Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

THE ART OF CHIRURGERY.

BOOK I.

PRAECOGNITA

Concerning the Definition and Parts of Chirurgery.

BEfore we come to treat of Chirurgery it self, there are several Prae∣cognita fit to be known by him, that would be a Proficient therein. For these Praecognita are Introductory, and will clear the Way for the bet∣ter Understanding of what shall af∣terwards be discoursed: And they are these:

• 1. Of the Antiquity and Dig∣nity of Chirurgery.
• 2. Of such Authors as have written of it.
• 3. Of the Definition of it.
• 4 Of the Division or Parts of it.

And then my Intent is to pass through all the Parts of Chirurge∣ry methodically, that so the Rea∣der's Memory may more easily Re∣tain what he peruses: And I shall give you nothing but what is war∣ranted by the Authority of the most Learned and best Experienced Men in all Ages.

As for the Antiquity of Chirur∣gery, its Pedegree is as old as A∣dam. But if any Gentleman doubt it, I dare tell him, I can produce

more probability for it, than per∣haps he can for his Descent from his Great Grand-father, though he would oblige the World with a Ge∣nealogy elder and stouter than the Conqueror. For can we think, that Adam and Cain, after Fratricide committed upon Abel, would not both contrive how to ward a Blow, yea, and to cure a Wound, if need were? Certainly, when their know∣ledge of Evil had, through amaze∣ment and horrour at the first obli∣terated all recognition of Good, Pru∣dence must needs take care to re∣dress such Disasters; and Adam especially, if he were so good an Herbarist, as most Divines hold him to have been, must from his knowledge of Vulnerary Herbs, naturally proceed to the use of Plasters. Indeed concerning the Antediluvian Transactions Moses gives us but short Remarques; yet we find by those, that Lamech committed Murder, and gloried in it: And the Earth being filled with Violence, there must of ne∣cessity be Work for the Chirurge∣on. And it cannot be imagined, but that when Men had received Wounds and Hurts, they would try to cure them. As for pro∣fane History, in it we find Chirur∣gery as ancient as any Records of that sort. Podalirius and Ma∣chaon, sons of Aesculapius, were Chirurgeons to the Grecian Camp before the Walls of Troy; yea, Ci∣cero de nat. Deor. tells us, That Aesculapius himself drew Teeth, and dressed Wounds. Apollo was an Oculist; Mercury cut Aesculapius out of his Mother Coronis her belly; and Venus her self some∣times plaid the good old Woman in dressing the Wounds of her dear Diomed, and their Boy Aeneas, when Virgin Pallas had in these Heroes chastised the tricks of that wanton Goddess her Youth.

But secondly, to leave these more obscure and antique Times, and that we may come to the Men, who have left us the Monuments of their Skill in Chirurgery, let us descend a little lower, and we shall find Hippocrates, the seventeenth in a lineal descent from Aesculapius, to have been the first and the skilful∣est of all who have written of this Subject, as his Books De Officin•• Medici, De Articulis, De Vulneri∣bus, &c. do testifie. From which Treatises it is plain, that Hippo∣crates not only understood Chi∣rurgery, but also practised it. Se∣veral other Grecians have writte•• of it, as Galen, Oribasius, Paulus, Aegineta, Aëtius, Alexander Tra∣lianus, Actuarius, and others. A∣mong the Latins Celsus has writte•• skilfully, and expressed his Skill i•• most elegant Latin: and he in∣deed is the only Latin Author a∣mong the Antients. But after the Partition of the Empire into th•• Eastern and Western, when War and Devastations had made way so an inundation of Barbarism into these Parts, Learning began to flourish among the Arabians; and the Chief of them in Chirurgery i•• Albucasis. After this some ski••∣ful Men arose, who having derive their Skill from the Arabians, a•• well as the Greeks and Latins wrote in a most barbarous Style Amongst these Guido de Cauliac•• is the most Eminent: for Fallo∣pius (the great Anatomist, and Glory of his Age) makes no scruple

to parallel Guido, notwithstanding his barbarous Style, with Hippo∣crates. There were several others, who wrote in a barbarous Style, who deserve to be read, as Brunus, Theodoricus, Rolandus, Lanfrancus, Bartepalia, R••gerius, and Guliel∣mus à Saliceto Placentinus, also Johannes de Vigo, but he had taken what he wrote from Guido; and Tagaultius turned him into more elegant Latin. Marianus Sanctus Barolitanus was one of Vigo's Scho∣lars, who afterwards published a Compendium of Chirurgery. Con∣stantinus Africanus, who lived, An. 1080. wrote something in Chirurgery. And Petrus de Ar∣gillata of Bononia wrote about 1490. But of Guido, Fallopius confesses ingenuously, that except∣ing Hippocrates and Galen, he not only excelled all the Grecians, La∣tins, and Barbarians, especially con∣sidering the barbarism and obscurity of Physick at the time when he li∣ved, but that he added many useful & learned Things of his own to Chirur∣gery: He lived about the year 1363.

But to come to the Writers of the preceeding, and of this present Century, I think I may place the incomparable Fallopius in the first Rank. It were to be wished, that he had lived to give the finishing stroke to those excellent Pieces, that came out in his Name at Venice 1606. for then I know not what a Man could have wisht for more: for he discourses every thing, with that Candor, Judgment, Reason and Accuracy, that one may easily observe, he was no less a Physician and Chirurgeon, than that he was a most excellent Anatomist. Next to him comes Ambrosius Paraeus, Chirurgeon to the King of France, a Man who by his great experience in difficult Cases greatly enriched Chirurgery: But we must understand, that that huge Volume, which came out in his Name, was made by the Doctors in Physick of Paris, whom Paraeus furnished with an ample stock of Chirurgical Ex∣amples: They put them into Me∣thod, and to make the Work the bigger, they added many things superfluous and alien from the bu∣siness of Chirurgery. But truly I think it had been more for this worthy Person's credit, had he in a less Volume published his par∣ticular Cures, and Observations of rare Cures, and their Remedies, as he found them by infallible Pra∣ctice, and so many years Experience: As Gulielmus Fabricius Hildanus, the Honour of the Germans, whose Fame Ages to come shall celebrate, has to his immortal Glory done. For, as Seneca says, Longum est iter per praecepta, breve & efficax per exempla; and so in reality every man finds, what Impression is made in our Minds by particular Cases (in which Diseases appear to us far otherwise, than what Authors make them to be in their Writings, so that it is no marvel, if he be mi∣serably gravelled, who has all he knows from Books) and the Cures, when the success of Remedies, as day by day they are used, the su∣pervening Symptoms, and the good or bad Events, are faithfully related. And when all is done, if after the Patient's death, an accurate search of the Parts affected were made (which I wish the Patient's Rela∣tions would give way to, though the Physicians are hindred from

doing it by the vain superstition of the dead parties Friends) the Busi∣ness would be complete. Also Hie∣ronymus Fabricius ab Aquapen∣dente is a Learned Writer, and has done excellently well in his Books, entituled, De Chirurgicis Opera∣tionibus, wherein he endeavours to imitate Celsus, while according to the order of the parts of his Body, he accurately treats of the Names of Diseases incident thereto, the Signs, and the Cure which is per∣formed by manual Operation, and so he frequently professes himself to be Celsus his Interpreter and Com∣mentator. And with Aquapendent may be joyned Johannes Jessenius à Jessen, Stephanus Gourmelinus, and Vidus Vidius junior. And for a clear conception of the Operati∣ons, the Figures of. Scultetus with their Explications are excellent, in which the Manual Operations, used by others, are set before our eyes. In our English Tongue we have these, who have written well, Mr. Gale, Mr. Banister, Mr. Clowes, Mr. Woodall, Mr. Wiseman, and the Learned Dr. Reed (who so far as he has gone shall be my Pattern and Precedent.) And these have writ∣ten of Chirurgery in general.

As for such as have written of peculiar Parts of Chirurgery, I shall select some of the most approved. Of Tumors Ingrassias has written, no unlearned Man: But he is too much taken up in the reconciling the Greek and Arabick names, and confounds his Reader in enume∣rating the Species of Tumors. Sa∣porta is but an ordinary Author. But among Authors to be prized are Julius Caesar Arantius and Marcus Aurelius Severinus, who wrote a Book De Recondita Ab∣scessuum natura, a Work certainly full of recondite Learning establish∣ed by many years Experience. He it was who left us that Excellent Work De Efficaci Medicina. Of Wounds of the Head Jacobus Be∣rengarius Carpensis has written, or, who is the same, Jacobus Carpus, for whose excellent Work we are be∣holden to the famous Conringius. But because in so noble a Part too great diligence cannot be blamed. Jo. Bapt. Carcanus Leo his Book may be perused, as may Andreas Al∣casar a Spaniard, and Ludovicus Queirats, a late French Writer: for there is an infinite number, who have commentated upon Hippo∣crates de vulneribus Capitis, as Arantius, Parma, and Petrus Paaw a Dutchman. Guillemaeus has written of Diseases of the Eyes; but we owe the Chirurgical way of curing them to Durant Scach, and to Peter Franco, who both of them wrote also of the Stone in the Bladder, though the first Writer of that way of Cure was Marianus Sanctus Barolitanus: And Hilda∣nus is to be preferred before all; who wrote a peculiar Treatise of Lithotomy, and Dr. Groenevelt in his Dissertatio Lithologica, who wrote since Hildanus died. Talia∣cotius is the only Man that treats of curing Parts cut off by Incision. Of Ruptures we have Franco, Scacchi, and Geigerus. Of Wounds, be∣sides Alcasar and others, who have designedly made it their business, there is Matthias Glandorpius an Excellent Man, and one that has shewn himself a Physician in his Speculum Chirurgorum. Magatus also in a peculiar Treatise com∣mends

a rare Inspection of Wounds: But of Inspection and Judgment of Wounds mortal and curable there have written Bernhar∣dus Suevus, Melchior Sebizius and Hieron. Welschius, to whom we may add Fortunatus Fidelis his Treatise De Relationibus Medico∣rum. And a Physician indeed ought to be well versed in this Affair; seeing usually according to his Judgment the injurious Party either loses his Life, or is acquitted. Although several have written of Gun-shot Wounds, yet they are most to be credited who have fol∣lowed the Camp, such as Paraeus, Botallus, and Guillemaeus. But as particular Observations faithfully related do give a Man much Light, so they are to be abominated, who, when they communicate theirs to the Publick, either out of Envy or Malice conceal what Remedies were administred; of which Guli∣elmus Losellus is guilty. But such as Riverius, Borellus, Barbette, Sculterus and others, who have candidly imparted their Secrets for the common benefit of the Sick, are to be commended. Besides, Johannes Van Horne in his Micro∣techne has given an admirable Intro∣duction to Chirurgery. And Johannes Muys in his Praxis Chirurgica Ra∣tionalis has begun to cultivate this Part of Medicine according to the newest discoveries in Nature, as the other Parts have been by other hands. Out of these and such other Authors as these, I shall give you according to my Abilities, a per∣fect Systeme of Chirurgery.

Thirdly, Chirurgery by virtue of its Etymology 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, signifies, Manual Operation, and by Learned Men is defined to be the third Branch of the Curative Part of Medicine, which teacheth how sundry Diseases of the Body of Man are to be cured by Manual O∣peration. By this as well as by Diet and Pharmacy doth the Phy∣sician attain his End, which is, his Patients Health.

Fourthly, The parts of Chi∣rurgery, must be assigned accord∣ing to the main differences of Ope∣rations. Those are four in num∣ber, and consequently so many parts: for either by Chirurgery, Solution of unity is removed, and union restored; or things unna∣turally united are separated and disjoyned; or things superfluous taken away; or last of all defects are supplied. Now Solution of u∣nity is either gathered by reason, or deprehended by sense. In Tumors, although the parts seem to the eye united; yet reason teacheth us, that there is a divulsion of them.

The doctrine of Tumors there∣fore ought to be the first particular Treatise. Solution of unity appa∣rent to the senses, to wit, sight and touch, is either in the soft parts, or in the more solid and hard. In the soft or fleshy parts there be two differences of Solution of unity: vulnus & ulcus, a wound, and an ulcer. In the hard parts there are found a fracture, and a luxation; two distinct sorts of Solution of unity. This part may be called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or parts compositrix, the part joyning together.

The second part of Chirurgery opposite to the first, teacheth to separate parts unnaturally united: where either the comely composi∣tion of the Body of Man is defaced

or impared, or the actions of the same hindred. Sundry have been brought into the World with the anus and vulva quite shut up. The consideration of that Membrane, which is found in the Neck of the Matrix of some Women, is in this place to be noted and considered: Seeing there have been, and yet are so many Concertations amongst both skilful Physicians and Chirur∣geons about it. Here also is the Cure of the wry Neck to be set down. In this Grief the Head is drawn on the one side, by reason of one or more Tendons of the Muscles of the Neck being shortned to∣wards the Claves more than on the other: whereby it cometh to pass, that the face groweth awry and distorted: and so the Beauty of the Countenance is much impared. To this part belongeth the curing of Tongue-ty'd Children, in whom Sucking and Speech are hindred. Not only Fingers and Toes cleave together in the same Person; but Twins also, and double Members of one Person. The consideration of such doth belong to the Histo∣ry of Monsters; not to any Art: seeing such things are to be ranged amongst raro contingentia, and so belong not to Art, which is of things necessary. This part may be termed 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or separa∣trix pars, the separating part.

Now followeth the third part of Chirurgery, which sheweth the means to remove from the Body things superfluous, which may fitly be called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or ablatrix pars, the subtracting or removing part. Things superfluous are such, either by Event, or by their own Nature. Things superfluous by Event are several: And first a dead Child in the Womb, or staying too long to the prejudice of its own and tho mothers Life. Here shall be set down the manner how to bring Women to bed (as we term it) artificially and safely. Secondly, a falling of the small Guts into the Cod by enlarging or rending of the production of the Peritonaeum, which we call a Rupture. When I come to this Point, I will set down the diversities of Ruptures, and the means of curing of each: which are either Incision, or Truss, or application of Medicaments, sometimes used solitary, sometimes concurring most or altogether. Thirdly, the amputation of a Limb by reason of a mortification, or some other accident. Here shall be set down the most accurate me∣thod of dismembring. Fourthly, the extirpation of any part, as the Breast, when a Cancerous either Tumor or Ulcer doth possess it. Here you shall be acquainted with the safest way of extirpating a Cancer and a Lupus. Fifthly, Blood, offending either in quantity or quality, is drawn by Phlebotomy, Leeches, or Ventoses, of all which I will particularly discourse. Things by their own nature superfluous, are either somewhat familiar to Na∣ture, or altogether adverse: Of the first sort, are Wens, and Strumae; when I come to them I will set down the diversities of them, and how they also are to be cured. Se∣condly, the couching of a Cataract offereth it self. Here I mean to set down the variety of Cataracts, the prognosticks of them, whereby it shall be known which are cura∣ble and which not, and the most

exquisite manner of couching of such as are curable. Things ad∣verse to Nature, are Stones in sun∣dry parts of the Body; but chiefly in the Bladder. The Incision for extracting of it, is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: of it I mean diligently to discourse; because it is a dangerous Operati∣on, and many times scandalous.

Last of all, I come to the fourth & last principal part of Chirurgery, which is the supplying of the defects of the Body, which may be called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or additrix the supply∣ing or adding part. Now things which are added, are either of the Body it self, as restoring of the Nose lost, or curing of the Hair∣lip. Of the first, I will set down the Method of several Physicians, and Chirurgeons; Of the second, many famous Mens Experiments in curing both the single and double Hair-lip. The matter of things, which is used for the repairing of the losses in other parts, as the Eye, the Ear, Arm and Leg, is no ways of the Nature of the Body. Ne∣vertheless when I am come so far, I will make an end of the course of Chirurgery with touching these so much as shall seem sufficient, to instruct such as have not been verst in these practices. I have varied, I confess, from all who have writ∣ten of this subject: Nevertheless I have the Light of Nature on my side, and the Experience of all skilful Practitioners. So that it is needless to take further pains, ei∣ther to confirm those things which I have alledged, or to refute that which hath been said by others; Seeing I intend rather to frame an able operating Chirurgeon, than to set out a contentious disputing Theorician: Besides reprehending of others doth not so much instruct the hearers in the knowledge of Truth, as it sheweth that, which is not to be learned, but shunned. Neither is a Chirurgeon contented to have performed so many Duties to the Body of Man while it is alive, and the instrument of the Soul for performing actions; but when it is dead, the spirit rerurning to God, who gave it, he ceaseth not to be officious to it, in dis∣secting of it, for the instruction of himself and others, and pre∣serving it from putrefaction and annoyance, until time and place fit for burying of it be offered: which he compasseth partly, by Encearing of it, and partly by Embalming: of the which two last, I mean also to discourse.

CHAP. I.

The General Doctrine of Tumors.

FIrst, I will declare what a Tumor is. Secondly, what the Causes of Tumors are. Third∣ly, the main difference of Tu∣mors.

Before I come to the essential definition of a Tumor, I will set down the denominations of it. A Tumor in Greek is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, that is, a prominence or protube∣rance in the Body. And from hence the Latin words uncus, a crook or hook, and aduncus, bended or crooked, are derived: Because things bended cause a sticking out. The Arabians and barbarous Phy∣sicians, who follow them, call all Tumors unnatural Apostemata, in Latin Abscessus: this word is de∣rived from the Greek Verb 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Abscedere: Because in Apo∣stems there is a collection of Hu∣mors in any place which have left their own proper seat, &c. For Hu∣mors which cause Apostems come from the Veins, and so leaving their own natural receptacle, seat them∣selves in other parts of the Body, being dependant and weak. And Chirurgeons commonly call Tu∣mors wherein there is collection of matter Apostems. Tumor which is a Latin word, and by frequent use made familiar in English Confe∣rences and Discourses, is derived from the Latin word Tumco, to be raised or puffed up.

Now bunchings or stickings out of parts of the Body, are three∣fold: for either they are natural; and then they serve for the comli∣ness of the Body, and further the actions, as we may see in the Head, Belly, Joynts, the Thighs, Calves of the Legs, and Arms: Or they only pass the ordinary dimen∣sions of some parts, such are the Dugs full of Milk, and the Bellies of Women which are with Child: Or they are altogether unnatural, not only marring the comely com∣position of that part of the Body which they possess; but hindering the actions also. Such a Tumor, or eminence of the Body, is called by Galen 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, id est, Tu∣mor praeter Naturam, a Tumor contrary to Nature. Having set down the denominations of a Tu∣mor, I must come to the Definition of it. Of all the Definitions, two are chiefly to be noted: the one of Fallopius in his Treatise of Tu∣mors, cap. 3. The other of Hieron. Fabricius ab Aquapendent. in ope∣ribus Chirurgicis, part 2. lib. 1. de tumoribus, cap. 1. That of Fallo∣pius is gathered out of Galen. cap. 1. lib. 13. de method. medendi: and it is thus. It is a Disease, whereby the parts lose their natural bigness, exceeding it. So that extenuation is contrary to a Tumor. He will have it to be a disease of the instru∣mentary parts: for quantity is on∣ly an instrument, whereby the

organical parts perform their acti∣ons, more strongly, or weakly, as we may see in Dwarfs, and tall Men. Galen lib. 1. de tumoribus praeter nat. c. 1. affirmeth, That in Tumors contrary to Nature, all Dimensions, that is, Length, Heighth and Breadth are increased. But the former Definition cannot be ascribed to every particular Tu∣mor, and so it is not large enough: for in an Erysipelas, extream Heat rather offendeth, than the bigness is enlarged, which very often can∣not be deprehended by the Sen∣ses.

The definition set down by Fa∣bricius ab Aquapendente is this: A Tumor against Nature is a Disease for the most part compounded, which is to be named of that thing which hindreth the actions. And he to make his definition plausible to his Readers, will have all to mark some remarkable points in his defi∣nition. And first of all, in that he calleth a Tumor against Na∣ture Morbus, or a Disease, he will not have Pushes in the Face, and such small Eminences of the Skin to be Tumors, because they hinder not the actions. He cannot de∣ny that the equality of the Skin is altered, and besides this, the action of the Skin, which is Perspiration in that place is hindred. Let no Man think it harsh, that I ascribe action unto the Skin, being a sim∣ple and similar part of the Body: It cannot be denied that all similar parts have an use; which use some∣times is an action, as this of the Skin; to send out by its Pores su∣liginous Vapors; and superfluous serosity of the Blood, by insensi∣ble Perspiration and Sweat. And although such small Eminencies commonly are denied to be Di∣seases, because they hinder not the Actions; yet they be Passions, and Affections, which require the skill of the Physician and Chyrurgeon: yea, those Pushes of the Face are sometimes more hard to be cured than great Tumors, and Artists many times gain more by those, than these: Besides this, by reason of the matter, they are to be re∣ferred to one or other of the main Tumors. Howsoever, they are not to be neglected. According to Aristotle 1 Rhetoric. c. 5. & Galen, ad Thrasibulum, there be three Gifts of the Body, to wit, Health, Strength, Beauty, all which Medicine is to direct: Health is preserved by wholesome nourish∣ment, Strength by convenient ex∣ercises: of the which 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Treateth, whereof Hieron. Mercu∣rialis hath written a Volume; 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 hath care of the Beauty: Now seeing by reason of the Face a Man is called Beautiful or Ugly, who can deny that they deserve the care of the Physician, and Chirurgeon? He addeth, that a Tumor is a Disease most common∣ly compounded; if he had said ever compounded, he had spoken a Truth: for in every one of these Tumors there is a Tumor conspi∣cuous or latent; or a solution of unity, either sensible or imaginary. In an Erysipelas it self, wherein there appeareth neither quantity of part encreased, nor solution of unity procured, yet in it there are undoubtedly both: for the first, seeing there is so great a heat in the part possessed with this Grief, the Humors must be rarefied, and

the part dilated, which will require a more spacious place than it had before, which is an evident Argu∣ment that the quantity is enlarged. As for the Second, the parts be∣fore arctly united, must be some∣what separated by stretching: Reason must teach us that which cannot be deprehended by the Senses. The last clause of the de∣finition. That the Tumor is to be named from that which hin∣dreth the Action; as Erysipelas a Disease of Distemperature, be∣cause Heat doth most hinder the action of the part: this is frivo∣lous, because not Heat only, but the bedewing of the Skin with Choler, by the which it is stretch∣ed, hindreth the contraction and extension of the Skin, and so by a necessary consequence, the hindring of the motion of the Part organi∣cal, wherein it is seated. To con∣clude, This definition may be ap∣plied to other Griefs than a Tu∣mor, as to the Headach, which is a Disease most commonly com∣pounded of distemperature of the Humors, and solution of Unity, and may have its denomination from the diversity of the Humor causing it.

Wherefore seeing neither the de∣finition of Fallopius out of Galen, nor the definition of Fabricius ab Aquap••nd••nte, can abide the tri∣al of the Laws of a good defini∣tion, we must assay to give ano∣ther; which shall be this: A Tu∣mor against Nature is most fre∣quently a Disease, sometimes a light Affection, for the most part incident to the organical parts, in∣creasing their quantity above Na∣ture, by reason of receiving of su∣perfluous Humours sent from other parts. Here I will labour to yield a Reason for every point of this Definition. The Genus is a Disease, because it hindreth the Actions; sometimes it is a Passion, or light Affection, which hindreth not the action of the Part, as appeareth in small Oedematous Tumors, and Scirrhosities: And therefore these Modifications frequently, and some∣times are added. The subject of a Tumor is a part organical, some∣times by its own Nature organical, as a Finger or Toe, sometimes Organical only by Office, as when the use of a similar part is per∣formed by an Action: as it ap∣peareth in the Skin, one of the uses whereof 〈◊〉〈◊〉 send forth by its Pores insen•••••• Perspirations, fuliginous Vapors, and superfluous serosity of the Blood by Sweat, and Ichors of Humors in the be∣ginning of Tumors and declinati∣on by discussive and resolutive Medicaments. The form of a Tu∣mor is quantity increased, where∣by it differeth from all other Griefs. The cause of increase of quantity, is receiving of superflu∣ous Humors, which is done two manner of ways, to wit, Affluxi∣on, and Congestion; Affluxion is, when an Humor offending either in quantity or quality suddainly with violence seizeth upon any Member, either by reason of the weakness of it, the rarity, loos∣ness, dependency, heat, or pain, or because the whole Body is full, or cacochymical, and the parts send∣ing strong. Congestion is, when a Humor is collected in any part by little and little, by reason of the weakness of the concocting and

expelling Faculty of the same: So that a Tumor against Nature is a Disease always compounded, against Fallopius in his Treatise of Tu∣mors, c. 3. For there is always a solution of Unity, either Manifest, or Latent and Occult, and this he granteth; for he saith, & de hac conveniemus: we shall agree con∣cerning this. Besides this, the quantity is encreased, and that al∣ways to Reason and Imagination, although not to the Sense, as hath been said of an Erysipelas. More∣over, you shall hardly find a Tu∣mor without some distempera∣ture, either simple, or compound∣ed. I have insisted somewhat the longer in clearing the definition of a Tumor against Nature, because there is great contention concern∣ing it amongst Authors, both An∣cient and Modern.

Now order of Doctrine requi∣reth, that we speak somewhat of the causes of Tumors: These are either External or Internal. The Causes External are in number Eight. 1. The Air, if it be con∣tagious, it causes Tumors, as Car∣buncles, and Botches in the Plague time. 2. The touching of things exceeding temperature in the act∣ive qualities, as we see in the ap∣plication of Vesicatories, and sit∣ting long upon any cold Seat. 3. Too hard binding of the part, which causeth sometimes Gan∣greens. 4. The application of an attracting instrument to the Body, as Cupping-glasses, and Horns. 5. Whatsoever may cause a solution of Unity, as Wound, Fracture, Luxation, or Contusion. 6. Biting of Beasts, whether they be venemous or no. 7. Taking inwardly things offensive to Nature, whether it be by the excessive quantity, as when by too liberal drinking Wine, an Erysipelas seiz∣eth upon the Head; or by a ma∣lign quality, as we may see fall out after the taking of Arsenick or Mercury sublimate. 8. Immode∣rate Motion, whereby immoderate Heat is procured, whereby the Humors become more subtil, and the passages to the weaker part more patent.

Now the part is weak, First, by Nature, and that either by reason of its substance, it being spongy and loose, as Glandules; so we see frequently Parotides behind the Ears, and Buboes in the Groins: Or by reason of the natural Humi∣dity of the Part; so Tumors more often appear in the Flesh than in the spermatick parts. A Part al∣so naturally is weak by reason of the situation; for the dependent Parts are more apt to receive in∣fluence of Humors, as the more high are to receive Halitus; so it is often seen, that it rising from the Stomach, or some inferior part, causeth in some the Falling Sick∣ness. A Part, Secondly, is weak by accident, and that by reason of Errors committed in the things not natural, as Air, Meat and Drink, Exercise, and such like, whereof much is spoken in that part of Physick which is called Physiologia. So that to the causing of a Tumor in a Part, there be required the weakness of the part which recei∣veth, patent passages, preparation of the Humor, and the strength of the Part sending.

The internal Causes of Tumors are either Humors or Flatuosities;

The Humors are either Natural or Unnatural: The Natural are either sincere, as Choler, Phlegm and Melancholy; or mingled, as some of these with Blood; for Blood is no where sincere, but according to the Humor mingled with it, which is predominant, it is called Cholerick, Phlegmatick, or Melancholy Blood. The Hu∣mor unnatural is Water, as in the Dropsie, for it never can become nourishment. Some add a Third cause of Tumors, the interpositi∣on of a solid Body, as in the Her∣nia intestinalis, zerbalis, exompha∣los. Of Tumors which are caus∣ed by reason of strange things, as Worms, Lice, Bones, Nails, Hair, Grisly Substances, and such like, I will speak when I come to the Third part of Chyrurgery, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Ablatrix, which ta∣keth away superfluities. But time admonisheth to come to the set∣ting down of the principal dif∣ferences of Tumors. In this mat∣ter I will leave all needless and fruitless distinctions of Tumors, from time, as that some are new, some old, some short, some long enduring: from the quantity, as that some are small, some great, some of a mean bigness: from the condition of them, as that some are mild, some malign, some cu∣rable, some uncurable, and such like; which either do not greatly further the knowledge and curati∣on of Tumors, or else are to be set down to some purpose in the explication of every particular Tu∣mor. Only now in my general Discourse of Tumors, which is to shew Light unto that which shall hereafter be spoken in the special Doctrine of each, I will meddle with the differences taken from the material Cause of Tumors, from whence spring the main prin∣cipal Species of Tumors, unto which all others may be reduced.

All Tumors then are either sim∣ple or compounded. The simple are caused either of Humors or Flatuosity: the Humors are either Natural, or Unnatural: the Natu∣ral Humors are Four, Blood, Cho∣ler, Phlegm and Melancholy: If Blood, which neither in the Veins, nor without, is found sincere and unmixed (as hath been said) cause a Tumor, it is called Phlegmone or Inslammatio, according to Galen. lib. 2. ad Glaucon. cap. 1. Of the divers kinds of it, which have their denominations from their places, and of the diversities which arise from the complication of it with other Humors, I mean to discourse when I come to the particular Treating of it: For I mean not to confound Particulars with Generals, because this would breed Confusi∣on, and so deprive Men of the Fruit of that which is delivered. Of all other Tumors a Phlegmone deserveth the first place, because it is caused of Blood, which is the Son of Nature, first begotten, and the Treasure of Life. If Choler cause the Tumor, it is called Ery∣sipelas; these Two are hot Tu∣mors. If Phlegm cause a soft and white Tumor like it self, it is cal∣led Oedema, unto which divers pi∣tuitous Tumors are reduced, of the which I will speak in their proper places. If a Tumor very hard be produced of the melan∣choly Juyce, and without pain, it is called Scirrhus; these two last

are cold Tumors. If a Tumor be caused of Water contained in any part, it is called Tumor aquosus: If from flatuosity; Emphysema; these two last Tumors are the off∣springs of Crudity, caused by the weakness and defect of the natu∣ral Heat. And seeing these have the material cause different from that of others, I will speak of these in several Chapters, as was done in every other particular Tumor. Be∣sides this, they require other Medi∣caments than the rest of the main Tumors do, as shall be shewed when we come to the Curation of them, differing them from the rest. I see no reason why they may not be accounted several Tu∣mors; one cannot truly say that either Hernia aquosa, or flatuous Tumors of the Joynts, can be re∣duced to the aforesaid Four prin∣cipal Tumors, or that they can be cured by the same Indications of Curing, and Medicaments which are applyed to the other. You see how I have set down six sim∣ple Tumors, for fewer I cannot, if you consider either the diversi∣ty of the material Causes, or the diversity of the Topical applicati∣ons, or the evidence of Doctrine. The combination of these begets the compound Tumors; in these compound Tumors, what Humor is predominant, that carrieth away the denomination: As for exam∣ple, if Bloud abound more than Choler, the Tumor is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. If Choler be predominant, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and so in all o∣ther combinations of Humors in Tumors, which shall be present∣ed to your view. When you have noted the Pathognomonical signs of each of the simple principal Tumors; it is an easie matter at the first sight to discern the kind of Tumor, and what compound Medicaments are to be applyed to it. Hitherto have I Declared un∣to you the Opinion of Hippocrates, Galen, and of the rest of the Gre∣cians; as also of the Arabians, con∣cerning the material Causes of Tu∣mors.

Now I will shew you what Para∣celsus and his followers think of this point: First then they acknowledge but Two Elements, Water and Earth; for if they should not grant so much, they could not be counted in the number of the Faithful; for in the very first Verses of Genesis mention is made of both. Second∣ly, they account the Humors parts of the Body, and so the causes of no Griefs, but erroneously; for if they were parts, they would be endued with Life, which they are not. Thirdly, they would have some Action, whereof they also are deprived: only they have an Use, which is to nourish the parts. Besides this, they maliciously dis∣semble the Doctrine of the rati∣onal Physicians and Chyrurgeons, for they make each Humor, con∣tained in the mass of Bloud, ei∣ther Natural, or against Nature: the Natural they make either, Ali∣mentary, which nourisheth the parts, or Superfluous, which Na∣ture reserveth for some other uses: of this abounding, Diseases pro∣ceeding of fulness are ingendred, called Plethora: of the Humor against Nature, causing impurity, Cacochymia is caused; so Choler in the Veins and Arteries is na∣tural,

and Alimentary. In the Cy∣stis fellis, and in the Porus bila∣rius, the superfluous i•• contained: if it leave the appointed Recepta∣cles, and pass to the habit of the Body, it causeth the Yellow Jaun∣dice; if by adustion, it become Bilis atra, it procureth Cancers and Wolfs; so that they hold not the natural, but those that are un∣natural to be Causes of Disea∣ses.

The Paracelsians appoint Three Principles of all things, Sal, Sul∣phur and Mercury, and not only by resemblance, or allegorically, but really: by Sulphur, they under∣stand the fatty substance; by Mer∣cury, the waterish substance: by Salt, the Earthly substance. Distil Cloves, there come Two Humidi∣ties, the Oyl and Spirit: in the bottom the Earthly substance stay∣eth, which hath Two Parts, Terra repurgata, the Crystalline Salt, and Terra mortua the Black Earth. The life of the Salt is a strong Water, which if it be by distillation drawn, it leaveth but a Terra damnata, on∣ly fit for the Dunghil. This Salt preserveth the Body from putrefa∣ction. From Defects in these Three, they will have all Diseases to proceed, and concerning Tu∣mors against Nature, the Hot they will have to proceed from Sulphur and Mercury; and the hotter the Tumor is, the more Sulphur to concur. The cold Tumors they will have to proceed from Mercury and Salt, and according to the loos∣ness, or firmness of the Tumor, the more Salt or Mercury to be required, as in an Oedema more Mercury, in a Scirrhus more Salt. This is their Doctrine concerning the material Causes of Tumors. In my judgment it is the safest course to insist in the Footsteps of the Ancients, for their way is plain and easie; no Man can deny that there are Four Humors in the mass of Blood, as may appear when it is drawn out of the Veins: Cho∣ler swimmeth about the Blood, which is known by its bright Red∣ness; Melancholy is in the bottom, which is deprehended by its gross∣ness and blackness; now Phlegm uniteth these Two last Humors, and maketh them tough. The Puracelsian Doctrine is full of diffi∣culties, which he maketh more ob∣scure by coyning strange Words, as his Reader will perceive; so that his Discourses are but a kind of canting Philosophy. Neverthe∣less I thought good in plain terms to acquaint you with it, that when any Emperick shall make a shew of Learning, by using these terms, you may find him out, and esteem of him as he is: that is, Like that Head which the Wolf afar off espi∣ed, representing the Head of a li∣ving Man, but coming near, and seeing it but curiously carved, af∣firmed it to be Pulchrum caput, sed sine scientia, A comely Head, but without Wit.

CHAP. II.

Of the general Indications of Cure in Tumors.

HAving set down the Defini∣tion, Causes, and Differen∣ces of Tumors, I will set down the general Indications of cure in Tumors.

Now an Indication is That which sheweth what course is to be taken for the recovery of Health: The general Indications are taken ei∣ther from the Matter, or from the times of every Tumor; in the Matter, we are to consider the mo∣tion of it, and its nature. As con∣cerning the motion of the Matter; it is either in flowing, or it is re∣ceived already into the Part. The Causes of Fluxion are Two, Ple∣thora, or fulness and Cacochymia, an ill complexion: Plethora or ful∣ness is twofold, Ad vasa, and Ad vires: Ad vasa is when the Veins are only full, and the Body not∣withstanding quick and nimble; this is twofold, Pura, when there is a due proportion of the Humors of the Body; and Impura, when there is an excess of any of the Three Humors besides Blood, as Choler, Phlegm, or Melancholy. Ad vires, is when there is such a fulness, as causeth sluggishness of the Body: this requireth Evacua∣tion by Phlebotomie, as Cacochy∣mia by Purgation. As for Phle∣botomie, Three things are to be observed concerning it. 1. The manner: In Fulness, Quoad vasa, at one time so much Blood is to be drawn as is requisite; but in Fulness, Quoad vires, because Strength is somewhat abated, you are to draw Blood by repetition, and not all at one time. 2. The quantity, how much then is to be drawn, the Weakness or Strength of the Party will inform you; for in a weak Body you are to draw less, in a strong Body more. Strength and Weakness are to be discerned by the Functions: The weakness of the natural Faculty is discerned by Crudity of Urine, and Excre∣ments of the Body; the weakness of the vital, by a weak and small Pulse, as also breathing weak and Sick; the weakness of the animal Function is found out by defect in moving and feeling; by the inte∣grity and Perfection of these Three Faculties, the strength of the Par∣ty is perceived: But we must dili∣gently distinguish between lan∣guishing and weakness indeed, and oppression of the Faculties by reason of Fulness, making them dull and slow; for, as in weakness, great Moderation is to be used, so in Op∣pression we may more bountifully

and boldly suffer the Vein to run. 3. The Third thing to be obser∣ved in Phlebotomy, is the end of it, wherefore it is instituted; the scopes of Blood-letting are Two; Derivation and Revulsion: Deriva∣tion is the drawing of the Humor to the part adjacent, or of the same side by opening of that Vein, or a branch of it, which is inserted into the part affected: as for example, if in Diseases of the Head or Neck, we open the Cephalica in the same side: and even in this there is a kind of opposition, to wit, high and low; for in Tumors of the Groyn, we open Vena poplitis: thus they do also who open this Vein in Podagra, if the Gout in∣vade the Foot. This kind of in∣terception we use, not only be∣cause there is a plentiful Fluxion to the part affected, but because a speedy Interception is required, lest the natural heat of the Part be oppressed, or the rupture of a Vessel ensue; so in Inflammation of the Lungs and Side, we open the Liver-Vein of the same Side, and draw Blood plentifully. Revulsion is a drawing of the Humor to a part opposite: Of this there are Four differences: 1. From the higher to the lower parts, as from the Head to the Feet. 2. From the Right Side to the Left. 3. From the Fore-part to the Back, which we shall do if we apply Leeches in Diseases of the Breast or Belly. 4. Is when we draw from the Cen∣ter unto the circumference, as in applying Ventoses with Scarifica∣tion to the Neck in Diseases of the Brain, as in the Apoplexy, and Lethargy. Vesicatories perform the same.

But one may ask, which are to be accounted high, and which low?

I Answer, That all those parts which are above the Navel, in∣cluding also the Liver and Sto∣mach, are accounted high: but the parts below the Liver are ac∣counted low, as the Kidneys, and Genitals in Man and Woman.

This kind of Interception we use in Two Cases: First, if the Matter flow but slowly, and so a suddain Interception is not requi∣red. Secondly, If we are to open a Vein to prevent a Disease, as Vena cubiti for to free one of a Fit of the Gout. But this kind of drawing hath no place in contagi∣ous Tumors, if they appear either in the upper or lower parts; for whether they appear either behind the Ears and Arm-pits in the upper parts, or in the Groins in the low∣er, Revulsion must be by the Vena cava, which is inserted into the Right Ventricle of the Heart: Now whether any contagious Va∣pour or Humor can be sent by this passage safely; let every judi∣cious Person consider.

Now there is a difference be∣tween Revulsion, Derivation, and Evacuation; for in the former two, Motion is required, but in Vacuation the Humors must be quiet. In the translation of Hu∣mors flowing from any part, we must mark according to Hippo∣crates, that it be done 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Secundum rectitudinem, by obser∣vation of a straight course; and that is done two manner of ways.

First, by the rectitude of the parts, as the Left with the Left, and Right with the Right, and

the hinder with the Fore-parts. Secondly, by the rectitude of the Vessels: As for example, The Li∣ver-Vein of the Arm hath a kind of streightness with the Veins ascend∣ing to the Head: So if one bleed immoderately at the Right Nostril, by applying a Ventose to the regi∣on of the Liver, the Flux ceaseth: If it flow from the Left Nostril, it must be applied to the region of the Spleen.

Having set down how Plethora is to be abated, if it cause Fluxion, we are to shew how Cacochymia is to be removed, which is not so much, by reason of the quantity oppressing, as by reason of an evil quality offending a part. Now this Matter offending in quality, it ei∣ther moveth from place to place, or it resteth where it had its first invasion; if it move from place to place, it is the safest course to abate the Humors wherein this quality is resident by Phlebotomy, lest it seize upon some principal part: if it be quiet, resting con∣tented with the first place, then let us use Purging, expelling the Hu∣mor, whether it be Choler, Phlegm, or Melancholy, with appropriate Medicaments, which Physick pre∣scribeth in that branch of the Cura∣tive part of Physick, which resto∣reth Health by the administration of inward Medicaments. Having set down the Indications which are taken from the motion of the Hu∣mor, we must come to those which are taken from the nature of it.

Now the Humor if self is either not contagious, or contagious: If it be not contagious, the Fluxi∣on of it proceeds from Three cau∣ses: The First is the strength of the part sending the Humor, which it doth, either because it is bur∣thened with the quantity, or prick∣ed on by the quality; we have shewed what is to be done in these cases. The Second is the thinness of the Humor. The Third is the attraction of the affected part. When Fluxion is caused by reason of the thinness of the Humor, if we cannot use Phlebotomy, or Purging, as in Children, decrepit Persons, and in Women with Child in the First and Last Months: then we must use Revulsion, and this is done six manner of ways. 1. By Ventoses without Scarifica∣tion, as when we apply a Ventose to the region of the Liver, when one bleedeth too much at the right Nostril. 2. Painful constriction, or binding of the Parts, as Arms and Legs: but we must first ••rub the Parts hard which are to be bound; and if we bind the Arm, we must use a Ligature in three Parts: First, near the Arm-pit. Secondly, a little above the Elbow. Thirdly, about the Wrist. In the Legs we must use a Ligature near the Groin, a little above the Knee, and near the Ankle. 3. Painful Frications when we mean to revell from the Centre to the Circum∣ference. 4. Bathing of the Parts with very hot Water. For First, by reason of the pain it doth re∣vell. Secondly, it doth discusse, because it openeth the Pores. And in Fevers, by bathing the Limbs Sleep is procured, the Va∣pours ascending to the Head. 5. Vesicatories, which are used in an Apoplexy, Lethargy, and such like. 6. Fontanels, and they are of great use, applied to divers Parts, for

the preventing and curing of sun∣dry Griefs: If the Fluxion be pro∣cured by the attraction of the part affected, there are two Causes of Attraction: First, the distempe∣rature of the Part. Secondly, Pain. If distemperature of the Part be the Cause, it must be removed by its contrary: but see∣ing it is most commonly a hot Distemperature, things cooling are to be applyed, as by applying Cloaths moistned with Oil of Ro∣ses or Violets cold; but when the Clouts become hot, they are to be removed, and cold to be applyed, or Cloaths moistned in the juyce of cold Herbs. If we apply Un∣guents, as Infrigidans Galeni, Re∣satum Mesuis, de cerussa Rasis, Populeon, we must not apply the Unguent immediately to the Skin; but on a thin linnen Cloth; for it keepeth the Unguent from drying, and doth not hinder the breathing out of the Vapours, which the immediate application of the Un∣guent would do, and so by stop∣ping of the Pores, would increase both the Heat and Pain.

And in application of Pultesses, they are to be spred between the foldings of a Cloth dipped in some convenient Oyl or Liniment; for so it doth not hinder Perspiration, and the applications are removed more easily from the part. This in your practice is to be noted, and the inveterate Error to be shun∣ned. If the ways by which the Humor passeth, be too ample and patent, and a hot Distemperature joyned, then things astringent and cooling are to be applyed, Roulers and other Cloaths being moistned in them. Wherefore in this case Myr∣tle-Berries, Red Rose Leaves dryed, Pomegranate Rinds and Flowers, Sumach, Sloes, Oaken and Owlar Bark boiled in Red astringent Wine, or Vinegar and Water, or new and fresh Tanners Woose, and strained, are effectual. The Parts therefore by which the Humor passeth, are to be rouled some∣what strait with the Rouler, Cloaths, Stupes, or Pledgets and Bowlsters being moistened in this Liquor, and wrung: You may also apply astringent and defensive Empla∣sters drawn upon Leather; such an one as this, ℞ rad. torment. bistort. symphyt. ros. rub. gallar. balaust. malicor. sang. drac. boli Armen. santal. rubr. ceruss. an. ʒ j. cerae albae ℥ iij. ol. myrtil. ℥ j. misc. fiat ceratum. So much then shall be sufficient to have been set down, concerning the attraction of the affected part, by reason of the Distemperature of it: Now we must come to the Second cause of the Attraction, which is Pain. There are Two causes of Pain, solution of Unity, and a venemous Quality: If the solution of Unity proceed from the affluxion of Hu∣mors hot or sharp distending the Parts, the Pain is to be eased with Medicaments convenient; these are of two sorts, Anodyne, and Narcotick; Anodynes gently con∣temperate the Part, by reason of the conformity which they have with the Nature of Man. They are hot in the first Degree, and of subtil parts; such are Milk, old Sallad-Oyl, Butter, Hogs Lard, Fat of Hens, Ducks, Geese, Eels, Man, Badgers, Bears, the Oyl of Chamo∣mil, Lilies, Earth-Worms, Linseed, Dill, Sweet Almonds, Eggs, the

Pulp of Cassia tempered with the Oyl of Roses, the Pulp of sweet Apples with the Powder of Saf∣fron. Narcoticks deprive the part of the faculty of Feeling, such are Opium, Hemlock, Henbane, the deadly Nightshade, Mandrakes, and the Apple of Peru, or prickly Apple: these we are to use when the former will not prevail, and when by reason of Watching, a Fever, or Faintness is to be fear∣ed. Sometimes in extremities they are used Solitary, sometimes with their Correctives, to wit, things hot, if we fear stupefaction of the part, unto which they are to be applyed: Such things are Castore∣um, Saffron, Cinamon, Cloves, Pepper, and such like. If the biting of a venemous Beast, as of a mad Dog, or a Viper, or Adder; or the stinging and pricking of any Beast, as of a Scorpion, or Insect, as a Hornet, be the cause of a Tu∣mor, we must address our selves to meet speedily with the Poyson. If therefore a venemous Beast bite or sting, First, the part is to be sca∣rified, and Ventoses to be apply∣ed, then the part is to be foment∣ed with Theriaca Andromachi, dis∣solved in strong Wine-Vinegar, and Stupes moistened in the same, ap∣plied to the same; or it is to be fo∣mented with the Oyl of Scorpions, and a Pledget wet in it to be ap∣plyed: And above the Pledget, this emplaster of Fallopius De tu∣moribus, c. 14. is to be spread warm, ℞ pic. naval, ℥ j. sal. nitri. ℥ss. se∣men. sinap. ʒ ij. cepar. allior. sub prun. coctor. an. ʒ iij. assae foetid. sagapen. an. ʒ ij. stercor. columbin. ʒ j ss. aristol. rotund dictamn. alb. an. ʒ j. ol. lil••albor. ℥ ss. fiat emplastrum: Pigeons also, and Hens, and Cocks di∣vided in Two parts, and applied hot, are available. Sometimes the actual Cautery is to be applied, to tame the malignity of the poyson, if the poyson hath continued a∣bove three days: Besides this, two things, more are to be done; First, according to Galen, 3. De loc. af∣fect. 7. the Member is to be bound hard, three or four Inches above the part bitten or stung: Secondly, Antidotes inwardly are to be given; but chiefly Theriaca Andromachi, for many days together in a Liquor, fit for the constitution of the di∣seased Person: Now if the matter of a Tumor be contagious, we are by all means to draw it out of the Body, lest if it go in, it deprive the Person of Life, as in the Plague; or infect the Liver, as in the Pox; wherefore Ventoses and Medicaments attractive are to be applyed: Such is Fallopius his Em∣plaster set down before, for the at∣traction of Poyson. In the Plague we must not fail to minister Anti∣dotes, even three times in a day, and to procure Sweat: Such are Theriaca, Electuarium de ovo, Ele∣ctucrium Orvietani, or this of Fal∣lopius, De tumor. 9. ℞. baccar. ju∣niper. caryophyll. nuc. moscat. rad. enul. an. ʒ ij. rad. aristol: utri∣usque, gentian. an. ʒ vj. semen por∣tul. acetos. doron. ben. rub. an ʒ j. spodii, oss. de corde cervi. ligni aloes. corallii albi & rubri, rasur. ebor. baccar. lauri. mastich. croci. an. ℈ ij. rut. morsus diabol. an. ʒj. Pulp. ficuum & dactylor. an. ℥j. cinamomi. liqiurit. an. ℥ss. tormentill. card. bonedict. dictani∣ni albi. an. ℥ iij. amygdal. dulc. & pinear. excort. an•• ℥ j. agaric. tro∣chiscat,

ʒ vj. rad. peuced. ʒ ij. ter∣rae sigillat. & bol. orient. an. ℥ j. zedoar. ʒ ij. caphur. ʒ iij. spec. 3. santal. spec. diarrhod. abbat. an. ʒ ij. cort. citri, pulv. smaragdi an. ʒ j. moschi ℈ j. Theriac. An∣dromach. & Mithridat. an. ℥ j. fol. mali Armeniaci ℥ ss. cum sy∣rup. de cort. citri. & de acetosita∣te citri. an. triplo pondere, ad pul∣veres, fiat Electuarium. Ʋt Ele∣ctuarium fiat magis efficax addi possunt cornu rhinocerotis ʒ iij. & cornu cervi praeparat. ℥ ss. Dos. a ʒj. ad ʒ ij. in conveniente li∣quore.

The stinging of Wasps or Bees is cured with Mallows stamped and mingled with cold Water, or Chaulk applied with the same.

CHAP. III.

Of the Four Times of a Tumor, and the Indica∣tions taken from them.

HAving spoken of the Indica∣tions Curative, taken from the Matter of a Tumor, now it followeth that we speak of the In∣dications taken from the times of a Tumor; The times of a Tumor are Four, the beginning, the in∣crease, the state and declination. The beginning is thought to be, when a part beginneth to swell, although the actions be not hin∣dred: in the beginning repelling Medicaments are required; repel∣ling Medicaments are cold, and of gross substance, for they are to thicken the part affected, and to cool the inner parts of it; such are the Whites of Eggs, Plantain, Night-shade, House-leek; Prick∣madam, Purslain, Rose-buds, dry Roses, Myrtle-berries, Pomgra∣nate-flowers, and Rinds, Galls, Su∣mach, Quinces, Sloes, Bole, San∣guis draconis, terra sigillata, sowre Wine, Tanners Woose; which you may apply either single, or ming∣led according to your scope. But in six cases we are not to use repel∣ling Topicks; First, if the Matter be vonemous or maligne, lest it being repelled, should assault some principal part. Secondly, if the Matter be critically turned to a part, so that it be not a princi∣pal part, by the error of Nature: for then it ought to be repelled; as when in a burning Fever, the Matter being sent to the Menin∣ges, causeth Ravings. Thirdly, when the Body is either Plethorick, or of an ill habit. Fourthly, when the Humor floweth to the emun∣ctories. Fifthly, If the Part have but little Natural Heat, we are not to use repercussives, lest the natu∣ral heat be extinguished, and the part mortified. Sixthly, when the pain is vehement, for then

Anodynes are only to be used.

We are to think the Tumor to increase, when the part is stretched, and symptomes are increased; and seeing in the increase the Matter partly floweth, and partly posses∣seth the Part, you are partly to repell, and partly to discusse: but if the Matter flow with such force and plenty of Humor, that it threat∣neth corruption of the Part, or if the Humor which floweth be thick, and so hot that the Part feeleth a burning, as in a Carbun∣cle; then are you to use sensible Evacuation by Scarification; but where we cannot conveniently Scarify, Leeches are to be ap∣plyed, as in the Hemorrhoids, and other griefs of the Anus. Now discussion is an evacuation of a thin Matter gathered in a Part, by in∣sensible evaporation, procured by the natural heat increased by proporti∣onate Medicaments. In this de∣scription insensible is added, to di∣stinguish it from Evacuation by Incision, Scarification, or Leeches, which evacuate sensibly to the Eye: the principal efficient cause is the natural Heat; the adjuvant discus∣sive Medicaments; the Matter which is to be resolved, must be thin; for it is in vain to go about to discusse a thick substance, be∣cause it is not apt to yield Vapors. In the description, discussive Me∣dicaments are said to help natural Heat by increasing of it; which being done: First, the Humor is made thin. Secondly, it is resol∣ved into a Vapor. Thirdly, it is drawn from the Centre to the Cir∣cumference. And Lastly, expelled by the Pores of the Skin. Such Medicaments then must be famili∣ar to Nature, and these perform their Office, by consuming super∣fluous Humidity: and so they must be hot and dry. They must then be subtil, that they penetrate to perform these Offices. There are three degrees of discussive Medi∣caments, they in the first Degree are hot and dry in the second, as dry Figs, Bran, Chamomil, Ammo∣niacum, galbaman, Leaven, Lilie∣roots, Melilot, the roots of Marsh-Mallow, Goos-Grease, and old Hens Grease; and because such as∣swage pain, we ought always to begin with them. In the second Degree are Calamint, Hysop, Pen∣niroyal, Mint, Cummin-seeds, and Dill-seeds, Bean-flour, the Flour of Vetches, Fenugreek, Horchound; the root of Peucedanum, the roots of the Birth-worts, Lyons Fat, old Bear's Fat, old Badger's, Cat's. Dog's, and Man's Fat: these are somewhat dryer and hotter than those of the first. In the third Degree, are those which are dry and hot in the third Degree, as Niter, unslacked Lime, Sulphur vive, assa-foetida, &c. These are to be applyed according to the constitution of the Party, and as the skilful Chirurgeon shall see cause.

The state of a Tumor, is when it is come to such a Degree, as that it can go no farther in big∣ness, the signs of it are these: First, all symptomes, as Tension, Pain, Redness and Fever symptomatical are at the height, and remain uniform, neither increasing nor decreasing: Secondly, the Veins of the parts adjacent continue in the same fulness and dilatation. In the state we are to use Anedynes

discussives by reason of the pain.

We are to think that the decli∣nation of the Tumor beginneth, when the aforesaid Symptoms be∣gin to abate, and then strong dis∣cussives only are to be applied, whereof we have spoken before. In necessity we may use these which are found in the Shops, Diachylon cum gummi, Diachylon magnum Mesuis, Diachylon ireatum. Tu∣mors end not only by Resolution, but often by Maturation; and some∣times by Induration and Corrupti∣on: and as Discussion is better than Apostemation; so Induration is better than the Corruption of the part: Fifthly, Tumors do end changing the place, as when in a Pleurisie the Matter falleth up∣on the Midrif, and causeth an Em∣pyema.

CHAP. IV.

Of curing of a Tumor come to Suppuration.

HAving shewed the Method how Tumors are to be dis∣cussed: now order requireth that the means be set down, how a Tu∣mor is to be handled, if it tend to Suppuration, or Maturation, which by our usual term is called Aposte∣mation. And we are inforced thus to go to work: First, if the Hu∣mor be too plentiful; for then the natural Heat cannot well rule it, and so it must be seconded by fo∣reign and external Heat, which working upon superfluous Humidi∣ty, causeth Putrefaction according to the Philosopher. Secondly, when it is crude; for then we must labour to concoct it with Medica∣ments, which are peptica or co∣quentia. Thirdly, when the Mat∣ter is hard, and then we must use emollient Medicaments. The Me∣dicaments which procure Quittour, they are temperately hot and moist: and these help natural Heat, that it may the more easily elaborate the Matter, and make it fit for expul∣sion, and this we call Concoction. Emollient Topicks are used to soften any Matter indurated, and such are dry in the first degree, and hot in the first, and in the beginning of the second. But it is to be noted that there is a difference between Tension and Hardness, and Relax∣ation and Softness: a part stretched will yield to the Finger pressing it, if it be hard it will not; and where there is any Tension, relaxing Me∣dicaments are to be applied, which attenuate and open the Pores, and therefore they must more discuss than dry, and so be drying in the first Degree, and hot in the second. A part indurated must have emol∣lient means applied to it: whereof

we will speak, when we come to discourse of a Scirrhus. In the Cure of Apostems, we are to do two things: First, we are to prepare the Matter; and make it fit for expulsion: Secondly, we are to evacuate it when it is prepared. To accomplish the preparation of the Matter, first, we are to remove Ac∣cidents: Secondly, to procure the maturation of the Matter. The Accidents are these, Pain, Tension of the Part, Hardness and Heat. As for the asswaging of Pain; nar∣cotical or stupefactive Medica∣ments have no place here: For first, they extinguish the natural Heat of the Part; which is the principal efficient cause of Cocti∣on: Secondly, by thickning of the Matter, they make it more rebel∣lious; wherefore we are to use Anodyne Medicaments, whereof we have spoken already: you shall do well to apply a Cataplasm of White Bread Crums, let the Apo∣stem be dressed with this, or such a Medicament Morning and Even∣ing.

If the part be stretched, use re∣laxing Topicks, such are those which are temperately hot, not drying much, and of subtil parts, as White Hore-hound, Archangel red and white, Mullen, Dill, Cha∣momil, Fenugreek, Mercury, Me∣lilot, Turneps, the leaves of Marsh∣mallow, the Flour of Barley, Beans and Vetches; of these you may frame to your purpose such a Ca∣taplasm; Take of Chamomil-flow∣ers beat to Powder ij. pugils, of Barly, Bean, and Flour of Vetches, of each ij. ounces, of Marsh-mallow Leaves and Flowers pounded a handful: boil these in Beef or Mut∣ton Broth strained, and the Fat taken away, until they come to the consistence of a Poultess: Then add to it the oyl of Dill, Chamo∣mil and Rapeseed, of each one ounce: dress the Apostem with this or the like, Morning and Evening.

If hardness hinder, use those things which are emollient, as all manner of Fats, the Dregs of Oyl, all sorts of Mallows, Colts-foot, Bugloss and Burrage, Quinceseed, Milk, the White Lilie, Linseed, Figs, Raisins, the Marrow of Beasts, Oyl of Sweet Almonds, Marsh∣violets, Ammoniacum, Bdellium: of some of these you may frame a Cataplasm after this manner: Take of Linseed Meal or Powder iiij ℥. of Marsh-mallow Roots, and White∣lilie Roots boiled in Water, and well bruised, of each ij ℥. of Violet Loaves and Flowers, and Colts-foot Leaves, of each an handful; boil these in new Milk, until they come to the consistence of a Cataplasm; unto the which add of Ammonia∣cum dissolved in Muscadine, of the pulp of Figs and Raisins of each j ounce, and so make up your Ca∣taplasm.

If immoderate heat trouble you, apply things cooling: but let them be cold either in the second de∣gree, or beginning of the third, for the Reasons yielded against Narcoticks, when I spake of Pain; such are umbilicus Veneris, or Na∣vel Woort, Prick-madam, Sen∣green, Barly meal, Endive, the pulp of the Pumpion, Sea-tong Lettico, Ducks-meat, the Water Lilie, the Water Archer, Plantain, Garden Night-shade: of these Herbs with Barly meal boiled in fair Spring

Water make a Poultess, and to eve∣ry pound of the Poultess, add ij ℥. of populeum unguentum, and ℥ j ss of unguentum rosatum Mesuis.

You may demand of me, how long the Application of these Topicks, prescribed for the re∣moving of Accidents, is to be con∣tinued?

I answer, until the Accident be almost gone, with the which you encountrred, and then you may proceed to assist Nature, by in∣creasing natural Heat by ripening Medicines, which was the second intention of curing Apostems set down by me: Now those Medica∣ments which help Nature, ought first to stop the Pores reasonably, only suffering the sharp Vapors to breath out, and to detain those which are mild and somewhat thick, which are the secondary cause of Coction. In this respect then they ought to be viscous and tough in substance, which are tem∣perate Oyls, and Mucilages, which by Galen are called Empla∣stica; secondly, they ought to be familiar to Nature, and so tempe∣rately hot and moist. One thing is to be noted, that hotter Sim∣ples are to be chosen, according to the temperature of the part, if the Tumor seem somewhat cold: wherefore if the Tumor seem hot, only Maturatives in the first De∣gree are to be used, and those of the second Degree to be shunned: But if the Matter be somewhat cold, then you are to use Matura∣tives of the second, yet always mingling with them some of the first Degree. And the Reason is this, because the Medicaments of the se∣cond Degree dry too much; where∣fore those of the first Degree are to be added, in the which there is much moisture, which is requisite to Coction and producing of Quit∣tor. These Medicaments are call∣ed Concoquentia, and Pus moventia, and Suppurantia: such ought to be hot and moist, as the Body of a temperate Man is, and so they ought neither to dry or moisten, or to heat or cool immoderately, but only to preserve and increase the Natural Heat; for a Suppurative Medicament ought to answer the Constitution of him unto whom it is applied.

Of these Suppurative Medica∣ments there be two Ranks; In the first, are Mans-grease, which as∣swageth Pain, also Ducks-grease, Geose-grease, Hens-grease, Oyl of sweet Almonds, sweet sallet Oyl, Mallows, sweet Butter, Figs, Fenu∣greek, Lily-roots, Linseed, Wheat∣flour; a Cataplasm made of Wheat∣flour, Water and Oyl, an Emplaster made of yellow Wax, and Oyl called Cerelaeum, Violet-leaves and flowers, Saffron; For an Exam∣ple, I will set down the description of a Suppurative. Cataplasm com∣pounded of some of these of the first Rank: Take of Milk a pint, in the which boil of Wheat-flour a quarter of a pound, of Violet∣leaves, and Mallow-leaves stamped, of each a handful, of Lily-roots, and Figs boiled in Water, until they be soft, of each two ounces; when they are come to the con∣sistence of a Poultess, add of Saf∣fron beat to powder a dram, of the Oyl of Linseed, sweet Almonds, Lilies, and Mans-greese, of each one ounce, and so make up your Me∣dicament, If the Tumor be im∣moderately

hot, mingle always with your Suppuratives those things which are cold and moist in the first Degree, as Violet-leaves, Lettuce, the pulp of Pompions, Grownsil, Succory, Dandelion, and such like. If on a sudden you be called, and be required to dress a Tumor tending to Suppuration, you may have re∣course to the Apothecaries shop, and with these things dress it. First, beat some Oyl of Violets and fair Spring-water together, taking two spoonfuls of Oyl, and one of Water, with the which embrocate the Tumor; then apply a Pledget moistened in this, upon the part which is like to break, or be opened: and above the Pledget, Diachylon simplex if the Tumor be hot, or Diachylon cum gummi if it be but a little exceed∣ing the ordinary temperament.

Suppuratives of the second De∣gree are these; Terebinthina, Am∣moniacum, Galbanum, Sagapenum, Gummi elemi, Pix navalis, Bur∣gundie Pitch, Saffron, Leaven, Fenugreek, Onyons and Garlick rosted under the Embers, old But∣ter, Oyl of Chamomil, and Dill, old Hens-grease, Badgers-grease, and Bears and Dogs-grease, Wheat∣flour, Flour of Linseed. In the Shops there are Emplastrum de mucilaginibus, Dialthaea cum gum∣mi, Diachylon cum gummi, Diachy∣lon magnum.

Now I will set down a com∣pound Medicament, framed of these Simples: Take of the Roots of white Lilies, of the Roots of Marsh-mallow, of Onyons boiled and bruised, with the Liquor of each iiij ℥. of Leaven ij ℥. of Lin∣seed-meal j ℥. and a half, of Saf∣fron beat to powder a dram, of Ammoniacum and Galbanum dis∣solved in Muscadine, and the pulp of Figs, of each j ℥. of Oyl of Chamomil and Lilies, so much as will make a Cataplasm of a good con∣sistence.

In Strumes, and Bubo's venereal, use this: take of Diachylon cum gummi, and Emplastrum de muci∣laginibus, of each j ℥. of Garlick and Onyons rosted under the Em∣bers of each ℥ ij. of Dialthaea cum gummi, Mans-grease, and Bears∣grease of each ℥ j. make a Medi∣cument. One thing I would have you to note, that Suppuratives of this Degree are fittest for all con∣tagious Tumors, and that to all such, Onyons and Garlick rosted, and mingled with other Medica∣ments, are to be applied, for being thus prepared, they lose their sharp∣ness, attract, and become familiar to the Natural Heat.

How Apostems are to be opened.

Hitherto you have heard, how that Tumors that cannot be dis∣cussed are brought to suppuration: Now I am to deliver unto you, how the Matter, which is suppurated, is to be discharged. This is done by opening the part: Now some things are to be considered before the Action, some in the Action, and some after the Action. Be∣fore we go about to open an Apo∣stem, 1. We must be certain whe∣ther it be ripe enough; 2. We must resolve how to open it.

The signs of Maturation, are; I. The Tumor, by contracting it self, seemeth less than it was in the state; for while the Natural

Heat concocts the Matter, Vapors are raised by the heat, and so the part is distended; but when the Matter is concocted, the Elevati∣on of Vapors ceases, and the Tu∣mor falls somewhat. II. The Tumor draws it self to a point, or prominence; because when Nature overcomes the Matter, it draws it together, and draws it to the skin. III. Hardness and tension are much abated; for Maturation being procured, many Vapors are discussed, which before stretched, and made the skin hard. IV. By pressing the Matter with the Fin∣ger, we find a fluctuation or coming and going of it: but we must be circumspect when a Tu∣mor in a great Joynt is offered un∣to us, as in the Knee; for if we press lateral parts of it, a certain un∣dation will appear. V. The party feeleth much ease in the part; part∣ly, because some of the sharp Va∣pors are resolved; partly, because the Matter concocted doth make the parts more loose. VI. The vehement Heat ceaseth; for the Humor being come to Maturation, the unnatural Heat abateth, and the natural Heat resteth. VII. If the part inflamed hath changed the co∣lour, and of red is become white, and chiefly in the pointed place. VIII. The Scarf skin becometh shriveled, and ruffled; and this is a good sign, for it sheweth that unna∣tural Heat hath left it.

The second thing which we said was to be resolved upon, was the In∣struments with the which the A∣postems are to be opened. They are three; I. The Lancet or Inci∣sion-knife, of the which there be divers forms set down by the Anci∣ents: of the which we will speak, when we come to discourse of par∣ticular Operations for the which they are required. II. Is the Cau∣stick or Pyrotical Medicament. III. The Actual Cautery, which we will leave willingly to Horse∣leeches, unless we be destitute of other means, and when we are to make a Fontanel, or to stay a great Flux of Blood, or to dry a Carious Bone, or to correct a Cancerous part after that it is extirpate.

As for the Steel Instruments, we are to use them. First, if Apostems be in the Face, to avoid the filthi∣ness of the Scar, after the Curati∣on. Secondly, in small Tumors: for so they will be the sooner whole.

As for Caustick Medicaments, we use two sorts of them: the first is made of the strongest Sope-lees, boiled to the consistence of a soft Stone. The second is made of the like Lee, and unslaked Lime, boil∣ed to the form of a firm unguent. The first is best in Tumors which possess the convex part. The second is most convenient, if they be in parts concave or hollow.

These Pyrotical Medicaments are most fit to be used in five Cases: I. If we intend to keep the Tumor long open, as is requisite in all conta∣gious Tumors, in the Plague, and Pox: for where the Caustick is ap∣plied, there is always loss of sub∣stance, and by it we make the O∣rifice round, which of all other Figures most slowly is cured. II. In large Apostems Causticks are fit∣test; for by them, making as large an Orifice as we will, we shall spare tenting and enlarging of it; besides, the stretched parts will the

sooner be contracted. III. They are to be used in deep Apostema∣tions, such as happen in the Belly and Back, for so the Matter shall have a readier way for Evacuation. IV. They are best, when a Flux of Blood may be expected. V. We apply them, when we will gratifie timorous persons.

When we are come to open the part, then these things are to be observed: I. The Nature of the Part: this teacheth us, to shun Veins and Arteries by reason of He∣morrhage; and Nerves, Tendons and Membranes by reason of the pain which ensueth. II. If the Skin only be to be divided, then the Apertion is to be made strait; but if a Muscle also be to be incided, it must be done according to the Fi∣bres of it. III. Apertion must be made in the depending part, because the Matter will be more readily so drawn out. IV. It must be done where the part is thinnest, for so less pain is caused. V. The Apertion must be proportionate; for if it be too little, then the Matter, especi∣ally if it be thick or grumous, can∣not be well drawn without expres∣sion, which maketh way for Callo∣sity and Fistulation. If it be too large; First, the Scar will be the more ugly; Secondly, the parts subjacent will be made more apt to be altered, by receiving the im∣pression of the cold air. VI. We are to know how much Matter is to be evacuated at one time: In great Tumors, and those which are in the Joynts, great moderati∣on is to be used; for with the Mat∣ter many Spirits breath out, and so are spent: from whence extenua∣tion of the Body, yea, and Death sometimes ensueth. The Chirur∣geon who is to do this, ought to be resolute, chearful in counte∣nance and speech, and no ways scrupulous: otherwise he shall make the Patient dismayed, and fearful, which doth much weaken and abate the courage of the Patient.

Things to be observed after the opening of an Apostem, are these: First, the removing of Accidents which most commonly fall out. Secondly, the manner of dressing. The Accidents are most commonly three, Fainting, chiefly if the par∣ties be Children or Women, but above these, Effeminate Men. Se∣condly, Pain. Thirdly, a Flux of Blood.

As for Fainting, we may labour to prevent it by giving the Patient a Caudle, Aleberry, or some sty∣ptick Wine with a Toast, as Alegant and Tent; or if it be like to ensue, we may give them some Cordial Water with Sugar, as Cinamon Water, Treacle Water, or Aqua coelestis. If pain ensue, let the part be embrocated with Oyl of Roses, and the third part of Wine beaten together: yet the Oyl is not to touch the brims, if Apertion hath been made by Incision, lest it cause Spungeous Flesh to grow. As for staying of Blood, I will set down the fittest, and most effectual means to perform this, when I shall come to discourse of Wounds, for in them it doth most commonly fall out.

As concerning the manner of dressing after opening: If this hath been done by Incision, either a Tent, if it be small, or Dosels with Pledgets armed with some restrin∣gent Powder, as Bole, Frankin∣cense,

and Flour tempered with the Whites of Eggs, if it be large, are to be used: and so it is to remain for the space of four and twenty hours. If the Caustick be applied, then Dialthaea simplex, or sweet Butter melted in a Saucer, are fit to be used until the Eschare fall; then the Cavity is to be Incarnate: If in the mean time Spungeous Flesh ap∣pear, it is to be removed with Ca∣theretical Medicaments, as Mercury precipitate alone in gentle Bodies, or mingled with Alume, taking the third part of this in harder Bodies: yea, you shall be enforced some∣times to use Pulvis sine pari, and other Fistula Powders with some Medicaments which cool and as∣swage pain, as Ʋnguentum Po∣puleum, and Rosatum Mesuis: take my word, Basilicum and Aureum are not so fit.

Last of all it is to be sealed up with Epulotical Medicaments, as Diapalma, Emplastrum de minio, Ʋnguentum comitissae, and Desicca∣tivum rubeum. If a Tumor end into an Induration, it must be cured as a Scirrhus, whereof I will speak in its proper place. If it end in the Corruption of the Part, the way of Dressing this shall be set down in my Discourses of Gangraena and Sphacelus. If a Tumor cease, be∣cause the Matter removeth from one place to another, as when Pleuritis endeth in Empyema, neither doth this belong to this place.

CHAP. V.

Of a Phlegmon.

HItherto I have delivered a Ge∣neral Method, common to the Cure of all particular Tu∣mors: now it remains that the use of the General Method be shewed in every special Tumor. Of all which a Phlegmon doth first offer it self: First, because it is caused by the most excellent Humor, to wit, Blood, the Matter of Spirits, and the Store-house of life. Secondly, because it is most frequent. Third∣ly, because very often, as a Sym∣ptom, it accompanieth other Griefs, as Wounds, Contusions, Ulcers, Luxations, and Fractures, as Galen noteth.

The word 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is derived from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, from whence flagro to burn, by reason of the heat of it.

A Phlegmon is a Tumor hot, proceeding from the affluxion of Blood to any part. In this Descripti∣on, where it is said to be hot, in this it is distinguished from an Oedema and a Scirrhus; and in this that it is said to proceed from

Blood, it is distinguished from an Erysipelas caused of Choler. The differences are taken either from the Material Cause of it, or else from some parts which it posses∣seth. The differences of it taken from the Matter are these: It is either Legitima, or Notha, either truly bred, or else bastardly.

A proper Phlegmon, is caused by good Blood, only offending in quantity: Good Blood is discerned by Colour, Taste and Consistence: In Colour it is Red, in Taste Sweet, in Consistence Mean, between Thick and Thin: of all other Hu∣mors it is most plentiful in the Bo∣dy, because it affordeth nourish∣ment to all the Fleshy Parts, as they have their being by it, next unto Blood.

The Signs of a true Phlegmon, are six. I. This Tumor begins suddenly, and increases speedily, because the Matter is plentiful, and the ways by which it is sent, very patent and large. II. It is very hot in respect of an Oedema and a Scirrhus, but yet not so burning as an Erysipelas. III. The Colour of the Part is of a fresh ruddy Co∣lour. IV. In this Tumor there is great Pain with Pulsation. V. There is a great Tension in the Part, be∣cause the unnatural Heat raiseth plenty of Vapors which distend the Part. VI. The Veins, which before lay hid, become conspicuous and appear either ruddy or blackish.

Now as I said, there be many differences of Phlegmons taken from the parts which they invade: for if it siese upon the Meninges or Membranes of the Brain, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; if the Conjunctiva of the Eye, then it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; if the Muscles of the Throat, it is termed Angina; if the Pleura, it is named 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; if the Lungs, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, if the Kidneys, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, if the Emunctory of the Heart and Liver, Bubo; of the Brain, Parotis; of the Gums, Pa∣rulis; of the Almonds, Paristhmia, Tonsillae: Phlegmons in other parts have no proper Names, and even these I will refer to the particular practice of Physick, wherein they are handled, and rest contented with the Doctrine of External Tumors.

These Inflammations, if they pos∣sess the external Parts, and be but moderate, are healthful; as those which either by reason of the plen∣ty, or Malignity of the Humor, threaten a Gangrene and Mortifi∣cation, are to be suspected. A Phlegmon which happens in a young Body, in a hot and thin Part, the Body being not very Pletho∣rick, and in the Summer time, is more speedily cured; but quite con∣trarily, if the conditions be oppo∣site. The Indications curative of a true Phlegmon are taken from the times of it: The Means by which we cure are two, a convenient Diet, and Artificial Application of apt means for curing of the Tumor.

In the beginning therefore, we must prescribe such a Dyet as is able to hinder the increase of su∣perfluous Blood, and the Fluxi∣on of that which is already bred: wherefore the Dyet must be spare and slender, only sufficient to su∣stain Nature, and withal cooling: the Patient then shall rest content∣ed with Chicken and Veal Broth with Bread, Calves-feet and Trot∣ters stewed, and seasoned with

Vinegar, thin Oatmeal-Gruel, Pa∣nadoes, Sallets made of Sorrel, Spinage, Purslain boiled in thin Chicken or Veal-broth, seasoned with some Vinegar, Verjuyce and Sugar; let his drink be small Beer or Ale, altered in the Summer with Burrage, Bugloss, and Bur∣net, Barley-water, fair Spring-wa∣ter, wherein the crust of a Loaf hath been boiled, and made plea∣sant with Oxysaceharuin, or Oxy∣mel diureticum, mingling with a pint of the Water one Ounce and an half of the Syrup. If the Party be weak, Almond-Milk made of Barley-water, or the thin Broth of a Chicken may be permitted: If we intend to make the Blood unapt to motion, and to detain it in its own receptacles, then we must institute a Diet, having these three qualities: First, it must cool: Secondly, it must make a constri∣ction, and pursing up of the Ves∣sels: Thirdly, it must be Diureti∣cal, or move Urine, for much se∣rosity being carried away by the passages of Urine, the Blood must be made thicker, and therefore not so apt to flow. But we must take heed that such a Diet be only pre∣scribed to such as are in their con∣stant age, and have large Veins; otherwise, we shall cause new ob∣structions, and multiply griefs: Now to this purpose you may or∣dain Broths, wherein Lettuce, Sor∣rel, Spinage, Purslain, Marigold-Flowers, Columbine-Flowers and Leaves have been boiled, Calves, Sheeps, and Lambs Heads boiled, with Green Sawce made of Sorrel, or Alleluja, beware of Alliaria, Jack of the Hedge, or those Sim∣ples which are hot. Young Chick∣ens with Gooseberry sawce, are good, and such like. We must for∣bid Wine, Flesh, Eggs, fat things, and such as breed too much Blood; and Spices, because they heat the Blood; and piercing Drinks, as stale Beer or Ale, because they further the Fluxion of Blood. To procure Urine, an Almond-Milk may be made of a Ptisan, having an emulsion of Seeds of Pompion, Gourd, Musk-melon, Cucumber, Lettuce, Purslain, and Plantain. Now the Humor flowing immo∣derately we must labour to stay, by abating of it, and that by two manner of ways, by Phlebotomy and Purgation.

