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 Tenth BOOK. Of the Green and Bloudy WOƲNDS of each Part.

CHAP. I. Of the kinds or differences of a broken Skull.

NOw that we have briefly treated of Wounds in general, that is, of their differences, signs, causes, prognosticks and cure, and also shewed the reason of the acci∣dents and symptoms which usually follow and accompany them, it remains that we treat of them as they are incident to each part, because the cure of wounds must be diversly performed according to the diversity of the parts. Now we will begin with the wounds of the head. Therefore the head hath the hairy scalp light∣ly bruised without any wound, otherwhiles it is wounded without a Contusion, and sometimes it is both contused and wounded: but a fracture made in the skull, is sometimes superficiary, some∣times it descends even to the Diploe, sometimes it penetrates through the 2 Tables, and the Me∣ninges, into the very substance of the Brain; besides, the Brain is oft-times moved and shaken with breaking of the internal veins, and divers symptoms happen when there appears no wound at all in the head: of all and every of which we will speak in order, and add their cure, especi∣ally according to the opinion of the divine Hippocrates. He in his Book of the wounds of the head, seems to have made 4 or 5 kinds of fractures of the skull. The first is called a fissure or fracture, the second a contusion or collision, the third is termed Effractura, the fourth is named Sedes, or a seat; the fifth (if you please to add it) you may call a Counterfissure, or as the interpreter of Paulus calls it, a Resonitus. As when the Bone is cleft on the contrary side, to that which received the stroak. There are many differences of these five kinds of a broken skull. For some fractures are great, some small, and others indifferent: some run out to a greater length or bredth; others are more contracted; some reside only in the superficies; others descend to the Diploe, or else pierce through both the Tables of the Skull; some run in a right line, others in an oblique and circular; some are complicated amongst themselves; as a Fissure is necessarily and alwayes accom∣pained with a Collision or Contusion; and others are associated with divers accidents, as pain, heat, swelling, bleeding, and the like. Sometimes the Skull is so broken, that the Membrane lying under it, is pressed with shivers of the Bone, as with pricking needles. Somewhiles none of the Bones fall off. All which differences are diligently to be observed, because they force us to vary cure, and therefore for the help of memory, I have thought good to describe them in the follow∣ing Table.

A Table of the Fractures of the Skull.

• A Fracture, or Solution of conti∣nuity in the Skull is caused either by
  • Contusion, that is, a col∣lision of a thing brui∣sing, hard, heavy and obtuse, which shall fall or be smitten a∣gainst the head, or a∣gainst which the head shall be knocked, so that the broken Bones are divided, or
    • Keep their na∣tural figure and site touching each other, whence proceeds that fracture of the Skull which is called a fis∣sure, which is
      • Either manifest, and apparent, that is
        • To your sight,
        • To your feeling,
        • Or instrument.
      • Or obscure and not ma∣nifest, when as not the part which received the blow is wounded, but the contrary thereto; and that happens either
        • In the same Bone, and that two manner of ways, as
          • On the side; as for example, when the right side of the Bone of the Fore∣head is strucken, the left is cleft.
          • Or from above to below, as when not the first Table which received the blow is cleft, but that which is un∣der it.
        • In divers Bones, to wit, in such men as want Sutures, or have them very close, or disposed other-wayes then is fit, and this op∣position is ei∣ther
          • From the right side to the left, and so on the contrary, as when the right Bregma is struck, and the left cleft.
          • From before to be∣hind, and the con∣trary, as when the Forehead is smit∣ten, the Nowl is cleft,
      • Or between both, that is, the obscure and manifest, as that which is termed a Capillary fissure, and is manifested by smearing it over with Oyl, and wri∣ting Ink.
    • Or lose their site, and that either
      • Wholly, so that the particles of the broken Bone re∣moved from their seat, and falling down, press the Membrane, whence proceeds that kind of effra∣cture, which retains a kind of attrition, when as the Bone struck upon is broken as it were into ma∣ny fragments, shivers, and scales, either apparent, or hid in the sound Bone, so that it is pressed down.
      • Or in some sort; as when the broken bone is in some part separated, but in others adheres to the whole Bone, whence another kind of effracture arises; you may call it arched, when as the Bone so swels up, that it leaves an empty space below.
  • Or by incision of a sharp, or cut∣ting thing, but that incision is made either by
    • Succision, when the bone is so cut, that in some part it yet adheres to the sound Bone.
    • Rescission, when the fragment falls down wholly broken off.
    • Or Seat, when the mark of the weapon remains im∣printed in the wound, that the wound is of no more length nor breadth than the weapon fell upon.

Another Table of the differences of a fractured Skull▪

• The differences of Fractures common to these of all o∣ther parts are drawn, either from
  • Their Nature, according to which fractures are call'd,
    • Simple, as when they are found solitary and by them∣selves.
    • Compound and that either
      • Mutually with themselves, as a contu∣sion, or Collision with Incision, a Fissure with an Effracture.
      • Or with other symptomes, as Swelling, Pain, Heat, Bleeding, Convulsion, and the like.
  • Their Quantity, whence they are called, great, indifferent and small, according to the triple dimension of length, breadth, and profundity.
  • Their Figure, from whence they are called
    • Right,
    • Oblique,
    • Transverse,
    • Round,
    • Triangular.
  • Their Site, whence they are termed on the fore or back, or the right or left, or the up∣per or lower part; or superficiary and profound.
  • The Part, whence it is called a Fracture of the Forehead, Nowl, Bregma, and Stony bones; and hence it is judged, what may be deadly or hopeful of recovery, easie or dif∣ficult to cure.

CHAP. II. Of the causes and signs of a broken Skull.

THe causes of a broken Skull are external, as a fall, a blow or stroak with any kind of weapon, sharp, obtuse, heavy, hard, the bitings of Beasts, and many other things of the like kind. But the signs by which we come to know that the Skull is broken, are of two kinds; for some of them are found out by the reasoning and discourse of the mind, other by the sense, as those which lay open the wound to the eye and hand.

The Rational signs shew by these things which have happened upon the thing it self, whether it be, and of what sort it is. For you may know the Skull is broken, if the Patient shall fall down with the stroak, or if he shall fall headlong from a high place upon some hard thing. If for sometime after the stroak, he shall lie without speaking, sight and hearing; if he shall have felt and feel much pain, so that he is often forced to put his hand to the wound. But also the weapon is to be considered, that is, whether if it be heavy, obtuse, pricking or sharp. Also we must consider with what and how great strength the stroak was given, and with how great anger, and from what distance the weapon fell. Also we must consider whether the Patient received the blow with his head unarmed and naked; whether he fell into a swoon presently after the blow; whether, when he came to himself, he was in his right senses; whether his eyes were blinded; whether he were troubled with a giddiness or diziness, and whether he bled at the nose, mouth, ears, or eyes; and lastly, whether he vomitted. For Hippocrates writes, that those who have their Brain cut must necessarily have a Feaver and Vomitting of choler to ensue thereupon, which Galen confirming in his Com∣mentary, saith, that the same happens also when the Wound comes to the Membranes of the Brain.

Also a dull sound as from a broken vessel coming from the skull, (the hairy scalp and Pericra∣nium being taken off) and it being lightly smitten upon with an Iron probe, is said to be a sign of a fracture thereof, as it is recorded by Paulus Aegineta. Truly, all these signs make a great con∣jecture, or rather assuredness that the skull is wounded, and the Brain hurt, as which cannot happen unless the bone be broken, as Celsus hath written. Yet many have had their skulls broken, who had no such sign immediately after the blow, but this is very seldom. But I do not think fit amongst so many signs, here to omit that which is set down by Guido. If any (saith he) will know in what place the skull is broke, let the Patient hold fast between his fore-teeth, one end of a Lute-string or thread, and the Chirurgeon hold the other in his hand, then let him lightly touch or play upon the string with his fingers; for in the very instant of the sound or stroke, the Pati∣ent will be certainly admonished, or perfectly perceive the part of the skull that is broken, and as orecome and forc'd by this sense of pain, will by lifting up of his hand make demonstration thereof. As yet I have not been able to find the truth hereof by experience, although I have made tryal of it in many. Wherefore I cannot say any thing certainly of this sign, as neither of that which is mentioned by Hippocrates in Coais Praes. In such as you doubt, whether the Bones of

the Skull be broken, or not, you must judg by giving them the stalk of the Asphodil, to chaw on both sides of their jaws, but so that you bid them withall observe, whether they perceive any Bone to crackle, or make a noise in their heads; for those which are broken seem to make a noise.

But passing over these things, now let us come to those signs, which may be obvious to our senses.

CHAP. III. Of the Signs of a broken Skull, which are manifest to our sense.

THose signs are here said to be manifest to sense, which, when the Bone is bared, manifest the wound to our Eyes, fingers, and probe. But if the hairs stand upon one end in the wound, you may know the Bone is broke, because the hair which yields to the violence of the blow, cannot be so cut, the Bone which resists the stroak being not violated, as it is observed by Hippocrates; wherefore we may by the sight of this one thing, before any inspection of the wound it self, suspect by a probable conjecture, that the Skull is broken, and perswade the be∣holders or standers by so much.

Moreover we may, before we have cut the skin across, or laid bare the Bone, give a guess by our feeling, whether the Skull be broken, or no, if we by pressing down our fingers neer the wound shall perceive the bone either to stand up, or be pressed down otherwise than it should na∣turally be.

The skin being c••t cross-wise, and the Bone laid bare, if the fracture be not obvious to the Eye, you must try with our probe: which must neither be too thin nor too sharp, lest by falling into some natural ••ranies, it may cause us to suspect without any cause that the Bone is broken; neither let it be too thick, lest the little clifts may deceive you. If when your probe comes to the Bone, it meets with nothing but that which is smooth and slippery, it is a sign that it is whole.

But on the contrary, if you find it any thing rough, specially where there is no suture, it shews the Bone is broken. But let the Chirurgeon consider, that the fractures are not seldom upon the sutures; and that the sutures have not alwayes one and their natural site; as also it often comes to pass that the broken cleft, or cut Bone, can neither be perceived by your sight, nor Instrument: wherefore if you think there is any such thing, by the rational signs above-mentioned; anoynt the place with writing Ink, and Oyl, and so you shall find the crack or clift, by the means we shall shew you hereafter.

When you are certain of the fracture, then you must diligently consider the greatness of the disease, and apply medicines speedily. Verily when a fracture chances to light upon any suture, the disease is hard to be known, unless the fracture be very great, because the sutures by their clifts and roughness resemble fractures; wherefore Hippocrates saith, that he was deceived by them. Now having briefly delivered the differences and signs of a broken Skull, it is time to come to the several kinds thereof, with a Fissure.

CHAP. IV. Of a Fissure, being the first kind of a broken Skull.

IF the Chirurgeon by the fore-mentioned signs shall know that the Skull is broken, or crakt, and if the wound made in the musculous skin shall not be thought sufficient for ordering the Fissure, th•••• must he shave off the hair, and cut with a razour, or Incision-knife, the muscu∣lous skin with the Pericranium lying under it in a triangular or quadrangular figure to a pro∣portionable bigness, alwayes shunning as much as in him lyes, the sutures and temples; nei∣ther must he fear any harm to ensue hereof; for it is farr better to bare the Bone by cutting the skin, than to suffer the kind and nature of the fracture to remain unknown by a too rel gious preservation of the skin; for the skin is cured without any great ado, though pluckt off to no purpose.

For it is much more expedient (in Hippocrates opinion) to cure diseases safely and securely, though not speedily, than to do it in a shorter time with fear of relapse and greater inconveni∣encies. Let this dissection be made with a razour or sharp knife, and if there be any wound made in the skin by the weapon, let one of your Incisions be made agreeable thereto.

[illustration]

A Razour, or Incision-Knife.

Now therefore the Musculous skin together with the Pericranium must be divided, and cut with a sharp razour pressed and guided with a strong and steddy hand; then it must be so pluckt

from the Bone, or Skull lying under it, that none thereof remain upon the Bone; for if it should be rent or torn with the Trepan, it would cause vehement pain with inflammations. You must be∣gin to pull it back at the corners of the lines crossing each other with right angles, with this Chis∣sel whose figure you see here expressed.

[illustration]

A Chissel or Instrument to pull back or separate the Pericranium from the Skull.

Then you must fill all the wound with boulsters of fine soft lint, that so the lips may be kept fur∣ther a-sunder. But you shall apply upon it medicines fit to stanch bloud. But if it come so to pass that the bloud flows forth so violently, that it can be stayed by no means, the vessel it self must be bound, after this manner.

First thrust through the musculous skin on the outside with a needle and thred, then thrust the Needle back again; then tye the thred on a knot on the outside, but first put some lint rolled up to the bigness of a Goose-quill between the thred and the hairy scalp on both sides thereof, lest the strait twitching of the thred which may serve to stay the bleeding, may cut and tear the skin, or cause pain: then must you raise his head somewhat higher.

I have lately tryed, and performed this upon a certain Coach-man, who thrown from the Coach upon his Head on a pavement of free-stone, exceedingly bruised the hind-part of the Bregma, for which cause it was fit to open the musculous skin, with a cross Incision, both that the congealed bloud might be pressed out, as also that the fracture (if there were any) might be observed. But an Artery being cut in performance hereof, when as the Chirurgeon, who was there present, could not stay the bloud leaping out with violence; and the Coachman already had lost so great a quantity thereof, that his strength was so much decayed, that he could not stir himself in his Bed, or scarse speak: I being called, shewed them by experience, that whereas astringent medicines were used before to no purpose, it was better to stay the bleeding by binding the vessel, than to let the Patient dye for a childish fear of pricking him.

But that we may return to our former matter, the Chirurgeon shall the next day consider, with what kind of fracture the Bone is hurt; and if no signs of hurt appear to the eyes, nor be perceived with your fingers and probe, yet some of the rational signs may cause one to have a con∣jecture that there is a fracture: Then you must anoint, as we told you before, the bared Bone with writing Ink, and a little Oyle of Roses; that the cleft or crack may be dyed or coloure therewith, if that there be any there. Then the next dressing you must dry the Bone with a linnen cloth, and scrape off the Ink, and Oyl, with scraping Instruments made for the purpose, if any part thereof shall be sunk into the Bone; for if there be any crack, it will be black; Wherefore you must continue scraping until no sign of the fissure remain, or else until you come even to the Dura Ma∣ter. But that he may be more certain whether the Fissure pierce through both the Tables of the Skull, he must bid the Patient, that stopping his Nose and Mouth, he strive to breathe with a great indeavour. For then bloudy matter, or sanies, will sweat through the Fissure: For the breath driven forth of the Chest, and prohibited passage forth, swells and lifts up the substance of the Brain, and the Meninges, whereupon that frothy humidity and Sanies sweats forth. Therefore then the Bone must be cut, even to the Dura Mater, with a Radula, and other scraping Instruments, fit for that purpose, yet so as you hurt not the Membrane; but if the Fissure shall be some∣what long, it will not be convenient to follow it all the extent thereof: for Nature will repair and restore the remnant of the Fissure by generating a Callus: besides also, the Chirurgeon accor∣ding to Celsus opinion must take away as little of the Bone as he can, because there is nothing so fit to cover the Brain as the Skull. Therefore it shall suffice to make a passage; whereby the bloud and Sanies may pass and be drawn forth, lest that matter being suppressed may corrupt the Bone, and cause an inflammation in the Brain. But the broken Bone must be taken forth within three days, if it be possible, especially in Summer, for fear of inflammation. Yet I have often taken forth with a Trepan, and with Scrapers the Bones of the Skull, after the seventeenth day, both in Winter and Summer; and that with happy success. Which I have the rather noted, lest any should, at any time, suffer the wounded to be left destitute of remedy: for it is better to try a doubtful remedy than none: Yet the By-standers shall be admonished and told of the danger, for many more dye who have not the broken bones of the Skull taken out, than those that have.

But the Instruments, with which the wounded or cleft Bones may be cut out, are called Scal∣pri or Radulae, of which I have caused divers sorts to be here decyphered, that every one might take his choyce, according to his mind, and as shall be best for his purpose. But all of them may be scrued into one handle, the figure whereof I have exhibited.

[illustration]

Radulae or Scalpri, (i.) Shavers or Scrapers.

[illustration]

Radulae of another form, for the better cutting of the greater Bones.

To conclude; When the Skull shall be wounded or broken with a simple Fissure, the Chi∣rurgeon must think he hath done sufficient to the Patient, and in his Art, if he shall divide the Bone, and dilate the Fissure, or cleft, with the described Instruments, though he have used no Trepan, although the Fissure pierce through both the Tables. But if it doth not exceed the first Table, you must stay your scrapers assoon as you come to the second, according to the opinion of Paulus: but if the bone shall be broken and shivered into many pieces, they shall be taken forth with fit Instruments, using also a Trepan, if need shall require, after the same manner as we shall shew you hereafter.

CHAP. V. Of a Contusion, which is the second sort of Fracture.

AN Ecchymosis, that is, effusion of bloud, presently concreting under the musculous skin, without any wound, is oft caused by a violent contusion. This Contusion if it shall be great, so that the skin be divided from the Skull, it is expedient, that you may make an Incision, whereby the bloud may be evacuated and emptied. For in this case you must wholly desist from suppurative medicines (which otherwise would be of good use in a fleshy part) by reason that all the moist things are hurtful to the Bones, as shall be shown hereafter.

Such like Contusions more frequently happen in children, being easily perceived by the softness, and inundation of the contused part: forth of which oft-times when I have open∣ed them with my Incision-knife, serous clotted and blackish bloud hath issued. The residue of the cure is perfected by moderate compression of the part, and drying medicines. More∣over the Skull of a child, may be pressed down, by a great contusion, even as we see it happens in thin vessels of Brass, Lead, or Pewter, for oft-times by the pressure of your finger, they are so dented in, that the print thereof remains; yet sometimes they fly back of themselves, and again acquire their former plainness and equability, which also happens in the bones of children, women, and such as are soft, humid, and phlegmatick. But if the bones do not spring back of themselves, you must apply a Cupping-glass with a great flame; withall command the Patient, to force his breath up as powerfully as he can, keeping his mouth and nose close shut; for thus there will be hope, to restore the depressed bone to its place, by the spi∣rits

forc'd upwards to the Brain and Skull, by the powerful attraction of the Cupping-glass. But

[illustration]

if so be that the Bone cannot by this means be restored, then you must make an Incision in the skin, and fasten such a Trepan, as you see here delineated, into the depre••••, or setl•••••• part of the Bone, and so pull it directly upwards; just as we see Coopers raise the staves of their Cask, when they are sunk too much in.

But if the Bone shall bee too strong, thick, and dense, so that this Instrument will not serve to pluck it forth; then you must perforate the Skull, in the very center of the depression, and with this three∣fold Instrument, or Levatory, put into the hole, lift up and restore the Bone to its natural site; for this same Instrument is of strength sufficient for that purpose. It is made with three feet, that so it may be applyed to any part of the head which is round; but divers heads may be fitted to the end thereof, according as the business shall re∣quire, as the figure here placed doth shew.

[illustration]

A three-footed Levatory.

But if at any time it comes to pass, that the Bone is not totally broken or deprest, but only on one side; it will be fit, so to lift it up, as also to make a vent for the issuing out of the filth, to divide the Skull with little Saws like these, which ye see here expressed; for thus so much of the Bone, as shall be thought needful, may be cut off without compression, neither will there be any danger of hurting the Brain or Membrane with the broken Bone.

[illustration]

The figures of Saws fit to divide the Skull.

But if by such signs as are present, and shall appear, we perceive or judg that the contusion goes but to the second Table, or scarse so far; the baring or taking away of the Bone, must go no fur∣ther than the contusion reaches; for that will be sufficient to eschew and divert inflammations and divers other symptoms. And this shall be done with a scaling or Desquamatory Trepan, (as they term it) with which you may easily take up as much of the Bone, as you shall think expedient: And I have here given you the figure thereof.

[illustration]

A Desquamatory, or Scaling Trepan.

[illustration]

A Delineation of other Levatories.

• A A. Shews the point or tongue of the Levatory, which must be somewhat dull, that so it may be the more gently and easily put be∣tween the Dura Mater, and the Skull, and this part thereof may be lifted up so much by the head or handle taken in your hand, as the necessity of the present operation shall require.
• ...

  B. Intimates the body of the Levatory, which must be four square, lest the point or tongue put thereon should not stand fast, but the end of this, Body must rest upon the sound bone, as on a sure foundation.

  The use thereof is, thus; put the point or tongue under the broken or depressed Bone, then lift the handle up with your hand, that so the depr••ssed bone may be elevated.

• C. Shews the first Arm of the other Levatory, whose crooked end must be gently put under the depressed Bone.
• D. Shews the other Arm, which must rest on the sound Bone, that by the firm standing thereof, it may lift up the depressed Bone.

CHAP. VI. Of an Effracture, or depression of the Bone, being the third kind of Fracture.

BEfore I come to speak of an Effracture, I think it not amiss to crave pardon of the curte∣ous and understanding Reader, for this reason especially, that as in the former Chapter, when I had determined and appointed to speak of a Contusion, I inserted many things of a Depression; so also in this Chapter of an Effracture, I intend to intermix something of a Contusi∣on; we do not this through any ignorance of the thing it self; for we know that it is called a Contusion, when the Bone is deprest and crusht, but falls not down. But an Effracture is, when the Bone falls down and is broken by a most violent blow. But it can scarse come to pass, but that the things themselves must be confounded and mixt, both as they are done; and also when they are spoken of: so that you shall scarse see a Contusion without an Effracture, or this without that. Therefore the Bones are often broken off and driven down with great and forcible blows, with clubs whether round or square, or by falling from a high place directly down, more or less according to the force of the blow, kind of weapon and condition of the part receiving the same: Wherefore you must be provided with diversity of remedies and instruments to encoun∣ter therewith. Wherefore admit the Bone is pressed down, and shivered into many pieces, now

for that these splinters need not be taken out with a Trepan, you may do the business with Levato∣ries made and neatly fashioned for that purpose; such as these, which here are exprest.

[illustration]

A Levatory.

But we must have special care, lest that, in pulling and taking out of these scales and splinters, we hurt the membranes. These scales are sometimes very rough and prickly, so that they cannot touch the Meninges without offence, but somewhiles the business is so intricate, that they cannot be taken out, unless by enlarging the Fracture. Wherefore in this case, if there be a space so large, as that the ends of these mullets may enter, you may easily shear off so much of the bone as shall be necessary and requisite for the taking away of these scales, without any assistance of the Tre∣pan, which I have done very often, and with good success; for the operation performed by these Mullets is far more speedy and safe, than that with the Trepan; and in the performance of every operation, the chief commendation is given to safeness and celerity.

[illustration]

Cutting Mullets; commonly called Rostra Psittaci, or Parrots beaks.

Moreover I have thought good here to give you the figures of Chisels; Scrapers, Pincers, toge∣ther with a leaden Mallet, because such Instruments are not only very necessary to take forth the scales of Bones which are broken, but also to plain and smooth those which remain whole.

[illustration]

The Figures of Scrapers, Pincers, a leaden Mallet, &c.

But Here you must note, that a Trepan nor Levatory, must never be applyed to a Bone quite broken, lest the mem∣branes lying under it be hurt by the compression thereof. Therefore you must apply them to a sound Bone, but as neer as you can to the Fracture, so that you take away as little of the Skull as is possible, lest the Brain despoiled of its boney-cover, take some harm thereby. Neither Effractures, nor yet Fissures, if they be of some length, must be followed to their ends; but think your self well, if you have made a pas∣sage for the issuing forth of the Sanies, or filth, and have drawn forth that Bone, which pricked the Membranes. For Nature is accustomed by generating a Callus to soulder, or unite the Bones of the Skul, as it also doth those of the other parts; as we have read it written by Hippocrates and Galen; for which purpose, it hath by singular Providence replenish∣ed both the Tables of the Skull, with a certain alimentary and bloudy matter, that with this as with marrow it might repair the loss and defect of the Bone.

The truth hereof was lately manifested in the servant of Master Grolo, who had an Effracture on the coronal bone, by a grievous blow, given him with the foot of a Mule; which when I un∣derstood, I divided the musculous skin with a three cornered section in that place, with an intent to apply a Trepan there; wherefore the day following, the bone being bored, and when I thought to draw it forth, yea verily endeavoured to pluck it forth, being already divided with the Tre∣pan, I perceived a fearful production of an Effracture; by the moveableness of the bone shaking under my hand; for it reached from the midst of the Fore-head, to the lesser corner of the Eye. Wherefore omitting both my determination, and endeavour to pull it forth, I thought I should do sufficiently for the Patient, if I should only raise up the bone which was deprest; for so it did not trouble the Crassa Meninx by pressing it, and the matter; and filth, were let forth by a passage made with a Saw. So that in conclusion, he recovered perfectly, but that he lost one of his Eyes which was adjoyning to the Fracture.

CHAP. VII. Of a Seat, being the fourth kind of a broken Skull.

HIppocrates calls a Seat that kind of Fracture of the Skull, when the weapon so falls upon the Skull, that the Fracture retaining the print thereof, is neither stretched forth any fur∣ther, nor contracted to any less space.

And seeing there be many forms hereof, they all (whether they shall be superficiary, or shall pierce even to the Diploe, or else pass through both the Tables, whether it be with any loss of the bony substance, whether it run long wayes, or else be but short; or otherwise are dilated to some breadth, or else be but narrow; whether they shall be done with a cut, or with a prick with a Dagger, Styletto, Lance, or other kind of weapon, whether they shall have this or that ac∣cident joyned with them, I say all of them, how many and various soever they be,) ought and must be cured by some of the formerly described Instruments and means. Yet this must be noted, which as yet we have not remembred, that if it happen by a violent stroak, and great wound, that a por∣tion of the bone is wholly so cut off, that it is clean severed from the rest of the Skull, and hang on∣ly by the Pericranium and the musculous skin; yet you must not pluck it from the Pericranium, and cast it away as unprofitable, but restore it to its proper seat and place, so by the force of Nature, to be glewed by a Callus, as Celsus hath observed.

I have tryed the truth of this Experiment, in Captain Hydron, not very long ago. He had the middle part of the Os Coronale, of the breadth, and length of three fingers, so cut with a sharp Sword, that it stuck not to the rest of the bone; but scarse adhering to the Pericranium, and muscu∣lous skin, lay turned down over his face, so that the Dura Mater was plainly seen; wherefore I prepared to pluck it from the skin, and cast it away, but that I remembred Hippocrates Precept, where he bids, that the Brain should not be robbed of its cover and left bare. Wherefore first of all I wiped away the bloud which was fallen upon the Dura Mater, whose motion you might plain∣ly see, then I restored the portion of the bone to its place, and fastned it on the upper side with a Suture consisting of three stitches; and that the residue of the matter might have passage forth, I filled the places between each stitch with lint: by this means, he by the mercy of God recover∣ed, though at the same time he received many other large wounds in his body; which is a certain experiment, that we must cast away no part of the Skull, nor the Pericranium, no not of the mus∣culous skin, unless necessity urge; therefore much less to leave the Brain naked and despoiled of its coverings.

CHAP. VIII. Of a Resonitus, or Counter-Fissure, being the fifth kind of Fracture.

SOmetimes the Fracture is made in the part opposite to that which received the blow; as if the right side be struck, the left is cloven; this kind of Fracture is very dangerous, because we cannot find it out by any certain sign, as it is written by Hippocrates Lib. de vuln. Capitis. Wherefore if at any time the Patient dye of such a Fracture, the Chirurgeon must be pardoned.

And although Paulus Aegineta laugh at this kind of Fracture; and thinks that it cannot hap∣pen to a mans head, as that which is hard and full, as it happens in empty glass Bottles, yet I have sometimes seen and observed it.

