculty, for these take away a Polypus by the roots; for if any part there remain, it will breed again. But Cauteries and acrid medicines must be put into the Nostrils with this Caution, that in the mean time cold re∣pelling and astringent medicines be applyed to the Nose and parts about it to asswage the pain, and hinder the inflammation. Such as are Unguentum de bolo, and Unguentum nutritum, whites of Eggs beaten with Rose-leaves, and many other things of the like nature.

CHAP. III. Of the Parotides, that is, Certain swellings about the Ears.

* 1.11THe Parotis is a Tumor against Nature, affecting the Glandules and those parts seated be∣hind and about the Ears, which are called the Emunctories of the brain; for these because they are loose and spongy,* 1.12 are fit to receive the excrements thereof. Of these some are critical, the matter of the disease somewhat digested being sent thither by the force of Nature. O∣thers Symptomatical,* 1.13 the excrements of the Brain increased in quantity, or quality, rushing thi∣ther of their own accord. Such abscesses often have great inflammation joyned with them, because the biting humor which flows thither is more vitiated in quality than in quantity. Besides also, they often cause great pain, by reason of the distention of the parts indued with the most exquisite sense, as also by reason of a Nerve of the fifth Conjugation spread over these parts; as also of the neigh∣bouring membranes of the Brain, by which means the Patient is troubled with Head-ach, and all his face becomes swoln. Yet many times this kind of Tumor useth to be raised by a tough, viscous, and gross humor.

This Disease doth more grievously afflict young men than old;* 1.14 it commonly brings a Feaver and watching. It is difficult to be cured, especially, when it is caused by a gross, tough, and viscid humor, sent thither by the Crisis.

The cure must be performed by diet,* 1.15 which must be contrary to the quality of the humor in the temper and consistence of the meats. If the inflammation and redness be great, which indicate aboundance of bloud, Phlebotomy will be profitable, yea very necessary. But here we must not use the like judgment in application of local medicines, as we do in other tumors, as Galen ad∣monisheth us; that is, we must not use repercussives at the beginning, especially, if the abscess be critical; for so we should infringe or fore-slow the indeavours of Nature forcibly freeing it self from the morbifique matter. But we must much less repel, or drive it back, if the matter which hath flowed thither be venenate, for so the reflow thereof to the noble parts would prove mortal. Wherefore the Chirurgeon shall rather assist Nature in attracting and drawing forth that humor. Yet if the defluxion shall be so violent, if the pain so fierce, that thence there may be fear of watchings, and a Feaver, which may deject the powers; Galen thinks, it will be expedient with many resolving medicines to mix some repelling. Wherefore at the beginning let such a Cataplasm be applyed.

℞ Far. hord. & sem. lin. ana ℥ij, coquantur cum mulso aut dececto cham. addendo but. recen.* 1.16 & olei cham. ana. ℥ i, fiat cataplasma. And the following Oyntment will also be good.

℞ But. recen. ℥ ij, olei cham. & lilior. an. ℥ i, uuguen. de Althea ℥ ss, cerae parum: make an Oynt∣ment to be applyed with moist and greasie wooll, to mitigate the pain: also somewhat more strong discussing and resolving medicines will be profitable, as:

℞ Rad. Altheae & lryon. an. ℥ ij, fol. rutae, puleg. orig. an. m. i, flo. chamae m. melil. an. p. i,* 1.17 coquantur in hydromelite, pistentur, trajiciantur, addendo farin. faenugraec. orobi. an. ℥ i, pul. Ireos, cham. melilot. an. ℥ ij, olei aneth. rutac. an. ℥ i, fiat cataplasma. But if you determin to resolve it any more, you may use Emplastrum oxycroceum & Melilot-Plaister. If the humor doth there concrete and grow hard, you must betake you to the medicins which were prescribed in the Chapter of the Scirrhus; but if it tend to suppuration, you shall apply the following Medicine.

℞ Rad. liliorum & ceparum sub cineribus coct. an. ℥ iij, Vitell. ovor. num. ij, axung. suillae & unguent.* 1.18 bafilicon, an. ℥ i, fari. sem. lini ℥ i ss, fiat Cataplasma. But if the matter do so require, let the tumor be opened as we have formerly prescribed.

CHAP. IV. Of the Epulis, or over-growing of the flesh of the Gums.

THE Epulis is a fleshy excrescence of the Gums between the Teeth,* 1.19 which is by little and little oft-times encreased to the bigness of an Egge, so that it both hinders the speech and eating; it casts forth salvious and stinking filth,* 1.20 and not seldom degenerates into a Can∣cer, which you may understand by the propriety of the colour, pain, and other accidents; for then you must by no means touch it with your hand. But that which doth not torment the Patient with pain, may be pluckt away; and let this be the manner thereof.

Let it be tyed with a double thred, which must be straiter twitched until such time as it fall off; when it shall fall away, the place must be burnt with a cautery, put through a trunk or pipe,* 1.21 or with Aqua fortis, or Oyl of Vitriol, but with great care that the sound parts adjoyning thereto be not hurt; for if so be that it be not burnt, it usually returns.

I have often by this means taken away such large tumors of this kind, that they hung out of the mouth in no small bigness, to the great disfiguring of the face, which when as no Chirurgeon durst touch, because the flesh looked livid, I ventured upon, because they were free from pain; and by taking them away and cauterizing the place, I perfectly healed them: not truly sodainly, and at once; for although I burnt the place after dissection; yet nevertheless they sprung up again, because a certain portion of the Bone and Sockets in which the Teeth stand fastned, were become rotten. I have often observed such like flesh by continuance of time to have turned into a grist∣ly and bony substance. Wherefore the cure must be begun as speedily as may be;* 1.22 for being but little, and having fastened no deep roots, it is more easily taken away, being then only filled with a viscid humor, which in success of time is hardened, and makes the taking away thereof more difficult.

CHAP. V. Of the Ranula.

THere is oft-times a tumor under the Tongue, which takes away the liberty of pronunti∣ation or speech; wherefore the Greeks call it Batrachium, the Latins Ranula,* 1.23 because such as have this disease of the Tongue, seem to express their minds by croaking rather than by speaking.

It is caused by the falling down of a cold, moist, gross, tough, viscid, and phlegmatick matter,* 1.24 from the Brain upon the Tongue, which matter in colour and consistence resembles the white of an Egge, yet sometimes it looks of a citrin or yellowish colour.

* 1.25That you may safely perform the cure, you must open the Tumor rather with a Cautery of hot Iron, than with a Knife, for otherwise it will return again. The manner of opening it must be thus. You shall get a bended hollow and perforated Iron-plate with a hole in the midst, and making the Patient to hold open his mouth, you shall so fit it, that the hole may be upon the part which must be opened. Then there you must open it with an hot Iron, for so you shall hurt no part of the mouth which is whole; but when you are ready to burn it, by thrusting your thumb un∣der the Patients Chin, you may somewhat elevate the Tumor whereby you may open it with more certainty; when it is opened, you must thrust out the matter contained therein, and then wash the Patients mouth with some Barly-water, Hony, and Sugar of Roses; for so the Ulcer will be safely and quickly healed.

[illustration]

The Delineation of the Iron-plate and crocked actual Cautery.

CHAP. VI. Of the swelling of the Glandules, or Almonds of the Throat.

* 1.26NAture at the Jaws near the roots of the Tongue, hath placed two Glandules opposite to one another; in figure and magnitude like to Almonds, whence also they have their name; their office is to receive the spittle falling down from the Brain, both lest that the too violent falling down of the humor should hinder the Tongue in speaking, as also, that the tongue might always have moisture, as it were, laid up in store, lest by continual speaking, it should grow dry and fail. For thus this spittle being consumed by feaverish heats, the Patients are scarse able to speak, unless they first moisten their tongue by much washing their mouth.

* 1.27These Glandules because they are seated in a hot and moist place, are very subject to inflam∣mations; for there flows into these oft-times together with the bloud, a great quantity of crude, phlegmatick and viscous humors, whence arises a tumor; which is not seldom occasioned by drink∣ing m ch, and that vaporous, Wine; by too much Gluttony, and staying abroad in the open air.