As for Phlebotomy, if the In∣flammation be great, the Party young and strong, and full of Blood, in the Spring time we may take a pound at a time; yea more, and iterate it if occasion be offer∣ed. In others, moderation is to be used, according to the strength of the Patient. If a Phlegmon possess the parts which are above the Liver, then the Veins of the Arms and upper parts are to be opened: but if it invade the parts which are under the Liver, as the Kidneys and Genitals, then the branches of the Vena cava de∣scending, are to be opened in the Hams or Aukles. One thing is to be noted in Phlebotomy; that we open not Veins too far distant from the part affected, as Vena frontis in diseases of the Feet; for we should evacuate too great a quantity of blood, before we should intercept any tending to the part affected. If a Phlegmon hath suc∣ceeded the staying of the evacuati∣on of Blood from any part, as from

the Nose, the Womb, the Haemor∣rhodes, means must be used to pro∣cure these accustomed evacuations.

As for Purgation, one may doubt whether it do any good, seeing no Blood, the matter of a Phleg∣mon, can be by this means spent. I Answer, That it helpeth by acci∣dent, and two manner of ways: For First, Purgation dryeth the Body, and so depriving the Blood of moisture, maketh it more un∣apt to flow. Secondly, By Purging sharp Humors, the part which sendeth the Humor is not irrita∣ted. But in this case, lenitives are better than eradicatives, because they rather cool than heat, and cause no ebullition in the Humors: such are Diacatholicum, Electua∣rium lenitivum, Electuarium de se∣besten, or a Bole, or Cassia, Tama∣rinds and Sugar of Violets.

As for the Topical means, which respect the Part and the Humor, they are of three sorts: Revellen∣tia, Defensiva or Intercipientia, and Repellentia: now Medicaments appointed for Revulsion, must be hot and attractive, and applyed to the parts opposite and remote, as I have set down in the general me∣thod of curing of Tumors. Of this kind are Fomentations, made of all sweet Smelling and hot Gar∣den Herbs boiled in strong Wine, as Calaminth, Penniroyal, Mints, Lavander, Tansie, Time, Smallage, Feverfew, Sage, Savory, Pellitory of Spain; the Fomentation must be very hot, the use of them must be continued until the part become Red. Sometimes, if the affluxion of the Humor be fierce, and plen∣tiful, we are to apply Vesicato∣ries, as in Inflammations of the Eyes to the Neck: but seeing there is none who is but initiated in the practice of Chirurgery, who is not fitted with a Medicament for this purpose, I mean not to mispend Time in setting down any descri∣ptions of them. But let me tell you, that some forts of Ranun∣culus, or Crow-foot green beaten and applied to the Part, are more secure than Cantharides; but the Bull-foot, which is found in most Pools by the High-way, is most excellent, being beaten, and ap∣plied in a Walnut-shell, or Muscle, or Cockle-shels, choosing the am∣pleness of the Shels, according to your purpose. If in the Winter time you apply Cantharides, you must correct them with Eupher∣bium, Mustard-feed, and Seeds of Ammi, or Dill; for if a Vesica∣tory of them be applied to thin and tender Bodies, it will cause difficulty of Urine, which will be removed speedily, if the Party drink of an Almond-Milk, made of Barley-water, wherewith the emulsion of the great cold Seeds hath been drawn, and that warm. Besides these local Medicaments, we are to use Cupping-glasses, sometimes without scarification, if the Party be timorous, and not very Plethorick; but if the affluxi∣on of Humor be great, and the Party strong and couragious, let scarification be used. Frictions also are not to be omitted; but in this exercise we must begin at the Extremities, as Hands and Feet, and end at the Trunk of the Body, to move the Humor, and then to labour again from the Trunk to the Extremities, to bring it downwards.

As for Ligatures, in applying them you must begin at the Trunk, as about the Shoulder, and articula∣tion of the Thigh, and end in the Hands and Feet, making three Li∣gatures in each Extremity; above the Elbow, and about the Wrist in the Arm, and above the Knee and Ankle in the Leg.

After revelling means, Defen∣sives succeed. These are applied to stay the Humor from flowing to the Part, these must be cold, dry, and astringent, sit to purse in and contract the Vessels. These are applied to the parts adjacent, and which have less Flesh, as to the Joynts, and parts above the Joynts; for there the Vessels are most con∣spicuous, and so are most apt to receive the impression of the Medi∣cament: so if the Foot or Hand be inflamed, let the Defensives be applied to the Wrist, and so forth.

Of these Defensives there be two sorts; for some are more mild, as Plantain, the White Rose, Night-shade, Red Poppy, or Wa∣ter of the Spawn of Frogs, Red Wine, Vinegar and Water, Vine∣gar and Oyl beaten together, cal∣led Oxelaeum, Verjuice, and such like, and these are to be applyed to tender Bodies, and who have but small Veins. Others are strong∣er, as Bole, Sanguis draconis, Ter∣ra sigillata, Pomegranate-Flowers and Rinds, the Decoction and Pulp of Sloes, Sumach, Myrtle-Berries. These are to be applyed to Bodies of a strong Constituti∣on, of ripe age, and who have large Veins, and in the Summer time, and when the Inflammation is fierce. Of such Simples we may make Compositions fitting our purpose: as mingling Ma∣stick and Bole with the Oyl of Myrtles, and Whites of Eggs: The juyce of Housleek with Milk is good, or a Decoction made of Red Wine and Tanners Woose, wherein are boiled Red Rose Leaves, Myrtle-berries, Sumach, and Pomgranate Pills and Rinds: Ceratum Santalinum is good. It is not amiss to have in readiness, such a Defensive as this, Take of White Wax Ten Ounces, of the Oyl of Myrtles, and Quinces of each one Ounce, of Mastick pow∣dered ʒ iij of Bole, and Sanguis Draconis beat to Powder, of each j Ounce and two Drams, make up an Emplaster: in the Winter you may add more Oyl.

Last of all Repellentia offer themselves, which beat back from the part affected, the Humor: The differences of such Medica∣ments, taken from their Substance are these. Some are cold and moist, as Housleek, Lettuce, Purs∣lain, Succory, Ducks-Meat, the White of an Egg, Navelwort, Night-shade. These are mild, you may use either the juyce of these, or a Cataplasm made of Bar∣ley-meal, and these Juyces. There be some Simples which more strongly cool, as the Henbane, Mandrake, Hemlock, the deadly Night-shade, and the Apple of Pe∣ru: but these are only to be used, when the Party is of a flourishing age, in the Summer, and the Veins large.

Again, some of these repelling Medicaments are astringent, cool∣ing and drying: these repell more strongly than the cold and moist, for besides cooling, whereby the

natural heat flying its contrary, doth carry with it the Blood; they draw together the part, and as it were wring out the Humor: of these some are weaker, as Vine-Leaves, Plantain, Horse-tall, Perl∣winkle, Bulls of Red Roses; Oyl of Myrtles: others are stronger, as Bole, Pomegranate Pills and Rinds, the Pulp of Sloes, Oaken and Ow∣lar Bark, Red Wine with Alum, Galls, the husks of Green Nuts: These if they be untimely used, wrinkle the Skin, increase the pain, indurate the Humor in the Part, and sometimes return the Matter to some principal part.

Wherefore if we will use aright the Simples, and make good Com∣positions of them, we must dili∣gently consider the temperature of the Party and Part, the mea∣sure of the Inflammation, the quantity of the Humor flowing, the Sense of the Part, the Passa∣ges and Air. Wherefore the hot Constitution of the Party and Part require gentler Topicks, because the excess is not great, only Heat being added to Heat; but if the Part be cold, and less fleshy, it requireth stronger Medicaments; because the Cause must be great∣er: So in Children and Women we use milder than in aged and strong Bodies: So the greater the Inflammation is, the stronger ought the Topick to be: So if the Part be very sensible, gentle means will serve, but if it be dull it will suffer stronger; so if the Veins be large, stronger Medicaments are to be applyed, because plenty of Blood must needs flow. Last of all, ac∣cording to the constitution of the Air, the local means must be strong∣er or weaker.

Now it is time to determine, what Medicaments are to be used in the beginning of a Phlegmon: If therefore the Party be offered while the Blood is wholly yet in the small Veins, then repelling Medicaments are to be applyed. 1. Because the Humor as yet is but little and thin. 2. Because Nature as yet is strong. 3. Because the Matter is not as yet setled or im∣pacted; If some of the Humor be in the small Veins, and some be without them in the distances of the Muscles, and Parts, or in the Porosities of the similar Parts, we are to apply Medicaments part∣ly repelling, partly discussing, but more of the repelling.

Nevertheless, in cases repelling, Medicaments are not to be apply∣ed unto Phlegmons beginning. 1. If the Parts be weak, lest their Natural Heat be quenched; such are Glandulous parts, for they are loose and flaggy. 2. When there is in∣tolerable pain; for then repelling Medicaments would cause greater pain, and so perhaps cause Fainting and Swouning. 3. When the Cause is External, and causeth the Malignity, as the biting of a Mad Dog, or of an Adder; for so the Matter should be driven to the principal Parts. 4. When the Fluxi∣on is vehement, and much Matter floweth; for then repelling Medi∣caments should be fruitless; the Part not being able to resist.

But seeing I have set down both the Simples, and some forms of compound Medicaments of the Two kinds of Topicks, I will ab∣stain from all idle repetition, and pass to the Augmentum, or increase of a Phlegmon. In it then we

are to apply discussing Medica∣ments mingled with repelling, yet the repelling during the whole course of the Augmentum, ought to have the Dominion; because un∣til the latt••r end of the increase, the greatest part of the Matter is within the Vessels, and may be repelled; for when Blood is once slipt out of the Veins, it cannot be evacuated by repelling, but by discussing Topicks: These are called also 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. They ought to be hot and dry in the Third Degree, and of a piercing substance: For First, they must make the Blood thin and fluxible: Secondly, They must convert it into Vapors; And Thirdly, They must evacuate by the Pores of the Skin, by insensible Perspiration. In thin and tender Bodies in the Summer time, mild Medicaments are most convenient, as Chamomil, Dill, Fenugreek, Bean-Flour, and such like. But in compact, and thick Bodies, strong are required, as, Sulphur vivum, Opopanax, Gal∣banum, Mints, Horehound, Worm∣wood, Calamint, &c.

When the Phlegmon is come to the state, or height of pain, Ten∣sion, and Heat, Medicaments equal∣ly repelling, and discussing are to be applied; because a great deal of the Humor is yet in the Veins, and much without them.

When a Phlegmon is come to the Declination wherein Tension, and Heat begin to abate, a dis∣cutient Fomentation, made of Cha∣momil Leaves and Flowers, Meli∣lot, Dill; Tanlie, Sage, Lavander, Mints, Scordium, and such like, and the application of Diachylon cum gummi will serve, or a Cata∣plasm of Bean-flour, Chamomil, Dill, Melilot boiled in strong Ale-Lees, adding to the Cataplasm, Oil of Chamomil, Dill, and White Lilies; but if the Inflammation be great, the Pain vehement, the Heat into∣lerable; if there be Tension and Swelling, notwithstanding the fol∣lowing of the former course, then Suppuration or Apostemation is to be procured.

If the natural Heat in the Body of Man be prevalent, it turneth all things to nourishment, that are familiar to Nature; if any Excre∣mentitious part be in them, it turneth that into Vapors, and ex∣pelleth them by insensible Perspira∣tion. But if the natural Heat be in∣forced to encounter the unnatural Heat upon equal terms, then the natural Heat discusseth some part, and the unnatural Heat not able to corrupt the Part, suffereth a Mean to be wrought, that is, Ge∣neration of Quittour. Now un∣to which of them the Victory in∣clineth, may be gathered by the qualities of the Quittour. If the Quittour be good, it is White, because it is caused by the coats of the Veins, Arteries, Nerves, and Membranes, which are in co∣lour White, and transmute the Matter into the same colour. Se∣condly, thick, because Concoction is performed by thickning. Third∣ly, Uniform, because the natural Heat hath an absolute Dominion over every part of the Quittour. Fourthly, Not stinking, the natu∣ral Heat induring no putrefaction: If contrariwise the Quittour be pale, red, or black, thin, une∣qual, of divers substances, and stinking; then the unnatural Heat

is prevalent. Now how a Phleg∣mon, which must be Suppurate is to be dressed, I have set down at large in the former Chapter of Apostumations of hot Tumors.

But because Examples are the most effectual Instructers, I will give you one out of Hildanus his Ob. Chir. Cent. 3. Ob. 100.

A Gentleman's Servant, a young Man, after over-violent walking, was troubled with a pain in his Foot, and not minding it in the beginning, the pain increased, and an Inflammation ensued. I was called, and found his Foot all swelled, and seized with a Phleg∣mon. The pain was great, and reached to the Hips, he was in a continual burning Fever, he was restless, delirous, and fainted away sometimes; I ordered his Cure in this manner. I prescribed him a spare Diet, and purged him with the following Potion. ℞ Elect. de succo rosar. Pulv. Pas∣savanti cum Rhabarb. ℈jss. Syrup. ros. solut. ℥ j. Cum decoct. agri∣mon. veron. rad. Lapat. acut. cor∣tic. inter. radic. frangul. & sem. anis. f. potiuncula. This purged him gently. The Evening of the same day, two hours after Sup∣per, I gave him Laudani gr. vj. He rested well that Night, and was a little refreshed. Wherefore the next day I took away Ten Ounces of Blood from the Arm of the Side affected, (for he was Plethorick and strong). Hereup∣on his Fever, Pain, and Inflam∣mation abated much; immedi∣ately after I anointed his Hip, Knee, and all thereabout, that was free from Inflammation, with the following Liniment ℞ Ol. ros. ℥ ij. Ol. Lumbric. Axung. human. a. ʒ ij. M. And because according to Galen l. 1. de simp. med. facult. Fat things ought not be applyed to the part af∣fected, I applyed the following Cataplasm. ℞ Sem. Cydon. Foenugr. Alth. a. ʒ ij. Pulv. rosar. ʒ ss. Coquantur cum s. q. aquae adfor∣mam cataplasmatis. Postea ad∣misce vitellum ovi cum albumine. Applicetur & renovetur quoties∣cun{que} opus videbitur. After these Medicaments were applied, the pain began to asswage very much, and the place of the Matter ap∣peared, to which I applyed Em∣plastr Basilic. and the Cata∣plasm prescribed all over the Foot. And because the Sole of the Foot is very callous, I dili∣gently fomented it with hot Milk, wherein Fenugreek Seeds, and Mallows, and Violet-Leaves were boiled. Then I shaved off the Callosity with a Razor, as I have written, Obs. 97. Cent. 7. in the Cure of a Whitlow. Thus in a short time the Aposteme broke in the Sole of his Foot, and he recovered. While I at∣tended his Cure, his Mistress told me, that a Kinsman of his died in a few days of the like Disease. which need not seem strange to any Man. For the Part being Nervous, and endued with a most exquisite Sense, it must needs oc∣casion most grievous Symptomes.

Hitherto I have spoken of a true bred Phlegmon, engendred of sin∣cere Blood. Now I shall take no∣tice of a Bastard Phlegmon, which is caused by the admixtion of some other Humor with Blood: If Cho∣ler be mingled, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

If Phlegm 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: If Melan∣choly 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. See∣ing compounded Diseases are to be discerned, esteemed, and cured by the Diseases and Simples solitary, I need not say much of them. If Choler abound, we are to cool and moisten in a higher measure than in a true Phlegmon. If Phlegm he joyned, we must heat more. If Melancholy, we are to use things warming and softning. They who have written of Tumors after a Phlegmon, have set down Dis∣courses of a Gangreen, Carbuncle, and a Pestilential Bubo, but imme∣thodically: For a Gangreen is an Accident, which doth not only accompany Tumors, but Wounds, Ulcers, Fractures and Dislocations, and that more often; of it there∣fore I will discourse in its pro∣per place. As for a Sphacelus Mortification, or Sideration of a Part, it belongs to the third part of Chirurgery, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which teaches to take away su∣perfluities: such as a Member is by Accident, when it is deprived of Life, and threatens Corruption to the whole, unless it be taken a∣way.

A Carbuncle and a pestilenti∣al Bubo are symptoms of the Pestilence, as a Venereal Bubo of the Pox. Of these I shall treat, when I discourse of Dis∣eases unto which they are to be referred.

Unto Phlegmon 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, that Tumor which is cal∣led Panus, Panis, or Panicula in Latin, from the Figure in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, is to be refer∣red: It is a Tumor most com∣monly in the glandulous parts, somewhat flat, in the top where∣of there is a representation of a Pustle: It hath a greater heat and pain than the bigness of the Tumor sheweth; it is com∣monly most discussed without A∣postemation: Because it hath more Choler than Blood. But contrariwise 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 hath more Blood than Choler, for it quick∣ly cometh to Suppuration. In form it is like to Panus, a Wea∣vers Roul or Touch-wood, and hath this same seat, to wit, the Glandules in the Emunctories. As for furunculus or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, it is en∣gendred of gross Humors mingled with Blood in Fleshy Parts most commonly: If it be mild and come to Maturation without any great difficulty, it may be referred to 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. If it be hard and stubborn to medica∣ments, it is to be referred to 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

CHAP. VI.

Of an Erysipelas.

BEfore I speak of an Erysipilas, that I may make all things more plain, I will tell you first the signification of this term Choler: Secondly, the divers kinds of Cho∣ler: Thirdly, the Signs of a cho∣lerick Person: For such an one is most subject to this Tumor. Cho∣lera then in Latin, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek signifieth not the Humor, which in English is called Choler or the Gall; but a Disease, where∣by this Humor is expelled vehe∣mently by Vomit and Stool. Ne∣vertheless in our Vulgar Speech, and with the Barbarous late Wri∣ters, it is taken for the Humor it self; and so I shall be inforced to use it. Thus much I thought fit to insinuate to you, that you should not be ignorant of the proper and learned significations of the terms of Art.

Now Bilis or Fel in Latin, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, Choler or Gall in Eng∣lish, is either Alimentary, or Super∣fluous: The Alimentary is the fourth part of the Mass of Blood dry and hot, which more properly might be called Bilious Blood: the Superfluous, which serves not for the nourishment of the Body, is either Natural or Unnatural: The Natural is that which in the Liver is separated from the Blood, and sent to the Vesica fellis. The Un∣natural comprehendeth four sorts under it. I. Is the Vitelline, like unto the Yolks of Eggs yellow; but thicker and hotter than that of the Gall. II. Is Porracea, which in colour representeth the Leek, it is engrendred in the Stomach by reason of Crudity, and eating of such Meats as engender it: as Gar∣lick, Onyons, Leeks, and Milk in Infants, who often by Stool dis∣charge such an Humor. III. Aeru∣ginosa, like Verdigrease engendred of more vehement Heat, and cor∣rupt Aliments in the Stomach. IV. Is I 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 like unto Woad, it is more green than that which resembleth the Leek: It is caused of the Aeruginosa more burned, and cometh near to Atra bilis.

Now, a Man is thought to be of a Bilious Constitution, if he be Watchful, Nimble, Hasty, Angry, and dreams of Fire and Thunder, his Urine is thin and yellow, his Pulse strong, swist and hard, his Veins are large, the habit of his Body is lean and dry, his colour yellowish: cold things refresh him.

These things premised, I come to the Tumor Erysipelas it self; Of it I will set down five things:

The Etymon of the Word, the Nature of the Tumor, the Signs of it, the Prognosticks of it, and last of all, the Indications of curing of it. 1. As for the Etymon of the Name of this Tumor it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek quasi 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: for the Antients for 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which signifieth red, used 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 signifieth near, wherefore 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is nothing else but a Tu∣mor in Colour, coming near to Red, and tainting often the adja∣cent parts: for thin and hot Blood, or Blood with which yellow Choler is mingled, dieth the Skin with the colour of a pale Rose: the Na∣ture of an Erysipelas is discovered by setting down the Description, and Kinds of it.

An Erysipelas then is a hot Tu∣mor proceeding most from Choler. In this Description Tumor is the Genus: for this is common to an Erysipelas with all other Tumors. In that it is said to be hot, it differeth from Oedema and Scirrhus: And whereas it is affirmed to proceed of most Choler, it is distinguished from all the rest of the Tumors.

But here it may be demanded, whether an Erysipelas be caused of Alimentary, or of superfluous Cho∣ler. I answer, that it is to be thought that it is caused of the ali∣mentary Choler, if it be exquisite: otherwise how could the yellow Jaundise and an Erysipelas so much differ, if they both did proceed from excrementitious Choler? For first, the yellow Jaundise possesseth the Skin of the whole Body, but an Erysipelas one part only Second∣ly, an Erysipelas hath always a symptomatical Fever annexed to it; but the yellow Jaundise is most commonly free from it. Thirdly, in an Erysiypelas there is always pain, but in the Jaundise none. Fourth∣ly, in the Jaundise the Skin is of a yellowish colour, but in an E∣rysipelas it is of a bright red co∣lour.

There are two kinds of Erysipe∣las, for it is either exquisite or not exquisite, or a true, and a bastard one: As for an exquisite Erysipelas it is a Tumor of a bright Red tend∣ing to Yellow, causing little swel∣ling, very hot, with a pricking pain, caused of alimentary Choler: this Choler abounding in the Body, if part of it be turned into any part, it causeth an exquisite Erysipe∣las. The parts which it most com∣monly invadeth, are the Nose and Face, for much thin Blood floweth to these parts. Secondly, the Legs: for Nature being moved by the plenty of this Choler, sendeth it first to the Emunctories of the Groins, and from thence it de∣scendeth to the Legs; it happeneth in the Summer, because then Cho∣ler is multiplied; but in the Win∣ter, because the Pores of the Skin are shut by Cold, and so insensible perspiration hindred; and because this Humor is thin, it spreadeth to a great part of the Skin.

As for the Signs of an exquisite Erysipelas, they are either taken from the Qualities of the Humor which causeth it, or from the diffe∣rences between it and a Phleg∣mon. The Signs taken from the Qualities of the Humor are these: The Pain is great and urgent, the Heat notable, the Colour a bright red tending to a yellowness, the Tumor is small, only possessing the Skin, the Pulsation is very

small, and less than in a Phlegmon, First, because the Parts in a Phleg∣mon are more compressed: and it reacheth deeper. Secondly, be∣cause in a Phlegmon the Humor is thicker, and cannot so easily be breathed out as in Erysipelas. The differences between a Phlegmon and an Erysipelas are these. I. A Phlegmon possesseth the Skin, and the Flesh lying under; but an E∣rysipelas the Skin only: the cause in an Erysipelas is the thinness of the Humor, which rather disperseth it self through the Skin than hea∣veth it up. II. The Heat in an Erysipelas is greater than in a Phleg∣mon: for sometimes the Cuticula is blistered. III. The symptoma∣tical Fever is greater in an Erysi∣pelas than in a Phlegmon: be∣cause Choler is hotter than Blood. IV. The pain in an Erysipelas is less than in a Phlegmon: because in it there is only a hot Distempe∣rature; but in this a Solution of Unity, besides the Parts being stretched. V. In a Phlegmon, the Colour is of a dark red by reason of thick Blood lying deep; but in an Erysipelas the Colour is a brighter Red, tending to a Yellowness. VI. In an Erysipelas there is a pricking pain, but in a Phlegmon a heavy and stretching one. VII. The Skin in an Erysipelas be∣ing pressed yieldeth, but in a Phleg∣mon it doth not: The Causes are the thinness and thickness of the Humor. VIII. In an Erysipelas the redness vanisheth away from the Skin, and it becomes white, if it be pressed with the Finger, but in a Phlegmon it doth not so. IX. In an Erysipelas there is no stretching of the Skin, but in a Phlegmon there is. Last of all, a Phlegmon set∣teth it self in one place; but an Erysipelas maketh the parts adja∣cent red by spreading.

As for the Prognosticks of an Erysipelas: I. That which proceeds from natural yellow Choler is mildest: for no vehement Symp∣toms succeed: and besides, seeing it appears in the outward parts, it is to be thought that the inner parts are discharged of this Humor. II. As it is a good sign, if an Ery∣sipelas be driven to the outward parts; so it is fearful, if it return from the outward to the inward parts, Aphor. 25. sect. 9. III. An Erysipelas appearing in the Head is more dangerous, than in other parts: because if the Matter pass to the Meninges, it causeth Phre∣nitis or Raving; if to the Muscles of the Neck, the Quinsie. IV. An Erysipelas appearing in Wounds, Ulcers, Fractures, and Dislocations, is commonly Mortal; if it proceed not from the Application of too hot local Medicines. V. If an Ery∣sipelas tend to Suppuration, it is not good: for then the Humor must be thicker than ordinary, and the Obstructions stronger, and so the solid Parts are in danger to be corrupted. VI. If a Bone be∣ing bare, the adjacent fleshy parts be possessed with an Erysipelas, it is ill: For first, the Body must be troubled with sharp Humors: Se∣condly, Flesh cannot be restored by such Blood.

There are four kinds of helps, Dyet, Chirurgery, internal Medi∣caments, and local Means. As for the Dyet, our nourishment must be cooling and moistning. Let the Patient then eat thin Chicken

broths, altered with cooling Herbs, Panadoes, thin Oat-meal Gruel, Sallets of Lettuce, Sorel, Purselain, and Spinage boiled. If the Choler be very thin, the party may eat fresh Fish, which live in clear sandy or rocky Waters, as Trouts, small Pickrels, Perches, and of Sea-fishes the Whiting-maps, and Smelts; he may eat also of the Brain of a Pig or its Petitoes, or Trotters with Vinegar and Sorel; let him refrain from all Meats which are fat and sweet. Let his drink be Spring-water, boiled with the bottom of a Loaf, made plea∣sant with some Oxysaccharum, or the distilled Waters of Endive or Sorel; he may use a plain Ptisan. Galen, lib. 9. met. c. 5. permits the Patient to drink as much cold Water as he will, for this cools the Body, quenches Thirst, abates the heat of Choler, and cooleth the Liver: but in this case the Season must be hot, and the Stomach good: with us Small-beer botled is best, all sorts of Wine are for∣bidden. In the Summer, let the Air be cool and moist, in Winter, let it be rather hot: for in this Season an Erysipelas is caused of the constriction of the Pores of the Skin, by reason of cold: let all perturbations of the Mind be ba∣nished, let sleep be procured; for watching drieth the Body. But if an Erysipelas be in the Face, watch∣ing is best: for immoderate and long sleep fills the Head full of Vapors, whereby the Grief is in∣creased.

As for the Chirurgical helps, it may be doubted whether Phlebo∣tomy be necessary or no: for the decision of this doubt, these Pro∣positions shall serve: I. If an Erysipelas invade the Head, Neck or Face, the Cephalica always is to be opened: lest a Phrenitis or Angina ensue. II. In an Erysipelas Phlegmonodes, wherein Blood in∣creaseth the heat, in what part of the Body soever it be, a Vein is to be opened. III. In an exquisite Erysipelas in other parts of the Body we ought not to let Blood: For first, by letting of Blood, the Blood which remains moveth more, and becomes more subtil: Secondly, the qualifier of Choler is taken away: Third∣ly, by taking away both good and bad Blood together, the party is weakned.

As for the internal Medicaments, they ought always to go before the local, if you except two Cases: I. If an Erysipelas be procured by an outward Cause, as a Blow: II. If the Heat be vehement, and the Tumor be far from any princi∣pal part. In these Cases we may apply something cooling and moistning, before we give any purging Medicament. If an Ery∣sipelas appear in the Head or Face, we must open a Vein, apply Leeches, give a purging Medicament, prescribe a slender Dyet, and use Revulsions by Frictions, Ventoses, Blisterings, and Vomiting if it appear in the Legs.

As for local Medicaments, we must look about us, for if we apply cold Medicaments, the Mat∣ter may be repelled to the Brain, from whence a Phrenitis may proceed, or to the Throat, which may cause an Angina: If you be inforced by the importunity of the

Patient, or standers by to apply a local Medicament; Aëtius coun∣selleth to apply a Swallows nest beat to powder, and tempered with Hony, that it may represent a Liniment with a Feather. This is a safe Medicament, for it only drieth and repelleth not: We may also apply the Decoction of Mallows with some Oyl of Violets, or sweet Almonds. Now the purging Me∣dicaments which discharge Choler, these or such like will suffice, Rheu∣barb, Tamarinds, Cassia extracted, Electuarium lenitivum, Diacatho∣licon, Diaprunum solutivum, Ele∣ctuarium de succo rosar. Caryoco∣stinum. If it be but a mild In∣flammation, sharp Clysters made of the decoction of cooling Herbs, with the aforesaid Electuaries will serve the turn.

Having set down the helps taken from Dyet, Phlebotomy, and the ministration of internal purging Medicaments, I must hasten to set down convenient local Medica∣caments; for in these we are most imployed and busied: one thing is to be observed, that we must not in any case apply astringent Medicaments, which are cooling and drying: For seeing the Vapors in this Tumor are sharp, if they be kept in, they might erode and corrupt the part. Now as con∣cerning local Medicaments; First, I will set down which they are: Secondly, how long they are to be applyed. These Medicaments ought to be cooling and moistning: but before I name them, let me warn you, that first you refrain from Narcotical Simples, unless exceed∣ing great pain, and a part far from a principal part call for them. Secondly, that you apply not unctuous and fat Medicaments: For first, they most easily are in∣flamed: Secondly, they stop the Pores. Now the Medicaments which are to be imployed, are either Simple or Compound: The Sim∣ple are Navel-wort, Horse-tail, Knot-grass, both the Plantains, Ducks meat, Garden Night-shade, Lettuce, Purselain, the Poppies: First, the Juyce of them expressed may be applied: Secondly, the distilled Waters drawn from them, some Powder of Myrrhe having been infused in them. We may also apply Clouts wet in the Juyces of the aforesaid Herbs, being mingled with Verjuyce or Vinegar. The compound Medica∣ments are Ceratum infrigidans Galeni made of lb j. of Oyl of Roses, and ℥ iiij. of white Wax: this is to be washed with Water and Vinegar. You may add to it the Juyce of Night-shade. Heurnius hath three good Medicaments: The first is Castle-soap dissolved in Spring-water: The second, is Bulls dung boiled in a Frying-pan with Vinegar, and a few Flowers of Chamomil and Elder, until it come to the consistence of a Lini∣ment: The third is made of two parts of Aqua Spermatis rana∣rum, and one part of Rose Vine∣gar, wherein some Myrrhe must be infused: these may be safely applied to an Erysipelas of the Head, Neck or Face: the Juyce of Horse-dung is not only good, being applied to this Tumor, but in Scaldings and Burnings also, if a little Camphor be added to it.

The Medicaments which are to

be applied to an Erysipelas must be very liquid, actually cold, and of∣ten changed; for when they be∣come hot, they will rather offend than profit, if they be not remo∣ved. The last thing which I pro∣mised to set down concerning the local Medicaments, was, How long they were to be applyed? This we may find out by two Signs. The First is, If the Heat be altogether a∣bated, or almost: The Second is, if the Skin hath recovered its own colour. When you perceive these two Signs, you must desist from applying cooling Topicks, lest the Skin become livid, or black, which threaten a Gangreen, and some∣times Mortification. If this ap∣pear, What then is to be done? First, a Fomentation is to be used, made of Calamint, Scordium, Worm∣wood, Peniroyal, the lesser Cen∣taury; and Betony boiled in a weak Lie made of ordinary Ashes: Af∣ter the part is sufficiently foment∣ed, you are to apply Hippocrates Cataplasm made of Barley-meal, Vinegar, and Oyl of Roses warm: or this, take of the Flour of Bar∣ley, Beans, and Vetches of each liij. ℥. of a weak Lie, iii j. lb. boil these to the consistence of an Em∣plaster, then put to it iiij. ℥. of Oxymel. If the discolouring of the Part pass through the Skin, and the part be immoderately cooled, it will not be amiss to scarify the part which only remaineth.

Hildanus Obs. Chirurg. 82. Cent. 1. gives good caution against using Oyls in an Erysipelas. He says, a certain Countrey fellow had an Ery∣sipelas Phlegmonocides in his Left Hand, who by a Barbers advice, anointed his Hand and Arm for several days with Oyl of Roses; whereupon Pain and inflammation ensued, and all Symptomes grew worse and worse, till in fine his whole Hand Gangrened: When he came to me, I treated him with Scarifications, and other Re∣medies proper for the Cure of a Gangreen, and he was Cured. So that as Galen, l. 5. de Simpl. Med. has advised, Oyl is bad for In∣flammations.

A Bastard, or spurious Erysipe∣las, is when with alimentary Cho∣ler another Humor doth concur. Now seeing Four other Humors may associate themselves to Cho∣ler, so many kinds of a Bastard Erysipelas may be accounted. If therefore some Blood be mingled with Choler predominant, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is caused: in this kind of Tumor the Redness is more dark, and the Swelling not so spreading. If a waterish Phlegm be mingled with Choler, then 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 ariseth: If gross Blood or thick Phlegm con∣cur with Choler, then 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is caused: Lastly, If Choler associate it self with the corrosive Salts of the serosity of Blood, it causeth Erysipelas ulce∣rosum, which breaks the Skin. But compound Humors are to be di∣scerned by the Doctrine of the simple, and the Medicaments are accordingly to be applyed.

Of that Erysipelas which breaks the Skin, there are two kinds, Herpes miliaris, and Herpes exe∣dens: Herpes miliaris is caused of a salt waterish Humor mingled with unnatural sharp Choler: the signs of it are these. First, many Pu∣stules rise in the Skin like to Mil∣let

Seeds. Secondly, When they break, a Matter issueth out repre∣senting Quittour and Sanies. Third∣ly, The place hath a mingled co∣lour between Red and Pale: This is without danger, the Medica∣ments which are to be applyed to this, ought to be cooling and dry∣ing, as Knot-grass, Horse-tail, Plantain, Owlar, Willow and Oaken Bark, Pomegranate-Flow∣ers and Rinds, Myrtle-Berries, Red Rose Leaves boiled in Tan∣ners Woose, Ʋnguentum album Ra∣sis, de cerussa, de minio, Diapompho∣lygos.

Herpes exedens, called by Celsus, ignis sacer, and by some ignis Sancti Antonii: it is caused of un∣natural Choler, hot and sharp, cor∣roding the Skin only, by the which sign it is discerned from Phagedena, or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Wherefore if many small Ulcers appear not, passing deeper than the Skin; you may pronounce this to be Herpes exe∣dens. In the curing of this, mi∣nister the decoction of Sarsa, and after the fomentation of it with Tanners Woose, wherein cooling and astringent Simples above-men∣tioned have been boiled; apply this local Medicament. ℞ cerae fla∣vae ℥ ij. resinae pini. ℥ j. ss. tere∣binth. ℥ j. ol. myrtini. ʒ vj. succi Nicotianae. ʒ iij. Coq. in ceratum molle. But here a question may be moved, why Choler which caus∣eth the Yellow Jaundise doth not ulcerate the Skin? This falleth out: First, because the Choler which caus∣eth the Yellow Jaundise is dispers∣ed; but in an Erysipelas it is uni∣ted. Secondly, Because the Choler is natural, and only excrementiti∣tious in the Jaundise, such as is contained in the Vesicula fellea, and discharged into the Guts. Thirdly, because thin Phlegm is mingled with Choler in the Jaun∣dise: for this Disease endeth with much Sweating.

CHAP. VII.

Of an Oedema.

IN the subsequent Discourse of an Oedema, the Third general Tu∣mor caused of Phlegm, I will use the same method which I did in the Doctrine of an Erysipelas. First then, I will set down what Phlegm is, Secondly, the differences of it: and Thirdly, the signs of a Phlegmatick Person, and then I will deliver the Doctrine of Oede∣ma, for such an one is most subject to this Tumor.

Phlegm then is the Fourth part of the mass of Blood, Cold and Moist: As concerning the sorts of it, it is either alimentary, or ex∣crementitious. The natural as it is cold and moist, so it is with∣out

any forraign Tast: as Oil and Butter are accounted Sweet, when as they have no rank taste. This Humor by the natural Heat increas∣ed (as in Famine) may become Blood, and serve for the restoring of natural Humidity: it ought ra∣ther to be called pituitons Blood, than Phlegm.

Unnatural Phlegm is that which cannot be turned into Aliment: of it there are three kinds. The First is Pituita acida, sowre Phlegm, so called from the Tast which it leaves in the Mouth, when it is spit out: This is a raw Phlegm, and bred in the Stomach, through defect of natural heat: so that being drawn into the Veins, it hardly can be altered. The Se∣cond is, Pituita salsa, salt Phlegm, this is caused by the admistion of a thin salt Moisture: For of bitter things, as Aloe, and Coloquint, mingle them with thin Humors as you will, a Salt Tast never can be procured. In Sweat, Tears, and Urine, this Tast is manifestly de∣prehended: a very Novice in Al∣chymie is able to make the Salt of Urine. The Third kind of unna∣tural or excrementitious Phlegm, is Pituita vitrea, representing in colour and substance, melted Glass. This is very cold, thick, and tough, and causes great pain, if it be de∣tained in any part. Galen affirms of himself; that being troubled with a vehement pain of the Belly, by injection of the Oil of Rue, he was discharged of such an Hu∣mor, and so the pain ceased: where∣as before he thought that a Stone had stuck in one of the Ureters.

Phlegmatick persons are slow and sluggish, their Senses dull, they are sleepy, they dream of Waters, Rain or Snow, they are not easily moved to anger, their Pulse is soft, small and slow: their Appetite is not great, they are seldom dry, they by the Mouth and Nose void many Phlegmatick Excrements: their Urine is White or Pale, some∣times thick, sometimes thin; their Stools often are raw and phlegma∣tick: The Blood, by what means soever it flow from the Body, is pituitous: their Body is Whitish, Soft, and Coldish, they are subject to cold and long Diseases, as the Dropsie, Lethargy, and such like: Lastly, they endure Fasting well. These signs shew natural and sweet Phlegm to abound in the Body.

Concerning an Oedema, or a Phlegmatick Tumor, I will dis∣course Five things: First, The sig∣nification of the term Oedema: Secondly, The differences of it: Thirdly, The Prognosticks of it: Fourthly, The Indications of Cure: and Lastly, What Tumors are to be reduc'd to it. As concerning the term 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, in La∣tine, Oed••m••: With Hippocrates and all other Ancients, it is the same with 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which sig∣nifies eminentia, eminence or bunching out: and so every par∣ticular Tumor may be called Oede∣ma. But with Galen, and later Authors, it is taken more strictly for that Tumor which is caused of Phlegm. An Oedema is either ex∣quisite or not exquisite: an exqui∣site is either primary or sympto∣matical: The Primary is caused of natural Phlegm, which is con∣tained in the mass of Blood, and by reason of the too great quan∣tity

of it, incites the expelling facul∣ty to discharge it into the weak∣er and depending parts. Natural Phlegm is cold and moist, thin in consistence, in colour White, in Tast Sweetish, or insipid. The signs of an exquisite Oedema are Five. 1. It is soft and loose, be∣cause it is caused of thin Phlegm. 2. If it be pressed with the Fin∣ger, it has either no pain, or ve∣ry little. 3. If it be pressed down with the Finger, it yields and leaves a pit, which is the most proper sign of an Oedema. 4. It is White, representing Phlegm in colour, whereof it is bred. 5. It is cold without heat, because the pitui∣tous Humor is cold and moist: Avicen calleth this Tumor Ʋndi∣mia. The material cause then of this Tumor, is the pituitous Hu∣mor redounding in the whole bo∣dy. This Humor is caused either of External or Internal causes: the External causes are Air, Cold and Moist, Phlegmatick Meats, Idle∣ness, too much Sleep, stinging of Wasps, and such like: the Inter∣nal are a cold and moist Consti∣tution of the Head, and Stomach, but chiesly of the Liver. This Tu∣mor invades not promiscuously all parts, but such as are cold, weak, and loose, such are the Feet and Hands, the Cods, as in Hernia aquosa, the Eye-lids: and then in them appears an outward Tumor loose, without pain, not altering the colour of them; which being pressed with the Finger, quickly yields and returns. The material Cause being a waterish Humor mingled with Flatuosity: So the Heart and Liver cannot suffer any such Tumor, as neither the Kid∣neys, because these parts are firm and hot. As for the Prognostick, an Oedema is a long continuing Disease, because it is cold, and therefore the natural heat of the parts affected, must be weak. 2. It is not very dangerous, because the pain is none or very small. As con∣cerning the Cure, it is performed either by Diet, or Internal Medi∣caments, or local means: As for the Diet of such as are subject to an Oedema, if it proceed from Ex∣ternal Causes they must be remo∣ved: The Air, which is to be cho∣sen, must be hot and dry, the Food must be drying: Wherefore roasted Meat is better than boil∣ed; Fowls and Birds which live in dry Grounds, are better than Water-Fowls; Rabbets, Chickens, and Veal are good; Mutton is bet∣ter than Lamb; Swines Flesh and Fishes are to be shunned, as also Heads, Brains, and Feet of Beasts: Sallets of cold Herbs are hurtful; use Biscoct-Bread, or good Hou∣shold-Bread baked with Aniseeds, Fennel-seeds, and Coriander-seeds. Let the Drink be altered with the rasping of Guajacum, Sarsaparilla, Radix chinae, Sassafras, Yellow San∣ders, Cummin-seeds, Coriander∣seeds, Fennel-seeds, Anise-seeds, Galingal, Nutmegs, Calamus aro∣maticus, some Ginger, Cinamon, Rosemary and Sage. A drying Dy∣et made of these, especially in the Summer time is good. Sweating in this case is very effectual, eve∣ry other Morning after taking of the Diet: Fasting is good, as al∣so Watching, Studying, and La∣bouring: for all these dry the Ha∣bit of the Body.

If an Oedema possess the Hands,

then walking is good; if the Feet, then we are to prescribe sitting and working with the hands. Seeing then an exquisite Dyet will not serve to conquer this Disease alone, we are to entertain purging Me∣dicaments for obtaining the victo∣ry. We need not to trouble the Patient with many preparative Me∣dicaments, seeing the pituitous Humor which causeth this Disease is thin, waterish and in motion; First of all, no Medicaments inter∣nal are so effectual in this Grief as Mercurius vitae, and safe Medi∣caments of Antimony: For first, they discharge the Stomach of cru∣dities by Vomiting, and so correct the cold and moist distemperature of it: Secondly, they dispatch the obstructions of the mesaraical Veins and Liver: Thirdly, they mightily evacuate waterish and phlegmatick Humors, and so correct the distemperature of the Liver and Kidnies.

As for ordinary internal Medica∣ments, Pilulae de hiera cum agarico, quickned with a grain of Elaterium, are good: Diaphaenicon, Diacar∣thamum, Diaturbith, Pilulae de Hermodactylis, de Aromatibus Co∣chiae. And the Pills of Galen made of Coloquint, Aloe, and Scammonie, with Syrupus Augusta∣nus.

But here you may demand of me what is to be thought of Phle∣botomy?

To this demand I answer, That in an exquisite Oedema opening of a Vein is to be shunned. I. Be∣cause in a Body cold and moist we open not a Vein; such is that which is tainted with an Oedema. II. Because in this Grief there is always Cacochymia, seldom Ple∣thora: III. Because in an Oedema, there is neither a malign Matter, nor a horrible Symptom, and so it cannot be called Morbus Magnus, or a fearful Disease: and so Phle∣botomy is not required. As for the local Medicaments, which are to be applied, they ought by dry∣ing and strengthning to alter the part.

In the beginning we are to apply such Medicaments as repell, and digest; but more digesting than repelling, because the Hu∣mor is cold; for in the beginning some part of the Humor is in the small Veins, some in the Pores of the Skin; but more in the Cavities, and greater Veins: towards the state of the Grief we are to use digesting means. Galen useth four Things. I. A Rowler with two ends, such as is used in Fra∣ctures; first the Rowler must bind the Tumor it self more straitly; but the parts on every side adja∣cent more slackly; for so the Hu∣mor is wrung out from the part affected, to the parts adjacent above and below. II. Is a Sponge; but in the use of a Sponge we must see that it cover all the affect∣ed part, otherwise at the next dres∣sing we shall see that the Humor hath flowed to the bare part: Instead of a Sponge we may use Pledgets of Hemp-tow; yea, and double Cloaths. III. Vinegar; for it doth consume Phlegm, and because it is subtil it pierceth. IV. Some Water to moderate the sharpness of the Vinegar: If the Oedema be above Sinews and Ten∣dons in a tender Body, less Vine∣gar is required. But in hard Bo∣dies,

and in other places more Vi∣••egar is to be applied: If you min∣gle some Alume with Vinegar and Water, the Medicament will be the more effectual. Avicen ad∣viseth to apply Lime-water with the Juyce of Myrtles: but instead of the Juyce we may boil Myrtle∣berries in Lime-water.

If you boil Scordium, Myrtle∣••erries, Sumach, Red-rose Flowers, dried Calamint, Wormwood and Peniroyal, in equal quantity of red ••stringent Wine, Vinegar, Tanners Woose and Lime-water, adding to every Pint of the Decoction strain∣ed 3. drams of Alume, you shall have an excellent Medicament. You may apply also an Unguent made of unslaked Lime, and old Swines-grease.

One thing is to be noted, that the Oedematous part is to be rub∣bed well with a Cloth before the Medicaments be applied, that they may penetrate more easily.

If an Oedema in the Belly accord∣ing to Hippocrates after 60 days tend to Suppuration (which cometh to pass because the Phlegm by long staying in the part, is altered by heat, and turned to Quittour) then we are to hasten Suppuration by the Application of Diachylon cum gummi. Then to open it. Third∣ly, to mundifie it. Fourthly, to incarnate it. And last of all to procure skinning.

Hildanus Obs. 91. Cent. 6. re∣lates a strange History of a Woman, who from her Childhood was troubled with an aedematous Tu∣mor, but hard, in her right Hand, which yet did not hinder the use of it, and she was otherwise very well in Health. Several things had been used, but without success. At last it was resolved to leave it to Na∣ture. And about the thirteenth year of her Age, when her Friends never dreamt of Cure, it began to decrease of it self; so that in few days it was quite gone. But the Physician predicted some ill Event, and so it proved. For it fell into her Shoulder and tormented her most grievously. By using proper means she seemed cured; but in a little time it fell into her right Hip, and there tormented her again; till at length the Head of her Thigh-bone slipt outwards, which made one Leg shorter than the other, which could not be re∣posited. Afterwards, when all was thought to have been over, a pain fell into her right Foot, especially about the Heel, with a great Inflammation, which required a new course. She was Purged, took Apozems, Juleps and Sudorificks, had Topical Anodynes, moderately repelling applied at first, and then things to cause Pus. At last the Abscess broke in her Heel, out of which there ran a great deal of Matter. In a few days a piece of Bone like a Fishes Scale came away; when it was got out, she was cured; only she halted a little.

It falls out many times that an Oedema, is a symptom of another Disease, as I have said: but chiefly of the Cough of the Lungs, Drop∣sie, or Cachexia, or ill habit of the Body, and doth possess the Legs and Hands: First, because they are farthest from the Heart, the Well∣spring of heat: Secondly, because they are framed of cold parts; see∣ing this Accident cannot be remo∣ved,

unless the Disease which is the cause of it be cured, and seeing these Diseases are for the most part mortal, I will suffer such as are Empiricks, and prodigal of their own Credits, to follow their own courses, and to undertake such Cures.

An Oedema is thus engendred: when Nature is troubled with Phlegm, the expelling faculty thrust∣eth the pituitous Humor from the great Vessels to the lesser, and be∣ing kept in by the density and coldness of the Skin, is gathered in the Musculous part, and so causes this Tumor. Hitherto I have discoursed of an exquisite Oedema. Now it remaineth that I briefly dispatch that Oedema which is not exquisite. This is caused when some other Humor is joyned with the pituitous: if Blood then be joyned with it, it causes 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: If Choler concur, it procureth 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: If Melancholy or thick and glutinous Phlegm, it causeth 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. In all these kinds of a not exquisite Oedema, the thin pituitous Tumor must be pre∣dominant. The other Humors concurring are found out by their own proper Signs, which are set down in the discourses of every principal Tumor, so that I should mispend time, if I should go about to set them down here. Some things I would have you to note. The first is, a primary Oedema is caused by congestion; for it creep∣eth on by degrees: But that which is Symptomatical, an Accident of other Diseases, as Tabes, Asthma, Cachexia and Dropsie, is procured by Fluxion: for it suddenly ap∣peareth. The second is this: li•• by reason of long keeping bed, either because one hath had a long and lingring Disease, or because h•• hath received a hurt in the Leg, the Feet swell and become Oedema∣tous: When by motion afterward the Natural Heat is increased, this flatulent Phlegm is discussed and the Tumor ceaseth. But it is time to set down those Tumors which are referred to an Oedema: of those some are enclosed within a Cystis or a Membrane; and some have no proper Membrane: those which have a proper Membrane are in number. 3. Atheroma, Steatoma, and Meliceris. But it may be doubted from whence this Cystis, Membrane, or Folliculus doth pro∣ceed: Undoubtedly it is framed of the tyes of the Cutis and Mem∣brana Carnosa: for seeing the Na∣tural Heat cannot concoct the Matter of these Abscesses, Nature doth providently separate it by its proper Cystis from the parts adjacent, lest it should corrupt them.

The Matter which causes these Abscesses and feeds them, proceeds from a Vein, which is not accom∣panied with an Artery; and so being destitute of Vital Heat, it is altogether unnatural, and cannot be assimilate to the parts unto which it floweth. Atheroma the•• containeth a substance like unto Rice-pottage, or Curds: The Mat∣ter of this Tumor is thick and gross Phlegm.

Steatoma is a Tumor not so high as Atheroma, containing a Matter like unto Grease, or that which we call the Sweet-bread, Pancreas: Blood flowing by the Vein which

hath no Artery, and so is desti∣tute of Vital Heat, is easily turn∣ed into this fatty substance. Me∣liceris contains a Matter repre∣senting Hony: so the Phlegm which causes this Tumor is thinner than that which breeds an Athero∣ma, and hath some Choler min∣gled with it, the heat where∣of maketh the Matter fluid and liquid.

The Tumors reducible to an Oedema which have no Cystis are three, Psydracium, Ficus and Talpa, Psydracium is a pointed white Pustule containing in it a wa∣terish Humidity. Ficus is a Tu∣mor so called; First, because it has a Root like unto a Fig; Se∣condly, because it contains small grains as a Fig hath. It is a Tu∣mor red, round, and somewhat hard and painful; from whence issueth a Matter, like unto the seeds of a Fig, if it be broken and wrung. The Matter of this Tumor is gross Blood, mingled with Phlegm and some waterish moisture. Talpa or Testudo is so called, because as a Mole heaves up the Ground, so this Tumor lifts the Skin from the Peric••anium: This Tumor is lar∣ger than a Ficus, and is caused of more gross Humors; wherein there is little moisture.

So you have a brief description of the Tumors which are reducible to an Oedema: As for the cure of them, I will reserve it until I come to that part of Chirurgery called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; which sheweth how superfluities of the Body are to be taken away. The Modern Authors add to these Nata, which is a large Tumor so called, because it repre∣sents the Buttocks called Nates, without pain, consisting of soft and pituitous Flesh; caused of congestion of pituitous Blood: it is seated most commonly in the Neck, Shoulders and Back: it is only cured by excision.

Ganglium and Lupia are round Tumors of the Nervous Parts with∣out pain: yet they differ; for Gangli∣um is hard but Lupia soft: Secondly, Lupia may be moved every way, upward, downward, and side ways: but Ganglium toward the sides only. Thirdly, Gang'ium is like to a knot of the Sinew; but Lupia possesses not the Sinewy Parts only, but other solid and hard Parts in the Hands and Feet.

CHAP. VIII.

Of a Scirrhus.

NOw are we to enter into the contemplation of a Scirrhus, the ugly progeny of muddy Me∣lancholy, as we have discoursed of a Phlegmon, Erysipelas and Oedema, who deduce their Pedigree from Blood, Choler, and Phlegm, and ascribe their being to them. But that you may hereafter discern the better the nature of a Scirrhus, I will first set down the description of Melancholy: Secondly, the di∣vers sorts of it: And thirdly, the proper signs of a Melancholick Person: which will both lead you to the knowledge of the Grief, and open the way of curing the person possessed with this Grief. Be∣cause the English Tongue doth promiscuously use Melancholy, both for 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Me∣lancholicus Succus, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Atra Bilis, I must give you warning, that these two do much differ; for Melancholicus Succus is the feculent part of the Blood, like unto the Lees of thick Wines, as Allegant. It is one of the four nutritive Humors natural to the Body, and gentle, having no cor∣rosive or stinking quality. But Bilis Atra is caused of immoderate Heat, and is Malign, for it burns and corrupts the Flesh, it is sowre and sharp, and being poured upon the ground, it boileth and raiseth it up, as Leaven doth Dough, and hath an unpleasant smell. There be three sorts of this: The first is caused of Blood burned, and of all others is the mildest: The second is ingendred of Succus Melancholi∣cus burned; and it differs as much from the natural Black, as Lees burned from the unburned: The third is caused of yellow or vitellin Choler more burned, which of all others is the worst; because Choler, whereof it is bred, is more hot and sharp than melancholick Juyce.

None of these are engendred in a sound and healthful person, whereas the Succus Melancholicus is found in all persons of what temperature or state soever they be. Wherefore Melancholicus Suc∣cus may be thus described: It is the fourth Humor in the Mass of Blood, black and thick, yet natural cold and dry. This Humor natu∣ral is either Alimentary or Excre∣mentitious. The Alimentary nou∣risheth the Melancholick Parts, which are cold and dry, as the Bones, Cartilages, and Ligaments. The excrementitious or superfluous is drawn by the Spleen.

Now these signs discover Melan∣cholick Persons; they are silent, pensive, constant in their purposes, slow to Anger; but if they enter∣tain it, they turn it unto Hatred: Their Sleep is troublesome by reason of fearful Dreams, as of black Things, dead Bodies, Death, they are sad, and given to fear without cause; their Pulse is small, slow and hard: their Colour is dark, their Appetite to Meat and Venus is more than ordinary: they sel∣dom thirst, because they abound with much superfluous Phlegm, their Blood is thicker and blacker than ordinary, from what part so∣ever of the Body it flow, the Urine is thin and white, if no Melancho∣ly be mingled with it; but if Me∣lancholy be mingled, then it is thick, black, or of a leaden colour; they Sweat much in their Sleep; the habit of their Body is lean, tough and hard: they are subject to Varices and Hemorrhoids: If such a one be presented to you possessed with a Scirrhus, it is easie to discern the Disease, and of what Humor it proceeds, and how the party is to be dealt withal. In my Discourse of a Scirrhus; I will set down first the Description of a Scirrhus: Secondly, the Signs of it: Thirdly, the Differences be∣tween it and other Tumors: Fourthly, the Kinds of it: Fifthly, the Prognosticks of it: And lastly, the manner of curing it.

To begin then with the Descrip∣tion of a Scirrhus, it is a Tumor hard, and without pain, caused ei∣ther of natural Melancholy, or thick, tough and cold Phlegm. If the Cause be Melancholy, it hath a leaden colour; if Phlegm, it chan∣ges not the colour of the Skin: for Phlegm is white; As for the Signs of it; I. It is hard.

Now there are four Causes of hardness: The first is coldness, as appeareth in Ice; This is removed by moderate Heat, as by the Sun. The second Cause, is Driness, as we may plainly see in the hands of Sailers and Felt-makers. The third Cause, too great Repletion, which doth appear in the Stomachs of Gluttons. The fourth Cause, may be the Combination of these, and indeed all these concur to procure hardness in a Scirrhus. As for Coldness, it may be induced either by things external, as cold Air, and narcotical Medicaments: Se∣condly, from the part affected, for Scirrhositles chiefly appear in the beginnings of the Muscles, Li∣gaments and Tendons, and other cold Parts: Thirdly, from the Humor; so the melancholick Juyce, and thick, and viscous Phlegm, the material causes of a Scirrhus, are very cold.

The second sign of a Scirrhus is, that it is without pain; and this comes to pass, either because the animal Spirits, cannot pass through an Humor so thick and glutinous as that which causes a Scirrhus, or because it is benummed by the coldness of the Humor. This is the third Sign that it is fixt, and as it were nailed to the part, and doth not move by pushing, as Scrophula, or Ganglium.

Now I will shew how it differs from other Tumors. It differs from a Phlegmon; for in this, there is great pain; from an Erysipelas, be∣cause this is not hard; from an Oedema, because this yieldeth to

the touch, and leaveth a pit. It is discerned from waterish and fla∣tuous Tumors, because they have a thinner, and more clear Matter. The differences betweeen it and a Cancer are these. I. A Cancer is always painful, because it is caused of Bilis A••ra, or adust Choler; but a Scirrhus is without pain. II. A Scirrhus is cold, but a Can∣cer hot; this is caused by reason of the Humors whereof they are bred. III. A Scirrhus invades the solid and hard parts, as the Joynts, Ten∣dons and Ligaments; but a Cancer the loose and slaggy parts, as the Breasts, the Privy parts, and such like. IV. In a Cancer, not in a Scirrhus, the Veins appear full of a black Humor: which for the likeness, one may call the Legs of the Crab, as the round Tumor the Crab it self. It is good to set down the predictions of the success of curing, which Scirrhosities are like to have, that when such Tumors are offered to you to be cured, you may be made circumspect and wary in taking of them in hand. An exquisite Scirrhus is uncurable; for seeing it is senseless, it is mani∣fest that the part is deprived of the influence of the Animal Spirits; and seeing this Humor doth distend the Sinews, Veins and Arteries, the Faculty it self is strangled and choaked, so that it neither can di∣rect, nor help the Natural Heat to concur with the means, to be applied for the dispatching of this Grief. Secondly, this being a cold Tumor, and the Natural Heat ex∣treamly weak, what hope can there be, that it can at any time tri∣umph over so great an Infirmity? A Scirrhus not exquisite, al∣though it be not mortal, unless it be very great, yet it hardly admits any Cure, and by much difficulty. A Scirrhus which is extream hard is altogether uncurable: for gentle means avail nothing, and those which are strong make it more hard: A Scirrhus from Succus Me∣lancholicus is warily to be dealt withal: because it has a great af∣finity with a Cancer, and so may degenerate into it, if improper Medicaments be applied. If a Scirrhus be caused of thick and glutinous Phlegm, you may be the more bold: for this cannot easily contract any Malignity. The differences and divers sorts of a Scirrhus are these: A Scirrhus then is either Primary, or Epigene∣matical. A primary Scirrhus is that, which is a Grief of it self, and not caused by reason of any infir∣mity preceding. This is twofold, for it is either exquisite, or not exquisite: a primary exquisite Scir∣rhus is that which at the first, is caused by collection of the Melan∣cholick Juyce in a part. A Scirrhus is thought to be not exquisite, when another Humor is joyned with Me∣lancholy. If therefore some lau∣dable Blood be joyned with it, it causeth Scirrhus Phlegmonoides; if Choler, Scirrhus Erysipelatodes: if Phlegm, Scirrhus Oedematodes. But these are compound Tumors, and are to be dealt withal accord∣ing to the doctrine delivered con∣cerning simple Tumors, whereof they are bred.

A Scirrhus Epigenematical or Symptomatical, is that which en∣sues after another Tumor, not handled according to Art, as a Phlegmon or an Erysipelas: this

happens two manner of ways. I. It may fall out by the immo∣derate use of local Medicaments too cold, and narcotic or stu∣pefactive: for these condense, and as it were congeal the Humor. Secondly, this may happen by the too continual application of reso∣lutive Topicks: for so only the subtil and thin parts are breathed out, and the thick and glutinous remain.

The Indications of Cure are ta∣ken from three things, to wit the Dyet, internal Medicaments, and external Applications. As for Phle∣botomy it is here fruitless, because the Humor is cold, unless the Veins be very full, the Blood black, and Age and Strength conspire: for then it is expedient, because so the Humors in the Mass of Blood will be more fluxible; and the quantity being diminished, the Natural Heat will the more easily rule the residue. If a Scirrhus be caused in a man by reason of the Hemorrhoides stopped, then Lee∣ches are to be applied; if in a Wo∣man by reason of the Menstrues supprest, then the Saphaena is to be opened.

As for the Dyet then, the Meat must be of easie digestion, moist∣ning and affording a thin Juyce: such are Chickens, young Pigeons and Mountain Fowl, Lamb, Veal, young Pullets and Cockrels, fed Rabbets, Poched Eggs, Asparagus Sallet, Spinage, Burrage, Purselain: Bread of good Wheat not too much leavened is convenient. Let the Drink be small White Wine, or reasonable strong Beer well boiled, clear, and neither too old, nor too new; good Cyder also with Rose∣mary, Burrage, Bugloss burned, and Sugar is good. Meats which af∣ford a gross Juyce are to be shun∣ned, as old Beef, all Meats dried in the Smoak, Venison, Fish living in muddy Waters, all Salt Meats, course Bread, the immoderate use of Vinegar is hurtful: Apple-tarts, and Warden and Pear-pyes baked with Fenil-seeds and Anniseeds will serve instead of other Sweat-meats. Let the Habitation of the diseased party be in a pure, hot and moist Air: too much Sleep, Idleness; Grief and Pensiveness are to be a∣voided. As for internal Medica∣ments, they ought to purge Me∣lancholy, and thick and glutinous Phlegm; but both of these are to be prepared before they are eva∣cuated. Those Medicaments which prepare Melancholy, ought to at∣tenuate or make thin, and moisten, such are the Syrups of the Juyce of Burrage, Bugloss, the Syrups of Fumitery, Hops and Apples, with the decoction of Balm, Harts∣tongue, Scolopendria, Tamarisk, and such like. Those Medicaments which prepare Phlegm, ought to be of an attenuating, and mundi∣fying quality, as the Syrup of Hysope, of Betony, of Staechas, Oxy∣mel and Mel rosatum in a decocti∣on of Calamint, Hore-hound Peni∣royal, and such like. The Hu∣mors being prepared, they are to be purged: Melancholy is to be purged with Confectio Hamech, Electuarium Indum, Pills De La∣pide lazuli, the extract of black Ellebor, Electuarium Lenitivum, and the like, which may be mini∣stred in the infusion of Sena-leaves and Polypodie. Phlegm is to be purged with Diaphoenicum, Dia∣carthamum,

Hiera Pachii, Pilulae de agarico & Hermodactylis, Dia∣turbith, and the like. Electua∣ries are to be ministred in a de∣coction of those Simples which prepare Phlegm.

One thing is to be noted, that nothing is more effectual in dis∣cussing these Scirrhosities, than the continual taking of the Decoction of Sarsa Parilla, and Guajacum instead of other Drink, using a convenient Dyet, and procuring every other Morning sweating: for L••gnum Vitae warmeth, and Sarsa dissolveth the hardness: if it per∣form this in Nodes, which are far harder than any Scirrhus possibly can be; why should it not perform this office in a Scirrhus?

Here it is no wonder if few be cured: for sundry are impatient if their expectation be not speedily answered; and besides this, they are unwilling to gain their health, by foregoing their sensuality and pleasure, being Ventris Mancipia, more careful of their Palate than health.

In external Applications, which are fit to be used in the Cure of a Scirrhus, you are to consider three things; their Faculties, their Diffe∣rences, and the right use of them. As for the Faculties then of the local Medicaments, they ought to be discussing and softning, emol∣lientia, and discutientia. Repelling Medicaments are not to be used, because the Humor is thick, and hard, and so unapt to mo∣tion.

Of emollient Medicaments there are four degrees: in the first are those which are gentlest; such are Mans-grease, Capons-grease, the Marrow of Harts, and Calves-bones, Ducks-grease, Swines-grease, sweet Butter. Galen advises to apply to gentle Scirrhosities, a Medicament made of sweet Butter, black Rosin; and new Wax. Dialthaea Simplex is of this Degree. In the second Degree are these, Goose-grease, Badgers-grease, Dogs-grease, old rank Oyl, Oyl of Linseed. In the third Degree, are, the Fat of Lions, Bears, Wolves, Foxes, Libards, and the Marrow of Horses, and Mans∣bones. In the fourth Degree, are Ammoniacum, Galbanum, Bdellium, Caranna, Tacamahaca, Opopanax, of these Simples you may frame unto your selves such Compositi∣ons as the quality of the Scirrhus, which you are to take in hand, shall require. Rases in all Scir∣rhosities commends a certain Ca∣taplasm, and it is excellent in∣deed.

The Description may thus be framed, take of Bdellium, Ammo∣niacum, and Galbanum, of each 1 ℥. dissolve these in a hot Mortar with Oyl of Lilies, add of the Mu∣cilage or Pulp of rosted Figs ij ℥. of the Mucilage of Linseed and Fenugreek, vj ℥. make up a Ca∣taplasm, dress the Scirrhus with this Cataplasm once a day. Diachy∣lon cum gummi, and Emplastrum de Macilaginibus are convenient. Riolan the Father commends this Medicament; Take of Ʋnguentum de Althaea, of Diachylon cum gian∣mi & Emplastrum de Mucilagi∣nibus of each 1 ℥. of the Oyl of Lilies vj. drams: mingle these well together, you may add to these Medicaments some Vinegar to help penetration. If a Scirrhus be above a Nerve or a Tendon,

instead of Vinegar you may use the Spirit of Wine.

One thing is to be observed, that before you apply any Medi∣cament, the part affected is to be fomented with the decoction of Mallows, Marsh-mallows, Chamo∣mil, Melilot, and Cowslip-flow∣ers in Vinegar, unto which after it is boiled, some Spirit of Wine is to be added.

As concerning the right use of local means, these Observations following are worth the noting; The First is: If a Scirrhus be caus∣ed of the melancholick Humor, which is cold, thick, and dry, you are to apply a Medicament which warms, attenuates, and moistens. II. If the Scirrhus be engendred of cold, thick, and tough Phlegm, then the Medicament ought to be warming, attenuating, cutting, and mundifying. III. Tender Per∣sons and Parts require milder; but Parts and Persons harder and stronger require more forcible means. IV. If a Scirrhus has been procured, because an unskil∣ful person has applied Medicaments too much repelling or discussing to an Inflammation; then apply this mollifying Liniment; Take of Yellow Wax, and Ducks Grease tryed, of each j ʒ. of Oil of Li∣lies ij ℥. of the Marrow of Ox Bones ij ℥. mingle them well to∣gether. V. If immoderate use of drying Topicks hath procured hardness, then Medicaments moist∣ning are to be used: such is a Ca∣taplasm made of Mallows boiled, and Capons Grease, or Swines Grease. Hildanus Obs. Chirurg. 79. Cent. 3. relates how a Gen∣tlewoman of Berne had grievous∣ly bruised her Right Hand, which put her to much pain in her Wrist, and caused her Hand to swell. Di∣vers remedies were used; but it ended in a Scirrhus. She went to him, and he found a very hard Scir∣rhus on the inside of her Right Wrist, as big as a Hens Egg; she could not bend her Fingers, be∣cause the Scirrhus stuck fast to the Muscle, which bends the Fingers, and to that part of it where it is distributed into four fleshy parts. After using Universals, such as were requisite, he applied a potential Cautery; after the Eschar was re∣moved, a thin Matter ouzed out for several days: Afterwards, when the Flesh was eroded deeper with Escharoticks, a thick, viscous, and yellowish Matter shewed it self, which he was forced to squeeze out with some violence, having first dilated the Ulcer with Sponges. This Matter, after it had been for some hours exposed to the Air, turned as hard as a stone. He ex∣tracted a great deal of such Mat∣ter at several times. For a pas∣sage was found from the Ulcer, which reached from the upper part of the Wrist towards the Elbow, to the Palm of the Hand under the transverse Ligament, and entring the Palm, between the extuberan∣ces of the Fifth and Eighth Bone of the Wrist. When the Ulcer was Mundified, he successfully cicatri∣zed it.

Unto a Scirrhus these Tumors may be referred, Strumae, Warts, Corns, Leprosie. As for Strumae and the Leprosie, they will require several Tracts.

Warts, if the root be small and the top broad, may be taken away

by Ligature; if the root be broad, they must be extirpate with Me∣dicaments. There I commend un∣to you strong Aqua fortis, or La∣pis infernalis relented; these must be applyed to the Warts with a Rush or a Straw. The Third is an experiment of Fabricius ab Aqua pendente, and that is this; of Purs∣lain bruised, and the Powder of Savin make a Cataplasm and ap∣ply it.

Corns must first be artificially cut, and then only these Medicaments which I shall name, must be ap∣plyed: Ammoniacum dissolved in Vinegar, and brought to the con∣sistence of Cerot, emplastorum de mucilaginibus, and Diachylon cum gummi.

CHAP. IX.

Of Aqueous Tumors.

I Have delivered what I thought most material concerning the Four principal Tumors, Phlegmon, Erysipelas, Oedema and Scirrhus, which are caused of the Four Hu∣mors in the mass of Blood; to wit, Blood properly so called, Cho∣ler, Phlegm, and Melancholy; and so might have concluded the Doctrine concerning the differen∣ces of Tumors, as sundry others have done who have written of this subject.

Nevertheless, seeing aqueous or watry and flatuous Tumors are often presented to Chirurgeons to be cured, I think it expedient to discourse of these, that the Do∣ctrine of Tumors may be com∣pleat.

First then I will discourse of the aqueous, and then of the fla∣tuous Tumor. The material cause of the aqueous Tumor by Physi∣cians is called Serum, or Serosus humor. Of this Humor there is but a small quantity in a healthful per∣son; no more than is fit to make the Blood thin, that it may be the more readily carried unto all the parts of the Body to afford them nourishment. This being done, it is discharged through the Pores of the Skin, either by Sweat, or in∣sensible Perspiration.

Wherefore Galen not without reason affirms all Serosity to be an Excrement.

This Serosity is not only of a moist and waterish substance; but of a salt quality in like manner; yea, this Serosity, Urine, and Sweat have the same Matter: yet they differ; for Serum is that aqueous Humidity which is contained in the Blood: and although Blood be

drawn, yet it cannot be discerned unless the Blood grow cold and congeal, and this thin part by the concretion of the Blood be separa∣rated from the thicker. But Urine is nothing else but the superfluity of this Serosity of the Blood ming∣led with the waterish Humidity of Meat and Drink, and separated from the mass of Blood, and drawn by the attractive faculty of the emulgent Veins and Ridneys, and by the Ureters sent to the Blad∣der, there to be detained until the convenient time of excretion. So that this kind of excretion pur∣ges the Blood from waterish Hu∣midity, whereby it is made more firm, and so more fit to nourish the parts. As for Sweat and in∣sensible Perspiration, they are no∣thing else but the excrements of the solid parts. Nevertheless, they carry with them some obscure signs of the constitution and tem∣perature of the Body. Some pre∣ternatural Causes will increase the serosity of Blood; as Meats afford∣ing plenty of waterish Humidity, as most Fruits, cold Herbs, and immoderate use of Water, and other Drinks: for although some Drinks be hotter than others, yet all of them have more waterish Humidity than Spirit, and by rea∣son of the distemperature and ob∣struction of the parts appointed for Sanguification, oftentimes this Serosity is not separated from the alimentary Humors; but is detain∣ed and increased, and not expel∣led by Urine and Sweat: from whence the Dropsie, Fevers, and Pustules of the Skin do proceed.

An aqueous or waterish Tumor then is caused of the superfluity of this Serosity detained in the Body, after that it has performed its Of∣fice, which is, when it has carried the nourishment through the nar∣row passages: such are the mesa∣raical Veins. If too much of this waterish Humidity be sent to the habit of the Body, and move the expelling faculty, then part of it is sent to the Skin, which causes waterish Tumors. Those which heave up the Cuticula, are called Sudamina. Those which arise in the night time are called Epinycti∣d••s. If waterish Humidity be ga∣thered in the Cod, it causeth 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; if in the Navil, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; if in the Head, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. And although neither Fallopius nor Tagaultius have made any men∣tion of waterish Tumors, think∣ing perhaps that they may be re∣duced to pituitous Tumors, yet these Tumors wherein nothing else but waterish Humidity is contain∣ed, do plainly evince, that an aque∣ous Tumor is one distinct from all others. Superfluity of this Se∣rosity is sent to the habit of the Body: partly because the weak∣ness of the Kidneys, doth not suf∣fer them sufficiently to draw it: partly because the Liver is too cold, and Lastly, by reason of some er∣ror committed in the use of the things not natural, as immoderate taking of Water, and other drink, as Wine, Ale, Beer, Cider. &c.

The signs of a waterish Tumor are these, First, It is sometimes more, sometimes less swollen, yet it yieldeth when it is pressed hard, whereby it is discerned from a Scirrhus. It is distinguished from a Phlegmon, and Erysipelas, be∣cause these are painful, but it not.

It is discerned from an Oedema by this, That it being pressed, it ad∣mitteth no pit, as an Oedema doth. It being beaten it yieldeth no noise, as a flatuous Tumor doth, as ap∣pears in a Tympany. Last of all, when it breeds, there is always an itching in the part, by reason of the Saltness, which is in the wa∣terish Humidity; These Tu∣mors appear in the Navel, Cods, and the habit or compass of the Bo∣dy: yet most frequently in the joynts of the Arms and Legs: be∣cause these parts being weak, cold, thick, are aptest to admit such wa∣terish Tumors. As for the Prog∣nosticks, that waterish Tumor which happens by reason of any imperfection of the Sanguification, is dangerous; not so much in con∣sideration of the Tumor it self, as of the infirmity of Sanguificati∣on. Other waterish Tumors, al∣though they be not so dangerous, yet by reason of the weakness, cold∣dess, and thickness of the Skin, are not so easily cured. As for those Tumors which rise in the compass of the Body, like to Bli∣sters, or small Bladders, and are called Sudamina, as they are no ways dangerous, so they are easi∣ly cured. As for the Cure of this Grief, Reason and Experience have found out four means to meet with it, to wit, a convenient Diet, internal Medicaments, external Applications, and manual Ope∣ration. If then an universal Hu∣midity possess the whole Body, the Diet must be drying, wherefore roasted Meat is better than boiled. Immoderation in Drink is by all means to be shunned: For

Jejunet, vigilet, sitiat, qui rheu∣mata curat. Watch he must, and thirst, and fast, Who means to cure a Rheum in hast.

And as Temperance and Sobri∣ety have a promise of prolonging our temporal Lives, so are they powerful helps in curing Diseases; but chiefly those which are caused by the superfluity of moist and wa∣terish Humors. Flesh then is better than Fish, and of Flesh Meats those are best which are dryest: Kid then is better than Lamb, Veal than Muton, Rabbets and Conies are good, Land-Fowl are better than Water-Fowl. Hippocrates himself commendeth Pork above Pigs-flesh: but neither of both is good; for Pigs-flesh is exceeding moist, and in Pork the Fat is moist, and dissolves the Stomach, but the lean is hard, and not easily concocted. All supping Meats are to be shunned, for they multiply moisture. Ludovicus Cornarus his Diet recorded by Lessius in his Hy∣giastieon, or Treatise concerning preservation of Health, is fit for such persons. For above the space of Forty years, he rested content∣ed every day with xij ℥. of Bread and Meat, and xiiij ℥. of Drink: when he was 80 years of age, so able he was by the observation of this moderate Diet, that without any advantage of ground, he usually backt the fairest Italian Horses. One thing is to be noted, that seeing superfluous Humidity seldom possesses the Body, unless there be some fault in the Sanguifi∣cation and Kidneys, you must by all means labour to reduce them to their natural temperature. The means to compass this are set down

by every one who hath penned the practice of Physick, unto whom I remit you.

The internal Medicaments ap∣pointed for the expugnation of this Grief, are of three sorts: for either they purge by Stool, or by Urine, or by Sweat, and insensible Perspiration. To touch the Ca∣thartick Medicaments, such are one grain of Elaterium with a scru∣ple of Pilulae Cochiae, or de Eu∣phorbio, or Aloephanginae: Two Drams of the Seed of Dwarf-Elder, or Ebulus beaten to Powder and ministred in White Wine, and a spoonful of the juyce of Ebulus, the Flour-de-luce, or soldanella mingled with ij ℥. of the Syrup of Damask Roses, dissolved in ij oun. of White Wine. The purg∣ing Diet is excellent, if you add to the ordinary Purgatives in it, the roots of Esula major, the Ber∣ries of Buckthorn, and Carthamus Seeds. Amongst all the Simples Mechoacan and Jalap are most commended, both for their effica∣cy in working, and safety in mini∣string. As for Diuretical means, I commend unto you this Medi∣cament: Take of the Ashes of Broom, and Bean-straw burned, of each a good handful; strain through those Ashes, iiij. pints of Rhenish-wine three times: then infuse in this Wine of the root of Sassafras sliced ij ℥. of Nutmegs and Cinnamon, of each two drams; of Bay-berries, and Juniper-ber∣ries, of each six in number, of Cummin-seeds ijʒ. of Fennel-seeds, and Anniseeds, of each one dram and an half, of Sugar four Ounces, of the Spirit of Salt one dram. Mi∣nister every Morning four Ounces of this Wine strained, and so much about four of the clock in the Af∣ternoon: the Decoction also of Penniroyal, Time, Calamint, with Seeds of the Melon, Pompion, Cu∣cumber and Purslain, made plea∣sant with the Syrup of Althea, de quinque radicibus, and of Hysop ministred as the former, is good.

As for Diaphoretick Medicines, the Decoction of Guajacum Sarsa∣parilla, Sassafras, and China-root, with Agrimony, Betony and Cori∣ander; sweet Fennel-seeds, and Anniseeds carry away the Bell. How effectual these Medicaments are, being judiciously used, not in this Grief only, but in moist Ulcers also, and other Diseases con∣tagious, I need not to labour to perswade. When these Decoctions are ministred, a strict Diet must be enjoyned, and plentiful Sweat procured, according to the tole∣rance of the diseased Party.