Neither is their reason of any vailidity, who think Nature therefore to have framed the head of many bones knit together by sutures; lest the fracture of the one side, should be stretched to the other. For peradventure this may take place, in such as have express Sutures, seated and framed according to Nature. But it takes no place in such as either want them, or have them not seated according to Nature, or have them very close and so defaced that it may seem one Bone grown together of many; This shall be made manifest by recital of the following History.

A servant of Massus the Post-master had a grievous blow with a stone, upon the right Bregma, which made but a small wound, yet a great Contusion and Tumor. Wherefore that it might more plainly appear, whether the Bone had received any harm, and also that the congealed bloud might be pressed forth, the wound was dilated, the skin being opened by Theodore Hereus the Chirur∣geon,

who as he was a skilful workman and an honest man, omitted nothing which Art might do for his cure. When he had divided the skin, the bone was found whole, although it was much to be feared, that it was broken, because he fell presently to the ground with the blow, vomited, and shewed other signs of a fractured Skull; so it happened that he dyed on the one and twentieth day of his sickness. But I being called to learn, and search, how he came by his death, dividing the Skull with a Saw, found in the part opposite to the blow, a great quantity of Sanies, or bloudy mat∣ter, and an Abscess in the Crossa Meninx, and also in the substance of the very Brain, but no Su∣tures, but the two scaly ones. Therefore that is certain which is now confirmed by the authority of Hippocrates; as also by reason and experience, that a blow may be received on the one side, and the bone may be fractured on the opposite, especially, in such as have either no Sutures, or else so firmly united and closed, that they are scarse apparent.

Neither is it absurd, that the part, opposite to that which received the stroak, of the same bone and not of divers bones may be cloven, and in those men who have their Skulls well made, and na∣turally distinguished and composed with Sutures; and this both was, and is, the true meaning of Hippocrates. That this may be the better understood, we must note that the opposite part of the same bone may be understood, two manner of ways. First, when the fracture is in the same surface of the smitten bone, as if that part of one of the bones of the Bregma, which is next to the Lambdal suture be smitten, and the other part next to the Coronal suture be cloven. Secondly, when as not the same superficies, and table which receives the blow, but that which lyes under it is cleft, which kind of fracture I observed, in a certain Gentleman, a Horseman of Captain Stempans Troop; He in defending the breach of the wall of the Castle of Hisdin, was struck with a Musket bullet upon the Bregma, but had his helmet on his head; the bullet dented in the helmet, but did not break it, no nor the musculous skin, nor skull, for as much as could be discerned, yet notwithstanding he died apoplectick upon the sixt day after.

But I being very desirous to know, what might be the true cause of his death, dividing his Skull, observed that the second Table was broken, and cast off scales and splinters, wherewith as with Needles the substance of the Brain was continually pricked, the first and upper Table being whole, for all this: I afterwards shewed the like example to Capellanus, and Castellanus, the King and Queens cheif Physitians in the expedition of Roane.

But Hippocrates prescribes no method of curing this fifth kind of fracture, by reason he thinks it cannot be found out by any circumstance, whence it happens that it is for the most part deadly: Yet must we endeavour to have some knowledge and conjecture of such a fracture, if it shall at any time happen. Wherefore having first diligently shaven away the hair, we must apply an Emplai∣ster of Pitch, Tar, Wax, Turpentine, the Powder of Iris, or Flower-deluce roots, and Mastich; now if any place of the head shall appear more moist, soft, and swoln, it is somewhat likely that the bone is cleft in that place, so that the Patient, though thinking of no such thing, is now and then forc'd to put his hand to that part of the Skull. Confirmed with these and other signs formerly mentioned, let him call a counsel of learned Physitians; and foretell the danger to the Patients friends which are there present, that there may no occasion of calumny remain, then let him boldly perforate the Skull; for that is far better, than forsake the Patient ready to yield to the greatness of the hidden disease, & so consequently to dye within a short while after. There are four sorts, or conditions of fractures, by which the Chirurgeon may be so deceived, that when the Skull is broken indeed, yet he may think there is no fracture. The first is when the bone is so depressed, that it presently rises up into its true place, and native equability. The second is when the fissure is only capillary. The third is when the bone is shaken on the inside, the utter surface nevertheless remaining whole, forasmuch as can be discerned. The fourth is, when the bone is stricken on the one side, and cleft on the other.

CHAP. IX. Of the moving, or Concussion, of the Brain.

BEsides the mentioned kinds of fractures by which the Brain also suffers; there is another kind of affect besides Nature, which also assails it by the violent Incursion of a cause, in l ke manner, external; they call it the Commotion or shaking of the Brain, whence Symp∣tomes like those of a broken Skull ensue. Falling from aloft upon a solid and hard body, dull and heavy blows, as with Stones, Clubs, Staves, the report of a peece of Ordnance, or crack of Thun∣der, and also a blow with ones hand.

Thus as Hippocrates tells, that beautiful Damosel the daughter of Nerius, when she was twenty yeers old, was smitten by a woman, a friend of hers, playing with her, with her flat hand upon the fore-part of the head, and then she was taken with a giddiness, and lay without breathing, and when she came home, she fell presently into a great Feaver, her head aked, and her face grew red. The seventh day after, there came forth some two or three ounces of stinking and bloudy matter about her right Ear, and she seemed somewhat better, and to be at somewhat more ease. The Feaver encreased again, and she fell into a heavy sleepiness, and lost her speech, and the right side of her face was drawn up, and she breathed with difficulty, she had also a convulsion and trem∣bling; both her tongue failed her, and her eyes grew dull; on the ninth day she dyed. But you must note, that though the head be armed with a helmet; yet by the violence of a blow, the Veins,

and Arteries may be broken, not only these which pass through the Sutures, but also those which are dispersed between the two Tables in the Diploe, both that they might bind the Crassa meninx to the Skull, that so the Brain might move more freely, as also that they might carry the alimen∣tary juyce to the Brain wanting Marrow, that is, bloud to nourish it, as we have formerly shewed in our Anatomy.

But from hence proceeds the efflux of bloud running between the Skull, and Membranes, or else between the Membranes and Brain; the bloud congealing there, causeth vehement pain, and the Eyes become blind, Vomitting is caused, the mouth of the Stomach suffering together with the Brain, by reason of the Nerves of the sixt conjugation, which run from the Brain thither, and from thence are spread over all the capacity of the ventricle; whence becoming a partaker of the offence it contracts it self, and is presently, as it were, overturned; whence first, those things that are contained therein are expelled, and then such as may flow, or come thither from the neigh∣bouring and common parts, as the Liver and Gall; from all which Choler, by reason of its natu∣ral levity and velocity, is first expelled, and that in greatest plenty; and this is the true reason of that vomitting, which is caused and usually follows upon fractures of the Skull and concussions of the Brain.

Within a short while after, inflammation seizes upon the Membranes and Brain it self, which is caused by corrupt and putrid bloud proceeding from the vessels broken by the violence of the blow, and so spread over the substance of the Brain. Such inflammation communicated to the Heart, and whole body by the continuation of the parts, causes a Feaver. But a Feaver by altering the Brain, causes Doting; to which if stupidity succeed, the Patient is in very ill case, according to that of Hippocrates; Stupidity and doting, are ill in a wound, or blow upon the Head. But if to these evils, a Sphacel, and corruption of the Brain ensue, together with a great difficulty of breathing, by reason of the disturbance of the Animal faculty, which from the Brain imparts the power of moving to the Muscles of the Chest, the Instruments of Respiration; then death must necessarily follow.

A great part of these accidents appeared in King Henry of happy memory, a little before he dyed. He having set in order the affairs of France, and entred into amity with the neighbouring Princes, desirous to honour the marriages of his daughter, and sister, with the famous and noble exercise of Tilting, and he himself running in the Tilt-yard, with a blunt-lance received so great a stroak upon his Brest, that with the violence of the blow, the vizour of his helmet flew up, and the trunchion of the broken Lance hit him above the left Eyebrow, and the musculous ••kin of the Fore-head was torn even to the lesser corner of the left Eye, many splinters of the same Trunchion being struck into the substance of the fore-mentioned Eye, the Bones being not touched or bro∣ken; but the Brain was so moved and shaken, that he dyed the eleventh day after the hurt. His Skull being opened after his death, there was a great deal of bloud found between the Dura, and Pia Mater, poured forth in the part opposite to the blow, at the middle of the Suture of the hind-part of the Head; and there appeared signs, by the native colour turned yellow, that the substance of the Brain was corrupted, as much as one might cover with ones Thumb. Which things caused the death of the most Christian King, and not only the wounding of the Eye, as ma∣ny have falsly thought. For we have seen many others, who have not dyed of farr more grievous wounds in the Eye.

The History of the Lord Saint-Johns is of late memory: he in the Tilt-yard, made for that time before the Duke of Guises house, was wounded with a splinter of a broken Lance, of a fingers length and thickness, through the visour of his Helmet, it entring into the Orb under the Eye, and piercing some three fingers bredth deep into the head; by my help and Gods favour, he reco∣vered, Valeranus and Duretus the Kings Physitians, and James the Kings Chirurgeon assisting me.

What shall I say of that great and very memorable wound of Francis of Lorain the Duke of Guise? He in the fight of the City of Bologne had his head so thrust through with a Lance, that the point entring under his right Eye by his Nose, came out at his Neck between his Ear and the Vertebrae, the head or Iron being broken and left in by the violence of the stroak, which stuck there so firmly, that it could not be drawn or plucked forth, without a pair of Smith's pincers. But although the strength and violence of the blow was so great, that it could not be without a fra∣cture of the Bones, a tearing and breaking of the Nerves, Veins, and Arteries, and other parts; yet the generous Prince by the favour of God recovered.

By which you may learn, that many dye of small wounds; and other recover of great, yea, very large and desperate ones. The cause of which events is chiefly and primarily to be attributed to God, the Author and Preserver of Mankind; but secondarily to the variety and condition of Temperaments. And thus much of the commotion or concussion of the Brain; whereby it hap∣pens, that although all the Bone remains perfectly whole, yet some veins broken within by the stroak, may cast forth some bloud upon the Membranes of the Brain, which being there concrete may cause great pain, by reason whereof it blinds the Eyes; if so••e that the place can be found against which the pain is, and when the skin is opened, the bone look pale, it must presently be cut out, as Celsus hath written. Now it remains, that we tell you how to make your Prognosticks, in all the fore-mentioned fractures of the Skull.

CHAP. X. Of Prognosticks to be made, in fractures of the Skull.

WE must not neglect any Wounds in the Head, no not those which cut or bruise but on∣ly the hairy scalp; but certainly much less, those which are accompanyed by a fracture in the skull; for oft-times all horrid symptoms follow upon them, & consequently death it self, especially in bodies full of ill humors, or of an ill habit, such as are these which are affect∣ed with the Lues venerea, Leprosie, Dropsie, Pthysick, Consumption: for in these, simple wounds are hardly, or never cured; for union is the cure of wounds, but this is not performed, unless by the strength of nature, and sufficient store of laudable bloud: but those which are sick of he∣ctick Feavers and Consumptions want store of bloud, and those bodies which are repleat with ill humors, and of an ill habit, have no afflux or plenty of laudable bloud: but all of them want the strength of nature; the reason is almost the same in those also which are lately recovered of some disease.

Those wounds which are bruised are more difficult to cure, than those which are cut. When the Skull is broken, then the continuity of the flesh lying over it must necessarily be hurt and broken, unless it be in a Resonitus. The bones of children are more soft, thin, and replenished with a san∣guine humidity, than those of old men, and therefore more subject to putrefaction; Wherefore the wounds which happen to the bones of children, though of themselves, and their own nature they may be more easily healed, (because they are more soft, wherby it comes to pass, that they may be more easily agglutinated, neither is there fit matter wanting for their agglutination by reason of the plenty of bloud laudable both in consistence and quality) than in old men, whose Bones are dryer and harder, and so resist union, which comes by mixture, and their bloud is serous, and con∣sequently a more unfit bond of unity and agglutination; yet oft-times through occasion of the symptoms which follow upon them, that is, putrefaction and corruption, which sooner arise in a hot and moist body, and are more speedily encreased in a soft and tender, they usually are more suspected, and difficult to heal.

The Patient lives longer of a deadly fracture in the Skull, in Winter than in Summer, for that the native heat is more vigorous in that time than in this; besides also, the humors putrefie soon∣er in Summer, because then unnatural heat is then easily inflamed, and more predominant, as many have observed out of Hippocrates.

The wounds of the Brain and of the Meninges or Membranes thereof are most commonly dead∣ly, because the action of the Muscles of the Chest, and others serving for respiration, is divers times disturbed and intercepted, whence death insues. If a swelling happening upon a wound of the head presently vanish away, it is an ill sign, unless there be some good reason therefore, as bloud-letting, purging, or the use of resolving local medicines, as may be gathered by Hippocrates in his Aphorisms. If a Feaver ensue presently after the beginning of a wound of the head, that is, upon the fourth or seventh day, which usually happens, you must judg it to be occasioned by the generating of Pus, or Matter, as it is recited by Hippocrates. Neither is such a Feaver so much to be feared, as that which happens after the seventh day, in which time it ought to be terminated, but if it happen upon the tenth or fourteenth day with cold or shaking, it is dangerous, because it makes us conjecture that there is putrefaction in the Brain, the Meninges, or Skull, through which occasion it may arise, chiefly if other signs shall also concurr, which may shew any putrefaction, as if the wound shall be pallid and of a faint yellowish colour, as flesh looks after it is washed.

For as it is in Hippocrates Aphoris. 2. Sect. 7. It is an ill sign if the flesh look livid, when the Bone is affected; for that colour portends the extinction of the heat, through which occasion, the lively, or indifferently red colour of the part, faints and dyes, and the flesh thereabout is dissolved into a viscid Pus or filth.

Commonly another worse affect follows hereon, wherein the wound becoming withered and dry, looks like salted flesh, sends forth no matter, is livid and black, whence you may con∣jecture, that the Bone is corrupted, especially if it become rough, whereas it was formerly smooth and plain; for it is made rough when Caries or corruption invades it; but as the Caries increases, it becomes livid and black; sanious matter with all sweating out of the Diploe, as I have observed in many: all which are signs that the native heat is decayed, and therefore death at hand; but if such a Feaver be occasioned from an Erysipelas, which is either present or at hand, it is usually less terrible. But you shall know by these signs that the Feaver is caused by an Erysipelas and conflux of cholerick matter; if it keep the form of a Tertian, if the fit take them with coldness, and end in a sweat; if it be not terminated before the cholerick matter is either converted into Pus, or else resolved; if the lips of the wound be somewhat swoln, as also all the face; if the eyes be red and fiery; if the neck and chaps be so stiffe, that he can scarse bend the one, or open the other; if there be great excess of biting and pricking pain, and heat, and that far greater than in a Phleg∣mon. For such an Erysipelous disposition generated of thin and hot bloud, chiefly assails the face, and that for two causes.

The first is, by reason of the natural levity of the cholerick humor; the other because of the rarity of the skin of these parts.

The cure of such an affect must be performed by two means, that is, evacuation, and cooling with humectation. If choler alone, cause this tumor, we must easily be induced to let bloud, but

we must purge him with medicines evacuating choler. If it be an Erysipelas Phlegmonodes, you must draw bloud from the Cephalick-vein of that side, which is most affected, alwayes using advice of a Physitian. Having used these general means, you must apply refrigerating and humecting things, such as are the juyce of Night-shade, Housleek, Purslane, Lettuce, Navel-wort, Water-Lentil, or Ducks-meat, Gourds; a Liniment made of two handfuls of Sorrel boyled in fair water, then bea∣ten or drawn through a searse, with Oyntment of Roses, or some unguent. Populeon added thereto, will be very commodious. Such and the like remedies must be often and so long renewed until the unnatural heat be extinguished. But we must be careful to abstain from all unctuous & Oyly things, because they may easily be inflamed, and so encrease the disease. Next we must come to resolving Medicines; but it is good when any thing comes from within, to without; but on the contrary, it is ill, when it runs from without inwards, as experience and the Authority of Hippocrates te∣stifie: If, when the bone shall become purulent, pustules shall break out on the tongue by the dropping down of the acrid filth or matter by the holes of the palat upon the tongue, which lyes under; now when this symptom appears, few escape. Also, it is deadly when one becomes dumb and stupid, that is, Apoplectick by a stroak or wound on the Head; for it is a sign that not only the Bone, but also the Brain it self is hurt. But oft-times the hurt of the Brain proceeds so far, that from corruption it turns to a Sphacel, in which case, they all have not only pustules on their tongues, but some of them dye stupid and mute, othersome with a convulsion of the opposite part; neither as yet I have observed any which have dyed with either of these symptoms, by reason of a wound in the head, who have not had the substance of their Brain tainted with a Sphacel, as it hath appeared when their Skulls have been opened after their death.

CHAP. XI. Why, when the Brain is hurt by a Wound of the Head, there may follow a Convulsion of the opposite part.

MAny have to this day enquired, but as yet as far as I know it hath not been sufficiently explained, why a Convulsion in wounds of the head seizes on the part opposite to the blow. Therefore I have thought good to end that controversie in this place. My rea∣son is this, that kind of Symptom happens in the sound part by reason of emptiness and dryness but there is a twofold cause, and that wholly in the wounded part, of this emptiness and dryness of the sound or opposite part; to wit, pain, and the concourse of the spirits and humors thither by the occasion of the wound, and by reason of the pains drawing, and natures violently sending help to the afflicted part.

The sound part exhausted by this means both of the spirits & humors, easily falls into a Convul∣sion. For thus Galen writes; God the Creator of Nature, hath so knit together, the triple spirituous substance of our bodies, with that tye, and league of concord, by the production of the passages; to wit, of Nerves, Veins, and Arteries, that if one of these forsake any part, the rest presently neg∣lect it, whereby it languisheth; and by little and little dyes, through defect of nourishment. But if any object that Nature hath made the body double, for this purpose, that when one part is hurt, the other remaining safe and sound, might suffice for life and necessity: but I say, this axiom hath no truth in the vessels and passages of the body. For it hath not every where doubled the vessels, for there is but one only vein, appointed for the nourishment of the Brain, and the Membranes thereof, which is that they call the Torcular, by which when the left part is wounded, it may ex∣haust the nourishment of the right and sound part; and through that occasion cause it to have a Convulsion, by too much dryness; Verily it is true, that when in the opposite parts, the Muscles of one kind are equal in magnitude, strength, and number, the resolution of one part, makes the con∣vulsion of the other by accident; but it is not so in the Brain.

For the two parts of the Brain, the right and left, each by its self performs that which belongs thereto, without the consent, conspiration, or commerce of the opposite part; for otherwise it should follow, that the Palsie properly so called, that is, of half the body, which happens by reso∣lution, caused either by mollification, or obstruction, residing in either part of the Brain, should inferr together with it a Convulsion of the opposite part. Which notwithstanding, dayly experi∣ence convinceth as false. Wherefore, we must certainly think, that in wounds of the Head wherein the Brain is hurt, that Inanition and want of nourishment are the causes, that the sound and oppo∣site part suffers a Convulsion.

Francis Dalechampius in his French Chirurgery renders another reason of this question; That, (saith he) the truth of this proposition may stand firm and ratified, we must suppose, that the Con∣vulsion of the opposite part mentioned by Hippocrates, doth then only happen, when by reason of the greatness of the inflammation in the hurt part of the Brain, which hath already inferred cor∣ruption, and a Gangrene to the Brain and Membranes thereof, and within a short time is ready to cause a sphacel in the Skull, so that the disease must be terminated by death; for in this defined state of the disease, and these conditions, the sense and motion must necessarily perish in the affe∣cted part, as we see it happens in other Gangrens, through the extinction of the native heat. Be∣sides, the passages of the animal Spirit must necessarily be so obstructed by the greatness of such an inflammation or phlegmon, that it cannot flow from thence to the parts of the same side lying there-under, and to the neighbouring parts of the Brain; and if it should flow thither, it will be unprofitable to carry the strength and faculty of sense and motion, as that which is infected

and changed by admixture of putrid and Gangrenous vapours. Whereby it cometh to pass, that the wounded part destitute of sense, is not stirred up to expel that which would be troublesome to it, if it had sense; wherefore neither are the Nerves thence arising seised upon, or contracted by a Convulsion.

It furthermore comes to pass, that because these same Nerves are deprived of the presence and comfort of the Animal Spirit, and in like manner the parts of the same side, drawing from thence their sense and motion, are possessed with a Palsie; for a Palsie is caused either by the cutting or obstruction of a Nerve, or the madefaction, or mollification thereof by a thin and watry humor, or so affected by some vehement distemper, that it cannot receive the Animal Spirit.

But for the opposite part and the Convulsion thereof, it is known and granted by all, that a Convulsion is caused either by Repletion, which shortens the Nerves by distending them into bredth; or by Ininatition, when as, the native and primitive heat of the Nerves being wasted, their proper substance becoming dry is wrinckled up and contracted; or else it proceeds from the vel∣lication, and acrimony of some vapour, or sanious and biting humor, or from vehemency of pain. So we have known the Falling-sickness caused by a venenate exhalation carryed from the Foot to the Brain. Also we know that a Convulsion, is caused in the puncture of the Nerves, when as any acrid and sanious humor is shut up therein, the orifice thereof being closed; but in wounds of the Nerves, when any Nerve is half cut, there happens a Convulsion by the bitter••ess of the pain.

But verily in the opposite part, there are manifestly two of these causes of a Convulsion; that is to say, a putrid and carion-like vapour, exhaling from the hurt, and Gangrenate part of the Brain; and also a virulent, acrid, and biting Sanies, or filth, sweating into the opposite sound part, from the affected and Gangrenous; the malignity of which Sanies, Hippocrates desirous to deci∣pher, in reckoning up the deadly signs of a wounded head, hath expressed it by the word Ichor; and in his Book of Fractures he hath called this humor Dacryodes & non Pyon, [that is, Weeping and not digested.] Therefore it is no marvail, if the opposite and sound part endued with exquisite and perfect sense, and offended by the flowing thereto of both the vaporous and sanious matter, using its own force, contend and labour as much as it can, for the expulsion of that which is trou∣blesome thereto. This labouring or concussion is followed (as we see in the Falling-sickness) by a Convulsion, as that which is undertaken in vain, death being now at hand; and Nature over-ruled by the disease. Thus (saith Dalechampius) must we in my judgement determin of that pro∣position of Hippocrates and Avicen.

But he adds further, in wounds of the head, which are not deadly, Practitioners observe that sometimes the hurt part is taken with the Palsie, and the sound with a Convulsion; otherwhiles on the contrary, the wounded part is seised by a Convulsion and the sound by a Palsie; otherwhiles both of them by a Convulsion or Palsie, and somewhiles the one of them by a Convulsion or Palsie, the other being free from both affects; the causes of all which belong not to this place to explain. Thus much Dalechampius.

CHAP. XII. A Conclusion of the deadly signs in the Wounds of the Head.

NOw that we may return to our former Discourse; you may certainly foretel the Pati∣tient will dye, when his reason and judgment being perverted, he shall talk idly; when his memory fails him; when he cannot govern his tongue; when his sight grows dark and dim, his ears deaf, when he would cast himself headlong from his bed, or else lies therein without any motion; when he hath a continual Feaver with a delirium; when the tongue breaks out in pustules, when it is chopt, and become black, by reason of too much dryness; when the wound grows dry, and casts forth little or no matter; when as the colour of the wound which was formerly fresh, it now become like salted flesh yellow and pale; when the Urin, and other ex∣crements are supprest; when the Palsie, Convulsion, Apoplexy; and lastly, often swooning, with a small and unequal pulse, invade him. All such signs sometimes appear presently after the wound, otherwhiles some few days after; therefore when as the Brain is hurt and wounded by the violence of the incision, or fissure, of the contusion, compression, puncture, concussion, or any other fracture, the forementioned signs appear presently in the first days; but when they do not appear till many days after the blow, you may know that they rise and appear, by reason of an inflammation and phlegmon in the Brain, occasioned by the putrefaction of the bloud poured forth upon it.

But we must observe this, by the way, which also belongs to the prognosticks, that flesh is easily regenerated, and restored in all parts of the head, except in that part of the forehead, which is a lit∣tle above that which lies between the Eye-brows, so that it will be ulcerated ever after, & must be covered with a Plaister. I believe that in that place there is an internal cavity in the Bone, full of air, which goes to the sieve-like Bones of the Nose, by which the growth of flesh may be hinder∣ed; or else that the Bone is very dense or compact in that place, so that there can scarse sufficient juyce sweat forth, which may suffice for the regeneration of flesh; add hereunto a great conflux of excrements flowing to this ulcer, which should otherwise be evacuated by the Eyes and Nose, which hinder by that means the dryness of the Ulcer, and consequently the healing thereof.

Hence certainly it comes to pass, that if you desire the Patient thus affected to breathe, shutting

his mouth and nose, the air or breath will come forth of the ulcer with such force, as it will easily blow forth a lighted candle of an indifferent bigness held thereto. Which thing, I protest, I ob∣served in a certain man, whom I was forced to trepan in that place, by reason the bone of the forehead was broken and depressed.

CHAP. XIII. Of salutary signs in wounds of the Head.

BUt, on the contrary, these are salutary signs; when the Patient hath no Feaver, is in his right mind, is well at the application or taking of any thing; sleeps well, hath his Belly soluble, the wound looks with a fresh and lively colour, casts forth digested and laudable matter, the Cr••ssa Meninx hath its motion free and no way hindred.

Yet we must note, which also is observed by the Ancients, and confirmed by experience, that we must think none past danger, and free from all chance, until the hundredth day be past. Where∣fore the Physitian ought so long to have a care of his Patient, that is, to consider how he behaves and governs himself in meat, drink, sleep, venery, and other things.

But let the Patient diligently avoid and shun cold, for many when they have been cured of wounds of the head, by careless taking cold have been brought into danger of their lives. Also you must know that the Callus, whereby the bones of the Skull are knit together, requires almost the space of forty or fifty days to its perfect coagmentation and concretion. Though in very deed one cannot set down a certain number of days, by reason of the variety of bodies, or tempers: For it is sooner finished in young men, and more slowly in old; And thus much may serve for Prog∣nosticks. Now will we treat as briefly and perspicuously as we can of the cure both in general and particular; wherefore beginning with the general, we will first prescribe a convenient Diet, by the moderate use of the six things not natural.

CHAP. XIV. Of the general cure of a broken Skull, and of the Symptoms usually happening thereupon.

THe first cure must be, to keep the Patient in a temperate air; and if so be, that it be not such of it self and its own proper nature, it must be corrected by Art. As in winter he must have a clear fire made in his chamber, lest the smoak cause sneesing and other accidents; and the windows and doors must be kept shut to hinder the approach of the cold air and wind. All the time the wound is kept open to be drest, some body standing by, shall hold a chafendish full of coals, or a heated Iron bar over the wound, at such a distance, that a moderate heat may pass thence to the wound; and the frigidity of the encompassing air may be corrected by the breathing of the diffused heat. For cold, according to the opinion of Hippocrates, is an Enemy to the Brain, Bones, Nerves, and spinal marrow; it is also hurtful to ulcers, by suppressing their excrements, which supprest do not only hinder suppuration, but also by corrosion makes them sinuous. Therefore Ga∣len rightly admonisheth us, to keep cold from the Brain, not only in the time of trepaning, but also afterwards. For there can be no greater, nor more certain harm befal the fractured skull, than by admitting the air, by such as are unskilful. For if the air should be hotter than the Brain, then it could not thence be refrigerated; but if the brain should be laid open to the air, in the midst of Summer, when it is at the hottest, yet would it be refrigerated; and unless it were relieved with hot things, take harm: this is the opinion of Galen, whereby you may understand that many who have the r Skulls broken, dye more through default of skill in the curing, than by the greatness of the fracture.