* 1.28Swallowing is painful and troublesome to the Patient, and commonly he hath a Feaver. Oft∣times the neighboring Muscles of the Throttle and Neck are so swoln together with these Glan∣dules, that (as it usually happens in the Squinzy) the passage of the breath and air is stopped, and the Patient strangled.

* 1.29We resist this imminent danger by purging and bloud-letting, by applying Cupping-Glasses to the Neck and Shoulders, by frictions and ligatures of the extream parts, and by washing and gar∣gling the mouth and throat with astringent Gargarisms. But if they come to suppuration, you must with your Incision-Knife make way for the evacuation of the Pus, or Matter; but, if on the contra∣ry,* 1.30 these things performed according to Art, defluxion be increased, and there is present danger of death by stopping and intercepting the breath, for the shunning so great and imminent danger, the top or upper part of the Aspera arteria, or Weazon must be opened, in that place where it uses to stand most out; and it may be done so much the safer, because the Jugular-veins, and Arteries are furthest distant from this place, and for that this place hath commonly little flesh upon it. And that the Incision may be the fitlier made,* 1.31 the Patient must be wished to bend his head back, that so the Artery may be the more easily come to, by the Instrument; then you shall make an Incision overthwart way with a crooked Knife between two Rings (not hurting nor touching the gristly substance) that is to say, the membrane which tyes together the gristly Rings, being only cut; you shall then judg that you have made the Incision large enough, when you shall perceive the breath to break out by the wound; the wound must be kept open so long, until the danger of suffocati∣on be past; and then it must be sowed up not touching the gristle: But if the lips of the wound shall be hard and callous; they must be lightly scarified, that so they may become bloudy for their easie agglutination and union, as we shall shew more at large in the cure of Hare-lips. I have had many in cure, who have recovered, that have had their Weazon together with the gristly rings thereof out with a great wound, as we shall note when we shall come to treat of the cure of the Wounds of that part

CHAP. VII. Of the Inflammation and Relaxation in the Uvula or Columella.

THE Uvula is a little body, spongy, and somewhat sharpened to the form of a Pine-Apple,* 1.32 hanging even down from the upper and inner part of the Palat, so to break the force of the Air drawn in, in breathing, and carryed to the Lungs; and to be as a quill to form and tune the voyce. It often grows above measure by receiving moisture falling down from the brain,* 1.33 becoming sharp by little and little from a broader and more swoln Basis. Which thing causes ma∣ny Symptoms; for by the continual irritation of the distilling humor the Cough is caused,* 1.34 which also hinders the sleep, and intercepts the liberty of speech; as also, by hindering respiration, the Patients cannot sleep, unless with open mouth: they are exercised with a vain indeavouring to swallow (having, as it were, a morsel sticking in their jaws) and are in danger of being strang∣led.

This disease must be resisted and assailed by purging, bleeding, cupping, taking of clysters,* 1.35 using astringent Gargles, and a convenient dyet; but if it cannot thus be over come, the cure must be tryed by a caustick of Aqua-fortis, which I have divers times done with good success.* 1.36 But if it cannot be so done, it will be better to put to your hand, than through idleness to suffer the Patient to remain in imminent and deadly danger of strangling; yet in this there must very great cauti∣on be used; for the Chirurgeon shall not judg the Uvula fit to be touched with an instrument, or caustick, which is swoln with much inflamed, or black bloud, after the manner of a Cancer; but he shall boldly put to his hand if it be longish, grow small by little and little into a sharp, loose, and soft point; if it be neither exceeding red, neither swoln with too much bloud, but whitish and without pain. Therefore that you may more easily and safely cut away that which redounds and is superfluous, desire the Patient to sit in a light place, and hold his mouth open; then take hold of the top of the Uvula with your Sizzers, and cut away as much thereof as shall be thought un∣profitable. Otherwise you shall bind it with the instrument here-under described. The invention of this Instrument is to be ascribed to Honoratus Tastellanus, that diligent and learned man, the Kings Physitian ordinary, and the chief Physitian of the Queen-mother. Which also may be used in binding of Polypi, and warts in the neck of the womb.

[illustration]

The Delineation of Constrictory-Rings, fit to twitch or bind the Columella, with a twisted thread.

• A, Shews the Ring, whose upper part is somewhat hollow.
• B, A double waxed thred, which is couched in the hol∣lowness of the Ring, and hath a running, or loose, kn••t upon it.
• C, An Iron rod, into the eye whereof the fore-mentioned dou le Thread is put, and it is to twitch the Colu∣mella, when as much thereof is taken hold of, as is unprofitable, and so to take it away without any flux of bloud. When you would straiten the Thread, draw it again through this Iron-rod, and so strain it as much as you shall think good, letting the end of the thred, hang out of the mouth. But every day it must be twitched harder than other, until it fall away by means thereof, and so the part and patient be restored to health. I have delineated three of these instruments, that you may use which you will, as occasion shall be offered.

[illustration]

A Figure of the Speculum oris, by which the mouth is held and kept open whilest the Chirurgeon is busied in the cutting away, or binding the Uvula.

But if an eating Ulcer shall associate this relaxation of the Uvula, together with a flux of bloud, then it must be burnt and seared with an hot Iron, so thrust into a Trunk, or Pipe, with an hole in it, that so no sound part of the mouth may be offended therewith.

[illustration]

A hollow Trunk with a hole in the side, with the hot Iron inserted, or put therein.

CHAP. VIII. Of the Angina, or Squinzy.

* 1.37THe Squinancy, or Squincy, is a Swelling of the jaws, which hinders the entring of the am∣bient air into the Weazon, and the vapours and the spirit from passage forth, and the meat also from being swallowed.* 1.38 There are three differences thereof. The first torments the Patient with great pain, no swelling being outwardly apparent, by reason the Morbisick humor lyes hid behind the Almonds or Glandules at the Vertebrae of the Neck,* 1.39 so that it cannot be per∣ceived, unless you hold down the Tongue with a Spatula, or the Speculum oris, for so you may see the redness and tumor there lying hid.* 1.40 The Patient cannot draw his breath, nor swallow down meat, nor drink; his tongue, (like a Gray-hound's after a course) hangs out of his mouth; and he holds his mouth open, that so he may the more easily draw his breath; to conclude, his voyce is, as it were, drown'd in his jaws and nose; he cannot lye; upon his back, but lying is forced to sit, so to breathe more freely: and because the passage is stopt, the drink flies out at his Nose; the Eyes are fiery and swollen, and standing out of their orb. Those which are thus affected are often sodainly suffocated, a foam rising about their mouths.

* 1.41The second difference is said to be that, in which the tumor appears inwardly, but little or scarse any thing at all outwardly, the Tongue, Glandules, and Jaws, appearing somewhat swollen.

* 1.42The third, being least dangerous of them all, causes a great swelling outwardly, but little in∣wardly.

* 1.43The Causes are either Internal, or External. The External are a stroak, splinter, or the like thing sticking in the Throat, or the excess of extreme cold, or heat. The Internal causes are a more plentiful defluxion of the humors either from the whole body or the Brain, which partici∣pate of the nature, either of bloud, choler, or flegm, but seldom of Melancholy. The signs by which the kind and commixture may be known, have been declared in the general Treatise of Tumors. The Squincy is more dangerous, by how much the humor is less apparent within and without. That is less dangerous which shews it self outwardly, because such an one shuts not up the wayes of the meat, nor breath. Some dye of a Squincy in twelve hours, others in•• ••o four or seven days.* 1.44 Those (saith Hippocrates) which scape the Squincy, the disease passes to the Lungs, and they dye within seven dayes; but if they scape these days, they are suppurated; but also of∣tentimes

this kind of disease is terminated by disappearing, that is, by an obscure reflux or the hu∣mor into some noble part, as into the Lungs (whence the Emprema proceeds) and into other principal parts, whose violating brings inevitable death; sometimes by resolution, otherwise by suppuration.

The way of resolution is the more to be desired; it happens when the matter is small, and that subtle; especially, if the Physitian shall draw bloud by opening a vein, and the Patient use fitting Gargarisms. A Critical Squincy divers times proves deadly, by reason of the great falling down of the humor upon the throttle, by which the passage of the breath is sodainly shut up. Broths must be used made with Capons, and Veal seasoned with Lettuce, Purslain, Sorrel, and the cold Seeds.