The topical Remedies ought not to be repercussives, although the Humor be thin, because see∣ing Nature can make no use of it, it is to be evacuated: wherefore the Remedies ought to discuss and rarefie the Skin, that vent may be given to the Humor. Fabri∣cius ab aqua pendente commends this Medicament; Take of Mallow Leaves an handful and a half, of the Meal of Lupines, j℥. of the Oil of Dill and Chamomil of each ij ℥. with f. q. of White Wine, make up a Cataplasm. The Lie of un∣slacked Lime, and branches of the Vine are good. Avicen out of Galen, against waterish Tumors describes thus the emplaster of Mustard, and affirms, that if this Medicament prevail not, there

is but small hope that any other will. Take of Mustard-seed, Nettle∣seed, Brimstone, Aristolochia ro∣tunda, of the Foam of the Sea, or Brine and Bdellium, of each j ℥. of Ammoniacum, old Oyl, and Wax, of each j ʒ. make a Cerot accord∣ing to Art. Let me advertise you of one thing, that the part is to be fomented before either Cata∣plasm or Emplaster be applyed. The Fomentation is to be made of a Lie made of Bean-straw, Broom, and twigs of the Vine burned with some ordinary Ashes, wherein you are to boil common Wormwood, Sea-Wormwood, the lesser Centory, Calamint, Cummin-seeds, Bay-berries, Juniper-berries, Scordium, Chamomil-flowers, Me∣lilot-flowers, and tops of Dill; un∣to the Decoction strained add the sixth part of Sherry Sack. Now to come to the last Remedy ap∣pointed for rebellious waterish Tu∣mors, to wit, manual operation. If they cannot be discussed, as of∣tentimes Hydrocephalos and Hernia∣aquosa cannot; then the Humor is to be let out sometimes by in∣cision, sometimes by a caustick Me∣dicament: then the part is to be mundified: Thirdly, It is to be in∣carnate; and Last of all cicatrized. But seeing I have handled these points when I discoursed of an A∣postem, and that I am to set down what is singular in every Chirur∣gical Operation, whereby super∣fluities are taken from the Body, in that part of Chirurgery which is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, here I desist, referring every thing to its proper place.

CHAP. X.

Of a Flatulent Tumor.

HAving set down the Doctrine of a waterish Tumor, I shall speak of a Flatulent Tumor; in La∣tin it is called Tumor flatulentus, in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, for the Grecians call Flatu∣osity sometimes 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, sometimes 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

The person in whose Body Fla∣tuosities are multiplied, is often trou∣bled with gudlings in his sides, he belches often, he is troubled with singing of the Ears, his Excre∣ments come forth with Flatuosity, his Urine is frothy, he finds a stretching of his Belly, yet with∣out any heaviness.

The causes of Flatuosity are Crudity and weak Heat. The Heat may be accounted weak two man∣ner of ways. 1. Of its own Na∣ture, and so it has some Power and Dominion over the Humor, and doth in some sort dissolve it, but imperfectly; and so it produces ha∣lituous Vapours, which are called Flatuosities, but is not able to dis∣cuss them; and so they remain in the

part, and distend it, and that be∣cause the Flatuosities are gross, and the part thick: this appears often in the Knees, and troubles Chirur∣geons and Physicians much. 2. Heat may be accounted weak, by rea∣son of the Matter it self; when as the Matter is so plentiful, that the Heat cannot wholly overcome it, but leaves some Vapours undiscus∣sed.

The causes of Crudity are Ebri∣ety, Gluttony, a sedentary Life, and flatuous Meats and Drinks; such are Beer and Ale not well boiled, Pease, Beans, Chesnuts, Turnips, Radishes, green Fruit, Swines Flesh, water-Fowl, salt Fish, and such like. It is discerned from a waterish Tumor, whereof we have spoken by the lightness of it; for an Aqueous Tumor is heavy, but this not. Secondly, By distending the Membranes, and stretching of them, it causeth often intolerable pain, whereas in waterish no pain is felt. It is discerned from an Oe∣dema by this, that it admits no pitting, although it be pressed: it is distinguished from a Scirrhus, because this is hard, but it not: it is discerned from a Phlegmon and Erysipelas, for in it the Skin is not discoloured, neither is there any extraordinary Heat felt; but in those both appear.

As for the Prognosticks, receive these; If these Flatuosities possess parts very sensible, as great Joynts, such are the Elbows, or Knees, which are compassed with thick Membranes, they are hardly cured, and will busie the most skilful.

As for those which invade other parts, they are not very easily cu∣red. First, because these halituous Spirits are gross. Secondly, be∣cause the parts thorow which they are to be discussed are thick. Third∣ly, Because the natural Heat is weak. Whosoever goes about to cure these flatuous Tumors; First, he must prescribe a strict Diet to the Patient, such as I have set down in the cure of a waterish Tumor. Secondly, he must bar him of the use of all flatuous Aliments, where∣of I have made mention, and pre∣scribe unto him Meats of easie concoction, and which afford a laudable Juyce. After Meals let him eat a slice of Marmalad of Quinces, with some Coriander, and Anniseed-Comsits, having but one covering of Sugar. The Stomach a little before Bed-time is to be embrocated with the Oil of Ma∣stick, Wormwood and Rue.

As for the Topical Remedies, the part first is to be fomented with Sheres Sack, wherein Dill, Rue, Bay-leaves, Chamomil, and Meli∣lot-flowers, Cummin-seeds, Annise-seeds, Fennil-seeds, and Bay-ber∣ries have been infused. Then the part is to be embrocated with the Oyl of Chamomil, Lilies, Dill, Rue and Bayes mingled with Aqua∣vitae. Thirdly, apply to the part the Cummin emplaster, or that of Bay-berries: if the Patient do feel inflation in his Stomach, or in the region of the Spleen, minister un∣to him of the Confection of Bay-berries ij, ℥. in three Ounces ei∣ther of good Hippocras, or Cana∣ry Wine, wherein Cinnamon hath been infused two hours before Sup∣per, ii j. or iii j. drops of the Oyl of Pepper, or vj. of Fennel-seed Oyl in the Sack-posset drink, are good. Digestion is furthered in such

persons, if they take a cup of Sack having a Toast in it, and after∣ward eat the Toast, being first besprinkled with Sugar. To such a remedy the meanest may attain, and it is very pro∣per. Take it two bours before Supper.

CHAP. XI.

Of the Kings Evil.

THe King's Evil is in French called, as by Us, Le Mal du Roy; The Spaniards call it, Porcellanas, Lamparones; The Portugueze, Las Porcas; The La∣tins call it Strumae, Scrophulae, Scro∣phae, Sodellae; The Greeks call it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, as the Latins Scrophae. This Disease, as Laurentius has defined it, is an obdurate Tumor of the Glands, enclosed in a coat of its own, bred of thick Phlegm dried, rarely simple, often adulterate and salt, and sometimes of a peculiar sort of indurate Flesh. Some would reckon the King's Evil among Scirrhi; but it may make a pe∣culiar Species of Tumors, it having a peculiar Seat, the Glands. Now the Glands are of two sorts. One sort is connate with our Body and the parts of it: Another is adven∣titious and preternatural. The first have some use; the latter none. They either serve for the divisions of the Vessels, or to im∣bibe superfluous Humors, or to irrigate the Parts. Besides, there are Glandulous Bodies, which can∣not properly be called Glands; so the Testicles, Breasts and other Parts are Glandulous Bodies, i. e like Glands. The adventitious and preternatural Glands are bred in almost all the Parts of the Body, most frequently in the Fat, and be∣tween the Flesh and vacuities of the Muscles; sometimes in Mem∣branous and Exanguous Parts, of∣ten in the extremities of the Vessels, from Blood, Phlegm, Mucus, and other redounding Humors. And all these Glands are subject to Scrophulous Tumors, and by con∣sequence the whole Body may be troubled with the King's Evil. The Matter of these Tumors is reckoned Phlegm or Serum (this being a new word Homonymous to the Ancients Phlegm.)

This Disease is either primigeni∣ous of it self, not following an∣other Disease: Or Secondary, which follows some other Disease, as an Inflammation. It either proceeds from Fluxion of an Hu∣mor from some where else, gene∣rally from the Head by the Vessels: Or by Collection or Congestion, which is bred of the Reliques of the proper Aliment, which the Glands through weakness of heat and laxity of substance could not expel. The diversity of Matter whereof the King's Evil is bred, which is various Humors, makes several differences of it. There is a difference in quantity; some∣times

there are many Knots, some∣times few, sometimes large, some∣times small; Sometimes it is mild, sometimes malignant. One is ex∣ternal, another internal. One is moveable, another fixt. One has Veins, Arteries and Nerves impli∣cated, another has none.

The Causes external are a thick, soggy, moist Air, bad Water, such as comes from the Alps when the Snow melts, and intemperance in Meat and Drink. The internal Efficient Causes are Intemperature of the inner Parts, Cacochymy, a bad Liver, a weak Stomach or Brain, an ill made Head. The material Cause is Phlegm or Serum, with a medley of the other Hu∣mors.

The King's Evil is very like to a Gland, a Node, and to all those Abscesses which Practitioners call Phlegmatick. But the Evil is di∣stinguished from a Gland, because a Gland is soft and without pain; the Evil, if it be touched feels hard and is painful. A Gland is single and only one; the Evil consists of many Knots. A Gland slips, when pressed, and returns again; the Evil gives not way to the touch. A Gland is usually Cutaneous, the Evil lies deep. As for a Ganglium it is indeed a round Body; but it differs from the Evil, because it is only in a Nervous Part. Nodes according to the Mo∣dern Latins, are pituitous Tumors, enclosed in Membranes, which gradually increase, as the Evil does; but they are separable from the subject parts, and the Evil sticks fast to the Flesh. A Node breeds in any; the Evil only in a glandulous part. As for the di∣stinguishing of one King's Evil from another, the efflorescence of the Humor in the Skin, which colours it, shews what Humor causes the Evil.

The Prognosticks are these, I. Every King's Evil is difficult to cure, because it comes from a gross Humor, because it is contained in a Coat of its own, and because it is hard and scirrhous. II. Many Knots are more difficult to cure than one, the painful, than one without pain; the Melancholick than the Phlegmatick; the fixt than the moveable; in the fore part of the Neck, than in any other part. III. Celsus says, the King's Evil tires Physicians, because it occa∣sions Fevers, nor ever comes to Maturation, whether it be treated with Instrument or Medicine; and therefore it often rises again in the very Scar it lest. IV. The Evil often ulcerates, when the Humor is putrid, when it is hot, or irrita∣ted with Applications; sometimes it turns Scirrhous, sometimes Can∣cerous. V. This Disease, according to Aph. 26. Sect. 3. is familiar to Children. VI. And in Coac. Praene∣tion. Hippocrates says, the Evil seldom comes after forty years of Age. VII. Such as have a nar∣now Forehead, flat Temples, broad and prominent Cheek-bones, and a narrow Neck, these are very liable to the Evil. VIII. Hip∣pocrates, l. 2. Prorrhetic. says, that as to these, Biles turn to Pus; and indeed Strumous ones selfe ma∣ny Children, and they go away again easily; but as they sel∣dom grow in elder Boys and Youths, so they go away with the more difficulty. But in

grown men such Swellings seldom arise.

The Cure of this Disease is two∣fold, Supernatural and Miraculous; or Natural. The Supernatural and Miraculous Cure of the King's Evil (waving all Metaphysical Spe∣culations and Theogical Concerta∣tions about it) I dare affirm to be one of the Regalia annext to the Crown of Great Britain, the gift being no way obliged to any spe∣cial Form of Religion; since our own Experience as well as History informs us, that Princes of different Perswasions in Religion have equal∣ly by their Sacred Touch in the Name of the Most High, cured mul∣titudes of the Evil, called, be∣cause the King cures it, the King's Evil.

But since all People asslicted with this Disease have not the Op∣portunity to approach the Royal Presence, and receive the Blessings of his Hand, it is a Work becom∣ing a skilful Chirurgion to supply a Miracle by his skill in Nature, and to save a Subject, where his Majesty is not present by his imme∣diate Hand to do it. That it is possi∣ble to be done (tho difficult) there want not Instances of several in Lon∣don cured of the King's Evil by a Method of Physick. For besides o∣thers, Doctor Willoughby at this present in London cures several of this pertinacious Disease, he having been very industrious to conquer it, and having spent much of his Medical Studies upon Enquiries in∣to this very particular Malady. He has likewise some Arcana, where∣by he effects strange Cures up∣on persons disaffected with the Evil; yet he frankly acknowledges that the same Method and Medi∣cines, in several Patients have quite different Effects, and that without proceeding Methodically nothing i•• to be done. Method therefore be∣ing the great Arcanum of a True Physician, I shall endeavour Me∣thodically to lay down the Cure of the King's Evil.

As for the Diaetetick part, the Air must be thin, dry, serene, pure and open to the East. Avoid a thick, foggy, moist, rainy, fenny and a Western Air. If it be not natu∣rally good, let it be rendred so by Art. Smell to a Pomamber. Fast∣ing is good sometimes, because it dries. The Bread must be well baked and seasoned with Anise or sweet Fenilseed. Avoid all Milk∣meats and Sweet-meats and Pulse. The Meat must be of good Juyce; Avoid all young, mucilaginous and fat Flesh, Pork and Feet of Qua∣drupedes. Sup little Spoon-meat. Eat roast Meat rather than boiled. Fish and Fruit are bad. Avoid much drinking, and corrupt Waters. But Spaw-waters are good. A Dyet drink altered with Rosemary, Thyme and Sage is good. And so is a China Drink. Mastich Wood strengthens all the nutritious Parts, invigorates the Blood and Humors, is amicable to the Brain, and keeps the Belly loose. Never sleep on the day. Use Exer∣cise. Keep the Body loose. Purge the Head, and apply Bags to it. Use Sneezing.

In the King's Evil there are two Indications of Cure. The first re∣moves or diminishes the Antece∣dent Cause. The second takes a∣way the Conjunct Cause. The An∣tecedent Cause of the Evil is a pi∣tuitous

Humor, either simple, or mixt with another Humor, which resides sometimes in the Veins, sometimes in the Brain, which Hippocrates calls the sent of Phlegm. Therefore the luxuriant and noxi∣ous Humor must first be evacuated, and then the Temperament and Strength must be restored to the Parts. Evacuation is either Sensi∣ble or Insensible. Sensible eva∣cuation is made by Vomit, Stool, Sweat and Bleeding. A Vomit is good, if there be much crudities in the Stomach. One may be given de decocto raphani, semine atri∣plicis, floribus genistae, & Oxyme∣lite, or Diasarum Fernelii, or this; ℞ Oxymel. simpl. ℥ ij. de∣cocti sem. atripl. hord. flor. genist. ℥ iiij. M. hauriat tepidè. It is good to vomit in the Morning fasting. Purging with Diaturbith and such things is good. Sudori∣ficks of the Woods are good: Mineral Waters are proper, such as the Spaw and Borbonne. Diure∣ticks may be given, when the Body is well purged and clean. Vene∣section in this case is seldom proper. When the whole Body is purged, the Head may be likewise purged by Apophlegmatisms, Errhines, Sternutatories. Issues in the Neck and Arms, and Blisters are proper. Thus the material Antecedent Cause of the Evil may be removed by sensible Evacuation. It may also be insensibly evacuated by such things as by degrees soak up, ex∣••aust and dry the Phlegm con∣tained in the Stomach, Veins and Brain. Such as Scrophularia, Ʋr∣••ica Mortua, Filipendula, Caryo∣phyllata, Gladiolus, Enula Campana, and such things; of which various Forms of Medicines may be made. Radix Gladioli is good taken ei∣ther in powder or preserved. Ar∣noldus Villanovanus commends this highly for the Evil, ℞ Pilae Ma∣rinae, Spong. Marin. Os. Sep. Pip. long. nigr. Zinzib. Cinnam. Sal. gemm. Pyrethr. Gallar. Spinae Ro∣sarum a. q. s. Omnia subtilissimè pulverizentur, exceptâ spongiâ & Pilis marinis, quae prins secundum artem comburantur, postea carum cinis cum aliis rebus pulverizatis misceatur. This Powder must be held night and day in the Mouth, and the Meat may be seasoned with it. Vipers and preparations of them are good, as Celsus ob∣serves, against the Evil. Cepha∣licks must then be used.

The Conjunct Cause of Tumors may be thus removed. Every Tu∣mor according to Galen is ei∣ther dispersed, or suppurated, or it turns scirrhous, or it gangrenes. Hot Tumors are easily dispersed and suppurated, because the Mat∣ter of them is thin and capable of coction: Cold ones with difficulty: and the Evil is well known to be of such a Nature. Yet when it be∣gins, it is capable of Resolution and Suppuration. One confirmed, and turned to a scirrhous substance, is sometimes cured by Emollients and Discutients. But one that will not give way to the foresaid Medicines, can only be cured by the Knife, Fire and Corrosives. Begin always with the gentlest means first. When therefore the Strumae are small and beginning, and are but inclosed in a tender Membrane, they are easily cured. For squeeze, bruise and rub them with the hand till they grow hot, at first they grow

soft; then beat them with some wooden Vessel till they disappear, and swathe a plate of Lead hard over all the Tumor. In the be∣ginning Resolvents are proper for the great ones, with which Galen mixes Astringents, because of the Laxity of the Glands, which ad∣mits defluxions. Here is a Cata∣plasm; ℞ Rad. Gladiol. ℥ ij. Lil. alb. ℥jss. Fol. Cupress. M. j. Sem. Foenugr. ʒ vj. Cymin. ℥jss. Flor. Melilot. Chamaem. Ros. Rubr. a. P. j. Coquantur omnia, pistentur, cribrentur, quibus adde Farin. Orob. aut Lupin. ℥ j. Mell. opt. ℥ ss. Ol. Aneth. q. s. f. Cataplasma. Langius describes a most excellent Remedy to dissolve the King's Evil. ℞ Ol. Philos. lb. ss. Thuris, Ma∣stich. Gum. Arab. Terebinth. a. ʒ iij. Pistata simul per Alembicum di∣stillentur, tandem adde salis ex cinere cerrae modicum, & iterum destilla, & in vitro serva. Here is a dissolving Plaster. ℞ Mass. Empl. de Melil. ℥ j. Bdellii aceto scillit. dissolut. dr. ij. Castor. Pin∣guis ʒjss. Pulv. Rad. Ireos, Fol. Cupress. a. ʒ j. Ol. Chamaem. Lil. Amygdal. Amar. a. q. s. f. Massa Emplastri. If the Evil cannot be dissolved by these Remedies, and some signs of Suppuration appear, it may be promoted by Diachylon, Ceratum Tripharmacum, a Cata∣plasm of Marsh-mallow Roots, and Sorel Roots boiled in Water, adding Wheat-Flour and Oyl. The Evil, when it is suppurated, must be opened with a Knife or a Caustick, then the Pus must be evacuated, and purged out, then the Sinus must be silled with Flesh by Ʋn∣guentum Iridis, de Betonica, de Tuthia, and the like. When the Evil is grown scirrhous, all means must be used to mollifie and dis∣cuss it. Aëtius takes equal parts of Sulphur and Galbanum, and makes a Plaster. These are mol∣lifying; Emplastrum nigrum Ga∣leni, de Meliloto cum Ammoniaco, Oyl of Lilies, and Powder of Iris Root. Emplastrum Vigonis cum Mercurio is good. Some commend this Unguent. ℞ Cineris Agni casti flore caeruleo, Senectae Serpen∣tis a. ℥ j. cerae q. s. Ol. Amygd. Amar. ℥ j. f. Ʋnguentum. Rogerius commends this Plaster, ℞ Rad. Filic. Asphodel. Ebul. q. v. Co∣quantur in vino optimo, & tun∣dantur in Mortario, addendo Sul∣phuris modicum & cerae q. s. f. Em∣plastrum. Some make an Oynt∣ment of Scrophularia Root gather∣ed in Autumn. If Ulcers arise, things good in malignant Ulcers must be used by the Chirurgeon. We shall refer the Chirurgi∣cal taking out of the Kernels to the proper place in the Parte Ablatrice. And thus we have compleated the first Book of Tu∣mors.

THE PRACTICE OF CHIRURGERY. BOOK II.

CHAP. I.

Wherein the Authors, and Definition of Ʋlcers, are set down.

I Divided Chirurgery into four Parts: whereof the first was 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which teaches to unite parts dis∣joyned. Solution of Unity I made twofold: either in∣telligible, to be apprehended by Reason or Understanding; or sen∣sible, which may be perceived by the very Senses. The intelligible I named a Tumor, in which very often no Solution of Unity offers it self either to the sight or touch, as in many cholerick Tumors, and others in their beginning. Sensi∣ble Solution of Unity, I affirmed either to be in the soft parts or in hard. As for the Solution of U∣nity in the soft Parts, I appointed two Differences of it; to wit, Ʋl∣cus and Vulnus, an Ulcer and a Wound.

In my proceeding, I will handle these ten Points: I. I will point out the Authors who have written laudably of this Subject. II. I will set down the Definition of an Ul∣cer. III. The Causes of an Ulcer.

IV. The Differences of Ulcers. V. The general Signs of Ulcers. VI. The general Prognosticks of Ulcers. VII. I will set down such Medicaments as are fit for all Ul∣cers in general. VIII. Of the ge∣neral Indications of curing of Ul∣cers. IX. Of their times. X. I will discourse of every particular sort of Ulcers.

First then, to come to the Au∣thors, I mean not to name all who are come to our hands, and have written of this Subjects but such as are famous for their Skill and Ex∣perience. Hippocrates and Galen, though they have not left to Poste∣rity particular large Monuments of this Matter, yet when occasion is offered, they omit not to set down both the Indications of Cure, and Medicaments effectual to cure. Hippocrates in his 6. Sect. Of Ʋlcers and Fistulaes. Galen in those excellent Books of his, which he penned, De method. medendi, lib. 3. of a Simple Ulcer, lib. 4. or an Ulceer with Accidents, of the orderly way to cure Diseases, for the most part doth illustrate his Precepts by Examples borrow∣ed from the Practice of Chi∣rurgery.

If you demand why he did so?

I will tell you the Cause in Fal∣lopius his words, in his first Chap∣ter of Ulcers, Quoniamut ait Cel∣sus, lib. 7. cap. 1. Quum cadem est, Seeing according to Celsus, the means which Physicians use in curing, sometimes take effect, some∣times avail not, it may be doubt∣ed whether Health may be ascribed to the good constitution of the Bo∣dy, or to the means applied; but the effect of Chirurgery is most evident. O pregnant testimony to evince the certainty and excel∣lency of Chirurgery! Let those Physicians who slight the Practice of Chirurgery, thinking themselves to be Chicks of the white Hen only, consider and weigh the weight of this Testimony of Celsus and Fallopius in the impartial ballance of Reason. Avicen, the chief of the Arabian Physicians, handles this Matter in the fourth Book of his Canon, and the third Treatise: although he writes confusedly; yet the reading of him will profit such as understand him, and will not be fruitless. Albucasis has some good things, but the number of the trifles are many more. Paulus Aegineta in his sixth Book, Of the Art of Curing, only touches some Points of this Matter, as a Dog doth Nilus when he drinks. Ga∣briel Fallopius follows, who has written an excellent Treatise of this Matter; but whosoever shall peruse him, shall find him in sun∣dry things intricate enough: I will bring him a new Companion, but far surpassing all other Modern Writers, Minadous, one of the Famous Professors of that renown∣ed University of Padua, in his three Books which he penned of the curing of the Deformities of the Body of Man: Whosoever he be who shall go about to make a parity between these two and others of the late Writers, I shall judge him worthy of Midas his Ears, and after that he hath pro∣ceeded, and been promoted in Germany, to be saluted a Doctor with four Feet. To these two Ita∣lians, I joyn the German Samuel

Haffenreferus, in his Four Books of the Affections of the Skin, in whom there are many varieties, if one with judgment discern them. The rest that can be named are of the lower Bench, as Guido de Cau∣liaco, and he who hath only taught him to speak a little more clo∣quently, Joannes Tagaultius, in the Third Book of his Instituti∣ons of Chirurgery. Joannes de Vigo accounted the Father of Empe∣ricks. Marianus Sanctus in the Third Treatise of his Compendium of Chirurgery, and Angelus Bo∣logninus in his two Books of Ul∣cers, shall bear him company. I must not omit that painful and ju∣dicious Chirurgeon Ambrose Parrey, unto whom Chirurgery is much beholding. Vesalius also deserves praise. The two latest who have written are the two Fabricii, Je∣rome and William: Hieronymus Fabricius in the Third Book of the Second Part of his Chirurgical Works: Gulielmus Fabricius in his Learned Chirurgical Observations, who in this course out-strip all their fellows. These Authors of all other are most to be perused; for in read∣ing of them, one shall become both more understanding, and more able to perform the Cures which shall be committed to his care and skill. As for the rest, I leave them unto those who rather chuse to feed upon Acorns, than pure Mancliet. Riolan the Father, Jaques Guilmeau, Peccetius and Pigraeus, although they deserve their own praise, yet in my opinion they are to give place to those whom I have named. If any one would mispend good hours, let him read Paracelsus his great and little Chirurgery, which are like Clouds without Rain. If you would be furnished with Forests of Chi∣rurgical Medicaments, peruse the Treatise of the Learned Hollerius de materia Chirurgica, of Chirur∣gical means, and Jacobus Dondus in his enumeration of Chirurgical Remedies, both simple and com∣pound.

As for those Medicaments which in my proceedings I shall from time to time set down, they shall not be a confused heap, but a choice of the best approved, to ease you of the labour of Election.

Now are we to descend to the de∣sinition of an Ulcer, which was the Second point: I will not stand up∣on the setting down of sundry de∣scriptions of sundry Authors, and the examination of them, because this labour would take up too much time, and little edifie. An Ulcer in English is derived from the La∣tin Ʋlcus, and this from the Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, because it disjoyneth the part which it pos∣sesseth; and so this term, in its ge∣neral signification, comprehends every solution of unity: and so Hippocrates in his Treatise con∣cerning wounds of the Head, doth entitle it.

But seeing solution of Unity may proceed from two Causes, to wit, an external instrument dividing, and a sharp Humor eroding, according to Galen: there must be two dif∣ferences of solution of Unity like∣wise according to the same Author, de constit. art. c. 6. Vulnas, a wound, procured by an external instru∣ment, and Ʋlcus, an Ulcer, caus∣ed of an inward cause eroding, Thus then an Ulcer is to be de∣scribed: It is a solution of Ʋnity

proceeding from an inward cause eroding the part. The subject of an Ulcer, I make not only the fleshy part, (whereby I understand, all the parts which cover the Bones) but the Bone it self also. Unto the Ulcer of a Bone the Author of the Book De constit. art. c. 6. gives a peculiar Name, calling it Teredo, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which properly signifies the little Worm which pierces Wood, and consumes it. I see no reason why the name of an Ulcer may not be ascribed to the solution of Unity in a Bone, if it proceed from an inward cause eroding, as the term of a wound is, if it be divided by an external instrument, as a Sword or Hatchet. An Ulcer then is a compound Disease; for in it there is both solution of Con∣tinuity, and loss of substance.

CHAP. II.

Of the Causes of Ʋlcers.

IN the third general concern∣ing Ulcers, is set down by me the causes of Ulcers. These are either antecedent or conjunct: The antecedent causes may be re∣duced to three; to wit, Cacochy∣mia or the evil habit of the Body; Contagium, or the communicati∣on or imparting of an infecting quality, Vapour or Humor, by the which an Ulcer is caused in any part; a venemous moisture, as in biting and stinging of Serpents; or lastly, the distemperature of the part it self.

As for Cacochymia, the specula∣tion of it belongs to the practice of Physick! yet in my Discourses of Tuniors I set down the signs of every Humor redounding as much as was requisite for any to know, who only meddles with the pra∣ctice of Chirurgery. While any of the three Humors (Blood being excepted) in the masse of Blood contained in the Veins is faulty, and peccant in quality, it is accounted the cause antecedent of an Ulcer. Sometimes these Humors are soli∣tary, sometimes they are associate together.

Contagium, or Infection, it is communicated sometimes by a rot∣ten and corroding Vapour; and so very often, if one visit often one having a Phthisis, such Vapours be∣ing mingled with the Air, infect the party who visits, especially if he draw too near to the diseased Party. So Ulcers of the Yard come from dealing with Women, whose Secret parts are touched with Venereal Ulcers: yea, the Itch it self, and scabbedness, is gotten by either lying with one troubled with it, or by sleeping in a Bed

where a scabbed person hath rest∣ed.

As for the distemperature of the Part, it may be procured either by Cold, as appears in Kibes; or by Heat, as we may see in a Gangrene, because the Blood flowing copious∣ly to the part pained, and not being concocted, it putrefies and erodes the part. Last of all, by biting or stinging, as of a mad Dog, or a venemous Serpent, a corruption of the Humors may be caused, the conjunct cause of an Ulcer: so that every Humor that is changed from its own natural temperature, whether it be by putrefaction, adu∣stion, or commixtion of any thing unnatural, may procure an Ulcer, in whatsoever part it seats it self.

But the followers of Hippocra∣tes and Galen, speak otherwise of these Humors than the Chymists do. The Galenisis make the three Humors of the masse of Blood; to wit, Choler, Phlegm, and Me∣lancholy, to be the causes both an∣tecedent and conjunct of all Ul∣cers, if they become contrary to Nature. So they will have Rheu∣matick Ulcers to be caused of salt Phlegm, Herpes exedens to be caused of aeruginous Choler; can∣cerous Ulcers of Bilis atra, which are the worst and most deplorable of all others.

The Chymists on the other part, affirm that the Discourse of Hu∣mors doth not manifest unto us the Essence, and proper Nature of any Disease. So Quercetan in his advice of curing the Gout, brings in the Stone, which he affirms not to be ingendred of the Galenical Humors. Petrus Severinus the Dane in his Idea Medici••ae Philosophicae, or Pourtraicture of the Philosophi∣cal Physick, wonders at the folly of those who make those phanta∣stical Humors Blood, Choler, Phlegm, and Melancholy the cau∣ses of Diseases; wherefore they out of Minerals, Salt, Sulphur, and Mercury, fetch the causes of all Griefs. Although Galen some∣times calls the Humors salt, ni∣trous, and aeruginous; yet the Chy∣mists have no reason to reject the ordinary names of Humors, and to call contumeliously dogmatical Physicians Humorists, and to de∣ny any Disease to proceed from the ordinary Humors of the Body becoming unnatural: For seeing that according to Galen 1. De loc. affect. c. 2. that is to be accounted the cause of a Grief, which being present, the Disease continueth, and which being removed, the Grief ceaseth; and seeing we perceive Diseases to be caused of vitious Humors abounding, and these be∣ing expelled, the Grief to vanish, I see no reason why these Humors may not be accounted the true causes of Griefs; and that it is a meer folly, and an affection of novelty, to Baptize these by names of Minerals far fetched; as to call that which in Fevers is cast up by vomit, rather Sulphur than Cho∣ler. Besides this, the Chymists are injurious to dogmatical Physicians, in labouring to perswade Men, that they by the name of a Humor, un∣derstand nothing else but a wate∣rish substance void of all other Fa∣culty; which should be the prin∣ciples of all Bodies, and the causes of all Diseases: whereas every ra∣tional Physician, by the term of a Humor, understands a liquid Bo∣dy

mixed with Blood: which see∣ing it is a several body of its own kind, and is more compound than water, so it has far more excellent qualities than water: The Phy∣sicians their own selves have set the Alchymists at work, while talking of Humors, and the causes of Di∣seases, they so much talk of the first qualities, Heat, Cold, Moi∣sture, and Dryness. For although sundry Diseases are caused of Heat, Cold, Moisture, and Dryness, yet we shall find other qualities in the Humor, which may as well hurt the Body as these: For Hippocrates in his Book De prisca Medicina, or ancient Physick, affirms, not that which is hot, cold, moist, or soft, to be most powerful, but that which is bitter, salt, sweet, and sowre, unsavoury, and sharp, with some Sowerness; these and a thou∣sand such, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 being ex∣alted in their Faculties, he will have to be the causes of Diseases, and not the first qualities only: and from these the differences of sym∣ptomes in Fevers of this same kind do depend. These whilst they are exquisitely mixed in the Body are harmless, yet when one of these is severed from the rest, and is ex∣alted in its quality, it manifests it self, and annoys Man; so the corrosive Salt bewrays it self in Cancers and corrosive Ulcers. Nei∣ther is it to be thought absurd, that Minerals are in the Body of Man; for seeing Man is sed by Plents, and Beasts which seed also upon Plants; seeing also the Herbs have their Aliment from the ground, which is not alike in all places, but often is mingled with a salt Juyce, and other Mineral Spirits, which the Beasts and Herbs cannot per∣fectly convert into their own sub∣stance; one can hardly think that a Man can live upon these, and participate of no such thing. So we see what variety of Wines the diversity of Soils brings forth; and that in every Wine there is Tartar or Argol, which appears al∣so very often in podagrical Persons. In vomiting sundry times sub∣stance like to Leeks, green, and aeruginous, exceeding hot and sharp, are thrown up, which being received in Basons, die them with a bright aeruginous colour. See Histories in Schenkius Med. obser. lib. 3. ob. 63 in the Third Book of his Physical Observations, the 62 Ob∣servation. Michael Doringius lib. 1 De Medico & Medic••••a, in his First Book of the Physician and Physick reporteth, That a certain Lawyer made such Urine as did fret his Linings, as if it had been the Spirit of Vitriol; such Humors ap∣pear plainly in Scubbedness, fret∣ting Ulcers, but especially in a Cancer. Wherefore Bertinus: in his Third Book and Eleventh of his Physick, doth rashly and inconsi∣derately assirm, that not one whit of Mercury, Salt, or Sulphur, lies hid in the Body; for in the Itch, Scabbiness, some Catarrhs, Inslam∣mations of the Eyes, and fretting Ulcers, it may be perceived; but in Urine, which is also an excre∣mentitious Humor, the Salt may be separated and presented to the sight: yea, besides the Salt in Urine, another substance the cause of Diseases may be marked: for if you take a clear Urine and suf∣fer it to settle, a Matter like unto the powder of Brick, and some∣times

a white muddy substance will so cleave to the sides of the Chamber-pot or Urinal, that it can hardly be sometimes washed away: of such a Matter Tophi in gouty persons, and Stones in the Bladder are ingendred.

Whoever shall go about to re∣duce the causes of all Diseases to Blood, Choler, Melancholy, and Phlegm, shall wrap himself into a number of difficulties: I will desire him to yield me a reason, Why he calls salt Phlegm so, seeing Phlegm is said to be cold, but this hot? Why is Atra bilis comprehended under Melancholy, seeing it is ve∣ry hot, but this cold? Besides this, if any Physician go about to cure Diseases, procured either by Con∣tagion, or Poison, he without any great respect to the Humors, pre∣sently goes about to minister Alexi∣pharmica, as in the Plague, which is gotten by Contagion, to abate the force of it, and then he addres∣seth himself to the preparation and evacuation of the Humors. If Poy∣son be ministred to any one in Meat or Drink, which according to Cardan, commenting upon the 62 Aphor. of the 4. Sect. may be suspected, if he find griping in his Stomach, and if he Vomit and go to Stool, if within six hours the Skin become greenish or spotted, then Antidotes are ministred, and not such as respect Choler, Melancho∣ly, or Phlegm. Let the Humors then which are ingendred in the Body, retain the accustomed names; but if an external cause make them degenerate from their Nature, let these be distinguished from the ordinary, and have their denomina∣tion from that which altereth them. If Salt, Nitre, Alume, Vitriol, Ver∣digrease be mingled with any Hu∣mor, let it be called from the Mine∣ral mingled with it, salt, nitrous, aluminous, vitriolate or a••••ugi∣nous. And for this cause some late judicious Physicians writing of ma∣lign and pestilent Fevers, and con∣sidering their notable differences, have affirmed some to participate of the nature of Arsenick, some of Mercury, some of Hellebore, some of Opium, some of Leopards-bane, some of Hemlock; some to parti∣cipate of the poyson of a Viper, Scorpion, mad Dog and such like, noting the variety of Symptoms in sundry persons.

One doubt remains concerning the Melancholick Humor, whether it be only thin and waterish, as Reusnerus affirms in his Book of the Scurvy, Exercit. 4. out of sundry places of Hippocrates, who calleth Melancholy 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, as in his Book De morbis, and in his first Book De morbis Mulierum; or whether it be thick and earthy, according to the vulgar and received Opinion. Be∣fore this doubt be solved, some Pro∣positions are to be premised. 1. In the Chyle there are two substan∣ces, one liquid and thin, the other thick and terrestrial, which can no more nourish than Ashes. 2. Na∣ture mingles these which are not sent away by Stool, with part of the aqueous and superfluous Hu∣midity, caused of Drink and liquid Meats. So in a Lie the Salt and some adust Parts are so mingled, that they are not discerned before separation. I say then, that this thick and feculent Humor temper∣ed with much moisture, is to be accounted the superfluous melan∣cholick

cholick Humor, and that it is at∣tracted by the Spleen. For First, Seeing this feculent Humor is alto∣gether unapt to nourish, it must be separated from the Chyle, which cannot be performed by any other part besides the Spleen. Secondly, the Spleen is of a darker Red co∣lour than the Liver is, which pro∣ceeds from the thick, feculent, and terrestrial Humor, which it imbi∣beth. Thirdly, Hippocrates de aere, aq. & loc. affirms, that such per∣sons as dwell in Fenny places, are subject to passions of the Spleen. The cause is, because the waters are not pure but muddy. Fourth∣ly, if the Spleen did draw only thin and waterish Humors, it could not be so subject to obstructions as it is. The feculent Humor mixed with much Humidity, is the cause of sundry Diseases, the thin parts sometimes ascend to the upper parts, the gross to the lower parts, as we see in the Scurvy, wherein the Gums are ulcerated, and the Legs tumefy. The Spleen being spongy, draws much Humidity to it, wherefore splenetick persons ought to drink sparingly; for if they bib too much, the natural heat of the part is easily oppressed, and so they become Hydropick. The waterish Humor of the Spleen is not insipid, but sharp and biting, and copious: so we see those who are troubled with Quartanes, about the end of each Fit to sweat plen∣tifully; and those who are oppres∣sed with Melancholy, to spit much. In the thick, feculent, and terre∣strial blackish Matter, sometimes there is no excess of the Spleen: in qualities sometimes there is, and those are two: Acerbitas, an astrin∣gent sharpness, such as appeareth is green unripe Fruits; and Acidit••, sowreness: from these qualities in∣tended and exalted, atra bilis beco∣meth so corrosive. So much I thought good to set down of Me∣lancholy, to clear the doubts which are moved about it, and to shew one use of the Spleen.

To return then to the carbonary Cure of unlearned Alchymists, they object thus, The rational Physici∣ans affirm the Body to be nou∣rished by the four Humors, How can they then be causes of the Di∣seases?

It is strange that any Man should wilfully shut the eye of the Mind (Understanding I mean) that they may not see Truth, seeing Man, as Aristotle in the very first words of the Book of his Metaphysicks affirms, naturally covets knowledg, and our first Parents to their own and our loss, are witnesses. No dogmatical Physician ever affirmed any disease to be caused of any Humor of the Body, as long as it continues in its own natural estate; but then to stir up Griefs, when it is separate from the rest, when it putresies, when forraign substances and qualities are added, which make it of a familiar Humor a professed enemy to Health, consist∣ing of the natural constitution of the Body, a result of the laudable commixtion of the four Humors natural. I have insisted somewhat long in the setting down of the causes of Ulcers, because he (who∣soever he be) that goes about to cure Ulcers without the know∣ledge of the Causes, is like one, who being blind-folded, is set to thrash a Cock.

CHAP. III.

Of the general Differences and Signs of Ʋlcers.

NOw the fourth Point, con∣cerning the differences, and sundry sorts of Ulcers, offers it self to be handled, and in Truth the course of Nature so requires: for the form of every particular Ulcer doth spring from the Cause con∣junct of the same: for Example, a Cancer ulcerate is discerned from all other Ulcers by its proper and Pathognomonical Signs, all which, as effects, are ascribed to Atra bilis, impacted in the part, the Cause conjunct of the same.

Here of purpose I omit the idle and fruitless distinctions of Ulcers, set down by sundry Authors, which neither better the understanding, nor further the Cure. These only I will set down, which are mate∣rial. The material differences then of Ulcers, are taken either from the Nature or Constitution of an Ulcer, or from the subject or part affected. From the Nature and Constitution, an Ulcer is either simple or compound.

In a simple Ulcer, nothing is offered which may stay the Chi∣rurgeon from going about the con∣solldation of it, as the Cause con∣junct, a cruel Symptom, Adjuncts, or some Disease.

A compound Ulcer wherein either some of these, or all are found, which must be removed before Unition be procured, is either of the milder sort, or ma∣lign.

The more mild sort of Ulcers yield to ordinary and usual Medi∣caments, if they be judiciously ap∣plied.

The Malign yield not, and be∣sides have fearful symptoms: those Malign Ulcers proceed ei∣ther from inward, or outward Causes.

From internal Causes spring a Cancer Ulcerate, Phagedaena, Nome, fretting Ulcers, and others which are called Chironia, or Telephia, which denominations insinuate no∣thing unto us concerning the Na∣ture or Cure of an Ulcer, but bring only unto our Memory the Names of those who are celebrated by Poets, which belong more to Grammarians than Physicians or Chirurgeons to be known.

The external Causes, which pro∣cure Ulcers, are two, to wit, Con∣tagium, Contagion, or a venemous quality, Vapor, or Humor, com∣prehended under the name of Ve∣nenum, or Poison.

The Differences taken from the Subject or Part affected are two,

for either an Ulcer possesses the outward part, and is called exter∣num or outward; or it afflicts the inner parts, and is named inter∣num or inward. Other differences taken from the continuance, figure and quantity, are here impertinent, and further only predictions, of which I will speak in the Progno∣sticks of Ulcers.

As concerning the signs of Ul∣cers; an internal Ulcer is found out and discerned by the Excreti∣on, or Matter expelled. As for Example, if the Urine be purulent, we conjecture the Kidnies or Blad∣der to be ulcerate. If purulent Matter be voided by coughing, it is like that the Lungs are ulcerate; if much of such Matter be reject∣ed, and signs of an Apostem have gone before, it is an apostematous Ulcer; if the purulent Matter be but little, and no signs of an In∣slammation have been noted, then it is but a primary Ulcer proceed∣ing of Erosion, by reason of a sharp Humor separating the unity of the substance of the Lungs. These in∣ternal Ulcers I will leave to the consideration of Physicians, unto whom they are most commonly presented to be cured. Only I will set down such things as tend to the cure of Ulcers of the ex∣ternal Parts. I need not to busie my self about setting down of the general signs of such, seeing they are presented to the view of the Chirurgeon by the parts grieved. Only let me give you warning, that you mistake not a Wound for an Ulcer: into this errour you may easily fall, if you admit the most ordinary description of an Ul∣cer, strange even to judicious Phy∣sicians and Chirurgeons; which is, that it is a Solution of continuity in a fleshy part, yielding Quittour; it matters not, they think, whe∣ther it be laudable or illaudable. It is set down that there should be set down no other difference be∣tween a Wound and an Ulcer, than this, that the one is bloody, and the other purulent. Doth not, I pray you, a Wound become pu∣rulent of it self, although no Chi∣rurgeon deal with it, and may not an Ulcer become bloody if Incisi∣on be used, as it may daily be seen? Frivolous it is also in my judgment, that a Solution of Unity inflicted by an Instrument that woundeth in a Bone, as a Sword, may be called a Wound; and that a Solution of Unity in a Bone, procured by an eroding Humor, may not be term∣ed an Ulcer.

Seeing the Causes conjunct make the true differences of an Ulcer and Wound: which are an exter∣nal Instrument dividing, and a sharp Humor eroding, the parts; Who can imagine that in a Vene∣real Ulcer, wherein there is cor∣ruption of the Bone, there should be two sorts of Ulcers specifically differing, to wit, one in the fleshy part, and another in the Bone, the same Humor causing both?

But a Solution of Unity in the Bone by a corroding Humor is cal∣led Terede, say they.

What then? Must a Malign Ul∣cer in the Face, because it is called Noli me tangere, be ex∣empted out of the list of cance∣rous Ulcers?

No. Let this then be accounted an undoubted Truth, that a Solu∣tion of Unity procured in the

Body by a Humor eroding, whe∣ther it be in the Flesh or Bone, may be, yea ought to be, called an Ulcer, as a Solution by an In∣strument separating is called a Wound in both.

CHAP. IV.

Of the general Prognosticks of Ʋlcers.

THe next thing I shall proceed upon concerning Ulcers is their general Prognosticks. The consideration of these will make one circumspect, when an Ulcer is offered to him to be cured, in the election of his Cure: for whoever takes in hand a grief uncurable, he discredits himself, and causes the Art to be contemned by those who are simple and ignorant, im∣puting the Error of the Practicer to the insufficiency of the Art. Let this be the first prediction: an Ulcer in a Body of an evil com∣plexion, which may be conjectured by the colour of the Skin, if it be of a tallowy whiteness, yellow or swarthish, is not easily cured: for it is likely, that corrupt Phlegm, Vitellin Choler, and feculent Me∣lancholy do abound, which Hu∣mors hinder the regeneration of Flesh: but on the contrary, an Ulcer is easily cured in a person of a good complexion, who digests well and does not increase super∣persluous moisture. II. Ulcers in Bodies which are either very moist or dry, are hardly cured. This is plain in the Bodies of Hydropical persons, and those who are aged; for as superfluous Humidity con∣trary to desiccation hinders the healing in those first: So in the latter the defect of Radical Moi∣sture is an impediment. III. Ul∣cers in Children by reason of their excessive Humidity, and in Wo∣men with Child, because the most laudable part of the Blood is turn∣ed to nourishment of the Child, are not easily cured. IV. Ulcers which fall out after critical Apo∣stems in the Sphondyls of the back, or great joynts of the Body, for the most part are mortal: because af∣ter sickness, and Apostemation Nature must be exceedingly weakned, the Natural Heat much abated, and the Radical Moisture almost spent. Such A∣postems do fall out when as sharp Fevers end not critically in the decretory days by some E∣vacuation, as Bleeding at the Nose, Vomiting, Sweating, Purging by Stool and Urine, but extend them∣selves to the fortieth day. V. If the place wherein the Ulcer is seat∣ed be blackish, blewish, or greenish, it hardly can be cured: for the Blood must be naughty, and the flesh corrupt. VI. Ulcers with a

round figure are cured with diffi∣culty; the reason is this, Consoli∣dation is procured by unition of the parts; the farther the parts are asunder, the more slowly it is pro∣cured: but a round Figure, of all other within the same bounds, is most ample. VII. Painful Ulcers in Children are dangerous, because their Bodies being raw, and the Spirits subtil, they are easily spent, which is the cause that they are much weakned, and so disposed for death it self. VIII. If an Ulcer become either blewish or pale, the party being ill, death is not far off; for these colours in the Natural Moisture shew the Mortification of the part; and driness shews, that is gone. IX. If an Ulcer be com∣plicate with a Disease which main∣tains it, the Ulcer, according to the Nature of the Disease, is either of easie or hard cure. So a Vene∣real Ulcer in a succulent and strong Body is easily cured, but if the party be in a Marasmus, neither the Ulcer nor the Disease can be cured: Because the use of the desiccatives, which only avail in these Infirmi∣ties, will only hasten death, in∣creasing the extenuation of the Bo∣dy: In like manner Ulcers in He∣ctick and Hydropick persons are hardly cured, in these because su∣perfluous Humidity hinders Desic∣cation of the Ulcer; in those be∣cause laudable juyce flows not to the part ulcerate. X. If Tu∣mors in Ulcers suddenly vanish without any evident and manifest Cause, as Bleeding, or application of a discussive Medicament, they portend no good; but Convulsions, if they appear in the hinder parts, because the Spina is very Nervous; and Madness, Pleurisie or Suppu∣ration, if they were red, and i•• the forepart. XI. Soft Tumors in Ulcers are laudable, because they will yield to Medicaments; but hard, not easie to be cured, be∣cause the Humor is more rebelli∣ous. XII. If the Hairs fall in places of the Body about the Ul∣cer, it is an evil sign: For then there must be great Acrimony, and Corruption of the Humors, as in quartane Agues, the Pox, and Leprosie. XIII. If in an Ulcer where there is Cariosity of the Bone, the colour of the Flesh be livid, the party must be in dan∣ger; for it is a sign of extinction of the Natural Heat. XIV. Ulcers that afford Quittour which is white, smooth, and uniform, and not stink∣ing, promise an easie cure; for these qualities in the Quittour shew the dominion of the Natural Heat, and the soundness of the solid parts. XV. A Flux of Blood coming in an Ulcer after strong pulsation is ominous, according to Hippocrates, sect. 7. Aph. 21. for there must be a strong Phlegmon, and the Arteries must be much pressed, so that a Gangrene may be expected: however, of such fu∣rious Blood no Flesh can be rege∣nerate. XVI. If an Erysipelas ap∣pear, the Bone being bare, it is no good sign, Hippocrat. Sect. 7. Aphor. 19. for Flesh cannot be regenerate by such a sharp Humor as this, that causeth so hot a Tu∣mor. XVII. From malign Ul∣cers two sorts of Quittour flow; One thin, and it is called Ichor or Sanies; such a virulent Mat∣ter issues also from the pricking of the Nerves, and corruption of the

Periosteon. The other sort of Quit∣tor is thick, and is called Sordes. XVIII. In Ulcers which have con∣tinued a Twelve-month or longer, the Bone must be scaled, and the skinning be hollow, Hip. lib. 6. Aph. 45. But to make good this Aphorism of Hippocrates, some conditions are to be required: The First is, that much Flesh above the Bone be not in the part ulce∣rate. Secondly, the Humor which flows to the part must be very cor∣rosive. Thirdly, it must not have been dealt withal by any Physician or Chirurgeon. If one or more of these Conditions fail, the Apho∣rism must miss of its prediction. What Galen and late Writers have set down in the explication of this Aphorism, clears not the truth of it: only these Conditions set down by me do. The signs which lead you to the knowledge of a Bone corrupted, are these. 1. If the Ulcer, having been skinned, breaks out again: for it is likely that the Bone casts out an ichorous substance, which is the cause of this recidivation. 2. If the Ulcer yield more and thinner Matter than the bigness of it requires. 3. If the brims of the Ulcer will not come in. 4. If the brims become reddish. 5. If the Bone, being pre∣sented to the Sight, appear rug∣ged, and of a blackish colour, not smooth, or a ruddy white colour. XIX. Whatsoever Ulcers cast out much Sanies or ichorous Matter, which is too thin, of a leady, pale, or black colour; or glutinous, or stinking, and which frets the Skin adjacent, are hard to be cured, for this Humor keeps the Ulcer moist, and cannot easily be dryed, even if you apply powerful Topicks. XX. Inveterate Ulcers which cast out a Quittour called by the Gre∣clans 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 like unto white Oil, are hardly cured; for this signifies a colliquation of the part, and an extenuation of the rest of the bo∣dy.

CHAP. V.

Of the general Cure of Ʋlcers, and their Times.

THE Universal Cure of Ul∣cers is comprised in this one Proposition: All Ʋlcers ever de∣sire desiccation, So Hippoc. in princ. lib. de Ʋlcer. & Galen. lib. 3. Method. c. 3. for whether we go about to in∣gender Flesh, or to seal up an Ulcer by cicatrisation, desiccative Medica∣ments are still required.

There are four times to be ob∣served in Ulcers.

I. Principium, The beginning; In it the Quittour is thin and wa∣terish.

II. Augmentum, the proceed∣ing; In it the Quittour flows more sparingly, and thicker.

III. Status, The consistence; In it there is no ichorous Matter but Pus, yet it appears somewhat thinner.

IV. Declinatio, When the Ul∣cer is on the mending hand; then laudable Pus shews it self. It is white, being altered by the natu∣ral temperature of the Veins, Ar∣teries Nerves and Membranes, whose substance is white. Second∣ly, It is uniform, not grumous, or cruddy, natural heat working equally upon every part of it. Thirdly, It is without all ill smell, seeing the natural heat has correct∣ed all the evil qualities of it.

The Cure of Ulcers is perform∣ed by two means; The First, is the removing of the Causes antecedent. The Second, is the artificial dres∣sing of them.

The Causes antecedent are four, Cacochymia, Contagium, Venenum, and the distemperature of the part.

The ill habit of the Body is to be removed by alteration and evacuation, if an Humor a∣bound.

Contagion is to be overcome by Alexipharmaca.

Poison is to be contemperate by Antidota.

The distemperature of the part is to be removed by things contra∣ry unto it. And that we may the more easily attain to these scopes, a convenient order of Diet must ever be prescribed.

The cause conjunct, which is the eroding Humor, that is setled in the part, is surprised by such Medica∣ments, as suit the four times of an Ulcer before-mentioned.

In the beginning then Suppu∣ratives or Digestives are to be ap∣plyed. First, because the Matter which has left the Vessels, and has insinuated it self within the po∣rosities, putrefies: wherefore it

ought to be concocted, that it may become laudable Quittour.

Secondly, good Flesh cannot be procured by sarcotical Medica∣ments, unless the Matter be con∣cocted; For so the Ulcer is made apt to admit the Generation of Flesh. These Suppuratives ought in the first qualities to be propor∣tionate to the temperature of the part to which they are to be ap∣plied; so to parts hot in the First or Second Degree, Suppuratives hot in the same degrees are to be applied: for if they exceed, they are so far from strengthening the natural heat, that they rather per∣vert it, making it Aguish and un∣natural: if the part be temperate, let temperate Suppuratives be ap∣plied.

But Digestives ought not to be applyed, First, to putrid Ulcers: for seeing Suppuratives are hot and moist, if they should be ap∣plyed, they would cause the great∣er putrefaction.

Secondly, they are not fit for Rheumatick Ulcers; for such Me∣dicaments relax the part, and make it more subject to receive the Mat∣ter that flows, and so a Tumor might be caused. And since Sup∣puratives are to be applied to the parts ulcerate, because the Hu∣mor, which is hot and sharp, would inflame the part, if it were not sup∣purated and cleansed: So repelling Topicks are to be applyed to the parts about the Ulcer, to repell the Matter which flows.

1. That the heat of the Suppu∣rative Medicament draw nothing from the parts adjacent.

2. To strengthen the parts, that they may resist Fluxion.

3. Because by the repelling of the Humor, the desiccation of the Ulcer is furthered.

4. Because the heat of the part ulcerate is intended and strength∣ened, it being kept in by the cold∣ness of repelling Medicaments.

And for as much as I affirm, that Ulcers always require desicca∣tion, it is not amiss to mix with Suppuratives some driers; yet, that in the beginning the Suppuratives have the upper hand, but in the end the Desiccatives.

After that the Ulcer is well di∣gested, and yields laudable Quit∣tour, Mundificatives are to be ap∣plied: for if you apply sarcotical Medicaments, before the Ulcer is well digested, spongy and naughty Flesh will grow, which will admit of no cicatrization. In mundify∣ing we must not use too sharp Medicaments, for these may cause an unskilful Physician or Chirurge∣on to believe that it is a corrosive Ulcer. The pain which the Pati∣ent feels in the part ulcerate will bewray this error. These three scopes being compassed to over∣come the Cause conjunct, nothing remains but to seal up the Cure by Cicatrization.

Seeing most ordinary Ulcers proceed from Fluxion, it is to be withstood, First, by Revulsion. Se∣condly, by Repulsion. In Revul∣sion, wherein the Matter is drawn to parts far distant, the rectitude of the part and vessels is to be ob∣served. So if the Ulcer be in the Right Leg, Revulsion is to be procured in the Right Arm, if you respect the rectitude of the part; but if you consider the re∣ctitude of the vessels, Revulsion is

to be used in the Left Leg, if the Ulcer be in the Right: for so the communion of vessels is kept.

Revulsion is performed by at∣tractives, and these are three; Heat, Pain, and the shunning of Vacui∣ty. Hot things which procure At∣traction, are hot Inunctions, and Baths: strait Ligatures cause pain; but both pain and heat are caused by Ventoses, and Vesicatories. Fon∣tanels attract by reason of the shunning of Vacuity; for they sending out still some substance, some other must be drawn to fill up the place of that.

Repulsion, wherein the Humor is staied in its passage, is performed by applying those Medicaments which commonly are called De∣fensives: these Medicaments are astringent and cold, and rather dry than moist in Ulcers. Now that you may know whether you proceed according to Art in the curing of Ulcers, receive this Apho∣tism: When Medicaments apply∣ed to Ʋlcers do good, or at least hurt not, it is a sign that they are conve∣nient; but if they do harm, by ma∣king the Ʋlcer hotter or colder, dry∣er or moister than is fit, then you may gather that such are to be changed, and their contraries ap∣plyed.

To conclude this Point, nine things make Ulcers hard to be cu∣red.

1. The defection of good Blood in Bodies extenuate.

2. The impurity of Blood in Ca∣cochymical persons.

3. The filthiness of the Ulcer.

4. Soft and cadaverous Flesh about the Ulcer.

5. The malignity of the Humor.

6. The hardness of the brims of the Ulcer.

7. A secret cause in the Air of some places, it being hot and moist.

8. When the Bone is corrupted.

9. The application of unfit Me∣dicaments.

CHAP. VI.

Of Medicaments befitting Ʋlcers in general, and First of repelling Medicaments.

IT is not unknown how many sawcy and malepert Empericks there are in London, who basely and irreverently speak of those who are skilful indeed, and deserve well of the Art of Chirurgery, (pur∣chasing unto it credit, and to their own selves profit and renown, by their methodical and successful practice) and so impudently boast of their Secrets, and exalt them∣selves as if they had no Fore∣head. That you may be the more able, not only to encounter with these consident Cowards; but to overthrow them also, I will endea∣vour, according to that talent of Skill which I have, to furnish you with competent, both Theorie and Practice. It is a shame for a Chi∣rurgeon not to be furnished with admirable variety of Medicaments; seeing Nature hath been so provi∣dent for him. Turn your Eyes whither you will, and behold the fertility of Nature, and you shall see and find that in her Works she has not been unmindful of you. As for Plants, you have Dioscorides and Galen, yea all who have writ∣ten of them, witnesses; that the greatest part of them have fallen to your share. As for the things which lye hid in the bowels of the Earth, as Metals, Spirits, Marca∣sites, do they not serve your turn? The Metals for your instruments, the rest for your Medicaments. Let no Man think then, that a skilful and industrious Chirurgeon can by his Art, perform no other Cures, but such as may be com∣passed by the compositions in his Salvatory. These he must have in readiness, other Medicaments he is able to fetch out of the Trea∣sure of Nature, which he has at his Command. This I will make good by setting down only those Medicaments, which are known to belong to the cure of Ulcers. Of these there are two Orders or Ranks: for some serve for ordina∣ry Ulcers, some for those which have a Malignity annexed. Those that serve for ordinary Ulcers, are of five sorts, for some are Repelling, some Digesting, some Mundifying, some Incarnating, and some Cica∣trizing, and the Medicaments which perform these Offices, are either simple or compound.

The Simples Repelling are these that follow.

Of these, some are of an Aque∣ous substance, as Water it self,

Lettuce, all sorts of Succory, Knot∣grass, Horse-tail, Periwinckle, Night∣shade, Comfrey, Purslain, Navel∣wort, Housleek, these four yield not their Juyce easily; wherefore they must be beaten in a Mortar, and some Verjuyce, Vinegar, or joyce of Quinces mingled with them. There be some Simples not so waterish as these are, as Plan∣tain, Milfoil, Vine-Leaves, astrin∣gent Red Wine, Verjuyce, Vine∣gar, the fruit of the Berbery, the fruit of the Quicken-beam, Sloes, Myrtle-berries, Pomegranate-rinds and Flowers infused in Red Wine, which is astringent, Tanners Woose, which will be more effectu∣al, if these Simples together with Red-Rose Leaves dried, be boiled a little in it; but the Woose must be taken when it is newly made, and before any Leather be put in it. The Leaves and Apples of the Mandrake, the Henbane, the Leaves of Stramonea, black Poppy, and deadly Nightshade are more cool∣ing than the former; but they must be left before the part be∣come livid, or of a Leady colour. If you use the Juyces or Decocti∣ons of the aforesaid Simples, which you shall be enforced to do, if the cure of Ulcers and Wounds be pre∣sented unto you, being in the Countrey, where no Apothecary is, by whom you can be furnished with Medicaments which are fit to repel, then you must apply to the parts adjacent to the Ulcer, Pledg∣ets of Wooll or Tow moistned in them; then above these Stupes of linnen or woollen Cloaths, accord∣ing to the temperature of the Party, and the season of the year, moistned in the same and wrung, are to be applied.

Last of all, the part ulcerate is handsomly to be rowled, the Row∣ler having been moistned in these Juyces or Decoctions. One thing is to be noted, that it is the best course still to mingle some Astrin∣gents with those which have a wa∣terish juice: for as these cool best, and repress the Fluxion and In∣flammation; so these by wrink∣ling of the Skin repel more effe∣ctually. As you rowl up Fractures, so must you rowl Parts Ulcerate. Of this kind of rowling I will speak in its proper place.

The compound Medicaments that repel are these.

1. Oyls, as the Oyl of Roses made of green Oyl, the juice of unripe Grapes, and the juice of Red Roses, boiled together over a sim∣pering fire, until the juices are consumed. Last of all, infuse some Roses picked in the Oyl; the Oyl of Myrtles, the Oyl of Quinces, the Oyl of Mastick, the Oyl of Henbane, Poppy, and Mandrake. Sallet Oyl, whereof these compound Oyls are made, must not be old or rank. If an Inflammation hath possessed the parts adjacent, use not Oyls; for they are easily set on fire.

2. Cataplasms, made of the a∣foresaid juices, and Barley-flour, with some of the forenamed Oyls, or Bole, Terra sigillata, or Amber tempered with some of the fore∣named Oyls, and Whites of Eggs beaten, Vinegar or Verjuice.

3. Unguents, as Tripharmacon; Ʋnguentum album, Camphoratum either of it self, or mingled with Ʋnguentum populeum.

4. Emplasters, as Emplastrum de Minio, the Sope-Plaster, Dia∣palma made with the juices of Plan∣tane, Horse-tail, Knot-grass, Yar∣row, Comfrey, and Perywinckle. When you make your Diacalciteos, reserve one part for the Juices, which must be added by little and little, as you bring your Emplaster to a consistence. This Medica∣ment is second to none.

Of Suppuratives or Digestives.

Being furnished with Medica∣ments repelling, which are to be applied to the parts adjacent to the Ulcer, to hinder Fluxion, you are to look for Medicaments which are to be applied to the Ulcer it self: Amongst them Suppuratives offer themselves first; Those as the for∣mer, are either simple or com∣pound.

The Simples are these, which are to be temperately warm and moist.

The Flour of Wheat and Barley, Swines-grease, sweet Butter, Ca∣pons-grease, Calves-tallow, rape Oyl, Black Rosin, the juice of the Flowers of White Lilies, the pulp of Figs and Raisms, the mucilage of Marsh-mallow, Fenugreek, and Linseed. These are convenient, if any hardness or callosity be in the Ulcer, Saffron, Bird-lime, Pitch, Storax, Galbanum, Gummi Elemi, the Burr-Dock, Mell••ot, the Flow∣er-de-luce, new Wax.

Of Compounds.

Tetrapharmacum of the Anci∣ents, which is made of Pitch, Ro∣sin, Wax, and any of the forena∣med Fats: Dialthaea simplex, Ba∣silicum majus & minus, Ʋnguen∣tum aureum: if a little Mercurie precipitate washed in Plantain, and Rose-water, be mingled with these Unguents, as a Scruple with an Ounce, they will be the more effectual: for the precipitate doth excellently thicken and digest any ichorous Matter. Above these, ap∣plied unto the Ulcers, either up∣on Lint or Tow, lay Emplastrum diachylon simplex in the Summer, and cum gummi in the Winter, if the brims of the Ulcers be hard: otherwise use your Diapalma cum succis; for there is no Emplaster comparable to this.

Of the fore-named Simples, as your Flowers, or Meals, Pulps, Mu∣cilages, and Juices, you may frame unto your selves sundry Suppura∣tives, according to the tempera∣ture of the party, the condition of the Ulcer, and season of the year. Let this be an example; Take of the pulp of Figs and Raisins, of each an Ounce, of the Mucilage of Marsh-mallow, Linseed, and Fenu∣greek, of each two drams; of the juice of the Flowrs of white Lily, two drams and a half; of Barley∣meal, three drams; of Saffron beat to powder, half a Scruple; make up a Medicament, This is power∣ful in callous Ulcers.

Of Mundificatives.

When the Ulcer is well digest∣ed, which you may conjecture, if the Quittour be somewhat lauda∣ble, if the brims of the Ulcer be soft and well coloured; and Last∣ly, if you find no ill damp to rise

from the Ulcer; then you are to address your selves to the applica∣tion of Mundificatives; for if you use sarcotick or incarnative Medi∣caments before Mundification, on∣ly loose Flesh will arise, which will admit of no cicatrization.

The Simples that Mundify are these.

Aristolochia or Birthwort, where∣of there be two sorts, the long and the round; Hore-hound, Smallage, Vitriol calcined to red∣ness, Verdigrease, Orpiment, Arse∣nick natural and sublimed, Mer∣cury sublimate, and precipitate; the yellow Turbith, if you use it be∣fore it be washed, it is as power∣ful as Arsenick, or Mercury subli∣mate, but much more safe; for it dispatches its operation sooner, causes not so great Inflammation, and is more familiar to the body of Man. Honey also mundifies, Sa∣vin, Cockle-shels burned, Alume burned or calcined, the flour of Vetches. All Vegetables calcined mundify, by reason of the Salt in the Ashes, but some more pow∣erfully than others, as the Ashes of Tobacco, Vine-stalks, and the stalks of Beans: joyn to these the juyce of Celandine, the root of Arum, Wormwood, Century the lesser, Carduus Benedictus, Beet, Colewort, Gentian, bitter Almonds, Scordium, the white and black Hel∣lebore.

Compound mundifying Medicament.

L. 15. of Fabricius ab aqua pen∣dente: ℞ Terebinth ʒ ij. syrup. ros. vel mel, ros. ℥ ss. succi apii ℥ i ss. farin hord. & lupin. aq. q. s. ut spissentur. That which is called Paracelsus Mundificative, is second to none: It receives these things; Take of Honey ℥ iiij. of Turpen∣tine ij ℥. boil these with a very soft fire, until they come to the con∣sistence of a soft Unguent; then take them from the fire, and mingle with it the yolk of an Egg; in∣corporate all well together. If a foul Ulcer be offered unto you, mingle with an Ounce of this Un∣guent, a dram of Mercury preci∣pitate, washed with Plantain and Rose-water, and you shall find it to excel all other Mundificatives. In the Shops you have Ʋnguentum Aegyptiacum, and Apostolorum; Aegyptiacum is good to be injected into sinuous Ulcers, being mingled with White-wine, and Mel rosa∣tum: Ʋnguentum Apostolorum is best for plain and superficial Ulcers, If you mingle with Basilicum and Aureum, precipitate mingled with Alume calcined, you shall have a Medicament which will both di∣gest and mundify. Take of your precipitate two parts, and one of Alume, and grind them upon a Painters-stone, until they come to an impalpable Powder. From the enumeration of these Medicaments, you may gather of what qualities Mundificatives ought to be; They are drying without astriction, with∣out any notable cold quality, or great heat; but of a subtle sub∣stance: by reason of the dryness they consume the humidity of the Ulcer: and by reason of their sic∣citie and tenuity, they take away the glutinousness of the Quittour. These must not pass the second de∣gree of dryness: otherwise they

would consume the Flesh it self. Extersion then is the removing of filth cleaving to the Ulcer, by drying of it, and abating the vi∣scosity, by which it cleaves to the part.

Of Incarnatives.

When the Ulcer is sufficiently mundified, which you shall learn of Celsus lib. 5. c. 20. If the Ulcer appear red, sensible and clean, and neither too dry nor too moist, then it is sufficiently mundified: but on the contrary, if it appear pale or whitish, or of a livid or black co∣lour, and want sense, and be either too moist or too dry, then it is not cleansed sufficiently. These signs may be seen in a plain and open Ulcer.

But you may ask, how shall we know when a sinuous Ulcer is suf∣ficiently mundified?

Galen will tell you, l. 4. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. cap. 2. That you shall conjecture a hollow Ulcer to be clean, when the part begins to be more sensible of the Mundificatives than it was before.

When these signs of sufficient Mundification appear, then you must go about incarnating of the Ulcer. And although Incarnation be the effect of Nature principally, that is, of the temperature of the part, from whence the faculty of the part, the cause of all the or∣dinate actions of the part doth flow: yet it is requisite that the Physician and Chirurgeon should help Nature now, being weakned by the grief, by removing the Im∣pediments and Lets which hinder the natural constitution of the part. Nature when she is in her vigor, cannot totally convert the Aliment into the substance of the solid parts, but after she has had a care of the preservation of them, hath a task to expel both a waterish or thin, and a thick Excrement by the pores of the Skin to the out∣ward superficies of it, (as is mani∣fest in the Morphew,) when she is disabled by a Solution of Unity; much less can she effect her pur∣pose, whereof the thin Excrement a humid Ulcer is procured; but of the thick a sordid. Wherefore if you will go about to cure an Ulcer, you must labor to dry the humid Ulcers by desiccatives, and the sordid by Mundificatives; and be∣cause in all Solution of Unity Na∣ture is ever vigilant and busie, and in Ulcers to regenerate flesh, in per∣fecting of which work these two Excrements must be separated; it is manifest that there cannot be one moment designed in the curing of Ulcers, where drying and mun∣difying Medicaments are not re∣quired. Now Medicaments in∣dued with these two qualitles of desiccation and mundification in a temperate degree, are called sarcotical or incarnative Medica∣ments.

The Simples are these.

S. Johns-wort, Clown's-panax, Milfoil, Knot-grass, Hors-tail, the garden and mountain Avens, our Ladies mantle, Sanicle, Salemens-seal, fresh Galls, Barley-flour, Ma∣stich, Myrrhe, Aristolochia rotunda, Harts horn calcined, Bones calci∣ned, Sarcocol, Rosin, Pitch, Gum∣mi Elemi, Butter, Turpentine,

Swines-grease, Sheep's, Goat's, and Deer's-shet, sweet Tallow, Oliba∣num, Frankincense, the powder of Snakes and Adders: these most effectually. Green To∣bacco.

The Compound are these.

And amongst the first of these, suffer me to commend unto you this of mine: Take of Swines∣grease eight ounces, and Rosin ℥ iij. of Wax, and Gummi Elemi, of each one ounce, of the juice of the aforesaid Vulneraries one pound, of the Leaves of Tobacco stamped two handfuls: boil all these over a soft fire until the juices be con∣sumed, then strain the Unguent. Make trial of this, and leave it when you have found out a better. You have in the Shops Ʋnguen∣tum Basilicum majus & minus, and Aureum set out with glorious Titles. But I will shew you anon, how these cannot fit all Bodies. Ʋnguentum de tutia is in much use. You may use these Compo∣sitions if you will, or you may frame unto your selves, of Sarco∣tical Simples, such Compositions as you shall think most fit for your purpose.

But let me warn you, that your Incarnatives must not exceed the first Degree in drying; yet seeing there is a Latitude in this Degree, for some are mild, some more harsh; you are to apply them ac∣cording to the constitution of the party, temperature of the Part, and the quality and quantity of the Ulcer it self. So if the party be of a tender and soft constitution mil∣der driers are required to ingen∣der soft flesh: but if a party b•• offered to you to be cured who hath a firm and dry flesh, more strong desiccatives are to be ap∣plied. If the Ulcer be in a place not so fleshy, as in the Joynts, the beginning or tail of the Muscles, then your desiccatives must be forcible. Last of all, if the Ulcer be large and moist, more strong desiccatives are to be used in it, than in small and not very moist Ulcers.

When you go about your Com∣positions of Incarnatives for Ulcers, observe these Rules: The first is, That they be neither too soft, nor too hard, for if they be too hard, the weak part cannot easily take benefit of them; if they be too liquid, the heat of the part will cause them to spread, and fall from the Ulcer; besides, these are apt to ingender spongy flesh.

The second is, that they be smooth, and equal: otherwise they will cause pain in the part.

Of skinning Medicaments.

The Ulcer being filled with good and laudable flesh, now are you to skin the part ulcerate. Nature in the Womb doth frame first the Skin, but it being after∣ward lost by any accident, she can∣not repair it any more, lacking seminal Matter: wherefore here, there is need of the help of Art to supply this defect. This is done by hardning and thickning the upper part of the flesh rege∣nerate, until it be able to supply the office of the Skin.

The Epulotical Medicaments which bring this to pass, must be,

1. Cooling, for so the thin parts are wring out, and the thick parts are brought together, as we may see in Ice.

2. They must be drying; for these consume the thin parts; so the hands of Sailers, and Felt∣makers, become dry and hard. Then a Cicatrix is nothing else, but flesh thickned, dried and made callous.

These Medicaments ought to be drying in the third Degree: for In∣carnatives are dry in the first De∣gree, because they only are to dry the Excrements, which are super∣fluous in the generation of Flesh. Glutinative Medicaments are dry in the second Degree: for they are not only to dry the Excrements, but whatsoever else flows to the part, although it be alimentary. But cicatrizing Medicaments are dry in the third Degree: for these are to dry not only Excrements, and what flows from other parts, but the natural humidity of the part it self also. But Catheretical or Cor∣rosive Medicaments are drying in the fourth Degree; for these con∣sume not only the Excrements, and that which flows to the part, and the natural humidity of the Super∣ficies of the part, but the flesh sub∣jacent also. These Epulotical Me∣dicaments are in like manner sim∣ple or compound.

The Simple are these.

Aes ustum, Lead made to Pow∣der, the Amalgama of Lead and Quick-silver beat to Powder. When you would make this, melt two ounces of Lead in a Crucible, then take it from the Fire, and put to it an ounce and a half of Mercu∣ry; these will incorporate toge∣ther; when the Mass is cold, you may beat it to a Powder. The Pumice-stone and Cuttle-bones cal∣cined, Stags-horn calcined white, all bones well calcined, the Head of Vitriol after the Spirit is drawn, well washed and dried; it is called by the Chymists Henricus Rubeus, and indeed it is a potent desiccative. Chalk powdered is good; to drive it into Powder, you must rub it upon a broad Tile somewhat fine, and then scarce it; otherwise you shall hardly do it. Terra sigillata, Bole-Armenick, Umber, are good; and unslaked Lime, well washed and dried, Alabaster beat to powder, Minium, Litharge, Cerusse, Cala∣minaris, Tutia, Regulus of Anti∣mony, Crocus Martis, Galls, Pome∣granate-flowers and Rinds, Com∣frey Roots, Sandarach of the Greci∣ans, Egg-shells calcined, the Roots of Tormentil and Bistort, Swine's-grease, Dear's and Sheep's-suet.

Skinning compound Medica∣ments.

Sundry very effectual Medica∣ments may be made of the afore∣said Simples; wherewith I mean not to burden you, only I will commend you unto one of Fallopi∣us, and another of my own. That of Fallopius is thus described, ℞ Ol. Ros. & Ol. Omphacin. an. ℥ vj. Ol. Myrtin. & Ʋnguent. popul. an. ℥ iij. fol. Plantag. & Solan. Hor∣tens. incis. an. man. j. Bulliant ista ad consumpt. succorum, ac co∣lentur:

colaturae adde cerae ℥ jv. Spatha lignea misceantur: Quum incipiunt frigere, adde litharg. auri vel argenti ℥ vj. Cerussae, tutiae praeparat. ʒ ij. Plumbi calcinati ℥ i ss. Ducantur ista in Mortario plumbeo per hor. 2. The ingre∣dients do shew what is to be thought of this Medicament. That which I use is this, ℞ Sevi Ovilli lib. ss. Axung. Porc. ℥ iij. Cerae, Vernicis, Colophon. an. ℥ ij. liques∣cant ista simul. Amotis ab igne ac coeuntibus, adde litharg. auri, aeris usti, tutiae praeparat. Henrici rub. an. ℥ss, Calaminaris ℥ j. Fiat ce∣ratum ex l. a. You have in the Shops Diapalma, Emplastrum de minio, Ʋnguentum comitissae, De∣siccativum rubrum, & Emplastrum contra rupturam Fernelii. Now seeing amongst these, some do more weakly, some more strongly dry, the gentlest are to be applied to tender and moist Bodies, but the strongest to solid and hard Bodies: wherefore neither are mild Skinners to be applied to the Bodies of Clowns and Artificers; nor strong to the Bodies of Children, and dainty Wo∣men: to these use Emplastrum al∣bum coctum. Before I conclude this Point, two things are to be set down: the first is when these E∣pulotical means are to be applied. Secondly, how they are to be ap∣plied.

As for the first, they are to be applied before the Flesh be even with the Skin, according to Galen. 13. method. c. 5. otherwise the Ci∣catrix will be higher than the na∣tural Skin, which will cause de∣formity: wherefore they are to be applied while there is some cavity.