But (when the wound is bound up with the pledgets, cloths, and rowlers, as is fit) if the air chance to be more hot, than the Patient can well endure, let it be amended by sprinkling, and strawing the chamber with cold water, oxycrate, the branches of Willows and Vine. Neither is it sufficient to shun the too cold air, unless also you take heed of the over light, chiefly until such time as the most feared and malign symptoms are past.

For a too great light dissipates the spirits, increases pain, strengthens the feaver and symptoms. Hippocrates wholly forbids wine, therefore the Patient instead thereof must drink Barly water, fair water boyled and tempered with Julep of roses, syrup of Violets, vinegar & the like: water where∣in bread crums have been steeped, Water and Sugar with a little juyce of Limmons, or Pomecitron added thereto, and such like, as the ability and taste of the Patient shall require. Let him continue such drinks until he be free from malign symptoms, which usually happen within fourteen days.

His meat shall be pap, Ptisan, shunning Almond-milks; (for Almonds are said to fill the Head with vapours and cause pain) stued Damask Prunes, Raisons and Currants, seasoned with Sugar, and a little Cinamon (which hath a wonderful power to comfort the stomach, and revive and exhila∣rate the Spirits) Chickens, Pidgeons, Veal, Kid, Leverets, Birds of the fields, Pheasons, Black-birds. Turtles; Partridges, Thrushes, Larks, and such like meats of good digestion, boyled with Lettuce, Purslain, Sorrel, Borage, Bugloss, Succory, Endive, and the like, are thought very convenient in this case. If he desire at any time to feed on meats rosted, he may; only dipping them in Verjuyce, in the acid juyces of Oranges, Citrons, Limons, or Pomegranates, sometimes in one, and sometimes

in another, according to his tast and ability. If any have a desire to eat fish, he must make choyce of Trouts, Gudgeons, Pikes, and the like, which live in running and clear waters, and not in mud∣dy; he shall eschew all cold Sallets and Pulse, because they fly up and trouble the head: it will be convenient after meat to use common dridg powder, or Aniseed, Fennel-seed, or Coriander-comfits; also Conserve of Roses, or Marmilate of Quinces to shut up the orifice of the Ventricle, lest the head should be offended with vapours arising from thence.

Children must eat often, but sparingly; for children cannot fast so long as those which are elder, because their natural heat is more strong, wherefore they stand in need of more nourishment: so al∣so in winter all sorts of people require more plentiful nourishment, for that then their stomachs are more hot than in Summer.

When the fourteenth day is past, if neither a Feaver, nor any thing else forbids he may drink wine moderately, and, by little and little, encrease his diet, but that respectively to each one's na∣ture, strength, and custom. He shall shun, as much as in him lies, sleep on the day time, unless it happen that a Phlegmon seise upon the brain or the Meninges. For in this case it will be expedient to sleep on the day time; especially from morning till noon, for in this season of the day, as also in the Spring, bloud is predominant in the body, according to the opinion of Hippocrates. For it is so vulgarly known, that it need not be spoken, that the bloud when we are awake is carryed into the habit and surface of the body; but, on the contrary, by sleep it is called into the noble parts, the Heart and Liver. Wherefore if that the bloud by the force of the Sun casting his beams upon the Earth at his rising is carryed into the habit of the body, it should again be more and more diffused by the strength and motion of watching, the inflammation in the Brain and Meninges would be much encreased. Wherefore it will be better, especially then, to stay by sleep the violence of the bloud running into the habit of the body, when it shall seem to rage and more violently to affect that way. Watching must in like manner be moderate; for too much depraves the temper of the Brain and of the habit of the whole body; it causes crudities, pains, and heaviness of the head, and makes the wounds dry and malign.

But if the Patient cannot sleep by reason of the vehemency of the inflammation of the brain and Meninges, Galen wishes, to wash, besmear and anoint the head, nose, temples and ears with refrigera∣ting and humecting things, for these stupefie, and make drowsie the brain and membranes thereof, being more hot then they ought to be. Wherefore for this purpose let the temples be anointed with Unguentum populeon, or Unguentum Rosatum with a little Rose-vinegar, or Oxycrate; let a spunge moistned in the decoction of white or black Poppy-seed, of the rinds of the roots of Man∣drages, of the Seeds of Henbane, Lettuce, Purslane, Plantain, Night-shade, and the like. He may also have a Broath, or Barly-cream, into which you may put an emulsion made of the Seeds of white Poppy, or let him have a potion made with ℥ i, or ℥ i ss, of the syrup of Poppy, with ℥ ij, of Lettuce-water; Let the Patient use these things four hours after meat, to procure sleep. For sleep doth much help concoction, it repairs the efflux of the triple substance caused by watching, as∣swageth pain, refresheth the weary, mitigates anger and sorrow, restores the depraved reason, so that for these respects it is absolutely necessary that the Patient take his natural rest.

If the Patient shall be plethorick, let the plenitude be lessened by bloud-letting, purging and a slender diet, according to the discretion of the Physitian who shall over-see the cure. But we must take heed of strong purgations, in these kinds of wounds, especially at the beginning, lest the fea∣ver, inflammation, pain, and other such like symptoms be increased by stirring up the humors.

Phlebotomy, according to Galen's opinion, must not only be made respectively to the plenty of bloud, but also agreeable to the greatness of the present disease, or that which is to come, to divert, and draw back that humor which flows down, by a way contrary to that which is impact in the part; and which must be there evacuated, or drawn to the next. Wherefore for example, if the right side of the head be wounded, the Cephalick-vein of the right arm shall be opened, unless a great Plethora or plenitude cause us to open the Basilica, or Median; yet if neither of them can be fitly opened, the Basilica may be opened, although the body be not plethorick. The like course must be observed in wounds of the left side of the head; for that is far better by reason of the straitness of the fibers, than to draw bloud on the opposite side; in performance whereof you must have diligent care of the strength of the Patient, still feeling his pulse, unless the Physitian be present, to whose judgment you must then commit all that business. For the pulse is, in Galen's opinion, the certainest shewer of the strength. Wherefore we must consider the changes and inequalities thereof, for as soon as we find it to become lesser and more slow, when the forehead begins to sweat a little, when he feels a pain at his heart, when he is taken with a desire to vomit, or to go to stool, or with yawn∣ing, and when he shall change his colour and his lips look pale, then you must stop the bloud as spee∣dily as you can; otherwise there will be danger lest he pour forth his life together with his bloud. Then he must be refreshed with bread steeped in wine, and put into his mouth, and by rub∣bing his temples and nostrils with strong vinegar, and by lying upon his back. But the part shall be eased & freed from some portion of the impact and conjunct humor by gently scarifying the lips of the wound, or applying of leeches. But it shal be diverted, by opening those veins which are nighest to the wounded part, as the Vena puppis, or that in the midst of the forehead, or of the temples, or those which are under the tongue; besides also cupping-glasses shal also be applyed to the shoulder sometimes with scarification, sometimes without; neither must strong, & long frictions, with coarse clothes, of all the whole body, the head excepted, be omitted during the whole time of the cure, for these will be available, though but for this; that is, to draw back and dissipate by insensible tran∣spiration

the vapours which otherwise would ascend into the head; which matters certainly in a body that lyes still and wants both the use and benefit of accustomed exercise, are much increased.

But it shall be made manifest by this following and notable example, how powerful Bloud-let∣ting is, to lessen and mitigate the inflammation of the Brain, or the membranes thereof, in wounds of the head. I was lately called into the suburbs of Saint German, there to visit a young man twen∣ty eight years old, who lodged there in the house of John Martial, at the sign of Saint Michael. This young man was one of the houshold-servants of Master Doucador, the steward of the Lady Ad∣miral of Brion. He fell down head-long upon the left Bregma, upon a marble-pavement, whence he received a contused wound, without any fracture of the skull, and being he was of a sanguine tem∣perature, by occasion of this wound, a Feaver took him on the seventh day with a continual deli∣rium, and inflammation of phlegmonous tumor of the wounded Pericranium. This same tumor possessing his whole head and neck by continuation and sympathy of the parts, was grown to such a bigness, that his visage was so much altered, that his friends knew him not; neither could he speak, hear, or swallow any thing but what was very liquid. Which I observing; although I knew, that the day past, which was the eighth day of his disease, he had four sawcers of bloud taken from him by Germain Agace Barber-surgeon of the same Suburbs; yet considering the integrity and con∣stancy of the strength of the Patient: I thought good to bleed him again; wherefore I drew from him fourteen Saucers at that one time; when I came to him the day after, and saw that neither the Feaver, nor any of the fore-mentioned symptoms were any whit remitted, or asswaged, I forth∣with took from him four Saucers more, which in all made two and twenty; the day following when I had observed that the symptoms were no whit lessened, I durst not presume by my own only ad∣vice, to let him the fourth time bloud, as I desired. Wherefore I brought unto him, that most fa∣mous Physitian Doctor Violene, who, assoon as he felt his pulse, knowing by the vehemency there∣of, the strength of the Patient, and moreover considering the greatness of the inflammation and tumor which offered it self to his sight, he bid me presently take out my Lancet and open a vein. But I lingered on set purpose, and told him, that he had already twenty two Saucers of bloud taken from him: Then said he, grant it be so, and though more have been drawn, yet must we not there∣fore desist from our enterprise, especially seeing the two chief Indications of bloud-letting yet re∣main, that is, the greatness of the disease, and the constant strength of the Patient. I being glad of this, took three Saucers more of bloud, he standing by, and was ready to take more, but that he wished me to defer it until the afternoon; wherefore returning after dinner I filled two Saucers more, so that in all, this young man to his great benefit, lost twenty seaven Saucers of bloud at five times, within the space of four days. Now the ensuing night was very pleasing to him, the Feaver left him about noon, the tumor grew much less, the heat of the inflammation was asswaged in all parts, except in his eye-lids, and the laps of his ears, which being ulcerated cast forth a great quan∣tity of Pus or matter. I have recited this history purposely, to take away the childish fear which many have to draw bloud in the constant strength of the Patient, and that it might appear how speedy and certain a remedy it is, in inflammations of the head and brain.

Now to return from whence we digressed, you must note that nothing is so hurtful in fractures and wounds of the head, as venery; not only at that time the disease is present, but also long after the cure thereof. For great plenty of spirits are contained in a small quantity of seed, and the greatest part thereof flows from the Brain; hence therefore all the faculties, but chiefly the Animal, are resolved; whence I have divers times observed death to ensue in small wounds of the head, yea when they have been agglutinated and united. All passions of the mind must in like sort be avoided, because they by contraction and dissipation of the spirits cause great trouble in the body and mind. Let a place be chosen for the Patient as far from noise as can be, as from the ringing of Bells, beatings and knockings of Smiths, Coopers, and Carpenters, and from high-ways through which they use to drive Coaches; for noise encreases pain, causes a Feaver, and brings many other symptoms.

I remember when I was at Hisdin at the time that it was besiged by the forces of Charles the fifth, that when the wall was beaten with the Cannon, the noise of the Ordnance caused grievous tor∣ment to all those which were sick, but especially those that were wounded on their heads, so that they would say; that they thought at the discharging of every Cannon that they were cruelly strucken with staves on that part which was wounded, and verily their wounds were so angered herewith, that they bled much, and, by their pain and Feavers encreased, were forced with much sighing to breathe their last. Thus much may serve to be spoken of the cure in general: now we will out of the monuments of Ancients, treat of the particular.

CHAP. XV. Of the particular cure of wounds of the head, and of the musculous skin.

LEt us begin with a simple wound, for whose cure the Chirurgeon must propose one only scope, to wit, Union; for unless the wound pierce to the skull, it is cured like other wounds of the fleshy parts of our bodies. But if it be compound, as many wayes as it is complicate, so many Indications shew themselves. In these, the chiefest care must be had of the more urgent order and cause.

Therefore if the wound shall be simple and superficiary, then the hair must first be shaven away,

then a plaister applyed made of the white of an Egge, Bole Armenic, and Aloes. The following day you must apply Emplastrum de Janua, or else de gratia Dei, until the wound be perfectly healed. But, if it be deeper and penetrate even to the Pericranium, the Chirurgeon shall not do amiss, if at the second dressing he apply a digestive medicine (as they call it) which may be made of Venice-Turpentine, the yolks of Egges, Oyl of Roses, and a little Saffron, and that shall be used so long, until the wound come to maturation; for then you must add Honey of Roses and Barly flour to the digestive. Hence must we pass to these medicines, into whose composition no oyly or un∣ctuous body enters, such as this; ℞ Terebinth. venetae, ℥ ij, syrupi rosar. ℥ j, pul. Aloes, Myrrhae, & Mastich. an. ʒ ss. Let them all be incorporated and made into an unguent, which shall be perfect∣ly regenerated, then it must be cicatrized with this following powder. ℞ Aluminiis combusti, cor∣ticis granatorum combust. an. ʒ i. Misceantur simul & fiat pulvis: but if the wound be so large, that it require a suture, it shall have so many stitches with a Needle, as need shall seem to require.

Whilst I was at Hisdin, a certain Souldier, by falling of the earth whilst he undermined, had the Hairy scalp so pressed down even to the Pericranium, and so wholly separated from the beginning of the hind-part of his head, even to his fore-head, that it hung over his face. I went about the cure in this manner; I first washt all the wound with Wine, a little warmed, that so I might wash away the congealed bloud mixed with the earth; then I dryed it with a soft linnen cloth, and laid upon it Venice-Turpentine mixed with a little Aqua-vitae, wherein I had dissolved some Sanguis Draco∣nis, Mastick, and Aloes; then I restored the hanging skin to its former place, and there stayed it with some stitches, being neither too strait, nor too close together, for fear of pain and inflammation, (which two chiefly happen whilst the wound comes to suppuration) but only as much as should serve to stay it on every side, and to keep forth the air, which by it entrance doth much harm to wounds: the lower sides of the wound, I filled with somewhat long and broad tents, that the mat∣ter might have passage forth. Then I applyed this following cataplasm to all the head. ℞ farinae h••rd. & falarum an. ℥ vi, olei rosati ʒ iij, aceti quantum sufficit, fiat cataplasma ad formam pultis; this hath a faculty to dry, cool, repel, mitigate pain and inflammation, and stay bleeding.

I did not let him blood, because he had bled much, especially at certain arteries which were broken neer his Temples; he being dressed after this manner grew well in a short time. But if the wound be made by the biting of a wild Beast, it must be handled after another manner, as shall ap∣pear by this following History. As many people on a time stood looking upon the King's Lyons, who were kept in the Tilt-yard at Paris, for the delight of King Henry the second, and at his charges: it happened that one of the fiercest of them broke the things wherein he was tyed, and leaping amongst the company, he with his paws threw to the ground a Girl of some twelve years old, and taking her head in his mouth, with his teeth wounded the musculous skin in many places, yet hurt not the Skull. She scarse at length delivered by the Master of the Lyons from the jaws of Death and the Lyon, was committed to the cure of Rowland Claret Chirurgeon; who was there present by chance at the same time; some few days after, I was called to visit her; she was in a Feaver, her head, shoulders, brest, and all the places where the Lyon had set his teeth, or nails, were swoln; all the edges of the wound were livid, and did flow with a waterish, acrid, virulent, ca∣daverous, dark, green and stinking matter, so that I could scarse indure the smell thereof; she was also opprest with pricking, biting, and very great pain; which I observing, that old saying came in∣to my mind, which is: That all wounds made by the bitings of beasts, or of men also, do somewhat participate of poyson. Wherefore there must principally great care be had of the venenate im∣pression left in the wounds by the nails and teeth, and therefore such things must be applyed, as have power to overcome poyson. Wherefore I scarified the lips of the wounds in divers places, and applyed Leeches to suck out the venenate bloud, and ease the inflammation of the parts, then I made a Lotion of Aegyptiacum Treacle and Mithridate, after the following manner.

℞ Mithrid. ℥ i, theriac. ℥ ij, aegyptiac. ℥ ss, dissolvantur omnia cum aqua vitae, & Carduiben. Let the wounds be fomented and washed with it warm; besides also Treacle, and Mithridate were put in all the medicines which were either applyed, or put into the wound; and also of the same with the conserves of Roses and Bugloss dissolved in the water of Sorrel and Carduus benedictus, poti∣ons were made to strengthen the heart and vindicate it from malign vapours.

For which purpose also this following Epithema was applyed to the region of her heart. ℞ aquae rosar. & nenuphar, an. ℥ iiij, aceti scillitici ℥ j, corallorum, santalorum alborum & rubrorum, rosar. rub. pulveris, spodii. an. ℥ j, Mithridatii, Theriacae an. ʒ ij, flo. cordial. pulverifatorum p. ij, croci ʒ j, dissolve them all together, make an Epitheme and apply it to the heart with a scarlet cloth or spunge, and let it be often renued. Verily, she drest after this manner, and the former remedies but once used, pain, inflammation, and all the malign symptoms were much lessened; to conclude, she recovered, but lingred, and was lean some two years after, yet at length she was perfectly restored to her health and former nature. By which you may understand, that simple wounds must be handled after another manner, than these which have any touch of poyson.

But now that we may prosecute the other affects of the hairy scalp; say that it is contused with a blow without a wound; that which must be first and alwayes done, (that so the affect may better appear, and the remedies which are applyed may take more effect) the hair must be shaven away, and at the first dressing a repelling medicine applyed, such as this following Oxyrhodinum. ℞ ol: ros. ℥ iij, album ovorum nu. ij, pulveris nucum cypressi, balaust. alumin. rochae. rosar. rub. an ʒ j. Let them be all incorporated, and make a medicine for the former use; or in stead thereof you may ap∣ply the catalpasm prescribed before, consisting of Farina hordei, fabarum, aceto & oleo rosaceo.

But such medicines must be often renued. When the pain and defluxion are appeased, we must use discussing medicines for dissipation of that humor which remains impacted in the part; ℞ Em∣plastri de mucilagin. ʒ ij. oxicrocei, & emp. de meliloto, an. ℥ i. olei chamaem. & anethi. an. ℥ ss. malax∣entur simul, & fiat emplastrum ad usum dictum. Such a fomentation will also be good. ℞ vini rub. lib. iiij. lixivii. com. lib. ij. nuces cupressi contus. nu. x. pul. myrtillorum ℥ i. rosar. rub. absinth. fol. salviae, majoranae; staechados, florum chamaem. melil. an. M. ss. aluminis rochae, radicis cyperi, calami aromatici an. ℥ ss. bulli∣ant omnia simul, and make a decoction to foment the grieved part. After somewhat a long foment∣ing it, whereby it may the better discuss, dry and exhaust the concrete humor, the head must be dryed and more discussing things applyed, such as the Cerate described by Vigo called de Minio; which hath an emollient and digestive faculty in this form. ℞ Olei chamaem. lilior. an. ℥ x. olei mastich. ℥ ij. pinguedinis vervecis lib. i. litharg. auri, ℥viij. minii ℥ij. vini boni cyathum unum, bullianb omnia simul baculo agitando, primum quidem lento igne, mox verò luculentiore, donec tota massa colorem nigrum vel sub∣nigrum contrahat; adde in fine cocturae Terebinth. lib. s. pulveris mastich, ℥ ij. gum elemi. ℥ j. cerae quantum sufficit, bulliant rursus una ebullitione & fiat empl. molle. But if the humor be not thus discussed, but only grow soft, then the tumor must be quickly opened, for when the flesh is inflamed and putre∣fied through occasion of the contained humor, the bone under it putrefies also by the contagion of the inflammation and the acrimony of the matter falling upon the bone. When you have opened it, wash away the filth of the ulcer with this following deter••ive medicine. ℞ syrupi ros. & absinth. an. ℥ i. terebinth. ℥ ss. pul. ireos, aloes, mastichis, myrrhae, farinae hordei an. ʒ ss. In stead hereof, if there be great putrefaction, Aegyptia, either by it self, or mixt with an equal quantity of Unguentum Aposto∣lorum, may be put into the Ulcer. When the Ulcer is cleansed, it will be time to use scarcotick and cicatrizing medicines.

CHAP. XVI. Of the particular cure of a Fracture or broken Skull.

IF the Skull be broken, so that it be needful to trepan it, or to elevate and lift it up, or scrape it away, the musculous skin being cut; as we formerly noted, the Pericranium shall be plucked from the Skull, as we said before; which because it can hardly be done without great pain, by reason of its exquisite sense and connexion with the membranes of the brain, we must labour to mi∣tigate the pain for fear of inflammation and other accidents. Therefore, the first dressing ended, and the corners of the wound drawn each from other; at the second dressing put to the wound, a digestive (as they term it) made of the yolk of an Egge, and Oyl of Roses, but you must apply no humid thing to the bone, because we desire to keep it sound and whole. For Galen's opinion is, that bared bones must not be touched with unctuous things; but rather on the contrary, all dry things must be applyed to them, which may consume the superfluous humidity. Therefore we must lay some lint and the cephalick powders which we shall hereafter describe, upon the bone we in∣tend to preserve, and must have diligent care that it be not offended either by the air, or touch of humid medicines. You must in Trepaning have a special care of the Crassa meninx. For I have of∣ten observed a great quantity of bloud to have flowed from some broken vessel, which adhered to the second Table: neither must we presently and forthwith stay such bleeding, but suffer it to flow according to the plenitude and strength of the Patient; for thus the feaver, and together therewith the rest of the symptoms are diminished. For the opinion of Hippocrates, in every green wound it is good to cause often bleeding, except in the bellies; for thus the vehemency of pain, inflammation and other accidents will be less troublesome; also it is not amiss too for old Ulcers to bleed much, for so they are freed from the burden of the impact humors. When you think it hath bled sufficiently, it may be stanched with this following medicine described by Galen.

℞ pulveris Aloes ʒ ij. thuris Mastiches, an. ʒi ss. albumina ovorum nu. ij. agitentur simul cum pilis leporinis minutim incisis, fiat medicamentum. When the bleeding is stayed, you shall, for the asswage∣ing of pain, drop upon the Meninx some Pigeons bloud, yet warm by opening a Vein under the wing, then it shall be strewed over with this following powder, ℞ Aloes, Thuris, Myrrhae, sanguinis draconis an. ʒ i. Misce, fiat pulvis subtilis. Also you may make an irrigation with Rose Vinegar, or some repelling medicine such as is a cataplasm ex farinis, & oleo rosaceo. Which may be applyed un∣til the fourth day to asswage and mitigate pain.

Vigo's Cerate will be of good use in this case, as that which in my opinion is most fit for fractures of the Skull, because it draws powerfully, resolves and dryes moderately, and by reason of the smell refreshes the animal spirits, and strengthens the Brain and Membranes thereof, as you may easily perceive by things which enter into the composition thereof. ℞ Olei ros. Omph. resinae pini, gummi Elemi, an. ℥ ij. Mastiches ℥ i ss. pinguedinis vervecis castrati ℥ij ss. foliorum beton, caprifol. an∣thos. an. M j. ammoniaci ʒ ss. granorum tinctorum ʒ x. liquata pinguedine; terenda terantur, & ammoni∣acum simul cum aceto scillitico, eliquetur; deinde bulliant. omnia simul in lib. ij. vini boni, lento igne usque ad consumptionem vini, deinde exprimantur; cum expressione addantur terebinth. Ven. ℥ iiij. cerae albae quantum sufficit, fiat cerotum molle ad usum praedictum. Also let the neck, and all the Spine of the Back be anointed with a liniment, which hath force of mollifying the Nerves, lest they should suf∣fer Convulsion; such is this.

℞ Rutae, marrubii, rorismar. ebulor. salviae, ••erb. paralys. an. M. s. rad. Ireos, cyperi, baccarum lauri, an. ℥ i. florum chamae. melil. hyperici, an. M j. pistentur & macerentur omnia in vino albo per noctem, deinde coquantur in vase duplici cum oleo lumbricorum, liliorum, de terebinthina, axungiae anseris & hum. an. ℥ ij.

usque ad consumptionem vini, postea colentur, & in colatura adde terebrinth. venet. ℥iij, aquae vitae ʒ ss, cerae quantum sufficit. Fiat linimentum secundum artem.

But when the pain is asswaged, we must abstain from all such unctuous things, lest they make the wound become sordid and malign, and putrefie the adjacent parts, and consequently the Crassa meninx and Skull; for the integrity of all parts may be preserved by their like, and such are dry things in a fracture of the Skull. Wherefore all humid and oyly things must be shunned in the cure thereof, unless peradventure there shall be some need to mitigate pain, and bring the humor to suppuration.

For, according to Galen, we are oft forced for a time to admit the proper cure of the disease, so to resist the symptoms; furthermore Hippocrates would have us not to foment the Skull, no not with Wine; but if we do, to let it be but with very little. Vidius interprets that little to be, when there is fear of inflammation; for Wine if it be red, tart and astringent, hath a repressing, refrige∣rating and drying faculty: for otherwise all Wine although it heats and dryes by its faculty, yet it actually humects and cools, both which are very hurtful in wounds of the head, or a fractured skul, especially when the Bone is bare; for from too much cooling of the Brain there is fear of a Con∣vulsion, or some other evil symptom. Wherefore let this be ratified, that is, we must not use hu∣mid and unctuous medicines in wounds of the head, except for curing of inflammation, or the mi∣tigation of pain caused thereby. Therefore let the bared Skull be strewed with catagmatick and cephalick powders, (being so called by the Ancients, for that they are convenient and good in fractures of the Skul and the rest of the Bones); for by their dryness they consume the superfluous humidity, and by that means help Nature in the separating of the broken Bones, and the regene∣rating of flesh. Such powders usually consist of such things as these ensuing; Thus, Radix Iridos flo∣rent. farina hordci, & Ervi, pulvis Aloes Hepaticae, sanguis Draconis, Mastiche, Myrrha, rad. Aristolochiae, Gentianae: and generally all such Simples as have a drying and an abstergent faculty without biting; but you must not use these things before the pain, inflammation, and apostumation be past; that is, then, when the membranes must be cleansed, the bones scaled, and the flesh generated. For the Skull, by how much it is the dryer, by so much it requires and more easily endures more powerful and dryer medicines than the Dura Mater, or Pericranium, as that which in quickness of sense comes far short of these two. Wherefore when you would apply the fore-mentioned cephalick powders to the Meninges, they must be associated and mixed with Hony, Syrup of Roses, or of Wormwood, and such other like, that so their too violently drying faculty may be allayed and tempered.

CHAP. XVII. Why we use Trepaning, in the Fractures of the Skull.

THere are four causes of this remedy: The first is, to raise up the deprest Bones, and take forth their fragments, which press upon the Meninges, or also upon the substance of the Brain. The second is, that the Sanies or matter may be evacuated, clensed, wasted, and dry∣ed up, which by the breaking of any vessel is poured forth upon the Membrans, whereby they, and not they only, but the Brain also is in a great danger of corruption. The third is, for the fitter application of medicines, convenient for the wound and fracture. The fourth is, that so we may have something whereby we may supply the defect of a Repelling Ligature, and such an one as may hinder defluxions; for such a Ligature cannot take place here as it may in the other parts of the body, by reason of the Sphaerical or Round figure of the head, which doth not easily admit binding; and then the density and hardness of the interposed Skull is a means that the vessels lying under it, (by which usually the defluxion comes) cannot easily be bound with a rowler sufficiently to repel the running bloud. And the external vessels, (to whom the force of the Ligature may come) can∣not be bound without great pain, and danger of inflammation. For by such a compression the pul∣sation of the Arteries would be intercepted, and the efflux of the fuliginous excrements which useth to pass pass through the sutures of the Skull, would be supprest, by reason of the constriction of these sutures.

Besides also, the bloud would thus be forced from the wounded part without, to within into the Membranes and Brain; when pain, inflammation, a Feaver, Abscess, Convulsion, Palsie, A∣poplexie, and lastly, Death it self would insue.