If the Patient shall be somewhat weak, let him have potched Egges, and Barly Creams,* 1.45 the Barly being somewhat boyled with Raisons in Water and Sugar, and other meats of this kind. Let him be forbidden Wine, in stead whereof he may use Hydromelita, and Hydrosachara, that is, drinks made of Water and Honey, or Water and Sugar; as also Syrups of dryed Roses, of Violets, Sorrel and Limmons, and others of this kind. Let him avoid too much sleep. But in the mean time the Physitian must be careful of all, because this disease is of their kind, which brook no delayes. Wherefore let the Basilica be presently opened, on that side the tumor is the greater;* 1.46 then within a short time after the same day, for evacuation of the conjunct matter, let the vein under the tongue be opened; let Cupping-Glasses be applyed, sometimes with scarification, sometimes without, to the neck and shoulders, and let frictions and painful ligatures be used to the extreme parts. But let the humor impact in the part be drawn away by Clysters and sharp Suppositories.* 1.47 Whilst the matter is in defluxion, let the mouth without delay be washed with astringent Gargarisms to hin∣der the defluxion of the humor, lest by its sodain falling down it kill the Patient; as it often hap∣pens, all the Physitians care and diligence notwithstanding. Therefore let the mouth be frequent∣ly washed with Oxycrate, or such a Gargarism: ℞ Pomorum sylvest. nu. iiij. sumach, Rosar. rub. an. m. ss. berber. ʒ ij, let them be all boyled with sufficient quantity of water to the consumption of the half, adding thereunto of the Wine of sour Pomgranats, ℥ iiij, of Diamoron ℥ ij, let it be a little more boyled, and make a gargle according to Art. And there may be other Gargarisms made of the waters of Plantain, Night-shade, Verjuyce, Julep of Roses, and the like. But if the matter of the defluxion shall be Phlegmatick, Alum, Pomgranat-pill, Cypress-nuts, and a little Vinegar may be safely added. But on the contrary, Repercussives must not be outwardly applyed, but rather Lenitives, whereby the external parts may be relaxed and rarified, and so the way be open either for the diffusing or resolving the portion of the humor. You shall know the humor to begin to be resolved, if the Feaver leave the Patient, if he swallow, speak, and breathe more freely, if he sleep quietly, and the pain begin to be much asswaged.* 1.48 Therefore then Nature's en∣deavour must be helped by applying resolved medicines, or else by using suppuratives inwardly and outwardly, if the matter seem to turn into Pus. Therefore let Gargarisms be made of the roots of March-Mallows, Figs, Jujubes, Damask-Prunes, Dates, perfectly boyled in water. The like benefit may be had by Gargarisms of Cows-milk with Sugar, by Oyl of Sweet-Almonds, or Violets warm, for such things help forward suppuration and asswage pain; let suppurating Cataplasms be applyed outwardly to the neck and throat, and the parts be wrapped with wooll moistned with Oyl of Lillies. When the Physitian shall perceive that the humor is perfectly turned into pus, let the Patients mouth be opened with the Speculum oris, and the abscess opened with a crooked and long Incision-knife; then let the mouth be now and then washed with cleansing Gargles; as ℞ Aquae hordei lib. ss. mellis ros. & syr. rosar. sic. an.* 1.49 ℥ i, fiat gargarisma. Also, the use of oenomel, that is, Wine and Hony, will be fit for this pur∣pose. The Ulcer being cleansed by these means, let it be cicatrized with a little Roch-Alum added to the former Gargarisms.

[illustration]

The Figure of an Incision-Knife opened out of the hast, which serves for a sheath thereto.

CHAP. IX. Of the Bronchocele, or Rupture of the Throat.

* 1.50THat which the French call Goetra, that the Greeks call Bronchocele, the Latins Gutturis Hernia, that is, the Rupture of the Throat. For it is a round tumor of the Throat, the matter whereof comming from within outwards, is contained between the skin and wea∣zon; it proceeds in women from the same cause as an Aneurisma.

* 1.51But this general name of Bronchocele undergoes many differences; for sometimes it retains the nature of Melicerides, other-whiles of Steatoma's, Atheroma's or Aneurisma's; in some there is found a fleshy substance having some small pain; some of these are small, others so great, that they seem almost to cover all the Throat; some have a Cist, or bag, others have no such thing; all how many soever they be, and what end they shall have, may be known by their proper signs; these which shall be curable, may be opened with an actual or potential cautery, or with an Inci∣sion-knife.* 1.52 Hence, if it be possible, let the matter be presently evacuated; but if it cannot be done at once, let it be performed at divers times, and discussed by fit remedies; and lastly, let the ulcer be consolidated and cicatrized.

CHAP. X. Of the Pleurisie.

* 1.53THe Pleurisie is an inflammation of the membrane, investing the ribs, caused by subtile and cholerick bloud, springing upwards with great violence from the hollow vein into the Azygos,* 1.54 and thence into the intercostal veins, and is at length poured forth into the empty spaces of the intercostal muscles, and the mentioned membrane. Being contained there, if it tend to suppuration, it commonly infers a pricking pain, a Feaver, and difficulty of breathing. This suppurated bloud is purged and evacuated one while by the mouth; the Lungs sucking it, and so casting it into the Weazon, and so into the mouth: otherwhiles by Urin: and sometimes by Stool.

* 1.55 But if nature, being too weak, cannot expectorate the purulent bloud poured forth into the capacity of the chest, the disease is turned into Empyema, wherefore the Chirurgeon must then be called, who beginning to reckon from below upwards, may make a vent between the third and fourth true and legitimate ribs;* 1.56 and that must be done either with an actual or potential cautery, or with a sharp knife drawn upwards, towards the back, but not downwards, lest the vessels should be violated which are disseminated under the rib. This apertion may be safely and easily performed by this actual cautery; it is perforated with four holes, through one whereof there is a pin put higher or lower, according to the depth and manner of your Incision: then the point thereof is thrust through a plate of Iron perforated also in the midst, into the part designed by the Physitian, lest the wavering hand might peradventure touch, and so hurt the other parts not to be medled withall. The same plate must be somewhat hollowed, that so it might be more easi∣ly fitted to the gibbous side, and bound by the corners on the contrary side with four strings. Wherefore I have thought good here to express the figures thereof.

[illustration]

The Figure of an actual Cautery with its Plate fit to be used in a Pleurisie.

But if the Patient shall have a large Body, Chest, and Ribs, you may divide and perforate the Ribs themselves with a Trepan; howsoever the apertion be made, the pus, or matter, must be eva∣cuated by little and little at several times; and the capacity of the Chest cleansed from the puru∣lent matter by a detergent injection of vi. ounces of Barley-water, and ℥ ij, Honey of Roses, and other the like things mentioned at large in our cure of Wounds.

CHAP. XI. Of the Dropsie.

THe Dropsie is a Tumor against nature by the aboundance of waterish humor,* 1.57 of statulen∣cies, or Phlegm, gathered one while in all the habit of the body, otherwhiles in some part and that especially in the capacity of the belly between the Peritonaeum and entrails. From this distinction of places and matters, there arise divers kinds of Dropsies. First, that Dropsie which fils that space of the belly, is either moist or dry. The moist is called the Ascites, by reason of the similitude it hath with a leather-bottle, or Borachio,* 1.58 because the waterish humor is contai∣ned in that capacity, as it were in such a vessel.

The dry is called the Tympanites, or Tympany, by reason the belly swollen with wind sounds like a Tympanum, that is, a Drum, But when the whole habit of the body is distended with a phleg∣matick humor, it is called Anasarca or Leucophlegmatia. In this last kind of Dropsie the lower parts first swell, as which by reason of their site are most subject to receive defluxions,* 1.59 and more remote from the fountain of the native heat; wherefore if you press them down, the print of your finger will remain sometime after; the patients face will become pale and puffed up, whereby it may be distinguished from the two other kinds of Dropsie. For in them first the belly, then by a certain consequence the thighs and feet do swell. There are besides also particular Dropsies, contained in the strait bounds of certain places, such are the Hydrocephalos in the head; the Bronchocele in the throat; the Pleurocele in the Chest; the Hydrocele in the Scrotum, or Cod;* 1.60 and so of the rest. Yet they all arise from the same cause; that is, the weakness or defect of the altering or concoct∣ing faculties, especially of the liver, which hath been caused by a Scirrhus, or any kind of great distemper, chiefly cold, whether it happen primarily, or secondarily by reason of some hot distem∣per dissipating the native and inbred heat, such a Dropsie is uncurable; or else it comes by consent of some other higher or lower part; for if in the Lungs, Midriff, or Reins there be any distemper, or disease bred, it is easily communicated to the gibbous part of the Liver, by the branches of the hollow vein, which run thither. But if the mischief proceed from the Spleen, Stomach, Mesentery,* 1.61 Guts, especially the jejunum and Ileum, it creeps into the hollow side of the liver by the mese∣raick veins, and other branches of the Vena porta or Gate-vein. For thus such as are troubled with the Asthma, Ptisick, Spleen, Jaundise, and also the Phrensie, fall into a Dropsie.