As for the second, seeing always in skinning there is lest a greater cavity in the middle, than about the brims of the Ulcer, stronger desiccatives are to be applied to the brims; but milder to the middle, that the Flesh be not too soon dried. Wherefore Powders and Cerots are to be applied to the brims, but only Cerots or Unguents to the middle. When you have cicatrized an Ul∣cer by Methodical proceeding, there be some persons who will not rest so contented; as Ladies (who make much of their Skins) and Whores (who gain much by theirs) but will desire to have the Cica∣trix made by any means somewhat beautiful to the Eye. I will fur∣nish you with two Medicaments, that you may be the more enabled to fulfil their desires.

The first is this, ℞ Ʋnguent, Rosat. Mesuis ℥ j. Ol. de Been. ʒ ij. Talci Pulv. ʒ iij. Fiat linimentum.

The second make thus, ℞ Ax∣ung. Porc. aquae florum fabar. lotae ℥ j. Spermatis Ceti, ʒ ij. Ol. Amyg∣dal. dulc. ʒ i ss. Talci praeparati. ʒ ij. Fiat linimentum.

Every night a little before bed∣time anoint the Cicatrix with some of either of these liniments, and apply a soft linen rag moistned with the same.

CHAP. VII.

Of the cure of a plain and hollow Ʋlcer, being Simple.

HAving passed thorow the ten Points whereof I intended to write, before I was to meddle with the Cure of any particular Ulcer; now it is time to set down the Method of Cure of Ulcers in particular. I would have you to call to remembrance the material differences of Ulcers delivered by me in the third Chapter, which were taken either from the Nature and Constitution of an Ulcer, or from the parts affected: from the Nature of the Ulcer I deduced two forts of them; some I called Sim∣ple, some Compound. Now the Simple Ulcer is to be accounted such an one, as hath neither a Disease, Cause, or Symptom an∣nexed to it, or complicate, besides the Solution of Unity caused by Erosion. Of these simple Ulcers there are two kinds; for some are plain and equal to the natural Skin, wherein only the Cuticula and Cutis are lost. Some are hollow, cava, wherein, besides the Cuticula and the Cutis, a part of the Flesh is lost. It is not needful severally to set down the Cure of Ʋlcus planum, or aequale, a plain, or even Ulcer; because in prosecuting the Indications of cure of Ʋlcus cavum, a hollow Ulcer, I must set down the means of curing a plain one: for this is contained as a part in the other.

Seeing then there are two affe∣ctions in a hollow Ulcer, to wit, Solution of Unity and Cavity; three scopes of Cure offer themselves, Unition, Incarnation, and Clcatri∣zation. Wherefore if the Quit∣tour be white, smooth, small in quantity, reasonable thick, and not evil smelling: If besides the Ulcer it self be red, and sensible, then we may go about to ingender Flesh, by applying Sarcotical Medica∣ments. But on the contrary, if the Pus be black, uneven, grumous, rough and stinking, and if the Ul∣cer it self be not red and sensible, the Ulcer cannot be incarnate, be∣fore it be prepared by Suppuratives and Mundificatives. Besides Pus, which is reasonable thick, three sorts of Excrements appear in Ulcers.

The first is thin, and waterish, like to Water wherein Flesh has been washed: this has received no alte∣ration, but has flowed pure, as it is in the Veins and Flesh; and is

called Ichor. The second is thin too, but it has received some alte∣ration by the temperature of the part; this is called Sanies or Vi∣rus. The third is very thick and glutinous, and is called Sordes.

Now the Excrements which are thin, moisten the part ulcerate, that it cannot sufficiently discharge it self by breathing out the humidi∣ty. Wherefore Desiccatives are to be used, to consume this superflu∣ous moisture: but the Excrements which are thick cleave to the part, and hinder the addition of Flesh. These are obviated by Abstersives or Mundificatives. The Ulcer be∣ing prepared by Suppuratives and Mundificatives, you are to ingen∣der Flesh by incarnating Medica∣ments. There are two Causes of this Flesh, which is to be procured. 1. Is the efficient Cause: This is Nature it self, not only of the whole Body, but of the part it self also, which is called Temperies, the na∣tural Temperature or Constituti∣on of it: whereby it attracts, concocts, applies and assimilates the nourishment to it self. 2. Is the material Cause: this is sincere and pure Blood. If the part ul∣cerate enjoy such, then nothing re∣mains but to maintain it: If the Blood be not pure, then it is to be altered; if it be too hot, it is to be cooled; if too cold, it is to be warmed; if it be too thin, it is to be thickned; if it be too thick, it is to be attenuated; if there be too great plenty of it, it is to be diminished; if it be too little, then it is to be increased by convenient order of Dyet.

To come nearer to the Cure of of a simple Ulcer: First, we must discreetly order those things which are called not natural: seeing a convenient Dyet preserves and maintains the good Constitution of the whole Body, and tempera∣ture of the part. Wherefore all those Meats and Drinks that make the Blood too hot, too sharp, too thin, or too thick, are to be shun∣ned; and those only to be permit∣ted, which afford good Juice, and are of easie concoction, especially if the diseased party be tender and weak. Besides this, they must be taken moderately, and at conve∣nient times. The part it self must be kept quiet; for motion heats the part. Care also is to be had of sleeping and watching: for as watching dries the Body, and con∣sumes superfluous humidity, so sleep∣ing moistens the parts; but those chiefly which are nervous or si∣newy, as Membranes, Tendons and Ligaments. If then the Ulcer be humid, enjoyn watching; if it be dry, command sleeping. As con∣cerning vacuation of the Excre∣ments, let it be appointed, that they may answer in quantity the Food which the diseased party takes. If he proves costive, either minister unto him a Clyster, or give him an ounce of Electuarium lenitivum in Chicken Broth. As perturbations of the Mind change the state of the whole Body, so the tranquillity of it maintains the same. A special care is to be had of the Air; for it wonderfully preserves the temperature of the part. Southerly and Northerly winds are not fit for Ulcers: for as the first moistens and heats, so the second doth much cool and dry: but cold is an Enemy to Ulcers. So it is observed

that the Air in Angien is hurtful to Ulcers in the Legs, but in Paris good. So in Pisa and Ferrara it is hurtful; but in Florence wholesome.

As for the Prognosticks of the simple Ulcers: If I should set down any, you might justly think I did abuse the time; for there is none so simple, who may not gather out of the very denomination of them, that they are most easie to be cured, and that great skill is not required to compass the same: only let me give you warning that the Cure may be either more easie or hard, according to the Nature of the part ulcerate, and the Dyet of the Patient. So simple Ulcers are more easily cured in a fleshy part, than in a Joynt or a Nervous part; for in these stronger Desiccatives are required, and in them the natural Heat is not so powerful to make use of the Medicaments applied. In like manner a simple Ulcer is more easily cured in the Body of a temperate person, than it is in the Body of one given to debauchery. Having set down the right use of the things not natural, as Dyet, Sleeping and Watching, evacuation of the Excrements, the perturbati∣ons of the Mind and Air; I shall set down some local Medicaments for the accomplishing of the Cure of these Ulcers, according to the general Indications of Cure, set down in the fifth Chapter.

As for the Digesting, Mundify∣ing, and Incarnating of a simple Ulcer, if it be hollow, these Inten∣tions and Scopes shall be perform∣ed by the Application of my Basili∣cum; The description of it is this; ℞ Cerae & Resin. an. ℥ vj. Picis Navalis ℥ iv. Gummi Elemi ℥ ij. Ol. Olivar. ℥v ss. Vernicis clarae ℥ iv. Sevi Ovil. ℥ ij. Terebinth. ℥ ij ss. Olib. Myrrh. pulv. an. ℥ j. fiat Ʋn∣guentum ex l. a. If you make trial of this, you shall find it not a little better than the ordinary two, bearing this name, to wit, Basilicum mag∣num and parvum. If an hollow simple Ulcer prove sordid, mingle with an ounce of this my Basili∣cum, two scruples of the Cathere∣tical Powder made of Precipitate and Alume calcined; or if you ap∣ply Paracelsus his Mundificative tempered with the same, you shall haply Mundifie it; but if a plain or equal Ulcer be unclean, yellow Turbith or Precipitate washed, be∣sprinkled, and covered with a Pled∣get of Lint will serve. Above these Medicaments apply Diapalma cum Succis, and above this a double cloth moistned in red astringent Wine, having some Alume dissolved in it. If you be in the Country, ap∣ply to the parts adjacent to the Ul∣cer, Clouts moistned in the Juyces of cooling and astringent Herbs, as Plantain, Garden-Night-shade, Knot-grass, Purselain: if you a∣noint the parts with Tripharmacum, and Ʋnguentum populeum mingled together, you shall prevent Fluxi∣on and Inflammation.

When you have fill'd an hollow simple Ulcer with flesh, nothing re∣mains but to cover it. Now the co∣ver of the Flesh is the Skin it self: and as the Flesh lost is to be re∣paired, so is that which covers it. But seeing the Skin is framed in the Womb of a seminal Matter, it, be∣ing lost, cannot be restored, by rea∣son of the defect of Matter: Where∣fore we must find out another co∣ver. This cover is called by Artists

Cicatrix. This is nothing else but the uppermost Supersicies of the Flesh so dried, that it repre∣sents the Skin. And as in in∣gendring of good Flesh in an Ulcer laudable Blood was the ma∣terial Cause of it, so good Flesh is the material Cause of the Ci∣catrix.

This Cicatrix is procured by three means; by Nature it self, the Air, and epulotical Medica∣ments. That Nature has an hand in this Business it doth appear ma∣ny ways: for we may see daily Ulcers skinned with these same Medicaments by Empirlcks, which they used in incarnating, so that Nature must be the chief effici∣ent Cause. Secondly, many times a Scab covers such Ulcers being incarnate, which being removed, or falling away of it self, the place appears skinned. Only Nature is the cause of this; for no Medica∣ment was applied. Thirdly, if Nature had not a hand in this Bu∣siness, such an order would not be observed, that the brims of the Ulcer should first be skinned, and then the middle. Fourthly, Nature works in her actions to the period appointed: so in an Ulcer she not being hindred fills the Ulcer with Flesh, even unto the uppermost Superficies; which being done, she ceases from affording any more Matter of Flesh; whereby it comes to pass, that the up∣per Superficies, being deprived of further nourishment, must become dry.

What power the Air has, doth manifestly appear in the Bodies of Infants newly born; their whole Skin is soft and red; the cold Air afterward repels the Bloood, dried the Skin, and makes it more hard.

But seeing Nature very often in such an action proves slow, so that if you would wholly re∣ly upon her, and expect her lea∣sure, you should seem of purpose to protract time, and be in dan∣ger to lose your Patient, it is the safest and best course to aid Na∣ture by assisting her with conve∣nient and good epulotical or skin∣ning Medicaments. In the Monu∣ments both of Ancient and Modern Writers one shall find great varie∣ty, whereof notwithstanding a dis∣creet and judicious choice must be had, if he mean to make good use of them; for I dare be bold to affirm, that there are almost in∣finite descriptions of Medicaments, whereof the first describers never made any trial, but set them down, being induced only by ima∣gination. And amongst these Me∣dicaments, you shall find not a small number, which are either ridiculous, or superstitious, or both. Seeing then the case stands thus, I will only commend unto you three Medicaments fit for skin∣ning of simple Ulcers: The first is, Diapalma cum Succis. The second my Epuloticum, which I described in the former Chapter. The third shall be Heurnius his Sparadrap. The description of it, is this, taken out of his Method of Practice, Lib. 1. pag. 81. of the Leyden Edition. ℞ Ol. Omphacin. & Axung. Porcin. an ℥ iij. Ly∣thargrr. Auri vel Argent. ℥ iv. Cerussae ℥ j. Coq. ista lento igne ad Emplastri consistentiam: tum adds Cerae, Picis, an. ℥ i ss. Colophon. ℥ ij.

Plumbi Pulverizati ℥ i ss. Fiat Emplast. sec. art. Sparadraps made of this help not only simple Ul∣cers, but parts of the Body excoriate by reason of long ly∣ing in bed, caused of weak∣ness brought by Chronical Dis∣eases.

CHAP. VIII.

Of compound, but milder Ʋlcers, in General.

IN the former Chapter, I set down what did belong to the Cure of simple Ulcers, as well plain as hollow, wherein no other offence besides the loss of the Skin and Flesh is found. Hereafter I am in like manner to write of com∣pound Ulcers, wherein besides So∣ution of Unity, caused by Erosi∣on, there is somewhat else that hinders the consolidation of the ul∣terated part.

These compound Ulcers are ei∣ther of the milder sort, or else Malign. Those of the milder sort, have annexed either a Disease, or a Cause, or Symptoms, which hin∣der the Chirurgeon from going a∣bout Unition of the part ulcerate. Sundry Diseases in the Body of Man may keep Ulcers from heal∣ing: some corrupting the Humors, as the Leprosie and Pox: I mean the French; some hindering of lau∣dable Blood in sufficient quantity to be sent, as Phthisis, and a Hectick Fever: some by sending too much waterish Humidity with Blood hinder the Unition of the part ul∣terated. If Ulcers in such persons be presented to you to be cured, you are seriously to ponder in your mind, how hard a task is put upon you, if any of the former Diseases be complicate with the Ulcers, if you only except the French-pox in a reasonable strong Body. But if the Body of one troubled with the French-pox be extenuate much, then permit the Cure of him also amongst the rest, to the charge of such as are only 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Citizens of the World, having no permanent habitation; and resting contented at the first with half the bargain made for the Cure, wil∣lingly (tho not honestly) commit the second payment to the arbitra∣tion of Fortune. They during their life time, continuing scandals to Art and Artists, it is strange, if at the hour of their Death, their Con∣sciences for the present seared, grow not tender, and fearfully ac∣cuse them. Seeing the practice of Physick and Chirurgery are severed in England, I hold it to be the safest course for you to leave the Cure of Diseases to learned Phy∣sicians, and to assume only to your

selves the methodical dressing of Ulcers: for so the whole discredit, (if any redound) will fall to the Physicians share, who cured not the grief, the only hindrance of the cure of the Ulcer. This is my ad∣vice, If an Ulcer complicate with a dangerous Disease, come at any time to your handling: (It is not your desire, I know, that I should set down the manner of Cure of any inward disease: for then I should be be busie with my Sicle in the harvest of other Men) that then in this case you have recourse unto some Author who hath writ∣ten most Learnedly of the manner of curing that Disease which is an∣nexed to the Ulcer, and follow his Indications in dealing with the Di∣sease, if you have not the oppor∣tunity of a Physician, whose ad∣vice you may follow.

In the cure of the French Pox, if you intend to use the Unction, be directed by Ambrose Parry, Mr. Clowes, or Mr. Wijeman. If you resolve to insist in the cleanly way of curing this Disease by Diet, then follow renowned Fallopius or Capivaccius. There is a Volume in Folio, wherein are contained the Monuments of such as have writ∣ten of this Disease, according to the Talent of skill granted unto them: I rather would have you acquainted with these, than to range much, and imitate the Swal∣low, which flies much, but preys only upon flies.

As concerning the Dropsy, the Cough of the Lungs, the Hectick Fever, or Marasmus, and the exte∣nuation of the Body: if these being complicate with an Ulcer, hinder the cure of it, have recourse to the Learned Works of that famous mo∣dern Writer Daniel Sennertus, the late Professor of Physick in Witten∣berg, who hath couched in his Learned Books, what almost can be spoken, either by Galenists or Chymists, concerning these and other diseases. The Plagiary Bar•••• in his method of Physick, and Bruel are but like unto rotten Reeds, appointed for the ruine of impotent, and lame persons, if they rely upon them.

From a disease joyned to an Ul∣cer, I will descend to the causes hindring the cure of an Ulcer. These are two: the Humors that slow, and the distemperature of the part.

As for the Humor, if it be in slowing, then you are to obviate it with ordering the things called not natural; as Air, Meat and Drink, Sleeping and Watching, Eva∣cuation and such like, and by Purg∣ing of the Humor offending; where∣of I spake sufficiently in the do∣ctrine concerning Tumors. If it hath flowed to the part, and be impacted in it, then it is to be re∣moved by three means; to wit, by drying, expressing, and removing of the causes of the Fluxion.

You shall dry the Hunior, if you use sarcotical Medicaments drying at the least in the third de∣gree, as Bones calcined, Harts∣horn calcined, and made up in Tro∣chisces with Plantain, and Rose∣water, Aes ustum, the Pumice∣stone calcined, Calaminaris, Borax, the powders of Tormentil, Bistort, Comfrey, and such like; whereof I have spoken sufficiently before; yet Nunquam satis dieitur qual nunquam sat is discitur, a thing re∣markable

can never be too much pointed at; so fluxible and gliding are the objects of our memory.

You shall express the Humors: First, by using such repelling Me∣dicaments as I have often spoken of, which are to be applied to the parts adjacent to the Ulcers.

Secondly, by rowling the Ulcer, as Hippocrates prescribes in his Treatise of Fractures, that it be∣gin about the Ulcer, using so ma∣ny revolutions, or windings of the Rowler, as are fit, and ending in the sound part.

As for the causes of Fluxion, they are three; Transmission, At∣traction, and the furious motion of the Humor it self. A part sends, either moved by the super∣fluity of the Humor, or urged by an offending quality, or both. If the Humor offend in quantity a∣bounding, then it is to be abated by Phlebotomy, Purging, slender Diet, and such means as have been delivered by me in the Treatise of Tumors, to lessen plenitude, or Pletbora, the signs whereof I de∣livered there also, so that I need not to repeat them here. If the Humor offend in quality, urging and pricking the part to the ex∣pulsion of it, as the Liver, which being tainted with the French Pox, sends the Humor to the Groins, Yard, Matrix, the Fundament and Throat. When we have ob∣served and noted the quality and nature of the Humor, then we are to go about the expulsion, or alte∣ration of it, or both.

If the Humor offend both in quantity and quality, then are we to use both purging and altering. Now to find out the Humors in qua∣lity offending, seeing I have set down their Pathognomonical and proper signs, when I discoursed of every special Tumor, I will remit you to the places where they were set down. If Humors do flow by reason of the attraction of the part, it is procured either by the heat, or the pain of the part. If a Humor flow to the Ulcer, neither being sent from a part, nor received by a part, but because the Humor it self is eliquate, either by the ve∣hement perturbations of the Mind, or an aguish Constitution, or the exhibition of an eradicative or strong Medicament: then the tran∣quillity of the Mind is to be procu∣red, the aguish heat to be abated, and the exhibition of such Medi∣caments to be stayed. Having dis∣coursed of the fluxion of Humors so much as is fit for our present pur∣pose, now I am to touch briefly the other cause of mild, yet com∣pound Ulcers, to wit, the distem∣perature of the part.

The single distemperatures are in number four, to wit, too dry, too moist, too hot, too cold. A dry distemperature is found out by these signs: the colour of the ul∣cerate part is ill-savoured, not live∣ly, little or no Matter flows from it. in touching it seems hard and dry.

This distemperature is removed by two means: First, by drawing out the natural Humidity to the part affected, by opening the pas∣sages, which before by reason of immoderate dryness were drawn together. In this case Friction is excellent.

Secondly, dryness is removed by the application of humecting Me∣dicaments. Two such are com∣mended

by the Ancients pure Spring-water, and Water and Oyl mingled together.

As for the use of Spring or River∣water, it must be applied luke∣warm, not very hot; for if it be very hot, it discusses; because the Humors having been attenuate by it, they are turned into vapours, and so resolved: but if it be tem∣perately hot, and the part foment∣ed by it, it moistens.

The Second Medicament com∣posed of Water and Oyl, by the Ancients is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. The ulcerate part immoderately dry, is to be fomented with this Medica∣ment warm: Take either two parts of Water and one of Oyl, or equal; warm them in a single Vial-glass, then shake them well together that they may be mingled, and apply the Medicament. This is a conve∣ment Topick in the winter; for though warm water warm the part during the time of Fomentation; yet after Fomentation it leaves the part cold, because it drew out the heat to the Superficies of the Bo∣dy: wherefore Oyl is excellent, for it stops the Pores, and keeps in the heat. These two Medicaments are to be applyed to the ulcerate part by stupes, sponges, or pledgets.

One thing you are to look to, and to provide before fomentation, that the Body of the party, unto which they are to be applyed, be neither plethorick (for then too much moisture may he attracted) nor cacochymical (for then cor∣rupt Humors may be drawn) both which will hinder the cure of the Ulcer. Use therefore first of all Phlebotomy, or Purgation, accord∣ing as you shall see cause.

But you may not without cause ask, when Fomentation is to be left?

I answer, that two things shall declare unto you the period of Fo∣menting: the First is the substance of the part, the Second is the co∣lour: wherefore when you see the part a little tumefied, soft and moist, and of a ruddy colour, de∣fist from Fomentation; otherwise the Humor attracted will be discus∣sed.

If a moist distemperature hath possessed the part, then the flesh of the part will be moist; spongy flesh will be apt to grow, and plenty of excrements will flow from the Ulcer: In this case strong De∣siccatives, or Sarcoticks mingled with Basiticum aureum, or Arcaeus his Liniment are to be used: with an Ounce of any of these Unguents you may use one dram and a half of these Desiccatives: such are the Regulus of Antimony, Lead cal∣cin'd, Lapis Calaminaris, Bones and Horns calcin'd, the powder of the root of Iris, Mastick, Oliba∣num, and such like. Aes ustum, the Pumice-stone calcined, and Hen∣ricus rubeus are excellent. If the part be distempered with heat, then the part ulcerate will be somewhat tumesied, hard and red; and besides the relation of the di∣seased party, your own feeling will assure you. In this case use Aqua caleis vivae, so called; but more properly Lixivium calcis vivae, wherein some litharge of Silver hath been boiled: you may use al∣so Snow-water, wherein some of your Vitriolum album or white Copperas hath been dissolved: In a quart of Epsome water, dissolve

two drams of Roman Vitriol, you shall have a water of the colour of a light Emerauld fit for your pur∣pose. In a pint of Plantain wa∣ter dissolve two drams of ordinary Vitriol or Alum; and this also is a ••t Medicament. Let me acquaint you with one thing, that in Redriffe a Copperas is made of Mars or ••ron, which is most fit in the cure, not only of ordinary Ulcers, but of those also which are in the Eyes, Bladder, Throat, and the Intesti∣num rectum. Make trial as I have done, and you shall find that true which I say. You see how plain I am with you, concealing nothing, which may purchase unto you cre∣dit and gain.

If Cold distemper the part, which you shall discern by its colour, hardness, sense of the Patient, and your own feeling, then apply to the ulcerate part Basilicum mag∣num, my Basilicum, Arcaeus his li∣••iment upon Pledgets, and above these Diachylon cum gummi, Em∣plastrum de mucilaginibus, or Pa∣racelsus his Styptick Emplaster. But before the application of these, soment the part with a Fomenta∣tion made of Sack and March-Beer, wherein Calamint, Centaury, Wormwood, Spike, Chamaemill. Tansey, Scordium, Rue, and Bay-Leaves have been infused and boiled.

The Third thing which we af∣firmed to make up a compound Ulcer, was a symptome annexed to an Ulcer. Now of all other, Pain it the chiefest: for First, pain by attraction brings much moisture to the part, and so hinders the Cure. Secondly it inflames the parts. Thirdly, it causes watching, Fainting, and oftentimes Convul∣sions. Pain is removed two manner of ways. First, by taking away the cause of pain, which is affluxion of Humors: How this is to be done we have spoken already. Se∣condly, by application of Anodyne Medicaments. These ought to be temperately hot, and subtil. Sim∣ples of this kind are the waters of warm Baths, Chamaemil, Dill, Mil∣let, Linseed, Fenugreek, Marsh∣mallow, the pulp of Casia, Raisins, sweet Apples, and Turneps, with a little Saffron, they are effectual, Milk, Butter, Oesypum, or the grea∣siness of Wooll, Sapa, new Wine boiled to the Third part, Swine's, Hen's, and Man's Grease, the fat of Eels and Calves, Oyl of Eggs, Earth-worms, Foxes, Swallows, Rue and Elder: the Oyl of Wax, and Sallet-Oil, Oil of Chamaemil, Dill and Roses: Of these you may frame unto your selves compositi∣ons, as occasion shall require. Take this for an example; ℞ Farin. Hord. Milii, Furfur. an. ℥ ij. Lact. recent. lb. ss. coq. ad consistentiam cataplasmatis, tum adde Pulp. Cass. & Passul. major. an. ℥ vj. Pulp. Pomor. redol. ℥ j. Ol. Ros. Lum∣bric. Aneth. Chamaemil. & Ovo∣rum, an. ℥ j. Oesypi. ℥ i ss. Croci. ʒ j. Make a Cataplasm. Some∣times the pain will be so great that you shall be enforced to use narcotical Medicaments: The Sim∣ples are Opium. Henbane, Hem∣lock, the Apple of Peru, Mandrake: of these, adding White-bread crums, Milk and Saffron, you may make Pultesses: I will set one down as an example, after which you may frame others: ℞ Lact. recent. lb.ss. Mic. pan. albiss. ℥ iv. Hyoscyami, Solani. Cicut. Contus. an. man. 1.

Buliiant ista ad cataplasmatis con∣sistentiam: tum adde unguent. po∣pul. ℥ ij. Dress the Ulcer with Plan∣tain water, wherein some Alume is dissolved, or Roman Vitriol. Then apply Diapalma cum succis, and above it this Cataplasm. Drest this Ulcer at the least Morning and Evening until the pain be gone.

CHAP. IX.

Of the differences of the milder sort of compound Ʋlcers, and first of a sinuous Ʋleer with∣out any callosity.

HAving discoursed in the for∣mer Chapter of those things which make the milder fort of Ul∣cers to be accounted compound; to wit, a sickness, cause or symp∣tome complicate with an Ulcer; In this Chapter I will set down the differences of milder Ulcers, and the cure of them. These diffe∣rences are taken either from the Fi∣gure or Adjuncts. From the Fi∣gure these. Of the milder com∣pound Ulcers some are plain, some sinuous. I call that a plain Ulcer, wherein the Skin is eroded, and the subjacent flesh, and the whole Ulcer is presented to the sight, be∣ing bare and uncovered. No com∣pound Ulcer is to be accompted of an easie cure: because both skill and experience are required in per∣forming this.

And thô these plain Ulcers be fubject wholly to the sight, yet let no Man imagine that all of them are of equal facility to be cured; for according to the nature of Grief, the quality of the cause, and the invasion of the symptomes, the Ulcers with which these things are complicate, are either of more easie or difficult cure. A plain compound Ulcer has three scopes in the cure of it; for First, that must be removed which makes it com∣pound, whether it be a disease, cause, or symptome: Secondly, That which is by erosion lost, must be repaired; and Thirdly, The part must be cicatrized: How all these three indications are perform∣ed, I have set down at large in the former Chapter, so that I need not to repeat any thing.

Ʋlcus sinuosum, or a sinuous Ul∣cer, I call that which is like to a Cony-burrow; for sinus, or sinu∣osity, is a cavity or hollowness of parts under the Skin, separate by a Flux of an eroding Humor, which

according to Nature were uni∣ted.

There be two causes of these si∣nuous Ulcers, to wit, Apostemes lying deep a long time, or not time∣ly opened, although they be not so deep, and wounds not well cured: for Quittour lurking a long time, either in a Tumor suppurate, or in a deep wound not well cleansed, must needs corrupt and get a sharp quality, which makes to it self these cavities, which are not so easily fil∣led with Flesh and united: for unto the part affected, now weakened, excrementitious Humors slow, not only from the parts adjacent, but from the whole Body also, which make the Ulcer hard to be cured. These Burrows are found out by Probes of Silver, or Lead, and wax-Candles: If there be more Orifices than one, by Injections. They sometimes are superficial, sometimes deep; sometimes streight, sometimes oblique; sometimes there is but one cavern, sometimes there be more.

Of these sinuous or cuniculous Ulcers, some have neither hard∣ness nor callosity, such I will term Ʋlcera cavernosa, hollow Ulcers; some have both hardness and cal∣losity, these are termed Fistulae. First, ••hen I will shew you how cavernous Ulcers are to be cured, and then how Fistula's. There are two ways of curing of a ca∣vernous Ulcer: the First is by In∣jection of Medicaments: the Se∣cond is by opening and dressing, according to Art. If you go about to cure such an Ulcer by Medica∣ments, without opening, then two scopes offer themselves; to wit, the filling of the Cavity with Flesh, and the agglutination of the parts disjoyned. The incarnatives must be drying without erosion, and the glutinatives must have astricti∣on, besides desiccation. Both these intentions you may perform with the Injection of this Medicament following, ℞ Aq. decoct. hord. lb j. Mell is rosat. ℥ iij. Sarcocol. ʒ ij ss. Myrrh. Thur. an ʒ ij. Rad. Termen∣till. Bistort. Symphyt, an. ʒ j ss. Ba∣laust. ʒ j. Baccar. myrt. ʒ ij ss. Su∣mach. ʒ i ss. Vini odorifer. ℥ vj. Bul∣liant ad consumptionem tertiae par∣tis, ac coletur decoctum, cui adde Spirit. vini ʒ i. If you perceive that the Ulcer is not sufficiently mun∣dified, which you may conjecture, if the Quittour be either stinking, reddish, pale, blackish, or thin and waterish, then apply this Medica∣ment: ℞ Vini, in quo infusa sint marrubium album, Centaurium mi∣nus, Absinthium, Flores Hyrerici, & Carduus Benedictus ad lb, ss. Ʋnguenti Aegyptiaci ʒ ij. Mel ros. ℥ ss. misc. inject this. You can hardly devise more effectual Medi∣caments than these are for agglu∣tination of a cavernous Ulcer: Yet whosoever shall apply them, not dressing and binding the Ulcer ar∣tificially, shall hardly cure any such Ulcer: Wherefore I think ex∣pedient that I shew you the way of dressing: First, lay upon the whole process of the Cavity Dia∣palma cum succis, or Emplastrum album coctum, or Emplastrum con∣tra rupturam: Then inject your Medicament warm. Thirdly, in the Orifice put in a leaden Tent, or Pipe: but short, hollow, wider in the upper than lower part, and having the brims of the upper part turned. That it may be kept from

slipping in, shut the Orifice and the upper part of the Tent or Pipe with an Emplaster; let it be one of those named before: the Em∣plaster must be snipt, that it may give way to the Quittour which flows out of the Cavity: above the Emplaster apply a piece of a Sponge, which must be soft, moist∣ned with the Medicament with which you dress the Ulcer, and wrung out: for the Sponge sucks into it self the Quittour, keeps the brims of the Orifice dry, and preserves them from excoriation: above the Sponge lay a pledget of Tow: the lower Cavity, or from the bottom of the Ulcer to the Orifice, must be boulstered. Above all lay a double soft linnen Cloth. Begin your rowling at the bottom, where it must be somewhat strait, to bring the sides of the Ulcer to∣gether, both to express the Quit∣tour, and to procure agglutination, but let it cause no pain; for it would distemper the part: to∣wards the Orifice the rowling must be somewhat slack, that the Quit∣tour may have way to issue out. Every third day (if much water flow not) dress it, loose first the Rowler, the turnings whereof are about the Orifice, take away the Sponge and Emplaster; First, that you may come to cleanse the Ul∣cer; Secondly, that you may make trial whether Nature goes about to agglutinate the parts: which you shall discern, if the excrementitious Matter abate, be laudable in co∣lour and consistence, and have no ill smell, and if the Cavity be with∣out pain, and without any remark∣able Tumor. On the contrary, if the Quittour be plentiful, ill-coloured and stinking, if the Ca∣vity be painful, and a conspicuous Tumor appear, you may perswade your selves that no unition is pro∣cured. Dress the Ulcer according to this manner, until perfect ag∣glutination be caused, which yo•• shall know by the signs afore said going before; if no Quittour or very little appear in the Orifice, ï the Cavity be equal without Tu∣mor, and no pain be felt: when you perceive these signs, then ad∣dress your selves for the cicatrizing of the Ulcer. If after a dressing or two, thin gleeting Matter ap∣pear, yet despair not; for often∣times such Matter is wrung out of the parts by reason of the Medi∣cament drying; the nature of the part, as being nervous, membra∣nous, or glandulous; or Lastly, by compressing of the Ulcer by bolstering and rowling. As for the Emplaster applied to the Ca∣vity it self, it is to be renewed, when it is defiled with Quittour, or leaves cleaving. Dress the Ul∣cer as seldom as you can, contrary to Empiricks; for often dressing gives way to cold Air, which is hurtful to Ulcers, and hinders uni∣tion. Thus you may proceed in curing of cavernous Ulcers, if the excrementitious Matter have way to flow from them freely; which will be, if the Orifice be in a de∣pending part, or lateral, the Ca∣vity or Sinus being lateral also; for then, such a posture may be ap∣pointed, as will further evacuation of the Matter. But if by reason of other Figures of the Cavity, the Cavity cannot discharge it self of the filth of the Ulcer, then until this impediment be removed, no

expurgation, incarnation, or ag∣glutination can be expected: where∣fore way is to be made by incision or a caustick.

This you must do: First, if the Cavity be lower than the Orifice either directly, or obliquely, but not very deep: Secondly, if it go very deep also, as in Fistula's, and such Ulcers, penetrating in the Breast, where the Cavity most commonly is lower than the Ori∣fice. Thirdly, if the hollowness be very broad. In these cases way must be made by these means for the Matter, that it may be expur∣ged: otherwise, if it be kept in, it will erode the parts adjacent, and no incarnation or consolidation can be looked for. We may make way for the Quittour two manner of ways: First, by opening the lower end of the Sinus only; Se∣condly, by opening the whole Ca∣vity.

The first course we are to take, if the Sinus be of an enormous bigness, or if it be in a great joynt; for great wounds in such Joynts are mortal, according to Hippocrates: or if there be great Vessels, Nerves or Tendons of Muscles in the way; which are like to bring fearful fluxes of Blood, or lameness: which things skill in Anatomy will teach you. If none of these cases hinder you, then it is the su∣rest way to lay open the whole Ca∣vity, which is the second way. These two scopes we may attain unto by two means; to wit, by a Caustick and Incision.

The Caustick we are to use: First, if the party be timorous, and will not admit Section: Se∣condly, if the Cavity be in a part, wherein a great sear may cause de∣formity: Thirdly, if there be fear of a great flux of Blood: Fourth∣ly, if the diseased Party be sick and weak.

If a Caustick be to be applyed, if the situation of the part where∣in the Sinus is, be in the upper side, then apply your Lapis internalis: for it corrodes soonest, deepest, with less pain, and will not be so apt by running and spreading to burn the parts adjacent, or to cause a greater solution of unity than we intended. But if the Si∣nus be in the lower side, as in the sole of the Foot, or in a part very depending; then I advise you to use a Caustick made of strong Sope••lees and unslaked Lime, which will not run. It is an ordinary practice of some to ••ub the part with a Caustick-stone, and when the part is mortified then to open it: First, this is not to be done, but when the Skin is very thin; besides this, this rubbing causes far great∣er pain than the application of it to the part, being defended. Be ever of this mind in your practice, to use the mildest means; the fruits which you reap by so doing will be Respect, Love, Credit, and Gain. When you have perceived that the force of your corrosive Medicament has mortified all to the very Cavity, then procure the fall of the Eschar, with the application either of Dialthaea simplex, or But∣ter without Salt. There is no sub∣stance comparable to this for this purpose, When the Eschar is gone, then proceed in curing of the Ulcer, as hath been said, by mundificative incarnative, and cicatrizing Medicaments.

If the party be couragious and strong, use Incision: this is soon∣er performed; has less pain, and sooner will be cured. When you have made Incision, arm Dosils and Pledgets with a Medicament which strongly dries and mundifies; such is this: Take of Al••e Hepatica two drams, of black Rosin and Amber, of each a dram and a half, of Mill∣dust two drams, of unslaked Lime two drams and an half, with this Powder, and the white of an Egg, and the yolk beaten together, make a Medicament in consistence re∣presenting an Unguent: then ap∣ply the Medicament to the Sinus incised, filling it well, that the brims may be kept asunder. Open not the Sore till the end of the Second day, at the least; for this Medicament will both dry the su∣perfluous humidity of the Ulcer, and will excellently digest it. Af∣terward dress the Ulcer as the me∣thodical indications of Cure shall move.

If you find these Ulcers so hand∣led, do not heal to your mind, then hold your Patient to the decocti∣ons of Sarsaparilla, Guajacum, and the China root, with which mingle some of your most effectual Vul∣neraries, as Agrimony, St. Johns-wort, Sanicle, Avens, Ladies∣mantle, Virga aurea, Solomons seal, the roots of Comfrey, Tormentil, Bistort, Horehound, Borage and Bugloss. I will not conceal from you the description of a Decocti∣on, wherof I have made often proof in Ulcers of the Breast, Joynts and Belly: ℞ Sals. paril. ℥ vj. Rad. Sassafras. ℥iss. Scob. Guajac. ℥ iij. Eupator. Scabios. Tussilagin. Sani∣cul. Hyper. an. man. j. Rad. Sym∣phyt. Tormentill. Bistort. an. ℥ss. Rad. Borag. Bugloss. an. ℥j. Pas∣sul. major. enucleator. ʒ iij. Li∣quirit. ℥ ij. Infundantur infunden∣da per noct. in aq. font. fervent. lb. xxiv. Sequente die coquantur len∣to igne cum reliquis ad consumpt, lb. viij. Bibat aeger singul. dieb. lb. iiii. hujus decocti: Hauriat: lb. ss. mane, ac tantundem hor. quartâ pomeridiarâ: In prandio bi∣bat lb. j. ac tantundem in coena: Quum sit it, superest. lb. j. hauri∣enda. The Simples of this com∣position may plead for the effica∣cy of it. Let him continue the taking of this Decoction for the space of One and twenty days: du∣ring which time he is to use a spare Diet, and to eat Flesh af∣fording a good juice, and of an ea∣sie concoction. As for the local Medicaments which are to be ap∣plyed to an Ulcer, I have spoken of them already: too much re∣petition will breed loathing.

CHAP. X.

Of the Palliative Cure of a sinuous Ulcer with callosity in general.

HAving already treated of a sinuous or hollow Ulcer, without a callosity or hardness of the inward Superficies of the parts disjoyned. Now the order of Do∣ctrine requires, that I discourse of a sinuous Ulcer, which hath a callosity in these same parts.

In times past it was accounted such a master-piece in the practice of Chirurgery to cure such, that Mr. Boovie a Chirurgeon, who once dwelt in Tower-street, set up above his Door a new Sign, with this In∣scription: Here dwelleth one who can cure a Fistula. And in truth not a small skill, or ordinary pro∣ceedings, is required to effect this matter: for the greatest part of such an Ulcer lies hid, and little is offered to the Eye. Besides this, ordinary means are for the most part here ineffectual, and so magi∣stral means are required. Where∣fore I have diligently laboured to couch in this my Discourse what∣soever can be required in the curing of such an Ulcer.

First then, I will deliver the ge∣neral Doctrine of this kind of Ul∣cer: then I will set down the cure of such in some particular parts of the Body, A sinuous or hol∣low Ulcer with a callosity or hard∣ness in the inner Superficies of the parts disjoyned and separated, is cal∣led in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, from the si∣militude which it hath with the long and hollow windy instruments of Musicians: in Latine it is called Fistula, and so in the English Tongue for this same cause,

A Fistula then is a sinuous Ʋlcer, narrow and long with callosity. Here you are to observe, that a Fistula besides sinuosity, must have callo∣sity and narrowness. It happens most commonly, when Apostemes have been opened, that the inner Superficies of the parts, kept asun∣der by a sharp Humor, become in progress of time callous. The Hu∣mor which causes this callosity, must be more astringent than sharp; for it rather tanus the part by reason of its acerbity, than erodes it by reason of its acrimony? besides this, Fistulas are for the most part indolent, unless they end in parts very sensible, as Nerves, Tendons, Membranes, and Joynts. Where∣fore the Chymists will have this Humor to be the Saltpeter of the little World, or Man, separate from

the natural Salt of the Balsam, or radical moisture of the Body. That this Salt is cooling and anodyne, Practicers of Physick do bear Wit∣ness: for in burning Fevers it is added to Juleps, which are appoint∣ed for cooling, and asswaging of pain, under the name of Sal prunellae: It doth also, by reason of its styp∣ticity unite the Spirits, and stay the immoderate Exhalation of them.

The Signs are taken either from the Essence of a Fistula, or from the Accidents. Callosity then with a Fistula, or Whistle-like Fi∣gure, is the Pathognomonical Sign of a Fistula. The Signs ta∣ken from the Accidents are two sold: for they are taken either from the Quittour, or the manner of pain. In a Fistula the Quit∣tour is ever virulent, ugly and stinking: as for the manner of pain, it is but small; unless it be by reason of the sensibleness of the parts named by me be∣fore.

As for the differences, or divers kinds of Fistula's, I will only set down those which further either the Cure, or Prediction. Let this then be the first difference: Fistula's ei∣ther go shallowly along under the Skin; or they pass deeper to the subjacent parts.

Secondly, Fistula's end either in the Fleshy parts, or they pass to the Bones, or to the Cavities them∣selves. Thirdly, some are streight, some crooked. Fourthly, some are single, some manifold; yet proceeding from some one Ori∣fice. These are the most mate∣rial, or profitable differences of Fistula's.

Now it follows, that I speak of the Signs of these Differences. 1. Whether there be more callous Sinuosities than one, you may con∣jecture by the quantity of the Quittour; for if more copious Quittour flow from a Fistula, than can be expected from one Sinus, it not passing to any remarkable Cavity, it is likely that there are more than one. The changing al∣so of the position of the Body, and compression of the part will shew this; for the flowing of the Mat∣ter having ceased, if after the changing of the position of the whole Body, or one Member, it run out again, it is probable that there are more Sinuosities. More∣over, if variety of Quittour flow, it is an Argument that sundry parts are affected, and more Sinuosities like to be. But to what parts the Fistula passes, receive these Signs: If it pass to the fleshy parts, the Quittour appears white, smooth and plentiful; besides this, thy part whereon the end of the Probe stays, seems soft. If it pass to a Nerve, a fatty and oleous Matter issues out, the motion which is caused be that Sinew is impaired, and the Fistula is more painful than others are; besides, the Probe touching the Sinew, causeth a pricking pain with a certain numness. If the Fistula pass to the Veins and Arteries, yet so that the Coats of them be not eroded, then the Matter which it yieldeth is like unto the Lees of Claret wine; for Blood, sweating thorow the coats or porosities of the Vessels, mingled with the Quit∣tour, causes such a substance.

If the Coat of a Vein he cor∣roded, Blood issues thick, of a

dark Colour, and without quaver∣ing and leaping; but if the Tunicles of an Artery be pier∣ced, then the Blood is redder of a more bright colour, and comes forth with ejaculation.

If a Fistula reach to the Bone, that which the end of the Probe toucheth appears hard, and yields not to the Probe, neither is any pain felt. If the Probe being pressed slip, no Cariosity has seized upon the Bone; for a sound Bone is smooth and slippery: If the Probe stay upon it, appearing smooth, it is disposed to Cariosity; but if the Bone appear unequal and rough, then it is undoubtedly ca∣rious, Besides this, the Quittour which flows from a corrupt Bone is thin, yellow, and ill smelling. So much then concerning the Signs, which shews us the divers kinds of Fistula's.

Now let me give some remark∣able Presages or Predictions touch∣ing the curing of them, that Men may become circumspect in under∣taking the Cure of such as shall be presented to them. Let this then be the first.

1. No Fistula is of easie Cure. First, by reason of the unaptness of the part to admit convenient application of Medicaments: for unless they reach to the very ex∣tremity of the Fistula, which is not so easie a matter (as you shall find by practice) no good can be done. Secondly, by reason of the quality of the Medicaments, which are able to remove the Callosity; for these must be sharp and biting, and so cause pain: from whence come symptomatical Fevers, and fainting very often, especially in tender and young Bodies. And thirdly, by reason of the Humor, which causes a Fistula, which yields not to ordinary and vulgar Medicaments. Let this be the se∣cond.

2. Fistula's which are shallow, passing no deeper than the Mem∣brana Carnos, or at the furthest than the Membrane of the Muscles or Muscle subjacent, are more easily cured than those which pierce deeper; for those by Inci∣sion may easily be cured, but these not so.

3, The third shall be this: Fi∣stula's wreathed, or with multi∣plicity of Sinuosities, require incisi∣on, that Medicaments may be con∣veyed to all the parts.

4. The fourth, if a Fistula not passing further than the fleshy parts, be not of a long continu∣ance, and that in a young and a strong Body, it affords good hope of curing: Imagine the contrary event, if contrary circumstances be accompanied.

5. Receive this as the fifth. If the extremity of a Fistula end in the Tunicles of the Veins or Ar∣teries, or both, (the Signs where∣of I have delivered, when I spake of the differences of Fistula's) then you are to meet with the Symp∣tom of Haemorrhage, the Coats be∣ing eroded; for if you labour ei∣ther to enlarge the Orifice, or to take away the Callosity by sharp Medicaments, the Flux will be en∣creased. This accident happens most commonly in Bubo's of the Groyn, not speedily cured, and Parotides under the Ear, and Phlegmons in the Arm-pits: These

parts being Emunctorious, and near to the divarication of the great Vessels, to wit, the Vena cava, and the Aorta, descending and ascend∣ing.

6. Fistula's ending in very sen∣sible parts, as Nerves, Tendons, the Bladder, the Intestinum rectum, and the like, are carefully and mildly to be handled, by reason of the Symptoms which often ensue, as accidental Fevers, Lipothymies, loss of Appetite and Sleep: all which are apt to bring an extenua∣tion unto the whole Body, and so to defraud the part of more than requisite nourishment, without which Consolidation cannot be ef∣fected.

7. Fistula's in remarkable cavi∣ties, as the Throat, Brest, Belly, are hard to be cured, because the end is more dependent than the Orifice, which exceedingly hinders Consolidation.

8. If in Fistula's of the back the Spina be carious, shun the Cure, for these at length bring an extenuation of the Body, the ani∣mal Spirits not being in requisite plenty communicated to the ex∣tremities of the Body.

Fistula's in the Joynts are dan∣gerous; for if great Wounds of the Joynts, even in Bodies of a good ha∣bit, be pronounced by Hippocrates to be mortal: what shall we deem of Fistula's in these parts, where besides the enormous dilations, that must be procured in Cure, there is of necessity an ill com∣plexion of the Body?

Secondly, seeing the Joynts are framed of parts very sensible, as Tendons, Nerves, Membranes and Ligaments, exceeding great pain must be caused by the application of Corrosive Medicaments, with∣out which a Fistula cannot be cured, and so the party must ex∣ceedingly be troubled and perplex∣ed. Thirdly, seeing the Joynts are seated in depending parts, and are not fleshy (and so, as they are apt to receive Humors attracted by pain, they are less able to discuss the Humors received, partly by reason of the thickness of the Membranes, partly by reason of the weakness of Natural Heat) who may not easily perceive the difficul∣ty of curing of Fistula's in these parts?

9. Fistula's having sundry Si∣nuosities are more hardly cured than those which have but one; both because the labour is the greater, and Medicaments cannot so conveniently be applied.

10. Fistula's which have conti∣nued a long time, seated in a de∣pending part, remote from any principal, by which Nature hath been accustomed to discharge su∣perfluities of the whole Body, and not painful, but rather slovingly or sluttish, are rather to be kept open than cured; for they pre∣serve the health of the Body, and hinder the assault of other Diseases.

I know a Gentleman who had a Fistula in a•••• about twenty years, yet unknown to his Wife, who lived notwithstanding very health∣ful to be 〈◊〉〈◊〉 period of his life: having sent for me a few days be∣fore his death, he acquainted me with it. Having taken a view of it, and perceiving that it was dry, and of 〈◊〉〈◊〉 colour; I pronounced

his end to be at hand, which ac∣cordly fell out.

Now it is time to hasten to the setting down of the Cure of Fistula's in general. In the sixth Section of the Treatise ascribed to Hippo∣crates, there is one of Fistula's: In it he speaks somewhat particularly of a Fistula in ano, and of the curing of it by Ligation. Whatso∣ever is delivered in that Treatise, seems to be an exscription of notes out of his Adversaria or Note∣book, rather than a deliberate or methodical Discourse of the Sub∣ject. Howsoever, it is to be em∣braced rather as a Pledge and Sign of his willing mind to plea∣sure his Posterity, than a Patri∣mony to enrich the Knowledge, and further the Practice of any one who shall go about to cure any mean Fistula. Peruse the Treatise, and you shall find me to speak a Truth, if you shew your selves impartial Censurers. Seeing I have delivered unto you in the presages of Fistula's, that sometimes it is most expedient to leave some Fi∣stula's uncured, I must make men∣tion of a twofold manner of curing them: The one shall be called palliative or cloaked; the other true and real.

The first affords some consola∣tion and ease to the Patient; but the second procures perfect health. A palliative Cure, I would have you to understand, to be when a Sinuosity is inwardly dried for a time, and the Orifice seems to be shut up by a thin Skin, until fresh and new Humidity bedew the in∣ward Sinuosity, and open the Ori∣fice again. This kind of Cure is most sit to be used towards those in whose Bodies a Fistula supplies the place of a Fontanel, to discharge superfluous Humors, which Nature turns out from the principal parts, for the preservation of the health of the Body.

You shall know this manner of Cure ought to be used, if the par∣ty immediately before the opening of the Orifice find some distempe∣rature, and afterward, the Orifice being opened, ease. To compass this manner of Cure, three inten∣tions are required.

First, a convenient Diet must be observed: This is performed by feeding upon such meats as are of easie concoction, and afford good Juice, and in such measure as Leonardus Lessius in his 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 prescribes; and Lodovicus, Cornarus observed from his con∣stant to his decrepit Age. They advise moderation both in Meat and Drink. Patients now a days would think themselves hardly dealt with, if they should be stint∣ed every day to eat no more Bread and Meat than a pound, and to drink no more Drink than four∣teen ounces. It is an easier mat∣ter to satisfie Nature, than the Appetite.

Secondly, the Body is to be purged, not by an Eradicative Me∣dicaments, wherein Scammonie, Ellebore, or Colocynth enters; but a purging Diet, or a purging Ale; I will deliver unto you a Pattern of both. Let your purging Drink be thus Dispensed: ℞ Sars. ℥ iij. Rad. Tormentillae, Bistortae, & Symphyti, an. ℥ i. Polypod. querc. ℥ iij. Her∣modaclyl. fol. Sen. & Semin. Car∣thami, an. ℥ ij. Rab. ℥ j. Semin.

Anisi, Coriandri & faenicul. dulc. an ʒ iiij. G••ycyrrhiz. ℥ iss. Infun∣dantur infundenda in aq. font. fer∣vent. lb. x. per noctem: deinde, ad∣ditis reliquis, lento igne coq. ad med. atque Ar••matizetur decoctum cinam. ℥ j. ac coietur: Sumat aeger manè. lb. ss. calid. hyeme. ac tan∣tundem hor. quartà pomeriduanà. As for the purging Ale receive this description. ℞ Scob. Guajaci & Sars. paril. an. ℥ iv. Rad. Tor∣mentill. Bistort. & Symphyti, an. ℥iss. Polypod. ℥ iij. Eupat. Sanicul. Alchymill. an. man. j. Fol. Sen. Her∣modactyl. an. ℥ v. Rab. ℥ j. Semin. Anisi. Coriand. & Fenicul. dulc. an. ʒ vj. Glycyrriz. ℥ ij. fiat ex omnibus pulvis crassiusculus inden∣dus sacculo laneo rarae texturae, qui suspendatur in gadon. duobus Zythi non lupulati recentis & fortis. Let the Patient begin to drink of this Ale the fourth day. He is to take half a pint in the Morning, and to sleep upon it; and so much about four a Clock in the Afternoon. When either of these Purgatives are ministred, let the Patient a∣bout Ten a Clock in the Fore-noon take some Broth without Bread, made of a Chicken, Mutton or Veal, wherein Mallow, Parsley, Fennil, and Succory Roots, with some Raisins, Prunes and Dates have been boiled. Let him Dine on the boiled Meat; but Sup with rost Meat. The purging Ale is more convenient for aged persons, than the Decoction, and for such as have a weak Stomach.

Thirdly, convenient local Medi∣caments are to be applied, to fur∣ther the drying of the Sinuosity, and skinning of the Orifice. I will only set down two Injections for the first. The one is this: Take of Aqua caicis, wherein some Li∣tharge either of Gold or Silver hath been boiled ℥ iij. and of the Syrup of red Rose leaves dried, or of Myrtil Berries one ounce: min∣gle these together. The other is this; Take of Plantain water ℥ iij. of Roman Vitriol beat to powder, a dram and a half: let the Vi∣triol dissolve in the Water: inject these Medicaments warm; apply to the Orifice a pledget of lint, wet in either of these Medicaments warm; and above the Lint Dia∣palma cum Succis. Dress the Fi∣stula every other day only, unless the Quittour which flows from the Fistula be plentiful. So you have the palliative Cure of a Fistula.

CHAP. XI.

Of the true Cure of Fistula's in general.

NOw I will set down the Me∣thod of Curing truly and really Fistula's in general, and the practice of the same in curing of some Fistula's in some special places of the Body, which require some extraordinary considerations. Such are Fistula's in the the great corners of the eyes, Fistula's in the Breast, Fistula's in ano, and Fistula's in the Joynts.

The means to attain to this manner of Cure are threefold Diae∣tetical, Pharmaceutical, and Chi∣rurgical.

As for the Diaetetical, I have set it down amongst other things which are required in the Cure of an Ulcer in general. It shall be sufficient to insinuate now only, that the Diet of those who are troubled with Fistula's must be very sparing, and of Meats and Drinks which afford a laudable Juice, and are of easie concoction, that Crudities and sharp Humors flow∣ing to the affected part, hinder not the Cure. And undoubtedly too liberal Diet, unto which the In∣habitants of these parts are too much accustomed, is the cause of the Recidivation of these, and other Griefs.

As for the Pharmaceutical means, they are of two sorts, to wit, Purgative and Consoli∣dative.

If the Body of the diseased par∣ty be Cacochymical, with some Plethora, minister the purging de∣coction, or Ale, for the space of a Week, described by me in the former Chapter. And while these are in preparing, you may for the better operation of these, minister this or such like a potion: ℞ Garyo∣cost. & Electuarii de Succo Ros. an. ʒ iij. Syrup Ros. solut. cum Agarico ℥ j. Aq. Cichor. ℥ iij. M. ut fiat potio, sumenda cum corporis custodia. These two Electuaries purge the Body of thin, hot; and sharp Hu∣mors; the Syrup and Water correct the malignity of the Humors.

The Consolidatives are either Simple or Compound. The prin∣cipal Simples set down by most authentick Authors, and tried by practice are these; Gentian and the Roots of round Birthwort, a dram of either of these mingled with three ounces of white Wine, and ministred every other day in the Morning, and fasting three hours after taking of the Medica∣ment. The lesser Centaury, Os∣munda regalis the Root of it, Agrimony, Virga aurea, white Hore∣hound,

the Roots of Borage, Tor∣mentill, Bistort, and Comfrey, Sar∣saparilla, the rasping of Guajacum, Plantain, Vinca Pervinca, and Equisetum. Of the Juices of these Herbs, mingled with Ale, you may make Possets: the Drink where∣of strained and sweetned with some Saccharum rosatum, or the Con∣serve of red Roses, you may mi∣nister Morning and Evening to young persons, and those who are either weak, or abhor all Physical means, whereof there is no small number now adays, who hasten by their own misdemeanors to bring on griefs; but when they are to use means, esteem them harsh: not knowing that God of his in∣finite goodness and providence to∣wards Mankind, hath appointed the means of recovering of Health to be unpleasant to Nature, that Man should refrain from Sin, the primitive cause of Griefs.

Of these Simples aforenamed, you may frame unto your selves sundry Compositions: for a Pattern, I will set down one decoction: ℞ Sars. Paril. ℥ iv. Scobis Guajaci, ℥ vj. Rad. Tormentill. Osmund. regal. Bistor. Symphyt. an. ℥ j. I ipat. V••rg. aur. & si nil restat praeter consolidationem & cicatrizationem. Summitat. Hyperic. & Sigill. Salo∣mon. an. man. j. Passular. major. exacinat. ℥ iij. Liquirit ℥ ij. Se∣min. Coriand. & Fenicul. dulcis, an. ʒ v. Infundantur infundenda in aq. font. fervent. lb. xx. deindo coq. lento igne, additis reliquis, ad consumptionem lb viij. ac coletur decoctum. If the party be strong, let him drink three pints aday: One half pint in the Morning, and another about four a clock in the Afternoon, for Dinner and Supper there remaineth a quart. If the party be young, or cannot take such a quantity, by reason of weak∣ness of Stomach, make half of this quantity, which being vj lb. add to the decoction of Sugar and Hony, of each j lb. and by gentle eva∣porating away some Humidity, bring the Decoction to the con∣sistence and taste of a pleasant Ju∣lep, which minister according to the toleration of the party. This Pharmaceutical course you shall (I dare assure you) find effectual, to your own credit, and the patient's comfort.

The Chirurgical means afford unto us five intentions.

First of all then, the Fistula is to be dilated; for seldom doth it fall out otherwise, that this Indi∣cation is not requisite, unless it be in a Fistula in the Cheek, which was caused and maintained by a cor∣rupt Tooth, which being drawn, the Fistula will heal of it self, a consolidative Emplaster being ap∣plied to keep out the Air.

A Fistula may be dilated three manner of ways, by Incision, by putting in Tents framed of such things, as swell, after they have im∣bibed the humidity of the Fi∣stula; and last of all by the Fi∣stula tent.

As for Incision, it is to be used in strong Bodies, if the Fistula be not deep, and only runs along un∣der the Skin, no deeper than the Membrane of a Muscle, if it be in a fleshy part. Secondly, if the Fistula have many Sinuosities before the Incision is made, the Fistula is to be dilated by some of the other means, which I will deliver

presently: Secondly, the Medica∣ments which remove Callosity (whereof anon) must be applied; both these Intentions must be per∣formed before Incision; otherwise you shall hardly know how far your Incision is to be extended, and shall leave some part of the Callus still, which will make way for Re∣cidivation and Relapse.

The second way to dilate a Fi∣stula, is to use instead of Tents such things as swell, whereof there be sundry, as Gentian root, the pith of the Elder; or Dane∣wort; but the Sponge twisted with Thread, after that it is wrung hard and wreathed, far exceeds all these: for it both imbibes more moisture, and dilates much more. I will acquaint you with a preparation of the Sponge, which is excellent: and this is it: Melt a rowl of your simple Melilot Em∣plaster; when it is very hot, let a thick Sponge imbibe it. This Sponge having so drawn unto it self the Emplaster, put between two Trenchers, which Trenchers with the Sponge put into a strong Press, and press them hard. After an hour or two, when you think the Sponge to be cold, unscrue the Press and take out the Trenchers with the Sponge, you shall find the Sponge become a firm sub∣stance, resembling Green Cheese. Of this substance you may cut out Tents of what fashion you will: This will not only exceedingly di∣late the Fistula by sucking unto it the Humidity; but will also digest the Callosity.

The third way of dilating a Fi∣stula, I set down to be by the Fi∣stula-Tent. It is this way to be made; Make good store of sine Lint, from which draw away all the Threads, that nothing remain but the Fluet, or the soft Down of it; of this soft Down, with the white of an Egg beaten, make your Tents of what thickness or length the Sinuosity of the Fistula re∣quires, by adding still some of the Down: Do this upon a piece of Deal-board smooth and eve••••. If you still enlarge the quantity of the Tents, you may dilate the Fistula as much as you will; for these Tents being dried, will pierce in∣to any Cavity, as a Probe, without bending (if they be well made) by reason of their stifness. Of this manner of Tent there is great use, in taking away the Callosities of of some Fistula's, and in healing of them, besides this use, as you shall hear anon.

The second Chirurgical inten∣tion is to remove the Callus: this is bred by reason of the influxion of an Humor, not of an uniform substance: for besides the thin parts, which are discussed or dried by both the natural and extraneous Heat, it must have a thick sub∣stance to cause this Callus, it being indurated: this must be either Phlegm, if the Callus be white; or Melancholy, if it be livid, accord∣ing to the dogmatical Physicians; the Chymists appoint it to be Salt∣peter, as I have said.

In the beginning this Callosity is bred rather in the external Orifice, than in the inner Sinuosity: For first, the Skin, which is thick of it self, sooner grows hard than the Flesh which is soft; Secondly, because Na∣ture still labours to thrust out Ex∣crements to the Skin. In progress of

time Fistula's having become in∣verate, the whole passage con∣tracts Callosity.

You shall know by this, whe∣ther the passage be fistulated or no: If by the intrusion of the Probe great pain is selt, and Blood issues out, the Callus is not con∣firmed; but if no Blood follow, and little pain is selt, be sure then that it is confirmed.

The Callosity is removed either by Medicaments, or an actual Cautery. The Medicaments are of three degrees: for some are more mild, and these are of an emolliting and digesting quality, first if the Callosity be but small in a fleshy part and young body: such are Dialthaea cum gummi, and Ʋnguentum de poeto. Every ounce of either of them having a dram of Turbith mineral, or Precipitate mingled with Alume with it, is effectual.

Secondly, some are more harsh, for they must mundifie strongly, if the Callus be somewhat hard, and the party somewhat aged; such are Ʋnguentum Apostolorum, Avicen. having Precipitate and Alume or Turbith with Alume mingled with it. Egyptiacum is stronger than this, but I should rather use Ʋnguentum Apostolorum than it, adding more of the aforenamed Cathaeretical Powder to it; for it causes greater pain, and procures not so good Quittour as the Apostolorum.

Last of all, the Medicaments which are to remove an inveterate Callus, are Caustick; and even of these some are more gentle, some exceedingly fierce. The more gen∣tle are these. I. ℞ Auripigmenti Sulphur. vivi, & Calcis vivae an. ℥ j. siat Pulvis subtilis. II. Is Pulvis sine pari, cujus haec est descriptio. ℞ Auripigmenti, & virid. Aeris, an. ℥ ss. Vitriol. catcinat. ℥ j. Al∣min. usti. ℥ ij. siat Pulvis sabtilis. III. ℞ Turbith. Mineralis non leti, Vitrioli vomitivi, & Boli orient. optimi, an. partes aequales.

Of the strongest of all I will deliver unto you two magistral de∣scriptions only, far surpassing all others. I. Is M. Hale his Powder, who was famous in his time for curing of Fistula's: this is the com∣position of it: ℞ Aquil. mineral. Vitrioli vomitivi, & Terrae rubr. oriental. an. part. aequales. II. Is this, which I use in Fistula's and Struma's: ℞ Realgar. albi, At∣ripigment. & Calcis vivae, an. part. aequales.

You may enquire how these are to be used; If you have dilated the Fistula by Incision, besprinkle the Callus with some of the Powders; but if you have done it by the se∣cond way set down by me, then use the Powders mingled with Ʋn∣guentum Populeon, wherewith ann your Fistula Tent, or apply a Trochisk made of these Powders and Populeon, and afterwards dryed.

After the application either of the Fistula Tent armed with the Unguent, or of the Trochisk, two things you are to observe: I. That you apply an Anodyne Cataplasm; the fellow to this which I shall now deliver unto you, shall not be found. It is also matchless in raging pains of the Gout: ℞ Lact. Vaccin. lb. j. Mic. Pan. albi, ℥ vj. coq. ad Cata∣plasmat. consist. tum adde Ʋngnent Popul. ℥ ij. Sem. Hyosc. ℥ ss. Croci-pulo. ʒjss, fiat Cataplasma; quod appli∣cetur

parti affectae mane & vesperi. ••I. You must not force out either the Tent armed, or the Trochisk, before they pop out of their own accord: for so they bring the Cal∣••us out with them, and the Tent with the Callus will present a Fin∣ger within a Glove. If there be ma∣ny Sinuosities, yet do not pierce to any remarkable Cavity, as of the Brest and Belly, then you are to dissolve these Powders in some Li∣quor, as in Aqua calcis, Plantain water, Metheglin, a gentle Lee; Alume water, or Vitriol wa∣ter. Alchymists exceedingly com∣mend in this case the Spirit of Nitre.

The second way to remove a Callus by an actual Cautery is an Invention of Ab aqua pendente: He will have an Instrument like to 〈◊〉〈◊〉 setting Iron to be made, the case to answer the wideness and ••ength of the Fistula, and to be ••hrust into the bottom of the Fi∣stula, then must the other round Iron sill the Cavity of this, toward the point only, and be round an much long, and be put in red hot. It is not to stay long where pain ••s caused, because there is no Cal∣lus; but to be rubbed up and down where the place is indolent, until pain be caused by reason of the re∣moving of the Callus by the Fire. And although he highly commend ••ectual Fire, and discommend the potential: yet I am not of his mind in sundry cases: As for this Invention, whosoever shall go a∣bout to practise it, I shall hold him much like to him who is to throw at a Cock blind-sold.

The Third Chirurgical Intenti∣on is, to mundisie the part: this medicament will perform it: ℞ Vi∣ni albi lb ss. Ʋnguent. Aegyptia∣ci ℥ss. Spirit. vini, ʒ vj. misc. In∣ject this warm, but once a day. You may conjecture, that the Fi∣stula is sufficiently mundified, if the Quittour have no ill smell, if it be uniform, thick and white.

Then you are to address your selves to the fourth Intention Chi∣rurgical, which is to unite and consolidate the parts disjoyned. To accomplish this: first draw by an Alembick the Spirit of these Herbs following, putting so much Spring-water, as will be three inches above the Simples, to them; The Roots of Aristolochia rotunda, Tor∣mentil, Bistort, Comfrey, the lesser Centaury, Virga aurea, Burnet, Plantain, Knot-grass, Yarrow, and Solomons Seal. Reserve the Spirit by it self: take the decoction remaining in the Pot from the Herbs by straining; for every quart of this Decoction take half a lb of Hony, and so much Sugar: This mixture being clarified with the whites of Eggs, and strained again, let it be boiled by a soft Fire to the consistence of a Syrup. Take two ounces of the Spirit, and one ounce of the Syrup; which mingle and inject into the Sinuo∣sity, and deal with it as I prescribed, when I delivered the manner of dressing a sinuous Ulcer. If any man deliver a more probable way than this, to consolidate a Fistuld after the extirpation of the Callus, I shall willingly lend him mine Ears.

The last intention Chirurgi∣cal, is to skin the Orifice, which requires no new directions. You

shall know the Fistula to be near whole, when the Humor which flows is little, thick, concocted, and the place void of pain and tumor: If it be altogether dry, you may pronounce the Orifice to be skin∣ned, and the Fistula perfectly cured.

From the Premises you may ga∣ther that four things hinder the Cure of a Fistula. I. Is the Afflux of a vitious Humor. II. Is the natrowness of it, which hardly ad∣mits the Application of conveni∣ent Medicaments. III. Is the deep∣ness which hinders the conveying of the Medicaments to the bottom. IV. The Callosity which contents ordinary Medicaments. I have shewed you the way to remore these Lets and Impediments. I•• the next Chapter I shall discourse of the Cure of Fistula's in particu∣lar places, which when I have done, I will put an end to this Trea∣tise of Fistula's.

CHAP. XII.

Of Fistula Lachrymalis.

BEfore I put an end to this point, I will set down the Cure of some particular Fistula's, differing only in the parts wherein they are seated, wherein some spe∣cial directions are required. I will only speak of three, to wit, of Aegilops in the great corner of the eye, of a Fistula in the Breast, and last of all of a Fistula in ano.

First then I will deal with Fi∣stula Lachrymalis, the Fistula in the great corner of the Eye. In Pau∣lus Aegineta, De arte meden. lib. 3. c. 22. there are words in sound much like 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, but in signification different: He will have 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 to be a Tu∣mor or Apostem before it is open∣ed. but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 he affirms to be when the Tumor is opened, whe∣ther it be fistulated or no: his words are these: Aegilops abscess•••• est, qui inter majorem oculi angr∣lum & nares fit: qui ruptus sing∣ligatur, usque ad os Fistulam ape∣rit. Idem, priusquam ruptum ex∣ulceretu••r, Apostema Anchilops ap∣pellatur. So according to the ver∣sion of Albanus Torinus, Thus it may be Englished: Aegilops is a•• Apostem between the great comer of the Eye and the Nose; which it it be neglected, it makes way to a Fistula, even to the Bone: this Apostem is called Anchilops, before it is broken. All modern Authors, who have left any Monument of Chirurgery, follow him. This kind of Fistula is called by the Neoterick. Chirurgeons Fistula Lacrymalis. By Avicen lib. 3. can. sen. 3.

tract. 2. c. 14. the Apostem is called Kaktius, or Akilas, and the Fistula it self Garab or Alstarab. Fabricius ab aqua pendente, de ope∣rat. chirurg. part. 1. c. 21. pur∣posely handles this matter, and Ambrose Parey lib. 6. c. 15. and Taliacotius in chirurg. curtor. lib. 1. c. 15. The place then wherein this kind of Fistula is seated, is the inner corner of the Eye: although it be∣gin first at the holes of the upper and lower Eye-lid, from whence the Tears flow.

The signs are manifest to the Senses: for First, the Orifice offers it self to view: Secondly, by com∣pression the Quittour issues out: Thirdly, a small Probe may be thrust within the Cavity to the ve∣ry end of the Sinus.

As for the Prognosticks: First then, all these Fistula's are hard to cure; for the moistness of the place hinders desiccation, which is requi∣red in the cure of Ulcers, Second∣ly, the part, (while one is awake) is in continual motion, Thirdly, by reason of the niceness of the part, choice of Medicaments must be had. II. If the Quittour hath made way for it self to the inner passage of the Nose, by that hole which passeth thorow the Bone of the Nose from the corner, then we are only to procure the shutting up of the upper Orifice, and not to go about the scaling of the Bone by a fruitless labour, which will not∣withstanding cost the Patient great pain and grief. III. If a Fistula in this place become cancerous, which you shall conjecture by the hard and livid brims, a stinging pain, and stinking virulent Matter, you are only to use a palliative cure, applying those Medicaments which are fit for a cancerous Ulcer, whereof in the cure of a Cancer I will speak at large. IV. If this continue long, it causes a Con∣sumption of the Eye, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 sometimes blind∣ness of that Eye, and corruption of the Air, which we draw by the Nostrils, if the Quittour pass from the Glandule, thorow the bone of the Nose to the Nostril.

Now to come to the differen∣ces of these Fistula's; some are malign, the signs whereof I have delivered in the Prognosticks. Some are not malign. Of these where∣in there is no malignity, some are without cariosity of the Bone, and some with cariosity of the Bone. You shall know that there is no cariosity of the Bone. 1. If the Apostem was not long continuing before it brake; for it the Tumor was first an Oedema Scirrhodes, and continued a long time so before it brake, then it is likely that the Humor corrupted the Bone before it brake. 2. If the Probe rest not upon a part hard and rugged 3. If after dilatation of the Fistula, the cariosity be not presented to the sight. If circumstances contra∣ry to these be offered, you may conjecture that there is a cariosi∣ty in the Bone.

To hasten to the cure of these Fistula's: If a Fistula lcebry∣malis, without corruption of the Bone, be offered to you to be cu∣red, proceed after this manner: First of all you are to dilate it: Secondly, you are to remove the callosity: Thirdly, you are to mun∣difie it: Fourthly, you are to con∣solidate it: And lastly, to cicatrize it.

You shall dilate it by the Fistula Tent framed (as I taught in the former Chapter, according to the proportion of the sinuosity in the beginning: then you shall enlarge it more by Sponges prepared with Melilot Emplaster, which I like∣wise set down there. This man∣ner of dressing will discover all cor∣ners of the sinuosity. The Fistula having been thus dilated, you are to go about the removing of the Cal∣lus. Now in performing this, there is not so great liberty granted, as is in Fistula's of other parts. For First, stuid and running means ha∣ving a remarkable acrimony are not safe: for passing unto the Con∣junctiva, and from thence to the Cornea, they are able to erode it; from whence an Ulcer may ensue, and so the grief be doubled. Se∣condly, even means solid carefully must be applyed, that they go no further than the sinuosity of the Fistula. It is not unknown unto you, what horrible symptomes of∣tentimes afflict the Eye, by reason of a familiar Humor only exalted in degrees of acrimony: What mis∣chief then is to be expected, if heterogeneal Bodies, endued with extraordinary sharpness, as these must be which remove a Callus, do seise upon the Membranes of the Eye, adjacent unto the part af∣fected.

Some there are who cure these lacrymal Fistula's with liquid Me∣dicaments, as with the water of Elder, or Wall-wort flowers, in every pint of these dissolving two drams of Mercury sublimate, or more, according to the hardness of the callosity. The proportion of mixture you must conjecture by the continuance of the Fistula, by the age of the party, and con∣stitution of the Body. If therefore a Fistula be offered to be cured in a body young, of a short continu∣ance, and of a tender constitution, then the water is to be mild; if contrary conditions do offer them∣selves, then you are to make it more strong according to discre∣tion. If you take two parts of Plantain water, and one part of the Spirit of Niter, you shall have an excellent Topick according to the Principles of the Chymists.

One thing is to be observed, that these liquid Medicaments be spa∣ringly applyed to the sinuosity, that no part of them touch the Mem∣branes; to avoid the accidents where∣of I spake before.

As for mine own part, I more commend the solid Medicaments than these stuid: for First, their fa∣culty is more durable: Secondly, they are more secure, because they are not so apt to spread: If the Body be young and tender, this Medicament will serve. Take Mer∣cur. Praecipitati, aut Turbith loti ʒ ij. Aluminis caicin. ℥ j. Exquisi∣tè misceantur; postea ℞. Ʋnguent. pop. ℥ j. Pulveris praedicli ʒ ij. Mis. ceantur, ut resultet vnguentum. When you apply this Medicament, arming a Tent with it, pull it not out forcibly; but suffer it to pop out of it self. Continue the ap∣plication of this Medicament until the Callus be removed, which you may guess, if the process of the sinuosity appear soft, and th Quit∣tour which cleaves to the Tent ap∣pear landable.

The Callus being thus removed, you must mundifie it: To this

purpose you shall use this local Medicament: ℞. Aq. Chelidoniae aut Rutae. ℥ ij. Syrupi è succo rutae, aut Mellis rosati ℥ i. Misc. appli∣cetur calefactum. Dress the Fistu∣la but once a day.

The part being mundified, which you shall know by the redness and tenderness of it: Then go about the consolidation. This you shall procure by this Medicament: ℞. Aq. Plantag. ℥ ij. Syrupi Myrtille∣rum. aut. Ros. rub. siccat. ℥ i. Mis∣ceantur. Apply this, and renew it but every other day, if no remark∣able store of Quittour flow

As for the skinning: Diapalma cum succis, de minio, or Empla∣sirum rubrum astringens will serve.

If in an Aegilops or lachrymal Fistula, the bone of the Nose be corrupted by the Humour staying in the embosement, then two ways of curing are offered unto you.

The First is by actual cautery, the Second is by incision. Peruse all who have written of the curing of this kind of Fistula's, and you shall find that all with one accord subscribe to the actual cautery.

The actual cautery must repre∣sent in Figure the stone of an Olive: The parts adjacent must be defend∣ed from the fire, either by an hol∣low Plate according to Parey, or a Cane according to Ab aqua pen∣dente; you may make choice of which you will: you must effectu∣ally impress it, to dry the Humi∣dity, and the sooner to procure the scaling of the Bone. And although Authors, after the application of the actual cautery, prescribe fatty things to hasten the separation of the eschar, yet I advise you not to use them; for the part is moist of it self, and so the application of such Medicaments would procure a sordid Ulcer: Apply therefore on∣ly Pledgets or Tents dipped in Red Wine, and above all Diapalma or Emplastrum de minio, or de Smeg∣mate. When the Bone hath cast a scale, then consolidate and skin it, as I have set down before.

It is not unknown with what difficulty Patients admit the appli∣cation of an actual cautery, to a part much distant from any of the principal, and wherein there is but small sensibility. What will a Patient troubled with this grief do, if you make mention of cauteriza∣tion to be made in this place, so near the Eye and the Brain it self? If at any time you make mention of such a kind of cure to a Patient, to try how he stands affected to this operation; let me intreat you not to urge it too much, as if the cure of the Fistula could not otherwise be compassed, if you find the Pa∣tient averse, lest you drive him away, and so you loose both cre∣dit and gain. When in the Coun∣trey I practised Chirurgery, sun∣dry times this kind of grief having been presented unto me, I ever found the Patients strucken into a terror and amazement, as soon as mention was made of Cauterizati∣on; wherefore I set my imagina∣tion at work, to find out a way to cure a Fistula lachrymaliss, less ter∣rible, but more sure and effectual, which I will not conceal from you, because this grief doth often come to your hands, and both great cre∣dit and gain is purchased by per∣forming the Cure.