And these are the cheif causes, that Trepaning is necessary in fractures of the skull, and not so in the fractures of other Bones.

But before you apply or put to your Trepan, the Patient must be fitly placed or seated, and a double cloth must be many times wrapped about his head, and then his head must be so laid, or pressed upon a Cushion or Pillow, that when you come to your operation, it may not sink down any further, but remain firm and stedy. Then you must stop the Patients Ears with Cotten-wool, that so he may not hear the noise made by the Trepan, or any other Instrument.

But before you put to your Trepan, the Bone must be pierced with an Instrument, having a three-square point, that so it may be the more speedily and certainly perforated. The point there∣of must be no bigger then the pin of a Trepan, that so the Trepan which is forthwith to be applyed may stand the more firm, and not to play to and again in too wide a hole.

The shape of this Instrument is not much different from a Gimblet, but that the point is three-square, and not twined like a screw, as you may perceive by this following figure.

[illustration]

A Gimblet or Piercer to perforate the Skull, before the setting of the Trepan.

• A. Shews the handle.
• B. The points which may be screwed and fitted into the handle.

CHAP. XVIII. A Description of Trepans.

TRepans are round Saws, which cut the Bone circularly, more or less according to their greatness; they must have a pin standing in the middle a little further out than their teeth, so to say and hold fast the Trepan that it stir neither to this side nor that, until it be en∣tred and you have cut through the first Table at the least: then you must take forth the pin, lest going quite through the bone, it may prick or hurt the Crassa Meninx. Wherefore when you have taken forth the pin, you may safely turn it about until you have cut through both the Tables; Your Trepans must also have a cap, or somewhat to ingirt or incompass them, lest no way hindred they cut more of the one than we would, and in conclusion run into the Meninx. They must also be anointed with Oyl, that so they may cut more readily and gently; for thus Carpenters use to grease their saws. But you must, during the time of the operation, often dip them in cold water, lest the bone by attrition become too hot: for all hard solid bodies by quick and often turning about, become hot; but the bone made more hot and dry, is altered and changeth its nature, so that after it is cut more off, its scales and falls away. Now you must know that the Bone which is touched with the Trepan or the Air, alwayes casts off scales: for the speedier helping forwards whereof, you must strew upon it powders made of Rocket, Briony, wild Cowcumber, and Aristolochia-roots. When the bone is sufficiently scaled, let this following powder be put upon it, which hath a faculty to co∣ver the bone with flesh, and to harden it with dryness convenient to its kind. ℞ Pulver. Ireos Illy∣ricae, Aloes Mannae thuris, Myrrhae Aristolochiae an. ʒ i. Flesh being by this means generated, let it be cicatrized by strewing upon it the rinds of Pomegranates and Alum burnt.

Neither shall the Chirurgeon forcibly take away these scales, but commit that whole work to Nature, which useth not to cast them off before that it hath generated flesh under them. For otherwise if he do any thing rashly, he brings new corruption to the Bone; as we shall more at large declare, when we come to treat of Caries, or rottenness of Bones.

He which useth the Trepan, must consider this, that the head is of a round figure, and also the Trepan cuts circularly, and therefore it is unpossible to cut the Bone so equally on every side, as if it were performed upon a plain body. Furthermore the thickness of the Skull is not alike in all places, wherefore you must look, and mark whether the Trepan go not more deep on one side than on the other, which you may do by measuring it now and then with a pin or needle, and if ye find that it is cut deeper on one side, than on the other, you must press down the Trepan more power∣fully upon the opposite part.

But seeing there are many sorts of Trepans invented and expressed by many men, yet if you weigh & rightly consider them all, you shall find none more safe, than that I invented & have here delineated. For it cannot pierce one jot further into the skul, than he pleases that uses it, and there∣fore it cannot hurt either the Meninges, or the Brain. An Iron head, or cover, stays it as a bar, that

it can penetrate no further than you shall think it requisite. This head or cover is to be drawn up and down, and set higher and lower, as he which uses it shall think good, and so it will stay the Trepan that it shall not go a hairs bredth beyond your intended depth. So that hence forwards there shall be no Chirurgeon, howsoever ignorant in the performance of his Art, which by the benefit of such a Trepan may not perform this operation without any danger, or fear of danger, of touching the Dura Mater, the hurting whereof, puts the life in jeopardy.

[illustration]

The figure of our Trepan opened and taken in pieces.

The figure of the same Trepan fitted and put together.

• A, Shews the whole handle or Brace of the Trepan.
• B, The Cover or Cap of the Trepan.
• C, The ferule.
• D, D, The screw pins which hold and stay the ferule and Trepan.
• E, The Trepan without his pin.
• F, The Trepan furnished with its pin.
• A, Shews the Brace and Trepan filled in every point.
• B, The place into which the Trepan i•• is put and fitted.
• C, C, C, The upper end of the Trepan which is to be fitted and put into the Brain.
• D, The Trepan with its cover or cap upon it.
• E, The ferule.
• F, A screw-pin by the twining whereof the Trepan is fastened in the Brace.
• G, Another screw-pin which fastens the Ferule closer to the Trepan.
• H, The three-square-point.

Instead of the other Trepan set forth by the Author, I have thought fit to give you the figure of that Trepan that is here most in use, and the fittest therefore, as it is set forth by Mr. Dr. Crook.

[illustration]

A Terebellum or Gimblet consisting of three branches.

[illustration]

A Lentil-like cutting Scraper.

All these particulars of the Trepan taken sunder, you may see united and fitted together in the other figure. But when you cannot bring out the bone which you have cut off with your Trepan, then you may take it forth with the Terebellum, or Gimblet here exprest, that is, screwing the point thereof into the hole made by the three-square pin; the handle of this Instrument may also serve in stead of a Levatory. When with the Gimblet you have drawn or taken forth that part of the Skull which was cut away by the Trepan; if there shall be any sharp splinters in the second Table, which may hurt and prick the Meninx, when it is heaved up by the motion of the brain, they must be shaved away and planed with this Lentil-fashioned scraper; being so called, because it hath the head thereof fashioned and smooth like a Lentil, lest being sharp it should hurt and prick the membrane in the smoothing thereof.

But if by reason of the thickness, the Skull cannot be cut with the Lentil-like scraper, you may

use the cutting scrapers, and a Mallet. The Mallet must be of Lead, that so it may shake the Brain as little as may be. But you must diligently with your Mullets take forth the sharp splinters, and pie∣ces of the bone. But if the fractured part of the Skull be such, that it will not admit that Section which is requisite for the bared bone, as when the fracture is upon the temporal muscle, or at the sutures; then in the stead of one Trepan, two or three must be applyed, if the necessity of the pre∣sent case so require, and that within a very small compass; but they must not be applyed to the fractured part, but nigh thereto, as we shall shew more at large in the following chapter. But the Trepans shall be applyed so near to each other, that the ring of the second may be joyned with the ring of the first and third. But if a fracture shall happen to light upon a Suture, then you must not apply a Trepan to it, but use two thereto on each side; he that shall do otherwise, shall tear in sunder the nervous and membranous fibers, and also the Veins and Arteries by which the Dura Mater is fastened to the Skull, and yields matter to the Pericranium. He which shall apply one Trepan, that is, but upon one side of the Suture, he shall not be able to get forth all the sanies which is fallen down on both sides by reason of the partition of the Crassa Meninx, which lies be∣tween, and rises up by the Suture of the Skull.

To conclude, when for what cause soever we cannot make use of a Trepan, we may imploy this Instrument, if so be as much of the bone be bared as is needful. It is made in form of a pair of Compasses, and by means of a screw may be opened, more or less, as you please. You as need shall require may change the points, and put other into the places, for they may be fitted to one side of the Compass with a Screw.

[illustration]

A pair of cutting Compasses to cut forth the Skull.

• A. Shews the one leg of the cutting com∣passes, which as you carry it about, cuts the skull.
• E. The screw which fastens the point to the leg of the Com∣passes.
• C, C, Two different points which may be screwed to the leg of the compasses, as need shall require.
• D, A great screw which fastens upon an Iron string, alongst which the one of the legs of the Compass running may be widened and straitned as you please.

[illustration]

A crooked Iron plate fit to sustain and hold steddy one leg of the Compass upon the head.

[illustration]

Another pair of Compasses of the like nature and use, which may be widened and straitned by a Screw.

Moreover it is fit that the one leg of such cutting Compasses should stand firm and steddy,

whilst the other is drawn circularly to cut. Wherefore it is fit you have an Iron plate made full of little holes, wherein you may firmly stay that leg of the compass, lest it waver against your will; it is requisite that this plate be crooked, (because the head is round) that so it may be fit∣ted to any part thereof.

CHAP. XIX. Of the places of the Skull whereto you may not apply a Trepan.

FIrst of all, you shall not apply a Trepan, to a Bone that is so broken that it is wholly, or in the greater part thereof, divided from the Skull by the violence of the stroak, lest by your weight and pressing of the Trepan, you force it down upon the membrane. Secondly you must not apply one to the fractured Sutures, for the reasons mentioned in the former chapter. Thirdly, nor to that part of the fore-head which is a little above the eye-brows, for those reasons we gave you before in the twelfth chapter. For there is in that place under the first Table of the Skull it self, a large cavity replenished, with a certain white and tough humor, as also with a cer∣tain spirituous and airy substance, placed there by Nature, to prepare the air which ascends to the Brain by the Nostrils: unless the Chirurgeon observe and be mindful hereof, he may be deceived supposing this cavity to be an Effracture of the Bone, and a depression thereof. Fourthly, neither in the lowest parts of the Skull, lest the marrowy substance of the Brain, by reason of its weight, should slide through the hole made by the Trepan. Fifthly, neither to the Bregma-bones of chil∣dren, as those which as yet have not acquired just solidity, to endure the impression of a Trepan. Sixtly, nor to the Temples by reason of the Temporal muscle, the cutting whereof in the opinion of Hippocrates causes convulsion of the opposite part. For being cut athwart it loses its proper acti∣on, that is, to move and lift up the lower Jaw; but then the opposite Temporal muscle being whole and perfect, using its strength, (his Antagonist suffering it, and not resisting or labouring any thing at all to the contrary) it draws the same Jaw to it, whereupon the Mouth and all the parts of the Face are drawn awry, and suffer a Convulsion towards the sound part, the other being re∣solved according to Hippocrates his rule. For as often as the muscles of one kind are equal in num∣ber, magnitude, and strength on each side, the resolution of the one part, causes the Convulsion of the other.

Neither doth this danger alone arise from the cutting of the Temporal muscle, but also another, which is, that this muscle when we eat and speak, is in perpetual motion, whereby it comes to pass, that being once cut it is scarse ever united again, beside also the commissure or joyning together of the stony bones lye under it. But by the second caution we are forbid to trepan upon the sutures; moreover also many veins, arteries and nerves are spread over the substance thereof, so that by cut∣ting of them, there is danger of many and malign symptoms, as pain, inflammation, a Feaver, a Con∣vulsion not only of the part it self, but also of the whole body, whence lastly death insues. Where∣fore let no Chirurgeon be so fool-hardy, as to attempt the cutting of this muscle so to trepan the bone which lies under it; rather let him apply his Trepan above it, or on the side thereof, or as neer to the affected part as he can, as I did in a Gentleman called Monsieur dela Bretesche. He in the triumphant entrance of King Henry the second, into the City of Paris, was so hurt with a stone, that the Os Petrosum, or scaly bone, was broken with the violence of the blow, and the temporal mus∣cle was vehemently contused; yet without any wound. I being called the next day (viewing the manner of the hurt, and the condition of the wounded part) thought good to bring some Physiti∣ans, and Chirurgeons with me to consult hereof, of whom when some thought it expedient pre∣sently to divide the temporal muscle that baring the bone we might apply a Trepan, and so take forth the broken bones: I, on the contrary, begun earnestly to withstand that opinion, citing that saying of Hippocrates, ex libro de vulneribus Capitis, wherein Chirurgeons are forbidden to cut such muscles, for fear of the fore-mentioned symptoms; also I cited experience, how that I had of∣ten observed all those which had this muscle cut, dyed with a Convulsion; but that it should be far better, that neer above the fracture the bone should be trepaned, not touching the Temporal muscle at all, if he could. When all of them at the last had inclined to my opinion, I presently divided the musculous skin which was over the upper part of the fracture with a three-corned se∣ction: the day following, which was the third of his disease, I trepaned him, and, after I had done, some few days after, I took out some four splinters of the broken bone; and I put in a plain leaden pipe, by which (I wishing the Patient ever when I drest him to hold down his head, to stop his mouth and his nose, and then strive as much as in him lay to put forth his breath) much sanious matter came forth, which was gathered between the Skull and Crassa Meninx. Other filth which stuck more fast, I washed out with a detergent decoction, injected with such a Syringe as is here exprest; And I did so much, God blessing my indeavours, that at length he recovered.

[illustration]

A plain leaden pipe for to carry forth the Sanies gathered under the Skull.

[illustration]

A little Syringe fit to make injections withall.

The like chance and fortune besel Monsieur de Pienne at the siege of Mets. For he, is he fought at the breach of the wall, had the bone of his Temples broken with a stone struck out of the ad∣jacent wall, by a piece of Ordinance shot from the Emperor's camp, he presently fell down with the blow, and cast bloud out of his mouth, nose and ears, with much vomitting, and remained dumb, and, as it were, senseless almost fourteen dayes, so that he knew none of the by-standers. He had often palpitations, and convulsive twitchings, and his face was swoln. His forehead-bone was tre∣pan'd at the side of the temporal Muscle by the hand of Peter Aubert the King's Chirurgeon: and although, on the 25. day, soft flesh endued with exquisite sense grew out of the hole made with the Trepan, whose growth could not be hindered by Cathaeretick powders, yet at the length he recovered. The Ancients called this kind of growing flesh a Fungus [i. a Mushrome] for that it is soft, and grows with a small root and broad top like a Mushrome: but it increases and decreases, according to the plenty of the flowing matter, and industry of the Chirurgeon hindering by art the growth thereof. This flesh stinks exceedingly, they commonly call it Ficus sancti Fiacrii [i. the fig of S. Fiacrye.] This disease commonly hath its original after this manner. Even as in the bodies of trees from the excrements of nourishment, a certain half putrid, gross and viscous humor sweats through the bark, and gathered together by little and little grows into a Mushrom; so bloud melancholy both in temper and consistence, springs from the broken vessels of the skull and Crassa Meninx, which also is sent sometimes by nature for the necessary repairing the flesh in these parts whereupon a certain fungus breeds, which in Galen's opinion savours or partakes of the nature and condition of the parts to which it grows, though in general it be of the nature of ma∣lign warts, or excrescences. But for to take away such Fungi, you must apply medicines which have a specifick faculty to waste superfluous flesh; such are those which strongly dry, and gently waste and eat, such as this which follows. ℞ Sabinae ʒ ij. ecreae ʒ j. pulverisentur simul, aspergatur caro excrescens. Or else ℞ Hermodactylorum combustorum ℥ ss, make a powder for the same use. But if so be that this fungous flesh come to such growth, (as it often happens) as to equal the bigness of an Egg, it must be tyed and strait twitched, close to the root with a silken thred; and when it shall fall away by reason of this binding, the place must be strowed with the forementioned pow∣ders, for so it will be more certainly cured, than with more acrid Cathaereticks.

CHAP. XX. Of the corruption and Caries, or rottenness of the Bones of the Head.

THere sometimes follows a corruption and Sphacel of the fractured bones of the skull up∣on wounds of the head; which happens either because they are touched by the air, which they are not sensible of; or for that the Sanies putrefying and detained under them, hath infected them with like putrefaction; or by the cure unskilfully handled, they by the rash appli∣cation of suppurating and oyly medicines becoming more moist, and so undergoing an unnatural change of their proper complexion and native temper, as we shall shew more at large, when we shall treat of the reason of the Caries in the Lues venerea. We shal know this unnatural change and corruption, partly by sight, that is, when from white they become to be yellowish, livid, and black; partly also by putting down a Probe, when as it meets with nothing smooth and slippery, but feels rough in many places, and besides also when it enters and easily penetrates with a small thrusting down into their substance, as if it were fungous. Yet this last sign may often deceive you, for I have divers times observed rotten bones, which being bare had long suffered the injury of the air, to become so hard, that a Trepan would scarse pierce them; for it is putrid humidity which makes the bones soft and fungous; but the air by drying them exhausts this humidity, and lastly dryes it, whence follows such contumacious hardness. This sign will be far more certain, if the flesh which is grown upon the bone be more soft than is fit, loose, and have little or no sense of feeling. You may correct and amend this corruption of the bone with cauteries as well actual, as potential; or with the powders of Aloes, Gentian, Aristolochia, Centaury, Cortex pini: as ℞ radic. Ireos, Flor. Aristolochiae an. ʒ. j. centaur. ʒ ij, corticis pini ʒ ss, Misce & fiat pulvis subtilissimus ossi in∣spergendus. But if it be much corrupted, it must be scraped forth with your Scalpra. And you must expect the falling or scaling of the corrupt bone from the sound, and not forcibly procure it; for otherwise the sound Bone, which lies under it, being as yet covered with no flesh growing over it, would be corrupted by the appulse, or touch of the air. Yet you shall by little and little gently move and shake rotten Bones with your Probe, that so they may more easily scale, and with less trouble to Nature. But note by the way, that the scaling of the Bone which hath invironed the Trepan, is commonly performed in the space of forty or fifty days. So long also will that caused by the unusual appulse or touch of the air, or application of a cautery, or the aspersion of the Cepha∣lick powders; besides also, in the same number of dayes broken bones may be united and joyned together by a Callus, which is to them as a scar, yet sometimes sooner, somewhiles later, according to the variety of the ages, tempers, & habits of divers men. But if the Caries or rottenness can neither by these fore-mentioned remedies be orecome & amended, neither the loosed continuity aggluti∣nated nor united, you must give the Patient a vulnerary potion; for hence I have found happy suc∣cess in many. But sometimes not only a certain portion of the Bone, is taken with a Caries, but also the whole is often seised upon with a sphacel, and all falls out. For, in Hippocrates opinion, Lib. de vulneribus capitis, the Bone of the skull being broken falls from the sound more or less, according

to the violence of the blow; which also is confirmed by experience. For which purpose, I think good in this place to recite a History, whereof I was an eye-witness, whilst I served as a Chirurge∣on in Piemont under the Marshal de Montejan (who was the King's Lieutenant there.) It happened that a Lackey of Monsieur de Coulains came to me to be cured; he had the Bregma-bone of the left side broken with a Sword, neither yet did the fracture come to the second Table; a few days af∣ter his recovery, the bone being agglutinated and united, it came to pass that a company of Gas∣coine Souldiers his Countrymen came to Turin, with whom one morning he eat plentifully Tripe fryed with Onions and Spices, and drunk a great quantity of strong Wine. Whereupon he present∣ly fell into a continual Feaver, and lost his speech and understanding; his head swelled, his eyes looked red and fiery, and as though they would have started out of his head. Which things being considered, I let him bloud, having first (by the Physitian's advice) given him a Glyster, and applyed to his head such things as were fit; and also I laboured with Frictions and Ligatures of the extream parts to draw the humors downwards; yet for all this, the part of the head which was formerly affected begun to apostumate; which being opened, there came forth a great quantity of matter, and at the length the musculous skin and P••ricranium sinking down, both the Tables of the Skull became putrefied and rotten, as you might know by their blackness and stench. Now to take away this corruption, I applyed at certain times actual cauteries, both to amend the corruption and separate that which was altered: but mark, after some months space, a great number of worms came forth by the holes of the rotten bones from underneath the putrified skull; which moved me to hasten the separation and falling away of the putrid bones. Which being done, upon the very Crassa Meninx, which is more strange, in that place which nature had covered with flesh, I observed 3. cavities of the largeness of one's thumb filled with worms about the bigness of a points tag, with black heads, diversly wrapped among themselves. The bone which Nature separated was of the bigness of the palm of ones hand, so that it was strange that so large a portion of the skull should be cast off by Nature, and yet the Patient not dye thereof; for he recovered yet beyond all mens expectation, but after the agglutination of the wound the scar remained very hollow according to the decree of Hippocrates. For flesh doth not easily grow upon a Callus, because it is a thing strange and supposit••tious by Nature: besides, as a scar is a thing more dense than the skin, so is a Callus than the bone, so that through the more compact substance thereof, the bloud can neither freely nor plentifully sweat through for matter to regenerate flesh. Hence it is, that wheresoever any portion of the skull is wanting, you may there by putting to of your hand perceive and feel the beating of the brain, wherefore the skull must needs be much weaker in that place. Now to help this infirmity, I wished this Lacky to wear a Cap made of thick Leather, so more easily to withstand external injuries: and verily thereby he grew much better. Now I think good in this place to lay open the deceit and craft of some Impostors falsly styling themselves Chirur∣geons, who when they are called to cure wounds of the head, wherein any part of the skull is lost, perswade the Patient and his fr••ends, that they must put a plate of gold in the place of the skull which is wanting. Wherefore they hammer it, in the presence of the Patient, and turn it divers wayes and apply it to the part, the better to fit it; but presently after they slily convey it into their purses, and so leave the patient thus couzened. Others brag, that they are able to put the dryed rind of a gourd in the place of a lost bone, and fasten it on to defend the part; and thus they grossely abuse those which are ignorant in the Art. For this is so far from being done, that Nature will not suffer nor endure so much as an hair, or any other small body to be shut up in a wound when it is cicatrized; neither is the reason alike of a leaden bullet, which shot into the body lies there for many years without any harm to the Patient; for although lead have a certain fa∣miliarity with mans body, yet is it at length (unless the density of the opposed flesh, ligament, tendon, or some other such like substance hinder) thrust forth by nature impatient of all strange bod••es. And thus much of the rottenness and corruption of fractured bones; now must we speak of the discommodities which befal the Meninges by wounds whereby the Skull is broken.

CHAP. XXI. Of the discommodities which happen to the Crassa Meninx by fractures of the Skull.

MAny discommodities chiefly happen to the Crassa Meninx by a fracture of the skull and rash trepaning thereof; for it sometimes chances to be cut and torn. Agglutination is a remedy for this disease, which Hippocrates wishes to be procured with the juyce of Nepeta, [that is, of that Calamint, which smells like Penny-royal] mixed with Barly-flour. In stead whereof this following powder having the like faculty may take place.

℞ Colophon ʒ iij, Myrrhae, Aloes, Mastiches, sanguinis Dracon. an. ʒ j, croci, sarcocollae, an. ʒ ss. misce & fiat pulvis subtilis. But to purge the bloud and matter which is gathered and lyes between the Crassa Meninx and Skull, you shall put in a Tent made of a rag twined up some four or five double, and steeped in syrup of Roses or Wormwood, and a little Aqua vitae; for thus you shall press down both the Crassa Meninx, lest lifted up by the accustomed and native pulsation of the Brain, it should be hurt by the edges of the Skull, yet rough by reason of the sharp splinters of the bone lately trepaned, and give freer passage forth for the matter there contained. But as oft as you shall dress the Patient, you shall renew the forementioned Tent, until all the matter be purged forth. And so often also you shall press down with this following Instrument the Dura Mater,

and bid the Patient to strive to put forth his breath, stopping his mouth and nose, that so the matter may more easily be evacuated. This Instrument wherewith you shall hold down the Dura Mater, must have the end round, polisht, and smooth, as it is here exprest.

[illustration]

A fit Instrument to press and hold down the Dura Mater, so to make way for the passage forth of the Sa∣nies or Matter.

And let there be laid upon the Du∣ra Mater strewed over with the formerly forementioned powder, a spunge moistened and wrung forth of a drying decoction made of aromatick and cephalick things, such as this which follows. ℞ Fol. salviae, majoran. betonicae, rosar. rub. absinth. Myrtil. florum cha∣maem. melil. stoechad. utriusque an. M. iij. ss. rad. cyperi, calam. aromat. ireos, caryophyllatae, angelicae, an. ℥ ss. bulliant omnia secundum artem cum aqua fabrorum & vinoru••ro, fiat decoctio ad usum dictum. And instead hereof you may use claret with a little aqua vitae, that so the contained matter may be evacuated and dryed up. A spunge is fitter for this purpose to draw than a linnen rag or any other thing, both because it is good of it self to draw forth the humidity, as also for that by its softness it yeelds to the pulsation of the Brain. Then apply to the wound and all the adjoining parts, an emplaister of Diacalcitheos dissolved with vinegar, or wine, or oyl of Roses, that so the plaister may be the more cold and soft. For, in Hippocrates opinion, nothing which is any thing heavy or hard must be applyed to wounds of the head, neither must it be bound with too strait, or hard a ligature, for fear of pain and inflammation.

For Galen tells (as he had it from Mantias) that a certain man had lost his eyes by inflammation and impostumation, arising for that an Apothecary had used too strait a ligature to his head and face; for, this strait ligature so pressed the sutures, that the fuliginous vapours, which used to pass through them and the pores of the skull, were stopped from passing that way; besides, the beating of the Arteries was intercepted and hindered; by which means the pain and inflammati∣on so encreased, that his eyes were rent and broke in sunder and fell forth of their orb. Where∣fore Hippocrates rightly commends an indifferent ligature: also he fitly wisheth us to let the em∣plaisters be soft which are applyed to the head, as also the cloaths wherewith it is bound up to be of soft and thin linnen, or of Cotton, or wool. When the patient is in dressing, if there come much matter out of the wound, you shall wish him if he can, to lye upon the wound, and now and then by fits to strive to breathe, stopping his mouth and nose, that so the brain lifted and swoln up∣wards, the matter may be the more readily cast forth; otherwise suffer him to lye so in his bed, as he shall best like of, and shall be least troublesome to him. You may with good success put upon the Crassa Meninx oyl of Turpentine with a small quantity of aqua vitae and a little Aloes and Saf∣fron finely powdred, to clense or draw forth the Sanies, or matter. Or else, ℞ Mellis rosar. ℥ij. farinae hord. pulver. aloes, mastich. & Ireos florent. an. ʒ ss. aqua vitae, parum; let them be incorporated together and make a detersive medicine for the foresaid use.

Sometimes also the Crassa Meninx is inflamed after Trepaning, and swoln by a Phlegmon, that, impatient of its place, it rises out of the hole made by the Trepan, and lifts it self much higher then the skull, whence grievous symptoms follow. Wherefore to prevent death, of which then we ought to be afraid, we must inlarge the former hole with our cutting mullets, that the mat∣ter contained under the skull, by reason of whose quantity the membrane swells, may the more freely breathe and pass forth; and then we must go about by the prescript of the Physitian to let him bleed again, to purge and diet him. The inflammation shall be resisted by the application of contrary remedies, as this following fomentation. ℞. Sem. lini, althae, fon. psillii, ros. rub. an. ℥ j. solani, plantag. an. M. j. bulliant in aqua tepida communi, ex qua fiat fotus. Anodyne and repelling me∣dicines shall be dropped into his ears, when it is exceedingly swoln, that the tumor may subside, you shall cast upon it the meal or floure of lentils, or vine leaves beaten with Goose grease. With all which remedies if the tumor do not vanish, and withall you conjecture that there is Pus or mat∣ter contained therein, then you must open the Dura Mater with your incision-knife, holding the point upwards and outwards, for so the matter will be poured forth and the substance of the brain not hurt nor touched. Many other Chirurgeons, and I my self, have done this in many patients with various success. For it is better in desperate cases to try a doubtful remedy then none at all; also it oft-times happens, whether by the violence of the contusion and blow, or concretion or clotting of the blood which is shed, or the appulse of the cold ayre, or the rash application of me∣dicines agreeing neither in temper nor complexion with the Crassa Meninx, or also by the putre∣faction of the proper substance, that the Dura Mater it self becomes black. Of which symptome the Chirurgion must have a great and special care.