Lastly, all such as have the menstrual or haermorrhoidall blood suppressed or too immoderate∣ly flowing contrary to their custome, either overwhelms, diminisheth, or extinguisheth the native heat; no otherwise than fire, which is suffocated by too great a quantity of wood; or dieth and is extinguished for want thereof. We must look for the same from the excrements of the belly or bladder, cast forth either too sparingly or too immoderately: Or by too large quantity of meats too cold and rashly devoured without any order; To conclude, by every default of external causes through which occasion, error may happen in diet or exercise.

The Ascites is distinguished from the two other kinds of Dropsies,* 1.62 both by the magnitude of the efficient cause, as also by the violence of the Symptoms, as the dejected appetite, thirst, and swelling of the Abdomen. And also when the body is moved or turned upon either side, you may hear a sound as of the jogging of water in a vessel half full. Lastly,* 1.63 the humor is diversly driven upwards or downwards, according to the turning of the body and compression of the Abdomen; It also causeth various Symptoms by pressure of the parts to which it floweth. For it causeth diffi∣culty of breathing and the cough by pressing the Midriffe; by sweating through into the capacity of the Chest it causeth like Symptoms as the Empyema. Besides also the patients often seem, as it were, by the ebbing and flowing of the waterish humor, one while to be carried to the skies, and another whiles to be drowned in the water, which I have learnt not by reading of any author, but by the report of the Patients themselves. But if these waterish humors be fallen down to the lower parts, they suppress the excrements of the guts and bladder by pressing and straitning the passages. When the patient lies on his back the tumor seems less, because it is spread on both sides; On the contrary, when he stands or sits, it seems greater, for that all the humor is forced or driven into the lower belly, whence he feels a heaviness in the Pecten or share. The upper parts of the body fall away by defect of the blood fit for nourishment in quality and consistence, but the lower parts swel by the flowing down of the serous and waterish humor to them. The pulse is little, quick, and hard with tension.

This disease is of the kind of Chronical or long diseases; wherefore it is scarce,* 1.64 or never cu∣red, especially in those who have it from their mothers womb, who have the Action of their sto∣mach depraved; and those who are cachectick, and old; and lastly, all such as have the natural faculty languishing and faulty.

On the contrary, young and strong men, especially if they have no feaver, and finally all who can endure labour, and those exercises which are fit for curing this disease, easily recover; prin∣cipally if they use a Physitian, before the water which is gathered together do putrefie and infect the bowels by its contagion.

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,* 1.65 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,* 1.66 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.

* 1.67The 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,* 1.68 and tops of Dill, of Stoechas, and the like, be added, the business will goe bet∣ter forwards.* 1.69 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,* 1.70 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.

* 1.71Galen 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.

* 1.72But 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,* 1.73 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.

* 1.74For, 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.* 1.75 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;* 1.76 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;* 1.77 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.* 1.78 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.* 1.79 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,* 1.80 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,* 1.81 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,* 1.82 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.

CHAP. XIII. Of the tumor and relaxation of the Navell.

* 1.83THe Exomphaelos or swelling of the Navel, is caused by the Peritonaeum, either relaxed or broken: for by this occasion oft-times the guts, and oft-times the kal, fal into the seat of the Navel, and sometimes superfluous flesh is there generated; otherwise, this tumor is as an Aneurisma by too great a quantity of blood poured forth in that place: otherwise by a fla∣tulent matter, and sometimes by a waterish humor. If the humor be occasioned by the kall, the part it self will retain his proper colour,* 1.84 that is, the colour of the skin; the tumor will be soft and almost without pain, and which will reside without noise, either by the pressure of your fingers, or of it self when the Patient lieth on his back; but tumor caused by the guts, is more unequal, and when it is forced in by the pressure of your fingers,* 1.85 there is such a noise heard, as in the Entero∣cele; but if the tumor proceed of superfluous flesh it will be harder and more stubborn, not easily retiring into the body, although the patient lie upon his back, and you presse it with your fingers.

* 1.86The tumor is softer which proceeds of wind, but which will not retire into the body, and sounds under your nail like a taber. If the swelling be caused by a waterish humor, it hath all things common with the flatuous tumor, except that it is not so visible, and without noise. If it be from effusion of blood, it is of a livid colour; but if the effused blood shall be arterial, then there are the signs of an Aneurisma. Wherefore when the tumor is caused by the guts, kall, wind or a waterish humor, it is cured by Chirurgery: but not if it proceed from a fleshy ex∣crescence or suffusion of blood. The tumor of the navell proceeding from the kall and guts, the Patient must lie upon his back to be cured; and then the kall, and guts, must with your fingers be forced into their due place: then the skin with which the tumor is circumscribed must be ta∣ken up with your fingers, and thrust through with a needle, drawing after it a double twined and strong thred; then it must be scarified about the sides, that so it may be the easier agglutinated. Then must it be thrust through with a needle three or four times, according to the manner and condition of the distention and tumor. And so twitch it strongly with a thred, that the skin which is so bound may at length fall off together with the ligatures. But also you may cut off the skin so distended even to the ligature, and then cicatrize it, as shall be fit. A flatulent tumor of the navell shall be cured with the same remedies, as we shall hereafter mention in the cure of a windy rupture, but the watery may be poured forth by making a small incision. And the wound shall be kept open, so long, untill all the water be drained forth.

CHAP. XIIII. Of the Tumors of the Groins and Cods called Herniae, that is, Ruptures.

* 1.87THe ancient Physicians have made many kinds of Ruptures, yet indeed there are only three to be called by that name, that is, the Intestinalis, or that of the guts; the Zirba∣lis, or that of the kall; and, that which is mixed of them both. The other kinds of Rup∣tures have come into this order, rather by similitude, than any truth of the thing: for in them the gut or kall doe not forsake their places.

* 1.88The Greeks have given to all these several names, both from the seat of the tumor, as also from their matter. For thus they have called an unperfect rupture which descends not beyond the Groins, nor fals down into the Cods, Bubonocele: but the compleat which penetrates into the Cod, if it be by falling down of the gut, Enterocele: if from the kall, Epiplocele; if from them both toge∣ther,* 1.89 they name it Enter••-••piplocele: but if the tumor proceed from a waterish humor, they term it Hydrocele: if from wind, Physocele; if from both, Hydro-physocele; if a fleshly excrescence shall grow about the testicle, or in the substance thereof, it is named Sarcocele. If the veins interwoven,* 1.90 and divaricated divers ways, shall be swoln in the cod and testicles, the tumor ob∣tains the name of a Cirsocele. But if the humors shall be shut up or sent thither, the name is im∣posed upon the tumor,* 1.91 from the predominant humor, as we have noted in the beginning of our Tractate of Tumors. The causes are many, as, all too violent motions, a stroak, a fall from a high place, vomiting, a cough, leaping, riding upon a trotting horse, the sounding of trumpets, or sackbuts, the carrying or lifting up of a heavy burden, racking, also the too immoderate use of viscid and flatulent meats; for all such things may either relax or break the Peritonaeum, as that which is a thin and extended membrane. The signs of a Bubonocele are a round tumor in the groin, which pressed,* 1.92 is easily forced in. The signs of an Enterocele are a hard tumor in the cod, which forced, returneth back and departeth with a certain murmur and pain; but the tumor proceeding of the kall, is lax and feels soft like wool, and which is more difficultly forced in, than that which proceeds from the guts, but yet without murmuring and pain; for the substance of the guts, see∣ing it is one, and continued to it self, they do not only mutually succeed each other, but by a cer∣tain consequence doe, as in a dance, draw each other, so to avoid distention, which in their mem∣branous body cannot be without pain, by reason of their change of place from that which is na∣turall, into that against nature: none of all which can befall the kall, seeing it is a stupid body, and almost without sense, heavy, dull, and immoveable. The signs that the Peritonaeum is broken, are the