My manner of cure is this: First of all, having with a small

Probe bended, found out the Cavity both upwards and down∣wards, I draw a line with Ink be∣tween the Glandule of the Eye, and the Trochlea or the Pulley, through which the small Tendon of the first oblique Muscle called Superi∣or, or Ma••or, the uppermost and greatest, passes, and ends obliquely in the uppermost part of the Cor∣nea: then I make incision to the Bone; the part incised I divide with the Nails of the fore-singers, until the incision be so much dilated, that it will without difficulty admit a pretty Pledget: this being done, I thrust in a small Trochisk made of Turbith mineral before it be washed, the vomitive Vitriol, and the best Terra sigillata wrought with Populeum to the form of a stiff Paste, and afterward dried. About the Trochisk I apply a Pledget armed with Populeum, which I keep to the Fistula by an Emplaster of Diapalma cum succis, malaxed with the Oil of Henbane. Afterward filling the orbit of the Eye with little bolsters made or soft Linnen-cloth folded, and moist∣ned in Aqua spermatis ranarum ca∣phurata, I rowl up the Eye. The same dressings I use Morning and Evening, until the Trochisk with the Callus fall out of its own ac∣cord: which when I perceive, I diligently view the Bone, to see how much is carious, unto it I apply the Powder of Euphorbium, if the diseased party be aged, and of a firm constitution of Body; but if the party be young, and of a tender constitution, I besprinkle the Bone with Pulvis Cephalicus. The cavity of the part incised I fill up with a piece of the Sponge dressed with Melilot Emplaster, as I delivered in the former Chapter: about it I apply a Pledget armed with Popúleum, all which I couch down close, with the Emplasters and Bolsters kept to the Eye with a Rowler.

This manner of dressing I conti∣nue until the scale of the carious Bone casts, which most commonly falls out about the Twentieth day. When the scale is removed, I mun∣disie the part with Mel rosatum, or Mel rutaceum; then I procure con∣solidation by the Syrup of Myrtles, or of red Roses dried, And last of all I cicatrize the part affected with some epulotical Emplaster, whereof I have set down sufficient store heretofore, and shall hereaf∣ter, when I shall discourse of an Ulcer which hardly admits skin∣ning. I have made sufficient ex∣periment of this manner of curing an Aegilops in sundry persons. And I truely affirm, that I never missed of the Cure of any one with whom I thus dealt: neither shall you (I hope) if punctually you observe these observations in your proceed∣ings.

And this Practice is confirmed by Hildanus, Obs. 23. Cent. 5. Who cured a Fistula lachrymalis in a Boy about Thirteen years old; he had been troubled Four years with it in his Left Eye: the Bone was not only carious, but tears, when he cryed, trickled out at the Fistula, the Gland was so much eroded. This Boy was so impati∣ent and peevish, that an actual Cantery (which Hildanus accounts the best remedy for a lachrymal Fistula) could not be used. There∣fore, having ordered his Diet, he

purged the Patient, and made a Seton in his Neck. A few days after, when the Seton run, he ap∣plied his potential Caustick, which causes no pain. When the Eschar was fallen, he dilated the Fistula to the Bone with an escharotick Unguent, and prepared Sponge. Then he strewed good store of powdered Euphorbium on the Fi∣stula, and upon it applied a Pla∣ster of Gum Elemi; when these things had been used for some weeks, the Bone scaled; and when the Scale was extracted, half a drop of Balsam of Tolu was applied once a day to the Ulcer, which quickly healed up, and continued sound and firm. And a little after the Seton was dried and healed up. And by the way observe, that Hildanus in this Cure ascribes most to Eu∣phorbium.

It may fall out that the whole substance of the Bone of the Nose subjacent to the Fistula may be carious, being of its own nature thin, and the Head of the party besides very rheumatick, so that being often cured in the opinion both of the Chirurgeon, and di∣seased party, yet it breaks out a∣gain. In such a case you may de∣mand of me, how you shall fall off from such a Cure with your own credit. To this I answer, that there is yet a Subterfuge; and a way left to give contentment to the afflicted Patient: To com∣pass this, first dilate again the sinu∣osity, until the corrupt Bone ap∣pear, as hath been shewed hereto∣fore. Secondly, pierce the bone of the Nose with a Gimlet, that the Quittour may have recourse to the Nostrils, which are appointed as shoars to discharge the flegma∣tick excrements of the Brain, and to draw in fresh Air for the refri∣geration of the Lungs: and then cure the superjacent fleshy and skin∣ny parts, as I taught you, when I set down the palliative manner to cure a Fistula. This manner of cure being the last refuge, it will undoubtedly give contentment to the Patient: for the eyes of the be∣holders shall observe no deformity external in him, and he himself shall not be able to discern the turning of the Quittour from the Glandule outwardly, to the No∣stril inwardly: besides this, he himself shall perceive no smell that shall offend him; the smell of Garlick is not offensive to those who have eaten of it.

Now to conclude this my dis∣course of a Fistula lachrymalis, if you perceive any such Fistula ma∣lign, or to tend to a cancrosity, which you shall discern by the signs set down, when I delivered unto you the Prognosticks: then use this Medicament of Heurmus the Father, set down in methodo ad praxin. lib. 1. p. 106. which he purchased both with Money and Entreaty, of one who got much Money by it.

This is the description of it: ℞. Ca••imin. ter ••sti atque in vini aceto extincti ℈ j. myrrhae, plumbi usti ac loti an. ℈ ss. creci gr. v. opii gr. ij. aeris usti ℈ iiij. decocti fe∣••ugraeci ℥ j. Misceantur exquisitè omnia super lapidem picter••m. If you mean to make an Ointment to continue long, instead of the Mucilage of Femgreek, use new Swines-grease washed in Rose∣water;

this is an admirable Eye∣salve in all Ulcers of the Eyes: (whereof I have made often trial) whether they be malign or no.

CHAP. XIII.

Of Fistula's in the Breast.

NExt to Fistula lachrymalis, Fistula Thoracis; a Fistula in the Breast doth osser it self. Of which Cornelius Celsus l. 7. Am∣brosius Paraeus l. 9. ca. 31. and Fa∣bricius ab aqua pendente de operat. Chirurgic. part. 1. c. 47. have writ∣ten.

This kind of Fistula happens two manner of ways: First, by rea∣son of a penetrating wound of the Breast.

Secondly, by a Phlegmon pos∣sessing the intercostal Muscles, and the Pleura.

It is a superfluous matter to set down any figus, seeing they appear to they Eye. and are easily found out, by applying the signs set down in the general method of curing of Fistula's, to every Fistula in particular.

As for the differences; a Fistu∣la ensuing a wound penetrating to the Cavity of the Breast, hath but one Orifice, the passage and sinu∣osity whereof is according to the penetration of the wound; but a Fistula following after an Apo∣steme, hath frequently more Ori∣sices than one; whereof some pass to the Cavity of the Breast direct∣ly, some windingly.

To come to the Presages. All Fistula's of the Breast are hard to be cured, and that for seven rea∣sons.

1. For First, the Breast is in con∣tinual motion by reason of its dila∣tation and contraction caused by the intercostal Muscles: now, that motion hinders the curation of any Sore, it is so manifest, and con∣firmed by experience, that it needs no proof.

2. Secondly, because in penetra∣ting Fistula's of the Breast, the Pleura is always ulcerate; which being thin, without Blood and membranous as the Bladder, hard∣ly admitts any consolidation.

3. Thirdly, seeing the Virus of the Fistula doth often corrupt the Rib; and seeing the internal sub∣stance of the Rib is cavernous and so apt to lodge corrupt Matter, the difficulty of curing is increased.

4. Fourthly, in Fistula's of the Breast, the end of the Fistula is often lower than the Orifice, which hinders the expurgation of the su∣perfluous matter.

5. Fifthly, the Sinuosity within, in penetrating Fistula's doth fre∣quently extend it self between the Pleura and the upper Rib, to the distance between it and the lower Rib. Now how hard a matter it is to cleanse this Cavity, I refer it to your own consideration.

6. Sixthly, that liberty of apply∣ing of Medicaments, which is per∣mitted in sundry other parts of the Body, is here denied, the Lungs and Heart being lodged in this Ca∣vity, whereof special regard is to be had, seeing upon the safety of these parts the life of the Individu∣um depends.

7. Seventhly, because Fistula's bring an extenuation of the Bo∣dy, and a Hectick Fever.

Let this be the second Progno∣stick: If the party afflicted with a Fistula in the Breast, be fallen in∣to a Hectick Fever, and his Body begin to be extenuate, pronounce the grief to be incurable; for if you use desiccative means, which are required in curing of Ulcers, you shall increase these symptoma∣tical griefs, and hasten death.

The third prediction Celsus de∣livers unto us in these words, So∣lent quoque, &c. Fistula's use some∣times, when they have passed by the Ribs, to corrupt the Midrisf; which may be gathered by the place affected, and the greatness of pain; in this case there is no hopes of cure.

As for the cure of a Fistula of the Breast; to it three means are required; a convenient Diet, pe∣ctoral Decoctions, and local Ap∣plications. In a Fistula, which hath caused neither a Hectick Fe∣ver, nor extenuation of the Body, a greater variety of Meats is per∣mitted, than when these symp∣tomes are annexed. Howsoever Meats of easie concoction, and which afford laudable nourishment, are to be appointed for the Pati∣ent, and a moderate use of them is to be prescribed: of these two means I have spoken amply enough, when I set down the general cure of Ulcers.

As for pectoral Decoctions, up∣on the use of which the greatest part of the cure of such Fistula's depends, you shall find divers de∣scriptions of them in divers Au∣thors.

The Simples whereof these De∣coctions are made, are these; The Flowers and Leaves of Colts-foot, Maiden-hair, white Horehound, Comfrey, Tormentil, and Bistort-roots, Violet-flowers, Borage roots and flowers, Elecampane-roots, Hyssop, Germander, the flowers and roots of Mallows, the roots of Parsley and Fennel, Liquorice, Scabious, Valerian, Burnet, Sarsa∣parilla, Guajacum, China-root, Raisins of the Sun, and blew Figs: of these Simples you shall find sun∣dry Decoctions set down by Au∣thors, who have written of Wounds and Fistula's of the Breast.

Amongst all others, the Pecto∣ral Decoction of Franciscus Arcaeus you may most safely and securely trust unto: He, while he lived, was so fortunate in the practice of Chi∣rurgery, that he drew that emi∣nent Linguist and Divine Arias Montanus, very often to be a spe∣ctator of his Operation. The De∣coction I need not set down, be∣cause you may fetch it out of the Author himself, who is transla∣ted

into the English Tongue.

I will not stick to commend un∣to you one of my own, whereof I have sundry times made expe∣riment. This is the Composition of it. ℞. Sars. paril. ℥ vj. scob. gua∣jac. ʒ v. rad. Chin. ℥ iij. rad. enul. campan. 1. capil. vener. scabios. fol. tussilag. scolopend. summitat. hyper. an. man. 1. flor. borag. buglos. viol. beton. an. pug. 1. polypod. ℥ iij. liquirit. ℥ ij. passul. major. exaci∣nat. & sicuum pinguium incisar. an. ℥ ijss. Infundantur ista per noct. in aq. font. ferventis lib. 24. deinde lento igne coq. ad consump. lib. 8. ac coletur decoctum. Bibat aeger fingulis diebus lib. 4. Let the Pa∣tient every Morning about five a clock, drink half a pint of this Decoction warm, and so much a∣bout four a clock in the Afternoon: at Dinner let him take a Pint, and at his Supper another: the third Pint he may drink between Meals. Marvel not at this quantity, for a less will little avail; for strong de∣siccation is required in this Cure.

Three things hinder the cure of these Fistula's:

The First, is the inconvenient situation of the Orifice, when it is higher than the ending of the Fi∣stula.

The Second is the extenuation of the Body.

And the Third is a Hectick Fe∣ver: Of these in order.

If then the ending of the Fi∣stula be lower than the external Orifice, a lower Orifice is to be made by incision. In this opera∣cion two things are to be diligent∣ly noted: The First is the place. The Second, the cautions to be ob∣served in the Section.

As for the regions of the Breast: The Left Side is safer than the Right: for in this Side the Liver by its gibbosity beareth up the Diaphragma, and insinuates it self to the cavity of the Breast: If then either one of these, or both should be wounded imprudently, it is an easie matter to prognosticate the tragical event of this operation.

As for the determinate part of the Breast, which is to be opened, let it be about the beginning of the next Rib, and not at the lower end of that Rib, above which the orifice of the Fistula shews it self; for under it are couched a Vein, a Nerve, and an Artery.

In your Section proceed thus: First, divide the Skin towards the upper part of the lower Rib, then make way thorowout the interco∣stal Muscles: These things being done, dry all things with a Sponge, and put into the new Orifice a swelling Sponge, both to dilate it, and to draw to it self the Quittour. If you go thus to work, you need not fear any danger, if you pass no further than the division of the Pleura: so that neither the Dia∣phragma, nor the Lungs, nor the Pericardium be touched.

If with a Fistula of the Breast a Marasmus or Hectick Fever be complicate, the difficulty of curing is exceedingly increased; two Di∣seases joyntly conspiring to the ru∣ine of the diseased Party, which notwithstanding for their Cure re∣quire adverse indications, the Fi∣stula requiring Desiccation, and Marasmus, and the Hectick Fever craving Humectation. If then a Fistula of the Breast be offered to any one, First of all be sparing in

your promises, lest ye be account∣ed Clouds without Rain: who but an Ignorant will give free reins to liberal promises to cure a Fistula of the Breast, complicate with other Deutero-pathetical griefs, of their own nature hard to be cured, when as it is a difficult matter to cure a Fistula of the part?

Marasmus, in Latine Authors Marcor, is an immoderate driness and consumption of the whole body. by reason of the defect of the sub∣stantial Humidity, according to Trallianus. According to Galen. li. de marc. there are two degrees of it: The one is when this extenu∣ation of the Body is in Fieri, in con∣suming; the other is when it is in Facto esse, or consummate.

If it be in Fieri only, the Mu∣scles begin to fall, the Skin be∣becomes flaggy and loose, strength and agility decay, and the party finds a manifest defect, and impo∣tency in all the actions of the Bo∣dy, whether they be animal, vital, or natural. Against this degree you may contend by instituting a Diet moistening.

If a Marasmus be in Facto esse, or consummate; then the Eyes grow hollow, and seem to be hid in the pits; the lively colour of the skin fades, the skin of the Fore∣head seems dry, and stretched like the head of a Drum; the Eye∣lids seem heavy, and scarce able to lift themselves up, as it happens to those who are wearied by rea∣son of watching; the Temples are hollow: in the cavities of the Breast and Belly, one would think that there were neither Viscera, Mem∣bers contained, nor Guts: for the Muscles are so consumed, and the Cavities so drawn in, that nothing seems to remain besides the Fibrae and the Skin. To conclude, one having a consummate Maras∣mus seems to be nothing else but a walking Skeleton. Whosoever shall undertake the cure of such a one, and perform it, I will give him leave to give himself out for another Savi∣our, and to publish a Fifth Gospel.

A Marasmus is two-fold: for one is accompanied with heat, and may be called a dry Marasmus, and this is nothing else but a Hect∣ick Fever, which has consumed the radical moisture of the solid parts, and it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or an extenuating Fever.

The other is accompanied with Cold. This is two-fold: The one is natural, and it is decrepit old age: for old age is defined by driness and coldness.

The other is unnatural, and it is called Senium ex morbo, a decay by reason of sickness: old age comes by the course of time.

This last is of a violent cause, for it follows after a burning or a Hectick Fever; and that by reason of the sickness it self, or by reason of Medicaments used in the curing of the afore-named griefs: for a Hectick Fever does not only wast the natural Humidity, but the na∣tural Heat also seated in the Hu∣midity: wherefore the Heart it self, the wel-spring of this heat, must become colder than it ought to be. In this case the Pulse is small and weak, and slow: in like manner the breathing is weak, slow and cold. By reason of the use of refrigerating Medicaments appointed by the Physician in cu∣ring of a Hectick, or a Febris

Marasmodes, many times Senium ex morbo succeeds: and this is more intolerable, because, the heart be∣ing somewhat immoderately cool∣ed, the less of the Radical Moisture is spent, than would be, if the Hectick had its full course.

A Hectick Fever, is an unna∣tural heat which has seized upon the solid parts, and wastes the Moisture of them. But seeing there is a three-fold Moisture in the Body: to wit, Blood in the small-Veins and Arteries of every part, a dewy substance in every part by which it is nourished, and gluten which keeps together the Terrestrial substance of each part, moistens it, and keeps it from fall∣ing to dust:

There are also three degrees of a Hectick. In the beginning when the two first Humidities begin to fail, the Hectick Fever is not easi∣ly discerned, although it may be without great difficulty cured: But if the Radical Moisture be con∣sumed, as it is easily discerned, so it is hardly cured. As long as this Moisture is somewhat plentiful, sufficient to entertain the Natural Heat, the Body seems well colour∣ed, of a comely Figure, and of a decent quantity.

If therefore you perceive the Body of any one having a Fistula in the Breast, by reason of the de∣fect of this gluten, or Radical Moisture, become discoloured, the Figure to be altered, some parts bunching out, some growing hol∣low, and the thickness of the Members to become slenderer, the Flesh colliquating; leave such a one to himself, that he may march peaceably to the period of his life.

Having treated of a Marasmus or extenuation of the Body, and a Hectick Fever (so much as is ex∣pedient for you to know in your Chirurgical Practice) without the knowledge of which, you cannot possibly proceed, warily and cir∣cumspect, in curing Fistula's of the Breast, I am to shew you what uses you may make of what hath been delivered.

If therefore one having a Fistula in the Breast, be brought unto you, whose Body seems to be no∣thing else but Skin and Bone, (as the vulgar proverb is) acquaint him with the danger wherein he is, lest death seize upon him unprepared. Nevertheless if he implore your aid of Christian Charity, withdraw not what comfort you are able to pro∣cure unto him; appoint then a Diet moistning and nourishing, if no Physician be at hand, which I will set down anon; and dress him with those Medicaments, which are anodyne and healing. Inject into the Fistula Plantain-water, having some red Rose-leaves dried mingled with it; cover your Tent and Pledget with Diachylon sim∣plex. If you perceive that there is so much of the Radical Moisture re∣maining as is able to cherish the Natural Heat (which you shall discern, if the colour of the Body be fresh, if the Figure be decent, if the proportion of the parts be ac∣cording to Nature, and the dis∣eased party can in some good measure perform all actions) you may conceive some hope of his recovery.

Wherefore if a Marasmus has extenuated his Body, appoint for him a Diet which is likely to re∣pair

the Natural Moisture impair∣ed. Let him then take Broths made of Mutton, Veal or Chickens, wherein Damask Prunes, Raisins of the Sun stoned, Currans wash∣ed and bruised, Mallow-flowers and Roots, Marigold-flowers, Cinque∣foil, Cowslip-flowers, and Colts-foot-leaves and flowers have been boiled: Gellies are good, made of young Cockrels, and a Knuckle of Veal; use no other Spice to it than a little Mace and Nutmeg. Let him between meals take Almond-Milk made of Broth of a Chicken boiled with French-Barley. It is good for him also every Morning and Evening, to take a draught of Asses or Goats Milk: or in want of these, of Cows Milk, milked thorow the Conserves of Borrage, and Bugloss flowers; Calves and Sheeps-feet stewed with Currans are good: sometimes let him eat Pigs-flesh. If he have a mind to Fish, grant unto him Whiting∣mops, Smelts, Perches, young Pickerels, Trouts, yea sometimes Eels: the Sole, Flownder and Plaice may also be permitted; poched Eggs, and sweet Butter without any Salt, or Almond-But∣ter, are good for break-fast.

If an extenuation of the Body do proceed from an Hectick Fever, then you must not only moisten the Body, but cool it also. In the Broths then boil Borage, and Succory Roots, common Sorrel, wood Sorrel, Primrose, Violet, Borrage, and Bugloss-flowers: let his Sallets be Lettuce, Spinage, and Purselain boiled in Chicken-broth. An Almond-milk made of the de∣coction of French Barley, where∣with the Emulsion of the Seeds of the Pompion, Musk-melon, Cu∣cumber, Purselain, and White Poppy has been drawn, is excel∣lent taken Morning and Evening. Permit no Milk but Butter-milk, and that when it begins to be a little sowrish, with a little of Su∣gar, or Borage, or Bugloss. If the diseased party complain of im∣moderate heat, and watching, give him twice a week Philoninum Per∣sicum, with Syrup of white Poppy, red Poppy, Gilly-flowers, Maiden-hair, Colts-foot, or of the juice of Limons, or Citrons in Aqua Sper∣matis Ranarum or red Poppy. If you perceive that by the following of these courses the party has reco∣vered his strength, and a good ha∣bit of Body, then you may con∣ceive a good hope of his recovery, and put him in good comfort, and so boldly proceed in the Cure, still endeavouring by following the In∣dications (as Thescus did the Thread of Ariadne to come out of the Labyrinth) to restore per∣fect health to the Patient.

In setting down of local Appli∣cations I will be brief, because they little differ from the general, if you except a few observations. You may safely dilate a Fistula of the Breast, with the Fistula Tent and Sponge; but in removing of the Callus you must he wary; for if you apply the Trochisk, it must not reach to the Cavity of the Breast; for the point of it will re∣lent, break, and fall upon the Septum transversum, which un∣doubtedly will erode it, cause an Inflammation, procure a sharp Fe∣ver, a Paraphrenitis, and at last death it self. Apply then a Tent armed with Populeon, wherewith

the Fistula Powder must be min∣gled, as hath been taught. The Callus being removed, mundifie the Ulcer with Aqua calcis, and Mel rosatum mingled together: Take heed that you inject no bit∣ter Medicament, for such Medica∣ments are easily sucked in by the Lungs, from whence by the Tra∣chaea Arteria they easily pass to the Throat and Mouth, from whence there is felt a horrible bitterness, a desire to vomit, and an over∣throw of the Appetite, Paraeus lib. 9. c. 13. affirms this to have happened unto him twice, be you ware by the example of others. The Ulcer having been mundified, proceed to consolidation; for sores in this part are not to be long kept open: This you shall procure by injecting two or three days the Syrup of red Rose-leaves dried, mingled with Plantain-water; and then only moistning a Pledget wet in this Syrup, or the Syrup of Myrtles. Above the Pledget ap∣ply Paracelsus his Styptick Em∣plastrum; for in this case it ex∣ceeds all others: because it not only draws the brims together, but it skins also.

CHAP. XIV.

Of Fistula's in the Belly and Joynts.

FIstula's of the Belly are two-fold: for they are either in the Inguinal parts, or else in Ano.

Of these in the Groins I will discourse; because they most fre∣quently fall out, being Accidents, for the most part, which ensue af∣ter Venereal Bubo's, either neglect∣ed, or ill cured; yea, they fall out in Plethorick and Cacochymical Bodies very often, wherein there is no Neapolitane Seed: and that somewhat above the Emunctory it self; the Matter not coming to the Emunctories themselves, which receive the Excrements of the Li∣ver; but being hindered, either by reason of the weakness of the expulsive faculty, or by the crossing and thwarting of the Muscles, oblique and tranverse in those places, as they who are skilful in Anato∣my well know. It is no wonder that both Abscesses, and Fistula's often fall out in these places, see∣ing the Belly is as a Draught or Sink in a House, or a Keel in a Ship, whither all impurities flow. Yea, such plenty of sharp Humors sometimes flows to these parts, that perforation of the Guts is caused, and that the Excrements come out at the Orifice of the Fistula; a lamentable case, noisome to the diseased party, and intolera∣ble

to the company. It falls out sometimes that some of the Ver∣tebrae of the Spina are cor∣rupted.

As for the Presages: Fistula's in these places, which pass to the Cavity of the Abdomen, are hardly cured.

First, because the Liver is still apt to afford new Matter.

Secondly, because great circum∣spection is to be used, if you shall use either Incision, or Corrosive Medicaments, by reason of the Fibrae of the Muscles, and the bran∣ches of the Vena cava, and Aorta descending.

The second Presage is this: If the Vertebrae of the Spina be cor∣rupted, pronounce the Fistula to be incurable: you shall conjecture the Vertebrae to be foul, if extra∣ordinary store of stinking Sanies issue out of the Fistula, and the party daily grow weaker, and more extenuate, notwithstanding that you use all convenient both inter∣nal and external means.

The third Presage shall be this; If the Guts be eroded, and the Excrements come out at the O∣rifice of the Fistula, the life of the diseased party is in great hazard: because the Guts are thin, mem∣branous, and destitute of store of Blood.

Secondly, because the Fistula is apt to creep thorow the distances between the Muscles, which in those places are many; to wit, the oblique and transverse, one placed above another.

Thirdly, because in curing such Fistula's, we find little help of Hand and Eye.

Fourthly, because topical means can hardly be kept to the Guts, to help consolidation.

As for the Cure of these Fi∣stula's: If they be not deep, but run along superficially, the best course is to make incision, and then to apply one of the Fistula Pow∣ders described by me, care had of the age and constitution of the party.

As for the Mundification, Con∣solidation, and Cicatrization of such, seeing no special observation is required, you are to have re∣course to that, which I have copi∣ously delivered heretofore. If the Vertebrae of the Spina be foul, you are to promise no Cure.

Nevertheless, if persons of worth will (upon good consideration) en∣tertain you to dress them, they finding a comfort by your pains, make an injection of Plantain, or Carduus Benedictus Water, adding some fragrant Water of Medow-sweet, the Syrup of red Rose-leaves dried, and the Spirit of Wine, having the tincture of Aloe, Myrrhe, Mastick, and some Saffron. Let your Emplaster be Diachylon cum gummi, or Paracelsus his Styp∣tick. If the Guts fall out to be per∣forated, having acquainted the friends of the party with the dan∣ger, yet despair not, but go on, and use Methodical means. Let the party eat Calves and Sheeps-feet stewed, Sheeps and Calves heads; for they afford a glutinous juice; Rice boiled in Milk, where∣in Steel hath been often quenched, is also good. Every Morning and Evening let the party take a draught of Allegant, warmed with a Wheat Toast, when he has drunk off the Wine, let him eat

the Toast. Make injection of red Wine, having a little Alume dis∣solved in it, and some of the Sy∣rup of Myrtle-berries: keep the Orifice open with a Sponge, until the Gut be consolidate: then pro∣ceed to the extirpation of the Gallus, Mundification, Consolida∣tion, and Cicatrization, as has been heretofore taught. Event oftentimes falls out above expecta∣tion.

Not long ago a Country Youth, who had an Enterocele, was bound to a Barber in Aldersgate-street; one applying to the Rupture a Truss somewhat strait, caused a Sideration or Mortification of the part, so that the Excrements came out plentifully, with much stinking Matter out of the Cavity of the Belly. Notwithstanding, by dili∣gence and application of conveni∣ent means, the Gut was consolidate and the Youth kept alive. So much I thought good to deliver concerning the Cure of Fistula's, which happen in the Inguinal Region.

Now it follows, that I speak of Fistula's in Ano which was said to be the second kind of Fistula's in∣vading the Abdomen, or the lower Belly.

This kind of Fistula very often follows after a Plegmon in the A∣nus, broken and ill cured.

There be two sorts of these Fistula's, for some pierce not the Intestinum rectum, and some do: and both these are either shallow or deep.

You shall conjecture the Fistula to pass thorow the Intestinum rectum: First, if after breaking of Wind, part of it make way thorow the Sinus of the Fi∣stula.

Secondly, if the Excrements ap∣pear mingled with the Quittour, or if the Quittour smell as the Ex∣crements use.

Thirdly, injection being made at the outer Orifice of the Fi∣stula, if part of it pass within the Anus.

Fourthly, the foregoing being put into the Anus, if you feel the Probe bare, it being thrust thorow the Sinus of the Fistula, this is an infallible and certain sign.

As for the Presages of these Fistula's: First, no Fistula ani is easie to cure: for this part being the Jakes of the Body, it affords great plenty of Impurities, and much superfluous Moisture, which hinder the Cure.

Secondly, if a Fistula in this place be not very painful and noi∣some, by reason of much stinking Quittour, but shuts and opens it self sundry times. It is expedient for the health of the Patient, if such a one be left uncured: for by this means the Body is discharged of superfluous Humors, and the Body kept in health. I have known this Accident to have happened to sundry, and to have continued to the end of their lives.

Now to come to the Cure of these Fistula's: The means to at∣tain this are five: Diet, internal Medicaments, Incision, Deligation and Topical means.

As for the Diet, and internal Me∣dicaments, I have discoursed suf∣ficiently heretofore.

As for Incision and Deligation, they have place when the Fistula is shallow; but if the Fistula be

deep, neither of these means are to be attempted.

If therefore the Fistula be shal∣low, and pass not to the Intestinum rectum, after you have dilated it, and removed the Callus, upon a Tent, incise all the hollowness: then fill it with Dosels, armed with a Medicament made of a restrictive Powder, and the white of an Egg, to keep the brims of the incised parts asunder; for if you go about to unite the parts too soon, it may be feared that a Cavity will still remain, and make way for Reci∣divation: wherefore it behoves you, to see that sound and laudable Flesh be ingendred in the bottom. Let not your incarnative Medica∣ments be satty, for such will cause loose and spongy Flesh: use there∣fore the Sanative Syrup made of vulnerary Plants, having some Pul∣vis cephalieus mingled with it. If the Fistula go deep inwardly, so that you cannot use conveniently incision, dilate the Fistula with the Fistula Tent, and the Sponge: then remove the Callus with a Fistula Trochisk; the Trochisk being come out, and the Callus quite spent, mundifie it with Mel rosatum, mingled with Aqua cal∣cis: when you perceive laudable Quittour, endeavour to consolidate the part, by applying the Sanative Syrup, and Pulvis cephalicus upon the Tents, which you must day by day shorten, until at last the whole Sinus of the Fistula is shut up; which you shall conjecture by the little and laudable Quit∣tour which the Fistula yields. Then nothing else remains, but to cicatrize the part with your Dia∣palma, or Ʋnguentum de minio.

If the Fistula penetrate to the Intestinum rectum, then cutting asunder of the whole Sinus of the Fistula by deligation is most fit. But first of all, you must dilate the Sinus, and remove the Callus (as has been said) for so the part which is to be bound will be more thin, and so more easily cut asunder. As for the Thread wherewith you are to bind the Sinus, two I com∣mend unto you: First, Sealing Thread, which is made of the best Hemp, unboiled, and unwhiten∣ed: For is is exceeding strong, and will not rot before it hath wrought its effect. The second, is a strong Thread of Silk, twist∣ed; there is no great Matter in the colour, whatsoever scrupulous Au∣thors affirm: you may use either of these as opportunity shall be offered.

When you go about to bind the Sinus, put in one end of the Thread in the Eye of a small and flexible Probe, then thrust the Eye with the Thread thorow the Sinus into the Intestinum rectum: this being done, put into the Anus your Finger, and with it pull the Thread out of the Eye of the Probe, and draw it out at the Anus, or having bent the Eye of the Probe, bring it without the Anus, and then put∣ting the Thread into the Eye, draw that end thorow the outer Orifice of the Fistula. If the Sinus be not very thick and long, you may by one strong Deligation bind off all the Sinus; but if the Sinus be thick and long, you must use sundry constrictions, tying still the ends of the Thread with a running knot, that it may be the more readily loosed. Some

after one Deligation only more and more draw in the ends of the Thread, with a round piece of a Stick turned about. When all the Sinus after division by Deligation, lies open, go forward in the Cure, as has been set down, when the Si∣nus was incised. Job à Meek'ren in his Obs. Medico-Chir. Cap. 61. recites the following Case:

Fran∣cis Volkertsen, a melancho••••k Man, after a great commotion of Mind, felt a defluxion run along his Back down to his Rump, and from thence to the meeting of the Buttocks, where the Intesti∣num rectum lies upon the Os Caude. Presently a swelling a∣rose, which perforated the fat, the edge of the Muscle Glutaeus, and the Intestinum rectum. When I came to the Patient, besides the Fever I considered the vio∣lence of the Pain, the hardness of the Tumor, its redness and extension. And because I knew these and other symptoms must be ascribed to the Tumor, I presently applied this Cataplasm, to promote Maturation; ℞ Rad. Alth. Bryon. Lilior. alb. an. ℥ jss. Fol. Malv. Bismal. Violar. a. M. j. Flor. Chamaem. M. ss. Sem. Lin. ℥ ss. Coquantur & contundantur, addendo Faenugr. Sem. Lin. a. ℥ ij. Axung. porcin. q. s. Butyr. recent. ʒ j. Vitell. Ovi n. j. M. f. Cataplasm. I applied it hot to the Tumor. The second day I thought it advisable to open it, and a great quantity of foetid purulent Matter ran out. Afterwards I observed Wind and Excrements to come out at the Tumor, whence I concluded, the Gut was perforated. I applied several things to regenerate Flesh; but to no purpose. Therefore I was forced to Incision, in which I was obliged to cut the rest of the Gut that was sound, the Skin, and a Musculous portion of the Gut. When the dissection was done, because there was a grievous flux of Blood after open∣ing of the Haemorrhoidal Veins, I applied an ordinary Astringent to the Wound. The next day I found less Pus than usual in the Wound. All things promised well and so they succeeded: for he was perfectly sound.

Now no∣thing remains to conclude these discourses of Fistula's, but to speak somewhat of the curing of Fistula's in the Joints. These griefs, what pains they procure to the Patients, and troubles to the Chirurgeons who dress them, it is so well known to those who have been imployed in such businesses, that I need not use many words to perswade any to believe this: ex∣perience hearing witness.

The differences of the Fistula's are these. Some are without cor∣ruption of the Bones and Carti∣lages, and some have these annexed.

Again, some of these are with∣out any Tumor of the adjacent parts, and in some there is a re∣markable swelling of the parts ad∣jacent; so that the Skin it self is either brawny and hard, or loose and Oedematous; and some of the Tendons of the Muscles are foul, and corrupted very often: such Tu∣mors often fall out, when Fistula's happen in the Wrists and Ankles.

Thirdly, in some of these Fi∣stula's the Joint abides firm; but in some it becomes loose and weak

by reason of the relaxation of the Membrane which covers it, and the Ligament by which it is strengthened.

Before I come to Prognosticate of the Events, let me acquaint you with one thing, and that is this; that if ye be called to Children or Young Persons troubled with a Fistula, or Fistula's in the Joint or Joints, that you make trial of the Sinus with a Mallow stalk an∣swerable to it; for this kind of probation is of all others less pain∣ful, and will incourage the diseased persons to commit themselves to your care, when they perceive that you searched the Sores so easily, hoping that your proceedings will be according to your beginning. The small stalk of the Mallow next to the Leaf is always slimy and flexible, and so is apt to slip in∣to the Sinus, causing either no pain, or very little.

As for the Presages: 1. No Fi∣stula of the Joint, although it be without corruption of the Carti∣lages or Bones, is of an easie Cure: for first by reason of the pain, which is caused by reason of the sensibleness of the part, and the increase of it by reason the sharp Medicaments which must be ap∣plied to remove the Callus, sym∣ptomatical Fevers, loss of Appetite, watching, extenuation of the Body, and at last a Hectick Fever may be procured.

2. If a Fistula of the Elbow or Knee have corruption, either of the Cartilages or Bones, annexed, it will require long time to have it cured: for the joints themselves being very sensible, it must be gently dressed.

3. If in Fistula's of the Wrist the bones of it, or of the back of the Hand, be carious, you shall find the Cure to be difficult: for these Bones are very spongy, apt to receive superfluous Humidity, and so are hard to be scaled.

4. For these same Reasons, the Bones of the Joint of the foot, and the Instep are hard to be cured.

5. If Fistula's in the Wrist or Instep be accompanied with large and hard Tumors of the Bands and Feet, pronounce the Cure to be uncurable: for then the Mem∣branes, Tendons of the Muscles, and Bones commonly are corrupt.

6. If an extenuation of the Bo∣dy, or a Hectick Fever do accom∣pany Fistula's in the great Joints, shun the Cure: for the Indicati∣ons of curing, which prescribe dry∣ing and cooling, in drying increase these griefs. Besides this, complicate Diseases are more hardly cured then those which are solitary.

If you shall demand of me, what course is to be taken with those who are possessed with such incurable Fi∣stula's, If you be intreated of the diseased party, or the parties friends to do your best?

I answer, that if after some trial, you perceive the party to be in∣curable, you ought to move the party to suffer extirpation and dismembring of the Limb, whether it be Foot or Arm, before he grow weak, and become unable to endure any such operation. In young persons you may attempt this operation (for I have adven∣tured it with good success) but in aged and crasie persons be not too

bold; for the loss of the Radical Moisture is more easily, by Diet and Medicaments, restored in those, then these: the other may, but these must die.

Now to come to the Topical means, which are convenient for the curing of Pistula's in the Joints (for as concerning the Diet, and internal Medicaments, I have spoken of them sufficiently already) you must note that you must have good Anodyne Cataplasms to as∣swage pain, and good, easie, and effectual means to remove the Cal∣lus. If you apply Mercury subli∣mate, or Arsenick to remove the Callosity of Fistula's in the great Joints, you shall always cause a symptomatical Fever, and some∣times a mortification of the part, if the party be of a Cacochymical constitution.

As for the means which miti∣gate pain, I commend unto you Fallopius his Cataplasm, which he describes in his Treatise of Ulcers, c. 17. And it is this: ℞ Ol. Lum∣bric. Chamaem, & Aneth. an. ℥ ij. Furfur. flor. Chamaem. Farin. hord. Oesypi. an. ℥ ij ss. Vini Allc∣gant. ʒ x. Etat. Cataplasma. Re∣new it every twelsth hour.

As for the removing of the Cal∣losity, no Medicament is compa∣rable in parity with the Powder of Turbith Mineral before it be wash∣ed, being mingled with Terra Lemnia sigillata, Oriental bole, and the vomitive Vitriol; this composition may be applied, being made up in form of a Trochisk, or mingled with P••puleon, and applied upon a Tent. This Me∣dicament, neither procures extra∣ordinary Inslammation, nor any hor∣rible symptom.

As for the Mundification, Con∣solidation, and Cicatrization of any Fistula in the Joints, after the re∣moving of the Callus, seeing these intentions may be compassed by the means which I have delivered to you before, I will cease to trou∣ble you with the Repetition of them, and so will conclude this Treatise concerning Fistv••a's.

If in Fistula's of the Joints there be Cariosity of the Bones, I will deliver the means to obviate this Accident, when I shall discourse of the Accidents of Ulcers, be∣fore I make an end of this sub∣ject.

CHAP. XV.

Of an Herpes exedens.

HAving delivered unto you, what I thought pertinent of compound Ulcers without Malig∣nity, Method requires that I speak fully in like manner of Malign Ulcers.

Malign is that, which differing from ordinary Ulcers, is not easily cured. By Gal. de Crisib. l. 1. c. 3. not Ulcers only, but all Dis∣eases which have a Malignity an∣nexed to them, are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. As a mild Grief has a mild Cause, and no horrible or extraordinary symp∣toms, and yields to ordinary Me∣dicaments; so that which is Ma∣lign has a fierce Cause, extraordi∣nary symptoms, and yields not to ordinary Medicaments. These Malign Ulcers do happen, when such a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 hath possessed the ulcerate part, that it corrupts the good nourishment which is sent to the part affected. The Ali∣ment sent to the part is cor∣rupted, either by putrefaction, or a venenious quality commu∣nicated.

First, Then the signs of a Malign Ulcer are three: First, it corrupts the part which it invadeth, either by Putrefaction, or a Malign fret∣ting quality.

Secondly, It causes extraordi∣nary Symptoms, as pain and plen∣ty of virulent stinking Matter.

Thirdly, It yields not to ordi∣nary Medicaments.

The differences of Malign Ul∣cers are these: First, these Ulcers are either Ancient or Modern. I call these Ancient, whereof men∣tion is made by the Antient Au∣thors: those I call Modern, which were only known to late Writers: such are those Ulcers which appear in scorbutical, and pocky persons, whereof I mean not to speak in this Doctrine of Ulcers, because they are symptoms of the Scurvy and Pox, which cannot be cured unless the Griefs themselves be cured. Now the setting down of the Cure of the Diseases, will require large and particular Trea∣tises.

Of malign Ulcers known to the Ancients, some are less Malign, some more Malign.

Of the less Malign there are three sorts: Herpes exedens, Pha∣gedaena and Nome. Herpes exe∣dens, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, being caused of thick and sharp Choler, it corrodes the Skin even to the subjacent musculous Flesh. It differs from Phagedaena, because

it erodes the skin only; but Pha∣gedaena, both the skin and subja∣cent flesh. Celsus lib. 5. and c. 28. thus describes it: Herpes. fit cum cutis exulceratione, & est sine al∣titudine, latus, sublividus, inaequa∣lis tamen, mediumque sanescit, ex∣tremis affectis, &c. That is, a Herpes is caused when the skin is ulcerate. It is not deep, but broad, of a livid colour, uneven notwith∣standing, and the middle heals, the bruns remaining sore. Wherefore if you perceive an Ulcer to spread and cause sundry other small Ul∣cers, which reach no deeper than the skin, you may pronounce it to be Herpes exedens, or Formi∣ca ambulativa; or Corrosiva.

One thing is to be noted in the words of Celsus, that a Herpes ex∣edens may be of a livid colour; and so with thick and corrupt cho∣ler that melancholy must be joyn∣ed, which is bred of Bilis atra, and so it must somewhat participate with a cancerous Ulcer. And in truth such Ulcers often shew them∣selves in old persons about the be∣ginning of the tails of the Muscles of the Legs; and from these a moist, noisome and stinking viru∣lent Matter will flow, and the Ul∣cer it self will be very painful, and rebellious.

The signs then of a Formica cor∣rosiva are these: It only corrodes the skin, and so is not deep, but broad; uneven it is, and sometimes of a livid or leaden colour, if Me∣lancholy caused of Bilis atra be joyned with thick and putrid cho∣ler: otherwise the brims of this Ulcer, and the parts adjacent are of a yellowish colour, bewraying the Humor, which is the material cause of this kind of Ulcers.

As for the Prognosticks: First, that Herpes exedens, which is caus∣ed only of thick and putrid choler, is not easily cured. For First, the Body which is troubled with such an Ulcer, is not so soon altered; for the Liver, the Gall it self, and the Porus bilarius must be much out of frame, when they cannot make shift to dispatch this Humor, by the passages appointed for the Evacuations of it; to wit, by the Guts, and passages of the Urine; but suffer it to pass by the habit of the Body by the Vessels which car∣ry nourishment; to wit, Veins and Arteries.

Secondly, because this Humor being altogether contrary to Na∣ture, it causes a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ill Con∣stitution of the part, by which the profitable nourishment which is sent to the part, for preservation of it, is corrupted: and so not on∣ly the part affected is defrauded of Aliment, but the parts adjacent al∣so are drawn to the same society of corruption.

Let this be the third Progno∣stick: If a sincere Herpes exedens proceeding only of thick putrid Choler, be hardly cured, as hath been proved; then if Bilis atra be annexed, surely the cure must be much more hard; for this is a Hu∣mor, which causes more fearful symptomes; as extream pain, greater corrosion, and rebellion to ordinary Medicaments: and if the Body has gotten a habit of breed∣ing of it; it is hard, without rege∣neration, to reduce it to its natu∣ral constitution, and to hinder the provent and increase of it. Al∣chymists promise much, but for

the most part they prove Clouds without Rain.

The Alchymist will have the ef∣ficient and material causes of all Ulcers, to be the superfluity of the Salt of the natural Balsame of the Body, consisting of a due propor∣tion of Salt, Sulphur, and Mer∣cury.

This superfluous Salt being sepa∣rate from the natural Balsame by the expelling faculty, it is turned sometimes to one, and sometimes to another part of the body, ac∣cording as it is apt no be moved, according to its thinness or thick∣ness, volatility or fixation.

It setling in the part, is more coagulate and calcined (the ex∣pelling faculty not being able to expel it by the Pores of the Skin) and so it acquires a certain corro∣sion, and is the cause of those Ul∣cers, which have no maligne qua∣lity accompanying the Salt. They will have a volatil and subtil Salt, such as is in the Nettle, and crow∣foot, to be the cause of an Erysi∣••elas, and Herpes miliaris; but a thicker and more fixed Salt, such as that is of Vitriol, to be the causes of these Ulcers which corrode the parts adjacent: such a Salt then as is not very thick, and throughly fixed, they will have to be the cause of Herpes exedens: but such a Salt as is dense and thick, and throughly fixed, having some malignity, to be the efficient cause of a Phage∣dena and Nome. This is their Philosophy, concerning the effici∣ent and material causes of these Ulcers. And in truth it doth sit∣••ly represent to the eye of the un∣derstanding the nature of the Hu∣mor, which dogmatical Physicians will have to be the causes of Ul∣cers. It is no heresie to maintain either opinion; but he deserves both credit and gain, who shall perform the cure of those Ulcers, which he takes in hand. Most Patients re∣quire rather speedy and easie cure of their griefs, than learned dis∣courses of them. Howsoever, these discourses are requisite for you, who meeting sometimes with scru∣pulous Physicians and Patients, shall be drawn to shew your The∣orical as well as your Practical parts.

As for the cure, Three intenti∣ons are required to cure a Herpes exedens: The First is, that the Humor which slows to the part be stayed. The Second is, that the Humor which is impacted in the part, be evacuated. The Third is, the Cure of the Ulcer it self by convenient means.

The first intention, which is the staying of the Humor from flow∣ing to the part affected, is per∣formed by purging of the Body from thick choler, and Bilis atra, if the Formica corrosiva be of a li∣vid colour. To this purpose pre∣scribe such a Potion: ℞ electuar. lenit. ℥ vj. pulver. sancti. ʒ j. aq. en∣diviae ℥ iij. Misc. ut fiat potio. Or if the Patient be of a dainty tast, and loath Electuaries and Powders, then such a potion as this which I will set down will be convenient: ℞ rhab. ʒ j. fol. sen. ʒ iij. zinzib. ʒ ss. spicae ℈ ss. Infundantur ista per hor. 2. in aq sont ferventis ℥ vj. deinde lento igne exhalent ℥ iij. ao coletur decoctum, in quo dissolve mannae & syrupi de cichor. cum rhab. dut syrup. Augustan. an. ℥ j.

Misc. ut fiat potio. If the Body of the party troubled with the Ul∣cer, be plethorick and cacochymi∣cal, it is convenient that he take a purgative Decoction for sundry daies together. I will set down such a one as a pattern; accord∣ing unto which you may frame un∣to your selves, others like unto it in efficacy. ℞, rad. cichor. malvar. borag. an. ℥ j ss. polypod. querc. ℥ j. flor. borag. bugloss. viol. an. pug. 1. sol. sen. & hermodactyl. an. ℥ ij. semin. anisi & foenicul. dule. an. ʒ vj. rhab. ʒ vj. liquirit. ℥ jss. In∣fundantur infundenda per noctem: in aq. font. fervent. lib. 8. sequen∣te die adjectis reliquis, coq. ad me∣dias, ac coletur decoctum, quod aro∣matizetur cinam. ʒ vj. sumat aeger mane lib. ss. ac tantundem hor. quartâ pomeridianâ. Between ten and eleven a clock in the Morning, let the Patient take some broth without Bread, or a Caudle, or Aleber••ie. These Medicaments must be ministred cold in the Summer time, and warm in the Winter.

The Second intention in curing of Herpes exedens, was said to be the vacuation of the Humor im∣pacted in the part. This is effect∣ed by cathaeretical Medicaments, or such as correct spongy flesh: they are sharper than the strongest Mundisicatives.

In the Monuments of the Anci∣ents, we find the Trochisk of An∣dron, Polyides and Musa, exceed∣ingly commended in such fretting and creeping Ulcers: which I will set down both to ease you of the enquiring of them, and the better to apprehend and understand them. The Trochisci Andronis are thus de∣scribed: ℞. malicorii. ʒ x. alumi••, ʒ iv. vitriol. ʒ xij. myrrh. ʒ iv. thur. aristol. rot. gallar. an. ʒ viij. sal. ar. moniac. ʒ iv. siat ex omnibus pulvis, Trochisci Polyidae are thus set down! ℞. malicor. ʒ vj. myrrh. ʒ viij. alu∣min. ʒ v. thur. ʒ iv. vitriol. ℥ iij. The Trochisci Musae receive these things: ℞. alum. aloes. myrrh. vi∣triol. an. ʒ vi. croci. ʒ iij. malicor. ʒ iv. I should advise to calcine both the Alume and Vitriol, which en∣ter into those Trochisks; because they more strongly dry than those which are uncalcined. No sub∣stance is so fit as Ʋnguentum pe∣puleum to make up the Troch••sks; When you are to use these Tro∣chisks; you are to beat some of them to a subtil powder, and to mingle some of the Powder with some convenient Unguent, taking a dram of the powder for every ounce of the Unguent: but what Unguents are most fit you shall hear anon. These are the ma∣gistral means which the Anci∣ents used in curing spreading Ul∣cers.

The modern and neoterick Chirurgeons, not contented with these, have found out other means not inferiour to these: The one is Mercurie precipitate, first nobilita∣ted by John de Vigo, and since his time much used by all famous Chi∣rurgeons. This powder being wash∣ed with Plantain and Rose-water, and mingled with sarcotical Un∣guents, doth admirably heal rheu∣matick Ulcers in tender persons. If it being unwashed be mingled with Alume calcined, taking two drams of it, and one dram of Alume, it is a catheretical Medicament, and fit to be applied to foul and spreading

Ulcers, such as Horpes exedens, Phagedaena, and Nome are. The other Medicament invented by the ••ate Chymists, is the Turbith mi∣••eral precipitate by the Oil of Sul∣phur, or Vitriol; it is now much used both in the practice of Physick and Chirurgery; it is ministred with good success to persons, infected with the Neapolitane Lues; if they have either Cephalaea Gallica, ex∣••ream pain in their Heads or venere∣••l Ulcers. After that precipitate and ••alcined, it is very white, and is on ••scharo••ical Medicament, far sur∣passing either Mercurio sublimate or Arseniok: for it is more safe, and ••s not so painful; besides this, it doth not cause such inflammation as these do, neither doth it pro∣••ure so promptly symptomatical Fevers. Being washed, it is used to work these effects which Mercury precipitate doth, but much more effectually. To cause these Medi∣caments to evacuate the peccant Humors out of the parts affected, ••ou are to mingle these with Pa∣••acelsus his Mundificative; taking for every ounce of the Unguent, a dram either of the Mercury preci∣pitate, or of the Turbith mineral washed, if the parties grieved be of a tender constitution: or a dram of either, washed and mingled with Alumen ustum, in that quantity as hath been said, if the bodies of the persons who are troubled with the Ulcers be firm and hard, such as labouring Men have. You are to continue the use of these topi∣cal me••ns, until the Ulcer spread no more, and be red, and very clean. Having the two first Indi∣cations required in curing of Her∣pes exedens, the Third Indication follows; which is the cure of the Ulcer it self.

To this effect two scopes are re∣quired: The First is to fill up the Cavity caused by the loss of the skin. The Second is to cicatrize the Ulcer.

As for the First scope, those Medicaments are to be used which dry strongly, yet have no corrosive faculty. Paulus Aeginot. de art. me∣dend. lib. 4. cap. 20. has sundry Me∣dicaments for this grief: if you peruse the Author, and consider the descriptions; you will esteem them but sorry ones. Tagaultius in institut. Chirurgici•• lib. 1. de tumoribus praet. naturam, has tran∣scribed them, whom you may see: he has done this, for no other cause (as I suppose) than this, that he had no better of his own. Am∣brose Pa••eus, lib. 6. cap. 84. hath some Medicaments for this grief, which are not to be contemned, The First is this: ℞. ceruss. & tut. prepar. an. ℥ j. ol. ros. & adi∣pis caprae an. ℥ ij. cort. pini. ℥ ss. cer. q. s. fiat unguentum. If you add to these things some lead calci∣ned, Pomegranate-rinds and flow∣ers beat to powder, the Unguent will be more effectual. The Se∣cond is, Ʋnguentum enulatum cum Mercurio, which he com∣mends as an infallible Medicament, if to every ounce of it you add a dram of the flower of Brimstone, you shall not miss of your purpose. He gives one good note, that if you perceive the brims of the Ulcer more and more to be eroded, you touch them with Aqua fortis, Ole∣um Vitrioli, or Sulphuris, for by these means, Sores which seem un∣curable are often healed. Hieron.

Fabric. ad aquapend. part. 2. lib. 1. cap. 28. advises to minister inward∣ly either Goats-milk, or the de∣coction of Sarsa-parilla; and with∣out all doubt both are good; but there is no parity between Goats∣milk, and the decoction of Sarsa: there is no Chirurgeon, who is ig∣norant of the faculty of Sarsa in curing all malign and creeping Ul∣cers: Goats-milk may have some place, if the party be extenuate, and a Hecttick Fever feared.

As for the local Medicaments, he commends this cerat. ℞. succi de peto, ℥ iij. cerae citrinae. ℥ ij. resin. pini. ℥ jss. ol. mrrtini ℥ j ss. tere∣binthin. ℥ j. Bulliant ista donec con∣sumptus sit succus tobaccae, ac fiat ceratum molle. I will not stick to communicate with you the descri∣ption of an unguent of Tobacco which I use mine own self, neither am I ashamed to prefer it before all others of this kind; the de∣scription whereof I have seen. Thus then it is to be made; ℞. ax∣ung. porcin. viij. unc. colophon. ʒ iv. cer. ℥ iij. succi de paeto lib. 1. peti contus. man. ij. coq. baec. ad succi consumpt. tum adde Gummi ele•••• vernicis alb. terebinthin. an. ℥ ••. ac coletur unguentum. It is an er∣cellent incarnative in wounds as well as Ulcers: besides this no bet∣ter Mundificative can be devised 〈◊〉〈◊〉 tender bodies; if one dram 〈◊〉〈◊〉 Mercury precipitate washed, or 〈◊〉〈◊〉 the yellow Turbith be mingled with an ounce of it. When you per∣ceive the Ulcers to be filled up: then skin them with this Desicca∣tive of mine: ℞. Sevi damar. lb. ss. Axung. porcin. ℥ iij. Cer. ter∣nic. colophon. an. ℥ ij. hisce 〈◊〉〈◊〉 igne amotis insperge calaminar. i•• vino albo ter extinct. ℥ 1. Lyth••∣gyr. Plumbi calcin. Aeris usti, H••••∣rici rub. an. ℥ ss. fiat ceratum. The two prime Medicaments which are set down in Antidotaries to effect this, are Desiccativum rubrum, and Ʋnguentum de minio, otherwise called Ʋnguentum rubrum caphure∣tum. Your Emplaster de Mi∣nio doth not come near to these in efficacie. Let this serve for the discerning and curing of Herpes miliaris, or, Formica ambulati••••, or corrosiva.

CHAP. XVI.

Of Phagedaena and Nome.

BEcause Phagedaena and Nome do much resemble one the other, I will treat of them jointly, and deliver unto you what the Grecians, the Parents of Physick, and of all other Liberal Arts and Sciences, have delivered Methodi∣cally: As for the Medicaments that are to be applied, I will pick ••ut the best, which either the An∣cient or the Modern Writers have ••evealed to us: neither will I conceal from you what I have found effectual in mine own practice.

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 then is a Greek de∣comination, derived from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which is edo, to eat: so that 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 may be called in Latin Ʋlcus exedens: in English an eat∣••g Ulcer.

It signifies two things: First, ••t is taken for all manner of corroding Ulcers, which seize not upon the Skin only, but upon the subjacent Flesh also: In this sig∣••ification it is taken by the Ancient Physicians, who flourished before Galen's time. Secondly, it is ta∣ken for a special kind of Ulcer by the latter Physicians, as Galen com∣••ent. in aphor. 45. lib. 6. Hip∣••x. witnesseth. And it is fit, that in discourses and writings all things be set down distinctly, for this much helpeth the Me∣mory.

It being taken thus for a par∣ticular kind of Ulcer, it may be described an Ʋlcer tumefied with∣out putrefaction, deep and cor∣roding the parts adjacent; In that it is said to be an Ʋlcer tumefied, it is distinguished from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, the third kind of eating Ulcers, which corrodes the sound parts near un∣to it, without any remarkable Tu∣mor, as more at large you shall hear anon. It is said to be deep, because it frets not only the Skin but the fleshy part also under the Skin. And by this circumstance is distinguished from Herpes exe∣dens: which is an exulceration of the Skin only. So this kind of Ulcer is not without cause called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Ʋicus exedens, be∣cause it eats and frets the sound parts near unto it, making them of the same condition with the diseased.

It is caused of a bilious adust Humor inclining to that Melan∣cholick Humor, which is super∣fluous and not natural; yet it is not to be thought that it is very thick, as is that which procures a Cancer: nor so thin as that which

causes Erysipelas and Herpes. This Humor, by reason of the plenti∣fulness of it, fills the brims of the Ulcer, and causes a swelling to ap∣pear; but by reason of its Ma∣lignity and Acrimony, it fre••s the parts adjacent, which are sound. Nevertheless this Humor is without Putrefaction, which is always in the Ulcer called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Ʋlcus depascens, an Ulcer which feeds upon the parts adjacent that are sound; for in Phagedaena there is erosion proceeding of a malign qua∣lity without Putrefaction, or Cor∣ruption of the whole substance, which is always joyned with Ma∣ligrity in a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

Then the Pathognomonical signs of a Phagedaena are these: First, it corrodes not the Skin on∣ly, as Herpes exedens doth, but the subjacent Flesh also: The se∣cond is this, that in Phagedaeni∣cal Ulcers the brims are tumefied. The third is, that tho there is Erosion of the sound parts adja∣cent, yet there is no Putrefacti∣on: And by these two last signs it is distinguished from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus depascens, a consuming Ulcer.

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, in Latin Ʋlcus depascens, in English a feeding or consuming Ulcer. It is derived from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Depascor, I feed upon: for passing from the diseased parts, it seizes upon the found and whole parts, and feeds upon them by communicating unto them both Malignity and Putrefaction. It may be thus described.

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is a corrosive Ʋlcer, with∣out any Tumor in the brims, en∣dued not only with Malignity, but Putrefaction, or Corruption of the part, also feeding upon the adjacent sound parts, and that deeply. I•• that it is termed a Corrosive Ʋl∣cer or Malign, it agrees in this with Herpes Miliaris and Phage∣daena. But whereas it is said to be without any Tumor in the brims, I mean remarkable, and to have Putrefaction annexed, by these two signs it is distinguished from Ph••∣gedaena, or Ʋlcus exedens, an eating Ulcer: for so I think fit to name it; that in denomination al∣so it may be known from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus depascens, a consuming or feeding Ulcer. Last of all where it is affirmed that it corrodes not s••∣perficially only the Skin, but the subjacent fleshy parts also: as it hath this common with Phaged••∣na, so by this it is known from Herpes exedens; for this cause•• exulceration only in the Skin.

But seeing there is often menti∣on made in the Monuments of the Ancient Physicians, of 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, of Chironical and Telephian Ulcers, as Galen, Paulus Aegineta, and others who follow them, it will not be amiss to discourse a little of such Ulcers; that you may know what is meant by these denominations, and be able to answer any, if you be de∣manded what is meant by these terms.

Of these Ulcers thus speaketh Galen. de tumorib. praet. nat. c. 13. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, &c. whose dis∣course may be thus English: Those Ʋlcers which consume and medd••e with the sound parts adjacent, 〈◊〉〈◊〉 about, corroding them; all these are called Phagedaenic. So that Phagedaena is framed of the Ʋlcer and the Tumor. Herpes in like

••inner erodes the parts about it, rests in the Skin only: but Pha∣gedaena extends it self as well to the subjacent parts as to the Skin. But it is to no purpose to call Ʋl∣••ers Chironian, or Telephian. It is sufficient to call such Ʋlcers 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Malignant: that is, of an evil condition or quality. By this passage of Galen translated by ••••e, you may gather three con∣clusions.

The first is, that in a Phage∣dana there is an Erosion not only of the Skin, but of the fleshy ••arts subjacent also, by which it is distinguished from Herpes exedens, or Formica Ambulativa, where∣of I discoursed in the former Chapter.

The second is, that in a Phage∣d••na there is a Tumor in the brims of the Ulcer, whereas there is none in a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or a consuming Ulcer, called by Latin Authors, Ʋlcus depascens, to distinguish it from Ʋlcus exedens, an eating Ulcer.

The third is, that the denomi∣nations of Chironian and Tele∣••••••an Ulcers, do signifie Malign Ulcers in general; but no special ••ird of Ulcer in particular. In P••••dus Aegineta de art. medend. ••ib. 4. c. 46. bearing this inscripti∣••n of Ʋlcers of an evil condition, ••hich are called Chironian and Telephian by Physicians: these ••ords are read as I have transla∣••ed them. Old and inveterate Ʋlcers, which hardly admit skin∣••ing, which are named 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ••r malign, some call Chironian, as ••f they did require the hand of the Certaure Chiron, the most excel∣•••••• in the Art of Curing; others call them Telephian, such as Te∣lephus was troubled with which re∣quired the helpful hand of Achilles, who cured him. So he jumps with Galen, that these Titles were ascribed to all malign Ulcers; but did point at no particular kind of Ulcer.

Now it cannot be amiss briefly to shew, what men Chiron and Telephus were, seeing they are so famously recorded by the Poets: They who are Scholars cannot but be delighted, when the Studies of Youth are brought to remem∣brance. Chiron then was one of the Centaurs, who were a People that inhabited the places near to Pelion, a Hill of Thessaly. These first began to break Horses, to sight on horseback: wherefore the neighbouring People, when it first saw them, believed them to be strange Creatures, composed and framed partly of Humane, partly of Horses Members: O strange sim∣plicity! this Chiron was the Son of Saturn and Philyra. It seems that he was called Chiron, because he had a singular dexterity in the Manual Operations of Chirurgery: for 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in Greek is an hand. He taught Aesculapius the Art of Curing: Peleus, Achilles his Father, was his Son-in-Law, of whose Daughter Thetis he be∣gat Achilles, so much commended for Valour and Strength by the Heathen Poets. He taught Achil∣les, being his Grandchild, Chirur∣gery, Playing upon the Cithern, and Horsemanship. The two kinds of Centaury, the greater and the less, Centaurium majus & minus are named of him, whereof there is great use in Practice both of

Physick and Chyrurgery. It is like, that he was fortunate in the curing of malign Ulcers, by reason of the great Skill which he had in the knowledge of the faculty of Plants. He lived but two 2690 years af∣ter the Creation of the World, that is, 77 years before the destructi∣on of Troy, which fell out Anno mundi 2767. Then 2685 years are expired since famous Chrion lived. This may serve to prove the Antiquity of Chirurgery. po∣sterity for his worth named the ninth Sign of the Zodiack Sagit∣tarius (who rules the Thighs) from him. From whence Vngil of these twelve Signs:

Armatusque aren Chiron, & cor∣niger hirens. Chiron armed with Bow, and the horny Goat.

By this we may gather how Vertue and Learning were re∣garded in the rude and simple Ages, which are very little esteem∣ed in these Civil Times, wherein most Men are given to enjoy their pleasure, which will cost them too dear, when the general accompt shall be made.

Telephus was one of Hereules his Sons, who being adopted by the King of Mysia who then reign∣ed, after his death, succeeded him in Government. When he would have hindred the Grecians march∣ing towards Troy, from passing thorow his Country, in Combate he was wounded by Achilles; but afterward being reconciled to Achilles, he was cured by him; he mingled with either an Un∣guent or a Cataplasm, (for Malagm•• signifies both) the rust of his Spear. And it is not unlikely; for most Chirurgeons know the faculty of Crocus Martis in cicatrizing of Rheumatick Ulcers, it drying strongly without any sharpness; unto which the rust of old Iron washed and prepared comes very near. So Achilles made sufficient proof of his Skill in the Art of Chirurgery, which he learned of his Grand-father Chiron. Go to then, let effeminate Hind-calves despise the Art of Chirurgery, which, so eminent a Person as A∣chilles was, was not ashamed to practise. From Achilles Millfod is called Sideritis Achillea, Achilles his Star-woort: and it may be that it was one of the chiefest in∣gredients in the Cataplasm; sure∣ly it is an excellent healing Plant. To conclude then this Point; malign Ulcers which are not easily cured, are called Chironia, be∣cause Chiron was able to cure them; and Telephia, because Te∣lephus was troubled with such an one.

Now time calls to go forward in the handling of these corrosive Ul∣cers: but before I set down the manner of Curing, the Predicti∣ons of Events which are like to fall out in the course of Cure are first to be set down. I. Neither of these corrosive Ulcers are of easie Cure, upon what Body so∣ever they light; and upon three Causes: For first, there is a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 an ill constitution and tempe∣rature of the part, by which the Aliment, which is sent to the part, too it be good, is corrupted. Se∣condly, a fresh supply of noxious

Humors is sent most commonly to maintain the Grief. Thirdly, because the ordinary Medicaments, which are applied with good suc∣cess most commonly to other. Ul∣cers, in these Ulcers are ineffectu∣al. II. If these Ulcers light upon a Cacochymical Body, the case is yet worse: for the Constitution of the Body must be altered before these Griefs can be cured, which is a matter of no small difficulty. III. If these seise upon decrepit Persons, the case is in a manner desperate: for in such the natural Heat is weak, and the Radical Moisture almost spent: so that great store of corrupt and saltish Humors are bred in the Bodies of such, which being sent to the weak parts ulcerate, increase these Griefs.

The Cure is performed by three means: to wit, a convenient Diet, internal Medicaments, and local Applications: As for the Diet, those Meats and Drinks must be used which afford a landable Juice; whereof I have spoken before: and in that measure that the na∣tural Heat may be able to con∣coct them, that no superfluities be bred. Besides this, Meats which are easily corrupted in the Sto∣mach are to be shunned, as Milk∣meats, Summer-fruits, and Salt Meats: slimy Fishes, and Swines flesh are to be shunned, be∣cause they afford no good nou∣rishment.

Of internal Medicaments I mean not to speak much. If a person troubled with an ordinary Phage∣daena or Nome, be of strong Con∣stitution, and Plethorick, you may minister unto such Hiera Diacolo∣cynthidos Magistralis; or Pilulae aggregativae Majores. If the party be weak, you may minister Pi∣lulae Stomachicae: Those which I use are these: ℞ Aloes ʒ ij. Rhab. Agar. Trochisc. an. ʒ j. Myrrhae, ℈ ij. Mastich. ℈ j. Syrup. Augu∣stani, q. s. ut fiat massula. dos. Pilul. 2. pond. ʒss. a primo somno; vel sumat unam paulo ante coe∣nam, alteram paulo antequam ineatur somnus. Whether the parties be strong or weak, who are troubled with these corrosive Ulcers, they are to use Decoctions made of Sarsaparilla, Guajacum, Radix Chinae, Tormentil, Bistort and Comfrey Roots, with which you are to join some Vulneraries, as Agrimony, the tops of S. Johns wort, Sanicle, our Ladies Mantle, Mountain and Garden Avens, So∣lomon's Seal.

Nomae of the privy parts were known to the Ancient Writers, as we may perceive by Paulus Ae∣gineta de art. med. lib. 40.44. sub finem. In our times they sel∣dom are seen to proceed from any other Cause, than impure Co∣pulation. Such are often seen, in the which the whole Praeputi∣um doth sometimes rot away. These corroding Venereal Ulcers require the general Cure of the Neapolitan disease, besides effectu∣al Topicks.

Now follows the last indication of curing these corrosive Ulcers; which is the Application of local Medicaments. In a Phagedaena wherein there is a Tumor of the brims, you are to apply Ʋnguen∣tum populeum, and Ʋnguentum albion caphuratum, mixed toge∣ther in equal quantity, to them.

The second thing which I would have you to observe is this, that N••me, or Ʋlcus depascens, doth require stronger Topicks than Phagedana, or Ʋlcus exedens. Mark then these Medicaments which I have picked out of Aegi∣neta; ℞ Caleis vivae, Vitriol. Vo∣mit. an. ʒ ij. Auripigment. ʒ j. fiat pulvis subtilis ex his. For a Pha∣gedaena apply the Unguent of To∣bacco, having some of this Pow∣der mingled with it, as ʒ ij. for an ounce of the Unguent. If you have to do with a Nome, make a Liniment of this Powder and Oxy∣mel, and apply it to the Ulcer. ℞ Vitriol. albi ℥jss. Crcci Martis, ℥ vj. Gahar. ʒ viij. Crocus Martis well prepared far exceeds Squama ferri, the Scales of Iron. Receive this Medicament of my descripti∣on: ℞ Calc. Viv. Vitriol. aibi, Au∣ripigmenti an. ℥ j. Malicor. Ba∣laustior. cornu Cervi ust. Gallar. Pu∣micis calcinati, Alum. usti, rad. Aristol. rot. an. ℥ss. Croci Martis, Plumbi calcinati, aeris usti, an. ʒ vj. cum melle despumato fiat elect••••a∣rium. Let me commend unto you an A••gyptiacum, which is not the vulgar: Primo infundantur absyn∣thium, Carduus benedictus, Cen∣taurium minus, Scordium, Cha∣maedeys, Malicorium, Ba••at stia, Gal••e, & rad. Aristol. rot. in acc∣t•• fortissimo: ℞ hujus Aceti colati ℥ vij. Aerug. ℥ v. Mel. ℥ xiiij. ceq. lento igne ad unguenti consistentiom. This Medicament is effectual in Venereal Ulcers of the Throat, and Privy Parts, and in all sordid Ulcers.

You are to continue the Appli∣cation of these Medicaments, un∣til you see the corrosion stayed, and the Ulcers red and well mon∣dified. When you have perce••ved this, incarnate the Ulcers with some of the Consolidatives before set down by me. Last of all, ••••∣catrize the Sores with such Epa∣lotical means as I set down in the former Chapter.

But to shut up the delivery of these Ulcers, which are of the mildest sort of the Malign, so much as concerns the knowing and curing of them; let me advise you that you promise no suddea Cure of any Ulcer, if it hath con∣tinued but one Month: For the Bodies of the Inhabitants of this Island are for the most part Ple∣thorick; they will observe no good Diet, and will not be estranged from the sacrifice of Venus. It is a strange thing to see what cor∣rupt and ugly stuff is covered by the Curtains of a beautiful Skin, in a number of them. I make no doubt but many, who are least im∣ployed in practice, have had sundry Patients, who have come to them, pretending that they were only troubled with a Pimple on the Forehead, a red Eye, a difficulty of swallowing, shedding of the Hair, watching in the Night time, and pains between and in the Joints: whereas indeed those Griefs were Venereal Pustules, the Neapoli∣tan Opthalmia, virulent Ulcer•• of the Throat, Alopecia Gallica, the Vigils of Venus, and last of all the Pocky-Joint-Ague. It is no hard matter to those who are judicious to find out the symptoms of that Grief, which Vigo the Father of Empiricks doth affirm to be able to bring the Accidents of all Dis∣eases in particular, according to

••e diversity of the Constitution of ••e Bodies upon which it seiseth. 〈◊〉〈◊〉 then you see any Ulcers, in what ••arts soever, more painful than the ••lution of such an unity requires, ••at they yield not to ordinary Me∣••caments appointed for Ulcers, ••en suspect that there is a latent ••alignity. Value not therefore your ••redit for a trifle, be not too ••ountiful in promises, lest they be ••equired at your hands: suspect ••nd pronounce in doubtful Cases ••ways the worst: for the best will ••ve it self. Thus doing, you shall ••ing in no new practice. Many ••racticers there be, it is uncertain whether of Ignorance or Policy, who aggravate the Grief of those who wholly commit themselves to them, that the greater Credit and Gain may redound unto them∣selves, if the Persons diseased escape, and the less blame may be laid to their charge if they die. In these proceedings there are two excellent Teachers, Skill and Con∣science: The first is to enable, the second is to direct pra∣ctice. So much I thought good to deliver of the three mildest kinds of malign Ulcers, to wit, Herpes exedens, Phagedaena, and Nome.

CHAP. XVII.

Of a Cancer and a cancerous Ʋlcer.

NOw am I to discourse of those Ulcers which are ac∣compted most Malign, and are so ••deed. Of these there are two ••orts, a cancerous Ulcer, and a ••ep••ous Ulcer: Of purpose I re∣••erred the handling of a Cancer ••nd a cancerous Ulcer to this place, ••ecause it fits them best, as you may perceive anon. First then, 〈◊〉〈◊〉 will discourse of a cancerous Tumor, and then of a cancerous Ulcer. A cancerous Tumor is ••alled by Galen. de tumor. praet. nat. c. 12. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in Latin Cancrosits Tumor; It may be but defined:

It is a Tumor proceeding of Bilis atra, round, hard, unequal, of a leaden colour, hot, very painful to the Patient, and having full Veins implanted in the adiacent parts. For as a Crab, in Latin Cancer, hath a Body and feet of a livid colour, and whatsoever it claspeth with the claws, it holds it firmly; so this Grief is of a livid colour, and so girds the part which it possesses, that it seems to be nail∣ed to the part, and about it the full Veins exquisitely imitate the Feet of a Crab: and from these similitudes the Tumor has its name.

In the description the Tumor is said to proceed from Atra bilis, or Melancholy, or Choler adust; for it signifies both: for there are two sorts of Atra bilis: the one is caused of natural Melancholy adust: the other is caused of yel∣low Choler burned, and it is much more Malign than the former, See Gal. lib. 3. de atra bile.

There are sundry efficient causes which ingender these Humors in our Bodies: First, a strong hot distemperature of the Liver, which burns the natural Melancholy and yellow Choler, and so hatches this Bilis atra. Secondly, according to Gal. c. 10. lib. 2. ad Glaucon. the Spleen by reason of its weakness and distemperature, doth not draw unto it self the superfluous natural Melancholy, and so staying long without its own proper place, it is inslamed and burned. Thirdly, sometimes this Humor is caused of the Menstrual. Courses, and He∣morrhoids stopped. Fourthly, ve∣ry often an ill Diet breeds this Hu∣mor, as when one uses Meats of an ill Juice, and of a thick substance and hot quality, as Garlick, Oni∣ons, Leeks, Snails, Venison, Pease and Beans, and such like. But there is nothing more pernicious than the immoderate use of potent and strong Wines, such are all kinds of Sacks, and Greek Wines, which exceedingly burn the Hu∣mors in the mass of Blood. An hot Air and perturbations of the Mind set forward also this Humor. But seeing there are degrees of Malignity in Atra bilis; the cancerous Tumor, or Cancer not ulcerate, is caused of the milder sort of it; but a Cancer Ulcerate is procured of that kind which i•• most Malign.

Take heed that you imagine not any sort of Cancer to be engendred of natural Melancholy, which G••∣len. de art. curat. ad Glaucon. c. 10. lib. 2. affirms to be that part of the Blood which represents the Wire Lees, when it is made by the li∣ver, which is drawn by the Splece, wherewith it is nourished: for f••∣persluons natural Melancholy causeth only a Scirrhus. Of the material cause of a Cancer th•••• speaketh Galen. De tumor. prae•• nat. c. 12. When Bilis atra seatech it self in the flesh, if it be sharp it corrodes the adjacent flesh, and causes an Ulcer; but if it be milder, it procures a Cancer with∣out ulceration. Aeginet. lib. 6. c. 45. has these words: A Cancer is a Tumor unequal, with tumefied ••rin••s, ugly to behold, of a lea∣den colour, indolent, sometimes not ulcerate, which Hippocrates called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or hidden; some∣times ulcerate: And seeing it has its beginning from Atra bilis for the most part it becomes ulce∣rate: So he,

Where you are to note, that h•• affirms a Cancer to be indole•••• or without pain, which is contrary both to experience and reason Celsus also, lib. 5. c. 28. seems to grant some Caucers to be without pain. For first, there is a Solution of Unity, by reason of plentiu•• Matter stretching the parts, and pressing the sensible parts, Se∣condly, there is a very hot distem∣perature, by reason of the Hu∣mor, that cannot be discussed which of necessity must cause pain. The explication of the rest o••

••he particulars set down in the description, shall be set down ••n the delivery of the Signs, to a∣••old tedious repetition of the ••ame things.

The signs then of a cancerous Tumor are these: 1. According to Galen, lib. 14. method. c. 9. a Can∣••er in the beginning is hardly dis∣cerned: for the symptoms are but mild, and sometimes it is no big∣ger than a Pease, or Bean, or a Filbert-nut. 2. It is hard, by rea∣son of the the thickness of the Humor, which withstandeth the ••ouch. 3. It is of a leaden colour, representing the colour of the Hu∣••nor whereof it is bred, yea, the more Malign it is, the more livid and black it appears. 4. The Tu∣mor is very painful: First, because Atra bilis the material Cause of it is hot: Secondly, because no heat can breath out, the substance of the Cancer being so compact. 5. It is round, because the mat∣ter being thick, is not so apt to fleet abroad. 6. It is unequal, by reason of the ebullition of the Hu∣mor, which notwithstanding is not equally active in all parts of the Tumor. Last of all, a Cancer bath black or livid Veins extend∣ed to the adjacent parts: for this atrabilious Humor cannot sueat out of the Veins, which is the cause that they appear very full.

As for the parts which a Cancer invades, tho it may breed in all parts of the Body, yet it is most often seen in the Breasts and Ma∣trices of Women, and in the Lips and nose of the Face. I have seen it also in an••, and in the top of the ••ard.

The Breasts most promptly re∣ceive this atrabilious Humor, be∣cause they are of glandulous and loose substance. Besides, the Mam∣mariae Veins meet with the Ʋteri∣nae under the strait Muscles of the Belly, so that the Matrix may discharge it self of adust and secu∣ient Melnncholick Blood by regur∣gitation, which may cause a Can∣cer if it pass to the Dugs.