Therefore that thou mayst take away the blackness, caused by the vehemency of the contusion, you shall put upon it oyle of eggs with a little Aquae vitae, and a small quantity of Saffron and Or∣ris roots in fine powder, you shall also make a fomentation of discussing and aromatick things boy∣led in water and wine; and Vigoes Cerat formerly described shall be applyed. But if the harm come from congealed blood, you shall withstand it with this following remedie. ℞ Aqua vitae ℥ij. granor. tinctorum in tenuem pulverem tritorum ʒijss. croci, ℈1. Mellis rosat. ℥ijss. sarcocol. ʒiij. Leviter & simul ••••lliant omnia, & de colatura infundatur, quousque nigrites fuerit obliterata. If this affect come by the touch of the ayre, it shall be helped with this following remedy. ℞ Tereb. ven. ℥iij,

Mellis. ros. ℥ij. Vitellum ov. unum, farin. hordei ʒiij. croci ℈j. sarcocol. ʒij. aq. vitae ʒij. Incorporentur simul, & ••ulliant paululum. This remedy shall be used untill the blackness be taken away, and the membrane recover its pristine colour.

But if this affect proceed from the rash use of medicines, it must be helped by application of things contrary. For thus the offence caused by the too long use of moist and oyly medicines, may be amended by using catagmatick and cephalick powders; but the heat and biting of acrid medi∣cines, shall be mitigated by the contrary use of gentle things: for both humid and acrid things somewhat long used make the part look black; that truly, by generating and heaping up filth; but this, by the burning and hardening heat. But when such blackness proceeds from putrefaction, Iohn de Vigo commends the following remedy. ℞ aqua vitae ℥ij. mellis rosat. ℥ ss. But if the affect be grown so contumacious that it will not yeeld to this gentle remedy, then this following will be convenient. ℞ Aq. vitae ℥iij. mellis ros. ℥j. pulver. Mercur. ʒij. unica e••ullitione bulliant simul ad usum dictum. Or ℞ aqua vit. ℥jss. syrup. absinth. & mellis rosat. an. ʒij. unguenti Aegyptiaci ʒjss. sarcocol. myrrhae, aloes, an. ʒj. vini albi boni & odoriferi, ℥j. Bulliant leviter omnia simul, colentur ad usum dictum. But if the force of the putrefaction be so stubborn, that it will not yeeld to these remedies, it will be helped with Aegyptiacum (made with plantain water instead of Vinegar) used alone by it self, or with the powder of Mercury alone by it self, or mixt with the powder of Alome. Neither must we be afraid to use such remedies especially in this extream disease of the Dura Mater; for in Galens opinion the Crassa Meninx after the skull is trepaned delights in medicines that are acrid, that is, strong and very drying, especially if it have no Phlegmon: and this for two reasons; the first is, for that hard and dry bodies, such as membranous bodies are, be not easily affected unless by strong medicines; the other is, which must be the chief and prime care of the Physitian, to pre∣serve and restore the native temper of the part by things of like temper to it. But if the auditory passage not only reaching to the hard membranes of the Brain, but also touching the Nerve which descends into it from the brain, suffer most vehement medicines, though it be placed so neer; cer∣tainly the Crassa Meninx will endure them far more easily and without harm. But if by these means the putrefaction be not restrained, and the tumor be encreased so much, that the Dura Mater ri∣sing far above the skull, remains unmoveable, black and dry, and the patients eyes look fiery, stand forth of his head and rowl up and down with unquietness and a phrensie, and these so many ill ac∣cidents be not fugitive, but constant; then know that death is at hand, both by reason of the cor∣ruption of the gangraen of a noble part, as also by extinction of the native heat.

CHAP. XXII. Of the cure of the Brain being shaken, or moved.

WE have formerly declared the causes, signs and symptoms of the concussion, or shaking, of the Brain, without any wound of the musculous skin, or fracture of the bone; wherefore for the present I will treat of the cure. Therefore in this case, for that there is fear that some ves∣sel is broken under the skull, it is fit presently to open the cephalick vein. And let blood be plen∣tifully taken according to the strength of the Patient, as also respectively to the disease both which is present, and like to ensue, taking the advice of a Physitian. Then when you have shaven away the hair, you shall apply to the whole head and often renue the forementioned cataplasm, Ex f••rinis, oleo rosaceo, oxymelite, and other like cold and moist repelling medicines. But you must es∣chew dry; and too astringent medicins must be shunned, such as are Unguentum de bolo and the like; for they obstruct too vehemently, and hinder the passage forth of the vapours both by the sutures and the hidden pores of the skull. Wherefore they do not only not hinder the inflammation, but fetch it when it is absent, or encrease it, when present. The belly shall be loosed with a clyster, and the acrid vapours drawn from the head; for which purpose also it will be good, to make frictions from above downwards, to make straight ligatures on the extream parts, to fasten large cupping-glasses with much flame to the shoulders and the original of the spinal marrow, that so the revulsion of the blood running vio••ently upwards to the brain, and ready to cause a phlegmon, may be the greater, The following day it will be convenient to open the Vena Puppis, which is sea∣ted upon the Lambdall suture, by reason of the community it hath with the veins of the brain, and shutting the mouth and nose to strive powerfully to breathe. For thus the membranes swell up, and the blood gathered between them and the skull, is thrust forth; but not that which is shut up in the brain and membranes, of which if there be any great quantity, the case is almost desperate, un∣less nature assisted with stronger force, cast it forth turned into Pus. But also after a few dayes the vena frontis or forehead-vein may be opened, as also the Temporal Arteries, and Veins under the tongue, that the conjunct matter may be drawn forth by so many open passages. In the mean space the Patient must keep a spare diet, and abstain from wine, especially until the 14^th day, for that un∣til that time the fearful symptoms commonly reign. But repelling medicins must be used untill the 14^th day be past, then we must come to discussing medicins, beginning with the more milde, such as is this following decoction. ℞ rad. Alth. ℥vj. ireos, cypari, calam. arom. an. ℥ij. fol. salviae, majoran. betonic. flor. chamaem. melil. ros. rub. stoechad. an. M. ss. salis com. ℥iij. bulliant omnia simul secundum artem cum vin•• rub. & aqua fabrorum, fiat decoctio. Let the head be washt therewith twice a day with a spunge. But yet when you do this, see that the head be not too much heated by such a fomentation, or any such like

thing, for fear of pain and inflammation. Then you shall apply the cerate of Vigo which hath power to discuss indifferently, to dry, and draw forth the humors which are under the skull, and by its Aromatick force and power to confirm and strengthen the Brain; it thus described. ℞ Furfuris bene triturati ℥ iij. farin. lentium ℥ ij. ros. myrtillor. foliorum & granorum ejus, an. ℥ j. calam. aro∣mat. ℥ i ss. chamaemel. melil. M. ss. nuces cupressi num. vj. olei rosacei, & chamaem. an. ʒ iij. cerae albae ℥ ij ss. thuris, mastichis, an. ʒ iij. myrrhae ʒ ij. In pulverem quae redigi d••bent redactis, & liquefactis oleis cum cera, omnia misceantur simul & fiat mixtura, quae erit inter formam emplastri & ceroti.

Vigo saith, that one of the Duke of Urbins Gentlemen found the Urine hereof to his great good. He fell from his Horse with his head downwards upon hard Marble, he lay as if he had been dead, the bloud gusht out of his nose, mouth and ears, and all his face was swollen, and of a livid colour; he remained dumb twenty days, taking no meat but dissolved Gellies, and Chicken and Capon broths with Sugar; yet he recovered, but lost his memory, and faultered in his speech all his life af∣ter. To which purpose is that Aphorism in Hippocrates; Those that have their Brain shaken by what cause soever, mus of necessity become dumb; yea also, as Galen observes in his Commentary, lose both their sense and motion. That Cerot is not of small efficacy, but of marvellous and admirable force, which could hinder the generating of an abscess, which was incident to the Brain by reason of the fall. Yet there be many men so far from yielding to reason, that they stifly deny, that any impostumation can be in the Brain; and augmenting this errour with another, they deny that any who have a portion of the Brain cut off can recover, or rise again; but the authority of ancient Writers, and Experience, do abundantly refel the vanity of the reasons whereon they rely. Now for the first, in the opinion of Hippocrates; If those which have great pain in their heads have ei∣ther pus, water or bloud flowing from their Nose, Mouth or Ears, it helps their disease.

But Galen, Rhasis, and Avicen, affirm that Sanies generated in the Brain disburdens it self by the Nose, Mouth, or Ears; and I my self have observed many who had the like happen to them.

I was told by Prothais Coulen, Chirurgeon to Monsieur de Langey, that he saw a certain young man in the Town of Mans, who often used to ring a great Bell; he once hanging in sport upon the rope; was snatcht up therewith and fell with his head full upon the pavement: he lay m••te, was deprived of his senses and understanding, and was besides hard bound in his Belly. Wherefore presently a Feaver and Delirium with other horrid symptoms assayled him, for he was not trepanned because there appeared no sign of fracture in the skull: on the seventh day, he fell into a great sweat with often sneesing, by violence whereof a great quantity of matter and Pus flowed of forth his ears, mouth and nose; then he was eased of all his symptoms, and recovered his health.

Now for the second, Galen affirms that he saw a Boy in Smyrna of Ionia that recovered of a great wound of the brain, but such an one as did not penetrate to any of the ventricles. But Guido of Cauliac saith, he saw one which livad and recovered after a great portion of the brain fell out by reason of a wound received on the hind part of his head. In the year of our Lord 1538. while I was Chirurgeon to the Marshal of Montejan at Turin, I had one of his Pages in cure, who playing at quoits received a wound with a stone upon the right Bregma with a fracture, and so great an Ef∣fracture of the bone: that the quantity of half a hasel Nut of the brain came forth thereat. Which I observing, presently pronounced the wound to be deadly; a Physitian which was present contra∣dicted my opinion, affirming that substance was no portion of the brain, but a certain fatty body. But I with reason and experience in presence of a great company of Gentlemen, convinced the pertinacy of the Man, with reason; for that fat cannot be generated under the skull, for although the parts there contained be cold, yet because they are heated by the abundance of the most hot and subtle animal spirits, and the heat of vapours rising thither from all the body, they do not suf∣fer fat to concreat about them. But with experience, for that in dissecting of dead bodies, there was never any fat observed there; besides also fat will swim on the top of water; but this sub∣stance as marrowy, cast into the water presently sunk to the bottom.

Lastly, fat put to the fire becomes liquid and melts; but this substance being laid upon a hot iron, became dry, shrunk up and contracted it self like a piece of leather; but dissolved not at all. Wherefore all those which were present, cryed out, that my judgment was right of that substance that came forth of the skull. Yet though it was cut away, the Page recovered perfectly, but that he continued deaf all his life after.

CHAP. XXIII. Of the Wounds of the Face.

HAving treated of the wounds of the head by their causes, signs and cure, it follows that we now speak of the wounds of the Face, if but for this, that when they are carelesly handled, they leave deformed scars in the most specious and beautiful part of the body. The causes are the same which are incident to the skull, that is, external. But this may be added to the kinds and differences of the wounds, that the life may be out of danger though any one whole part of the face (as the ear, eye, nose, lip) may be cut away by a wound, but not so in the head or skull. Wherefore beginning at the wounds of the eye-brows, we will prosecute in order the wounds of the other parts of the face.

This is chiefly to be observed in wounds of the eye-brows, that they are oft-times cut so over∣thwart, that the muscles, and fleshy pannicle which move and lift them up, are wholly rent and

torn. In which case the eye-lids cannot be opened, and the eyes remain covered, and, as it were, shut up in the cases of their lids; so that even after the agglutination of the wound, if the Patient would look upon any thing, he is forc'd to hold up the eye-lids with his hand; with which infirnity I have seen many troubled, yet oft-times not so much by the violence of the wound, as the unskil∣fulness of the Chirurgeon who cured them; that is, by the negligent application of the boulsters, an unfit ligature, and more unfit future. In this case the skilful Chirurgeon, which is called to the Patient, shall cut off as much of the skin and fleshy pannicle as shall serve the eye-lids, that so they may by their own strength hold and keep open, without the help of the hand: then he shall sow the wound as is fit, with such a stitch as the Furriers, and Glovers use; and then he shall pour there∣on some of the Balsom of my description, and shall lay such a medicine to the neighbouring parts. ℞ Olei rosar. ℥ ss, album. ••vor. nu. ij. boli armen. sanguinis Dracon. Mastich. ad. ʒ j. agitentur simul, fi•• medicamentum. Then let the part be bound with a fitting Ligature. Afterwards you shall use Em∣plast. de gratia Dei, Empl. de Betonica, Diacaleitheos, or some other like, until the wound be cicatri∣zed. But such like, and all other wounds of the face may be easily healed, unless they either be associated with some malign symptoms, or the Patient's body be repleat with ill humors.

There sometimes happen a quite contrary accident in wounds of the eye-brows, that is, when the eye-lids stand so up that the Patient is forc'd to sleep with eyes open; wherefore those which are so affected, are called by the Greeks Lagophthalmi. The cause of this affect is often internal, as a carbuncle, or other kind of abscess, as a blow or stroak. It shall be cured by a crooked or semicir∣cular incision made above the eye-lids, but so, that the extreams of the semicircle bend down∣wards, that they may be pressed down and joyned as much as is needful to amend the stifness of the eye-lid. But you must not violate the gristle with your Instrument, for so they could no more be lifted up; the residue of the cure must be performed as is fit.

CHAP. XXIV. Of the Wounds of the Eyes.

WOunds of the Eyes are made by the violence of things pricking, cutting, bruising, or o∣therwise loosing the continuity. But the cure must always be varied according to the variety of the causes and differences. The first head of cure is, that if any strange and heterogeneous body shall be fallen into the eyes, let it be taken forth assoon as you can, lifting and turning up the eye-lid with the end of a spatula. But if you cannot discern this moat or little body, then put three or four seeds of Clary, or Oculus Christi into the pained Eye. For these seeds are thought to have a faculty to cleanse the eyes and take out the moats, which are not fastned deep in, nor do too stubbornly adhere to the membranes. For in this case, you shall use this fol∣lowing Instrument, for herewith we open the eye-lids the further, putting it between them and the eye, and also keeping the eye steddy by gently pressing it, that so with our mullets we may pull out the extraneous body; this is the figure of such an Instrument.

[illustration]

The delineation of a Speculum oculi, fit to dilate and hold asunder the Eye-lids, and keep the Eye steddy: it is so m••de, that it may be dilated and contracted according to the greatness of the Eyes.

All strange bodies taken out, let this me∣dicine be put into the eye. Take the strains of a dozen eggs, let them be beaten in a leaden Mortar, with a little Rose-water, and so put into the eye; but let this repercus∣sive be laid upon the eye and the neigbouring parts. ℞. Albumin. ovor. nu. iiij. pulver. aluminis rechae combusti ʒ ij. sanguinis Draconis ʒj. aquae rosar. & plantag. an. ℥ ij. agitentur simul, make a repercussive, which you may fre∣quently use. Or else apply cheese-curds well wrung, mixed with Rose-water, the white of an Egge, and as much acacia as shall suffice. This which followeth doth more powerfully stay the flowing hu∣mor. ℞ gum arab. & tragac. an. ʒ ij. psilii. cydon. semin. portul. plant. sumach. an. ʒ ij. fiat mucag. cum. aqua plantag. solan. & rosar. concinnetur collyrium, of which you may drop some both within and about the Eye.

But note, that all such remedies must be applyed warm, both that they may the better penetrate by their moderate heat, as also for that all actual cold things are hurtful to the eyes and sight, be∣cause they dull the sight by incrustating the visive spirits. For I have knnown many who have be∣come dull of sight by the frequent using of medicines actually cold to the eyes. I have on the con∣trary seen not a few, who have recovered with the fit use of such like medicines, who have had any part of their eye (so it were not the pupilla or apple of the eye) so pricked with a needle or bod∣kin, that much of the waterish humor ran forth thereat.

The milk of a woman which suckles a girl (for that is reputed the cooler) mitigates pain and cienses, if it be milked out of the dug into the eye; to which propose also the bloud of turtles, pge∣ons

or chickens much much conduces; being dropt into the eye by opening a vein under their wings. Also this following cataplasm asswageth pain and inflammation, and hinders defluxion, being applyed to the eye and the adjacent parts. ℞ Carnis pomorum sub cin••re calido decoctorum ℥ v. vitel. ••vorum num. iij. cassiae fistulae recenter extractae ℥ ss, mucaginis psilii, altheae & cydon. an. ℥ i. farin. hordei parum; incorporentur omnia simul. fiat cataplasma. Also Sheeps Lungs boyled in Milk and ap∣plyed warm, and changed as they grow cold, are good to asswage pain. But if the too violent heat and pain shall not yield to such medicines, but require more vehement, then Foliorum Hyoscyami, m. j. sub. cineribus coquatur, atque in mortario cum mucagine seminis psilii, & cydonior. ex∣tract in aquis solani & plantag. pistetur: then let this medicine be wrapped in a linnen cloth and applyed to the Eyes and Temples. The mucilages of Psilium, or Flea-wort, and Quince-seeds extracted in a decoction of Poppy-heads, and mixed with a little Opium and Rose-water, are used for the same purpose. But when there is need of detergent and sarcotick medi∣cines, then ℞ Syrup. rosar. siccat, ℥ i. aq. faenic. & rutae an. ʒ ij. aloes lotae, olibani an. ℥ ss. mix them for the foresaid use. The galls of Scates, Hares, and Partridges dissolved in Eye-bright, and Fen∣nil-water, are fit for clensing such wounds; as also this following Collyruim. ℞ Aquae hordei ℥ j. mellis despumati, ʒ iij. Aloes ter lotae in aqua plantaginis & sacchari cand. an. ʒ j, fiat collyrium. Also this insuing medicine is very sarcotick. ℞ Mucagin. gummi olibani, arabici, tragacanth. & sarcocol. in aq. hordei extract. an. ʒ iij. aloes ter lotae in aq. rosarum. ʒ j. cerus. ustae & lotae, tutiae praepar. an. ʒss. fiat collyrium. But here you must note, that the coat Adnota often swells so much by reason of a wound, or some other injury, and stands so forth by the falling down of humors, access and mix∣ture of flatulencies, that it hides the whole Pupilla, and hangs forth of the Eye-lids, like as if it were an unnatural fleshy excrescence, and it loses the native colour, and looks very red, so that the Eye can neither be shut nor opened.

Wherewith a young Chirurgeon being deceived, determined to cut away this protuberancy of the Adnata, as though it had been some superfluous flesh, and then to waste it with cathaere∣tick powders, had I not forbidden him, telling him of the certain danger of blindness which would thereupon befal the Patient. Wherefore I prescribed a fomentation of Chamomil, Melilote, Rose-leaves, Wormwood, Rue, Fennil, and Aniseeds, boyled in Milk with the roots of Oris and Marigolds. Then I presently added this following Fomentation, being more powerful and drying. ℞ Nucis cupressi, gallar. balaust. an. ℥ i. plantag. absinth. hippuris, flo. chamaem. ros. rub. an. M ss. bulliant simul. cum. aqua fabrorum, & fiat decoctum pro fotu cum spongia. Besides also you may apply a cataplasm made of Barly and Bean-flour, the powders of Mastick, Myrrhe, and Aloes, and some of the last described decoction. The tumor beginning to decline, I dropt the flowing liquor into the Eye, which hath a very astringent, drying and strengthening fa∣culty. Roast a new laid Egge in Embers until it be hard, then pill off the shell, take forth the yolk, and in place thereof put a scruple of Roman Vitriol in fine powder, then put it in a linnen cloth and wring it hard forth into some clean thing, and drop thereof for some dayes into the Eye, with a little Smiths-water wherein Sumach and Rose-leaves have been boyled. I have found by experience the certain force of this remedy; but if notwithstanding there be a true fleshy excrescence upon the coat Adnata, it may be taken away by this following powder. ℞ Ossis sepiae, & testae ovorum calcinatae an. ʒ j. fiat pulvis. Calcined Vitriol, burnt Alum, and the like may be commodiously used to this purpose. Yet you must warily make use of all such things, and always lay repercussives about the Eye, that no harm insue thereof. For divers times acrid humors fall down into the Eye with such violence, that they break the Horney-coat, where∣upon the humors of the Eye are poured out. Remember also, that in diseases of the Eyes, the Patient lye with his head somewhat high, and that he keep shut not only the pained, but also the sound Eye, because rest is always necessary for the grieved part. But one Eye cannot be moved without some motion of the other by reason of the connexion they have by their optick and moving nerves, both the Meninges and the Pericranium, Veins and Arteries; which is the cause that when the one suffers, the other in some sort partakes therewith.

But if we cannot prevail by all these formerly prescribed medicines fit to stay the defluxion, then it remains, that we apply a Seton to the neck; for it is a singular remedy against inveterate defluxions into the Eyes. For we know by dayly experience; that many who have had their sight dulled by a long and great defluxion, so that they were almost blind, have by little and little recovered their former splendour and sharpness of sight, when matter once began to be evacu∣ated by the Seton.

The truth hereof appeared in Paul the Italian Goldsmith, who dwelt near the Austin Fryers. For he having used many medicines of divers Physitians and Chirurgeons in vain, when he was almost blind, he applying a Seton, by mine advice, began by little and little to see better accor∣ding to the quantity of the matter which was evacuated, until at length he perfectly recovered his sight. But at last growing weary of the Seton which he had worn for a year (although matter came dayly forth thereof) yet he would have it taken forth and healed up; but this way of eva∣cuation being shut up, and the humor again beginning to flow into his eyes, so that he was in dan∣ger to become blind, he called me and made me again to apply the Seton in his neck. Whereby recovering his former soundness and perfection of sight, he yet wears the Seton.

I also once freed by this kind of remedy, by appointment of the most learned Physitian Holle∣rius, a certain young man of 20 years old, from the Falling-sickness, who before had many fits thereof; the Ichorous humors, the feeders of this disease, being by this means, as it is most pro∣bable, drawn away and evacuated.

[illustration]

A Figure of the Pincers, actual Cautery, and Needle, used in making a Seton.

Wherefore seeing a Seton is of this use, I have thought good in this place to set down in wri∣ting and by figure, the manner of making thereof, for the behoof of young practitioners: Wish the Patient to sit on a low stool, and to bend down his head, that so the skin and fleshy pannicle may be relaxed; then must you with your fingers pluck up and sever the skin from the muscles, and take hold of as much hereof as you can with your pincers, not touching the Muscles of the Neck for fear of a Convulsion and other symptoms; you shall then twitch the skin which is held in the pincers most hard, when you shall thrust the hot Iron through the holes made in the midst of them; that also the nerves being so twitched, the dolorifick sense may the less come to the part. The wound must be made or burnt in long-wayes, and not thwarting, that so the matters may be the better evacuated by the strait fibers. But the cautery or hot Iron must have a three or else a four-square point, and that sharp, that so it may the more easily and speedily enter. Then keeping the pincers immoveable, let him draw through the passage made by the cautery a needle and thred with a three or four doubled thred of Cotton [or rather a skean of Silk] moistened in the white of an Egge, and Oyl of Roses; then after you have applyed pledgets dipped in the same medicine, bind up the part with a convenient ligature. The day following the Neck must be anointed with Oyl of Roses, and the pledgets dipped in the former medicine applyed for some days after. But it will be convenient to moisten the Seton with a digestive made of the yolk of an Egge and Oyl of Roses, until the Ulcer cast forth much matter; then you shall anoint the Cotton thred with this fol∣lowing remedy. ℞ terebinthinae ven. ℥ iiij. syrupi rosat. & absinthii an. ℥ ss. pulveris Ireos, diacrydii, agarici trochiscati, & Rhei, an. ℥ ss. incorporentur omnia simul & fiat medicamentum. Which you shall use so long, as you intend to keep open the ulcer. For it hath a faculty to draw the humors from the face, and cleanse without biting.

I have found not long since by experience, that the apertion made with a long thick Triangu∣lar Needle of a good length like to a large Pack-needle, is less painful than that which is per∣formed with the actual cautery, which I formerly mentioned. Wherefore I would advise the young Chirurgeon, that he no more use the foresaid actual cautery. I have here given you the figure of the Needle.

[illustration]

The Figure of a Triangular Needle.

CHAP. XXV. Of Wounds of the Cheek.

SEeing a wound of the cheek seems to require a Suture, it must have a dry Suture (as they term it) lest that the scar should become deformed. For that deformity is very grievous to many, as to women who are highly pleased with their beauties. Therefore you shall spread two pieces of new cloath of an indifferent fineness, and proportionable bigness with this insuing medicine. ℞ Pulveris Mastichini, sanguinis Draconis, Thuris, farinae volatilis, traga∣ganthae contusae, gypsi, picis, sarcocollae an. ʒ ij. picis nigrae ʒ i ss. albumina ovorum quae sufficiant, fiat medicamentum. Apply the pieces of cloth spread with this, on each side of the wound one, some fingers breadth asunder, and let it alone till it be hard dryed to the skin. Then you shall so draw

them together with your Needle and thred, that the flesh by their sticking may also follow, and

[illustration] man having cheek sewn

[illustration] cheek sewing device

be mutually adjoyned, as you may see it here exprest. The wound shall be agglutinated by this means, together with the use of fit medicines, pledg∣ets, ligatures. But all the ligatures and stays which shall be used for that pur∣pose, must be fastned to the Patient's night-lap.

But when the wound is great and deep, and the lips thereof are much distant the one from the other, there can be no use of such a dry suture. Wherefore you must use a three or four square Needle (that so it may the more readily and easily enter into the flesh) being thred with a waxed thred; and with this you must thrust through the lips of the wound, and leave the Needle sticking in the wound, and then wrap the thred to and again over the ends thereof eight or ten times, just after that manner which women use to fasten a Needle with thred in it, upon their sleeves, or Tailors to their hats or caps, that they may not lose them.

The Needle thus fastened, shall be there until the perfect agglutination of the wound; this kind of suture is used in the wounds of the lips, as also in hare-lips, for so we commonly call lips which are cleft from the first conformation in the womb by the error of the forming faculty. But such a sutre will help nothing to agglutination, if there lye or remain any skin between the lips of the wound; Wherefore you shall cut away whatsoever thereof shall be there, otherwise you must expect no union. Other kind of Sutures are of no great use in wounds of these parts, for out of the necessity of eating and speaking, they are in perpetual motion; where∣fore a thred would cut the flesh; for which reason you shall take up much flesh with such Needles mentioned in this fast described kind of Suture as this following figure shews.

[illustration]

The figure of the suture fit for cloven or hare-lips; as also the delineation of the Needle about whose ends the thred is wrapped over and under, to and again.

To this purpose I will recite a History, to the end, that if any such thing happen to come to your hands; you may do the like. A certain Gascoin in the battel of Saint Lau∣rence, had his upper jaw cut overthwart even to his mouth, to the great disfiguring of his face. The wound had many worms in it, and stank exceedingly, because he could get no Chirurgeon until three days after he was hurt. Where∣fore I washed it with a decoction of Wormwood, Aloes, and a little Aegyptiacum, both to kill the Worms, and to fetch away all the putrid matter; I discussed the tumor with a dissolving fomentation and cataplasm, I joyned together the lips of the wound with the last described suture. But I ap∣plyed this following medicine to the whole part. ℞ Tere∣binth. venetae ℥ vj. gummi elemi. ℥ ij, pulveris boli armeni. san∣drac. Mastiches, Myrrhae, Aloes, an. ʒ ss. incorporentur simul, fiat medicamentum. The wound was agglutinated within a few days, but that there remained a certain little hole at the joyning of the lower jaw with the upper, wherein you could scarse put the head of the pin; out whereof nevertheless much serous and thin moisture flowed, especially when he either eat or spake; which I have also observed in many others. But for staying of this waterish humidity I dropped Aqua fortis into the bottom of the ulcer, and divers times put therein a little of the powder of burnt Vitriol. Thus by Gods grace he recovered and became whole.