sudden increase of the tumor, and a sharp and cutting pain; for when the Peritonaeum is only re∣laxed, the tumor groweth by little and little, and so consequently with small pain; yet such pain re∣turns so often, as the tumor is renewed by the falling down of the Gut, or Kall, which happens not to the Peritonaeum being broken: for the way being once open, and passable to the falling body, the tumor is renewed without any distention, and so without any pain to speak of. The rest of the signs shall be handled in their places. Sometimes it happens that the Guts, and Kall, do firmly adhere to the process of the Peritonaeum, that they cannot be driven back into their proper seat. This stub∣born adhesion happens by the intervention of the viscid matter, or by means of some excoriation caused by the rude hand of a Chirurgeon, in too violently forcing of the Gut, or Kall, into their place. But also, too long stay of the Gut in the Cod, and the neglect of wearing a Truss, may give occasion to such adhesion. A perfect and inveterate Rupture by the breaking of the process of the Peritonaeum in men of full growth, never, or very seldom admits of cure. But you must note,* 1.93 that by great Ruptures of the Peritonaeum, the Guts may fall into the Cod, to the bigness of a mans head, without much pain and danger of life, because the excrements, as they may easily enter, by reason of the largeness of the place and Rupture, so also they may easily return.

CHAP. XV. Of the Cure of Ruptures.

BEcause children are very subject to Ruptures, but those truly not, fleshy or varicous,* 1.94 but wa∣try, windy, and especially of the Guts, by reason of continual and painful crying and cough∣ing: Therefore in the first place we will treat of their cure. Wherefore the Chirurgeon, called to restore the Gut which is faln down, shall place the Child, either on a Table, or in a Bed, so that his Head shall be low, but his Buttocks and Thighs higher; then shall he force with his hands by little and little, and gently, the Gut into the proper place; and shall foment the Groin with the astringent fomentation, described in the falling down of the womb.* 1.95 Then let him ap∣ply this remedy: ℞ Praescript. decoctionis quantum sufficit, farinae hordei & fabarum, an. ℥ i, pulver. Aloes, Mastiches, Myrtill. & Sarcoco. an. ℥ ss, Boli Armeni ℥ ij. Let them be incorporated and made a Cataplasm according to Art. For the same purpose he may apply Emplastrum contra Rupturam: but the chief of the cure consists infolded clothes, and Trusses and Ligatures artificially made, that the restored Gut may be contained in its place, for which purpose he shall keep the child seat∣ed in his Cradle for 30 or 40 days, as we mentioned before; and keep him from crying, shouting,* 1.96 and coughing; Aetius bids, steep Paper 3 days in water, and apply it made in a Ball to the Groin, the Gut being first put up; for that remedy by 3 days adhesion will keep it from falling down. But it will be, as I suppose, more effectual, if the Paper be steeped not in common, but in the astringent water, described in the falling down of the womb.* 1.97 Truly I have healed many by the help of such remedies, and have delivered them from the hands of the Gelders, which are greedy of Childrens Testicles, by reason of the great gain they receive from thence. They by a crafty cozenage, perswade the Parents, that the falling down of the Gut into the Cod, is uncurable: which thing notwithstanding experience convinceth to be false, if so be the cure be performed according to the fore-mentioned manner, when the Peritonaeum is only relaxed, and not broken: for the process thereof by which the Gut doth fall as in a steep way, in progress of time and age is straitned and knit together, whilst also in the mean time the Guts grow thicker.

A certain Chirurgeon who deserveth credit, hath told me that he hath cured many Children,* 1.98 as thus. He beats a Loadstone into fine powder, and gives it in pap, and then he anoints with Ho∣ny the Groin, by which the Gut came out, and then strewed it over with fine filings of Iron. He administred this kind of remedy for ten or twelve days: The part for other things being bound up with a Ligature and Truss as was fitting. The efficacy of this remedy seemeth to consist in this;* 1.99 that the Loadstone by a natural desire of drawing the Iron which is strewed upon the Groin, joyns to it the fleshy and fatty particles interposed between them, by a certain violent impetuosi∣ty, which on every side pressing and bending the loosness of the Peritonaeum, yea verily adjoyning themselves to it, in process of time by a firm adhesion intercept the passage and falling down of the Gut or Kall; which may seem no more abhorring from reason, than that we behold the Loadstone it self through the thickness of a Table, to draw Iron after it any way. The same Chi∣rurgeon affirmed, that he frequently and happily used the following Medicine.* 1.100 He burnt into ashes in an Oven red Snails, shut up in an earthen Pot, and gave the powder of them to little chil∣dren, in Pap; but to those which were bigger, in Broth.

But we must despair of nothing in this disease, for the cure may happily proceed in men of full growth, as of forty year old, who have filled the three dimensions of the body, as this following relation testifies.

There was a certain Priest in the Parish of St. Andrews, called John Moret,* 1.101 whose office was to sing an Epistle with a loud voyce as often as the solemnity of the day, and the thing required. Wherefore seeing he was troubled with the Enterocele, he came to me, requiring help, saying, he was troubled with a grievous pain, especially then, when he stretched his voyce in the Epistle. When I had seen the bigness of the Enterocele, I perswaded him to get another to serve in his place; so having gotten leave of M. Curio, Clerk, and Deacon of Divinity, he committed him∣self unto me: I handled him according unto Art, and commanded him he should never go without a

Truss; and be followed my directions. When I met him some five or six years after, I asked him, How he did: he answered; Very well, for he was wholly freed from the disease, with which he was formerly troubled; which I could not perswade my self of, before that I had found that he had told me the truth, by the diligent observation of his genitals. But some six months after, he dying of a Pleurisie, I came to Curio's house where he dyed, and desired leave to open his body, that I might observe whether Nature had done any thing at all in the passage through which the gut fell down: I call God to witness, that I found a certain fatty substance about the process of the Peritonaeum about the bigness of a little Egg, and it did stick so hard to that place, that I could scarce pul it away without the rending of the neighbouring parts. And this was the speedy cause of his cure.* 1.102 But it is most worthy of observation, and admiration, that Nature but a little helped by Art, healeth diseases which are thought incurable. The chief of the cure consists in this, that we firmly stay the gut in its place, after the same manner as these two figures shew.

[illustration]

The Figure of a Man broken on one side, wearing a Truss, whose Bolster must have three Tuberosities, two on the upp r, and one on the lower part; and there must be a h••llowness between them in the midst, that they may not too str••itly press the share-bone, and so cause pain. The man∣ner of such a Truss, I found out not long ago, and it seem∣ed letter and safer than the rest for to hinder the falling down of the gut and k••ll.

• A, S••eas the Shoulder-band which is tyed before and behind to the girl••e of the Truss.
• B, The Truss.
• C, The Cavity left in the midst of the Tuberosities.

[illustration]

Another Figure of a Man having a Rupture on both sides, shewing by what means, with what kind of and what Shoulder-band he must be bound on each groin.

• A, Sheweth the Shoulder band divided in the midst for the putting through of the head.
• B, The Truss, with two Bolsters, between which is a hole for putting through the yard. The form of both Bolsters ought to be the same with the former.

In the mean time we must not omit diet. We must forbid the use of all things, which may ei∣ther relax, dilate, or break the process of the Peritonaeum, of which I have already treated suffi∣ciently. Sometimes, but especially in old men, the guts cannot be restored into their place, by reason of the quantity of the excrements hardned in them: In this case they must not be too vi∣olently forced, but the Patient must be kept in his Bed: and, lying with his head head low, and his knees higher up; let the following Cataplasms be appiled.