A Cancer in like manner ap∣pears very often in the Matrix by reason of the detention of the men∣struous Blood, which staying a∣bove the ordinary time is burned. The lips also are spongy and soft, and so apt to receive Atra bilis, the material Cause of a Can∣cer, Gal. de art. curat. ad Glau∣conem, lib. 2. c. 10. hath these words: Cancerous Tumors may be in all parts of the Body, but chiefly in the Paps of Women, which have not their purgation accerding to Nature, Aeginet. l. 6. c. 45. saith, A Cancer happens to sundry places of the Body, but chiefly to the Matrix and Paps of Women.

As for the Predictions before Curing, receive these: 1. Al∣though Cancers may appear in all the Quarters of the Year, yet most commonly they shew them∣selves about the ending of the Sum∣mer, and during the whole time of the Harvest: because in these Seasons Melancholy exceedingly in∣creases, and Humors become a∣dust. 2. No Cancer is easily cured; for if all ulcerate Cancers be in∣curable, according to Galen, c. 5. lib. de Atra bile; no cancerous Tumor can easily be cured, it having the same efficient Cause. 3. A Cancer not ulcerate, if it

hath possessed any deep cavity of the Body, as the Matrix or Anus, it is not to be dealt withal, ac∣cording to Hippoe. lib. 6, aphor. 38.

You must understand that he meaneth the curing by excision, caustical means, or ustion: for the Ulcer will not admit cicatriza∣tion, and so the diseased parties live in continual pain and filthiness, and at the last die miserably. But he forbids not the application of local means, which asswage pain and gently mundifie. 4. Cancerous Tumours in the outward parts, and only superficial in the begin∣ning, may be cured according to Galen, lib. 2. c. 10. ad Glaucon. 5. When cancerous Tumors are come to a remarkable bigness, they only can be cured by extirpation. 6. If a Cancer not ulcerate hath possessed the Matrix, the party feels great pain in the Groins, and hath often a difficulty in making of water: If the Cancer be ulcerate, it sends out a loathsome and cadaverous smell, the vapour whereof ascend∣ing to the Heart and Brain, causeth sometimes fainting. 7. If the af∣flicted party be weak, and the cancerous Tumor be inveterate, or of a long continuance, it is not to be dealt withal with excision, adu∣stion, or potential cautery: only lenitives are to be used, to pro∣cure a palliative cure: for sun∣dry have continued even to their decrepit old age, with a Cancer not ulcerate.

Now it is time to address my self to the setting down of the cure of a cancerous Tumor: The means appointed for it are three, Die∣tetical, Pharmaceutical, and Chi∣rurgical.

As for the Dietetical means, a•• thick and strong Wines are to be shunned, course Bread, Cabb••g••, and Coleworts, Cheese, old and salt flesh, old Hares, and Venison: Watching, immoderate Labour and Grief are to be shunned; as also all other things which thicken the Blood, and inflame the Humo•••• Let the Diet be cooling and moist∣ning. Barley-cream is good, and prisan, Mallow-flowers and roots, Borage, Bugloss, Violet-flowers, Endive, Spinage, Purslain, and a•••• sorts of Sorrel in Broths are good, young Mutton, Veal, Kid, Capo••••, Pullets, Chickens, young Leverets, Partridges: Fishes which live i•• clear and gravelly Rivers, and poched Eggs are permitted: let the Drink be Beer or Ale of a rea∣sonable strength, not too new not too old: small white Wine with Sugar, Borage, and Burnet, is be•••• of all others.

As for Phlebotomy, it has been observed, that the most conve••∣ent time for bleeding is the f••ll Moon; for it miraculously stays the ebullition of the Blood, asswages pain, and hinders the increase of the Tumor. But you may demand of me what Veins are to be open∣ed? I answer: If the Tumor be in the Lip, open the Cephalica; if it be in the Breasts, open the Basilica of the Right Arm, if it be in the Right Breast; and of the Left Arm, if it be in the Left Breast. If the Tumor be in the Matrix or Anus, open Vena poplitis, or the Saphaena.

As for purgation, minister Hiers diacolocynthidos, or Electuarium le∣nitivum in Whey; the infusion of Sena in Endive-water, and mini∣stred

with the Syrup of Succory, with Rhubarb, is very effectual: yea ʒiss. of Pulvis sanctus, with an ounce of the Syrup of Damask Roses in Whey is excellent. It is not suffi∣cient to give these Medicaments once; but at the first they are to be ministred twice a week, and af∣terward, either a day before or af∣ter every Quarter of the Moon and Full: for so not only some part of the Humor will be drawn from the Tumor; but new Matter also will be hindred from flowing.

Now having set down the cause of the name of a Cancer, the de∣scription of it, the Signs, the Prog∣nosticks, and the Dietetical, and Pharmaceutical means of curing of a Cancer not ulcerate, only the Chirurgical or Topical means re∣main to be set down.

But seeing the constitution of Bodies is not uniform, and the grief it self is of a most malign quality, variety of local Medica∣ments is required: I will labour therefore to answer your expecta∣tion in this: But first of all, see∣ing in a Cancer there is a double poison, as learned Heurnius upon the 36. Aphorism of the Sixth Book noteth: for the one is putrefactive, the other corrosive: If you apply hot and moist Medicaments, which usually bring maturation in Apo∣stemes, you shall procure putre∣faction: if you apply corrosive Medicaments, you shall assist the other poison, and increase the Grief. Wherefore those which re∣pel and digest, are aptest, as Ga∣len hath noted, 14 Method, Where∣fore no emplastick Medicaments can be good; for it hindreth Per∣spiration.

Of all things which give a con∣sistence to juices, Rye-meal and the Flower of Lupines are the best: for by a secret faculty they tame the fierceness of a Cancer. To pro∣ceed then in the setting down of lo∣cal means, you may apply a Cata∣plasm made of the juice of Night∣shade, Rye-flower, and some Ʋn∣guentum populeum, or the juice of Comfrey with the flower of Lu∣pines: you may use in like manner the juice of Horse-tail, Knot-grass, Plantain, Perwinckle, Shave-grass, Millefoil, Tapsus barbatus, Clowns all-heal, and Dracontium.

A cataplasm of Snails and ground-Ivie is excellent. If the Tumor be very painful, apply a cataplasm of the pulp of the roots of Henbane and Hemlock, with Rye-flower and some Oil of My••tles: or a cataplasm of the flower of Lupines; the water of the sperm of Frogs, and the Leaves of Herb Rebert, which is a kind of Cranes-bill, ex∣ceedingly commended by sundry. If you take ℥ ij. of the Oil of Quin∣ces, and one ounce of the Vinegar of Roses or Elder, and work them in a leaden Mortar, until they be∣come of a Leaden colour; you shall have an effectual Medicament; you may also dissolve Diapalma cum succis with Oil of Roses, that it may be brought to the consistence of a Liniment. Goats-dung with Honey brought to the form of an Unguent is commended: as also Radish-seed beaten and mingled with Vinegar. Many commend a cataplasm of Raisins stoned, Rue. and the Leaves of Night-shade. This Fabricius ab aq. pendent. commendeth; ℞ Solan. hort. virg. aureae, sonchi, an. man. ij. ••••ctis

in aq. & contusis. adde far. siligin. lb. i. Ol. ros. ℥ v. fiat cataplasma. The Chirurgeons in Italy had, in Fabricius his time, a Medicament of green Frogs effectual against a Can∣cer, and in the Gout: thus it is made; Take a good number of green Frogs, whose Mouths sill with sweet Butter, afterward put these Frogs in an earthen Pot well gla∣zed, having a cover, and the bot∣tom full of holes: place this pot in the mouth of another earthen Pot placed in the ground; lute these well together, and the cover of the upper Pot: then for the space of three hours, let a gentle fire of Charcole be set about the upper Pot, to drive down all the moi∣sture and fat to the lower: when the pots are cold, take up the Frogs out of the upper pot, and beat them until you feel no roughness, between your fingers: Last of all, mingle the Fat and moisture in the lower pot, with this substance, and keep this mixture in a clean Gally∣pot. Receive also this Medica∣ment from Parey, Lib. 6. de tumor. praet. nat. c. xxx. ℞ Theriac. veter. Succi. lactuc.e & ol. ros. an. ℥ j. Suc∣ci cancrorum ℥ss. Vitellos ovorum induratos numero ij. Ducantur in mortario plumbeo ad unglienti con∣sistentiam. He also in this same Chapter commends a thin plate of Lead anointed with Quick-silver. The Cancer is to be dressed Morn∣ing and Evening. So much then of a cancerous Tumor, or of a Cancer not ulcerate; now am I to deliver the cure of a Cancer ulcerate.

A cancerous Ulcer is an ugly Ʋlcer, having a most stinking smell, thick Lips, and turned out∣ward, greenish and fretted, which yields a Sanies black, or of a d••••k yellow colour, and is exceeding pain∣ful. Riolan the Father in his Chi∣rurgery, in the Second Section of Ulcers, c. 13. affirms this sanious matter to be a strong poison. No death could be devised too cruel for such a one as should give it to a Man.

The particulars of the defini∣tion contain the signs of a Cancer ulcerate, so that I need not to in∣sist longer in the explication of this point.

Of a cancerous Ulcer there are two differences, Lupus and Noli me tangere: that is in the Thigh or Leg, this in the Face. A Can∣cer in other parts of the Body has no particular denomination; but detains the general appellation, with addition of the part affected, as a Cancer of the Breast.

One thing is to be noted, that in other Countries, if a Lupus be troublesome, they apply the flesh of a Hen, Chicken; Pigeon, Whelp, or Kitling, out asunder, according to the length; for so the fury of the Disease ceases, the malignity of the Sanies is eased, and the corro∣sion is stai'd: See Riolan and Am∣brose Parey in the places before cited.

As for the Prognosticks: First, if a Cancer not ulcerate be of hard cure, an ulcerate must be of an harder. Secondly, if the Party be weak and Feverish, the matter is desperate.

As for the cure, the Diet, Phle∣botomy and Purging, which I have set down for the curing of a can∣cerous Tumor, will serve here al∣so; wherefore this only remains,

••o set down the local Medicaments.

This then shall be the first: ℞ Phumbi usti & loti, Tutiae & Thuris, an. ℥ v. Absynthii ℥ i. ol. Ros. lb ss. Cerae ℥iss. Succi solani, q. s. Ducantur in mortario plumbeo ad unguenti consistentiam. Apply this upon Pledgets of Lint, or sine Tow: above this, to asswage pain apply a cataplasm of the Leaves of Succory, Marsh-mallow, and white Poppy beaten, and tempered with Oil of Roses.

The Second shall be the applica∣tion of the Juice of Night-shade, out of Tagault••us, tractat. 3. ul∣cer. c. 19. Moisten a double cloth in the juice of Night-shade, and apply it to the Ulcer; then apply above this Cloth a Pledget of Tow or Wooll moistened in this same Liquor. You may keep the juices of Herbs all the year long, by putting them in a glass, having a Faucet in the bottom, and pour∣ing Oil upon the juice, that it may be three inches thick above the juyce.

You may also use the juice of our English Tobacco, and those which I named in the cure of a Cancer not ulcerate.

The distilled water of the Herbs with Camphore, applied after this manner is effectual.

If you dissolve the Camphore first in the Spirit of Wine, it will mingle the better with the waters: ℞ Mell is verbascini ℥ ij. pulv. Ma∣licor. ʒ iij. ol. Nuc. ℥ j. Misc.

This Medicament of Fallopius is excellent: ℞ ol. Ros. & Ompha∣cini, an. ℥ vj. ol. Myrtini & un∣guent. popul. an. ℥ iij. fol. Solan. & Plantag. an. man. ij. bulliant lento lentissimo igne ad Succorum consimptionem, tum colentur: co∣laturae adde cerae. ℥ iiij. hac eliqua∣câ, omnia amoveantur, ab igne. Quum adhuc tepent, adde lithar∣gy•• ℥ vj. Cerussae, ℥ ij. Tutiae, ʒ ij. Plumbi usti ʒ ij. ss. Ducantur in mortario plumbeo per duas horas. All these Medicaments which I have set down, only are to stay the increase of a Cancer, and to a bate the raging pain in those Can∣cers which are large and deep.

If a Cancer be but superficial, it may be eaten out with Arsenick sublimed: The manner of the sublimation of it and use, I did shew when I discoursed of Fistu∣la's.

A Noli me tangere in the Lip; if it has not eroded a great quantity, it may be cured as an Hare-lip, with little deformity.

As for a Cancer in the Matrix or Anus, use this Medicament: ℞ Stercor. bubül. lb. iiij. herb. Ro∣berc. Plantag. Sempervivi, Hyosc. Portulac. Lactuc. End. an. man. i. Canc. fluviat. numero 12. Con∣tundantur omnia, ac distillentur in: Alembico plumbeo. Imbuatur ca∣phurâ ac frequenter injiciatur, aut sola aut cum aqua spermat. ranar. As for the method of the extirpation of a Cancer, I will reserve it to that part of Chirurgery which teaches the way to remove things incove∣nient to Nature, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

The Medicaments in the Apo∣thecaries Shops fit for Cancers, are Ʋnguentum de tutia, de lithargyr. de minio, Desiccativum rubrum. Fabricius ab aq. pendent. de tumor. c. 3. sets down a method whereby an Emperick cured sundry Noli me tangere's and Cancers in other

places: and it is this, ℞ Vitriol. lb iss. Auripigment. Sulphur. vivi, an. ℥ iiii. Sal. gem. ℥ iii. cum aceto fiat pasta. In olla terrea probè lu∣taeta siccetur in furno. with this powder he consumed the Cancer, but by divers applications.

You shall know that the Cancer is quite extirpate, if laudable flesh appear, like to the seeds of the Pomegranate, if it yield good Quittour, and no sanious and stink∣ing Matter: then he healed it with this Unguent: ℞ Mell. despumat. ℥ iiij. Sevi hirein. ••imatur. chalyb. an. ℥ iss. Litharg. auri. ℥ i. Misc. Another in Essex some years ago, in curing of Cancers, used only the green Treat and white Vitriol, for every ounce of the Treat taking ℥ i. of the Vitriol: and by all like∣lihood the Medicament of one Payne a Smith, with the which he went about to cure Noli me tan∣gere's, was but a Medicament com∣posed of Arsenick, Orpiment, un∣slaked Lime, Bole and sweet But∣ter. You see how I conceal no∣thing.

Hildanus Obs. 88. Cent. 3. gives a History of a cancerous Ulcer cured in an old Woman. The Ul∣cer was upon the concourse of the Sagittal and Lambdoeidean Sutures very painful, foul, foetid, unequal; the Lips were hard, and as big as ones Fist. She was prepared by Diet, Purging, and Bleeding. He shaved off the Hair, and cut off the exulcerate mass, and all that seemed tainted with Malignity, to the Cranium; and because the C••∣nium was carious, he abrased it a while after. Then he strewed on it some Pulvis Catagmaticus, trea∣ted it as other wounds of the Head, cicatrized it, and she lived long af∣ter. till she was decrepit, and then died of the Plague.

The Chymists will have Arseni∣cal, realgarian, and orpimental substances separated from the ra∣tural Balsame, or composition of the Body, to be the causes of these cancerous Tumors and Ulcers, when they settle in the parts, and cannot be discussed: however they represent fitly the nature of a Can∣cer: for as it is, so are they of a putrefactive quality. Let no man marvel, that sundry Minerals may be in the Body, seeing we see stores in the Gall, Ridnies, and Bladder.

For the curing of Cancers, they commend Antimony so prepared, as it doth not vomit, or trouble the Body; but either procures Sweat, or purges downward: and indeed it is an excellent Medica∣ment: for it changes the constitu∣tion of the Body, and mundifies the mass of Blood.

As for Topicks, use the Oil of Arsenick, or whereof Mercurius vitae is made, mixed with Oil of Roses in due proportion, and these two have no fellows; for I pro∣test I have often made experiment of both. If any be desirous to know, and make use of any thing which I have delivered, I will not be nice to impart it.

CHAP. XVIII.

Of the Leprosie and Leprous Ʋlcers.

NOw follows the Second kind of Ulcers most malign; to wit, a Leprous Ulcer. But first of all I will discourse of the Leprosie it self, and then of the nature of a Leprous Ulcer.

The Leprosie in Greek and La∣tine Tongue is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 scaber, rough: for it makes the skin rough and uneven: or from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, squama, or cor∣tex a scale or bark, because it sends out scales, and makes the skin rough like to the bark of a Tree. There be two sorts of Leprosie: to wit, the Grecian and Arabian Leprosie.

The Grecian Leprosie may be thus described: It is a Tumor with a confirmed hot and dry distempera∣ture of the skin, both in the outer and inner part of it, wherein scales, like those of fishes are sent out: so that Pruritus, Scabies, and Lepra Graecorum the Itch, Scabbiness, and the Grecian Leprosie differ only in degrees of Tumefaction: and di∣stemperature.

In itching there is no remarka∣ble Tumor, neither doth any thing fall away from the Cuticula, un∣less it be fetched away by hard scratching. In scabbiness there is a remarkable Tumor, and whe∣ther we scratch or no, both sani∣ous Matter and Scales like to the cast skin of a Snake come away. In the Graecian Leprosie, there are greater Tumors than in scabbiness, and Bodies like unto the scales of Fishes, fall from such as are posses∣sed with this grief: so that Aven∣zoar fitly calls scabbiness Pruritum vesicalem, a blistery or powky itch∣ing; but the Grecian Leprosie Pruritum squamosum, a scaly itch∣ing.

The signs of this Leprosie are these: the skin is dry, rough, and full of small knobs, which itch ex∣ceedingly, and send out bodies like to the scales of Fishes.

The causes of it are either the external efficient causes, or the in∣ternal material.

The external efficient, are, 1. Un∣wholesome Meats and Drinks.

2. Slovenliness, Sluttishness, and Filthiness. Villanovanus the Poetical Physician hath comprised these two causes learnedly in two Hexameter verses, thus;

Illotus sudor, & inopia nobilis escae Saepe gravi scabie correptes asperat artus.

Sweat not washed away, and want of good food often do make rough the limbs being taken with noisome scabbi∣ness.

3. The menstrual courses, or Hemorrhoids, which were wont to flow, being suppressed, may cause this disease.

4. Fontanels, which have long been kept open, being shut up, may procure the same.

5. Varices, the Veins tumefied by reason of melancholick Blood, being cured, sometimes are the cau∣ses of this grief.

The material causes are discern∣ed by the colour of the grief: for if the knobs be of a livid or lead colour, superfluous impure me∣lancholy is the cause; if they be white, or of a greyish colour, then salt Phlegm is predominant, which is mingled with Melancholy: and because aged persons multiply salt Phlegm, they are often troubled with this grief.

As for the presages, let this be the first: this grief, if it be habi∣tual, and of a long continuance, it is not easily cured.

Secondly, if it be neglected, it may turn to the Leprosie of the Arabians.

Thirdly, the scabbiness is more contagious than this grief; for it is more superficial, and so the con∣tagion is more readily communi∣cated, if any lying with a person infected lay his skin to the others.

This Grief is cured by a conve∣nient Diet, purgation of the Body, and local means. The Diet must be cooling and moistning, and af∣ford a laudable juice, whereof I have spoken sufficiently before in several Chapters.

As for the Purgation, minister Electuarium lenitivum, or Diaca∣tholicum, or Manna with pulvis sanctus, or diasenna: for an ex∣ample receive this prescription, ℞ Electuarii lenitivi, diacathol. aut mannae ℥ i. pulveris sancti ʒ i. aq. cichor. aut endiv. ℥ iij. Misc. ut fiat potio.

As for the local means: One To∣pick cannot be convenient for all bodies: for some have a tender ha∣bit of Body, and some an hard and firm: for those which have a ten∣der, these two of Minadous will serve: ℞ lithargyr. acerrimo aceto ros. diluti, ac siccati, semin. althae. rad. lil. alb. contus. an. ʒ ij. ol. ros. butyr. op. an. ℥ i. succi limon ʒ ij. caphur. gr. iiij. pulverizand pulve∣rizatis, fiat ung. s. a.

II. ℞ Elleb. utriusque, salis petr. an. ʒ ss. unguent. ros. ℥ j. succili∣mon. ʒ iij. farin. lupin. ℥ ss. fiat. unguent. s. a. If you add ʒ j. of Sul∣phur vivum beat to powder, to ei∣ther of these Unguents, they will be the more effectual.

This of Renodaeus antidotar. l. 5. sect. 1. cap. 9. is good: ℞ ax∣ungiae suillae in succo scabios. saepius lotae lib. ss. rad. oxylapathi in ace∣to ad putrilaginem coct. & per se∣taceum traject. sulpbur. vivi in succo limon. ablut. an. ʒ i ss. un∣guent. popul. ℥ ss. succi rad. enul. ʒ iiss. ex omnibus probe in morta∣rio subactis fiat linimentum. If it be a stubborn scabbiness, or the Greek Leprosie, use Ʋnguentum enulatum cum Mercurio duplicate. So much I thought good to deli∣ver of Pruritus, Scabies, and Le∣pra Graecorum, of itching, scab∣biness,

and the Greek Leprosie.

Now I will proceed to the Ara∣bian Lepra; with the which who∣soever is troubled, he is called a Lazarous person.

This grief is called by the Gre∣cians Elaphantiasis, and that for three causes.

First, because the skin is deform∣ed with rough wrinkles; yea the chinks being sometimes deep, ap∣pear like furrows in a Hide, re∣presenting the skin of an Elephant.

Secondly, because if it possess the Legs, it makes the Leprous person go stiffe, as an Elephant doth.

Thirdly, because as an Elephant of all Beasts is the mightiest; so this grief is most rebellious: so that it was called Leontiasis according to Aëtius, because it is invincible as a Lion; and because the Fore∣head is wrinkled like to a Lions.

It is also called Satyriasis, and that for two causes: First, because Leprous persons Faces represent in Figure the Faces of the Satyrs, as they are described by Poets: for their Lips are thick, their Nose swells; wherefore in the ridge it seems low, their Cheeks seem red, and the Tumors in the Forehead look like horns, all which express the Face of a Satyr, feigned by the Poets.

Secondly, because in the begin∣ning of the Disease the persons af∣fected are very lecherous, as the Poets feign the Satyrs to be: See Galen. lib. de caus. morb. cap. 7. In the Introductory Book ascribed to Galen it is said, that it was called Dracontiasis, because as the Dra∣gon is said to be the worst of all Serpents, so this Disease is said to be the worst of all other griefs. Amongst us Christians it is called the grief of Lazarus.

As for the causes of the Lepro∣sie, I will divide them into the ex∣ternal efficient, and the internal material cause.

To the external efficient, I refer the continual use of Aliments apt to breed atra bilis; and for this cause the Germans have many La∣zarous persons, and Habitations appointed for them: for thorow∣out the whole year they eat Cab∣bage salted, much Cheese, old But∣ter, and Flesh dryed in the Smoak, but most of all Bacon. In like manner it is familiar to Aegypt: because there they eat much Asses flesh, and drink standing and cor∣rupt Waters, if you except those who inhabit places near to Nilus. ••ucretius learnedly expresseth this, lib. 6. de natur. rerum.

Est Elephas morbus qui propter flu∣mina Nili Gignitur, Aegypti in medio, neque praeterea usquam.

The Leprosie is a Disease which is bred by the River of Ni∣lus, in the middle of Aegypt, and no where else.

Hence it is, that Moses threatens the disobedient Jews thus, Deut. 28. vers. 27. The Lord will smite thee with the botch of Aegypt, and with the haemorrhoids, and with the scab, and with the itch, whereof thou canst not be healed. In the Hebrew Text, it is with the Ulcer of Aegypt, whereby is meant the Leprosie; by the Scab, he means the Greek Le∣prosie, whereof I have spoken. In

Spain and Africk it is more com∣mon than any where else. In Pro∣vence of France, the Delphinate, Languedock, and in Aquitane it is more frequent than in other parts of the Countrey, Paraeus l. 9. cap. 6. Before the time of Pompey it was not seen in Italy, as witnesseth Plin. nat. hist. l. 26. c. 1.

Secondly, the Leprosie may be taken by having carnal copulation with an infected person, see Gordon. l. med. particul. 1. cap. 22. and Philippus Schopsius in his Treatise of the Leprosie.

Thirdly, the Arabians, Avicen, Albucasis, and Averroes, think that if a Woman conceive while her Courses flow, the Child will prove Leprous, but it is not likely: for that Blood in sound Women is good, and after Conception it is retained to nourish the Child: so that if that Blood were venemous (as some think) no Man or Woman could be sound. Fourthly, this di∣sease being often hereditary; it is propagated from the Parents to their Children.

Fifthly, continual conversation with Leprous persons cannot be but very dangerous; for if one may be∣come Pthisical by often receiving the breath of one who is troubled with that grief, according to Clas∣sick Authors, much more may one be infected by receiving the Air, infected with the breath of a Le∣prous person, which is most cor∣rupt and stinking: wherefore La∣zarous persons in every well-or∣dered place dwell by themselves, that they infect not others; and so God himself commanded, Levit. 13.4. and Numb. 12. 14.

The internal material cause by all is concluded to be Bilis atra. Now seeing this Humor is caused of three several Humors altered from their natural qualities, three sorts of Leprosie do spring.

First, it is caused of the super∣fluous Melancholick juice burned; this Leprosie causes the skin to be of a ruddy black colour. This kind of Leprosie comes on but slowly, and has milder symp∣tomes.

The Second is of yellow vi∣telline choler adust: This spee∣dily corrupts the inner parts, chief∣ly the Liver and Spleen, and from thence passing furiously to the habit of the Body, produces hor∣rible symptomes: in this kind of Leprosie the Skin is o. a yellow∣ish colour tending to Green.

The Third is caused of salt or nitrous Phlegm burned: In this, the colour is a palish white co∣lour; the Leprosie which is caus∣ed of this Humor, is not so flerce as the former. There be two other differences taken from the progression of the Disease: for a Leprosie is either in the begin∣ning, or consummate.

The signs of a Leprosie begin∣ning, are these: The Face seems to be of a livid reddish colour, the breathing is with some diffi∣culty, the voice seems to be some∣what hoarse, livid spots appear in sundry parts of the Body, the Skin begins to lose its exqui∣site feeling, the Urine is muddy and thick. Plinie affirms, that it was not seen in Rome before the time of Pompey, and began first in the Nostrils, not exceed∣ing the bigness of a lentil, and from thence passed to the whole

body, producing spots of divers colours, making the skin unequal, and raising scurfs, and hard scabs.

The signs of a confirmed Lepro∣sie are these: 1. The Skin loses altogether its feeling, so that you may thrust a needle thorow it, without any offence to the diseased party; this happens because the Humor, by reason of its thickness, stops the Nerves, and so hinders the animal spirits from passage. Nevertheless, the Muscles move, al∣though sluggishly; because they have Veins and Arteries, by whose Blood and Spirits they are fed.

2. Knobs appear in sundry parts of the Body, but chiefly in the Face, about the Forehead; the Ears become thin, the Nose flat upward, the Lips thick.

3. The Face is of a leaden red∣dishness.

4. The voice becomes very hoarse, the Lungs and Windpipe being affected.

5. The Eyes become round, the thickness of the Humor bearing in the corners.

6. When the grief is consum∣mate, Warts very often do appear thorowout the whole body, like to hailstones, as we see in measly Hogs.

7. Levinus Lemnius affirms, that the powder of Lead calcined, will swim in the Urine of Leprous per∣sons, but sink in the Urine of all others.

8. They are troubled with much belching.

9. Their Sweat and Breath is most stinking, their breathing is with difficulty and stinking. by rea∣son of the constriction of the Breast.

10. The Hair of the Head begins to fall, that of the Beard to grow thinner, and those of the Eye∣brows and Eye-lids to fall also: this falls out, because corrupt nourish∣ment is sent to the Hair; for if you pull out a few of their Hairs, you shall also pull out with the roots a fleshy substance.

11. The Nostrils without are tu∣mefied, but within they are narrow, and ulcerate.

12. The Veins under the Tongue seem varicous, small knobs also like to hail-stones appear there.

13. The skin is unctuous, and will not admit water.

14. The skin is full of wrinkles and chops; as an Elephants skin is.

15. The Muscles of the Thumb wast.

16. If the Body, the Fingers, and Toes have stinking Ulcers, and Chops, you need not much to doubt.

17. If you open a Vein, it will be thick, burned, seculent, and have as it were fat upon the top, and it being strained thorow a cloth, leaves a greety substance behind it.

Now it is time to address my self to the Prognosticks, whereof this shall be the first: A Leprosie in the very beginning is hardly cured; for the material cause of it is Atra bilis: now all diseases of Bilis atra are hard to cure.

Secondly, a Leprosie consum∣mate is altogether incurable by Art.

Now the means of curing a Le∣prosie beginning, are three: Die∣tetical, Pharmaceutical, and Chi∣rurgical.

As for the Diet, that which I de∣livered for a cancerous Tumor and

Ulcer, in the former Chapter, in this Grief is also effectual. It is fit that leprous Persons eat of the biggest Snails dressed, as Wilks, or Perwinkles, and Frogs, and that for a Month together; for this food doth exceedingly contempe∣rate the Heat of the Blood: the Water also distilled off them is good to be drunk: Rodericus Fonseca commends this Drink: ℞ Rad. Chin. ℥ j. Succi Limon. ℥ iij. aq. Cichor. lib. vj. Infund. per diem natural. deinde coq. in B. M. per hor. iv. vase bene clauso, decoctum postquam refrixit, cole∣tur: The same China will serve a second time, but to the third Decoction you must have new China. The Flesh of Vipers or Adders eaten, is good: let them be boiled in Water with some Salt and Oyl; eat both the Flesh and Broth, but the Heads, Tails and Intrails must be taken away: the Trochisks of Vipers or Adders are good, being ministred in Ci∣chory Water: Poultry also fed with Paste made with the Flesh of these and Barley flower is good, if it be used a long time; Coral and Pearl prepared, ministred in Broths, are excellent; young Hares in March are good. Galen commends Viper Wine, and sets down the Histories of sundry who were cured by the use of it. And Aretaeus lib. 4. cap. 12. de signis ac causis acutorum: but as for pre∣parations of Vipers ministred in a confirmed Leprosie, Erast. part. 4. disput. cont. Paracel. and Palma∣rius lib. de Morbis contag. witness them to be ineffectual; for they made trial of them.

The Pharmaceutical means are of two sorts: for either they are Cathartic, or Specific. Amongst the Cathartic means, ℈ j. of the extract of black Ellebore is excel∣lent: the next is Purgative, or Diaphoretick Antimony: the third is the Flowers of the Regulus, mi∣nistring gr. viij. in conserve of Roses: The fourth is the infusion of the Glass it self, mingling with it a spoonful of the Syrup of Vio∣lets; Mercury precipitate with gold is admirable; gr. iij. are e∣nough for a Dose.

As for the Specifical means, these are commended; the Decoctions of the Elm, Larix-tree, the Roots of Tamarisk, Ceterach, Fumiter∣ry, and Juniper-berries, boiled as Guajacum is, and drunk for a long time; ℥ iij. of Strawberry water or of Cuscuta, Dodder, taken Morning and Evening. Crolli••s commends ℈ j. or ℈ ij. Spiritus Tartari in aqua conveniente, or gr. vij. of the Spirit of Salt mini∣stred after the same manner, gr. vj. Bezoar similiter laudatur, for it withstands Malignity.

As for Chirurgical means, they are two; Phlebotomy, and lo∣cal Applications: If Phleboto∣my be required, open the Saphaen•• about the change, or the Haemor∣rhoides, but take not much Blood at a time, for leprous persons are weak.

As for the local means, they are either Baths or Liniments; this Bath is commended. Take of Crow-foot ten handfuls, of Colts∣foot five handfuls, of Tobacco two handfuls and a half; boil these in a sufficient quantity of Spring∣water; use this Morning and Even∣ing, until the Body yields no filth.

Of all other Liniments Rodoric. Fonsec. consult. 1. commends this. ℞ Viperas duas, quas, nullâ parte rejectâ, inde phialae vitreae conti∣nent. lb ij. Ol. Veter. exponatur phiala aestivis solibus: tandem sub sinem aestat. evadet Ol. rubrum & foetens. hoc oleo inungantur axillae, inguina, & carpi. Intus autem exhi∣••eatur ʒ j. Trochisc. ex Viperis, ••el colubr. in ℥ iij. aq. Card. Be∣nedict. & ℥ j. Syrup. acetosit. citri, per dies xiv. To these Ulcers ap∣ply a Liniment made of this Oyl, and Goats-suet, taking equal quan∣ties of both. We may make an effectual Oyl of our Adders to this same purpose. Cardanus used to anoint the Spind, Joynts, and Pulses of the Hands and Feet with the Fat of Vipers, for the space of seven days in a Hot-house, and affirms, that he not only did mitigate the Leprosie, but did cure also Con∣sumptions of Body, and the Pthisis it self. If you have not these Medi∣caments at hand, you may apply such as I set down for the curing of a Cancer, in the former Chapter, which requires no repetition.

CHAP. XIX.

Of abating superfluous Flesh.

HAving set down the main dif∣ferences of Ulcers, and the Method and Means how to cure ••••em, I must discourse in the like ••unner of the Accident of Ul∣••ers, which may hinder the prime ••tentions of curing them, and so ••rove a let and impediment to you 〈◊〉〈◊〉 your proceedings.

These Accidents are taken ei∣••er from things familiar to Na∣••••re; or from things contrary to Sature.

Things familiar to Nature hin∣••er the cure of Ulcers, when they ••ecline from that which is accord∣••ng to Nature. From these four ••fferences of Ulcers do arise: for 〈◊〉〈◊〉 Ulcer is either with excrescence of superfluous Flesh, or with ca∣riosity of the Bone, or with the colour of the part altered, or va∣ricous. Thus you see, that al∣though Flesh, Bones, Veins, and colour be required to the natu∣ral Constitution of the Body; yet they may become domestick Ene∣mies, being altered by the unna∣tural temperature of the part ill affected.

First, then I will handle an Ul∣cer wherein superfluous flesh grows. The Flesh it self is either soft and loose, or hard. The soft Flesh is either but beginning to increase; or else it is much arisen. If it do only offer to increase, then strong Desiccatives will serve, such

are Galls, Terra sigillata; Terra Lemnia, Bole Oriental, Umber, Olibanum, Aloe hepatica, the Roots of Tormentil, Bistort, Comfrey, the Flower de Luce dried. Me∣tallic things, or Minerals, afford greatest variety, and are most effe∣ctual, chiefly if they be prepared and washed; such are Crocus Mar∣tis, Calaminaris, Tutia, Aes ustum, Lead calcined with Brimstone, the dead head of Vitriol calcined, being well washed, Minium, Cernss, Litharge, chiefly of Gold.

As for the use of Vegetables, al∣though these which I have named may be used in the form of Pow∣ders, yet they are not so effectu∣al as the Decoctions: and then you may add to these, Plantain, Knot-grass, Shepherds Purse, Yar∣row, Horse-tail, Bark of Oak, Owlar, and Willow. If you add to the Decoctions strained a con∣venient quantity, either of Alume or Roman Vitriol, you shall not only suppress the soft and fungous flesh budding, but shall incarnate the Ulcer also, and bring it to Cicatrization.

Receive this Decoction, which I will deliver unto you as a Pat∣tern, according whereto you may frame the other, having a regard of the Age, and Constitution of the party. ℞ Rad. symph. Tormen∣till. gallar. an. ℥ j. fol. plant••gin. Pelygoni, Bursae Pastoris, Millefol. equiseti an. man. ij. Rut. Sylv. si malignitas aliqua subsit. an. man. ss. Bulitant ista in lib. xij. aq. font. ad med. ac coletur decoctum: De∣cocto colato si addideritis alumi∣nis ℥ vj. habebitis decoctum colore vinum Malvaticum referens: si verò addideritis tantundem Vitridi Romani, decoctum nigrescet. And although the black Decoction be not pleasing to the Eye, and stains the Clouts and Rowlers; yet it is more effectual than the other, but chiefly in malign Ul∣cers. You may add to such de∣coctions as these are, Sumach, Myrtleberries, red Rose leaves dried, Pomegranate-pills and Flow∣ers.

If you mean to use these De∣coctions, moisten either Pledgets of Tow or Lint in them, warmed and wrung; and dress the Ulcer Morning and Evening. In your practice you shall sind such De∣coctions much more effectual than either Unguents or Em∣plasters.

As for the use of Minerals, if they be applied in form of a Powder, tho they are more effe∣ctual than Vegetables, yet they procure more pains to the Chi∣rurgeon to make clean the sore, and are not so pleasing to the Patients, as when they are ap∣plied, being reduced either to the form of an Unguent or Em∣plaster.

If an Unguent be fittest, as in a hollow Ulcer, receive this as a good one: ℞ Minii, Litharg•• auri, ceruss. an. ℥iss. Calaminar•• aeris usti, an. ℥ j. Tutiae ʒ iij. Ca∣phur. ʒiss. Ol. Ros. & Myrtin. a•••• lib. j. & ℥ iv. Cerae alb. ℥ iij. fia•• Ʋnguentum s. a.

If you will have for a plai•• Ulcer an Emplaster, let this be 〈◊〉〈◊〉 Pattern unto you: ℞ Sevi O•••• lib. ss Axung. Porci ℥ iij. O•• Myrt. ℥ ij. Cerae Alb. ℥ iv. Cal•• min. ℥ j. Litharg. auri. Aeris ust••

Tutiae, Henrici rub. an. ℥ ss. fiat Emplastrum ex p. a.

If the proud Flesh be grown to that height, that it will not stoop to Desiccatives, then you are to have recourse to those Medica∣caments, that are called Cathaere∣tica; Auferentia, which take a∣way superfluous fungous Flesh. These are not so hot as either es∣carotical, or septick Medicaments, and those which blister: yet hot they are, and burn, tho gently: being then hot and dry in the fourth Degree, they are of a thick and astringent substance; where∣fore such Medicaments pierce not deep, partly by reason of their thick Substance, partly by reason of their rebated Heat; wherefore these only superficially dry and corrode the Flesh. Neither do they cause any great pain, because their Heat is not very intense, un∣less they be graduate by the ad∣mixtion of some other things. So we see Mercury precipitate, or burnt Alume, if either of them be applied to any sore, do cause no great pain; but if they be used being mixed, they both cause pain, and a small eschar. Such are A∣••••me calcined, Shells burned, the Powder of Hermodactyls, Aspho∣dell, Verdigreese, but Mercury precipitate excells, and exceeds all these: for it works with small pain, and by Concoction thick∣ens thin and ichorous Quit∣tour: yea, being washed, and mingled in small quantity with in∣carnative Unguents, it furthers their Operation. Yellow Turbith M••eral exceeds it in faculty, the Oyl of Vitriol or Sulphur, where∣of Turbith Mineral is precipitate, is more familiar to Nature, and astringent, than Aqua fortis, or Aqua regis, whereof the precipi∣tate is made.

Two Catheretical Unguents are much used, Ʋnguentum Apo∣stolorum, and Ʋnguentum Aegypti∣acum.

Of these two, Aegyptiacum is the strongest: In plain Ulcers I would not advise you to use it, for it spreads, and by touching the sound part causes great pain. It is effectual in fretting sores of the Mouth and sinuous Ulcers, be∣ing dissolved either in decoctions, or distilled waters convenient for the kind of sores.

As for Ʋnguentum Apostolo∣rum, if it be made according to Art, it is a Catheretical Medica∣ment in tender Bodies; but only a Mundificative in those who have a firm and solid constitution of Body.

It falls out many times, that the supersluous Flesh is so hard and compact, that it contemns all Catheretical Medicaments, and cannot be abated by them. In this course we are to have recourse to those Medicaments which are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Putrefacientia, or rotting the part; and to those which are not named 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Crustam inducentia, which leave an Eschar or Crust after they are applied.

As for Escharotical Medicaments which are called Exedentia, or eating Medicines, seeing they cor∣rupt the natural Heat, they must be hot above the third Degree, and have a thick, viscous, and terrestrial Substance, the Heat is to be durable and permanent. And

we see that Pepper, Onions, and such like, tho they be hot above the third Degree, yet they are not caustick; and the reason is, be∣cause although they inflame, yet because their Heat is placed in a thin and subtil Substance, it is more easily dissolved, and at last overcome by the natural Heat of our Bodies.

So, when Causticks are applied, notable pain is caused: First, by reason of their extraordina∣ry and exceeding great heat.

Secondly, because by reason of their Terrestrial Substance, they are long in piercing thorow the part.

Of these same Medicaments two are most used: the Lapis infer∣nalis, and the white Caustick. I mean not to trouble you with the setting down of their preparations, because they are sufficiently known unto all who have profited any thing in the study and practice of Chirurgery.

Of these two the Lapis infer∣nalis is most effectual, and works most speedily; wherefore it is most fit for making of Fontanels, where it may be conveniently ap∣plied to the upper part of the Member, and be hindred from spreading: but if a Caustick Me∣dicament be to be applied to a depending part, and when there is fear of running, then the white Caustick is most convenient. Be∣sides these two, two other Escha∣rotical Medicaments I will com∣mend unto you.

The first is Mercury sublimate, mingled with Roman Vitriol cal∣cined, until it become red, and the true Terra sigillata.

The second, Turbith Mineral mingled with these same; but whilst it is white and not washed. These do work more gently, if they be mingled with any Narco∣tical or anodyne Unguent, than when they are applied to any Sore without mixture. But Turbith Mineral far exceeds Mercury su∣blimate, because it is more fami∣liar to Nature, and doth not cause such pain; besides, it is not so vo∣latil and piercing as the sublimate is, which in tender Bodies assaulting the Heart it self, doth cause sharp Djaries, although they be but Symptomatical.

For the suppressing of rebelli∣ous excrescent flesh in Ulcers, the second means I appointed, were called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Putrefacientia, corrupting Medicaments. These are not so hot as those Medica∣ments which procure an Eschar, or Crust, they have a more thin substance, and subtil, and hare not so much Terrestreity, or A∣striction. These do more easily pierce, and so cause not so great pain: the pain which these Me∣dicaments cause is pungitive, as if needles did prick being red hot, and it quickly ceases. And as caustick Medicaments leave the part corrupted in manner of a Crust, so these leave that which they corrupt, soft, moist, and of a blackish colour. If you will re∣quire Medicaments moist, en∣dued with such a faculty, have re∣course to the Oyl of Vitriol, the Oyl of Sulphur, Aqua Fortis, and Aqua Regis. But if you will have solid and hard Medicaments, the•• call to aid all sorts of Arsenick, a•• the white, yellow and red, passing

under the names of Ratsbane, Or∣piment, and Roses ager.

As for the Septick Vegetables, because they rather mortifie the inward parts, if they be ignorantly or maliciously ministred, than abate proud Flesh in Ulcers, as Dry∣opteris, the Fern of the Oak, and Aconitum or Leopardsbane, and such like, I will leave them to the consideration of villainous Poyso∣ners.

But having only made mention of abating of superfluous Flesh in Ulcers, by the Application of To∣pical Medicaments, you may de∣mand of me whether this may not be effected by Chirurgical Instru∣ments, as actual Cauteries, and Incision Knives and Razors? Truly hitherto I have deferred the men∣tion of this Kind of curing, be∣cause God of his bounty in these later times hath in all faculties re∣vealed many things which were kept from our Forefathers. If a Patient resolute offer himself to a skilful Chirurgeon to be cured, let the Chirurgeon, in Gods name, in extremities use Iron and Steel: yet let me advise him not to be too forward in three Cases. 1. If the party be of a ten∣der Constitution, and unwilling: for if a Chirurgeon do altogether urge these extremities, he may lose his Patient, who is prompt to hearken to the Syrenian speeches of deluding Knaves and Queans. 2. If you cannot handsomely come to the part, as if the Ulcer be sinu∣ous. 3. If the superfluous Flesh require not only abating, but dry∣ing also, it being marvellous moist, then a Medicament is better than the Instrument, because it dries more powerfully:

Now I will deliver unto you a Medicament of famous Fallopius, which is effectual both in correct∣ing of stubborn superfluous Flesh, and in curing of Cancers: the de∣scription of it is this: ℞ Arsen. Cry∣stallin. O. Citrin. an. ʒss. Aristol. rot. Aerugin. ʒ j. Opij. ℈ij. Axung. Porein. ℥jss. Misc. ut fiat Ʋnguen∣tum. One thing I had almost let pass, to wit, the description of Ca∣thaeretical Lint; use this of Fal∣lopius his description: ℞ Aq. Plan∣tag. Ros. Solam. an. ℥iv. Opii, ℈ j. Medullae panis, ℥ ij. Mercur. su∣blimat. ℈ iv. super Porphyritidem triti. Omnia haec commixta bul∣liant ad consumptionem medietatis: deinde colentur p••r pannum crassi∣usculum. Fila excerpta bulliant aliquandiu in hoc liquore, postea eximantur, siccentur, expriman∣tur, siccentur, ac serventur ad usum. So much then concerning a bating of superstuous flesh in Ulcers

CHAP. XX.

Of Scaling corrupt Bones.

HAving in the last Chapter set down the Fountains from whence all the Accidents of Ul∣cers do spring, and having dis∣coursed of the manner of curing an Ulcer, wherein there is Ex∣crescence of superfluous Flesh, which was set down to be the prime Accident flowing from things according to Nature, I must be carried to the second Accident, proceeding from things according to Nature, which is the Cariosity of the Bone.

Now seeing the Bones are the stays and props of the Body, ap∣pointed not only for local Motion; but for the parts also which fur∣ther this Action, as Muscles, Veins, Nerves, Arteries, I am with the greater care to set down the Cure of an Ulcer with the Cariosity of a Bone, seeing so many things of importance do depend upon the Cure of such an Ulcer. In run∣ning over the whole course of Chirurgery, I have resolved upon this first Trial, to set down on∣ly the general Practices, which they who are judicious may ap∣ply to all Persons and parts in spe∣cial. In handling of this Accident, I will set down these four Points. 1. The Causes which procure the Cariosity of the Bones. 2. The Signs of a corrupt Bone. 3. The Prognosticks of an Ulcer, wherein there is a Cariosity of the Bone: And 4. Of the means which are to be used for removing of this Ac∣cident.

Now the Causes which pro∣cure the corruption of the Bones, are either external, or inter∣nal.

The external Causes are two, to wit, too great Cold, and too great Heat: for as too great Cold quenches the natural Heat of the Bone; so immoderate Heat, by discussing the natural Humi∣dity, dries and corrupts the Bones.

The internal Causes which most frequently produce this Accident, are in number three. The first is a glutinous and superfluous Humi∣dity, first sostning, and then cor∣rupting the Bone, which often∣times causes a distortion of the Member, and a protuberance of the Bone, which I have sundry times seen, and have noted not to have proceeded from any Venereal Cause. Such an Humor seised upon one, whose name was James Wil∣kinson, who dwelt near to me, when I practised in the City of

Chester, and caused a bending out∣ward of both the Shin-bones, or Ossa tibiae: this happened to him when he was above sixty years old: neither did this Accident either cause Nocturnal or Diurnal pain, or hinder his going. Before this did besal him, he had a great eva∣cuation of Blood (by reason of the Rupture of a Vessel in his left Kidney) together with his Urine, of the which I cured him by the Decoction of some of the Myro∣balans.

The second inward Cause of the Cariosity of the Bones, is a sharp and Malign Matter, which by touching corrupts the Bone: this happens most commonly in old and inveterate Ulcers: the Perio∣steum being once eroded by the Acrimony of the Sanies, it pre∣sently corrupts the Bone. It is no marvel that a sharp Humor is able to corrupt Bones, in other parts of the Body, when we see the Teeth to be hollowed by a sharp Rheum, which a File of tempered Steel doth with some difficulty rase.

The third inward Cause is an hidden and strange quality of the Humor, adverse to the Bones, seising not only upon some parti∣cular Bones, but upon some parts also of these Bones: for if it did with any manifest quality corrupt the Bones, it would first have e∣roded the Flesh: this being most subject to the impression of any sretting Humor. But the Bones very often are found to be carious, when the parts covering the Bones, as the Cuticula cutis, and Mem∣brana carnosa are found whole. So when Nodes invade the Citizens of Naples, they appear most com∣monly in the Os frontis, or in the Ʋlna, or Tibia, and that between the Joynts: Who is able to give a demonstrative Reason of this In∣vasion? He undoubtedly, who is able to shew, why the Loadstone draws Iron, and Amber and Jet Chaff.

The signs discovering the Cario∣sity of a Bone, are either Sensual, or Intellectual.

The Sensual are in number Five.

1. Is, if the Bone appear black and fretted: Blackness is caused by the corruption of the natural Temperature, by which it is kept always white with a ruddy glimps, or of an Horse-flesh colour almost. Cariosity is caused by the Acrimo∣ny of Humor, fretting the substance of the Bone.

2. Is, when the Bone, being felt with a Probe, doth not appear smooth, but rugged.

3. Is, if the Probe slip not, be∣ing guided into the Bone, for then the Periosteum must be gone, and so the Bone either more or less corrupted, partly by reason of the Air, partly by reason of the Quittour settling upon the Bone.

4. Is, if the Flesh ulcerate above the Bone appear soft and spongy, or of a livid colour, it is to be doubted that the Bone is corrupt∣ed: for when the Bone is carious, the Flesh is made soft and cor∣rupt, so that any one may thrust a Probe thorow it, with∣out any great annoyance to the party.

5. Is this: If a Tent or Pled∣get reaching to the Bone stink

the next day when it is taken out, there is just occasion offer∣ed to suspect that the Bone is carious.

The Intellectual Signs are in number Four.

1. Is, if more Quittour flow, from the Ulcer, than the bigness of it seems to afford.

2. Is, if thin and stinking Sanies flow from the Sore, it is probable that the Bone is foul.

3. If an Ulcer admit skinning, and often break out again, it may not without cause be doubted that the Bone is foul: for an Humor still flowing from the corrupt Bone causes a new inflammation, where∣by the Skin is broken a new.

4. Is this; If an Ulcer hath continued a long time, and is re∣bellious to proper Medicaments, it may be thought that the Bone is carious, being much moisten∣ed, and so made soft by the Quit∣tour: and therefore must be scaled.

As for the Prognosticks of such Ulcers as are accompanied with Cariosity of the Bone, receive these.

1. No Ulcer accompanied with Cariosity of the Bone is of easie Cure: for it has a Mallgnity an∣nexed to the Solution of U∣nity.

2. If there happen a Cariosity passing the first Table in either of the Bones above the Eye-brows, it will be an hand matter to cicatrize it. If this be a true Aphorism in Wounds dividing these parts, how much more true in Ulcers; those only causing a Solution of Unity by an external Cause; but these eroding the parts by an inten•••• Humor, which for the most part is still supplied by some notable Distemperature of some noble part?

3. Shall be this; If any of the Vertebra's of the Spina prove foul, shun the Cure: for first the sub∣stance of the Vertebrae being hol∣low, they will hardly scape: Se∣condly, It is an hard matter to come to apply a Medicament unto them, by reason of the Muscles placed above them. Thirdly, be∣cause it is a hard matter to shun the pairs of Nerves, which spring from the tranverse Processes of them.

Let this be Fourth; If in Ulcers of the Breast, the Sternum or Ribs be foul, be not too forward to meddle with them; for the Acri∣mony of the Quittour may easily corrode and pierce thorow the in∣tercostal Muscles and the Pleura, and so lay open to the Air the Vital Parts, which ere it be long must cause an extinction of the natural Heat, and so death it self.

The Fifth shall be this; Ulcers in the great Joynts, as the Elbows, Knees or Ankles, wherein there is Cariosity of the Bones, with loss of the Cartilages, are for the most part uncurable, because the pain in the Joynts is great, depriving the diseased persons of their natural rest and sleep, and so of good digestion and concoction of their Food: be∣sides this, they seldom fall out alone, but bring with them a Marasm••s, or extenuation of the Body.

Having set down the Causes, Signs and Presages of the Ca∣••iosity of a Bone. I am to shew ••he way how the Cariosity is to be ••enoved. To perform this Task, two things are to be done: First of all, the Bone is to be laid bare, and no less of it than is to be scaled: Secondly, the scaling of ••t is to be procured by convenient means.

The discovering of the Bone is ••o be procured three manner of ways; to wit, by Incision, Exe∣••son, Dilatation.

As for Incision: we are not to ••se it where the Bones lye deep, ••nd have Muscles, Tendons, Veins ••nd Arteries above them, as in the Thighs and Arms, chiefly in the ••ener parts. Secondly, although ••he Bones lie not deep, if they ••are many Tendons above them, ••••e cannot use Incision safely: such ••••e the Bones of the Metacarpi∣••m, or the upper distance be∣tween the Wrist and Fingers, and the Bones of the Metapedium or Metatarsus, which are articulate with the Toes.

Exesion is performed by poten∣tial Cauteries; as Lapis inferna∣••••, the white Caustick, the Pow∣ders set down by me, where I discoursed of Fistula's and cance∣rous Ulcers.

These are not to be used where many Tendons or Nerves are, lest they deprive some parts of their motion, and cause Con∣tusions, by reason of their great 〈◊〉〈◊〉 which they procure, as al∣so symptomatical Fevers. Potential Cauteries are most convenient, when there is Cariosity in the Cra∣••••am, the Ʋlna, or Tibia.

Dilatation; or enlarging of a narrow Sore, by stretching out the Circumference of it, is per∣formed by such things as swell, when they have imbibed any Moisture, as the Roots of Genti∣an, the Pith of Elder, and Sponges brought close together, either by Thread, or Melilot Empla∣ster.

These are fit to be used in Ul∣cers which possess the back of the Hand, or the instep of the Foot. The Bone being by some of these means laid bare, I am to shew you how the Bone is to be scaled.

This is to be performed three manner of ways, to wit, by Medi∣caments, Instruments, or an actual Cautery.

The Medicaments which pro∣cure the Scaling of a Bone, ought to be very drying, and of a sub∣til and thin substance: for the sound Bone, being assisted and strengthned by such drying Medi∣caments, sends forth of its self Flesh, which being increased, se∣parates the corrupt Bone from the sound.

These Desquamatory Medica∣ments are of three degrees.

For some are mild, as the Root of Peucedanum or Sow-fennel, Aristolochia rotunda, the Root of Iris and Myrrh: these will serve if the Cariosity of the Bone be but Supersicial, and the Consti∣tution of the Party soft and tra∣ctable.

Some again are yet more drying and strong, as that Medicament of Avicenna, which is composed of equal parts of Aristolochia rotunda, Iris, Myrrh, Aloe, the rind of the

Plant Opopanax, whereout the Gumm issueth, the Pumice-stone calcined, the refuse of Brass melt∣ed, and the Bark of the Pine-tree. All these being beat to powder may be applied alone, or mingled with Honey. Of this Nature also are Aqua vitae, and the root of Dra∣contium or Dragons. Fallopius has two Medicaments to this purpose: the first is this, ℞ Rad. Peuceda∣ni, Iridis, an. ℥ j. Euphorb. ℈ j. fiat ex omnibus pulvis, qui exci∣piatur pastâ panis molli, atque ossi corrupto applicetur. The Second is this, ℞ Rad. Peucedan. Aristol. rotund. Opopanac. Euphorb, an. ʒ ss. Terebinthinae ℥ j. Cerae ℥ ss. Aceti ʒ j. fiat cerat. ex p. a. These and such Medicaments are to be used, when the cariosity is some∣what deep and the party of reason∣able firm constitution of Body.

Lastly, some are strongest of all, as Euphorbium, beat to powder, Aqua vitae having the tincture of Euphorbium, the Oil of Cloves, or Petroleum wherein some Camphore is dissolved, Aqua-fortis, Aqua regis, Oil of Sulphur, and Oil of Vitriol, and Roman Vitriol calci∣ned. These are to be used when the cariosity is deep, and the con∣stitution of the diseased party stub∣born and strong. When these Me∣dicaments are applied, the fleshy parts adjacent must be very well defended, otherwise pain and in∣flammation will be caused. If the Sores be well dressed, and these Medicaments judiciously applied, the Bones will scale within the space of Forty daies.

Sometimes the cariosity of the Bone is very deep, so that a long time will be required for the scaling of it: wherefore in this case we must have recourse to instruments: the chief of these instruments are the Mallet and Chissels, and Raspato∣ries: First then, the corrupt part of the Bone is to be knocked off with the Mallet and Chissel until you come to the sound Bone; which you shall know, if the Bone bleed, and appear white and firm, accord∣ing to Celsus. Secondly, the Bone is to be made even with the Ras∣patories, and smoothed. In this case a Leaden Mallet is best: for it is weighty, and causes a lesser noise: this being done, some of the aforenamed Medicaments must be applied according to the con∣stitution of the party; for by it you must be led.

In Ulcers of the Head it often falls out, that both tables of the Scull are foul, so that you shall be forced to remove a great piece of the Cranium: here you must use the Trepan and Headsaw, the use whereof shall be delivered, when I shall set down the Cure of the wounds of the Head.

The Third way to scale Bones, I named to be the actual Cautery: of it I will set down three docu∣ments: The First shall be, when it is to be applied? The Second sh•••••• direct, where it shall be applied? The Third shall teach, how the Sore is to be dressed after the ap∣plication?

As for the First: it is to be ap∣plied when superfluous Humidity flows to the Bone; this we may conjecture; First, by the moist and cold constitution of the body of the person affected: the signs of such a constitution I delivered un∣to you, when I discoursed of a

waterish Tumor: whither I remit you.

Secondly, if after the applicati∣on of the desquamatory Medica∣ments, the Bone still appear moist and soft, not changing its colour.

The Second document shall be, where it is to be applied? You may apply it safety to the Ʋlna and Ti∣bia laid bare.

Secondly, you may use the actu∣al Cautery in those places, where dilatation only is permitted, and not incision, or potential Cautery, as in the back of the Hand, and instep of the Foot: but this ope∣ration you must do thorow a pipe of White Iron, to save the circum∣jacent parts from burning.

Thirdly, you may apply the actu∣al Cautery to the Joints: if the car∣tilages be foul, and way be made. This practice Ambrose Parey used when he had dismembred one in the joynt of the Elbow: the dis∣membred party found great ease and comfort by the application of it: See the History, Lib. xi. cap. xxv. What forms of Cauteries you are to use, the sigure of the Ulcer will shew you. When the actual Cautery is applyed, you are to be acquainted with the manner of dressing of the Bone, which was the third document.

How this is to be done Guido à Cauliaco shall teach you in his own words:

I (quoth he) after the application of the Cautery, ap∣ply for the space of three daies Oil of Roses tempered with the white of an Egg, and for three other, it mingled with the yolk of an egg; and afterward Butter with Mel rosatum, and ever above these applications some mundificative, until the bone scale. Afterwards, I incarnate and consolidate the part with Avicen's Medicament, which I delivered unto you a∣mongst the Medicaments exfolia∣tive of the second degree.

Fal∣lopius counselleth after cauterizati∣on to use Pledgets moistned in Rosewater and the white of an Egg, to hinder inflammation for some few dressings: then to apply to the Bone Medicaments exfolia∣tive. Beware of the use of an actu∣al Cautery, if the Scull, or any of the Vertebrae of the Back be foul, by reason of the Brain con∣tained in the first, and the Spinalis medulla contained in the second; which being inflamed by the heat of the actual Cautery, will bring alienation of Mind, and Convulsions.

CHAP. XXI.

Of a discoloured and varicous Ʋlcer.

THE two last differences of Ulcers taken from things ac∣cording to nature, were said to be an Ulcer, wherein the natural co∣lour is altered; and an Ulcer vari∣cous. First then I will discourse of the Ulcer, wherein the colour is al∣tered, and then of an Ulcer varicous.

As for an Ulcer having the skin adjacent, and the substance of the part altered; The unnatural co∣lours which possess the part alter∣ed are most commonly four; red, yellow, livid, and black.

The red colour proceeds always from heat, causing an Inflamma∣tion.

The external efficient causes of it are superfluous hot garments, too thick boulsters, rowlers made of Wooll, or of hard and stub∣born linnen Cloth, the hot season of the year, too strait ligature, the use of hot Meats and Drinks, surfeting, venery troubling the masse of Blood, extraordinary mo∣tion of the part, perspiration hin∣dred by reason of the suffocation of the part, or incunneation of the Humor, and solemn evacuations suppressed, as of the flowing of Blood from the hemorrhoidal Veins in Men, or the menstruous Blood from the veins of the Matrix in Women, by the error of the Chi∣rurgeon, applying things actually and potentially cold.

The material cause of this co∣lour is Blood offending: Now the Blood may offend two manner of ways, to wit, in quality, if it be too hot or fervid; or in quantity, if the Body be plethorick. In re∣moving then this red colour, one of the symptomes of Inflammati∣on, our first care must be to re∣move the external efficient cau∣ses.

The Diet must be moistning and cooling, until this accident be removed: wherefore Broths made of Chickens or Veal, wherein Sor∣rel, soure three leaved Grass or Al∣lelujah, Endive, Succory, Purslain, Lettuce, and such like have beed boiled, are very convenient. If the diseased party delight in roasted Meat, let him use for his Sauce Sippets with the juyces of the com∣mon and Wood-Sorrel, with a lit∣tle Vinegar and Sugar.

If the season of the year be ex∣treme hot, let the room wherein he remains be hung with Sheets, which must be still moistned with spring-water: In this case it is good to garnish the windows with Me∣dow-sweet, called in Latine Regi∣••••

prati, and Gaul called Myrtus ••••rabantica.

Let his Cloaths be neither heavy, ••or heating: let the Rowlers be ••f soft linnen Cloth, and moist∣••ed in Rose, or Elder Vinegar ••••d fair Spring-water, taking two ••••rts of Water and one of Vinegar: ••et the rowling be somewhat slack, ••oly to keep the local Medica∣••ents to the Ulcer; for strait li∣gature causes pain, pain attraction of Humors, and the attraction of ••ot Humors Inflammation. The party must abstain from sacrificing ••o the Cyprian Dame: yea, he must ••••andon every violent motion. If this Symptom be caused by reason ••f the suppression of any solemn ••••acuations, as the staying of the ••••enstrual causes in Women, or the suppressing of the Hemor∣••hoids in Men, the accustomed ••••owings of these are to be procu∣••ed again.

The menstrual Courses are to be brought down; First, by opening of the Saphaena in what foot it is most conspicuous; and Secondly, by exhibiting the power of Steel, either in the form of Lozenges, or of an Electuary, or infusion in White-wine.

The Hemorrhoids must be open∣ed by application of Leeches, and m••nistration of Aloetical Medica∣ments. That Medicament, which by Paracelsus is called Elixir pro∣prietatis, and by others Pilulae pe∣••ilentiales Arabum, composed of Aloes, Myrrh, and Saffron, are ex∣cellent. These may be taken sundry Mornings together. But seeing these things are at large set down by those who have written of the Practice of Physick, I have only pointed at the best Indications, which serve for the curing of these griefs, and the rather because the speculation of them doth belong to another Faculty and Art, to wit, Physick.

If the material cause of this symptome, which is Blood, offend in quality, being too hot, then it is to be cooled by a refrigerating Diet, which I at large set down, when I discoursed of a Phlegmon, to which place I remit you. If in quantity it offend, first Phleboto∣my, or opening of a Vein is to be used, and Blood drawn, as the age, constitution of the party, and na∣ture of the grief shall require. Se∣condly, the part it self is to be sca∣rified, and either Ventoses or Leech∣es to be applied, that the Blood may issue out plentifully to dis∣charge the part.

A livid, or leaden colour in an Ulcer follows: Two causes pro∣duce a livid colour in Ulcers: the First is black Blood impacted in the part: The Second is external cold, or defect of the natural heat.

This livid colour doth happen most frequently by reason of black and corrupt Blood setled in the part: for as a bright red colour under white, causeth a lively blue, or azure colour, as we may see in the Veins of sound and healthful persons; so black under white causeth a livid, or a leaden colour. This accident is to be removed by scarification, and application of Cupping-glasses, Horns, or Leeches. Afterward the scarifications are to be fomented with Oxymel dissolved in Carduus Benedictus water.

If the lividity proceed from cold: you shall perceive it by the cold

constitution and temperature of the part. In this case you are to apply such local Medicaments as are able to reduce the natural Heat and Complexion. Fallopius in his Treatise de tumoribus, c. 26. de Gangraena, affords a notable one, and a parable, which is this: Take an ordinary Turnep; and a Rad∣dish-root of reasonable bigness, grate or scrape these two, and add to them of powder of Mustard Seed ℥ j. of powder of Cloves ʒ iij. of Oyl of Lin-seed and Wall-nuts very old, so much as is sufficient, and make a Poultice, which apply warm; he calls this Cataplasm, Medicamentum optimum & divi∣num; A most excellent and di∣vine Medicament; with which he affirms himself to have cured ma∣ny: so that you need not doubt of the efficacie and certainty of it: and the Ingredients seem to pro∣mise no less.

The last unnatural colour is a black colour: this may proceed either from Heat or Cold. If it hath proceeded from Heat, then an inflammation went before; if from Cold, then lividity did precede. The first betokens Adustion; but imperfect: so we see Wood, be∣fore it be perfectly burned, and in∣cinerate, or turned to ashes, to become black. And in a Car∣buncle the lower part is of a dark red, the middlemost black, and in the top thereof is a white Pu∣stule, the Heat beginning the A∣dustion in the lowermost, in∣creasing it in the middlemost, and perfecting the Adustion in the top: for it is the property of Fire to heat or mount up, and to be most effectual aloft. If before black∣ness lividity did appear, it is to be feared, that the part begins to be mortified at the least, if any feeling or heat remain: if these cannot be perceived, then you may boldly say, that a Sphace••••s or Mortification has possessed the part.

In both these Cases, first the parts are profoundly to be scarifi∣ed: Secondly, they are to be fo∣mented with a Decoction of Worm-wood, the lesser Centaury, Scordium, Carduus Benedictus, the Flowers of Chamaemil, Melilot, and tops of Dill boiled in a gentle Lixivium. Thirdly, fill the In∣cisions of the scarifications with some of the Medicaments follow∣ing, using a Feather: ℞ Oxymell. simpl. ℥ ij. Ʋnguent. Aegypt. ʒ iij. Spirit. Vini, ʒ ij. Misceantur. Fourthly, this Cataplasm is to be applied warm. ℞ Farin. fab. herd. & Orobi, an. ℥ iv. Lixivii mi∣tioris, lb. iv. coq. haec ad Cata∣plasmat: consistentiam; tunc alle Oxymel simpl. ℥ ij. Ʋnguent. Ae∣gypiaci, ℥ j. Omnia probe misce∣antur. Continue the use of this Medicament, until the parts be brought to their natural tempe∣rature and colour: then proceed as hath been set down, when I spake of the curing of a compound Ulcer.

Having set down the methodi∣cal Cures of the three first Acci∣dents taken from things according to Nature; to wit, of abating superfluous Flesh, removing of the Cariosity of the Bone, and reducing the natural colour to the parts, I am to shew how the fourth Acci∣dent Varices, the Tumefaction of the Veins by reason of superflu∣ous

gross Blood, are to be cured.

This Accident is called in La∣tin Varix, from the similitude and likeness which it hath with the protuberances that are seen in Trees above the Bark; called Va••ices: according to Avenzoar, lib. 2. tract. 7. c. 25. Albucasis Chirurg. part 2. c. 93. called this affection Vitis, or the Vine, be∣cause these pass along the parts by windings, as the Vine doth: In Greek it called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or as it is found in Pollux 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. It is called by Hippocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and by Ari∣stot. 3. de histor. animal. 11. and in sundry other places.

This affection may thus be de∣scribed: A Varix is a Dilatation of a Vein causing a Tumefaction of it, with windings and tortuosity arising in one or more parts of the Body. It is called the Dilatation of a Vein, because the Dilatation of the Artery is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. This Particle [causing a Tumefacti∣on]. is added, to exclude Veins which are naturally big. Galen de method. medend. lib. 14. c. 13. numbers this affection amongst the Diseases which proceed from the Quantity increased. It may be accounted a Disease, because the Actions of the Parts which it pos∣sesses are hindred; for if it possess the Legs, they become extenuate, and by reason of the heaviness of the Humor, they become slow in motion. If this affection invades the Stones, the party becomes barren.

The Causes of it are either in∣ternal or external. According to Aristotle, the material Cause is Blood, being impregnate with Spi∣rit; he affirms it proceeds from Blood, lib. 3. de histor. animal. c. 19. where he notes, that Wo∣men are not troubled with Varices; because they turn out their super∣fluous Blood by their natural Fluxes, and that they are less trou∣bled with the Hemorrhoids in like manner. And the this doth prove true in most Women, yet there may be sundry Women found, who both have Varices, and are subject to the Hemorrhoids. He thinks, that the Blood in the Varices is full of Spirits; and therefore pro∣nounces, Sect. 6. Problem. 3. & Sect. 4. Problem. 21. that they who have their Testicles varicous are barren, because the Spirits of Generation pass to the Varices, and so leave the Seed unfruitful, being deprived of Spirits. But Hippocrat. 3. de Articul. Text. 4. & 6 Aphor. 21. & Galen. 4. de compos. Medicament. think the material cause of Varices, to be gross and flatuous melancholick Blood: yea, both Galen and Avi∣cen are of the opinion, that Varices may sometimes be caused of lauda∣ble Blood, only offending in quan∣tity, and dilating the coats of the Veins.

The antecedent Causes are in number Four.

1. Is a melancholick and pitui∣tous temperature: so they who have a bad Spleen, are most subject to this Disease.

2. An hairy and an hard habit of the Body.

3. The Masculine Sex: for Wo∣men are not so frequently trou∣bled with this affection, because monthly they discharge all super∣fluous

Blood, if they be healthful: as hath been said out of Aristot. 3. de Histor. Animal. c. 11. & Sect. 10. Probl. 29.

4 Either ripe or old Age: for according to Hippoc. in Coac. prae∣not. they happen not before the fourteenth year of the Age, in the Legs; although even Children may have Varices in the Testicles. Why Eunuchs are not troubled with Varices, Arist. Sect. 10. Problem. 29. yields a reason; be∣cause they are deprived of Seed and Spirits. Avicen adds to these, sharp Diseases going before: for in these the thinnest part of the Humors being spent by sweat, in∣sensible perspiration, and discussi∣on procured by Art; the thicker part being turned to some parti∣cular places, may procure Varices.

The Primitive Causes are these.

1. A thick and impure Air; because it weakens the Legs, and makes them more apt to receive superfluous Humors. And for this cause Hippocrates affirms, that men who dwell in the Western part, are frequently troubled with this affection, and Ulcers in the Legs.

2. Immoderate Exercise; so we may see Foot-men and Porters of∣ten to have Varices.

3. Long standing: according to Averr. 6. collect. 2. From hence Juvenal saith; Fiet varicosus aru∣spex: He shall become a varicous Sooth-sayer: for they who took upon them to find out future con∣tingences by the flying of Birds, were enforced often to stand a long time.

4. Thick Wine and gross Food: such are old Flesh salted, or smoak∣ed, Pease and Beans.

As for the Presages, let this be the first:

1. If Varices appear in those who are mad by reason of the melancholick Humor; the Grid ceases.

2. The Varices mitigate Gib∣bosities, or bunching in any part of the Body: for the Humor which causes them, is by these means averted from maintaining of them.

3. The Varices appearing either in the right or lest Testicle, help a squeaking Voice; the Humor be∣ing turned from the Breast to the Testicles, according to Hippocrates, in the fifth Section of his Epide∣micks. This may happen for two Causes. 1. By reason of the con∣sent which is between the spiritual and genital Members. 2. Because Baldness, Stutting, Lisping, and a Squeaking Voice, according to Hippocrates in the same Book, are melancholick affections.

4. They who never become bald, have not large Varices. And again, if in those persons who are bald, large Varices appear, Hair will grow again, Hippoc. 6. Aplxr. 34. & Arist. 3. de Histor. Animal. 11. But you must understand this of the Varices of the Testicles called Hernia varicosa, The cause of this is the consent of the Brain, and of the genital Members, which is so great, according to Aven∣zoar, lib. 2. tract. 3. c. 1. that Castration impairs both Wit and Courage. Then Humors melan∣cholick

being gathered in the Te∣sticles, Vapors ascend to the Head, which afford sufficient Matter for producing of Hair. And in Women, their Courses being stopped, Vapors ascend to the Chin, from whence a Beard doth bud out. As Hip∣poc. 6. Epi•• Of Sect. 8. doth re∣port of P••••••••usa the Wife of Pytheus, who got a Beard by rea∣son of her Husbands absence from her.

5. Varices caused by reason of some grief of the Spleen, are not to be cured, lest the diseased party fall into some melancholick Dis∣ease, according to Avicen. 22.3. tract. 2. c. 18. for seeing the Mat∣ter is lodged in the Spleen, and the Varices of the Legs are stopped by Cure, the Humor must be turn∣ed to some other parts.

6. Varices are hardly cured by Medicaments, according to Aven∣zoar, lib. 2. tract. 2. c. 22. Al∣though they may be cured by Chi∣rurgery without danger of Life, ac∣cording to Celsus, lib. 7. c. 22. This is true, if the Varices be caused of too copious laudable Blood; otherwise not, for the rea∣son before assigned.

The Cure, which is the last Point, is performed by two Indi∣cations, to wit, by discharging the Body of the thick and melancho∣lick Humors, and taking away the tumefied Veins.

The first is performed by ap∣pointing a convenient order of Diet, and administration of fit Medica∣ments.

The second is performed by Chirurgery.

As for the Diet, gross, tough, flatuous Meats are to be shunned, as Beef, Goats flesh, Venison, Oy∣sters, Fishes fed in muddy Wa∣ters, old Cheese, Beans and Pease, Lettuce, Colewort, Cabbage, and all those things which Galen for∣bids in melancholick Diseases, lib. 3. de loc. affect. c. 7.

As for Phlebotomy, the Liver or Median is to be opened in the Arm directly opposite to that Leg wherein the Hemorrhoids are; or Leeches are to be applied to the hemorrhodal Veins, chiefly if Blood was wont to issue from them.

As for purging, Lenitives mix∣ed with those which purge gross Humors are to be ministred: Take this for a Pattern, ℞ Ele∣ctuar. Lenitiv. ʒ vj. Pulv. Sancti ʒ j. Syrup. de Cichor. cum Rhab. ℥ j. Misc. ut fiat potio.

The Chirurgical Cure of Varices is performed by two means, Usti∣on, and Exection; Ustion is to be used when the Varix is streight, and not much tumefied.

The manner of Ustion is this: Incise the Skin until you come to the Vein, and separate it from the parts adjacent; then shunning the brims of the Wound, cauterize the coat of the Vein; four inches from this Ustion do the like, and so still, until you come to the end of the Varix. This being done, dress these Ustions as you use to dress parts burned.

Excision is to be used when the Varix is crooked, and hath wind∣ings, according to Celsus: but in my judgment a streight Varix is better cured by Excision than that which hath windings and creeks,

because it is more easily separated, and will admit a more beautiful Cicatrix: whereas in cutting the other there must be horrible pain, and an ugly Cicatrix must be left.

The manner of Excision is this: you are to begin at what end of the Varix you will, and to sepa∣rate the Vein from the adjacent parts, until you come to the other end; then bind the Vein hard at each end, and cut off what remains between the two Ligatures: this being done, the brims of the Wound are to be brought toge∣ther, and to be healed with glu∣tinative Medicaments. Plutarch in the life of Marius writes, that he having this Grief in both his Legs, submitted himself to this manner of Cure; and when he had put forth one, did constantly endure the Excision of the Varix in it, that no Man should have doubted of his Valour; but when the Ch∣rurgeon would have done the like in the other Leg, Marius answer∣ed flatly, that he meant not to buy Beauty with such pain; it is not to be thought that any in this our tender•• Age will ad∣mit either of ••or, two opera∣tions.

If a varicous Ulcer be offered unto you, which contemns ordi∣nary means, my counsel is, that you take up the Varix above and below, as you do the Veins of the Temples in inflam∣mations of the Eyes, and open 〈◊〉〈◊〉 between the Deligations, that the Blood may be discharged o•• of it. This Operation any 〈◊〉〈◊〉 will admit, if he be not too tender.

CHAP. XXII.

Of a verminous and lousie Ʋlcer.

HAving delivered unto you the two last differences of Ulcers taken from things accord∣ing unto Nature, yet changed from the natural Constitution, to ••uit, of a discoloured and varicous Ulcer; now I am to set down the differences of Ulcers taken from things alien to Nature, and Stran∣gers. These are two; Worms and Lice; from the first an Ulcer is called verminous; from the se∣cond, lousie. The Worms which ••reed in Ulcers may more fitly be called Maggots, in Latin Termites and Galbae, as those of the Guts are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, or Lambrici in Latin; as we find set down in a learned Epistle of A∣lexander Trallianus entituled 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, de Lumbricis, of Worms in the Belly, translated by that fa∣mous and learned Physician Hie∣rymus Mercurialis, which he an∣nexed to his Treatise written of the Diseases of Children.

They are ingendred of putrid Humors, in unclean and sordid Ul∣cers negligently dressed, but most frequently in hollow, deep, and sinuous Ulcers: for in such the Quittour is longest lodged, and the putredinal Heat is greatest. And for this cause they are seen in Ul∣cers of the Ears, for the Quittour is there long detained by reason of the windings and labyrinths of the Ear

The material cause of these Maggots for the most part is a pituitous Excrement, as Paulus Ae∣gineta witnesses, lib. 4. cap. 17.