CHAP. XXVI. Of the Wounds of the Nose.

THe Nose many wayes suffers solution of continuity; as by a wound, fracture, and contu∣sion, and it is sometimes battered and broken on the upper part; which when it happens, you shall restore the deprest Bones to their native seat and figure, with the end of a Spatu∣la, or fit stick wrapped about with Tow, Cotton, or a linnen rag. Then with pledgets dipped in an astringent medicine composed ex albumine ovi, Mastich. bol. armen. sanguin. drac. & alumine usto, and applyed to the side of the Nose, he shall labour to strengthen the restored Bones, and then bind them with a convenient ligature, which may not press them too much, lest the nose should become flat, as it happens too many through the unskifulness of Chirurgeons.

Then must you put little pipes into the no∣strils,

[illustration]

The Figure of Pipes to be put into the Nostrils.

and these not exactly round, but somewhat flat and deprest, tyed to the night-cap on each side with a thred, lest they should fall out. By the help of these pipes the bones of the nose will be kept in their place, and there will be passage forth for the matter, and for in∣spiration and exspiration. But if all the Nose, or some portion thereof shall be wholly cut off, we must not hope to restore it. But if the Nose be so cut, that as yet it adheres to much of the adjacent flesh, from whence it may receive life and nourishment, the sow it up. For the lower part of the Nose, it may be shaken, de∣prest and wrested aside, seeing it is gristly; but it cannot be broken, as the other which is of a bony nature.

CHAP. XXVII. Of the Wounds of the Tongue.

THe Tongue may be so wounded, that either it may be wholly cut off and deprived of some portion of the substance, or only slit long-ways, or athwart. The loss of the substance cannot be repaired, because every part separated and pluckt from the living body, from whence it had life, spirit and bloud, presently dyes. For, as Philosophers say, à privatione ad ha∣bitum non est regressus. But when it is cut or slit long-wayes or side-wayes, it is easily restored by suture, if so be that the cloven part yet adhere to the living body from whence it may draw both matter and form of life. Therefore a careful servant shall straitly hold with a soft and clean lin∣nen cloth the body of the Tongue, lest it should slip away by reason of its slipperiness, whilst the Chirurgeon stitch it above and below; when he thinks he hath sufficiently sowed it, let him cut off the thred as neer to the knot as he can, lest being left too long it might be tangled with the teeth as he eats, and so cause a hurtful laceration or rending of the sowed parts. In the mean time let the Patient eat Barley-Creams, Almond-Milks, Gellyes, Cullisses, and Broths, and the yolks of Egges; and let him often hold in his mouth Sugar of Roses and Syrup of Quinces; for such things besides their nourishing faculty, perform the part of an agglutinating and detergent medi∣cine. I have learned these things I have here set down, neither from my Masters whom I have heard with attention, nor by reading of Books, but they have been such as I have tryed with happy success in many; as in the son of Monsieur de Marigny President of the Inquisition, in John Piet a Carpenter dwelling in the Suburbs of Saint German.

But most apparently in a child of three years old, the son of the great Lawyer Monsieur Covet, who fell with his chin upon a stone, and so cut off a large piece of the end of his tongue, which chanced to be between his teeth; it hung but at a very small fiber of flesh, so that I had very little or no hope to agglutinate and unite it, which thing almost made me to pluck it quite away; yet I changed that determination by considering the loss of the most noble action of speaking, which would thereupon ensue, and weighing the providence of Nature often working wonders and such things as exceed the expectation of the Physitian in curing diseases; I also thought thus with my self, the flesh of the Tongue is soft, loose, fungous and spongy, neither is altogether spungy, nei∣ther is altogether obvious to the external injuries of the air; wherefore after that I had once or twice thrust through the Needle and Thred upwards and downwards, and for the rest ordered the child to be used and dieted after the manner I lately mentioned, he grew well within a short time, and yet remain•• so, speaking well and distinctly.

CHAP. XXVIII. Of the Wounds of the Ears.

THe Ears are sometimes wholly cut off, sometimes but in part, otherwhiles they are only slit, so that the rent portion as yet adhering to the rest, is joyned with it in communion of life. In this last case it is fit to use a suture; but yet so that you touch not the gristle with your Needle; for thence there would be danger of a Gangrene, which happens to many by foolish curing; therefore you shall take up and comprehend with your needle only the skin, and that little flesh which encompasses the gristle. You shall perform the rest of the cure with pledgets and ligatures artificially fitted, and shall resist inflammation and other symptoms with fit medicines. But you must take special care that no superfluous flesh grow in the auditory pas∣sage, which may hinder the hearing; wherefore you shall keep that passage free by stopping it with a piece of Spunge. But you shall procure agglutination and consolidation of the gristly part (and therefore next to a bone most dry) with dry medicines. But those who have their Ears quite cut off, can do nothing but hide the deformity of their mis-hap with a cap, stuffed with cotton on that side.

CHAP. XXIX. Of the Wounds of the Neck and Throat.

THe Wounds of the Neck and Throat are somewhiles simple, as those which only use the continuity of the muscles; otherwhiles compound, such as those which have conjoyned with them a fracture of the Bones, as of the Vertebrae, or hurt of the internal and external jugular Veins, or sleepy Arteries; sometimes the Trachea Arteria, or Weazon, and the oesopha∣gus or gullet are wounded; sometimes wholly cut off, whence present death ensues. Wherefore let not the Chirurgeon meddle with such wounds, unless he first foretel the danger of death, or the loss of some motion to those that are present. For it often happens that some notable nerve or tendon is violated by a wound in the neck, whence a Palsie ensues, and that absolutely incurable, if the wound shall penetrate to the spinal marrow, also hurt therewith. Wounds of the Gullet and Weazon are difficultly cured because they are in perpetual motion; and chiefly of the latter, by reason it is gristly and without bloud. The wounds of the gullet are known, by spitting of bloud, by the breaking forth of meat and drink by the wound; but if the Gullet be quite cut asunder, the Patient cannot swallow at all. For the cut parts are both contracted in themselves, the one upwards, and the other downwards. But we know the weazon is hurt, by casting up bloud at the mouth with a continual cough, and by the coming forth of the breath or wind by the Wound. The Wounds of the jugular Veins and sleepy Arteries, if they be great are usually deadly, because they cannot be straitly bound up; for you cannot bind the throat hard without danger of choaking or strang∣ling the Patient. But for defect of a strait ligature in this case the flux of bloud proves deadly. If the recurrent Nerve of either side be cut, it makes the voyce hoarse; if cut on both sides, it takes away the use of speech, by hurting those instruments which impart motion to the muscles of the Larinx. For the cure, if the wound be small, and not associated with the hurt of any notable vessel, nor of the Weazon and Gullet, it is speedily and easily cured; and if there shall be need you shall use a Suture, then you shall put therein a sufficient quantity of Venice-Turpentine mixed with Bole-Armenick; or else some of my Balsam, of which this the Receipt. ℞ Terebinth. venetae lb ss. gum. elemi ℥ iiij. olei hypericonis ℥ iij. boli armen. & sang. draconis an. ℥ j. aqua vitae ℥ ij. liquefiant si∣mul omnia lento igne, & fiat Balsamum ut artis est, ad dendo pulveris ireos florent. aloes, mastiches, myr∣rhae an. ʒ j. I have done wonders with this Balsom in the agglutination of simple wounds, wherein no strange body hath been. Now when you have put it in, lay upon it a plaister of Diacalcitheos dis∣solved in Oyl of Roses and Vinegar, as that which hath power to repress the flowing down of humors, and hinder inflammation, or in stead thereof you may apply Emp. de Gratia Dei, or Emp. de Janua. But if the jugular Veins and sleepy Arteries be cut, let the bleeding be stayed, as we have shewed in a chapter, treating thereof. When the Weazon or Gullet are wounded, the Chi∣rurgeon shall sow them up as neatly as he can; and the Patient shall not endeavour to swallow any hard thing, but be content to be fed with gellies and broths. When a gargarism is needful, this following is very good. ℞ hordei M. j. florum rosar. p. j. passul. mund. ju••ubarum an. ℥ ss. glycyrhizae ℥ j. bulliant omnia simul, addendo mellis ros. & Julep. ros. an. ℥ ij. fiat gargarisma, ut artis est.

With which being warm, the Patient shall moisten his mouth, and throat, for it will mitigate the harshness of the part, asswage pain, cleanse and agglutinate, and make him breathe more freely. But that the Chirurgeon may not despair of, or leave any thing unattempted in such like wounds, I have thought good to demonstrate by some examples how wonderful the works of Nature are, if they be assisted by Art.

A certain servant of Monsieur de Champaigne, a gentleman of Anjou, was wounded in the throat with a sword, whereby one of the Jugular-veins was cut together with his Weazon. He bled much and could not speak; and these symptoms remained, until such time as the wound was sowed up, and covered with medicines. But if medicines at any time were more liquid, he, as it were, sucked them by the wound and spaces between the stitches, and presently put forth at his mouth

that which he had sucked or drawn in. Wherefore more exactly considering with my self, the greatness of the wound, the spermatick, and therefore dry and bloudless nature unapt to aggluti∣nation, of the affected part, but chiefly of the Weazon and Jugular-vein; as also for that the rough Artery is obnoxious to those motions which the gullet performs in swallowing, by reason of the in∣ner coat, which is continued to the coat of the gullet, by which means these parts mutually serve each other with a reciprocal motion, even as the ropes which run to the wheel of a pulley; fur∣thermore, weighing that the Artery was necessary for the breathing, and tempering the heat of the heart, as the Jugular-veins served for the nourishment of the upper parts; and lastly, weighing with my self the great quantity of bloud he had lost, which is, as it were, the treasure of Nature, I told those which were present, that death was near and certainly at hand. And yet beyond excepta∣tion, rather by divine favour then our Art, he recovered his health.

Equally admirable is this History following. Two Englishmen walked out of the City of Paris for their recreation to the wood of Vincenne; but one of them lying in wait to rob the other of his money, and a massie chain of gold which he wore, set upon him at unawares, cut his throat and rob∣bed him, and so left him amongst the Vines which were in the way, supposing he had kill'd him, having with his dagger c••t the Weazon and Gullet. This murderer came back to the City; the other half-dead, crawled with much ado to a certain Peasant's house, and being dressed with such medicines as were present, and at hand, he was brought to the City, and by his acquaintants com∣mitted to my care to be cured. I at the first, as diligently as I could, sowed up the Weazon which was cut quite asunder, and put the lips of the wound as close together as I could; I could not get hold of the Gullet, because it was fallen down into the Stomach, then I bound up the wound with medicines, pledgets, and fit ligatures. After he was thus drest he begun to speak, and tell the name of the villain the author of this fact, so that he was taken and fastened to the wheel, and having his limbs broken, lost his wretched life, for the life of the innocent wounded man who dyed the fourth day after he was hurt.

The like hurt befel a certain German, who lay at the house of one Perots, in the street of Nuts; he being frantick, in the night cut his throat with a sword: I being called in the morning by his friends who went to see him, drest him just after the same manner as I dressed the Englishman. Wherefore he presently recovered his speech, which before could not utter one syllable, freed from suspition of the crime and prison the servant, who, lying in the same chamber with him, was upon suspition committed to Prison, and confessing the thing as it was done, lived four days after the wound, be∣ing nourished with Broths put into his Fundament like Clysters, and with the grateful vapour of comfortable things, as Bread newly drawn out of the Oven and soaked in strong Wine; I having thus by Art of Chirurgery made the dumb speak for the space of four days.

CHAP. XXX. Of the Wounds of the Chest.

SOme wounds of the Chest are on the fore-side, some behind, some penetrate more deep, others enter not into the capacity thereof, othersome pierce even to the parts contained therein, as the Mediastinum, Lungs, Heart, Midriffe, hollow Vein, and ascendent Artery; Othersome pass quite through the body; whereby it happens that some are deadly, some not.

You shall thus know that the wound penetrates into the capacity of the Chest, if that, when the Patients mouth and nose be shut, the breath, or wind break through the wound with a noise, so that it may dissipate, or blow out a lighted candle being held near it. If the Patient can scarse either draw, or put forth his breath, this also is a sign that there is some bloud fallen down upon the Diaphragma.

By these signs you may know that the heart is wounded: If a great quantity of bloud gush out, if a trembling possess all the members of the body; if the pulse be little and faint, if the colour become pale, if a cold sweat and frequent swooning assail him, and the extream parts become cold, then death's at hand.

Yet when I was at Turin, I saw a certain Gentleman who fighting a duel with another, received a wound under his left brest which pierced into the substance of his heart, yet for all that he struck some blows afterwards, and followed his flying enemy some two hundred paces until he fell down dead upon the ground; having opened his body, I found a wound in the substance of the heart, so large as would contain ones finger; there was only much bloud poured forth upon the midriffe.

These are the signs that the Lungs are wounded, if the bloud comes foamy or froathy out of the wounds, the Patient is troubled with a cough, he is also troubled with a great difficulty of breathing and a pain in his side, which he formerly had not; he lies most at ease when he lies up∣on the wound, and sometimes it comes so to pass, that lying so, he speaks more freely and easily, but turned on the contrary side, he presently cannot speak.

When the Diaphragma, or Midriffe is wounded, the party affected is troubled with a weight or heaviness in that place, he is taken with a Delirium, or Raving, by reason of the sympathy of the Nerves of the sixth conjugation which are spread over the midriffe; difficulty of breathing, a cough and sharp pain troubles the Patient, the Guts are drawn upwards; so that it sometimes hap∣pens by the vehemency of breathing, that the Stomach and Guts are drawn through the wound into the capacity of the Chest, which thing I observed in two.

The one of these was a Mason, who was thrust through the midst of the Midriffe, where it is nervous, and dyed the third day following. I opening his lower belly, and not finding his stomach, thought it a monstrous thing; but at length searching diligently, I found it was drawn into the Chest, through the wound which was scarse an inch broad. But the stomach was full of wind, but little humidity in it.

The other was called captain Francis d' Alon a Native of Xantoigne, who before Rochell was shot with a Musket Bullet, entring by the breast-bone near to the sword-like Gristle, and, passing through the fleshy part of the midriffe, went out at the space between the fifth and sixth bastard ribs. The wound was healed up on the outside, yet for all that there remained a weakness of the stomach, whereupon a pain of the guts like to the colick took him, especially in the Evening, and on the night; for which cause he durst not sup but very sparingly. But on the eighth month after, the pain raging more violently in his belly then it was accustomed, he dyed; though for the miti∣gating of the vehemency thereof Simon Malm••dy and Anthony du Val both learned Physitians, o∣mitted no kind of Remedy. The body of the diseased was opened by the skilful Chirurgeon James Guillemeau, who found a great portion of the Colick-gut swelled with much wind gotten into the Chest, through the wound of the Diaphragma, for all it was so small that you could scarse put your little finger in thereat. But now let us return from whence we digressed.

We understand that there is blood poured forth into the capacity of the Chest by the difficulty of breathing the vehemency of the increasing feaver, the stinking of the breath, the casting up of blood at the mouth, and other symptoms which usually happen to those who have putrefied and clotted blood poured out of the vessels into the belly, infecting with the filthy vapour of the cor∣rupt substance, the parts to which it shall come. But also, unless the Patient cannot lye upon his back, he is troubled with a desire to vomit, and covets now and then to rise, whence he often falls into a swound; the vitall faculty which sustains the body being broken and debilitated both by reason of the wound, and concreat or clotted blood; for so putting on the quality of poyson, it greatly dissipates and dissolves the strength of the heart.

It is a sign the spinal marrow is hurt, when a Convulsion or Palsie, that is, a sodain loss of sense and motion in the parts thereunder, an unvoluntary excretion of the Urine and other excrements, or a totall suppression of them, seises upon the Patient. When the hollow vein and great Artery are wounded, the Patient will dye in a short time, by reason of the sodain and aboundant effusion of the blood and spirits, which intercepts the motion of the Lungs and heart, whence the party dies suffo∣cated.

CHAP. XXX. Of the cure of the Wounds of the Chest.

WE have read in John de Vigo, that it is disputed amongst Chirurgeons concerning the conso∣lidation of wounds of the Chest. For some think that such wounds must be closed up, and cicatrized with all possible speed, lest the cold air come to the heart, and the vitall spirits fly away and be dissipated. Others on the contrary think that such wounds ought to be long kept o∣pen; and also if they be not sufficiently large of themselves, that then they must be inlarged by Chirurgery, that so the blood poured forth into the capacity of the Chest may have passage forth, which otherwise by delay would putrefie, whence would ensue an increase of the feaver, a fistulous ulcer, and other pernicious accidents. The first opinion is grounded upon reason and truth, if so be that there is little or no blood poured forth into the capacity of the Chest. But the latter takes place where there is much more blood contained in the empty spaces of the Chest. Which lest I may seem rashly to determin, I think it not amiss to ratifie each opinion with a history thereto agreeable.

Whilst I was at Turin, Chirurgeon to the Marshall of Montejan, the King of France his General, I had in cure a Souldier of Paris, whose name was Levesque, he served under captain Renovart. He had three wounds, but one more grievous than the rest, went under the right brest, somewhat deep into the capacity of the Chest, whence much blood was poured forth upon the midriff, which caused such difficulty of breathing, that it even took away the liberty of his speech; besides through this occasion he had a vehement feaver, coughed up blood, and a sharp pain on the wounded side. The Chirurgeon which first drest him, had so bound up the wound with a strait and thick suture, that nothing could flow out thereat. But I being called the day after, and weighing the present symp∣toms which threatned speedy death, judged that the sowing of the wound must straight be loosed which being done there instantly appeared a clot of blood at the orifice thereof, which made me to cause the Patient to lye half out of his bed, with his head downwards, and to stay his hands on a Settle which was lower than the bed, and keeping himself in this posture, to shut his mouth and nose that so his Lungs should swell, the midriffe be stretched forth, and the intercostal muscles and those of the Abdomen should be compressed, that the blood poured into the Chest might be evacu∣ated by the wound; but also that this excretion might succeed more happily, I thrust my finger somewhat deep into the wound, that so I might open the orifice thereof being stopped up with the congealed blood; and certainly I drew out some seven or eight ounces of putrefied and stinking blood by this means. When he was laid in his bed, I caused frequent injections to be made into the wound of a decoction of Barly with Honey of Roses and red Sugar, which being injected I wisht him to turn first on the one, and then on the other side, and then again to lye out of his bed as before: for thus he evacuated small, but very many clots of blood, to∣gether with the liquor lately injected; which being done, the symptomes were

mitigated, and left him by little and little. The next day I made another more detergent injection, adding thereto wormwood, centaury, and Aloes; but such a bitterness did rise up to his mouth together with a desire to cast, that he could no longer indure it. Then it came into my mind that formerly I had observed the like effect of the like remedy in the Hospital of Paris, in one who had a fistulous ulcer in his Chest. Therefore when I had considered with my self that such bitter things may easily pass into the Lungs, and so may from thence rise into the Weazon and mouth, I determined that thenceforwards I would never use such bitter things to my Patients, for the use of them is much more troublesome than any way good and advantagious. But at the length this Patient by this and the like means recovered his health beyond my expectation.

But, on the contrary, I was called on a time to a certain Germain gentleman who was run with a sword into the capacity of his Chest; the neighbouring Chirurgeon had put a great tent into the wound at the first dressing, which I made to be taken forth, for that I certainly understood there was no blood powred forth into the capacity of the Chest because the Patient had no feaver, no weight upon the Di••phr••gma, nor spitted forth any blood. Wherefore I cured him in few dayes by only dropping in some of my balsome and laying a plaister of Diacalcitheos upon the wound. The like cure I have happily performed in many others. To conclude, this I dare boldly affirm, that wounds of the Chest by the too long use of tents degenerate into Fistula's. Wherefore if you at any time shall undertake the cure of wounds which penetrate into the capacity of the Chest, you shall not presently shut them up at the first dressing, but keep them open for two or three dayes; but when you shall find that the Patient is troubled with none or very little pain, and that the mid∣riffe is pressed down with no weight, and that he breathes freely, then let the tent be taken forth, and the wound healed up as speedily as you can by covering it only with lint dipped in some bal∣some which hath a glutinative faculty, and laid somewhat broader than the wound; never apply liniments to wounds of this kind, lest the Patient by breathing draw them into the capacity of the Chest. Wherefore also you must have a care that the tent put into those kinds of wounds may be fastned to the pledgets, and also have somewhat a large head, lest they should be drawn as we said into the capacity of the Chest; for if they fall in, they will cause putrefaction and death. Let Em∣plast. Diacalcitheos or some such like be applyed to the wound. But, if on the contrary, you know by proper, and certain signs, that there is much blood fallen into the spaces of the Chest, then let the orifice of the wound be kept open with larger tents, untill all the Sanies or bloody matter, wherein the blood hath degenerated, shall be exhausted. But if it happen at any time, as assuredly it sometimes doth, that notwithstanding the Art and care of the Physitian, the wound degenerates into a Fistula, then the former evil is become much worse. For Fistula's of the Chest, are scarse cured at any time, and that for divers causes. The first is, for that the muscles of the Chest are in perpetual motion; Another is, because they on the contrary inside are covered only with the mem∣brane investing the ribs, which is without blood. The third is, for that the wound hath no stay, by means whereof it may be compressed, sowed, and bound, whereby the lips being joined together, the wound may at length be replenished with flesh and cicatrized.

But the reason why wounds of the Chest do every day heap up and pour forth so great a quan∣tity of matter, seems to be their vicinity to the heart, which being the fountain of blood, there is a perpetual efflux thereof from thence to the part affected. For this is Natures care in preserving the affected parts, that continually and aboundantly without measure or mean it sends all its sup∣plyes, that is, blood and spirits to their aid. Add hereto, that the affected parts by pain, heat, and continual motion of the Lungs and midriffe, draw and allure much blood to themselves. Such like blood defiled by the malignity and filth of the wound, is speedily corrupted: whence it is that from the perpetual afflux of blood, there is a continual efflux of matter or filth, which at the last brings a man to a consumption; because the ulcerated part like a ravenous wolf consumes more blood by the pain, heat and motion, than can be ministred thereto by the heart. Yet if there be any hope to cure and heal the Fistula, it shall be performed, (after the use of diet, and phlebotomy, according to the prescript of the Physitian) by a vulnerary potion, which you shall find described when we treat of the Caries or rottenness of the bones. Wherefore you shall make frequent injec∣tions therewith into the Fistula, adding and mixing with it syrup. de rosis siccis and mel rosarum. Neither do I, if the putrefaction be great, fear to mix therewith Aegyptiacum. But you must have a care to remember & observe the quantity of the injected liquor, that you may know whether it all come forth again after it hath performed its detergent office. For if any thereof remain be∣hind in the corners and crooked passages, it hurts the part, as corrupted with the contagion thereof.

[illustration]

The form of a Syringe fit to make injection, when a great quantity of liquor is to be injected into any part.

After the injected liquor is come forth, a pipe of gold, silver, or lead, shall be put into the fi∣stulous ulcer; and it must have many holes in it, that so the filth may pass forth at them; it must be fast tyed with strings, that it may not fall into the capacity of the Chest. A great Spunge steeped in Aqua-vitae, and wrung forth again, shall be laid hot to the end or orifice thereof, both to hinder the entrance of the air into the Fistulous ulcer, as also to draw forth the filth there by its gentle heat; the which thing the Patient shall much further, if often times both day and night he hold his breath, stopping his mouth and nose, and lying upon the diseased side, that so the Sanies may be the more forcibly evacuated; neither must we leave the putting in the pipe, before that this fistulous ulcer shall be almost dry, that is, whole; as when it yields little, or no matter at all, then it must be ci∣catrized. But if the orifice of this fistulous ulcer being in the upper part hinder the healing there∣of, then by a chirurgical Section, a passage shall be made in the bottom, as we said before in an Em∣pyema.

[illustration]

The delineation of the Pipes with their Strings and Spunges.

The Reader must note that the Pipes which are fit for this use, need not have so many holes as these here exprest; but only two or three in their ends: for the flesh growing and getting into the rest, makes them that they cannot be plucked forth without much pain.

A wound made in the Lungs admits cure, un∣less it be very large, if it it be without inflamma∣tion; if it be on the skirts of the Lungs, and not on their upper parts; if the Patient contain himself from coughing much, and contentious speaking, and great breathing: for the wound is inlarged by coughing, and thence also arises inflammati∣on; the Pus and Sanies whereof, whilst the lungs again endeavour to expel by coughing, by which means they are only able to expel that which is hurtful and troublesome to them, the ulcer is dilated, the inflammation augmented, the Patient wastes away, and the disease becomes incurable.

There have been many Eclegma's described by Physitians for to clense the ulcer; which when the Patient useth, he shall lye on his back, to keep them long in his mouth, so to relax the muscles of the Larinx; for thus the medicin will fall by little and little alongst the coats of the Weazon, for if it should fall down in great quantity, it would be in danger to cause coughing. Cows, Asses, or Goats-milk with a little Hony, lest they should corrupt in the Stomach, are very fit remedies for this purpose; but Womans milk exceeds the rest.

But Sugar of Roses is to be preferred before all other medicins, in the opinion of Avicen, for that it hath a detergent, and also an astrictive and strengthening faculty, than which nothing is more to be desired in curing of ulcers. When you shall think it time to agglutinate the clensed ulcer, you must command the Patient to use emplastick, austere, and astringent medicins, such as are Terra sigillata, bolus armenus, hypocystis, Plantain, Knot-grass, Sumach, Acacia, and the like, which the Patient shall use in his Broaths and Eclegma's, mixing therewith Hony of Roses; which serving for a vehicle to the rest, may carry away the impacted filth which hinders agglutination. But see∣ing an hective Feaver easily follows upon these kinds of wounds, and also upon the affects of the Chest and Lungs, it will not be amiss to set down somewhat concerning the cure thereof, that so the Chirurgeon may know to administer some help to his Patient, whilst a Physitian is sent for, to overcome this disease with more powerful and certain remedies.

CHAP. XXXII. Of the differences, causes, signs, and cure, of an Hective Feaver.

A Hective Feaver is so called, either for that it is stubborn and hard to cure and loose, as things which have contracted a habit; for Hexis in Greek signifies a habit; or else for that it seises upon the solid parts of our bodies called by the Greeks Hexeis; both which the Latin word Habitus doth signifie.

There are three kinds, or rather degrees of this Feaver. The first is when the hectick heat con∣sumes the humidity of the solid parts. The second is, when it feeds upon the fleshy substance. The third and uncurable is, when it destroys the solid parts themselves. For thus the flame of a Lamp first wastes the Oyl, then the proper moisture of the we••k. Which being done, there is no hope of lighting it again, what store of Oyl soever you pour upon it. This Feaver very seldom breeds of it self, but commonly follows after some other.

Wherefore the causes of a hective Feaver are, sharp and burning Feavers not well cured, espe∣cially if their heat were not repressed with cooling Epithems applyed to the Heart and Hypochon∣dria. If cold water was not fitly drunk. It may also succeed a Diary Feaver which hath been caused and begun by some long great and vehement grief or anger, or some too violent labour, which any of a slender and dry body hath performed in the hot Sun. It is also oft-times caused by an ulcer or inflammation of the Lungs, an Empyema of the Chest, by any great and long continuing

Phlegmon of the Liver, Stomach, Mesentery, Womb, Kidneyes, Bladder, of the Guts Jejunum and Colon, and also of the other Guts, if the Phlegmon succeed some long Diarrhoea, Lienteria, or Bloudy-flux, whence a consumption of the whole body, and at last a Hectick Feaver, the heat becoming more acrid, the moisture of the body being consumed.