℞ rad. alth. & lil. ana ℥ ij. seminis lini & faenugr. an. ℥ ss, fol. malvae, & viol. pariet. an. m. ss.* 1.103 Let them be boyled in fair water, afterwards beaten, and drawn through a searse, adding there∣to of new Butter without Salt, and Oyl of Lillies as much as shall suffice. Make a Cataplasm in the form of a liquid Pultis. Let it be applyed hot to the Cod, and bottom of the Belly; by the help of this remedy when it had been applyed all night, the Guts have not seldom been seen of themselves, without the hand of a Chirurgeon, to have returned into their proper place. The windiness being resolved, which hindered the going back of the excrements into another Gut, whereby they might be evacuated and expelled. But if the excrements will not go back thus, the flatulencies, yet resisting undiscussed, an emollient and carminative clyster is to be admitted, with a little Chymical Oyl of Turpentine, Dill, Juniper, or Fennil. Clysters of Muscadine,* 1.104 Oyl of Walnuts, and Aqua vitae, and a small quantity of any the aforesaid Oyls, are good for the same purpose.

It often happens that the Guts cannot yet be restored, because the process of the Peritonaeum is not wide enough. For when the excrements are fallen down with the Gut into the Cod; they grow hard by little & little, and encrease by the access of flatulencies caused by resolution, which cause such a tumor as cannot be put up through that hole, by which a little before it fell down: whereby it happens that by putrefaction of the matter there contained, come inflammations, and a new access of pain; and lastly, a vomiting and evacuation of the excrements by the mouth, be∣ing hindered from the other passage of the fundament. They vulgarly call this affect Miserere mei. That you may help this symptom, you must rather assay extreme remedies, than suffer the Patient to dye by so filthy and loathsom a death. And we must cure it by Chirurgery, after this manner following. We will bind the Patient lying on his back, upon a Table or Bench; then pre∣sently make an Incision in the upper part of the Cod, not touching the substance of the Gut; then we must have a silver Cane or Pipe, of the thickness of a Goose-quill, round and gibbous in one part thereof, but somewhat hollowed in the other, as is shewed by this following Figure.

[illustration]

The Figure of the Pipe or Cane.

We must put it into the place of the Incision,* 1.105 and put it under the production of the Peritonae∣um being cut together with the Cod, all the length of the production, that so with a sharp Knife we may divide the process of the Peritonaeum, according to that cavity separated from the Guts there contained, by the benefit of the Cane in a right line not hurting the Guts. When you have made an indifferent Incision, the Guts must gently be put up into the Belly with your fingers, and then so mush of the cut Peritonaeum must be sowed up, as shall seem sufficient, that by that passage made more strait, nothing may fall into the Cod after it is cicatrized.

But if there be such abundance of excrements hardned, either by the stay or heat of inflamma∣tion, that that Incision is not sufficient to force the excrements into their place, the Incision must be made longer, your Cane being thrust up towards the Belly: so that it may be sufficient for the free regress of the Guts into the Belly. Then sow it up as is fit, and the way will be shut up a∣gainst the falling down of the Gut or Kall; the process of the Peritonaeum being made more strait, by reason of the future; for the rest, the wound shall be cured according to Art. But before you undertake this work, consider diligently whether the strength of the Patient be sufficient, neither attempt any thing before you have foretold, and declared the danger to the Patient's friends.

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

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.

* 1.106There 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.

* 1.107There 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,* 1.108 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

the testicles into the Cod. I observed this not long ago in a Boy,* 1.109 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;* 1.110 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,* 1.111 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.* 1.112 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.

CHAP. XVIII. Of the cure of other kinds of Ruptures.

EPiplocele is the falling down of the Kall into the Groin, or Cod; it hath the same causes as an Enterocele. The signs have been explained. It is not so dangerous, nor infers a consequence of so many evil symptoms, as the Enterocele doth, yet the cure is the same with the other.

Hydrocele is a waterish tumor in the Cod; which is gathered by little and little between the membranes encompassing the testicles, especially the Dartes and Erythroides;* 1.113 it may be called a particular dropsie, for it proceeds from the same causes, but chiefly from the defect of native heat. The signs are a tumor encreasing slowly without much pain, heavy, and almost of a glassie clearness,* 1.114 which you may perceive by holding a candle on the other side; by pressing the cod above, the water flows down, and by pressing it below, it rises upwards, unless peradventure in too great a quantity it fils up the whole capacity of the cod, yet it can never be forced or put up into the belly as the kall or guts may, for oft-times it is contained in a cist or bag; it is distinguished from a Sarcocele, by

the smoothness and equality thereof.* 1.115 The cure must first be tryed with resolving, drying, and discussing medicines, repeated often before, and in the Chapter of the Dropsie; this which fol∣lows I have often tryed and with good success.

* 1.116℞ Ung. comitissae, & desiecat. rub. an. ℥ ij, malaxentur simul, and make a medicine for your ease. The water by this kind of remedy is digested and resolved, or rather dryed up, especially if it be not in too great quantity. But if the swelling, by reason of the great quantity of water, will not yield to those remedies, there is need of Chirurgery; the Cod and Membranes wherein the wa∣ter is contained, must be thrust through with a Seron, that is, with a large three-square pointed Needle, Thred with a skean of Silk; you must thrust your Needle presently through the holes of the mullets made for that purpose, not touching the substance of the Testicles. The skean of Thred must be left there, or removed twice or thrice a day, that the humor may drop down, and be e∣vacuated by little and little. But if the pain be more vehement by reason of the Seton, and inflam∣mation come upon it, it must be taken away, and neglecting the proper cure of the disease, we must resist the symptoms.

Some Practitioners use not a Seton, but with a Razor, or Incision-knife, they open the lower part of the Cod, making an Incision some half fingers bredth long, penetrating even to the contained water; alwayes leaving untouched the substance of the testicles and vessels, and they keep the wound open, until all the water seems evacuated; truly by this only way the cure of a watery rupture whose matter is contained in a cist, is safe, and to be expected; as we have said in our Treatise of Tumors in General.

* 1.117The Pneumaetocele, is a flatulent tumor in the Cod, generated by the imbecillity of heat residing in the part.

* 1.118It is known by the roundness, levity, renitency and shining. It is cured by prescribing a conve∣nient diet, by the application of medicines which resolve and discuss flatulencies, as the seeds of Annis, Fennel, Faenugreek, Agnus Castus, Rue, Origanum, and other things set down by Avicen in his Treatise of Ruptures. I have often used, with good success for this purpose, Emplastrum Vigo∣nis cum Mercurio; and Emplastrum Diacalcitheos, dissolved in some good Wine, as Muscadine with Oyl of Bays.

* 1.119A Sarcocele is a Tumor against Nature, which is generated about the Stones by a scirrhous flesh. Gross and viscid humors breed such kind of flesh, which the part could not overcome and assimi∣late to it self;* 1.120 whence this over-abundance of flesh proceeds like as Warts do. Varices, or swoln veins often associate this tumor; and it increases with pain. It is known by the hardness, asperity, inequality, and roughness. It cannot be cured but by amputation, or cutting it away; but you must diligently observe, that the flesh be not grown too high, and have already seized upon the groin; for so nothing can be attempted without the danger of life.

But if any man think, that he in such a case may somewhat ease the Patient by the cutting away of some portion of this same soft flesh,* 1.121 he is deceived. For a Fungus will grow, if the least portion thereof be but left, being an evil far worse than the former; but if the Tumor be either small or in∣different, the Chirurgeon taking the whole tumor, that is, the testicle tumified through the whole substance, with the process incompassing it, and adhering thereto on every side, and make an Inci∣sion in the Cod, even to the tumor; then separate all the tumid body, that is, the Testicle from the Cod: then let him thrust a needle with a strong thred in it, through the midst of the process, above the region of the swoln testicle; and then presently let him thrust it the second time through the same part of the process; then shall both the ends of the Thred be tied on a knot, the other mid∣dle portion of the Peritonaeum being comprehended in the same knot. This being done, he must cut away the whole process with the testicle comprehended therein. But the ends of the thred, with which the upper part of the process was bound, must be suffered to hang some length out of the wound, or Incision of the Cod. Then a repercussive medicine shall be applyed to the wound, and the neighbouring parts with a convenient ligature. And the cure must be performed as we have formerly mentioned.

* 1.122The Cirsocele is a tumor of veins dilated, and woven with a various and mutual implication about the Testicle and Cod, and swelling with a gross and melancholy bloud. The causes are the same as those of the Varices. But the signs are manifest.