The efficient cause is Heat, and that of two sorts: The one is extraneous, and putrefactive, causing corruption of the Hu∣mors.

The other is Natural: seeing, according to the Philosopher, lib. 3. de generat. animal. cap. 2. no∣thing can be produced of Putre∣faction only, unless Concoction put to its helping hand; then in a verminous one which is preterna∣tural, there is Putrefaction, Heat and the Ulcer it self, besides Worms, the effects of the first two.

As for the Signs, they are three: The first is the sense of Sight, for oftentimes they are seen, if either the cavity of the Ulcer be ample, or that they are voided with the Quittour.

The second is the motion of them felt by the Patient: their motion is called Motus undesus, like unto the waves of the

Sea, contracting and extending it self.

The third is a pinching pain now and then: for living they must be fed, and their feeding must of necessity cause more or less pain.

The fourth Sign is horrible stink, by reason of great putrefa∣ction.

When you go about to cure such an Ulcer, attempt not the taking out of the Maggots with any Instrument, for your labour will be fruitless, and the pain of the Patient great; and grant that you take many away with your Instrument, yet you must leave the putredinal Heat, and the cor∣rupt Humor, for the breeding of more.

I wonder, that even great Au∣thors make mention of applicati∣on of the actual Cautery in this Case: they might be born withall, if these Ulcers were plain, and shallow; for so the superfluous Humidity might be dried, and Pu∣trefaction removed: but they with an unanimous consent confess, that these Maggots are most com∣monly bred in sinuous and hol∣low Ulcers, (as hath been said) and most frequently in the Summer time, and Southerly winds blow∣ing: and so a great heat would be induced, and the Patient put to great pain, if they could reach to the cavity of the Ulcer, which can∣not be.

These Worms then must first be killed, and then they will issue out of the Ulcer without any dif∣ficulty.

Those things which kill these Worms, do it either by a manifest, or hidden quality.

They which kill them by their manifest quality must be bitter, such are Wormwood, Southern∣wood, Calamint, Aloe, Fern, Bulls gall, Meal of Lupines, Leaves of the Peach-tree, Capers, the Roots or the distilled Water of the Roots of Couch-grass, called Gramen caninum, Horebound, Scordium, Mugwort, Centaury the lesser, Mints. Of these you may make Decoctions, whereof you may find sundry descriptions in the Mo∣numents of those who have writ∣ten of this Subject. Ambrose Parcy, lib. 12. cap. 8. sets down this Medi∣cament: ℞ Absynth. centaurij mi∣nor. & Marrub. an. M. j. decoq. in lib. j. aq. font. ad lib. ss. decoct. coletur: In quo. dissolve Aloes ℥ ss. Ʋnguent. Aegyptiac. ʒ iij. He puts in the decoction ℥ ij. of Aloe, and ℥ j. of Aegyptiacum: but who may not perceive the quantity of these to be too great? This of Ricla•••• the Father, in his Chirurgery, d•• Ʋlcerib. cap. 8. is excellent: ℞ Ellebor. alb. rad. cappar. gentlan dictamni alb. an. ʒ ij. centaur. mi••∣nor. scord. Absynth. Marrub. Ca∣laminth. an. man. ss. decoq. i•• sufficiente quantitate aquae fen•• ac coletur decoctum. In lib. j. 〈◊〉〈◊〉 laturae dissolve Mellis ℥ ij. Aegypt••∣aci ℥ j. Above the Ulcer he ad∣vises to lay Ʋnguentum Apostol•• rum. If a Tent may reach to th•• bottom, use this commended b•• Fallopius in his Treatise de Ʋlce∣ribus cap. 21. ascribed to Arch••∣genes, as also Ambrose Parey, 〈◊〉〈◊〉 the place aforementioned: ℞ Ce∣russae, polii montan an. ℥ ss. pic liquid. q. s. ut fiat linimentum

This cannot chuse but be effectu∣al, for the faculty of Tar is known even to Hunts-men and Shepherds.

As for those Medicaments which kill Worms from a hidden qua∣lity in Ulcers; they are taken either from Minerals or Vege∣tables.

Amongst Minerals all Waters in∣dued with the quality of Mercury or Antimony are effectual: where∣fore you may use Aqu. Aluminis Magistralis of Fallopius, set down by him in his Treatise of the French Pox thus, ℞ Aq. Plantag.& Ros. or lib. 1. Alum. & Mercur. sit∣blmat. an. ʒ ij. Pulverizat. These are to be mingled together, and being put into a separating Glass, half of the Water is to be evapo∣rated away. Fallopius counsels the Glass to be set upon a Grid∣iron, and Coals to be put under: but the safest way is to have this done in a Pan, with some Sand set upon a little Furnace. After that half is evaporated away, the separating Glass is to stand five days, and then the clear Water is to be poured off, and kept for 〈◊〉〈◊〉.

It is not to be used alone, but ringled sometimes with a double, sometimes triple, sometimes qua∣driple quantity of Rose, Plantain, or Night-shade-water. These A∣••tions of Crocus Metallorum, precipitate, and Turbith Mineral, are effectual: Vitriols of all sorts, Reolved in fair Spring-water, and ••••ing some Champhore added, ••re very good: for they not only ••ill Worms, but powerfully cor∣rect Putrefaction in Ulcers.

Amongst Vegetables which kill Worms by a hidden and unknown quality, Tobacco carries away the bell, and not only the Juice of the green, but the decoctions of the dry also, do effect this, being ap∣plied to the Ulcers by injection, or moistening the Tents or Pled∣gets with the same. Seeing you may find this Medicament, whose faculty and operations are certain, I will not trouble you by setting down a rabble of uncertain toyes, Ʋnguentum de Paeto, having some Mercury precipitate mingled with it, is excellent in such Ul∣cers.

Seeing Worms in the Belly by Erosion cause Ulcers in the Guts, in so much that Worms have of∣ten come out at the Navel and Groins, whereof you may read memorable Histories set down by Schenkius in his third Book, Pag. 407. titul. de Lumbricis, it will not be a thing impertinent to discourse briefly of them, seeing they often tro•••• Children, and procure sometimes death.

These Worms are called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ferae, be∣cause they cruelly torment the Bo∣dy; in Latin Lumbrici.

The efficient cause is the tem∣perate heat of the Guts: for intem∣perate heat rather burns the Hu∣mors, than produces any thing of them.

The material Cause, is the in∣concocted part of the Chyle sent away to the small Guts from the Stomach, and left undrawn by the mesaraical Veins. This part of the Chyle, being crude, and left in the Intestines, mixt with the pi∣tuitous Humor, is elaborate by the temperate heat of the Guts; and

the form, which lay hid in this Matter before, is brought forth af∣terward by this heat; and accord∣ing to the diversity of the latent forms, sundry sorts of Worms are bred. In the aforenamed Title of Schenkius, you may read of the stupendous figures of Worms, set down by learned and famous Men in their Monuments, who have seen them.

As for the differences of them: they are either ordinary, or extra∣ordinary.

Of the ordinary there are three sorts: The First is Teretes, the round ones, not unlike to Earth∣worms in Figure; but in colour different: for they are whitish.

The Second are called, Ascari∣des: these are like unto Worms which grow in Cheeses, and Mag∣gots in Flesh: they are for the most part bred in the Intestinum rectum.

The Third kind is called Lum∣bricus latus, the broad Worm; and Taenia, which in Greek is called a Swadling-band, by reason of its Fi∣gure, for it is broad and long, and it has sundry joynts. This Worm will be of a strange length. Plin. lib. 11. nat. histor. cap. 33. affirms, that some have been thirty foot in length. Conciliator diff. 101. saies, one voided such a one fifteen Foot in length. Alexand. Benedictus, in prooem. lib. 21. Practicae, saies he saw the like. If you desire greater variety of such Histories, peruse Schenkius his observations, lib. 3. pag. 412. I my self when I was in the Newry, a Town in the North part of Ireland, being desired to visit a young Man who had a Fistula in Perinaeo, and whose Body was ex∣ceedingly extenuate; when I had ministred a dose of 2 gr. of Mer∣cur. vitae to him, he voided such a Worm, tucked like a crabtree cudgel, about the thickness of a Childs finger, he kept it in a little pewter Basin for my coming: when he was in voiding of it, he was in great fear, thinking that his Guts came out.

As for the signs of Worms; you shall know any one to be troubled with round Worms by these signs: the party finds gnawing and pinch∣ing pain in the Belly, has gnashing of the Teeth, chiefly in sleep; is troubled with a dry and continu∣al Cough; the Nostrils itch: where∣fore Children having them, are still picking their Nose; the Face is evil coloured, the Cheeks are some∣times of a red, sometimes of a livid colour: the Eyes are hollow; the Mouth is waterish; the Breath is strong; there is a desire to vo∣mit; the Hicket oftentimes; Hun∣ger; and heaviness of the Head; Drowsiness; Convulsions; starting in the Sleep; stretching of the Belly: an extenuation of the rest of the Body; horrible Dreams, looseness of the Belly; ugly and stinking Excrements do fall out. This is holden for an experiment, if water be poured upon the sto∣mach in the Morning, the party being fasting, he or she shall find a drawing in of the Belly, by rea∣son of the shrinking of the Worms, shunning cold. All these signs are not found in every person, but some in sundry.

If Ascarides, or small Worms be bred in the Intestinum rectum, a horrible itch troubles the party, and they are often seen in the Ex∣crements.

If Taenia, or the long broad Worm be in the Guts, the party has an insatiable appetite, the Bo∣dy consumes, and some substance comes from it like to the seeds of a Cucumber. The falling Sick∣ness oftentimes proceeds from the round Worms, but seldom from the broad and the Ascarides.

Let us now come to the pre∣sages which the diversity of Worms afford.

1. Ascarides, if they be small, they are of all sorts least dangerous, for they are farthest from the no∣ble parts, and are most easily kil∣led, by Clysters, or injections of bitter things; it is otherwise if they be big, for then they are ingen∣dred of a worse matter.

2. The Taenia is of all others the worst, because it is biggest, and hardest to be killed.

3. The bigger are worse than the lesser, and many more dange∣rous than few, and the red are worse than the white.

4. If in the beginning of sharp di∣seases round worms come out alive, they betoken pestilent diseases.

5. It is good if round Worms come out, even when the Crisis is at hand, or in the declination of the Disease.

6. If in persons not sick, Worms come out either at the Mouth or Nose, it betokens no harm; be∣cause this they do for lack of food.

7. If this happen in sick persons, it is an ill sign, for it argues the malignity of the Matter, which the worms labour to shun.

8. If Worms expelled, seem to be sprinkled with Blood, it is an 〈◊〉〈◊〉 sign; for it shews the Guts to be ill-affected.

As for the Cure, it is performed by two Indications; the First is by killing of them; the Second by expelling of them killed.

They are killed either by inter∣nal Medicaments, or external Ap∣plications.

The internal Medicaments are either simple or compound; the simple are either Vegetables, or Minerals, or Animals.

The most powerful amongst the simple Vegetables are these; Coral∣lina, the Dose of it is ʒ j. The seeds of Tansie, and common Worm∣seed, the dose of them is ʒ j. the juice of Vervain; give a spoonful, the juice of Scordium, Wormwood, the lesser Centaury, Cardnus Bene∣dictus, or Beer or Ale brewed with these, Garlike, the roots of Grass.

As for compound Medicaments, let this be the first: ℞ Corali••n. lumbric. terrest. rasurae cornu cer∣vi, semin. Santonici, & tanaceti an. ʒ j. rad. dictamni albi, rha∣barb. agaric. trochiscat, an. ℈ ij. fiat ex. omnibus pulvis: dos. ʒ j.

The Second shall be that Medi∣cament, which Quacks in Germany call Panis vitae; the composition is this, ℞ mustacei ℥ iiij. semin. san∣tonici ʒ v. mellis puri q. s. ut siat pasta: dos. ℥ ss. ad ℥ j.

The Medicaments taken from Minerals: Mercur. crudus, dos. ℈ ij. Mercur. dulcis, dos. à gr. iiij. ad xx. secund. ratienem aetatis & vi∣rium. Mercur. vitae, cujus dos. à gr. ss. ad gr. j. vitrum antimc∣nii, crocus metallorum, in pulvere vel infusione.

As for external Applications, re∣ceive these as patterns:

1. ℞ Aloes hepat. ʒ ij. fellis tan∣rini ℥ iiij. absinthii contus. ℥ ij ss.

siat cataplasma applicandum umbi∣lico.

2. ℞ farin. lupin. ℥ j. myrrh∣alces an. ʒ j. pulp. colocynth. ℈ iiij. croci ℈ j. fell. boum ℥ j ss. aceti acerrim. ʒ ss. mise. Applicetur cu∣minum pultum cum felle tauri, quod commendat Sebastian. Austrius lib. de morb. infant. morb. 42.

The efficient cause of Lice, is the natural temperate heat, mixed and concurring with the heat pu∣trefactive.

The material cause, is the excre∣ments of the third concoction, or assimilation, which are hot; but not sharp or malign. This is the opinion of Galen, lib. 1. de compos. medicam. secund. loc. cap. 7. and Avicen. lib. 4. fen. 7. tractat. 5. cap. 26. That you may the better understand this opinion, you must understand, that when Blood is turned to the nourishment of the parts, divers excrements are pro∣duced; of which some are discharg∣ed by insensible Perspiration, some by Sweat, some cleave without to the Skin, as the Morphew and the filth which cleave to the soles of the Feet, called Strigmenta; and scales in the Head and other parts: some stay within the Cuticula, and these are either sharp and of a ma∣lign quality, and these cause shed∣ding of the Hair; or they are de∣stitute of both these qualities, and they produce Lice.

The disserences of these Lice are two: for some are most commonly without the Cuticula, and some within the Cuticula; of those that are without, some are familiar as the common sort; some are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, feri, wild and cruel ones.

As for the ordinary and familiar, most commonly in Boys and Girls, they swarm in Ulcers in the Neck below the Suture Lambdoides: but sometimes, and in some persons, they possess the distance between the Cuticula and the Cutis, divel∣ling and separating the one from the other. If one will know what store of these moveables may issue out of the Cuticula of one person, let him read Amatus Lusitanus cent. 3. curat. 58. & schol. ad curationem eandem; where he reports, that one of good note in Lisbon, called Tabora, was so troubled with them, that two Negroes had enough to discharge him of them, and to carry them to the Sea; and at last they pro∣cured his death.

The 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or feri, Crab-lice, are most commonly engendred in the Arm-pits, and in the Forest of Ve∣nus in nasty Men and Women.

These which are always found under the Cuticula, are called Si∣rones, unknown to the Grecian Physicians: they draw a trench a•• Moles do in the Earth, under the Cuticula, leaving Pustules behind them, as they march: their seat (when they rest) is easily discern∣ed at the end of the Trench, where when the Cuticula is opened, they may with the point of a sharp pin or needle be taken out: they re∣semble Nits in Cheese.

As for the Prognosticks, 1. They who are troubled with any kind of Lice are nasty persons.

2. In an Hectick Fever, they shew that one is entred into the third degree of it, and so is incu∣rable.

3. In persons not diseased, if they abound, you may advise them

to keep their hands from their Mouth, and to labour to be clean∣ly.

When Lice swarm over the whole Body, the disease is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, à pediculis, from Lice.

Three Intentions are required for the cure of them: Phleboto∣mie, Purgation, and local Appli∣cations.

As for Phlebotomie, the Sex, Age, Constitution of the party, and Strength, with the rest of the In∣dictions are to be observed.

When you purge, use rather Mi∣terals than Vegetables, because they more strongly evacuate, and are of a more subtil, durable, and pe∣netrating Faculty. These same will serve to hinder the increase of these, which I set down as powerful to kil Worms.

As for local Applications, Ama∣tus Lusitanus in the place afore∣••••med, affords two: the one is a medicate Vinegar; the other a Li∣niment: The description of the Vinegar is this: ℞ Lupin. amar. pug. iij. Staph. agriae pug. ij. Let these be boised in a sufficient quan∣tity of Vinegar, with it moisten the whole Body. The Liniment is thus made: ℞ Staph. agr. part. 2. Sandarach. Gran. part. 1. salis pe∣trae partem dimidiam, postquam ista fuere infusa in Olei Raphani∣ni part. 2. & Aceti acerrimi part. 3. fiat linimentum, quod illinatur toti corpori. Paulus Aegineta af∣firms, that he found good success in the application of Oil and Vi∣negar.

As for Crab-lice, the waiting Maids of Venus rest contented with the application of an Unguent made of sweet Sope and Quick∣silver. If any one be desirous to know more of the mystery of these moveables. I will advise him to repair to the Pilgrims of the tribe of Gad, in the Summer time to be found by Hedges, and in Barns. If any be desirous to read a learned and Philosophical discourse of this Subject, let them have recourse to Minadous, lib. 2. c. 9. de turpitu∣dinibus.

CHAP. XXIII.

Of Ʋlcers of the Hairy Sealp.

SEeing I have set down the ge∣neral Doctrine of Ulcers, suf∣ficient to instruct any one, how every Ulcer in particular parts is to be cured; yet seeing some Ulcers in these parts require some special consideration, I will run thorow them, and not omit any thing which shall shall seem material. I will begin at the Ulcers of the Head, partly because some of them are incurable, and that it is neces∣sary that you know which be such; partly because it were a foul shame that Women should go beyond a Chirurgeon in this business, who confidently take upon them the cure of these Ulcers.

Ulcers of the Head are of two forts: for some are moist, and some are dry.

The moist are two, Achor and Favus. These dispositions of the Head are called by the Arabians, Sahafati, by Avicen. 7.4. tract. 3. c. 1. Serap. lib. 1. tract. 1. c. 3. A∣venzoar, lib. 1. tract. 1. c. 7. and they are nothing else but small ul∣cerate Tumors of the whole skin of the Head, caused by sharp ex∣crementitious Humors. All small Tumors, in Latine, Tubercula, by the Arabians are called Bothor. So then as the Cuticula, or the scarf∣skin, is the seat of Pthiriasis or the Lousie Malady, so the place of these griefs is the whole Skin, both the Cutioula, and the Cutis.

The material cause is a sharp ex∣crementitious Humor.

Now sharp Humors are of two sorts: for some are sharp of their own nature, as Choler: and some by accident. By accident, Humors may become sharp two manner of ways. First, by exustion and pu∣trefaction, as Bilis atra, and Me∣lancholy not natural but excre∣mentitious. Secondly, by admi∣stion of a sharp Humor. These ul∣cerous Tumors of the Head may be caused not only of simple sharp Hu∣mors of their own nature, but also of Humors made sharp by accident.

The Chymist will have a Vitri∣olick Salt to be the material cause of these Ulcers. See Joan. Faler. Chirurgiae Spagyricae, c. xv. Acber so called according to Alex. Tral∣lianus, lib. 1. c. 8. because from it a sanious Quittour called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 doth flow. Galen in his book of Tumors thus discourses of it; Acher also is a small Ʋlcer in the skin of the Head; you may think that it is caused of a salt and nitrous Phlegm; out of it flowes a sanious Matter, which is not altogether waterish, nor so viscous and thick as Honey, which appears in those Ʋleers

which are called Favi•• for in these there is a certain Tumor, and sun∣dry holes, out of which floweth Metter like unto Honey. He also in his Lib. 1. de compos. Pharma∣corum secund. loc. affirms the holes in this Tumor to be less than those are which are called Favi, and that out of them floweth a thin Humor with some clamminess. Oribas. lib. 4. ad Eunap. c. 4. thus speaks: Achor is seated in the skin of the Head, and hath but small boles, out of which a thin and rea∣sonable viscous Sanies doth flow. That affection which is called Favus is like to this; but it hath greater holes, which contain a matter like to Honey. Trallianus lib. 1. c. 9. subscribes to these in these words: We must know also that Cerion, (which is Favus in Latine) is a grief like to Achor, yet differing in bigness; for the holes out of which to Humor issues, represent the Ho∣ney-comb: wherefore by the Anci∣ents it was called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. The like hath Paulus Aegineta, lib. 3. c. 3.

So that Achor differs in three points from Favus: For First, in it the Tumor is less: Secondly, in it the holes are less: And Thirdly, the holes in a Favus are conspicu∣ous; but in Achor not. Aëtius lib. 6. c. 68. hath these words, Achor is seated in the skin of the Head, and hath but small holes, out of which a thin and viscous Sanies doth flow. The grief called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Fa∣vus, is like to this, wherein there are large holes, out of which issueth a Matter thick, like unto that which is contained in Honey-combs: where∣fore it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. As for Favus, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, Actuar. lib. 2. de dignosc. morb. c. 5. thus descri∣beth it: Small Ʋlcers arise in the Head thick, and red like little dugs, of which, that which is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 has but small holes, which sends out a clammy Sanies; but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Fa∣vus hath greater holes, which con∣tain an Himor like to Honey.

Out of these passages, which have been alledged out of those anci∣ent and learned Authors, these de∣scriptions of these two Ulcers may be gathered: Achor is an ulcerous Tumor of the skin of the Head, red and dug-like, having small holes, out of which issueth a thin and vis∣cous Sanies. Favus is the like Ʋl∣cer; yet wherein the holes are larger, containing an Humor in thickness resembling Honey, from whence it hath its name.

The primitive causes are in num∣ber two: corrupt nourishment and contagion: of the first I have dis∣coursed heretofore; of the second there is doubt to be made: for it may be daily seen, that these griefs are communicated by contact and frequent conversation.

The material cause is a sharp and fretting Humor, viscous in both these Ulcers, yet thinner in an Achor, than it is in that which is called Favus. Galen and Aegine••a in the places afore-cited, affirm it to be a salt and nitrous Phlegm. The Chymists affirm them to pro∣ceed from the vitriolick salt of the lesser world, or Man.

The cause conjunct is the same humor impacted in the skin of the Head.

The signs of these two are these: First, in both these Tumors there is an itching and a Tumor. Se∣condly, holes appear in both, but in an Achor less, in a Favus greater.

And although Lice are often seen in both; yet it is proper for Favus to have scales.

As for the Prognosticks receive these.

1. Young persons are most sub∣ject to these griefs, and amongst these Children most frequently: The causes of this may be two. First, because they may have recei∣ved many impurities in the Mothers womb, which when they are come to the light, the natural heat in∣creasing, they labour to expel; or it may happen by reason of the cor∣rupt Milk of the Nurse, who useth an ill Diet.

2. These Ulcers, if they have continued long, and have much al∣tered and corroded the Skin, when they are cured, they leave behind them baldness of the parts affect∣ed.

3. These griefs free Children from the Falling-sickness, according to Hippocrates, Lib. de sacro morbo, Avicen, lib. 1. 3. c. de Epilepsia. For the Humor which might cause this disease, is sent from the inner to the outer parts.

4. If these griefs be hereditary, they hardly can be cured: feeing this is true in all other Maladies, how much more certain, when to the Humor a malignity is joyned, as in these, as all must confess?

The means which are appoint∣ed for the cure of these griefs are of two forts, Physical and Chirur∣gical.

The Physical are three; A con∣venient order of Diet, Phlebotomy and Purgation.

As for the Diet, that is most fit which was set down in the Chapter delivered concerning the cure of the Leprosi•••• for by some this is accounted a particular Leprosie. All surfetting, strong and sweet Wines; sharp, salt, and fried Meats are to be shunned; and such as af∣ford a gross impure juice, as hard Eggs, Fishes living in muddy waters: Purslain, according to A∣venzoar, exceedingly furthers these griefs.

As for Phlebotomy, two Indica∣tions may induce you to use this: First, a Plethora of the whole bo∣dy: Secondly, much corrupt Blood setled in the vessels of the Head. If there be a fulness in the whole body, then it is fit to open the Me∣dians of both the Arms: it matters not much at which you begin: Let some daies pass between the open∣ing of the one and the other. Let the strength, age, time of the year, and the like circumstances shew you what quantity of Blood is to be drawn. If much impure Blood be congested in the Head, open the Cephalica, the Veins under the Tongue, the Venafrontis, yea, and the Arteries of the Temples; for they powerfully derive corrupt Blood and foul Spirits from the Head.

As for Purgation: if this must be general, then no Medicament is better than Confectio Hamech, or Hiera Diacolocynthidos, with Syrup of Roses solutive with Agarick in Betony, Eye-bright, Strawberry, Cowslip, or water of Black Cher∣ries. Receive this description as a pattern: ℞ Confect. Hamech, aut Hier. Diacolocynth. ʒ iiij. Pulv. sancti ℈ ij. Pulv. Holland. ℈ j. Sy∣rup. ros. solut. cum Agaric. ℥ j. Aq. praedict. ℥ iij. Misc ut fiat po∣tio. If the party affect Pills, these,

or such like you shall find very ef∣fectual: ℞ Pilul. aurear. & aggre∣gat. an ℈ j. Trochiscor. Alhand. pultorum gr. vij. spirit. Vitriol. gutt. 5. Formentur pilul. ʒ j. quae deau∣rentur. These purgative Medica∣ments are to be ministred once every week, until the party be cu∣red.

If you go about particularly to purge the Head, use Sternutato∣ries made of white Hellebore, and the best and strongest Tobacco, with a little of the powder of the seeds of sweet Majoran and Lavan∣der; or use Gargarisms: This wa∣ter drawn by a Quill into the No∣strils, which I will set down, is ve∣ry effectual: ℞ Pulv. Lap. mag∣••et. & calamin. an. ʒ ij. Virid. aeris & Euphorb. an gr. vj. Lap. hamatit. ʒ j. Succini albi ʒ ss. Aq. major. ℥ j. Misceantur. Let this Medicament be kept in a Glass, and drawn into the Nostrils every Morning, or every other Morning, at the Patient is able to endure.

The Chirurgical means are the artificial dressings of the Ulcers with local Medicaments. To at∣tain to this, two things are to be noted: The First is, what Medi∣taments are to be applied. As for the qualities of the Medicaments, they ought to be astringent and repelling: when I discoursed of Tumors, I set down an ample ca∣talogue of them, whither I send you.

But seeing some magistral com∣positions are required in the cure of these griefs, which often prove very obstinate and stubborn, I will not leave you unfurnished, but will deliver unto you some which are very effectual. The First is this of mine own: ℞ Butyri recent. lb ss. Axung. porc. ℥iiij. ol. Scor∣pion. ℥ij. Sulph. vivi. Helleb. alb. & nigri. Rad. Enul. pulveriz. an. ℥ss. Calcis vivae ʒiij. Mercur. cr••∣di ℥jss. Misc. ut fiat linimentum. The second is that of Gordonius, described by Renodaeus, Dispensa∣tor. med. l. 5. sect. 1. thus: ℞ El∣leb. alb. & nigr. Sulphur. viv. Au∣ripig. Litharg. Calc. viv. Alum. Gallar. Fulig. Ciner. Clavellat. an. ℥ ss;. Mercur. & virid. aer. an ʒij. pulveriz. & pulv. coq. in Succ. Bot∣rag. Scabios. Fumar. Oxylap. & Aceti, an. ℥ iij. ad Succorum con∣sumpt. deinde addantur Ol. veter. lb j, Picis liquid. ℥ ss. Cer. liquat. q. s. ut fiat linimentum. I have made trial of it, and have found it effectual. If you but consider the ingredients, you cannot but allow of it. The Author commends it in a scald Head, in all manner of Scabs, and in Malum mortuum it self.

When you are to apply these Unguents, which was the Second point of the Chirurgical means: First, you are to mark whether the roots of the Hairs be corrupt or no; for if the roots be corrupt, they must be pulled out: you shall know this by pulling out of a few, and observing the roots: for if the roots be thicker than ordinary, and moist, you may be assured that they are corrupt: they are to be pulled out in Children, that you may the bet∣ter apply your Topicks: In aged persons, not only to this end, but to open the Skin also, and to make it more perspirable, that the cor∣rupt Humors may be the more easily corrected and spent.

The Hairs are readily pulled out, by application of an Emplaster of

red Wax new made, drawn upon Leather, and lying to the Ulcers twelve hours. Secondly, above the Unguents you are to apply Sparadraps made only of Wax, to save the Unguents, and keep them to the Sores without much waste. Thirdly, you are to foment the Sores with red Wine, or Tanners woose, wherein Pomegranate Flow∣ers and Rinds, Myrtil-berries, and Sumach, with red Rose-leaves dri∣ed, have been infused in a Pot set by the fire-side, before you use the Unguents.

If Children be offered to you to be cured, you must have a care that you use gentle Medicaments to them, and that their Caps be so tied to their Heads, that they can∣not pull them off. For Children, receive these Topicks: the first shall be that of Minadous, in his Treatise De turpitudinibus, l. 2. c. 10. which he learned of a Wo∣man, who professed the cure of these Griess, ℞ Suiphur. vivi, Litharg. Argent. pu••verizat. an. ℥j. cum aceto ros. terantur ac levigen∣tur; tum add•• Terrae Lemniae pulv. ℥ss. Succi Plantag. & Limon. an. ℥ j. Ol. Lentisein, & Myrtini. an. ℥ j. Misc. ut siat linimentum. If Ulcers in Children prove obstinate, use this of mine: ℞ Pomati, Ʋn∣guent. Pop••. & Ʋng. albi caphu∣rat. an. ℥ j. Ol. de vitell. ovorum ℥ ss. Ol. Scorpion. ʒ ij. Mercur. crudi ℥ss. Misc. in Ʋnguentum. You may add ʒjss. of Alume cal∣cined and beat to powder, if you will have it stronger. These Ul∣cers are to be dressed once in twenty four hours, and towards night: for then the Medicaments will prove most effectual. If these Ulcers be very moist, and apt to be enflamed, by the application of an Unguent, then you are to use a Medicament made of abstersive Powders, which the Ancients cal∣led Smegmata contempered with Oxymel simplex: such are the Ellebores, Sulphur vivum, Staphe∣sager, the Pumice-stone, Cuttle∣bones, the Roots of Iris, and Ari∣stolochiarotunda, and Barley-meal: these being beat to powder, and by the admixtion of Oxymel simplex brought to the consistence of a li∣quid Electuary, must be applied to these Ulcers, and above the Medi∣cament a Cap of Ivy-leaves sowed together must be set.

Having spoken sufficiently of the two kinds of moist Ulcers, which are found in the head, Achor and Favus, it is time that we reason of the dry Ulcer of the head, which properly is called Tinea.

This is a crusty Ʋlcer, fretting the skin like a Moth (from whence it has its denomination) without any great store of moisture, cer∣rupting the roots of the hair, and sending out of the Skin a dry fillb which stinks: Videatur Hieron. Mercurial. c. 14. de morb. cutan. But Petrus Joan. Faber, in his Chi∣rurgia Spagrrica, thus describeth it, c. 15. de Tinea: It is a pecu∣liar phagedaenical and cancerous Ʋlcer of the Head, caused of the salt of the Vitriol of the Body of Man, which frets the Skin, and produces Scales, sometimes white, and sometimes yellow. The ma∣terial Cause, and the manner of the generation of it, he thus prose∣cutes. Vitriol in the great World, while it is calcined in the Fire, it is coagulate into a mass; either

white, if the calcination be but mo∣detate: or yellow, if the Fire be intreased. So in the little World (he meanrith the Body of Man) the Vitriol, when it is separated from the Balsam of the Body, it marches ••••ards the Skin of the Head, which it corrodes, and above it produces a crasty and scaly substance. Thus he: and I protest very probably.

And if it be true, which Galen ard Aegineta affirm of the mate∣rial Cause of Achor and Favus, that it is a sharp nitrous Phlegm, as hath been said, it may very pro∣bably be affirmed, that the mate∣rial Cause of Tinea is Phlegma vi∣niolatum, Phlegm endued with Vitriol, yet grosser than that which is the cause of Achor and Favus. Avicen, Mercurialis, and the rigid Galenists affirm the me∣lancholick Humor to be the mate∣rial Cause, accompanied with some sharp Humidity, which pricking the expulsive faculty, moves it to drive out the Humor to the Skin of the Head, and so to cause this Ul∣cer: but this opinion carries no shew of truth: For first, this Grief most commonly selses upon phleg∣matick persons; Secondly, it can∣not be apprehended, how Melan∣choly, either by the admixtion of any Humor, or by any degree of b••at in the Body of Man, being of it self black, can produce such a coloured Ulcer, to wit, white or yellowish.

The Primitive Causes are four; Error committed in the things not natural; Heredity; the corrupt Milk wherewith Children are fed; and Contagion and Infection.

The Signs are dry crusty Scales, most commonly white, sometimes yellowish, or of an ash-colour, or greenish, never black altoge∣ther.

As for the Presages: let this be the first.

1. This Ulcer is hard to be cured, because it is Malign and Ve∣nemous.

2. Inveterate Ulcers of this kind are more Malign, and harder to be cured, than those which have but lately invaded any per∣son.

3. When they are cured, they often leave behind them an Alo∣pecia or Ophiasis.

4. Sometimes they end in the Leprosie, and pedicular or lousie Disease.

5. If in a Tinea the Skin be hard, or of a shelly substance, and send out many Scales, and the Hairs fall by reason of the corruption of the Roots of them, it is of all others most hard to be cured.

6. If this Ulcer being once cured, return, pronounce it to be hard to cure: for there must be some Seed of this malign Malady firmly impressed in the Brain.

In the Cure of this Grief, two Indications offer themselves: The first is the removing of the Causes; but seeing the Causes are Primitive or Conjunct: The Primitive Causes are removed, by rightly ordering those things which are called Res non Naturales: The Cause con∣junct is taken away by Purgation and Phlebotomy. As for Phlebo∣tomy and Purgation, although that may suffice which I have delivered in setting down the healing of Ti∣nea

and Favus; yet let me insi∣nuate this unto you, that it is ex∣pedient that once a quarter you open the Cephalica two days be∣fore the full of the Moon, and that for Purgation you call Mer∣curial Medicaments to aid, when Vegetables will not serve. Parcy is of opinion, that the means which are used in curing of the French Pox are effectual in curing this Grief: use these then, Mer∣curius sublimatus duleis, Tur∣bith Mineral, Mercury precipitate dulcified, Mercury coagulate, and fixed by Gold and Silver.

The second Indication is the cure of the Ulcer it self by local means.

But before you go about to ap∣ply any local Medicaments, observe these passages: First, that you meddle not with tender Children, if they have a malign Tinea, until they be able to abide sharp Medica∣ments; for you shall vex both them and their Parents, and so shall procure a dismission to your selves. In the mean time you may use a Liniment made of the Oyl of Eggs, Crocus Martis, and calcined Harts-horn to the part, laying above it either a cap of Ivy-leaves or Colewort-leaves. Secondly, that you apply no repercussives to the Malady: for the Humor causing it, is so thick that it cannot be repel∣led. The third is that unto new Tinea's and mild, you apply mild∣der; but to those which are old and malign, sharper and fiercer Me∣dicaments.

In the Application of the To∣picks, three things are to be done: First you are to procure the se∣paration of the Scale: Secondly, you are to pull out the Hairs by the roots: Thirdly, you are to hed the Ulcer, You shall procure the fall of the Scales, by embrocating them with a Medicament made of the Oyl of Trotters, and the Mu∣cilages of the Root of Althaea, Linseed and Fenugreek, adding some Oyl of Arsenick or Mercury. How the Hair is to be plucked up by the root, I have shewed be∣fore. To cure the Sore, anoint it with Ʋnguent. Enulat. cum M••••∣cur. duplicato, and above it lay Emplastrum de ranis Vigonis 〈◊〉〈◊〉 Mercurio itidem duplicato. Or use this of learned Mercurialis: ℞ Succi Fumar. Scabios. Berag. Oxylapathi, aceti, an. ℥ iij. Ol. an∣tiq. lb j. coq. omnia ad 〈◊〉〈◊〉 consionptionem: postea insperge∣tur hi pulveres. ℞ Ʋtriusque Hel∣lebor. Sulphur. vivi. Chalcanthi; Auripigmenti, Cale. vivx, Alum. Gallar. an. ʒ ss. virid. aeris ʒ ij Pi∣cis liquid. ℥jss. Cerae, q. s. ut. si•••• Ceratum. Apply this to the part affected: while you are thus busi∣ed, purge the party every eighth day.

Galen and the Greek Physici∣ans, who wrote after, have made mention of other affections of the Scalp. And tho they be not of that moment, of which the other are, yet I thought good to ac∣quaint you with them, to the end you may take notice of them when they are named by Physici∣ans: These are four: 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 according to Trallia∣nus, lib. 1. c. 5. are small knobs, like unto pushes, which are above the Cuticula; but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 are superficial exulcerations of the

Skin, somewhat red and rough, ibid. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 according to Acti∣us, are certain small Ulcers, thick and reddish, like unto Teats, out of which flows an ichorous sub∣stance. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 seu Ficatio, is a suall Ulcer, round, somewhat red, sometimes painful, like unto a Fig, from whence it is so called, where∣in flesh buddeth: See Aegin. lib. 3. c. 3. Galen lib. 11. de simpl. med. facultatib. Celsus, lib. 6. c. 3. makes two sorts of it: The one hard and round, out of which a little glu∣tinous Matter issues, which is seen in the Beard: The other moist and unequal, out of which more comes, and hath an ill smell. This appears in the Hair of the Head.

The material Cause of these is pituitous Blood, but the Phlegm is saltish; when you go about to cure these, you must first make them level with the Skin by rub∣bing of them with the Caustick, or some Catheretical Powder. Af∣terward they are easily cured with Ʋnguentum Enulatum cum Mor∣curio simplice, and Emplastrum de ran••s of the same kind.

CHAP. XXIV.

Of Ʋlcers of the Ears, and Ophthalmia.

IN the foregoing Chapter, I set down the divers kinds of Ul∣cers of the hairy scalp, and the ••••re of them, Empirical, as well as Methodical. Now the course of proceeding requires, that I set down the Ulcers of the face. And feeing in it are placed the Instru∣ments of four special Senses, to wit, of Hearing, Seeing, Smelling and Tading; I will, according to these, teasure the diversities of the Ul∣cers of it: I will begin first with Ulcers of the Ear, because in it are seated the Instruments of Hear∣ing. And tho the sight be more te••essary, if we respect the plea∣s••e which redounds from behold∣ing the multiplicity of Objects, or the commodity which it affords, in espying things which might hurt the Body, that we may pre∣vent and shun them: yet Hearing excels it, for it is Disciplinae sensus, the Sense of Learning, according to Aristotle; and the entertainer of Faith; for Faith is bred by Hearing, according to the Apo∣stle. And as the Sight furthers Invention, so by the Hearing things invented are commumcated to o∣thers. Besides, by Hearing, the perturbations of the Mind, as An∣ger, Envy, Wondering, and such like, are most stirred up.

The Causes of Ulcers of the Ears, are either antecedent, or con∣junct.

The antecedent are either Ex∣ternal, or Internal.

The External Causes are two; to wit, a blow, or a fall: for by reason of either of both these the part may be contused, and from hence Quittour bred, which being stayed long within the cavities of the Ear, and having the Ear-wax, and other sharp Excrements of the Brain mingled with it, may erode the parts.

The Internal Cause is a sharp Humor sent from the Brain to the cavity of the Ear, which first of all causeth Apostema∣tion.

As for the Prognosticks, let this be the first: These Ulcers are not to be neglected, for if the Cure be prolonged, deafness may ensue.

2. If greater plenty of Matter issue out of the Ear than the part of its own self is likely to afford, then you may pronounce, that the greatest part of it is sent from the Brain ill affected.

3. If before Matter issue out of the Ear, the party feel pulsation, and great pain, you may pronounce, that a Phlegmon has invaded the part.

These Ulcers are either with∣out any excrescence of Flesh, or they have excrescence.

In the Cure of Ulcers of the Ears, it is requisite that ever be∣fore the Application of any local Medicaments the Head be purged by Cephalic Pills. Receive a De∣scription of those which are very essectual. ℞ Pilul. aggregat. au∣rear. an. ℈ j. Trochiscor. Alhandal. & diagrid. an. ℈ss. Spirit. Vitri••. q. s. ut formetur massula. Ex hi•• massa efformentur pilul. iv. De∣glutiat duas hor. v. Matut. se∣quente die sumat totidem. Ex∣actis iv. horis à sumptione pilula. rum capiat jusculum sine pane, prandeat autem horâ consuetà.

In the Application of local Me∣dicaments, these five Points are to be observed, according to Pe∣trus à Largeleta, Medicus Bene∣niensis.

1. Let no sharp Medicament be put into the Ear before the Body be well purged, lest we procure a Fever, and cause an attraction of Humors.

2. Let all Medicaments which are poured into the Ears be nei∣ther too hot, nor too cold; for they being (for the greatest part) framed of spermatick parts, they can hardly endure any excess in heat or cold.

3. Let all the Medicaments, that are to be poured into the Ear, be of a liquid substance, that they may enter the deeper.

4. After the party is dressed, let him or her lie upon the sound Ear, the ill affected Ear being stopped with Cotton or Wooll for a good space of time.

5. Let not fatty Medicaments be either poured, or injected into the Ear, for it is composed of sper∣matick parts, and such things will cause a fordid Ulcer.

The local Medicaments which are fit to be applied to Ulcers of the Ears, wherein there is no su∣perfluous Flesh, are these: Tro∣chisci Andronis in aceto sambucino

dissoluti: Haec autem est eorum descriptio: ℞ Balaust. Vitriol. A∣ristol. gallar. an. ʒ ij. Alum. Myrrh. ••••is Ammon. an. ʒ j. Excipiantur ••••nia Melicrato & fiant Tro∣••••sci. If you boil Crocus Mar∣••is in strong Wine Vinegar, till both come to the consistence of a Li••iment, it is a good Medicine. A Sinative Syrup made of the ••••erary Plants, as, Self-heal, 〈◊〉〈◊〉 Ladies-Mantle, Avens, Sanicle, Solomons-Seal, Plantain, Horse-tail, ••••row, Knotgrass, is very effectu∣••••, ••ot only in Ulcers of the Ears, ••••t in all hollow Ulcers; in like 〈◊〉〈◊〉 Balaustia, Pomegranate 〈◊〉〈◊〉, Sumach, Myrtle-berries, and ••••d Rose-leaves may be added. ••••ee Medicaments are sure, and 〈◊〉〈◊〉 has you may trust unto. In 〈◊〉〈◊〉 Winter time, if you boil a suf∣〈◊〉〈◊〉 quantity of dry Tobacco 〈◊〉〈◊〉 strong Ale, and boil the De∣••••cton strained, you shall have 〈◊〉〈◊〉 effectual Medicine, chiefly if ••••e Ulcer be foul, and have Worms; ••••th you may conjecture by in∣••eable itching, that they will 〈◊〉〈◊〉 by their motion. If these 〈◊〉〈◊〉 afford great store of Qui∣••••, they must be dressed every 〈◊〉〈◊〉 and twentieth hour; but if 〈◊〉〈◊〉 yield but little Matter, it will efficient to dress them once in 〈◊〉〈◊〉 days.

I•• falls out sometimes, if Ulcers 〈◊〉〈◊〉 Ears continue long, that ••••perfluous Flesh doth so increase 〈◊〉〈◊〉, that it sills up all the 〈◊〉〈◊〉 of the Ear, and causes deaf∣••••. This happened to a Gentle∣man of the Race of the Fit∣•••• in Chester, when I pra∣••••ed Physick and Chirurgery 〈◊〉〈◊〉.

I thus cured her: First, I mini∣stred unto her Cephalic Pills.

Secondly, This being done, I consumed the spongy Flesh by of∣ten Application of the Fistula Pow∣der, so that it did not touch any part in the Circumference. The Powder I set down in that Chap∣ter, wherein was set down the methodical cure of a Fistula.

Thirdly, I made Injection in∣to the Ear, made of two ounces of white Wine, one drachm of Ae∣gyptiacum, and half an ounce of Mel rosatum.

Last of all, I healed, and cica∣trized it with my vulnerary Syrup dissolved in Plantain-water.

If such an Accident come to your hands, proceed thus metho∣dically, and you shall undoubted∣ly bring to pass that which you shall go about. So much I thought good to deliver unto you concerning the dignotion, and cure of the Ulcers of the Ears, which often prove troublesome to the Patient and Chirurgeon, and loathsome to others, who ap∣proach to the party grieved, by reason of the evil smell, which the Ulcer sometimes sends forth.

Now I will come to the Ulcers of the Eyes, which ought exqui∣sitely to be handled, seeing the sense of Sight, the Instrument whereof is the Eye, is so pleasing and necessary to all Persons. Of all the Ulcers of the Eye, Fistula lachrymalis, or Aegylops, first of∣fers it self; but seeing I amply discoursed of it, when I delivered the Doctrine of Fistula's, I will re∣mit you to that Chapter.

In this my Discourse of the other

Ulcers of the Eyes I will first set down the general Doctrine of them, and then descend to the particular handling of each one of them.

In the general Doctrine, I will deliver three Things: to wit, their Causes: Secondly, the Prog∣nosticks; And thirdly, the Indica∣tions of curing them.

The Causes are either External, or Primitive, or Internal.

The external Causes are two; to wit, a Blow, or a Contusion by reason of a Fall.

The internal Causes are sharp and eroding Huniors.

As for the Prognosticks, let this be the first: Ulcers of the Eyes in Persons of an ill habit of Body, seldom end without leaving some scar, or infirmity.

2. For this Cause be wary what you promise; for bountiful pro∣mises can hardly be called back; and the Patients, being for the most part careful of the come∣liness of their parts, will un∣doubtedly expect the performance of them.

3. If Children, or disordered Persons, be presented to you to be cured of Ulcers in the Eyes, ever pronounce that the Cure will prove difficult and hard.

The methodical general inten∣tions of curing these Griefs are in number four; Good order of Diet, Phsebotomy, Purgation, and the Application of a Seton or Fon∣tanel, for Revulsion and derivation.

Having dispatched the three Points, which the general Do∣ctrine of Ulcers contains, I am come to set down how each one of these Ulcers in particular is to be cured.

As for the differences of them, they are either mild, or Malign. The mild are either of the Adna∣ta, or Coniunctiva, or Cornea, or Ʋvea. The Ulcers of Conjuncti••s most commonly proceed from Ophthalmia.

Of it then I will speak, because it most frequently seises upon the Eye: 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, but Lip∣pitudo in Latin, according to Ga∣len 4. de Medicam. local. cap. 4. is an inflammation of that Tuni∣cle of the Eye, which is called Adnata.

There be two kinds of it: One properly so called, proceeding from inward Causes.

The other proceeding from ex∣ternal Causes, which properly is cal∣led 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Perturbatio.

Again, Ophthalmia vera is ei∣ther more mild, when only the Conjunctiva is inflamed, or vehe∣ment, when as the Eye-lid besides, is red, turned up, and somewhat ulcerate.

This Grief is thus bred, accord∣ing to Cassius Medicus 66. Prebl. medic. When Humors are impact∣ed in the Eye, they stop the pas∣sages, and keep in the heat: the heat kept in, burns when it can∣not breath thorow, and inflames the Humors; and these inflamed, cause an Ophthalmia, and hinder the sight: for the Conjunctiva being inflamed, great pain and heat are felt in the Eye. They draw Hu∣mors into the Eye; the Humors at∣tracted being dispersed thorow the Eye, trouble the Humors and Spi∣rits; and these being troubled, of necessity hinder the sight. The Eyes are subject to these affecti∣ons, according to Arist. Probl. 7.

Sect. ultim. & Alex. 1 Probl. 35. because they are moist and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 very passible.

All sorts of Humors may cause a true Ophthalmia, but sundry ways; for hot Humors, as Blood and Choler of themselves cause great Inflammations; but small Inflammations may be caused of cold Humors mixt with hot.

The primitive causes are the heat of the Sun, pain of the Head, a burn∣ing Fever, Dust, Smoak, great Cold binding the part, blows upon the Head, blustering Winds, Ebri∣ety, Venery, and according to Pau∣lis, Oil. It brings an Ophthal∣nia, because it cleaves fast to the Tunicles, and so stops the Pores, and so the heat is kept in, and inflames the Eye.

Hippocrat. lib. de aer. aquis & lxis, writes, that they which in∣habit the South, and hot regions, are easily assaulted by such diseases, and easily cured: and on the con∣trary, that they who dwell in the Northern parts are not so easily tainted with this grief, but are more hardly cured. Avicen yields the reasons for this, saying, that they who dwell under a hot climate, have their Heads full of vapours and Humors, which being resolved by the hot air, fall to the Eyes, and being there staied, cause an Inflam∣mation, which afterward is easily cured. First, because their Bodies are more perspirable. Secondly, because they have still a loose Belly. But in cold regions, thô they have plenty of Humors in their Heads, yet they are congealed, and do not so promptly flow to the Eyes; but if they come to the Eyes, and be there impacted, they cannot so rea∣dily be discussed, by reason of the thickness of the Skin, and con∣striction of the Pores. So inflam∣mations of the Eyes happen more frequently in the Summer to those who have their Heads stuffed with Vapours and Humors, the heat colliquating them, and turning them to the Eyes. In like manner in those diseases, wherein there is an ebullition of the Blood, Ophthal∣miae are forerunners, as in the small Pox, Measles, and sometimes the Plague, hot and sharp vapours be∣ing carried up to the Head.

As for the signs of an Ophthal∣mia; they are general, or particu∣lar.

The general are these: accord∣ing to Galen. 4. de medic. loc. 4. & lib. de totius morbi tempor. & Rha∣zes lib. 9. ad Almans. a swelling of the Eye, a redness of it, pain some∣times pricking, sometimes corro∣sive, sometimes tensive, flowing of tears.

The particular signs of a true Ophthalmia are these: a great tu∣mor and pain, horrible heat, turn∣ing up of the Eye-lids, which shew a great Inflammation.

These accidents, in a more re∣miss degree, shew a milder Oph∣thalmia: if the Humor proceed from the Stomach, then the par∣ty will desire to vomit; if from the Head, the Headach vexeth him and seeing the Humor may be sent both from the vessels within, and without the Cranium, if the veins of the Forehead, and the rest of th•• Face be full, if the Arteries of th•• Temples beat, and if the Eye-lids be heavy, then the Humor come from the vessels without the Crani∣um; but if none of these symp∣tomes

appear, and yet the party of∣ten sneezes, and finds itching in the Nose, the Humor or Vapour is sent from the vessels within the Cra∣nium.

Signs of the Humors sent are these: If Blood be it, the Eyes and Face will be red, the Veins will be full, the pain will be gravative, the matter that flows will not be very sharp. If it be a vapour or flatu∣osity, there will be a singing in the Ears, and a tensive pain. If it be pituitous Blood, the Tumor will not be very red, but whitish, less heat and pain, great heaviness of the Eyes and Eye-lids, the Eye-lids in the night time will be glued together.

This happens for three causes: First, because in the day-time the Eye is still in motion, and suffers not the Humor to cleave to the Eye-lids.

Secondly, because moisture is multiplied in the night-time.

Thirdly, because the Humor concocts in the night-time, grows thick, and so is more apt to cleave to the Eye-lids, they then being immoveable. If Choler be the cause, there will be but little red∣ness mingled with yellowness; the Humor which runs from the Eyes will be thin, the pain will be pinch∣ing. If flatuosity or a vapour, then none of these signs will ap∣pear, yet the Eyes will be some∣what swelled, and a noise will be noted in the Ears, and no humidi∣ty will flow from it.

As for the predictions: 1. An Inflammation coming of external causes, is more easily cured than that which comes of an inward.

2. When a continual pain of th•• Head is joyned with an Ophthalma•• and continues long, blindness mo•••• commonly ensues.

3. If in an Inflanimation of the Eye, the Humor which flows from it be thick, it will not long conti∣nue: for it betokens the benignity of the Humor, and strength 〈◊〉〈◊〉 Nature.

4. If a mild Fever, or a fla•• seize upon one troubled with an Ophthalmia, it ceases within a short time, the Humor being discussed by the first, and revelled by the se∣cond.

5. If the Tumor of the Eye be great, the pain vehement, and the matter which flows from the Eye be copious and thin, the Ophthal∣mia is like to continue long; but short, if signs contrary to these appear. Thus much then concern∣ing the causes, signs, and Prog∣nosticks of an Ophthalmia vera shall suffice.

Now it remains, that we speak a word or two of Ophthalmia sp••∣ria a Bastard Ophthalmia: This is caused only by external means, whereof we have spoken sufficient∣ly before, when we set down the primitive causes of Ophthalmia ve∣ra. And if the accidents, as in∣flammation, redness and the like, be but moderate, it will easily cease, and without great difficulty, by removing the ex∣trinsecal causes, and applying cooling waters, as Rose-water, or Plantain-water, with Camphore.

In the cure of Ophthalmia vera, some Precepts are to be observed before the application of local Me∣dicaments.

1. The party must eat and drink sparingly, abstain from Venery, and keep the Body soluble.

2. Let the party be kept in a dark room, and let his sleep be moderate; because immoderate sleep draws vapours to the Head.

3. Let the objects, which the party beholds, be green, blew, or back.

4. Let anger, serious cogitati∣ons, and motion be shunned.

5. If the Hair be too long and heavy, let it be polled.

6. Let the Drink be small Beer, or Barley-water, wherein Fennel-seeds, Coriander-seeds, and Eye-bright have been boiled.

7. Let Meats salt, vaporous, sharp, and hard of digestion be shun∣••ed.

8. If the party be strong, open 〈◊〉〈◊〉 the Median, then the Cepha∣••••••, then the Vena frontis, and those behind the Ears; and in the Temples, if the Inflammation be great: if circumstances will not admit Phlebotomy, apply Ventoses to the Shoulders, and Thighs; and Frictions and Ligatures to the Arms and Legs.

9. Purge according to the Hu∣nor offending, as Choler with Pi∣••••••cechiae, or Electuar. de succo ros. Folegm with Diaturbith cum aga∣••••, or Diaphoenicum, or Diacar∣••••mum.

10. If you use Fomentations, these five things are to be obser∣ved.

1. That the Body be clean, other∣wise the matter (being scattered by fomentation) will run to the Eyes.

2. The Matter must be dis∣charged into the Eye, and not in motion.

3. That it be used when the Matter is thick, for it attenuates it.

4. That it be used in the decli∣nation of the grief.

5. No astringent Fomentations are to be used; for they wedge in the Humor, and exasperate the grief.

11. To stay the fluxion, you are to apply a strong defensative to the Forehead and Temples.

12. Opiate Medicaments not well corrected, are not to be used; for if they be but weak, they may pro∣cure a little case for the time, but the fluxion and pain will return more fiercly: if they be strong, they may cause inevitable blindess, by hindring the influence of the visive spirits.

The local Medicaments must have three qualities: they must be somewhat astringent, cooling, and anodyne; such are the water of the white of an Egg, the muci∣lage of Fenugreek and Quince-seeds drawn with Rose and Plan∣tain-water, with a little Saffron, Trochisci albi Rhasis sine opio (un∣less the pain be very great) dissol∣ved in Violet, or Succory, or Eye-bright water. What I have spoken, I would have you to understand it of an ordinary Ophthalmia.

If you perceive it to be Venereal, or a symptome of the Pox; you must first cure the Disease, and then the accident will cease. If af∣ter the using of these means, the Ophthalmia prove rebellious, you must blister the Neck.

If this will not serve, you must apply a Seton, or make a Fonta∣nel in the Neck or Arm. But a Seton is most effectual: For First, by reason of the great pain which it brings, it makes a stronger re∣vulsion: Secondly, it discharges the Humor more plentifully, it ha∣ving two Orifices; but a Fonta∣nel only one.

Hildanus Obs. 16. Cent. 5. gives us an eminent Instance of an Oph∣thalmia, cured by him in a curious Limner and Graver above Seventy years old.

He was (says he) af∣flicted with a grievous Ophthal∣mia in his Left Eye. The Inflam∣mation which was high, had not only seized the Eye and Eye-lids, but halfe the Face. Besides, there arose a Protuberance as big as a Bean, in the Cornea, towards the greater corner, over against the Iris. His whole Head aked; but the pain was most violent, acute and pungent about the tubercle. Wherefore to hinder the afflux of Humors thither, having order∣ed him a cooling and spare Diet, I gave him the following Pills, ℞ mass. Pil. aur. ℈ i. Luc. major. ℈ ij. trech. Alhand. Didgrid. an. gr. iij. ol. faenic. gutt. vi. cum syr. res. f. Pilulae vij. involvantur pulvere cinnamomi. After I had purged him, I bled him in the Left Arm, and dropt the following Collyrium into his Eye. Aq. ros. plantag. fra∣gar. an. ℥ ij. sem. cyd. contus. fae∣nugr. an. ℈ j. M. maneant{que} in infusione horas 4. in expressierae dissolve Tutiae prepar. CC. preparan. ʒ i. Caphur. ℈ss. M. f. collyrium, instilletur & applicetur calid•• quater ant quinquies in die. When the Inflammation was laid, in∣stead of Strawberry and Plantain-water, I put Fennel and Eye-bright-water into the Collyrium. The next day after his Bleeding, I ordered Ventoses with much flame to be applyed. Then I gave him the Pills again, and breathed a Vein a second time, and applied Ventoses likewise. By these means the Tubercle wasted by little and little, the Eye grew well, and his Sight was restored, and grew more acute, especially in his Left Eye, than before. For whereas before this illness he had used Spectacles above Twenty years, he was then able to Read and Paint without Spectacles.

CHAP. XXV.

Of the rest of the Ʋlcers of the Eye.

NOw Order requires, that I should set down the Do∣ctrine touching the Ulcers of the Cornea.

These are either supersicial, or deep, corroding the substance of the Cornea.

The superficial are four, where∣of the First is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which signifies a troubling of the Air: and it is a very thin, and superficiary ••••ulceration, of a blush colour, resembling a dark air, and pos∣sessing the greatest part of the black of the Eye: the Latines call i•• Caligo, a Mist in English.

The Second is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i•• Latine Nubecula: this is deeper than Achlys or Caligo, yet narrow∣er and whiter.

The Third is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, it 〈◊〉〈◊〉 an Ulcer which grows about the circle Iris, possessing part of the white, and part of the black of the Eye: without the Iris it ap∣pears red, but within the Iris white.

The Fourth superficiary Ulcer is called by Aetius 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: this is a superficiary Ulcer also, which makes the Cornea rugged by ero∣sion, and to be of an Ash-colour, resembling a lock of Wooll, for which cause it is called of Avicen, the woolly Ulcer.

Of the deeper Ulcers of Cornea there are three sorts.

The First is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and it is an Ulcer of the Cornea, hol∣low, narrow, without filth, like to a round puncture: In Latine it is called Fossula; for 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek signifies Fovea, a pit.

The Second is called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and it differs from s••••∣••etor, in that it is wider, thô not so deep.

The Third, of the deeper Ul∣cers of the Cornea, is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Aetius; by Scribonius Largus ustio; and by others inustio, it is an impure, and crusty Ulcer of Cornea; thorow which some∣times the Humors of the Eye come out, when it is made clean by cleansing Medicaments applied.

These Ulcers of the Cornea of the Eye, whether they be supersi∣ciary or deep, are not to be slight∣ed, but carefully to be dressed; but those especially, which have deeply seized upon the substance of the Membrane, lest they corrode thorow the whole Membrane, and so the Humors issuing out, the Eye sink, and both deformity and inevitable blindess ensue.

For the material cause of these Ulcers is a salt and nitrous Humor, as Paulus Aegineta speaks, Lib. 3. c. 22.

If the Cornea be quite thorow corroded, then the Ʋvea falleth down, this disease of Ʋvea is cal∣led 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 procidentia.

Of this disease there are four kinds.

If it fall out but very little, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, caput muscae, the head of a Flie, and of Avicen formicalis, like the head of a Pis∣mire.

If it fall down yet more, and equal a Grape in bigness, it is cal∣led 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋvea, or Ʋvatio.

If it fall down yet further, and hang out like a little Apple; it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 malum the Apple-like Rupture.

But if the Ʋvea fall down and grow hard, brawny and flat, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 clavus, the nail-like Rupture. All these four kinds of the Rupture of the Ʋvea for the most part are uncurable: only the Apple-like, and Grape-like Rup∣ture, if the roots be small, and the party be of a good constitution, may be by binding cured, to take away and mitigate the deformity of the Eye. For if the sight be taken away before by these breach∣es of the Ʋvea, Deligations will not restore the sight; which must be intimated to the party before you go about these operations, that he think not himself deluded, having hoped for the recovery of his sight, as the reward of his patience, in enduring the manual operations.

Seeing all Ulcers of the Eyes ar∣gue a cacochymical Body (for they are caused of sharp corroding Hu∣mors) the constitution of the Bo∣dy must be altered, not suddain∣ly labouring to remove the whole cause at once: but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and that is, according to Gal. 9. meth. medend. when by little and little that is discharged, which is faulty, that that which is good may succeed in its place. Where∣fore you are to shun all strong Cathartical means, lest they pro∣cure Vomiting, which is very pre∣judicial to weak Eyes, such as are those which are ulcerate. The Body having been gently purged, Nature very often corrects the re∣sidue of the Humor, by turning that part which is benign into nourishment, and expelling that which is superfluous, by Stool, Urine and Sweat. Those twelve Observations which I set down in the delivery of the Cure of an Ophthalmia vera, I commend un∣to you in the curing of Ulcers of the Eyes also, which need not any repetition.

To set down all the local Me∣dicantents, which are delivered by the Ancients in curing Ulcers of the Eyes, were a fruitless la∣bour.

Nevertheless, I will furnish you with a few approved Medicaments. Then in superficial Ulcers of Cer∣nea, use these, 1. ℞ Succi n••t. Foenicul. Chelidon. Euphragiae an. ℥ ij. Vini Albi potentis ℥ iij. Sa••∣char. Cand. ʒ iij. Aloes, Sarcoce••••. an. ℥ss. Fellis Capon. ʒ ij. Distil these, and use the Water.

2. ℞ Aq. Chelidon. & rate an. ℥jss. aq. ros. ℥ j. Croci metall. ʒ j. siat infusio.

3. ℞ Sucei Foenicul. rutae an. ℥ iij. Mell. optimi ℥ ij. Exponan∣tur soli incliesa vitro stricti orifi∣cii probè obturato per mensem tem∣p••••e aestivo. Ʋtendum hoc Medi∣camento, abjectis foecibus.

4. ℞ Axung. Porci, aq. ros. a∣blatae ʒ ij. Caphurae ℈ss. Tutiae ••••epar. gr. x. Aloes pulv. ℈ j. Sac∣dati Cand. gr. xvj. siat collyrium.

In deep Ulcers of the Cornea T••nica use this of Heurnius, which he bought at a dear rate, and which he hath set down Meth. ad Praxin, lib. 1. pag. 106. ℞ Cala∣reinar. ter usti ac bis in vini aceto ••••tincti ℈ j. Myrrhae, plumbi usti 〈◊〉〈◊〉 ••ti an. ℈ss. Croci gr. v. opti gr. ij. aeris usti ℈ iv. decocti Foe∣••••gneci ℥ j. terantur omnia super lapi••••m pictorum, ac fiat collyri∣um. Having first made clean the Eyes with a Sponge dipped in the macilage of Fenugreek and Lin-seed, dress the ulcerate Eyes twice in the Forenoon, and as often in the Afternoon.

C••llyrium de plumbo described by R••••••••••us, set down by him in Impensatorio Medico, lib. 5. cap. 11. d••collyriis, is an effectual Me∣••••••ment: ℞ Plumbi usti, Anti∣••••••. Tutiae lotae, aeris usti, pummi Ar••••ici, tragacanthi an. ℥ j. opii ʒss. fiat ex omnibus pulvis, ex quo 〈◊〉〈◊〉 Aqua Rosacea formentur Tro∣••••ci: dissolve one of them in Fantain and Purselain Water, and dress the Eye with this Medica∣ment. When you are dressing Ulcers of the Eyes, minister once a Week a purging Medicament. If you use Pills, minister (according to the advice of the Arabians) Pi∣••••e Aloephanginae, or Pil. lucis majores & minores, or de agarico, minister a drachm made up into four Pills, which are to be cover∣ed with Silver Foil: or use this Pill. ℞ Specier. hier. ℥ss. Diagri∣dii ʒ ij. Trochiscor. Alhandal. ʒ v. Cum Syrupo Augustano fiat massa. One Pill of this composition weighing twenty grains, will purge sufficiently. If the party cannot swallow Pills, minister to him this Portion: ℞ Caryocostin. & Ele∣ctuar. lenitiv. an. ʒ iij. Pulv sanct. ℈ iij. Pulv. Holland. ℈ j. Syrup. Ros. solutiv. cum Agarico ʒ vj. aq. Beton. Foenicul. aut Euphrag. ℥ iij. Misc. ut fiat potio.

To these Medicaments both in∣ward and outward, the right use of those things which are called Non naturalia must be joyned, or else the Cure will be protracted and prolonged.

The Air then must be tempe∣rate in its first qualities, as being neither too hot, nor too cold, too moist, nor too dry. It is not good to abide in the heat of the Sun, nor the Beams of the Moon, nor any open Air: the party is to shun Southern and Northern Winds: for the Southern Wind, according to Hippocrates, troubles the Sight, causes hardness of hearing, an hea∣vy Head, dull Senses, a lazy Bo∣dy, it begets gross Spirits. And the Northern Wind is very sharp, and therefore it stings and pricks the Eyes; neither must the Air be too lightsome: for it scatters the Spirits.

The Bread must be made of clean Wheat, well leavened, and somewhat salted, wherein may be put Fenil, Anise, and Cori∣ander Seeds, for unleavened Bread

is accompted hurtful to the Eyes.

As for fresh Meats, these are good: Chicken, Capon, Hen, Par∣tridge, Pheasant, Pigeons, Larks; the Pie, the Swallow, and Goose∣flesh are accounted good for the Sight.

As for Fish, Trouts, Roches, Perches and Pickerels, of fresh∣water Fish, may for variety of Diet be admitted: of Salt-water Fishes, Whiting-mops, and Smelts are accounted the best. Baked and fried Meats, strong Spices, as Pepper, Ginger, Mustard, and Roots of Horse-radish are not to be used. To Meats minister this composition instead of Salt: ℞ Euphragiae, Semin. Poenicul. an. ʒ j. Cinnamomi & Macis, an. ℈ j. Salis communis ℥ j. siat ex omnibus pulvis. All bulbous Roots, as Onions and Garlick; and Pulses, as Pease and Beans, are to be re∣jected; as also moist and raw Fruits: Stewed Prunes, and Pears or Quinces preserved, are permit∣ted after Meat, to stay the ascend∣ing of Vapors to the Head, and Marmalade of Quinces, with some Aniseeds, Fenilseeds, and Corian∣derseed Comfits.

As for Drink, no Liquor is more convenient than six shillings Beer, neither too new, nor too stale, having had a bag of Boulting∣cloth hung in it, filled with Eye∣bright, Fenilseeds, Betony, Rose∣mary, sweet Majoran, and Sage.

If the party hath been accu∣stomed to Wine, let him use some small Wine, not sharp or vapo∣rous, wherewith some good Spring Water must be mingled; and Bo∣rage-flowers, and Burnet-leaves are to be put into the Cup: and this will serve for two purposes: for the colour will comfort the Eyes, and the Herbs by their property will re∣press the vaporousness of the Wine. The less one doth drink, the better will the Patient be, and the sooner cured. A small kind of Meath made after this manner will not be amiss. ℞ Aq. font. lb xv. Mellis optimi lb j. Foenicul. Euphrag. an. man. j. Macis ʒ j. Coq. ad tatiae partis consumptionem, semper spa∣mam auferendo, ac tandem colands. Immoderate sleep fills the Head full of Vapors, and immoderate watching spends the Spirits, cools the Brain, and hinders the Sight. It is good to go to Bed three or four hours after Supper, and to rise early, and to walk softly up and down the Chamber, to comb the Head, pick the Ears, and to emp∣ty the Excrements. Much read∣ing is not good, especially after Meals, and weeping is very hurt∣ful.

The Body must still be kept so∣luble with lenitive Clysters of Dia∣cathol. Syrup of Althaea, and Oyl of Lilies dissolved in the ordinary Decoction appointed for Clysters. Take this for a pattern, ℞ Dia∣cathol. ℥jss. Syrupi de Althaea ℥ ij. Ol. Lil. Albor. ℥ ij. Decoct. com∣munis pro clysterib. ℥ viij. Misc••••t siat clyster. If the party will not admit a Clyster, then mingle half an ounce of Electuar. lenititum, in seven spoonfuls of Broth made of a Chicken. After Meals use this or the like digestive Powder: ℞ Semin. Foenicul. & Coriand. Saccharo semel incrustatorum, an. ℥ j. Cort. Citri, & Myrebalan. Kebul. condit. an. ʒ iij. Euphrag.

siccat. ʒ j. Macis ʒ j. Sacchari Resat. Tabellat. ℥jss. fiat ex omni∣bus pulvis: Dos. cochl. j. à singulis pastibus.

Hitherto I have delivered unto you the differences of mild Ulcers; now I will treat of the divers kinds of malign Ulcers of the Eyes. These are either not contagious, or contagious. The not contagious are two; Nome, and Ʋlcera cancrosa. The contagious are three; Carbun∣c••lesa, Venerea, Morbillosa. Of these in order I will discourse briefly.

Nimae or Ʋlcera depascentia are malign Ulcers, which sometimes begin at the corners of the Eyes, sometimes at the white, and some∣times seise upon the horny Mem∣brane. In corrupt Bodies they fret exceedingly, and go forward in such sort, that oftentimes they consume the parts adjacent, as the Musoles and Lids of the Eye: from them flows a stinking slimy Mat∣ter, the pain is grievous, and the diseased party has an accidental Fever.

This Ulcer is dangerous, and seldom cured without deformity and loss of the Sight: wherefore my counsel is, that you foretel the darger, if such an Ulcer be offer∣ed to you to be cured.

Only I will acquaint you with some local means, having spoken sufficiently of the general Intenti∣ers. Apply then to the Ulcer the Juice of Plantain, Horse-tail, Knot∣grass, Night-shade, and Yarrow chrified with Hony, and the whites of Eggs: Dress these Ulcers Morning and Evening dropping a few drops into the affected Eye, covering the Eye with a Cata∣plasm made of Ʋnguentum rosa∣tum, the pulp of a Quince boiled, and some Oyl of Poppies. If these Ulcers prove very malign and cor∣roding, you may correct them by instilling some Oyl of Vitriol, or Sulphur, mingled with Plantain-water, taking only the fourth part of it. To asswage the pain, use this Cataplasm; ℞ Mala Cydonia numero 2. Sedi major. & Solani bortens. ana man. ij. coq. in s. q. Lact. muliebr. vacc. capr. aut a∣sin. addatur Croci scrup. j. ac fiat Cataplasma.

Ʋlcus crancrosum, a cancerous Ulcer follows; which the Chymists pronounce to be caused of an Ar∣senical Salt, and it is like to be so: for in this Ulcer, besides corrosion, there is a septick or putrefactive quality. It begins in the black of the Eye.

In it the black and white of the Eye are reddish, Lines seem to be sent from the Black to the Tem∣ples: the Patient refuses Food, by reason of the exceeding great pain, a thin darkish and sharp Humor flows from it, and it is exasperated, by reason of the application of sharp Medicaments.

You can only promise a palliative Cure of this malign Ulcer, by the Application of anodyne means, af∣ter you have used the general In∣dications before specified. Paulus Aeginet. lib. 3. c. 22. affirms it to be an uncurable Evil. He counsels to feed the Patlent with Milk, Panado's, and other Meats of a good Juice, and of an easie con∣coction.

Milde Eye-salves are also to be applied, as this: ℞ Mucilag. Se∣min. Cydon. & Paliur. Aq. ros.

extract. ℥ j. Trochisc. albor. Rhas. cum opio ʒ j. fiat collyrium, quod tepidum applicetur. Renovetur ma∣ne & vesperi. Desuper applicetur hoc Cataplasma. ℞ Poma cocta num. 3. Cassiae recent. extract. ℥ss. Croci ℈ j. Lactis mulieb. ℥ j. Al∣bumen ovi unius: siat Cataplasma. So much then concerning the handling of malign Ulcers of the Eyes, wherein there is no contagion.

Ulcers which are caused of con∣tagious Diseases follow, as the Small Pox, the French Pox, and the Plague: If you fear that the Small Pox are like to cause Ulcers in the Eyes (which you shall con∣jecture, if there was an Inflamma∣tion in the Eyes, before any did appear in the Body; if the party feel pain in the Eyes, and cannot open the Eye-lids) then are you to apply gentle Fomentations to the Eyes, and the Breast-milk of a sound Woman, having a little Saf∣fron mingled with it; or the Mucilage of Fenugreek, Lin-seed and Quince-seeds, drawn with Rose-water, having some Safforn added to it. You shall not need to look for any other Medicaments in these Ulcers.

If the Ulcers be Venereal, caused of the great Pox: then with all expedition are you to go about the cure of the main Grief, lest blind∣ness quickly ensue, and then to la∣bour to cure the Ulcers of the Eyes, which are but only symp∣toms of the Disease, Renod. in dispensat. med. lib. 5. c. 11. sets down an excellent Eye-salve for this purpose, ascribed to Lanfrank by the Neotericks, which he could not find in the Works of Lan∣frank (as he confesses) so that by all likelyhood it is a magistral re∣ceit. The description of it is this: ℞ Vini albi lb. j. aq. Plantag. & rosarum an. ℥ iij. Auripigment. ʒ ii. Virid. aer. ʒ j. Aloes, Myrrh. an. scrup. j. Terantur ista subtilissime, & siat collyrium.

I will add a little of the Ulcer of the Eye caused of a Pestilential Carbo, or Anthrax, and so end. In this Case, first there arises a small Tumor in the Eye, hot, hard, painful, and contagious, caused of a thick, burned and venomous Humor: It is hot, the unnatural heat causing an ebullition of the Humor. It is hard, because the heat burns the Humor: It is con∣tagious, by reason of the vene∣mous Humor which causeth it: when it yields Matter, it stinks by reason of the putrefaction of it.

It is accompanied with watching, drought, internal heat, raving, and the Urine is sometimes of a fiery colour, sometimes thick and troubled.

If these Symptoms appear, then are you first of all to minister such Antidotes as are fit for a pestilen∣tial Fever, as Theriac. Andromachi, Antidotus de sanguinibus, Electu∣arium de ovo, and such like, to tame the venenosity of the Matter, and then to proceed to the curing of it. If you perceive a Pustule in the top of it, open it with a Lan∣cet: then to extinguish the immo∣derate heat, soment it with Aqua spermatis ranarum, wherein Cham∣phore is dissolved, and lay a Cloth moistned in the same, to the Eye: above this Cloath apply a Cata∣plasm made of Goats, or Cows Milk, Bread made of Bran, and the Juice of Plantain: when the

crust is fallen, mundifie and fill up the Ulcer, by applying Mel rosatum dissolved in Plantain-water.

Last of all, skin the Ulcer with this Medicament: ℞ Vin. albi lb. j. tut. praep. Aloes, an. ℥ss. Sac∣••har. cand. ℥ ij. Haec inclusa vitro ••uctiorificii probe obturato, expo∣••••••tur soli omnibus diebus cani∣••duibus. Guilmeau in the fifth Section, c. 11. of his Treatise of the Diseases the Eye, confesses this Salve to have been given and communi∣cated to him, as an undoubted ex∣periment, in skinning the Ulcers of the Eyes, and procuring a come∣ly Scar in the Cornea.

If it fall out at any time (as it often does by the negligence and ••••••ki fulness of the Chirurgeon) that the Eye-lids grow to the ex∣ternal Membranes of the Eye, to ••it, the Conjunctiva and Cornea: when he has not a care in the time of curing to keep them asunder, then the natural motion of the parts of the Eye is hindred, a de∣formity ensues, and the Sight is much diminished.

It is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, 〈◊〉〈◊〉 Galen. lib. de desinit. medicis, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 according to Aegi∣net. lib. 4. cap. 55. and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; In Latin Coalitus, or In∣tik••tio palpebrarum, in English the Cleaving or Growing together of the Eye-lids, Galen. then in 〈◊〉〈◊〉 medic. c. 15. thus speaks of 〈◊〉〈◊〉. The Eye-lids grow to the 〈◊〉〈◊〉 of the Eye (he means the C••••junctiva, or the black, which be names Cornea elsewhere.) If they cleave to the black, the Sight 〈◊〉〈◊〉 altogether hindred; but if they cleare to the white only, the Sight is less impaired. Celsus lib. 7. cap. 7. thus discourses of this Disease:

Sometimes one of the Eye-lids grows to the other, so that the Eye cannot be opened: unto which Grief this inconvenience is often annexed, that the Eye-lids cleave to the white, as when a Sore in each, or both, has been negligently cured: for he has joyned them together in curing, which ought to have been kept asunder: both these Griefs the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

Out of these words of Galen, and Celsus, we may gather, that there are two kinds of this Grief. The one is, when the Eye-lids cleave one to another: The other is, when the Eye-lids grow to the Conjunctiva, and Cornea. Guil∣meau notes that the first happens from the Nativity, as the Matrix is often shut up. This I will leave to that part of Chirurgery, called by me 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 which teaches to disjoyn and separate those parts which are unnaturally united. As for the second, seeing it is an Accident which hath happened to an Ulcer of the Eye negligently cured, I am not to let it pass.