This kind of feaver as it is most easily to be known, so is it most difficult to cure; the pulse in this feaver is hard, by reason of the dryness of the Artery which is a solid part; and it is weak by reason of the debility of the vital faculty, the substance of the heart being assaulted. But it is little and frequent because of the distemper and heat of the heart, which for that it cannot by reason of its weakness cause a great pulse to cool it self, it labours by the oftenness to supply that defect.

But for the pulse, it is a proper sign of this feaver, that one or two hours after meat the pulse feels stronger than usual; and then also there is a more acrid heat over all the Patients body. The heat of this flame lasts until the nourishment be distributed over all the Patients body; in which time the dryness of the heart in some sort tempered and recreated by the appulse of moist nourishment, the heat increases no otherwise than Lime which a little before seemed cold to the touch, but sprinkled and moistned with water grows so hot, as it smoaks and boyls up. At other times, there is a perpetual equality of heat and pulse in smalness, faintness, obscurity, frequency, and hardness, without any exacerbation, so that the patient cannot think himself to have a feaver, yea, he cannot complain of any thing, he feels no pain, which is another proper sign of an hectick feaver. The cause that the heat doth not shew its self is, it doth not possess the surface of the body, that is, the spirits and humors, but lyes as buried in the earthy grosness of the solid parts. Yet if you hold your hand somewhat long, you shall at last perceive the heat more acrid and biting, the way being opened thereto by the skin, rarified by the gentle touch of the warm and temperate hand. Wherefore if at any time in these kind of feavers the Patient feel any pain, and perceive himself troubled with an inequality and excess of heat, it is a sign that the hectick feaver is not simple, but conjoyned with a putrid feaver, which causeth such inequality, as the heat doth more or less seise upon matter subject to putrefaction; for a hectick feaver of it self is void of all equality, unless it proceed from some external cause, as from meat; Certainly if an Hippocratique face may be found in any disease, it may in this, by reason of the colliquation, or wasting away the triple substance. In the cure of this disease, you must diligently observe with what affects it is entangled, and whence it was caused. Wherefore first you must know, whether this feaver be a disease; or else a symptom. For if it be symptomatical, it cannot be cured, as long as the disease, the cause thereof, remains uncured; as if an ulcer of the guts occasioned by a Bloudy-flix shall have caused it, or else a fistulous ulcer in the Chest caused by some wound received on that part, it will never admit of cure, unless first the fistu∣lous or dysenterick ulcer shall be cured; because the disease feeds the symptoms, as the cause the effect. But if it be a simple and essential hectick feaver, for that it hath its essence consisting in an hot and dry distemper, which is not fixed in the humors, but in the solid parts, all the counsel of the Physitian must be to renew the body, but not to purge it; for only the humors require purging, and not the defaults of the solid parts. Therefore the solid parts must be refrigerated and hu∣mected; which we may do by medicins taken inwardly and applyed outwardly.

The things which may with good success be taken inwardly into the body for this purpose, are medicinal nourishments. For hence we shall find more certain and manifest good, than from alter∣ing medicines, that is, wholly refrigerating and humecting without any manner of nourishment.

For by reason of that portion fit for nutriment which is therewith mixed they are drawn and caryed more powerfully to the parts, and also converted into their substance: whereby it comes to pass that they do not humect and cool them lightly and superficially, like the medicines which have only power to alter and change the body, but they carry their qualities more throughly even into the innermost substance. Of these things some are Herbs, as Violets, Purslain, Bugloss, Endive, Ducks-meat, or Water-lentil, Mallows, especially when the belly shall be bound. Some are fruits, as Gourds, Cowcumbers, Apples, Prunes, Raisons, sweet Almonds, and fresh or new Pine-Apple kernels; in the number of seeds are the four greater and lesser cold seeds, and these new, for their native humidity, the seeds of Poppies, Berberies, Quinces. The flowers of Bugloss, Violets, Wa∣ter-lillies, are also convenient; of all these things let Broth be made with a Chicken, to be taken in the morning for eight or nine days, after the first concoction.

For meats; in the beginning of the disease, when the faculties are not too much debilitated, he shall use such as nourish much and long, though of hard digestion; such as the extream parts of beasts, as the feet of Calves, Hogs-feet not salted, the flesh of a Tortois, which hath lived so long in a garden, as may suffice to digest the excrementitious humidity; the flesh of white Snails, and such as have been gathered in a vineyard, of frogs, river-Crabs, Eels taken in clear water, and well cook∣ed, hard Eggs eaten with the juyce of Sorrel without spices; Whitings, and Stockfish. For all such things because they have a tough and glutinous juyce, are easily put and glutinated to the parts of our body, neither are they so easily dissipated by the feaverish heat. But when the paient languish∣eth of a long hectick, he must feed upon meats of easie digestion, & these boyled rather than roast∣ed; for boyled meats humect more, and roasted more easily turn into choler. Wherefore he may use to eat veal, kid, capon, pullet, boiled with refrigerating and humecting herbs; he may also use barly-creams, almond-milks, as also bread crummed and moistned with rose-water, & boiled in a decocti∣on of the four cold seeds with sugar of roses; for such a Panada cools the liver, and the habit of the whole body, and nourisheth withal. The testicles, wings, and livers of young Cocks, as also figs and raisons. But if the Patient at length begin to loath & grow weary of boiled meats, then let him use

roast, but so that he cut away the burnt and dryed part thereof, and feed only on the inner parr thereof, and that moistned in Rose-water, the juyce of Citrons, Oranges or Pomegranates. Let him abstain from salt and dry fishes, and chuse such fishes as live in stony-waters, for the exercise they are forc'd to undergo in shunning the rocks beaten upon by the waves. Asses milk newly milked and seasoned with a little salt, sugar, honey, or fennel, that it may not corrupt, nor grow sowre in the stomach; or womans milk sucked from the dug by the Patient, to the quantity of half a pint, is much commended; verily womans milk is the more wholsome, as that which is more sweet and fa∣miliar to our substance, if so be that the nurse be of a good temper and habit of body. For so it is very good against the gnawings of the stomach, and ulcers of the lungs, from whence a Consumpti∣on often proceeds. Let your milch Ass be fed with barly, oats, oak-leaves; but if the Patient chance to be troubled with the flux of the belly, you shall make the milk somewhat astringent by gently boyling it, and quenching therein pebble-stones heated red hot. But for that all natures cannot a∣way with Asses-milk, such shall abstain from it, as it makes to have acrid belchings, difficulty of breathing, a heat and rumbling in the Hypochondria, and pain of the head. Let the Patient temper his Wine with a little of the waters of Lettuce, Purslain, and water-Lillies, but with much Bugloss-water, both for that it moistens very much, as also for that it hath a specifick power to recreate the heart, whose solid substance in this kind of disease is grievously afflicted. And thus much of things to be taken inwardly.

These things which are to be outwardly applyed, are inunctuous baths, epithems, clysters. In∣unctions are divers, according to the various indications of the parts whereto they are applyed. For Galen anoints all the spine with cooling and moderate astringent things, as which may suffice to strengthen the parts and hinder their wasting, and not let the transpiration; for if it should be let∣ted, the heat would become more acrid by suppressing the vapours. Oyl of roses, water-lillies, quin∣ces, the mucilages of Gum-tragacanth and Arabick extracted into water of Night-shade, with some small quantity of camphire, and a little wax if need require: but on the contrary, the parts of the breast must be anointed with refrigerating and relaxing things; by refrigerating, I mean, things which moderately cool, for cold is hurtful to the breast. But astringent things would hinder the motions of the muscles of the chest, and cause a difficulty of breathing. Such inunctions may be made of oyl of violets, willows, of the seeds of lettuce, poppies, water-lillies, mixing with them the oyl of sweet almonds to temper the astriction which they may have by their coldness. But you must have great care that the Apothecary for covetousness in stead of these oyls newly made give you not old, rancid and salted oyls, for so in stead of refrigerating, you shall heat the part; for wine, honey, and oyl, acquire more heat by age; in defect of convenient oyls, we may use butter well washed in violet and nightshade water. The use of such inunctions, is too cool, humect, and comfort the parts whereto they are used; they must be used evening & morning, chiefly after a bath.

Now for Baths, we prescribe them either only to moisten, and then plain warm water wherein the flowers of violets and water-lillies, willow-leaves and barly have been boyled, will be sufficient; or else not only to moisten, but also to acquire them a fairer and fuller habit, and then you may add to your bath the decoction of a Sheeps-head and Gather, with some Butter. But the Patient shall not enter into the bath fasting, but after the first concoction of the stomach, that so the nourishment may be drawn by the warmness of the bath into the whole habit of the body. For otherwise he which is sick of a consumption, and shall enter the bath with his stomack empty, shall suffer a great∣er dissipation of the triple substance, by the heat of the bath, than his strength is well able to en∣dure. Wherefore it is fit thus to prepare the body, before you put it into the bath. The day before in the morning let him take an emollient clyster, to evacuate the excrements baked in the guts by the hectick dryness; then let him eat to his dinner some solid meats about nine of the clock; and let him about four of the clock eat somewhat sparingly, meats of easie digestion to his supper. A little after midnight let him sup off some chicken-broth, or barly-cream, or else two rear egs tempered with some rose-water and sugar of roses instead of salt. Some 4 or 5 hours after, let him enter into the bath; those things which I have set down, being observed. When he comes out of the bath, let him be dryed and gently rubbed, with soft linnen cloaths, and anointed, as I formerly prescribed, then let him sleep, if he can, for two or three hours in his bed: when he wakes, let him take some Pti∣san or some such like thing, and then repeat his bath after the foresaid manner. He shal use this bath thrice in ten days. But if the Patient be subject to crudities of the stomach, so that he cannot sit in the bath without fear of swooning, and such symptoms, his stomach must be strengthened with oyl of quinces, wormwood and mastich, or else with a crust of bread toasted, and steeped in muskadine, and strewed over with the powders of roses, sanders, and so laid to the stomach, or behind neer to ••e 13. verte••ra of the back, under which place, Anatomy teaches, that the mouth of the stomach lies. Epithems shall be applyed to the liver and heart, to temper the too acrid heat of these parts, and correct the immoderate dryness by their moderate humidity. Now they shal be made of refri∣gerating and humecting things, but chiefly humecting; for too great coldness would hinder the pe∣netration of the humidity into the part lying within. The waters of bugloss, and violets, of each a quartern with a little white wine, is convenient for this purpose. But that which is made of French barly, the seeds of gourds, pompious, or cowcumbers of each three drams in the decoction, & mixed with much tempering with oyl of Violets, or of sweet Almonds, is most excellent of all other. Let cloaths be dipped and steeped in such epithems, and laid upon the part and renewed as oft as they become hot by the heat of the part. And because in hectick bodies, by reason of the weakness of the digestive faculty, many excrements are usually heaped up, and dryed in the guts, it will be conve∣nient,

all the time of the disease to use frequently clysters made of the decoction of cooling and humecting herbs, flowers, and seeds, wherein you shall dissolve Cassia, with Sugar and Oyl of Vio∣lets, or Water-lillies. But because there often happen very dangerous fluxes in a confirmed hectick Feaver, which shew the decay of all the faculties of the body, and wasting of the corporeal sub∣stance, you shall resist them with refrigerating and assisting medicins; and meats of grosser nou∣rishment, as Rice, and Cicers; and application of astringent and strengthening remedies; and using the decoction of Oats, or parched Barly for drink. Let the Patient be kept quiet and sleeping as much as may be, especially if he be a child. For this Feaver frequently invades children, by anger, great and long fear, or the too hot milk of the nurse, over-heating in the Sun, the use of wine and o∣ther such like causes; they shall be kept in a hot and moist air, have another Nurse, and be anointed with oyl of violets; to conclude, you shal apply medicins which are contrary to the morbifick cause.

CHAP. XXXIII. Of the Wounds of the Epigastrium and of the whole lower Belly.

THe wounds of the lower Belly are sometimes before, sometimes behind, some only touch the surface thereof, others enter in; some pass quite through the body, so that they often leave the weapon therein; some happen without hurting the contained parts; others grievously offend these parts, the Liver, Spleen, Stomach, Guts, Kidneys, Womb, Bladder, Ure∣ters, and great Vessels, so that oft-times a great portion of the Kall, falls forth. We know the Li∣ver is wounded, when a great quantity of bloud comes forth of the wound, when a pricking pain reaches even to the Sword-like gristle, to which the Liver adheres. Oft-times more choler is cast up by vomit, and the Patient lyes on his Belly with more ease and content.

When the Stomach or any of the small Guts are wounded, the meat and drink break out at the wound, the Ilia or flanks swell and become hard, the Hicket troubles the Patient, and oft-times he casts up more choler, and grievous pain wrings his Belly, and he is taken with cold sweats, and his extream parts wax cold.

If any of the greater Guts shall be hurt, the excrements come forth at the wound: When the Spleen is wounded, there flows out thick and black bloud, the Patient is oppressed with thirst, and there are also the other signs, which we said use to accompany the wounded Liver. A difficulty of making water, troubles the Patient whose reins are wounded, bloud is pissed forth with the Urin, and he hath a pain stretched to his groins and the regions of the Bladder and Testicles.

The Bladder or Ureters being wounded, the flanks are pained, and there is a Tension of the Pecten, or Share; Bloud is made instead of Urin, or else the Urin is very bloudy, which also divers times comes forth at the wound. When the Womb is wounded, the Bloud breaks forth by the Pri∣vities, and the symptoms are like those of the Bladder.

The wounds of the Liver are deadly, for this part is the work-house of the bloud, wherefore necessary for life; besides by wounds of the Liver the branches of the Gate or Hollow-veins are cut, whence ensues a great flux of bloud not only inwardly, but also outwardly, and consequently a dissipation of the spirits and strength.

But the bloud which is shed inwardly amongst the Bowels putrefies and corrupts, whence fol∣lows pain, a feaver, inflammation, and lastly death. Yet Paulus Aegineta writes, that the lobe of the Liver may be cut away without necessary consequence of death. Also the wounds of the Ventricle and of the small Guts, but chiefly of the Jejunum, are deadly; for many vessels run to the Jejunum, or empty Gut, and it is of a very nervous and slender substance, and besides, it receives the chole∣rick humor from the Bladder of the Gall. So also the wounds of the Spleen, Kidneys, Ureters, Bladder, Womb and Gall, are commonly deadly, but alwayes ill, for that the actions of such parts are necessary for life; besides, divers of these are without bloud and nervous, others of them re∣ceive the moist excrements of the whole body, and lye in the innermost part of the body, so that they do not easily admit of medicins. Furthermore, all wounds which penetrate into the capacity of the Belly, are judged very dangerous, though they do not touch the contained Bowels: for the encompassing, and new air entring in amongst the Bowels, greatly hurts them, as never used to the feeling thereof; add hereto the dissipation of the spirits which much weakens the strength. Neither can the filth of such wounds be wasted away according to the mind of the Chirurgeon, where∣by it happens, they divers times turn into Fistula's, as we said of wounds of the Chest, and so at length by collection of matter cause death. Yet I have dressed many, who by Gods assistance and favour have recovered of wounds passing quite through their bodies.

I can bring as a witness the Steward of the Portingal Embassadour, whom I cured, at Melun, of a wound made with a Sword so running through the body, that a great quantity of excrements came forth of the wounded Guts, as he was a dressing, yet he recovered.

Not long ago Giles le Maistre, a Gentleman of Paris was run quite through the body with a Ra∣pier, so that he voided much bloud at his mouth and fundament divers dayes together, whereby you know the Guts were wounded; and yet he was healed in twenty days. In like sort the wounds of the greater vessels are mortal, by reason of the great effusion of bloud and spirits which ensues thereupon.

CHAP. XXXIV. The cure of wounds of the lower Belly.

THe first cogitation in curing of these wounds ought to be, Whether they pierce into the capacity of the Belly; for those which pass no further than the Peritonaeum shall be cured like simple wounds which only require union. But those which enter into the capacity must be cured after another manner. For oft-times the Kall, or Guts, or both, fall forth at them.

A Gut which is wounded must be sowed up with such a seam as Furriers or Glovers use, as we formerly told you; and then you must put upon it a powder made of Mastich, Myrrh, Aloes and Bole. Being sowed up, it must not be put up boysterously together and at once into its place, but by little and little, the Patient lying on the side opposite to the wound. As for example, the right side of the Guts being wounded and falling out by the wound, the Patient shall lye on his left side, for the more easie restoring of the faln-down Gut, and so on the contrary. If the lower part of the Guts being wounded slide through the wound, then the Patient shall lye with his head low down, and his buttocks raised up by putting a pillow under them; If the upper part be hurt, then must he lye quite contrary, that the Guts falling downwards, by such a site, may give way to those which are faln out through the wound. But often in this case, the Guts having taken cold by the encompassing air, swell up and are distended with wind, the which you must discuss before you put them into their place, with a fomentation of the decoction of Camomil, Mellilot, Aniseeds, and Fennel, applyed with a Spunge, or contained in a Bladder; or else with Chickens, or Whelps cut alive in the midst and laid upon the swelling; for thus, they do not only discuss the flatulency, but also comfort the afflicted part. But if the inflation cannot thus be discussed, the wound shall be dilated, that so the Guts may return the more freely to their place.

If the Kall shall fall out, it must be speedily restored to its place, for it is very subject to putre∣fie; for the fat, whereof for the most part it consists, being exposed to the air, easily loses its na∣tive heat, which is small and weak, whence a mortification ensues. Hence is that of Hippocrates; If the Kall fall out, it necessarily putrefies. The Chirurgeon shall know whether it putrefie, or not, by the blackness and the coldness you may perceive by touching it; neither must you when it pu∣trefies presently restore it to its place, for so the contagion of the putrefaction would spread to the rest of the parts: but whatsoever thereof is putrefied shall be twitched and bound hard with a string; and so cut off, and the rest restored to his proper place; but it's good after cutting of it away to leave the string still hanging thereat, that so you may pluck and draw forth whatsoever thereof may by being too strait bound fall away into the capacity of the belly. Some think it to be better to let the Kall thus bound to hang forth until that portion thereof which is putrefied fall away of it self, and not to cut it off. But they are much deceived: for it hanging thus would not cover the Guts, which is the proper place. The Guts and Kall being put up, if the wound be great and worth speaking of, it must be sowed with that suture which is termed Gastroraphia; but this kind of suture is thus made. The Needle at the first putting in must only take hold of the Peritona∣um, and then on the opposite side only of the flesh, letting the Peritonaeum alone, and so go along put∣ting the Needle from without inwards, and from within outwards, but so that you only take the musculous flesh and skin over it, and then only the Peritonaeum, until you have sowed up all the wound. He which doth otherwise shall undergo this danger, that whereas the coat Peritonaeum is of it self without bloud, it being divided, or wounded, cannot of it self be united to it self, therefore it requires an intercourse of flesh: otherwise unless it be thus united by the benefit of the flesh in∣termixed therewith, there would remain an uncurable tumor after the wound is cicatrized on the outside. But that which we said before, according to Galen's mind, that al the wounds must be sowed, it is not so to be taken, as if that the wound must be sowed up to the very end; for in the lower part of the wound there must be left a certain small vent by which the quitture may pass forth, which being wholly cleansed and exhausted, the wound must be quite healed up. But the wounds which shall penetrate into the substance of the liver, spleen, ventricles, and other bowels, the Chirur∣geon shall not suffer them to be without medicines, as if they were desperate, but he shall spare neither labour nor care to dress them diligently. For doubtful hope is better than certain despair. The bladder, womb, and right gut being wounded, detergent and agglutinative injections shall be put up by their proper passages. I have read nothing as yet in any Author of the wounds of the fat, for all of them refer the cure thereof to the wounds of the Muscles. Yet I will say this by the way, that wounds of the fat, how deep soever they be, if they be only simple, may be dressed with∣out putting in of any Tent, but only dropping in some of my Balsam, and then saying upon it a plai∣ster of Gratia Dei, or some such like; for so they will heal in a short time.

CHAP. XXXV. Of the Wounds of the Groins, Yard, and Testicles.

WHen the Groins and neighbouring parts are wounded, we must first consider whether they pierce to within: and if they do penetrate, to what inward parts they come, whe∣ther to the bladder, the womb, or right gut: for these parts are such neer neighbours that oft-times they are all wounded with one blow. But for the wounds of the Testicles, and genital part, because they are necessary instruments for the preserving the species by generation of a suc∣cession

of Individuals, and to keep all things quiet at home, therefore the Chirurgeon ought to be very diligent and careful for their preservation. Wherefore if they should chance at any time to be wounded, they shall be dressed, as we have formerly delivered, the medicines being varyed ac∣cording to the state of the wound, and the appearing and happening symptoms; for it would be a thing of immense labour to handle all things in particular.

CHAP. XXXVI. Of the Wounds of the Thighs and Legs.

WOunds which have been received on the inside of the Thighs, have often caused sodain death, if they have come to the vein Saphena, or the great Artery, or the Nerves, the associates of these vessels. But when they are simple, there is nothing which may alter the usual manner of cure. Yet the Patient must be careful to lye in his bed: for the vulgar Italian Proverb is true: La mano al petto, la gamba al letto, [that is, The hand on the breast, and the leg on the bed.] But when they penetrate more deeply into the substance of the part, they bring horrid and fearful symptoms, as an inflammation, an abscess, from whence oft-times such aboundance of matter issues forth, that the Patient fals into an Atrophia and consumption. Wherefore such wounds and ulcers require a careful and industrious Chirurgeon, who may fitly make Incisions necessary for the corrupt parts, and callosity of the fistulous ulcer. Some Chirurgeons have been so bold as to sow together the end of the Tendons of the Ham, and of other joynts, when they have been quite cut asunder. But I durst never attempt it for fear of pain, convulsions, and the like horrid symptoms. For the wounds of that large Tendon which is composed in the calf of the Leg by the concourse of three muscles, and goes to the heel, I have observed that when it hath been cut with the Sword, that the wounds have been long and hard to cure; and besides, when at the last they have been healed, as soon as the Patient hath got out of his bed, and indeavoured to go, they have grown ill and broke open again. Wherefore in such like wounds let the Patient have a care, that he begin not to go, or too boldly to use his hurt leg before it be perfectly cicatrized, and the scar grown hard. Therefore that the Patient may be in more safety, I judge it altogether necessary, that he use to go with Crutches for a good while after the wound is perfectly healed up.

CHAP. XXXVII. Of the Wounds of the Nerves and nervous parts.

THe continuity of the nervous parts is divers ways loosed by the violent incursion of ex∣ternal things; as by things which contuse, batter, and grind in sunder, as by the blow of a stone, cudgel, hammer, lance, bullet out of a Gun, or Cross-bow; by the biting of greater teeth; or the pricking of some sharp thing, as a Needle, Bodkin, Pen-knife, Arrow, Splinter; or the puncture of some venemous thing, as of a Sea-Dragon; or the edg of some cutting thing, as a Sword or Rapier; or of stretching things which violently tear asunder the nervous bodies. Hence therefore it is, that of such wounds some are simple, others compound; and the compound, some more compound than other. For of these some are superficiary and short, others deep and long, some run alongst the nervous body, others run broad-ways; some cut the part quite asunder, others only a portion thereof. The symptoms which follow upon such wounds are, vehement pain, and defluxion, inflammation, abscess, feaver, delirium, swooning, convulsion, gangrene, sphacel; whence often death insues by reason of that sympathy, which all the nervous parts have with the brain. Amongst all the wounds of the nervous parts, there is none more to be feared then a pun∣cture, or prick, nor any which causeth more cruel and dangerous symptoms. For by reason of the straitness of the wound, medicines can neither be put in, nor the sanious matter pass forth; now the sanious matter by long stay acquires virulency, whereby the nervous parts are tainted and swoln, suffer pain, inflammation, convulsions, and infinite other symptoms; of these the wounds are most dangerous, by which the nervous and membranous bodies are but half cut asunder. For, the portion thereof which remains whole, by its drawing and contracting it self towards the ori∣ginal, causeth great pain and convulsion by sympathy. The truth hereof is evident in wounds of the head, as when the Pericranium is half cut, or when it is cut to apply a trepan. For the cutting there∣of infers far greater pain, than when it is cut quite asunder. Wherefore it is safer to have the ner∣vous body quite cut off, for so it hath no community, nor consent with the upper parts, neither doth it labour, or strive, to resist the contraction of its self; now this contrariety, and as it were fight, is the cause of pain; yet there arises another misery from such a wound, for the part where∣into the nerve which is thus cut insunder passes, thence forwards loseth its action.

CHAP. XXXVIII. Of the cure of Wounds of the Nervous parts.

IT is the ancient doctrine of the antient Physitians, that the wounds of the nervous parts should not presently be agglutinated (which notwithstanding the general and first indication usually

taken from the solution of continuity requires,) but rather, chiefly if they be too strait, that the punctures should be dilated, by cutting the parts which are above them, and let them be kept long open that the filth may pass freely forth, and the medicine enter well in. Yet I in many cures have not followed this counsel, but rather that which the common indication requires.

That cure is in fresh memory which I performed upon Monsieur le Co••q, a Proctor of the spiri∣tual Court, who dwelt in our Ladies-street; he gathering and binding up some loose Papers, run a Penknife which was hid amongst them, through his hand. Also one of his neighbours who went to spit a piece of Bief, thrust the spit through the midst of his hand; But I presently agglutinated both their wounds, without any danger, dropping presently in at the first dressing a little of my Balsom warm, and putting about it a repelling and astringent medicine, and by this means they were both of them healed in a short time, no symptom thereupon happening. Yet I would not have the young Chirurgeon to run this hazard: for first, he must be well practised and accustomed to know the tempers and habit of men, for this manner of curing would not do well in a plethorick body, or in a body replete with ill humors, or indued with exquisite sense. Therefore in such a case it will be safer to follow the course here set down. For wounds of the nerves do not only differ from other wounds, but also among themselves in manner of curing. For although all medicines which draw from far, and waste sanious humors, may be reputed good for the wounds of the nerves; yet those which must be applyed to punctures, and to those nerves which are not wholly laid open, ought to be far more powerful, sharp and drying; yet so that they be not without biting, that so penetrating more deep they may draw forth the matter, or else consume and discuss that which either lies about the nerves, or moistens their substance. On the contrary, when the sinews are bared from flesh and adjoyning particles, they stand in need but of medicines, which may only dry. Here you may furnish your selves with sufficient store of medicines good for the nerves how∣soever pricked. As ℞ Terebinth. vin. & olei veteris an. ℥ j. aquae. vitae parum. Or ℞ olei Terebinth. ℥j. aqua vitae ʒ j. cuphor. ʒ ss. Or ℞ radices Dracontiae, Brioniae, Valerianae & Gentianae exsiccatas, & in pulverem redactas, misce cum decocto centaurii, aut oleo, aut exungia veteri; drop hereof warm into the wound as much as shall suffice. Or else put some Hogs, Goose, Capons, or Bears-grease, old Oyl, Oyl of Lillies, or the like, to Gall anum, pure Rozin, opopanax dissolved in Aqua-vitae and strong Vinegar. Or ℞ olei hypericonis sam••uti, & de cuphor••io an. ℥ j. su••phuris vivi subtiliter pulverisati ℥ ss, gummi ammoni. bdellii an. ʒ ij. aceti boni ℥ ij. vermium terrest. praeparat. ℥ j. bulliant omnia simul ad consumptionem aceti. Let as much hereof as shall suffice be dropped into the wound; then ap∣ply this following Cerate, which draws very powerfully. ℞ olei supra-scripti ℥ j. Terebinth. venet. ℥ ss, diachylonis albi cum gummi, ʒ x. ammoniac. ••dellii in aceto dissoluterum, an. ʒ ij. resin. pini gum. clemi, picis navalis an. ʒ v. cerae quod sufficit, fiat ceratum satis molle. We must use some whiles one, some whiles another of these medicines in punctures of the Nerves with choice and judgment, ac∣cording to their conditions, manner, depth, and the temperaments and habits of the wounded bo∣dies. But if the pain yield not to such remedies, but rather increase, with the inflammation of the affected part, a swelling of the lips of the wound, and sweating forth of a serous, thin and virulent matter or filth, then you shall pour into it scalding Oyl, and shall touch three or four times not only the surface of the wound, but the bottom thereof with a rag dipped therein and tyed to the end of a Spatula. For this will take away the sense from the Nerve, Tendon, or Membrane, like as if they were burnt with a cautery, and so the pain will be eased. So in the most grievous pains of rotten teeth, the thrusting of an hot iron into their roots, or stopping them with Cotton dipped in Oyl of Vitriol, or Aqua-vitae, gives most certain ease; for by burning the Nerve which is in∣serted into their roots, the sense, and so, consequently, the pain is taken away. So also in malignant, gnawing, eating, and spreading ulcers, which are alwayes associated with much pain, the pain ceases by applying an Escharotick, the powder of Alum, or Mercury, or Aegyptiacum made some∣what more strong than usual. That the young Chirurgeon may be more ready for this practise and the use of the former medicines, I have thought good to insert the following History, both for the lateness of the thing and the pleasing memory of the most laudable Prince.