* 1.123To heal this Tumor, you must make an Incision in the Cod, the bredth of two fingers to the Varix. Then put under the Varicous vein, a Needle having a double thred in it, as high as you can, that you may bind the roots thereof: then let the Needle be again put after the same manner about the lower part of the same vein, leaving the space of two fingers between the liga∣tures. But before you bind the thred of this lowest ligature, the Varix must be opened in the midst, almost after the same manner as you open a vein in the arm to let bloud: That so this gross Bloud causing a Tumor in the Cod, may be evacuated as is usually done in the cure of the Varices. The wound that remains shall be cured by the rules of Art after the manner of other wounds; leaving the threds in it, which presently fall away of themselves. To conclude then, it being grown callous, especially in the upper part thereof, where the vein was bound, it must be ci∣catrized; for so afterwards Bloud cannot be strained or run that way.

* 1.124Hernia Humoralis is a tumor generated by the confused mixture of many humors in the Cod, or between the Tunicles which involve the Testicles, often also in the proper substance of the Testi∣cles. It hath like causes, signs, and cures as other Tumors. While the cure is in hand, Rest, Trusses, and fit Rowlers to sustain and bear up the Testicles, are to be used.

CHAP. XVIII. Of the falling down of the Fundament.

WHen the Muscle called the Sphincter which ingirts the Fundament is relaxed,* 1.125 then it comes to pass that it cannot sustain the right gut. This disease is very frequent to Chil∣dren by reason of the too much humidity of the Belly; which falling down upon that Muscle mollifieth and relaxeth it or presseth it down by an unaccustomed weight, so that the Mus∣cles called Levatores Ani, or the lifters up of the Fundament, are not sufficient to bear up any longer. A great Bloudy-flux gives occasion to this effect. A strong endevour to expel hard ex∣crements, the Haemorrhoids, which suppressed do over-load the right gut, but flowing relax it: Cold, as in those which go without Breeches in Winter, or sit a long time upon a cold Stone, a stroak or fall upon the Holy-bone, a Palsie of Nerves which go from the Holy-bone to the Muscles the lifters up of the Fundament: the weight of the Stone being in the Bladder.

That this Disease may be healed, we must forbid the Patient too much drinking,* 1.126 too often eat∣ing of Broth, and from feeding on cold Fruits. For local medicines the part must be fomented with an astringent decoction made of the rinds of Pomegranats, Galls, Myrtles, Knotgrass, Shepherds-purse, Cypress Nuts, Alum, and common Salt boyled in Smiths-water, or Red-wine. After the fomentation, let the Gut be anointed with Oyl of Roses or Myrtles, and then let it be gently put by little and little into its place, charging the Child, if he can understand your meaning, to hold his breath. When the Gut shall be resotred, the part must be diligently wiped, lest the Gut fall down again by reason of the slipperiness of the unction. Then let the powder prescribed for the falling down of the Womb be put into the Fundament as far as you can: Then you must straitly bind the Loins with a swathe, to the midst whereof behind let another be fastned which may be tied at the Pubes coming along the Peritonaeum, so to hold up the Fundament the better to contain it in its place, a Spunge dipt in the astringent decoction. The Patient, if he be of sufficient age to have care of himself, shall be wished when he goes to Stool, that he sit upon two pieces of wood being set some inch a sunder, lest by his straining he thrust forth the Gut together with the excre∣ment; but if he can do it standing, he shall never by straining thrust forth the Gut.

But if the Gut cannot by the prescribed means be restored to its place,* 1.127 Hippocrates bids that the Patient hanging by the heels be shaken; for so the Gut by that shaking will return to his place: but the same Hippocrates wisheth to anoint the Fundament, because that remedy having a drying faculty, hath also power to resolve the flatulent humors without any acrimony, by reason of which the Gut was the less able to be contained in his place.

CHAP. XIX. Of the Paronychia.

THe Paronychia or Panaris is a tumor in the ends of the fingers, with great inflammation,* 1.128 coming of a malign and venemous humor, which from the Bones by the Periosteum is com∣municated to the Tendons and Nerves of that part which it affecteth, whereof cruel symptoms do follow, as pulsifique pain, a Feaver, restlesness, so that the affected through impati∣ency of the pain are variously agitated like those tormented with Carbuncles: for which cause Guido and Johannes de Vigo judge this disease to be mortal; wherefore you must provide a skilful Physitian for the cure of this Disease, which may appoint convenient diet, purging and bloud-letting. In the mean time the Chirurgeon shall make way for the virulent and venenate matter, by making Incision in the inner part of the finger, even to the Bone alongst the first joint thereof; for Vigo saith, there is not a presenter remedy, if so be that it be quickly done,* 1.129 and before the matu∣ration of the matter; for it vindicates the Finger from the corruption of the Bone and Nerves, and asswages pain, which I have often and happily tryed immediately at the beginning, before the perfect impression of the virulency.

But the wound being made, you must suffer it to bleed well, then presently let him dip his finger in strong and warm Vinegar, in which some Treacle being dissolved may draw forth the virulen∣cy. But to appease the pain, the same remedies must be applyed to the affected part as are used in Carbuncles, as the leaves of Sorrel, Henbane, Hemlock, Mandrake roasted under the Embers and beaten in a Mortar with new Unguentum Populeon, or Oyl of Roses, or new Butter without Salt: for such like medicines also help forward suppuration: whilst by their coldness, they re∣press the extraneous heat affecting the part; and so strengthen the native heat being the author of suppuration: which reason moved the ancient Physitians to use such medicines in a Carbuncle: but if by reason of the fearfulness of the Patient, or unskilfulness of the Chirurgeon, no Incisi∣on being made, a Gangrene and Sphacel shall possess the part, it remains that you cut off with your cutting Mullets as much of the part as shall be corrupt, and perform the rest of the cure ac∣cording to Art. Yet it doth not seldom happen, that there may be no need to cut off such a finger, because it being corrupted together with the Bone by little and little dissolves into a purulent or rather sanious or much stinking filth. But in this affect there is often caused an Eschar by the adu∣stion of putredinous heat, and superfluous flesh indued with most exquisite sense groweth under∣neath it, which must in like manner be cut off with the Mullets, that the part may receive comfort, the pain being asswaged by the copious effusion of Bloud.

CHAP. XX. Of the swelling of the Knees.

* 1.130AFter long and dangerous diseases there oftentimes arise Tumors in the Knees, and also in Plethorick Bodies, and such as have evil juyce after labours and exercise. This kind of disease is frequent, because the humor easily falls into the part which hath been heated by labour. But if such Tumor follow long Diseases, they are dangerous and difficult to cure, and therefore not to be neglected; for bitter pain accompanyeth them, because the humor fal∣ling thither distends the Membranes, which being many involve the part; besides that, this humor participateth of a certain virulent and malign quality whether it be cold or hot, when it hath set∣led into those parts, being such as we find in the pains of the joynts, and in the bitings of vene∣mous creatures.

* 1.131For the cure if the tumor be caused by Bloud, let a slender and refrigerating diet be appoint∣ed, and phlebotomy for the revulsion of the antecedent cause; divers local medicines shall be used according to the variety of the four times. But for to asswage the pain, Anodynes, or mitiga∣ting medicines shall be appointed: of all which we have sufficiently treated in the Chapter of the cure of a Phlegmon.

And because these parts are of exact sense, if there be necessity to open the tumor, yet must we not do it rashly, or unconsiderately, for fear of pain and evil accidents.

This kind of tumor is oft-times raised by wind contained there; in which case the Chirurgeon must be very provident, that he be not deceived with the shew of flowing of the humor, which he seems to perceive by the pressure of his fingers, as if there were matter and humor contained there∣in, and so be brought to open the tumor. For the wind breaking forth in stead of the humor, causeth evil symptoms by reason of the section rashly made in a part so sensible.

But if waterish humors shall tumefie the part, the Body shall first be purged with medicines purging flegm: And then inciding, attenuating, rarifying, discussing, and very drying local medi∣cines shall be used.

Of which we have abundantly spoken in the Chapter of the Oedema. Yet this humor divers times lies deep between the Whirl-bone and the Joynt, which causeth it that it cannot be discus∣sed and resolved by reason of the weakness of the part and defect of heat, so that the adventitious humor often moves and excludes the Bones from their seat. As I have observed it to have hap∣pened to many.

In which case, Irrigations of red Wine, falling something high whereby the force of the me∣dicine may enter and more easily penetrate, are much commended.