Charles the ninth, the French King, being sick of a Feaver, Monsieur Chapellan and Castellan his Physitians thought it fit he should be let bloud; for the performance whereof, there was called a Chirurgeon wondrous famous for that business; but when as he by chance had pricked a nerve in stead of a vein, the King cryed out, that he felt a mighty pain in that place. Then I bid, that the ligature should straight-wayes be loosed, otherwise the arm would presently be much swel∣led. But he going slowly about it, behold the arm began to swell with such contraction, that he could not bend it, nor put it forth, and cruel pain molested not only the pricked particle, but all the whole member besides. I forthwith laid upon the wound a plaister of Basilicon, to hinder the agglutination thereof, and then I wrapped all the arm in a double linnen cloth dipped in Oxy∣crate, putting upon it an expulsive ligature, which beginning at the wrist, and ending at the top of the shoulder, might keep the bloud and spirits from fear of defluxion and inflammation. This being thus performed, we went aside to consult what was necessary to be done, both to asswage the pain, as also to divert the other symptoms, which usually happen upon punctures of the nerves. I being desired, thus delivered my opinion, that in my mind, there were nothing better, then pre∣sently to drop into the wound some Oyl of Turpentine warmed and mixed with a little Aqua-vitae. And then all the arm should be covered with a plaister of Diacalcitheos dissolved in Vinegar and Oyl of Roses, bound over and besides with the expulsive ligature, which we formerly mentioned. For the Oyl and Aqua-vitae have a faculty to penetrate into the bottom of the wound, and to ex∣haust

and dry up the serous and virulent humor, which sweats from the substance of the pricked nerve; and also to mitigate the pain by its actual heat. Furthermore emplaister Diacalcitheos hath a faculty to dissolve the humor which hath already fallen down into the arm, and to hinder the entrance and defluxion of any new matter. And the ligature is such as by its moderate astriction would serve to strengthen the muscles, and to press out and repel the humors which were fallen down into the upper part, and to prohibit that which is ready to fall down. Mine advice being approved of the Physitians both in word and deed, the pain was mitigated. But the humor stayed in the part, for the dissolving and drying whereof, this following remedy was used. ℞ far. hordei & crobi an. ʒ ij. flor. chamaem. & melilot. an. p. ij. butyr. recentis siue sale ℥ i ss. lixivii ••arbitonsoris quod sufficit, fiat cataplasma ad formam pultis. By these remedies the King at last after three months space was perfectly healed, so that there remained no sign of the depraved action in the part. But if at any time there shall be so great contumacy, that it will not yield to these means, but that there is imminent danger of a convulsion; it will be better to cut it in sunder whether Nerve, Tendon, or Membrane, than to expose the Patient to the danger of a deadly convulsion; for thus indeed the peculiar action of that part will be lost, but the whole body preserved thereby; for so we had determined by common consent, that if the pain which afflicted the King would not yield to the prescribed remedies, either to pour in scalding Oyl, or else to cut the sinew quite asunder.

For the late and sad memory of Mistris Courtin dwelling in the street of Holy-Cross was in our minds, who of a vein not well opened in her arm fell into a Gangrene and total mortification of that whole part, of which she dyed, because she was not dressed with the formerly mentioned me∣dicines. Yet we must abstain from these two powerful remedies, when the pricked nerve shall lye bare, for else the pain would be increased, and more grievous symptoms follow. Wherefore as I formerly wished; more mild medicines must be applyed, which may dry up the serous humor without biting or acrimony, as ℞ Terebinth. venet. in aq. ros. lota ℥ ij. boli armeni subtiliter pulve∣risati, ʒ ij. incorporentur simul. Our Balsom also is excellent in this case, and this of Vigo's which follows. ℞ Olei rosar. emphacini ℥ j ss. olei de terebinth. ʒ iij. succi plantag. ℥ ss. semin. hypericonis aliquantulum contriti••m. ss. tutiae praepar. ʒ iij. calcis decies lotae cum aqua plantagin. ʒ ij. antimonii ʒ j. s••vi hircini, & vitulini, an. ℥ v. vermium terrestrium cum vino lotorum ℥jss. bulliant omnia simul dempta tutia in cyatho decoctionis hordei, ad consumptionem aquae & vini, colentur rursum{que} igni admoveantur, addendo tutiam, & fiat linimentum cum cera alba, & ℥ ss. croci. This liniment asswages pains, and covers the bared nerves with flesh. This cure of punctured nerves, may with choyce and judge∣ment, and observing the proportion of the parts be transferred to the pricked Tendons and mem∣branes. But take this as a general and common rule, that all nervous bodies howsoever hurt, are to be comforted by anointing them with hot Oyls, such as the Oyl of Bays, Lillies, of Worms, Sage, or some other such like remedy being applyed to their originals and more notable passages; as to the original of the spinal marrow, the armpits and groins. Neither do I think it fit in this place to omit an affect which sometimes happens to the large Tendon of the heel, of which we former∣ly made mention. For it oft-times is rent or torn by a small occasion without any sign of injury or solution of continuity apparent on the outside as by a little jump, the slipping aside of the foot, the too nimble getting on Horse-back, or the slipping of the foot out of the stirrop in mounting in∣to the saddle. When this chance happens, it will give a crack like Coach-mans whip; above the heel, where the tendon is broken, the depressed cavity may be felt with your finger, there is great pain in the part, and the party is not able to go. This mischance may be amended by long lying and resting in bed, and repelling medicines applyed to the part affected in the beginning of the disease, for fear of more grievous symptoms, and then applying the Black-plaister, or Diacal∣citheos, or some other such, as need shall require; neither must we hereupon promise to our selves, or the Patient, certain or absolute health. But, on the contrary, at the beginning of the disease we must foretel that it will never be so cured, but that some reliques may remain, as the depres∣sion of the part affected and depravation of the action and going; for the ends of this broken or relaxed Tendon by reason of its thickness and contumacy cannot easily be adjoyned, nor, be∣ing adjoyned, united.

CHAP. XXXIX. Of the Wounds of the Joynts.

BEcause the wounds of the Joynts have something proper and peculiar to themselves, besides the common nature of wounds of the Nerves, therefore I intend to treat of them in parti∣cular. Indeed they are alwayes very dangerous, and for the most part deadly by reason of the nervous productions and membranous Tendons wherewith they are bound and ingirt, and into which the Nerves are inserted: whereby it comes to pass, that the exquisite sense of such like parts will easily bring malign symptoms, especially if the wound possess an internal, or, as they term it, a domestique part of them; as for example, the arm-pits, the bending of the arm, the inner part of the wrist, and ham, by reason of the notable Veins, Arteries, and Nerves of these parts, the loosed continuity of all which brings a great flux of bloud, sharp pain, and other malignant symptoms; all which we must resist according to their nature and condition, as a flux of bloud with things staying bleeding, pain with anodynes. If the wound be large and wide, the severed parts shall be joyned with a suture, leaving an orifice in the lower part, by which the quitture may

pass forth. This following powder of Vigo's description must be strewed upon the Suture. ℞ thu∣ris, sang. draconis, boli armen. terrae sigill. an. ʒ ij. aloes, mastich. an. ʒ j. fiat pulvis subtilis. And then the joynt must be wrapped about with a repercussive medicine composed of the whites of Eggs, a little oil of Roses, Bole, Mastich, and Barly flowr. If it be needful to use a Tent, let it be short, and according to the wound thick, lest it cause pain, and moreover let it be anointed with the yolk of an egg, oil of Roses, washed turpentine and a little saffron. But if the wound be more short and narrow, it shall be dilated, if there be occasion, that so the humor may pass away more freely. You must rest the part, and beware of using cold, relaxing, mollifying, humecting, and unctuous medicines, unless peradventure the sharpness of the pain must be mitigated. For on the contrary, astringent and desiccant medicines are good, as this following cataplasm. ℞. furfur. macri, farin. hordei, & fabarum. an. ℥ iiij. florum chamae. & melil. an. m. ss. terebinth. ℥ iij. mellis communis ℥ ij. ol. myrt. ℥ j. oxymelitis, vel oxycrat. vel lixivii com. quantum sufficit; fiat cataplasma ad formam pul∣tis. Or you may compose one of the Lees of wine, Wheat bran, the powder of Oaken bark, cy∣press nuts, galls and Turpentine, and such like, that have an astringent, strengthening, and drying quality, and thereby asswaging pain, and hindering the defluxion of humors. This following me∣dicine is astringent and agglutinative. ℞ terebinth, venet. ℥ ij. aq. vitae parum, pulv••ris mastich, aloes, myrrhae, b••li armen. an. ℈ ij. And also our balsam will be good in this case, if so be that you add hereto so much powder which dryes without acrimony, as occasion shall serve: I admonished you before to take heed of cold, and now again; for it is hurtful to all wounds and ulcers, but espe∣cially to these of the nervous parts: hence it is that many dye of small wounds in the winter, who might recover of the same wounds though greater in the Summer. For cold according to Hippo∣crates is nipping to ulcers, hardens the skin, and hinders them from suppuration, extinguisheth natural heat, causes blackness, cold aguish fits, convulsions, and distentions. Now divers excre∣ments are cast forth of wounds of the joynts, but chiefly albugineous, that is, resembling the white of an egg, and mucous, and sometimes a very thin water, all which savour of the nature of that hu∣mor which nourisheth these parts. For to every part there is appropriate for his nourishment and conservation, a peculiar balsam, which by the wound flows out of the same part; as out of the branches of the vine, when they are pruned, their radical moisture or juyce flows, whence also a Callus proceeds in broken bones. Now this same mucous, and albugineous humor, slow and as it were frozen, flowing from the wounded joynts, shews the cold distemper of the parts, which cause pain, not to be orecome by medicins only potentially hot. Wherefore to correct that, we must apply things actually hot, as beasts and swines bladder half full of a discussing decoction, or hot bricks quenched in Wines. Such actual heat helps nature to concoct and discuss the superfluous humor impact in the joynts, and strengthens them; both which are very necessary, because the natural heat of the joynts is so infirm that it can scarse actuate the medicin unless it be helped with medicins actually hot. Neither must the Chirurgeon have the least care of the figure and posture of the part, for a vicious posture increases ill symptoms, uses to bring to the very part though the wound be cured, distortion, numness, incurable contraction; which fault lest he should run in∣to, let him observe what I shall now say; If the forepart of the shoulder be wounded, a great boul∣ster must be under the arm-pit, and you must carry your arm in a scarf, so that it may bear up the lower part of the arm, that so the top of the shoulder may be elevated somewhat higher, and that so it may be thereby more speedily and happily agglutinated and consolidated. If the lower part be wounded, when flesh begins to be generated and the lips of the wound to meet, you must bid the Patient to move and stir his armes divers wayes ever and anon, for if that be omitted or negligently done, when it is cicatrized, then it will be more stiffe and less pliable to every motion; and yet there is a further danger lest the arm should totally lose its motion. If the wound be upon the joynt of the elbow, the arm shall be placed and swathed in a middle posture, that is, which neither too straitly bows it, nor holds it too stiffly out; for otherwise, when it is cicatrized, there will be an impediment either in the contraction or extention. When the wound is in the wrist, or joints of the fingers either externally or internally, the hand must be kept half-shut, con∣tinually moving a ball therein. For if the fingers be held straight stretched forth, after it is cica∣trized, they will be unapt to take up or hold any thing, which is their proper faculty. But if after it is healed, it remain half-shut, no great inconveniency will follow thereon: for so he may use his hand divers wayes to his sword, pike, bridle, and in any thing else. If the joints of the Hip be wounded, you must so place the Patient that the thigh-bone may be kept in the cavity of the huck∣lebone, and may not part a hairs breadth there-from, which shall be done with linnen boulsters and ligatures applyed as is fitting, and lying full upon his back. When the wound shall begin to cicatrize, the Patient shall use to move his thigh every way, lest the head of the thigh-bone stick in the cavity of the huckle-bone without motion. In a wound of the knee, the leg must be placed straight out, if the Patient desire not to be lame. When the joints of the feet and toes are wounded, these parts shall neither be bended in nor out, for otherwise he will not be able to go. To con∣clude, the site of the foot and leg, is quite contrary to that of the arm and hand.

CHAP. XL. Of the Wounds of the Ligaments.

THe wounds of the Ligaments, besides the common manner of curing those of the Nervs, have nothing peculiar, but that they require more powerful medicins, for their agglutination, de∣ficcation and consolidating; both because the Ligamental parts are harder, and dryer, and also for that they are void of sense. Therefore the foresaid cure of Nerves, and Joints, may be used for these wounds: for the Medicins in both are of the same kind; but here they ought to be stronger and more powerfully drying. The Theory and cure of all the symptoms which shall happen thereupon, have been expressed in the Chapter of curing the Wounds of the nervous parts, so that here we shall need to speak nothing of them, for there you may find as much as you will. Wherefore here let us make an end of wounds, and give thanks to God the Author and giver of all good, for the happy process of our labours: and let us pray that that which remains may be brought to a happy end, and secure for the health and safety of good people.

The End of the Tenth Book.

Notes

• The differen∣ces of a broken Head.
• The kinds of a broken Skull out of Hippo∣crates.
• Differences from their quantity.

  Differences from their fi∣gure.

  From their complication.
• The external causes.
• Rational causes.
• Aphor. 50. sect. 6.
• Lib. 8. cap. 4.
• Hippocrates and Guidoes conjectural signs of a bro∣ken skull.
• Sensible signs of a broken skull before the dividing of the skin.
• Lib. de vulner. cap.
• What Probe must be used in searching for a fracture.
• Lib. 5. Epid. in Aa••onomus of Omilum Hippocrates was deceived by the sutures.
• Upon what oc∣casion the hairy scal•• must be c••••
• Celsus.
• Hippocrates.
• The manner how to pull the hairy scalp from the bro∣ken Skull.
• The manner to bind a vessel in case of too much bleed∣ing.
• A History.
• A way to find a fracture in the skull, when it pre∣sents not it self to the view at the first.
• A sign that both the Ta∣bles are bro∣ken.
• You may use the Trepan after the tenth day.
• It is sufficient in a simp••e fis∣sure to dilate it with your Scalpri only and not to Trepan it.
• What an Ec∣chymosis is.
• How a contu∣sion of the skull must be cured.
• Different cures of a depressed skull.
• What a Con∣sion is.
• What an Ef∣fracture is.
• The cause of Effractures.
• The cure.
• Hip. lib. de vuln. cap. Gal. lib 6. meth. cap. ult.
• A History.
• What a Seat is.
• The cure.
• Lib. 8. cap. 4.
• A History.
• What a Re∣sonitus is.
• Lib. 6. cap 90.
• In whom this fractur•• may take place in diver•• bones of the Skull.
• A History.
• The Resonitus may be in the same bone of the Skull.
• A History.
• Why Hippo∣crates set down no way to cure a Resoritus.
• The manner to know when the Skull is fractured by a Resonitus.
• Gal. lib. 2. de comp m dic. cap 6. & Com. ad Aph. 58. sect. 7.
• Lib. 5. Epidem.
• The vessels of the brain bro∣ken by the commotion thereof.
• Signs.
• Celsus.
• The cause of vomitting when the head is wounded.
• Aph. 14. sect. 7.
• A History.
• What was the necessary cause of the death of King Henry the second, of France.
• A History.
• A History.
• Why some die of small wounds and o∣thers recover of great.
• Hip. de vul. cap.
• Whether the wounds of children, or old people are bet∣ter to heal.
• Aph. 15. sect. 1.
• Aph. 65. sect. 5.
• Aph. 47. sect. 2.
• Wounds which are dry, rough, livid, and black are evil.
• The signs of a Feaver caused by an Erysipe∣las.
• Why an Erysi∣p••las chi••fly ass••ils the face.
• The cure of an Erysipelas on the ••••ce.
• Why Oyly things must not be used in an Erysipelas of the face.
• Aph. 25. sect. 6.
• Deadly signs in wounds of the head.
• A Convulsion is cau••ed by dryness.
• A twofold c••use of Con∣vulsifick dry∣ness.
• Lib. 4. de us••e partium.
• Opinion of Dalechampius.
• The signs of a deadly wound from the de∣praved facul∣ties of the mind.
• From the habit of the body.
• From the time that such signs appear.
• Celsus lib. 8. cop. 4.
• When the Pa∣tients are out of danger.
• The Patient must beware of cold.
• How the air ought to be.
• Aphor. 18. sect. 5.
• Lib. 2. de us•• part. cap. 2.
• The Air though in Summe•• is colder than the brain.
• The discom∣modities of too much Light.
• What his drink must be.
• Almonds in∣crease the pain of the head.
• What fish he may eat.
• Aphor. 13. & 14. sect. 1.
• Aphor. 15. sect. 2.
• Why sleep up∣on the day time is good for the brain being in∣flamed. Lib. 2. Epidem.
• The discom∣modities ensu∣ing immode∣rate Watch∣ing. Gal. Meth. 18.
• Medicines pro∣curing sleep.
• The commodi∣ties of sleep.
• Lib. 4. meth.
• Lib. de cur. per sanguinis miss.
• The use of Frictions.
• A History.
• The two chief Indications in bloud-letting.
• The discom∣modity of ve∣nery in wounds of the head.
• How hurtful noyse is to the fractures of the skull.
• A History.
• Of a simple wound of the flesh and the skin.
• A digestive medicine.
• A sarcotick medicine.
• An Epulo∣tick.
• A H story.
• What things we must ob∣serve in sew∣ing.
• When we must not let bloud in wounds.
• A History.
• The bitings of man and beasts are venenate.
• Theriacal topick Medicines.
• A Cordial Epi∣thema.
• The cure of the hairy scalp when it is con∣tused.
• A repelling medicine.
• A disc••ssing Fomentation,
• Ceratum de Minio.
• Detersive or cleansing me∣dicines.
• Why the Peri∣cranium hath such exquisite s••nse.
• Gal. 6 m••th. The bones are offended with the applicati∣on of humid thi••gs.
• Lib. de ulcer.
• Gal. 6. mith.
• Vigo's Cerai•• good for a broken Skull.
• A liniment good against Convulsions.
• Gal. 4. meth.
• How farr hu∣mid things are good for a fra∣ctured skull.
• Why Cepha∣lick or Catag∣matick pow∣ders are good.
• When to be used.
• How to be mixed when they are to be applyed to the Meninges.
• Why a repel∣ling Ligature cannot be used in fractures of the skull.
• How the Pati∣ent must be placed when you Trepan him.
• What to be done before the application of the Trepan.
• The harm the bone receives by being heat∣ed with the Trepan. What things hasten the sca∣ling of the bone.
• The bone must not be forcibly scaled.
• A caution in Trepaning.
• A safe and convenient Trepan.
• The use of a Leaden Mul∣let.
• Why a Trepan must not be applyed to the Sutu••es.
• Why two Tre∣pans are to be used to a fra∣ctured Suture.
• A bone almost severed from the skull must not be trepan∣ed.
• A notable ca∣vity in the fore-head bone.
• Lib. de Vul.
• A rule out of Hippocrates.
• What discom∣modities arise from cutting the temporal muscles.
• A History.
• A History.
• The generati∣on of a Fungus.
• Why when the skull is broken the bones sometimes be∣come foul or rotten.
• The signs of foulness of the bone.
• Corrupt bones are sometimes hard.
• The benefit of a vulnerary potion.
• 〈1 paragraph〉〈1 paragraph〉.
• A great fal∣ling away of a corrupt bone.
• Aph. 45. sect. ••.
• The covetous craft of impo∣stors.
• Remedies for the lacerated Meninx.
• A spunge fit to foment withal.
• Lib. de vuln. cap.
• Lib. de fasciis.
• The discom∣modities of too strait binding of the head.
• What cloaths we must use.
• How the pati∣ent must lye in his bed.
• Paulus lib. 6. cap. 90.
• Remedies for the inflamma∣tion of the Crassa Meninx.
• How we must open the Cras∣sa Meninx when it is im∣postumate.
• The causes and remedies of the blackness of the Dura Mater. Remedies for contusion.
• For congealed blood.
• For the hurt received by the Ayre.
• What medicins make the Cras∣sa M••ninx black.
• Medicins a∣gainst the pu∣trefaction of the Meninx.
• Why the Cras∣sa Meninx easi∣ly endures a∣c••id medicins.
• Signs of death at hand.
• What the concussion of the brain is.
• The opening of the Vena Puppis.
• A discussing fomentation. A caution in fomenting the head.
• A caution in fomenting the head.
• A description of Vigo's Ce∣rate.
• A History.
• Aph. 58. sect. 7.
• That there may be an ab∣cess in the brain. Aph. 10. sect. 6.
• Gal. lib. de inae∣qual intemp. Rhas. cap. 4. contine••t. Avi∣cen. cap. de exit. sen. 3. lib. 4. cap. 20. A History.
• Lib. 8. de usu part. & com. ad Aph. 18. sect. 6.
• Why fat can∣not be genera∣ted under the skull.
• Signs of a fatty sub∣stance.
• Why we treat in particular of wounds of the face.
• A thing to be observed in wounds of the Eye-brows.
• Lagophthalmia is a quite con∣trary to the falling down of the Eye-lids.
• A repercussive to be put into the Eye.
• Divers reper∣cussives to be applyed to the Eye.
• Things actual∣ly cold are hurtful to the Eyes.
• Anodyne me∣dicines for the Eyes.
• Narcoticks.
• Detergent me∣dicines.
• A sarcotick medicine for the eyes.
• A drying fo∣mentation.
• A medicine to consume a fleshy excre∣scence without out biting.
• A Seton, a good remedy against in vete∣rate defluxions into the eyes.
• A History.
• A Seton good against the Falling-sick∣ness.
• The manner of making a Se∣ton.
• The use of a dry suture.
• How to make a dry suture.
• A Suture fit for hare-lips.
• The manner thereof.
• What hare-lips are.
• A History.
• A decoction good to wash away putrefa∣ction.
• A small hole remaining af∣ter the cure of great wounds.
• How many wayes the nose may be hurt.
• The cure of a broken nose.
• The uses of pipes in broken noses.
• How many ways the con∣tinuity of the the tongue may be loosed.
• The cure of a cloven tongue.
• A History. Nature oft doth strange things in the cures of dis∣eases.
• How many ways the uni∣ty of ears may be violated.
• How to sow a wounded Ear.
• The differen∣ces of wounds of the neck and throat.
• The Palsie fol∣lows upon wounds of the neck.
• Signs that the gullet is wounded.
• The wounds of the jugular veins and sleepy Arteries are deadly by accident.
• By hurting the recurrent Nerve, the voyce is hurt.
• The descripti∣on of the Au∣thor's Balsom.
• The faculty of Diacalcitheos.
• The cure of the wounded Weazon and Gullet.
• A Gargarism.
• The manifold use thereof.
• A History.
• A strange Hi∣story.
• Another Hi∣story.
• The diffe∣rences of wounds of the Chest.
• The signs.
• Signs that the heart is wounded.
• A History.
• Signs that the Lungs are wounded.
• Signs that the midriffe is wounded.
• A History.
• Another History.
• Signs that there is blood pouted into the capacity of the Chest.
• Signs that the Spine is woun∣ded.
• Vigo, tract. de vuln. thora••. cap. 10.
• A History.
• Why bitter things must not be cast in∣to the Chest.
• Read the His∣tory of Ma∣ryllus in Galen. lib. 7. de Ana∣••om. administra.
• What harm ensues the too long use of Tents.
• No liniments must be used in wounds of the Chest.
• Wounds of the Chest easi∣ly degenerate into a Fistula.
• Why there flows such plenty of mat∣ter out of wounds of the Chest.
• The cure of a Fistula in the Chest. When Aegyptiacum must be put into the injec∣tions.
• What wounds of the Lungs are curable.
• The harm that insues upon coughing, in wounds of the Lungs.
• How Ecleg∣ma's must be swallowed.
• The utility of Sugar of Roses in ul∣cerated or wounded Lungs.
• The reason of the name.
• The differ∣ences thereof.
• The causes.
• The Signs.
• Why in he∣cticks the heat is more acrid, after meat.
• The signs of a hectick joyned with a putrid Feaver.
• The cure.
• A symptoma∣tical hectick.
• An essential•• hectick.
• Things to be taken inward∣ly.
• The benefit of medicinal nourishments.
• The choice of meats.
• How Asses milk must be used in a he∣ctick.
• Womans milk more whole∣some than Asses.
• Things to be outwardly ap∣plyed.
• A caution in the choyce of Oyls.
• The differen∣ces of Baths.
• Why the Pati∣ents must not enter the Bath fasting.
• How to pre∣pare the body for the Bath.
• Things streng∣thening the ventricle.
• Epithems.
• What a flux happening in a hect ck feaver indicates.
• How children be cured.
• Their diffe∣rences.
• Signs of a wounded li∣ver. Signs that the stomach and smaller guts are wounded. Signs to know when the greater Guts are wounded. Signs that the Kidneys are hurt. Signs that the Bladder is wounded. Signs that the womb is wounded.
• Prognosticks. Lib. 6. cap. 88.
• A History.
• Another Hi∣story.
• The cure of a wounded Gut.
• The cure when the Kal falls out.
• Hip. Aph. 58. sect. 6.
• Lib. 6. Math. cap. 4.
• The cure of the wounded fat.
• Why wounds of the inside of the thigh are oft-times deadly.
• The large Tendon of the heel hard to consolidate.
• Differences drawn from things would∣ed.
• Their symp∣toms.
• Why a pun∣cture of a nerve is deadly.
• A wound of the nervous parts indicates contrary to the general cure of wounds.
• A History.
• Medicines fit for wounds of the nerves.
• What wounds of the N rves must be burnt.
• A certain A∣nodyne in pain of the teeth.
• Why Escharo∣ticks must be used to spread∣ing ulcers.
• A famous Hi∣story.
• A discussing and drying ca∣taplasm.
• A History.
• An Anodyne and Saicotick Balsom.
• A general rule for all wounds of all Ner∣vous parts.
• Why wounds of the joynts are malignant.
• The cure.
• An astringent and drying ca∣taplasm.
• Aphor. 20. sect. 5.
• What matter usually flows from wounds of the joynts.
• Why things actually hot must be apply∣ed to the wounded joynts.
• Of the site and posture of wounded joynts.
• Ligaments more dry than Nerves, and without sense.