CHAP. XXII. Of the Dracunculus.

* 1.132I 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.

* 1.133Paulus 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.

* 1.134But 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:* 1.135 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.

* 1.136Aetius 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.* 1.137 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,* 1.138 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,* 1.139 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,* 1.140 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,* 1.141 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.

* 1.142For 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,* 1.143 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,* 1.144 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,* 1.145 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,* 1.146 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,* 1.147 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;* 1.148 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.* 1.149 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

  What it is. The causes.
• * 1.2

  Differences by reason of place▪
• * 1.3

  Signs.
• * 1.4

  A History.
• * 1.5

  The reason the name.
• * 1.6

  Lib. 6. cap. 8.
• * 1.7

  The differences hereof.
• * 1.8

  Which of them admit no ma∣nual operati∣on.
• * 1.9

  An Anodyne.
• * 1.10

  Why it must be taken clear away.
• * 1.11

  What it is.
• * 1.12

  The differen∣ces.
• * 1.13

  Their Signs and Symptoms.
• * 1.14

  Prognostick.
• * 1.15

  The cure. Lib 3. de comp. med. see. Loco•• Hip. aph. 21 lib. 1.
• * 1.16

  Gentle resol∣ving medi∣cines.
• * 1.17

  Stronger re∣solvers.
• * 1.18

  A ripening medicine.
• * 1.19

  What it is.
• * 1.20

  The Symp∣tomes.
• * 1.21

  The Chirurgi∣cal cure.
• * 1.22

  Why the cure must not be deferred.
• * 1.23

  The Reason why it is so called.
• * 1.24

  The Cause.
• * 1.25

  The Cure.
• * 1.26

  Why the Glandules are called Al∣monds. Their use.
• * 1.27

  The Cruse of their tumor.
• * 1.28

  Symptoms.
• * 1.29

  Cure.
• * 1.30

  Extreme dis∣eases must have extreme remedies.
• * 1.31

  How you must open the Weazon.
• * 1.32

  What the Ʋvu¦la is, and what the use thereof.
• * 1.33

  The Cause of the swelling, thereof.
• * 1.34

  Symptoms.
• * 1.35

  The Cure.
• * 1.36

  The cure by Chirurgery.
• * 1.37

  What it is.
• * 1.38

  The differen∣ces.
• * 1.39

  The first kind.
• * 1.40

  The Symp∣toms.
• * 1.41

  The second kind.
• * 1.42

  The third.
• * 1.43

  The Causes.
• * 1.44

  Hip. sect. 3. proe 2. A∣p••••r. 10 sect. 5.
• * 1.45

  Diet.
• * 1.46

  Cure.
• * 1.47

  Repelling Gargarisms.
• * 1.48

  Ripening Gar∣garisms.
• * 1.49

  Detergent Gargarisms.
• * 1.50

  The reason of the name.
• * 1.51

  The differen∣ces.
• * 1.52

  The Cure.
• * 1.53

  What it is.
• * 1.54

  Of a Pleurifie coming to sup∣puration.
• * 1.55

  Of the change thereof into an Empyema.
• * 1.56

  Of the aperti∣on of the side in an Empye∣ma.
• * 1.57

  What the Dropsie is.
• * 1.58

  The differen∣ces thereof.
• * 1.59

  The Symp∣tomes.
• * 1.60

  The Causes.
• * 1.61

  How divers diseases turn into Dropsies.
• * 1.62

  The signs of an Ascites.
• * 1.63

  The Symp∣tomes.
• * 1.64

  Prognosticks.
• * 1.65

  Hip. lib. 4. de acut. & lib. de intern.
• * 1.66

  Bags.
• * 1.67

  Bathes.
• * 1.68

  Liniments.
• * 1.69

  Emplaisters.
• * 1.70

  Vesicatories.
• * 1.71

  Gal. lib. de fa∣cul. natur. 1.
• * 1.72

  Divers opini∣ons of Para∣cent••sit, or ope∣ning of the belly. Reasons a∣gainst it.
• * 1.73

  Erasistratus his Reasons a∣gainst it.
• * 1.74

  Reasons for it.
• * 1.75

  Lib. 3. cap. 21.
• * 1.76

  Lib. de morb. Ch. cap. de Hydrope.
• * 1.77

  The places of the apertion must be divers according to the parts chie∣fly affected.
• * 1.78

  The manner of making aperti∣on.
• * 1.79

  A History.
• * 1.80

  A caution for taking out the pipe.
• * 1.81

  Another man∣ner of evacua∣ting the water after the aper∣tion.
• * 1.82

  A medicine for the Jaundise.
• * 1.83

  The divers causes thereof.
• * 1.84

  Signs hereof occasioned by the kall.
• * 1.85

  By the guts. By flesh.
• * 1.86

  By wind. By a waterish humor. By bruised blood. Which may be cured by Chi∣rurgety, which not. The cure by Chirurgery.
• * 1.87

  These are only 3 sorts of Ruptures.
• * 1.88

  Bubonocele. Enterocele and Epiplocele.
• * 1.89

  Hydrocele. Physocele.
• * 1.90

  Sarcocele. Cirsocele.
• * 1.91

  The Causes.
• * 1.92

  The Signs.
• * 1.93

  What Rupture is uncureable.
• * 1.94

  To what Rup∣tures children are subject.
• * 1.95

  An astringen cataplasm.
• * 1.96

  Ser. 1. cap. 24.
• * 1.97

  The craft and covetousness Gelders.
• * 1.98

  Another way to cure Rup∣tures.
• * 1.99

  The reason this cure.
• * 1.100

  Another medi∣cine.
• * 1.101

  A notable Hi∣story.
• * 1.102

  We must ne∣ver desp••st in diseases if to be ••••o••e be asto∣••••ted by Art.
• * 1.103

  A Cataplasm to soften the excrements.
• * 1.104

  Chymical Oyl.
• * 1.105

  The Chirurgi∣cal cure by the Golden Tie.
• * 1.106

  Another man∣ner thereof.
• * 1.107

  The third manner there∣of.
• * 1.108

  A thing to be noted.
• * 1.109

  A History.
• * 1.110

  Lib. de arte medica.
• * 1.111

  Lib. de sem.
• * 1.112

  Lib. 3. cap. 33.
• * 1.113

  What a Hydro∣cele is.
• * 1.114

  The signs;
• * 1.115

  The Cure.
• * 1.116

  A medicine to draw forth the contained mat∣ter.
• * 1.117

  What a Pneu∣matocele is.
• * 1.118

  The Cure.
• * 1.119

  What a Sarco∣cele is.
• * 1.120

  The Signs. Prognosticks.
• * 1.121

  The Cure.
• * 1.122

  What a Cirso∣cele is.
• * 1.123

  The Cure.
• * 1.124

  Hernia Humo∣ralis.
• * 1.125

  The causes.
• * 1.126

  The cure.
• * 1.127

  Hippocrates hi•• cure.
• * 1.128

  What the Pa∣ronychia is.
• * 1.129

  Lib. cap. 4. tract.
• * 1.130

  Gal. com. ad sent. 1 ser. 4. lib. 6. Epid. Gal. Com. ad sent. 67. sect. 2. prog.
• * 1.131

  The Cure.
• * 1.132

  It is not as yet sufficiently known what Dracunculi are.
• * 1.133

  Lib 4. cap. ult.
• * 1.134

  The cure out of Aegineta.
• * 1.135

  Cap. 21. lib. 4. sent. 3, tract. 3.
• * 1.136

  Lib. 14. cap. ult.
• * 1.137

  The Cure out of Aetius.
• * 1.138

  Tractar. 7. c. 34. The cure out of Rhasis.
• * 1.139

  His opinion of them.
• * 1.140

  Soranus his o∣pinion.
• * 1.141

  Epist. 2. lib. 7.
• * 1.142

  Aetius opinion confuted. Tract. 3. sermo. 1 cap. 40.
• * 1.143

  4 Meteorolog.
• * 1.144

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

  Stink, an unse∣parable com∣panion to putrefaction.
• * 1.145

  What things usually breed worms.
• * 1.146

  Cap. 83. Chir, Gallic.
• * 1.147

  Why they are called Dracun∣culi.
• * 1.148

  The Cure.
• * 1.149

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