I marvel that Guilmeau, in the Book and Chapter aforenamed, pronounces out of Celsus and Mesue (not noting the places of the Authors) this Grief to be uncura∣ble: Seeing not only Celsus and Aegineta, but he himself sets down the manner of curing it, which he might well have spared, if he thought his labour lost. Yea, Fa∣bric. ab aq. pend. operat. chirurg. part. 1. c. 8. who in all Chirurgical Operations is very wary, injects no such scruple; but boldly pro∣ceeds in the Cure: you are not to

be daunted then by his discoura∣ging. If the Eye-lid cleave to the Cornea, against the Apple of the Eye, the Sight never will be per∣fect; because the Scar will hin∣der the passing of the Species visibiles to the crystalline Hu∣mor.

As for the manner of Cure; it is performed by Manuul Operati∣on only: in this Operation go on thus: Having placed the Patient in that posture as you shall think most convenient for your hand, lift up the Eye-lid, which cleaves to the Membranes, and put be∣tween the Eye-lids and the Mem∣branes, in that part which is free (for never doth the Eye-lid whol∣ly cleave to the Tunicles, as Aq. pendent. well observes) an Instru∣ment, like to that which you call the capital Instrument, the Gib∣bous or arched part being blunt, and having a back; but the belly being as sharp as a Razor: when you have compassed all the part united, having turned the back of the Instrument towards the Eye∣lid, cunningly separate the parts united, neither offending the Eye-lid, nor any Tunicle of the Eye. But if either of these must be touched, it is best that the Eye-lid, suffer, than any Tunicle: for it may more securely suffer the in∣jury. When this Operation is per∣formed, if you be not vigilant in keeping the parts separate afunder, they will easily unite again, as Celsus notes.

In setting down the Operations, Celsus calls the Instrument Specil∣lum. As for that Instrument, which goes commonly amongst the Anci∣ents under the name of Specillion; it did absolutely represent your or∣dinary Spathula's, being on the one end narrow and round, to serve for a Probe; ending in a round small button, to hinder it from offend∣ing, when you are to try the depth of an Ulcer, or Wound, and on the other broad and flat, to spread your Unguents: of the broadest end Galen speaks, Method. 13. c. 5. where he advises to besprinkle an Ulcer with the Powder, using lats Specilli mucrone, with the broad end of the Specillum, or Spathula.

One thing is to be noted, that if (in putting in of the Instrument into the Eye, to comprehend the parts united) you fear to hurt any part with the point, then it is re∣quisite to arm it with a little Wax, that it may be like the end of a Probe.

To the parts thus separated, ap∣ply a Collyrium made of Plantain-water, and Trochisci albi Rhasis sine opio: dissolving in an ounce of the Water, a drachm of the Tro∣chises. Keep the parts asunder with small dosils of Lint put be∣tween the parts disjoyned, laying upon the Eyes a couple of Boul∣sters, cross-ways, moistned with the afore-named Medicament, and then rouling it up. Dress the Eye Morning and Evening, to hinder Unition; and hasten the Cure, un∣till the incised parts be cicatrized, and no fear left of cleaving toge∣ther again of those parts, which by Mannal Operation were severed.

CHAP. XXVI.

Of an Ozaena.

HAving set down the Ulcers which ordinarily possess the Ears and Eyes, I must not let those pass which sometimes trouble the Instruments of the other two Senses, to wit, Smelling and Tast∣ing, which are the Nose and the Mouth. Of all the Ulcers of the Nose, I will only speak of Ozaena, omitting the rest; because they require no singular consideration: for the general Indications of curing of Ulcers, will serve to lead any man to the cure of these.

Ozaena hath its denomination from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which according to Celsus, lib. 3. c. 11. is Faetor oris, the stinking of the breath.

Of it Galen, de comp. medicam. sec. lic. lib. 3. c. 3. so discourses:

Polypodes are bred in the No∣strils, which are Tumors unna∣tunl; but Ozaenae are a kind of Ulcers, &c.

First of all, I will speak of the Ozaenae, which are produced of the influxion of sharp, and putrid, or rotten Humors. These Humors, if they be only sharp, they produce Ulcers hard to be cured, but not of a grievous smell: Out of Galen then you may gather, that Polypodes are only Tumors in the Nose, but Ozaenae are Ulcers. Secondly, that there are two sorts of Ozaenae; the one is of those which erode, being caused of the influxion only of sharp Humors, but stink not. The other is of those which smell grie∣vously, and are caused not only of sharp Humors, as the former, but such also as have Putrefaction annexed to the Erosion, Actuar. lib. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. c. 10. so speaks of this kind of Ulcer. Ozae∣na manifests it self by its very name, which it has taken from the stink∣ing smell which it sends out. It is caused when rotten and cor∣rupt Humors gather about the Meatus colatorii, or the holes of of the Ethmoeides, and commu∣nicate their Malignity to the adja∣cent part, and infect others, which flow thither, with their ill smell. And tho at all times the breath of the Patient stink; yet it is chiefly observed in strong expiration. Cel. lib. 6. c. 6. thus writes: But if Ulcers be about the Nostrils which have crust, and an evil smell (which the Grecians call Ozaenae) you are to understand, that this Grief can hardly be cured: so that you see, that to Erosion and Pu∣trefaction Celsus adds crusts in an Ozaena. Gorraeus definitionum med.

lib. 13. affirms that this Grief is more frequent in our times, than it was when the ancient Authors lived and practised: by reason of the Lues Venerea, or Pox, which hath gotten sure footing in all Nations, and may be accompted the badge and character of wan∣dring Lusts, and Gods judgment inflicted upon some for this hei∣nous offence.

The Ozaena of the Ancients was only a malign Ulcer: but Ulcers of the Nose which are seen in the Pox, are symptoms of that Grief which is contagious, and by con∣tact may infect others. Aegineta, lib. 3. c. 24. affirms Ozaena to be a carious and rotten Ulcer, bred of sharp Humors flowing to the No∣strils, and eroding them.

Out of the Discourses of the An∣cients, this description of an Ozaena may be framed, Ozaena is a malign Ʋlcer in the Nostrils, about the holes of the Ethmoeides, caused of sharp Humors eroding the parts, if no evil smell be adjoined; or ha∣ving a putrefactive quality, if a noisome smell accompany the Ʋlcer, sometimes without, sometimes ha∣ving crusts.

The Causes antecedent are cor∣rupt and sharp Humors flowing from the Brain, but sent thi∣ther by the Veins and Arteries, wherein such Humors are con∣tained.

The Causes conjunct are these same Humors impacted, and set∣tled in the part.

An Ozaena is two-fold: for it is either not contagious, such as the Ancients knew, or it is contagi∣ous, a symptom of the Venereal Disease.

As for the Prognosticks, re∣ceive these:

1. All sorts of Ozaenae are of a malign Nature, because such is the Humor, which produces each one of them.

2. All such Ulcers are of hard cure: First, because the Brain still affords plenty of these corrupt Humors. Secondly, because the part affected is of a moist tempe∣rature. Thirdly, because the fa∣culty of internal Medicaments, which are prescribed for correcting of the malignity of the Humors, is much abated before it come to the Head.

3. An Ozaena, a symptom of the Pox, is more easily cured, than that which is a Disease it self: First, because the last comes nearer to a cancerous quality than the first: Secondly, because we have more sure Medicaments against the first than we have against the second: if this kind of Ulcer con∣tinue long, it takes away the Sense of Smelling.

4. That which is apparent is of easier cure than that which is hid or latent: seeing then ancient Au∣thors, with unanimous consent, pronounce the cure of an Ozaenae to be difficult, in setting down the Method of curing this Grief, my part is to shew what means Modern Practisers by their indu∣stry have found out to remove this hardness of curing.

The means then which are ap∣pointed for the cure of this Ma∣lign Ulcer are either Physical or Chirurgical.

The Physical are in number

three: to wit, observation of a good Diet, Phlebotomy and Pur∣gation.

As for the Diet, that is most convenient which I set down in the two former Chapters, wherein I discoursed at large of the curing of Ulcers of the Eyes. If any one offer himself to be cured of such an Ulcer, let him be tied to these Observations: First of all, that he shun all sorts of Meats, which are either of an hard concoction, or afford a corrupt and evil Juice. Se∣condly, that he use great modera∣tion in the use of wholsom and convenient Food.

Fasting often in this case is very requisite; First, because it dries the habit of the Body: Secondly, becauses it furthers concoction: Thirdly, because by fasting those Vapors are digested, which other∣wise would mount up to the Head. And tho in the beginning, while the Body is fraught with sharp Humors, the Sore may be exasperated by fasting; yet after that the Body is clean, and dis∣charged of such Humors, by fre∣quent evacuations, you shall find the commodity of fasting: how∣soever, the Dinner must not be riotous, and the Supper very spare.

The second Physical means is Phlebotomy: If the Body be ple∣therick. First, open the Cephalica of the right Arm in Spring and Sammer; but of the Left, in Har∣vest and Winter. Then three or four days afterward, open the Veins under the Tongue, which will serve for derivation of the Hu∣mor, as the former did for revulsion of the same.

This must much further the Cure: For first, Phlebotomy im∣pairs the quantity of the Humors contained in the mass of Blood: Secondly, it makes way for the receiving of better Blood into the Vessels, which of necessity must ensue after the appointing of a convenient Diet, and exquisite purging of the Body, which im∣mediately after Phlebotomy is to be performed.

The third Physical mean ap∣pointed for the cure of an Ozaena, was said to be purging of the Bo∣dy by Cathartical Medicaments: for vomitive Medicaments are not so convenient as Cathartical, in the Diseases of the Head, unless the Stomach be foul, and pestered with raw and corrupt Humors, which require a long time for concocti∣on: Vomitions (as is confessed by all Practisers) send up Vapors to the Head.

These purging Medicaments are of two forts: for they are either Vegetable or Mineral.

As for the Vegetable Medica∣ments, they must be of the strong∣est, which are appointed for dis∣burdening of the Head of ill Hu∣mors: such are Agarick, Turpe∣tum, Coloquint, Scammony, black Ellebore. But seeing the purgative Simples are seldom ministred alone, I will shew unto you what com∣pound Medicaments are sittest to be used in this Case. The com∣pound purgative Medicaments are either Pills or Potions.

As for Pills: If the Humors be mixed, then use Extractum Pan∣chymagogicum of Paracelsus, or the Pilul. extract. Rudii; of them minister half a drachm for a dose:

Let the Patient use this Medica∣ment twice a Week. If Choler and Phlegm corrupted be the ma∣terial cause of the Ulcer, then mi∣nister the Pills called Sine quibus esse nolo. If thick and gross Hu∣mors be the cause, minister Pilulae anreae, & Cocciae, if corrupt Phlegm be the cause, minister Pilulae de Agarico. Of these Pills minister one drachm for a dose: let the number of the Pills be accord∣ing to the swallowing of the Pa∣tient.

If the Patient be hard to be moved to stool, you may actuate, and make the Pills more effectual, by adding to every dose of the Pills four grains of the Trochises of Albandal, and three grains of Diacrydium.

If the party cannot swallow Pills; then you are to minister Potions. The Electuaries most fit for this purpose, are Diacatho∣licum, Caryocostinum, Diaphaeni∣cum, Electuarium de succo Rosarum, Confectio Hamech, Diacarthamum, Of these Electuaries, and conveni∣ent Syrups, distilled Waters, or Decoctions, you may make Po∣tions fitting the constitutions of the parties grieved.

For one of a cholerick Consti∣tution minister such a Potion: ℞ Caryocestin. & Electuar. de succo Ros. an. ʒ iij. Syrup. de Cichor. cum rhab. ℥ j. aq. Endiviae ℥ iij. Misc. ut siat potio.

If the party be of a phlegmatick Constitution, minister this Potion: ℞ Diaphaen. & Diacarthami, an. ʒ iij. Syrupi Ros. solut. cum Agarico ℥ j. aq. Beton. ℥ iij. Misc. ut fiat potio.

If the diseased person be of a melancholick Temperature, then minister this Potion: ℞ Confect. Hamech. ʒ iv. Diacartham. ʒ iij. Syrupi Augustani. ℥ j. aquae Fu∣mariae ℥ iij. Misc. ut fiat petio.

Thus you may purge the Body with vegetable Medicaments, if the Body of the diseased party be weak, or if you fear the use of Mi∣nerals. But let me insinuate so much unto you, that Mineral Medicaments, if they be well pre∣pared, are most effectual, and if they be ministred by a skilful Pra∣ctiser, howsoever they are sleight∣ed and despised by those who glo∣ry of the denomination of Gale∣nists, amongst whom some may be found, whose Skill is inferior to the Envy of an Understanding Man.

Mineral Medicaments are more subtil and piercing than Vegeta∣ble, and sooner alter the complexi∣on of the party unto whom they are ministred. These Medicaments are most commonly taken from Antimony and Mercury.

Antimony which purges most by stool is excellent. The Sulphur of Antimony drawn by Art from the Recrements of the Regulus is good; as also the Regulus it self calcined and sixed with Saltpeter, and brought to a white Powder. The Glass of it, and Crocus Me∣tallorum, are not so convenient and secure, because they procure strong Vomitions.

There be divers preparations of Mercury which are very effectual; as Mercury precipitate with Aqua Fortis, the Oyl of Vitriol or Sul∣phur, with Gold or Silver, or precipitate, alone without the ad∣dition of any thing. There is

scarce a Chirurgeon, who is not able by one preparation or an∣other of Mercury to procure Sali∣ration.

These Mercurial Medicaments are effectual, as well in an Ozaena which is a primary Disease, or of it self, as in that which is a symp∣tom of the Pox. You have seen what Diet is most convenient, and what internal Medicaments are most effectual in curing of an Ozaena: The last point which I propounded unto my self, to at∣tain the Cure of this Ulcer, was the right use of external Medica∣ments.

These are in number two; to wit, local Medicaments, and an actual cautery.

As for local Medicaments, they are either Waters, or Decoctions, or Unguents: But before you ap∣ply any Medicaments, to mundifie, incarnate, or cicatrize, you must labour to remove the crusty sub∣stance, which doth fix it self in the forepart of the Ethmoides, or Os Cr••iriforme: and that for two causes: First, because the Brain is hindred from discharging of the residue of the malign Humor, which causes the Ulcer, and so the Cure is protracted: Secondly, because the Medicaments cannot touch the affected parts, and so no alteration can be procured.

For the removing of the crusty substance, I commend unto you two Medicaments:

The first is this: ℞ Ol. Amyg∣d••••••um dulcium ℥ j. Spermat. Ce∣•• ʒ ij. exquisitè misceantur.

The second is this: ℞ Axung. Ʋisi ℥ j. Pinguedin. Taxi ℥ss. Ol. Senm. lin. ʒ iij. Misc.

You must thus dress the Pati∣ent: Turn his Face upward, and let his Head be bent backwards, then Morning and Evening with three Feathers tied together, drop still some of these Medicaments warmed in a Sawcer, into the Nose, and let the party grieved still draw in his breath, until he feels the taste of them in his Mouth.

When you have perceived, that the crust is soft, Morning and Evening let him snuff up into his Nostrils some of this sternu∣tatory Powder: ℞ Ellebor. albi. Nigellae, Tobac. an. ℈ j. Rorismar. Salv. an. ℈ ij. Moschi, gr. ij. fiat puivis subtilis. Let him snuff a little up into his Nose every Morn∣ing, after you have moistned the crust with some of the Medica∣ments set down before. When part of the crusty substance is fal∣len out, dress it still after this same manner, untill all the crust is spent; then proceed to Applica∣tion of these Medicaments named by name.

Use these Waters.

First, the preeminence shall be given to Aqua Aluminis magistralis of Fallopius allayed with Plantain or White Rose∣water.

The second shall be this: ℞ Aq. Plantag. Card. Benedict. Ceras, nigror & fragor. an. ℥ iij. Spirit. Vitriol. ℈ j. Misc.

The third shall be this: ℞ Aq. Aurifabror. & gemmar. quer∣cus an. ℥ iv. Alum. ʒ ij. Ex∣quisitè misceantur & depuren∣tur.

The fourth shall be this: ℞

Aq. Alum. & Plantagin. an. ℥ iv. Mercur. dulcis ʒ ij. Dige∣rantur in cinerib. calidis per hor. 2.

As for Decoctions, I commend unto you these:

1. ℞ Flor. Ros. rub. pug. ij. Ba∣laustior. ʒss. Rad. Tormentill. ʒ j. fol. Plantag. Polygon. & Vincae pervinc. an. pug. 1. Boil these in six ounces of Spring Water, un∣til half be consumed; strain then the three ounces remaining, and dissolve in them one ounce of Mel Rosatum.

2. ℞ Rhois Coriar. lb. ss. Alu∣min. ʒ ij. coq. ista, ac clarificen∣tur albumine ovi unius, ac colen∣tur. Colaturae adde Mellis Rosat. Syrup. Myrtill. & de Ros. rub. sicc. an. ℥ j. I will not trouble you with great variety, as I might out of the Monuments of the An∣cients; seeing these will suffice, or else none.

The Waters and Decoctions you must inject by a Syringe warm, to make your Topicks answerable to the Air, which is drawn by the Nostrils, in the first qualities, to wit, moist and hot: moist, I say, actu; but potentia, drying; because Ulcers require such Medicaments: seeing both Water and Decoction, being ap∣plied, do quickly evaporate, and leave the part affected dry, and thirsting for other To∣picks.

Unguents now offer themselves; I will not supererogate in this point, but will deliver unto you such as shall be effectual; and what is deficient in number, shall be supplied by efficacy. Receive this as the first, out of David Sennert. med. pract. lib. 1. part 3. sect. 4. c. 1. ℞ Plumb. usti, ••••∣thargyr. an. scrup. j. Ceruss. 〈◊〉〈◊〉 Armen. balaust. an. scrup. ss, O•• Ros. Myrtin. an. ʒss. C••rae ••••. scrup. j. Ducantur ista in m••rta∣rio plumbeo, donce acquirant Ʋn∣guenti consistentiam. The second shall be this; ℞ Ʋnguent. de T••∣tia, & Ʋnguent. Albi Caphurati, an. ℥ j. O••. Myrtil. & Cydon. ••n. ʒ ij. Mercur. dulcis ʒ j. ss. p••••••∣rizati, Misceantur. These Ulcers are to be dressed twice a day, Morning and Evening.

Cancerous Ulcers also seise up∣on this part. This Grief hasten∣ed the end of that famous Ma∣thematician, Mr. Hariot, with whom I was acquainted but a short time before his death; whom at one time, together with Mr. Hughes who wrote of the Globes, Mr. Warner, and M•••• Turperley, the Noble Earl 〈◊〉〈◊〉 Northumberland, the Favourer of all good Learning, and M••••••∣nas of Learned Men, maintain∣ed (while he was in the Te••••) for their Worth and various Lite∣rature. But seeing those Docu∣ments, which I delivered for the cure of Cancers already, may suffice, I will only set down the description of an effectual Wa∣ter in this Grief, which is this: ℞ Spermat. Ranar. & Iamae•••• an. lib. ij. gemmar. quercûs & hederae terrest. an. ℥ iv. Ex••••lle∣tur aqua è stillatorio c••mmuns, unde•• prolici solet Aqua R••sacca in recipiens, cui immiss. sint C••∣phurae calcinatae ℈ ij. Inject this

Water into the Nose, and lay to the Sores either double Clouts, or Lint moistned in this Water, as you shall think most fit, Morning and Evening.

It only now remains that I speak a little of the Application of an actual Cautery, which was ••••d to be the second external mean in the curing of an Ozae∣ra: this mean is only used when the Sore is rebellious to power∣ful onlinary means; which hap∣pens either by reason of malig∣nity or supersluous Humidity; for according to Hippocrates, lib. 1. Aph. 6. Against extreme Griefs, extreme Remedies are last.

The actual Cautery is applied for two purposes.

First, to cause an Eschar by impressing of it upon the Ulcer.

Secondly, it is used only to dry the Ulcer, by often applying of it, still desisting before the par∣ty feel any pain, by reason of ex∣treme heat.

If you mean to procure an Eschar, both the ends of the Pipe by which the Cautery is carried, must be open: but if you intend desiccation, the end which you apply to the Ulcer, must be shut.

If you have procured an Eschar, the fall of it is to be procured, as I did shew in removing of the Crust: this being done, proceed in curing of the Ulcer as hath been taught.

If you have only caused Desic∣cation by Iteration of the Appli∣cation of an actual Cautery, the manner of Cure is not to be al∣tered.

CHAP. XXVII.

Of Ʋlcers of the Mouth.

NOw am I to discourse of such Ulcers as befall the In∣strument of Taste, which is the Mouth.

It begins at the Lips, and reaches to the beginning of the Wind∣pipe, and the Gula, or Mouth of the Stomach.

It hath four Uses: 1. It serves for Breathing, by sending fresh Air unto the Lungs, and discharging suliginous Vapors sent from the heart by the Arteria venosa.

2. It receives the Food, and having prepared it by the chew∣ing of the Teeth, and the Mandi∣ble, it sends it to the Stomach there to be chylified.

3. It serves for Speaking: the external and internal parts of it serving for the framing of the Voice.

4. It serves for discharging of the excrements of the Brain, by spitting out the excrements of the Lungs by expectoration, and by discharging the excrements of the Stomach by vomiting.

Seeing then the Uses of it are so manifold and necessary, it behoves me to discover such Diseases (be∣longing to our purpose) as deprive us of one or more of these Com∣modities which it 〈◊〉〈◊〉 us. But seeing some of the parts of it are external, as the Lips; and some internal, as the Teeth, Gums, Roof, the Tongue, the Almonds, the Ʋvula; I will only meddle with the Ulcers of the Lips, Roof, Tongue, Almonds, Ʋvula, and the Ulcers of it beyond the Ʋvula, as only being proper to my inten∣tion.

I will begin first with the Ul∣cers of the Lips: how hurtful the Ulcers of the Lips are, you may gather from the Commodities, which they (being sound) afford to Man.

The Lips afford a sixfold com∣modity to the Life of Man.

1. They serve for the conveni∣ency of Eating and Drinking, for they keep in the Meat until it be chewed.

2. They beautifie the Face, if they be well fashioned.

3. They keep in the Spittle of the Mouth.

4. They keep the Teeth and Gums from external injuries.

5. They serve for the framing of the Speech.

6. They serve for Kissing.

And tho the benefits, which re∣••••end to us by the Lips, being well affected, may be hindred by s••ndry means; yet I will touch only but two sorts of Solu∣tion of Unity befalling the Lips, as p••••per to the Subject that I have in hand, which are the Chaps of the Lips, and the Ulcers of the s••••e.

Fissurae labiorum, or the Chaps of the Lips, proceed from a salt, ••••p, and drying Humor, which 〈◊〉〈◊〉 these narrow, but long small Ulcers, which are hot and painful, chiefly when the party speaks, eats or laughs.

These Chaps, (tho they may without any great difficulty be ••••ed in persons of a laudable con∣••••••tion,) yet in Cacochymical bodies they will give you some∣what to do: insomuch that the Patient will wonder and fret, that such Toyes and Trifles cannot 〈◊〉〈◊〉 speedily be cured; for so they term such Griefs, considering not the quality but quantity of the Grief.

For the cure of these, I will commend unto you two Medica∣••••••••s of my own; which I fami∣••••••ly use: The first is this: ℞ C••••. Flav. ℥ ij. Ol. Ros. Mell. & Ax••••g. Por••. in Aq. Ros. lot. an. ʒ ••. Litharg. Argenti. Myrrhae, Zuzib. pulv. an. ʒ j. fiat linimen∣tar s. a. First moisten the part affected with the Liniment: it is effectual, not only in Chaps of the lips, but in other Chinks or Fis∣〈◊〉〈◊〉 in what part of the Body ••••••er they be, and it cures spee∣••••y.

The second is a Pomatum, the description whereof is this: ℞ Poma numero iij. quibus insige Ca∣ryophyll. ℥ss. Styrac. Calamit. ʒ iij. Benzoini ʒ ij. Ladan. ʒiss. Calam. Aromat. Cinamom. an. ʒ j. Axung. Porc. lib. 〈◊〉〈◊〉 Lavendul. & Ros. an. ℥ iv. Moschi, civetae an. gr. iss. In∣dantur ista vasi terreo satis am∣plo, ac calore B. M. evaporentur aquae, & coletur Pomatum, quod in vase puro servetur. You may con∣jecture the efficacy of this Medica∣ment by the ingredients.

As for the Ulcers of the Lips, they are either mild, or malign.

As for a mild Ulcer, this Oint∣ment described by Rened••••s, Anti∣dot. lib. 5. sect. 1. cap. 11. which he calls Ʋnguentum de minio, or Ʋnguentum rubrum caphur••tum, is very effectual: compos. haec est: ℞ minii triti ℥ iij lithar. argent. ℥ ij. cerussae ℥ ssj. tut. ʒ ij. caphur. ʒ ij. ol. ros. lb j. cer. albae, ℥ iij. siat ung. ut ars praescribit. This Unguent is effectual against even old and inveterate Ulcers, in what part soever of the body they be.

If you perceive an Ulcer of the Lip to be malign or cancerous, (which you may conjecture if the colour be livid, or blackish, if the brims be hard, if the heat and pain exceed the quantity of the Ulcer, and it yield a sanious and ill smel∣ling Quittor;) then you are to look about, and to espy which are the most powerful Medicaments.

When I discoursed of a Cancer, a Neme, and a Phagedaenical Ul∣cer, I set down choice of local Medicaments: for such Ulcers, if they happen to invade the Lips; here I will only give you a de∣scription of a distilled water, and of a magistral Unguent.

The water is thus to be made:

℞ fol. plantag. solani hortens. ve∣ronic. sempervivi major. & minor. an. man. iij. albumina ovorum con∣quassata numero xij. alumin. con∣tus. lib. ss. caphur. ʒiss. Excoletur aq. calore balnei: fomentetur can∣crosum aut malignum ulcus hae a∣quà, quae & faciei ruborem tollit. The description of the Unguent is this: ℞ plumbi ʒ iij. fundatur in crucibulo, eique addatur Mercur. ʒiss. postquam refrixit, in pulve∣rem vertatur massa, cui adde un∣guenti de tutia ʒ vj. cerae ʒ ij. te∣rebinthin. ʒ j. myrtil. ʒjss. fiat ung. quod ulceri post fotum applice∣tur. Delinatur ulcus singulis diebus, qu••ties opus est. If you find the Ulcer to be rebellious, and not to yield to these very convenient and effectual means, then are to you ap∣ply such Medicaments as I have set down for the cure of a Nome, Pha∣gedaena, and Cancer, whither I re∣mit you, to shun tedious and fruit∣less repetition.

To the Ulcers of the Lips, the Ulcers of the Palatum, the roof of the Mouth, must be annexed. It is vaulted, that the Air being re∣percussed, the voice should be the sharper: it is wrinkled and rough, where it covers the Bone, that it might the more firmly cleave to it. and the better stay the Meat whilst it is in chewing.

Now seeing all the internal parts of the Mouth are indued with the sense of Tasting, but chiefly the Membrane which covers the Tongue; and have the exquisite sense of Feeling by reason of the nervous Fibres, whereof they have great store, you are to have a care that your local applications be not distastful and loathsome, seeing the parts will abhor them. If then the wrinkled skin, which covers the Os palati, be ulcerate: First, touch it with Aqua Fallopii, allayed with Plantain water, if it be foul; or with this: ℞ aq. plant. card. bene∣dict. & sperm. ranar. an. ʒ iij. mal∣lis ros. ℥ ij. ol. sulphur. aut vitri∣ol. ℈ j. Misc. Having touched the Ulcer with either of these waters warmed sufficiently, apply this Me∣dicament; ℞ syrup. è ros. rub. sic∣cat. è baccis myrti, & de su••es granatorum an. ℥ j. ol. vitriol. ℈ss. Misc. Seeing the part is moist, and will not admit the deligation, you are to dress it the oftner. If you perceive the Os palati to be bare, then mingle some of this Pow∣der following, with these Sy∣rups: ℞ far. hord. rad. irid. s••••∣phyti, tormentil. an. ℥ss. mastiche••, b••racis, sarcocoll. an. ʒss. fiat ex omnibus pulvis. If the rough skin unite, as I have often seen, then have you obtained your desire.

If a small piece of the Os palati fall out; using these incarnative means, and keeping the brims of the Ulcer raw, you may bring them together; but if a large piece of the Bone come away, there is no hope of unition. In this case you are to cause the party to wear a plate of Silver to supply the defect of the Bone, that his speech be∣wray not the loss of it.

The third internal part of the Mouth, which uses to he ulcerate is the Tongue.

The Tongue affords four bene∣fits to the Body.

1. It is the instrument of Tast∣ing, by the benefit of the Mem∣brane wherewith it is covered.

2. It utters the Speech, by which we communicate our wants to others, and implore aid in time of distress.

3. It helps chewing, by gather∣ing of the Meat together, tossing ••it to and fro; it turns also the ••eat down to the Stomach.

4. It serves for licking. To omit, that in our insancy we could not s••ck without it: so we see, that if the fraenum of it come too near to the tip of it, the sucking is hindred, ••••d it must be cut. Children who ••••e this infirmity are said to be T••••gae-tyed. The flesh of it is 〈◊〉〈◊〉, that it might receive the 〈◊〉〈◊〉 of the Sapors, and more ••••••rately judge of them.

If the sores of this part be but ••••••••ry and mild, this Medica∣•••••••• will serve, if it be often ••••shed with it: ℞ hord. mundat. ℥ iij. rad. alth. ℥ ij. liquirit. ℥iss. B••••••ant. ista in lib. v j. aq. font. ••••••••dias, ac coletur decoctum, cui ••••••isce syrup. viol. tussilag. & sca∣••••sa an. ℥ j ss. ac serva mundo va∣s••••d usum.

It falls out sometimes, that Sores i•• this Member prove malign and very fretting, causing one of these Ulcers which are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, as it once happened to the Lord Mayor of London, R••ph Freeman. He lacked nei∣ther Physicians nor Physick, yet old age, weakness, and the ma∣lignity of the Sore hindred the pro∣••••••ing of his Health, which his ••••ysicians and Chirurgeons aimed at and wished for. The Ulcer was so corrosive, that it fretted asun∣der the Veins and Arteries of the lengue, on that side which it pos∣sessed, and caused a great flux of Blood, which exceedingly weak∣ned him, for that present causing a strong Syncope, so that afterward Nature could not recollect her self. When such griefs befall great personages, their case is worse than that of the poorest in the like in∣firmities, because Physitians and Chirurgeons are not permitted to use the like liberty in the applica∣tion of Medicaments to the one, as to the other. If the like case fall out hereafter at any time, I advise you so to use Medicaments borrowed of Vegetables, as that you contemn not Minerals: What hurt I pray you can come from the use of Merc. dulcis, and Merc. praecipitate with Gold? None I assure you, for these Medicaments are familiar to Nature, and are true Balsames for malign Sores.

But you may ask what was the reason that these Medicaments were not used?

I answer, because there was no mention made of these Medica∣ments at the first, and it was too late to minister them at the last, Nature being surprized; for this only would have made the Medi∣cament odious, and the Physician (who should have advised this course) obnoxious to calumny and reproach.

Now time admonishes me to come to the Ulcers of the Ʋvula or Gargarion.

If they be mild and ordinary, the former Medicaments set down for the cure of the Tongue will be sufficient.

But if it be a fretting Ulcer, first you are to admonish the Patient of some accidents, which may en∣sue:

and those are Two in num∣ber.

The First is, That if the Ʋvula be wholly fretted away, the party shall hardly be able to speak clear∣ly and distinctly. Howbeit both Bauhinus in his Theatr. anatomi∣cum, and Gulielmus Fabricius cent. 2. observ. 21. do affirm, that in some they observe it to have been lost, not leaving any defect in their speech

The Second accident is, the danger of a Phthisis, or Cough of the Lungs; for this is to be feared, seeing the member which did hinder the rushing in of the cold Air into the Lungs, and put back from the Breast Humors di∣stilling from the Head, is wholly taken away.

Having acquainted the Patient with the Prognosticks, I proceed to the Cure.

This is performed either by the application of convenient Medica∣ments, or else by cutting it away.

As for the Medicaments, use first this Clargarisme: ℞ fol. plantag. veroni••. & sigill. Solom. an. man. j. scord. orig. centaur. minor. an. man. ss. Bulliant ista in lib. ij. aq. font. ad consumpt. lib. j. & coletu. decoction, in quo dissolve oxymel∣lis simplicis ℥ iij. Then touch the Sore Morning and Evening with this liniment: ℞ ung. Aegypt. ℥ss alum. pulv. ʒ ss. mel. ros. ℥ i ss. Misc. applicetur mane & vesperi.

If it proceed from a Venereal cause, use this Topick twice a day: ℞ aq. card. benedict. & plantag. an. ℥ vj. aq. fort. ℥ j. Misc. You may also use the blue Water, which you may buy for three pence a pint af∣ter the Silver is separate, after so∣lution, and hath no other metal in it, but a little of Venus. If these means will not prevail, then you must wholly cut it away.

But according to Valescus de Ta∣ranta, you must observe these five things before you go about this operation.

1. You must purge the Body well.

2. No Humor must be in flow∣ing to the part.

3. You must not attempt this operation as long as there is hope, that other Medicaments will pre∣vail.

4. Go not about this operation, unless it be small about the root; for if it be thick, and red, or blue, such a flux of Blood may ensue, as will strangle the party, and cause fainting.

5. Mark, how much of a ne∣cessity must be cut off; for a lit∣tle remaining will both further the Speech, and repell the cold Air from the Lungs. If after the cut∣ting of it off, a flux of Blood en∣sue, either apply astringent pow∣ders to it, or else cauterize it with an Ʋvula Spoon made hot.

If the Tonsillae or Almonds be ul∣cerate by reason of the influxion of sharp Humors, which your Eyes can discern, the Tongue being pres∣sed down by your Spathula, carry in mind these prognosticks.

1. If these Ulcers be without a Fever, they are the more safe.

2. If these Ulcers happen in the Summer, they sooner spread.

3. If the Almonds become Scir∣rhous, they are hardly or never cured.

4. These Ulcers (as all other Ulcers of the Mouth) require stron∣ger desiccatives than Ulcers of the external parts. First, to hinder them from spreading. Secondly, because they are still kept moist with the spittle.

For the cure of these Ulcers, I ••ill deliver unto you two local Me∣••caments: The First is the de∣••oction of the root of the Devils∣••it, to be used instead of a garga∣••••••. The Second is a liniment ••o be applyed after gargarization ••••ed by Sennertus, and set down ••••dicin. pract. li. 2. c. 22. ℞ cen∣••••r, minor. rad. irid. stercor. ca∣rini. an. ℥ j. cum melle despumato fiat electuarium. As for the facul∣ty of a white Dogs-turd, read Ga∣len. li. 10. de simpl. med. facult. c. de stercore canino.

If the Throat beyond the Ʋvu∣la be ulcerated, use this water in∣stead of a gargarism as a certain experiment. ℞ aq. plantag. l. 1. ros. rub. flor. aurantior. an. ℥ j. pulv. Merc. subli. ʒ ij. digerantur in arena per horae quadrantem, ac co∣letur aqua, quae in vase vitreo ser∣vetur ad usum. If by reason of these Ulcers the party cannot swal∣low any solid meat, minister to the Patient Mercurius dulcis for four Mornings together, and you shall perceive a wonderful effect. Give it in new Milk.

CHAP. XXVIII.

Of Ʋlcers of the Lungs.

SEeing the Lungs very often be∣come ulcerate, a solution of ••••ty in the substance of them, or ••••apertion of the vessels of them, ••••ch are the branches of vena ar∣ai••sa and arteria venosa, being ••••sed by a wound: I must not ••et such Ulcers slip untouch∣ed.

Two causes of such Ulcers of ••••e Lungs after a wound inflicted ••ay be assigned: to wit, a solu∣••on of unity in the substance and ••essels of the Lungs, and effusion 〈◊〉〈◊〉 Blood into the hollowness of the Breast. You shall discern the Lungs to be wounded.

1. First, if srothy Blood issue out of the Wound and Mouth by coughing, which shews some of the vessels to be wounded, and opened.

2. Secondly, difficulty of breath∣ing troubles the party wounded.

3. Thirdly, pain of the Sides is grievous, which he felt not before.

4. Fourthly, It is more easie for the Patient to lye upon the wounded, than the whole Side:

so that often he can speak readily so lying; but being turned upon his sound Side he can but with pain and difficulty speak.

You shall perceive and gather, Blood to have been poured out in∣to the capacity of the Breast by these signs.

1. If a heavy weight seem to press down the Midriff.

2. Secondly, if the party breath with great difficulty.

3. Thirdly, if the Fever in∣crease.

4. Fourthly, if the wounded party void Blood at the Mouth.

5. Fifthly, if the breath of the party stink after a while: for that betokens the Blood to be turned into Quittour.

6. Sixthly, the wounded person can only lye upon his Back.

7. Seventhly, the party has a desire to vomit, and strives to rise, from whence fainting ensues; for noisome vapours arising from the clotted Blood turned into Quittour assault the Heart, and weaken it exceedingly, and dissolve the fa∣culty of the Stomach.

After that the wound is inflict∣ed, and that you have dressed it so long a time as you have required in former times for healing of a penetrating wound of the Breast, (which will be shorter in the Sum∣mer, than in the Winter: for heat helps digestion) you may fear that a Fist••••la at the least, or a putrid Ulcer of the Lungs will ensue: chiefly if a thin Sanies, and not a laudable Quittour flow out, far in quantity exceeding the bigness of the wound.

Why in wounds of the Lungs, so much Quittour every day is ••••••t out, these are the causes.

1. The vicinity and nearness of the Heart, which being the wel∣spring of Blood, sends too much of it to the part affected: And when as it cannot make use of all of it, by reason of weakness, it turning the remainder by its ••••••••∣ral heat into Quittour, discharg•••• it by the orifice of the Wound.

2. Because the sound parts se••d unto the diseased Blood and Spirits without mean or measure.

3. Because the Lungs draw more nourishment to themselves by their motion, heat, and pain, than they are able to digest,

4. Because the Ulcer like a de∣vouring Wolf by its malignity and filth, presently corrupts the Blood sent for nourishment unto the Lungs, turning the greatest ••••••t into Quittour, and defrauding the part affected of maintenance: from whence ensues an extenuati∣on of the whole Body.

Now that you may the better foresee and foretell to the Patients the events of such Ulcers, I would have you to mark these Progro∣sticks, which I shall deliver unto you.

1. All Ulcers of the Lungs are hardly, or with great difficulty ••••∣red, and that for four causes.

1. Because the Muscles of the Breast, Lungs and Heart, are in perpetual motion: now motion hinders consolidation, as all by er∣perience know.

2. Because the Lungs are onely

••nvironed by the Pleura, the skin inwardly investing the Ribs, which is endued but with small store of Blood, and being a spermatick part, to wit, a Membrane, is not easily united: and that only by the se∣cond intention.

3. Because local means cannot be kept to these Ulcers, by rowl∣ing, boulstering, and emplastering, as they may to Ulcers of the ex∣ternal parts.

4. Because the orifice of the Ulcer is not commonly in a depen∣ding part; but either parallel, or higher than the Ulcer. How hard a matter it is for Quittour to a∣scend, I leave it to your considera∣tion.

5. If the party pine not away, if he expectorate easily, if he sleep reasonable well, if he digest his Meat, if his Stools be orderly, if the Quittour be indifferent good; you may conceive some hope of a Cure.

6. But if the diseased parties Breath smell ill, if he consume, if the Quittour which flows from the Ulcer stink, if he hath a grievous Cough, and difficulty of breathing, if a ••ngring putrid Fever troubling Ear•• chiefly toward night, and hin∣dring his sleep, follow him, if his ••ppetite decay, and concoction of the Aliment be empaired; if a ••otten piece of the Lungs, or of the branches of the Windpipe, be thrown out at the Mouth, if he have a whistling voice, as if he ••••ke thorow a Cane, his case is desperate.

7. If his Hair fall, which happens by reason of the want and corrup∣tion of the nourishment: if the 〈◊〉〈◊〉 grow crooked, the flesh of the tops of the Fingers being spent, if the Cheeks grow to be of a lea∣den colour; but when after meat they seem ruddy, vapours mount∣ing thither; if the Feet begin to swell, the natural heat being spent, if Lice multiply by reason of the corruption of the Humors, you may pronounce that a Diarrhoea or humoral Flux ensuing, the party shall depart.

8. Although some have lived many years who have had an Ulcer of the Lungs, as Avicen reports, that he saw a Woman who lived twenty three years, or thereabout, with an Ulcer of the Lungs. And as Matth. de Gradib. in 9. Rhas. c. 54. affirms, that he saw a Wo∣man who still was busied about the fire, who lived twenty eight years; yet be not you too forward to take in hand such persons as have ulcerate Lungs; for the cure is uncertain, and that for four cau∣ses.

1. By reason of the symptomes which ensue, as a lingring Fever, and Consumption of the Body.

2. Because the Quittour which is contained in the spongy sub∣stance of the Lungs, cannot be voided by expectoration without coughing; which much troubles the Lungs, and exasperates the Grief.

3. Because the Medicaments which are ministred to cure these Ulcers, cannot come to the Lungs in their full force.

4. Because the Fever and Con∣sumption of the Body require those things which are moistning, but the Ulcer those things which mun∣dify and dry.

If it chance, that by Art and good luck you cure an Ulcer of the Lungs, charge the party that he walk circumspectly in the course of the residue of his life; for many times when the Ulcer has seemed to have been cured, yet the Cicatrix being removed by the ill carriage of the Patient, the Ulcer has gotten footing, and been the cause of untimely death, as Oalen witnesseth, lib. 4. de loc. af∣fect. c. 5.

When you go about to cure such Ulcers, you are to propose three Indications curative to your selves.

The First is, the appointing of a convenient Diet.

The Second is, the ministring of fit pectoral Decoctions.

The Third is, the artificial dres∣sing of the Ulcer.

As for the Diet: the party having an Ulcer of the Lungs, must eat meat of an easy concoction, be∣cause Nature is much weakned; of good juice, lest putrefaction be increased; and Lastly, of much nourishment, because the Body in this Grief is most commonly much extenuated only I will briefly touch some kinds of Food, which are en∣dued with these qualities

The First that offers it self is Milk, for it nourishes the Body, it affords matter for Bloud, it cor∣rects the acrimony of corrupt Hu∣mors; with the Wheyish part it mundifies the Ulcer, with the Cur∣dy part it consolidates, and with the buttery part it moistens, and staies the desiccation of the Body; Womans Milk is most familiar: By the sucking of a Womans Breast I saw a Weich Gentlewoman, cal∣led Mrs. Price, recovered of a Phthisis, who could not turn hee self in her Bed, by reason of weak∣ness, and could not take any other food. Asses Milk is thinner and more wheyish, and so more apt to mundify. Goats and Cows Milk obtain a mean between these two.

But lest it corrupt in the Sto∣mach, you are to dissolve some Su∣gar or Honey in it.

You are to minister it only when the Stomach is empty, and no other Meat is to be taken before it be digested; otherwise it will curdle, become sowre, and be cor∣rupted.

So much of it is to be given, as the Stomach of the party can well digest: wherefore first pre∣scribe a less quantity, and ascend to a greater.

Abstain from appointing of it, if the party be Feverish, have the Head-ach, and be troubled with flatuosity.

Snails and Crabs are much com∣mended in this grief; neverthe∣less seeing they are of a thick, tes∣restrial, and slimy substance, and afford corrupt and excrementiti∣ous juice, it may be doubted whe∣ther they be good or no: to omit, that they are of hard digestion; the broth of them boiled in Milk, and sweetned with Sugar, and mingled with other broths, may be good: for so the nourishment will be the more solid.

As for pectoral Decoctions, I will not trouble you with any great variety of them; only I will set down a few, but the paucity thall be recompenced with the effi∣cacy.

8. ℞ rad. enul. ℥ ij. scob. guai∣act lb. ss. hyssopi, marrub. a b••, an,

man. ij. Polypod. Liquirit. an. ℥iss. Fic••um incisar. passul. major. ex∣cinat. an. ℥ iij. Insundantur in∣fundend: per noctem in Aq. Font. servent. lb xviij. deinde, addit is re∣liquis, coq. ad consumpt. lb vj. a•• coletur decoctum, quod clarisicetur, edditis sacchari & Mellis an. ℥ ij. Creci ʒ j. atque iterum coletur: u∣t••tur aeger hoc decocto loco consueti p••••ûs.

2. ℞ Rad. Chin. ℥ iv. Symphyti, T••mentill. irid. an. ℥ j. Capill. Vener. Tussilag. scabios. Marrub. al∣ls, Hyssopi, an. man. j. Flor. Viol. B••ray. buglos. an. pug. j. Flor. Herbae Para••s. pug. ij. Flor. Alth. pug. i. ss. Caricar. ping. ℥ iij. Liquirit. ℥ ij. Sonin. Ceriand. Anis. an. ʒ vj. In∣f••••••antur ista, ut superiora, in pari quantitate aquae, ac decoq. ad ••••s••••pt. lb vj. ac coletur deco∣cton, quo utendum loco consuets paûs.

Every Morning the Patient is to take half a pint of either of these Decoctions warm, and to eat a logerge of Saccharum rosatum ••••••ell••tum, or two drachms of the Conserve of red Roses, being a ••••elve-month old.

Now I am come to the arti∣f••il dressing of Ulcers of the ••••••est.

The Medicaments which are sit∣••ct for the dressing, are Injections ••y a large Syringe.

As for the Simples whereof the Injections are made, they must not be of bitter things, as Worm∣••ood, the lesser Centaury, or Car∣•••••• Benedictus; for as judicious 〈◊〉〈◊〉 d••••gent Ambros. Paraeus notes, 〈◊〉〈◊〉 lib. 9. c. 31. these bitter 〈◊〉〈◊〉 being injected, are first drawn in by the spongy substance of the Lungs, and from thence are sent by the Trachaea Arteria, to the Throat; where such a bitterness is felt, that it causes a desire to vo∣mit, so that they rather hurt than profit.

These Injections are either ab∣stersive or consolidative.

Of abstersive Injections I will set down a few, as a Pattern, by which you may make others.

1. ℞ Marrub. alb. Hyssopi, Scabios. an. man. ss. Coqu. in lb iij. Aqu. Font. ad medietat. consump∣tionem. ac coletur decoctum; quod postea clarificetur addit. mell. lb i. ss. atque iterum coletur.

2. ℞ Aqu. hord. lb j. Mellis Ros. ℥ ij. Sacchari Rubri ℥ iij. Misc. bulliant 3 aut 4 ebullitionibus, ut injectio clarificetur, quae postea coletur.

If you perceive, that the Ul∣cer is sordid, and affords much matter, you may add either of Ʋnguentum Aegyptiacum, or the Oyl of Sulphur, or Vitriol, so much as you shall find fit to cleanse the Ulcer.

When you perceive that the Ul∣cer is sufficiently mundified; which you may gather, if laudable Quit∣tour flow, and in no great quan∣tity; then hasten to consolidate the Ulcer: I will in this case sur∣nish you also with effectual To∣picks, and but few: the first shall be this:

1. ℞ Decoct. pectoral. ℥ iv. Sy∣rupi è Ros. rub. sico. ℥ j. siat in∣jectio.

2. ℞ Hed. terrest. stor & sol.

Symphyt. Sanicul. Plantag. Polygon. Millefol. vinc. pervinc. Equiseti, Hyper. Eupat. Beton. Valerian. an. man. ij. Limaces numero xl. Can∣cros fluviatil. numero x. Addità Aqu. pluviali, instituatur distilla∣tio in alembico, ut extilletur A∣qua. ℞ Aqu. hujus lb ss. Syrup. Myrtil. & è ros. rub. siccat. an. ℥iss. Syrupi Granat. ℥ j. ss. Misc. ut siat injectio.

These Injections must be warm∣ed, when they are to be used. Into the Orifice, which is in the Breast, somewhat must be put to keep it open: this then is to be perform∣ed either by a Tent, or a Pipe made either of Gold or Silver.

The materials of the Tents are three; Lint, fine Tow, and a Sponge. Lint is altogether unapt, for it is apt to fall asunder after that it is made up into a Tent: if therefore a piece of it part, and rest upon the Diaphragma, it must putrefie there, and send noisome sents unto the Heart, which cannot but bring Faintings, and at the last shorten Life.

Good Tow then is better than it, because it cleaves fast together; but the Sponge is best of all, be∣cause it doth not only cohere sirmly, but draws also strong∣ly the Quittour, and imbibes it.

It is good so to form the Tent; that the outer end being broader than the inner, it may be staid from slipping: it is not amiss to halter them with thred for this same purpose.

A Pipe is best of all; it must be of thickness proportionate to the Orifice, having two stays to hin∣der the slipping of it into the cavi∣ty of the Breast; and sundry holes somewhat large about the end, to give way to the Quittour. It must also be somewhat arched lest the Lungs butting against it, should suffer any hurt. The outer hollowness is to be stopped with a Sponge dipped in Aqua Vitae and Wine mingled together, and warm∣ed, and wrung. Above the Teats and the Pipe apply Emplastramd•• menio, or Diachalciteos.

〈◊〉〈◊〉 the Ulcer run much, it must be dressed twice a day; but if it run little, once dressing will serve.

You may demand of me, when the Tents and Pipe are to be left?

I answer, when the Ulcer yields but a small deal of Quittour, and that good; and seems to be al∣most dry: for siccum est sano proni∣mum, that which is dry comes near to that which is whole.

If you keep the Orifice of the Breast too long open, it will fi∣stulate.

It falls out many times, that it Ulcers of the Breast, the diseased person grows lean. In this case you are to permit the party to drink some Almond Milk made o•• Chicken broth, wherein have bee•• boiled Pompion, Cucumber, and Muskmelon seeds, with Mallow roots, Cowslip flowers, Succo•• slowers, and Marigold flowers, be∣tween Meals, and in the Night time after two a Clock; or min•• ster a drachm and a half of the Powder which I will set down every Morning and Evening, in s•• ounces of one of the pectoral D••∣coctions, which I described 〈◊〉〈◊〉 the beginning of this Chapter.

The description of the Powder is this: ℞ Semin. Papav. albi. ʒiss. Gummi Tragacanth. Far. Oro∣•••• an. ʒiiss. Semin. Alth. Portul. C••••en. Melon. Pepon. Plantag. H••••••••am. alb. an. ʒ iij. Coral. rub. ••••eparat. Perlar. praeparat. Succini ••••i. preparat. an. ʒiss. Liquirit. ʒ iv. Sacchari rosat. Tab••llat. ad pondus omnium: siat pulvis.

If these courses being used faith∣fully; do not prevail, acquaint the diseased parties friends with the dangerous estate wherein he is; for no other Medicaments are like to prevail.

CHAP. XXIX.

Of Ʋlcers of the Back, the Abdomen, and Joynts.

ALthough one might rest con∣tented with what has been ••••eady delivered concerning Ul∣c••s; yet that none may justly say, that anything absolutely necessary has been omitted, and to further the practice of those which are ••••t so well versed in the curing of ••••p••ticular Ulcers, I will briefly 〈◊〉〈◊〉 down some notes concerning Ulcers of the Back, the Abde∣••••••, or lower Belly, and of the J••••••••s.

Ʋlcra dorsi, or Ulcers of the lack, most commonly fall out af∣ter 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ••lematous Phlegmons, where∣in Merbi acuti ex decidentia 〈◊〉〈◊〉.

Now that you may the better understand what I mean, I must degress a little, and shew you what D••••eases are termed Morbi acuti, and how many kinds of them there are.

Mer••i ac ti, or sharp Diseases, are properly called such as with great expedition, force, and dan∣ger go on to their status and ex∣tremity of the symptoms, as may be gathered out of Galen. 2. Aphor. 19. & 23.

Now there be three kinds of these Morbi acuti, or sharp Dis∣eases; for they are either peracuti; very sharp, acuti simpliciter, sim∣ple sharp, or acuti ex decidentiâ, or sharp Diseases ending into other Griess.

Peracuti end at the furthest on the seventh day, and they are of two sorts, exquisitè peracuti, of perperacuti, or exquisitely very sharp, which end on the fourth day, and non exquisitè peracuti, which are not exquisitely very sharp, which continue till the seventh day.

Now the simpliciter acuti in like manner are of two kinds: for they are either exactly so, and end for the most part on the fourteenth

day; or not exactly so, which may continue till the twentieth day. You may, and (I make no doubt) do see examples of these in burning and pestilential Fevers almost every Week. Last of all are acuti, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex deer∣dentia, which may be prolonged unto the fortieth day: Diseases which continue longer than forty days, are called Morbi Chr••••••••, or Diuturni, long or lingring Dis∣cases. Some of these Chronical Diseases may end in sixty, some in eighty, some in an hundred, some in two hundred days: some may continue a whole year, some se∣ven years, some twice seven years.

1. I law a Scotch-man, whose surname was Johuson, a Sadler by profession, who followed the Court in Queen Elizaboth's Reign, who was troubled twelve years with a Quartan Ague without in∣termission; neither can I affirm, that it left him during his life time.

2. Being in the Isle of Shepp••, in Minster-street, curing one Clover an Aged Man, whom I dismem∣bred, there was a Girl brought to me, of seven years of age, which for the space of six years was grie∣vously tormented with an exquisite Quartan. The Lives of these Per∣sons may be well termed living Deaths. Some of these lingring Diseases again continue in Boys un∣till the fourteenth year of their Age, and in Maids until their courses flow: as the Falling Sickness.

Now to come to Apostems of the Back, which leave Ulcers after they are brought to suppu∣ration and opened; They are for the most part critical Translations of Humors, sent in Morbis acutis ex decidentia, sharp Diseases which continue until the fortieth day; or in Chronical Diseases, the conti∣nuance of which is uncertain, sent from the inner either noble or mi∣nisterial parts from within out∣ward; the Physicians say, this is done per diadosin: whereas if noxious Humors be turned from without inward, as in pestilen∣tial and Venereal Buboes, they affirm this to be done per metasta∣sin.

Critical endings of Griess, are either performed by Excretion or Translation of the Grief.

1. By Excretion Nature exp••••••s the peccant Matter sundry ways, as by Vomit, Siege, Sweating, Bleeding at the Nose, the flowing of the Menstruous Courses, and the Apertion of the Hemonhold∣al Veins, as you may observe every day in the termination and ending of sharp Fevers.

2. In Translation, the peccant Matter is not altogether discharged out of the Body; but is sent from the part affected unto another part by provident Nature.

But seeing the Humor may be sent from the outward parts to the inward, and from the inner ports to the outward, this last Trans••••∣tion is most secure; for if the first be done in malign and contagices Diseases, as in the Pox and Plague, all understanding Practisers pro∣nounce either Death, or pro••••••∣ction of the Cure.

When therefore these Apostems appear either in the Back, or one of the great Joints, which after∣ward degenerate into Ulcers, the motion of the Matter by Nature is laudable, doing it by Translation; seeing she cannot by Excretion, partly by reason of the weakness of the principal parts, or by the plen∣ty, or hard concoction of the H••mor.

But this is the misery, that the F••aends or Kinsfolks of such a dis∣e••sed person think him or her to be ••together safe and secure, when they see them eased by the tran∣slation of the Humor, and there∣fore to spare charges call not for ••ilsul Physicians, and Chirurge∣ons, by whose Skill and diligence the motion of Nature might be furthered. And so it falls out ma∣ny times, partly by reason of the thickness of the Skin, as in the Back, or by reason of the thickness of the Skin and compactness of the Mem∣••••anes, as in the Joints, that the Ver∣t••••••ae of the Back are corrupted, and the Cartilages, and Tendons of the Joints, before remedy is sought for.

But that you may meet with these hide-bound Patients, and keep your selves from incurring d••nger of discredit, mark these Prognosticks, which I will deliver unto you.

1. If after Inquisition you find that a Tumor in the Back conti∣••••ed a long time before it did break of it self, or was opened, suspect the Ulcer to be of hard Cure: for it is likely that the Vertebrae of the b••••k are foul.

2. If the Vert••brae be foul, which you may easily find out by your Finger or Probe, the case is despe∣rate: wherefore take heed, that you promise not a Cure.

3. If in Ulcers of the Back you see the parties Body day by day to become more and more extenuate, advertise the Parties Friends of the danger: for it is an evident Ar∣gument that the principal Parts are weakned, and cannot wholly discharge the Humor which of∣fends.

4. Ulcers in the upper part of the Spina dorsi are more easily cured, than those in the Loyns•• Because the Abdomen or lower Bel∣ly sends out more superfluities than the Thorax or the Breast, which is the middle Cavity. Secondly, be∣cause they are nearer to the Heart, the Sun of the little World, who by his heat is able to consume much superfluous Humidity.

I think it will not be unpleasant to you for me to confirm my last Prognosticks, by true relation of the Events which besell me when I practised in Wales in the like Griefs: seeing Examples leave a deeper impression in the Mind, than Precepts, and lead best to the Cure of external Griefs.

In Denbigh-Town there was one Richard Pryce an Haberdasher, son to John Pryce, who kept the principal Inn of the Town, who after he had been troubled with a Chronical Disease, felt in his Back a little below the Shoulder∣blades, a Tumor still increasing in the outward parts, as he was eased in the inward, until at last it grew to the bigness of a Penny Loaf. I having been called unto it, by open∣ing of the Apostem, and using

Methodical Indications, cured the Patient. This Man (as I hear) ha∣ving given over his Trade, still keeps the Inn, which his Father did.

In this same Town about the same time, a lusty young man, whose sirname was Owen, whose Father was a retainer to Sir John Salisbury, had the like Tumor in the Vertebrae of the Loyns, after a lingring Grief: I having been en∣treated by the truly Worshipful Sir John Salisbury, (who had not an ordinary Skill in the knowledge of Plants, and in performing Chi∣rurgical Cures) took a view of the young Gentleman. After mature deliberation, I told Sir John and the young mans Friends, that there was much Quittour in the Tu∣mor, which must be discharged; and that the event of the Cure would be uncertain, if the Matter were let out, for the Reasons above specified. At the entreaty of Sir John Salisbury, and the young Man's Parents and Friends, I open∣ed the Apostem which was in the Vertebrae of the Loyns: And tho no means were omitted, which seemed to us effectual for the re∣covery of the young Man's health, and that the Verte••rae of the Loyns were not foul; yet he fell into a Marasinus, or extenuation of the Body, being otherwise a proper and valiant young Gentleman; and so ended his Life before Age called for his dissolution, to the great grief of his Parents (having no other Son but him) and the commise∣••ation of the worthy Knight. I have delivered unto you my Ob∣servations in this Grief, whereof I hope you will make good uses you having occasion ministred to be wary, by the Examples of others, which is no mean benefit.

How I performed the Cure of the first Patient, now I will de∣clare unto you: First, I purged his Body with a gentle Medica∣ment: It was this: ℞ Electues. L••nitiv. ʒ iv. Electuar. de s•••••• Res. ʒ ij. Srrup. Ros. solutsci 〈◊〉〈◊〉 Agarico ℥ j. Aq. C••cher. Mise. •••• fiat potio. Secondly, I applied the Lapis infernalis to the depending part of the Tumor: Thirdly, I opened the Apostem, making 〈◊〉〈◊〉 a small Orifice thorow the Esch••••. Fourthly, every day I dressed the Sore, still suffering a little of the Quittour to flow out, untill all was discharged. Fifthly, I used a m••n∣difying Injection, untill I per••••••e•• the Sore to be clean, not slia••∣ing, and so to afford both lauda∣ble, and small store of laudable Quittour. Sixthly, I used a ••••••∣solidative Injection, and Bo••••∣sters somewhat thick, to comp•••••• the Sore.

The mundifying Injection was this: ℞ Vini albi lb. j. M••••s Rosati ℥ iij. Ʋnguent. Aegyp•••••••• ℥ss. Misc. ut fiat injectio usa∣panda caada. The consolidati•••• Injection was this: ℞ Aq. Phe∣tag. ʒ iv. Srrup? Myrttni & 〈◊〉〈◊〉 Ros. rub. siccat. an. ʒss. Tro••••••se aiber. Rhas. sine Opio. ʒ ii. Mis•••••• fiat injecsin, applicanda item ca•••••••• All such Injections must be waun∣ed; for cold, as Hipp••••••es witnesseth, is hurtful to the S••••∣na••••s Medulla. The Emplister which I used was Diach•••••••• cum Gummi. By these mears I cured the party in three Weeks space.

Now Ulcers of the Abdomen, or of the lower Belly, do offer themselves only to be but compen∣diously touched. Seeing there are three parts of it, Regio Epigastrica, Ʋmbilicalis, and Hypogastrica, the upper, the Umbilical, and lower Region; I am to shew unto you what parts in these Regions most commonly suffer ulceration.

I saw the Stomach of one Mi∣shess Ferne, together with the Muscles perforated by the Erosion of a sharp Humor, in the Howlt, a Town distant from Chester five Miles: the Meat, Drink and Chyle came thorow the perforation: the Ulcer also smelled strongly. I being unwilling to deal with her, prescribed some local means, which wrought but small effect; for she died of a Marasmus, or extenua∣tion of the Body, within a short time: the Ulcer hindring the Chy∣lification of the Aliment, and so defrauding the Body of nourish∣ment. My Opinion was then, and now is, that Ulcers penetrating in∣to the cavity of the Stomach are mortal, tho Wounds of this kind be sometimes cured: for in the se∣cond there is but a bare Solution of continuty; but in the former there is a Solution of continuity having annexed to it the sharp∣ness and malignity of a Matter. Here in London, in an Inn a little above Fleet-conduit, one Richard, who was Tapster of the Inn, had for a long time a great pain in the right Side of the Epigastrical Region of the Abdanen: In progress of time there appeared a great hard Tu∣mor, causing a sharp Fever: at last the Plegmon breaking of it sell, sent out great store of Quit∣tour. I then lodging at the Sign of the Naked Boy, a little below the Conduit, was sent for, finding him in a strong Fever, and having difficulty of breathing, the Tu∣mor of the Liver hindring the free motion of the Septum trans∣versum, the Instrument of Natural Respiration, I pronounced his Grief to be mortal, and so it fell out: for tho no rational means were omit∣ted, fit to have recovered the party, if the Grief had been cura∣ble, yet the party died. It were but fruitless labour to set down the Me∣dicaments which were used, seeing they prevailed not.

This History I thought good to set down, that you may imagine what the Event is like to be, if you should be called to the like Grief.

It falls out sometimes, that su∣perfluous flesh grows above the Navel, if it be slackly bound, and be left somewhat long, which doth become ulcerate: This I saw once in Tavestock, a Town in the West Country, in Devonshire, in a Child of Master Moon's, a Draper of that Town. I having been called to the Cure, first bound off the Navel by a strong Ligature, afterwards I cured it by the Application of Ʋn∣guentum de cerussa.

In the Groin after a Phlegmon of it opened, oftentimes an Ulcer is left, penetrating thorow the oblique and transverse Muscles of the Abdomen: If you perceive such an Ulcer, pronounce it not to be of easie cure, chiefly if it fall out to be after a Venereal Babo: For first, there is Morbus cum causa, a Grief having the cause annexed: Secondly, it corrupts the Fibres of

the Muscles: Thirdly, it corrupts sometimes the Vertebrae of the Loins, in which case all Medica∣ments are fruitless, because the grief is mortal: This happened to a young Woman, who dwelt with the Lady Lucie, whom Master Napkin dressed, and opened after her death. Both Dr. Gifford and I were called to view the Sore sun∣dry times; and thô means were used for her recovery, yet they did not prevail; so that she died of a Marasmus, the Body becoming extremely extenuate; although she seemed to be of a firm and thick habit of Body, when the Tu∣mor first appeared. If any such Tumors come to your hands, after they are brought to maturation, use the general means prescribed for the cure of a Lues Venerea, lest the like event happen to you.

I will touch briefly the cure of Ulcers of the Joints, which differ∣eth but very little from the cure of Ulcers in other parts, saving that they require Medicaments of more desiccation without any sharpness, and more powerfull anodyne cata∣plalins for asswaging of pain, which is, an inseparable accident of Ul∣cers, seizing upon these parts.

Apply then to the Sore Desicca∣tivum rubrum, and annoint the brims with this liniment: ℞ Ʋn∣guent. popul. & albi Caphurati an. ℥ j. Ol. Cydonit. & Papaverin. an. ℥ss. Mise. ae fiat liniment. ex arte. Before you apply your Medica∣ments, foment the part with a fo∣mentation made of Sumach, Pome∣granate Pills and Flowers, red Ro∣ses dried, and Myrtle-berries infu∣sed in astringent red Wine, being put into a long and narrow Gally∣pot, and set it in a warm place, or in a Posnet having in it boiling water.

In curing of these Ulcers often purging is required, to stay the flowing of sharp Humors; but see∣ing every purgative Medicament is not of like efficacy, I will set down one as a pattern, after which you may frame others: ℞ Car••ocestin. & Elect. de succo ros. an. ʒ iij. sy∣rup. ros. solut. cum Agaric. ℥ j. aq. Cichor. ℥ iij. Misc. ut siat petie. You may either detract from the quantity of the purging Electu∣aries, or add to them what you shall think sit, after you have di∣ligently considered the strength of the party.

THE PRACTICE OF CHIRURGERY. BOOK III.

CHAP. I.

Of the description of a Wound, the differences, and general fountains of special Prognostications.

I Having completed the Do∣ctrine of Ulcers, which was the Second Treatise of the First part of Chirurgery, called by me 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which teaches the unition of parts d••••oined; now order of Doctrine requires, that I discourse of Wounds in like manner, whereby the appa∣tent solution of the unity of the soft parts of the Body is procured, as well as by Ulcers.

Of this Treatise there shall be Two parts. In the First I will set down those things that con∣cern Wounds in general. In the Second Part I will shew how Wounds of the several parts of the Body, which require special con∣sideration, are to be cured.

In the general Doctrine con∣cerning Wounds, I will set down these three things; The First shall be of the nature of a Wound: The Second of the general Progno∣sticks of Cure: The Third shall be of the last scope of the Chirurge∣on. The Nature of a Wound is made manifest by setting down, First, what a Wound is; Secondly,

which be the main differences of Wounds. In shewing what a Wound is, First I must deliver the denomination of it: Secondly, the description of it.

A Wound so called in English, in Latine is termed Vulnus, and in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Now to set down the variety of descriptions that are assigned by Authors, who have de∣livered Monuments of this subject to posterity, it would prove a task more laborious than fruitful: and the examination of them would serve rather for ostentation, than edification. Most of them which are set down by modern Writers, will not endure the trial of the Laws required by Logicians in a good Definition. Wherefore I will leave the refutation of the escapes committed by Authors in this matter, which only teaches what is not to be learned. Hieron. Fa∣bricius ab aqua pendente Chirurgiae suae part. secunda lib. 2. c. 1. thus defines a Wound.

It is a solution of continuity caus∣ed in a soft part of the Body by an external instrument: for explica∣tion of himself he adds. By a seft part, whereby I understand every substance of the Body, the Bones being excepted.

But by his good leave, as a so∣lution of unity in the Bone caused by erosion and putrefaction, is cal∣led 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or caries, and if it be caused by a violent but blunt ex∣ternal instrument, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or fractura; so if a soluti∣on of unity be procured in it by a sharp incising instrument it may be called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ••••bius, a Wound. Truely Hippocrates in his sixth Section in his Treatise of Wounds of the Head thus speak∣eth: Vulnerum ossis capitis tot sunt genera: Of the Wounds of the 〈◊〉〈◊〉 of the Head, so many sorts there are, &c. Besides this, in adding to a cariosity of the Bone caused of a corrupt Humor, and to a fra∣cture procured by the violence of a blunt instrument, a Wound in∣flicted by a sharp instrument inti∣sing, the discourse will be more methodical and plain: To the end then that you may fully know the nature of a Wound, receive this description of it.

A Wound is a Solution of Ʋni∣ty, caused by an external Inst••••∣ment incising in any part of the Body. In this description you are to note these four things; The First is the Genus; The Second is the efficient Cause of it; The Third is the Subject of it; The Fourth is the manner of making a Wound. The Genus is comprehended in the first words, where it is said to be a Solution of Ʋnity; for this is common to a Tumor, Uker, Wound, Fractures of the Bones, and Luxations of the same, be∣cause in all these there is a Soluti∣on of Unity; The efficient Cause is said to be an external Instru∣ment: An external Instrument, I call that which is without the Cuticula or scarf-skin, and has no coherence or familiarity with the parts of the Body, as a Sword or Knife. By the efficient Cause it is distinguished from an Ulcer: For as an Ulcer is procured by a sharp internal Humor eroding; so a Wound is caused by a sharp ext••••∣nal Instrument incising. The Sub∣iect wherein the wound is recei∣ved, I assi•••• to be any part of the

B••••, whether the part be exter∣ral, as when the Head is wound∣al with a Sword; or internal, as when the Stomach is cut, either by a piece of Glass, or a Diamond swallowed, they being sharp edged or peinted. And if the Bone b e incised, as well as the soft parts, a Solution of Unity in it is called ••••nus, a wound, against Fab. ab ••••a pendente. The manner of in∣flicting a wound is termed by me Incision, or Division by cutting: and this term makes the difference between a Wound and a Contusi∣on: for as a Contusion is caused by a blunt Instrument forcibly separa∣ting; so a Wound is inflicted by a sharp Instrument incising. Thus you have the description of a Wound, and the explication of eve∣ry part of it briefly set down: By which you may examine the desi∣uitions of others who have written of this subject, when you shall take them into your hands.

The Second point which I af∣firmed fully to make up the na∣ture of a Wound was, of the dif∣ferences of it. And in setting down of these, expect not the full enu∣meration of all which may be na∣med, as those taken from the quantity, whereby a Wound may becalled great or small; or from the time and continuance, from whence a Wound may be said to benew or old, and such like, which must be touched in the Progno∣sticks of every particular Wound. Onely I will deliver such as are ta∣ken more inwardly from the na∣ture of a Wound. Then a Wound is either such a one as was known to the ancient Writers, or was un∣known: the Wounds known to the ancients are either simple or compound: the compound are ei∣ther mild or malign: the malign are either caused by a poisoned weapon, or bitings, or stingings of venemous creatures. The Wounds which were not known to the ancients, are those which are made by Gun-shot. Here you have the requisite and necessary diffe∣rences of Wounds, which do cause some variation in the cutting, re∣presented to the Eyes of your Mind, as in a Table which in my proceeding I mean to handle ex∣quisitely. So much then shall be sufficient to have been set down concerning the nature of a Wound, which I affirmed in the beginning to be manifested, by delivering the description of a Wound, and the divers kinds of it: Now it fol∣loweth that I speak of the Second general point, to wit, of the ge∣neral Prognosticks of Cure in Wounds. Whensoever then a wounded person is presented unto you to foretell the event with∣out error, you are to consider that Wounds are two-fold: for they are either mild, which are ea∣sily cured, as a small wound in a fleshy part; or they are grievous, and cured with some difficulty at the least. Grievous Wounds are either periculosa, or malefica, or lethalia, or difficilia, Periculosa, or dangerous Wounds, are such as sometimes are cured, thô for the most part they bring death; such are superficial wounds of the Brain. Difficilia, or Wounds of hard cure, are such as may be cured, if they be skilfully dressed; but if they be not handled by a cunning Chi∣••urgeon, remain uncured, as some

penetrating wounds of the Breast, Malefica, or mischievous Wounds, are such as leave a hurt still after them, when they are cured: such is a Wound by which a Muscle is cut transverse quite asunder; for then the use of that part is taken away, which was moved by that Muscle.

Lethalia, or deadly Wounds, are such as bring inevitable death: such are Wounds which divide the great vessels near to the Liver or Heart. So the noble D. of Buck∣ingham was dispatched by a wound which he received in the Arteria venosa.

If you would know to which of these a Wound (which is offered to you to be cured) is to be refer∣red, you must diligently examine these four things: First, the part affected. Secondly, the adjuncts of the Wound. Thirdly, the ha∣bit of the Body. Fourthly, the things not natural.

As for the part, you are to con∣sider, First, its Dignity: Second∣ly, its Substance: Thirdly, the temperature: Fourthly, the situa∣tion of it: Fifthly, the quanti∣ty in the bigness and number: Lastly, the use of the part.

Adjuncts to be considered in a Wound are these: the bigness, the Figure, the Situation, the Symptomes, and last of all, other diseases complicate with the wound, as the French pox, or Dropsie.

As for the habit of the Body, you are to consider, whether it be good or ill, of a loose or a firm substance, whether it be full or extenuate: neither is the tempe∣rature of it to be neglected.

As for the things not natural, as Air, Meat, and Drink, sleeping and Watching, and the rest of them, I will shew the use of them when I am come to the consideration of every particular Wound.

Now it follows, that I shew you the use of these Prognostical Springs or Fountains, by setting down some Predictions derived from them.

First, a noble part, the Origina∣tion of a Faculty, in continual motion, the Body being of an ill habit, receiving a great wound, must of necessity cause death: By Induction I will make this ma∣nifest.

Secondly, the Heart being deep∣ly wounded, causes either a sudden or speedy death. First, because it is a principal part: Secondly, be∣cause the natural Faculty proceeds from it: Thirdly, because it is in continual motion: Fourthly, be∣cause it is of a hard and compact substance, and so not easily united: Fifthly, because it is a very hot part, and so very subject to inflam∣mation: Sixthly, because it is sin∣gle, and there is no other part which can perform the function of it.

Thirdly, Wounds of the Brain in like manner are deadly, if they penetrate to the Basis: Because it is a principal part, the well-spring of the animal faculty, in continual motion: and because Inflammati∣on, and a sharp Fever ensues. If a wound of the Brain be only su∣perficial, it is to be accounted on∣ly dangerous; partly because the motion is gentle, partly because the substance of the part is soft, and so apt to receive Consolidation.

Fourthly, small Wounds of the Liver, thô they be dangerous;

yet they may admit Consolidation: First, because the substance of the Liver is like coagulate Blood, and so may easily be united: Secondly, because if one part of it be wounded, the other will do its Office; as we may observe in those, the part of whose Liver is possessed with a scirrhous Tumor.

Fifthly, a Wound received in the Vena cava, within the Belly or Breast is deadly: First, by reason of its substance; for being nervous, it hardly admits Consolidation:

Secondly, by reason of the situ∣ation of it; for a Chirurgeon can hardly come to it to apply any lo∣cal Medicaments.

Sixthly, Wounds in the fleshy parts of the Diaphragma, or Mid∣••••ff, are dangerous: First, because we cannot come to dress them: Secondly, because it is in continual motion: Thirdly, because the parts within the Breast are easily infla∣med. But if it be wounded in the nervous parts, inevitable death ensues, because a delirium by rea∣son of the inflammation always en∣sues, and sometimes a Convulsion.

Seventhly, Wounds of the Lungs are sometimes deadly, if a great vessel in them be divided, as the Vena arteriosa. Yet if the party live, they prove most commonly m••••chievous, leaving a Fistula: of the cure of which I discoursed in my Treatise of Ulcers.

Eightly, Wounds of the Spleen, if they be not great, and procure not an Hemorrhage, they are not deadly: Because it is neither a prin∣cipal part, nor the Origination of any Faculty; but only appointed by Nature to be a Receptacle of saeculent and black melancholick Blood.

Ninthly, Wounds of the Costis fellis bring death at last, thô slow∣ly. First, because we cannot come to it conveniently to apply sit Me∣dicaments. Secondly, because it is of a nervous substance, which doth not easily admit unition. Thirdly, because the Humor which it ought to contain until the time of excretion; corrupts the parts, unto which it is sent.

Tenthly, a Wound in the mouth of the Stomach is grievous: First, because it is of an exquisite Sense. Secondly, because fearful symp∣tomes, and swoundings and faint∣ings ensue. Thirdly, because there must be a difficulty of swallowing.

Eleventhly, Wounds of the Kid∣neys, if they pass not to the Ca∣vity, bring not inevitable death: yea, some are of opinion, that 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, that is, extraction of stones out of the Kidneys by in∣cision, may safely be administred. Of this operation I will speak in its own place.

Twelfthly, Wounds of the small Guts are for the most part deadly: First, because they are of a mem∣branous substance: Secondly, be∣cause they are of an exquisite Sense. But Wounds in the thick, Guts are more easily cured; be∣cause their substance is more thick and so admits more promptly ag∣glutination; and being not so sen∣sible as the small Guts are, faint∣ings and other fearful symptomes do not so frequently invade.

Lastly, if one be wounded in the Mesentery, inevitable death must ensue: First, because there must be a great Flux of Blood by reason of the multitude of Veins in it: Se∣condly, because we cannot easily

come thither, to apply local means: Thirdly, because the Chyle is stay∣ed from passing to the Blood; and so Sanguification is hindred, with∣out which the Body cannot sub∣sist.

I did affirm some Wounds to be maligna, or mischievous, which leave some hurt or imperfection in the parts after they are cured: of such receive these Examples fol∣lowing.

First, a Wound above the Eye∣brows, with a Fracture of the Scull, when the Wound is incar∣nate, can hardly be brought to a cicatrice.

Secondly, if the Brain be re∣markably wounded, the party re∣mains foolish, and more stupid than he was before.

Thirdly, if the bottom of the Stomach be wounded, imbecillity and weakness of Concoction en∣sues.

Fourthly, if a Nerve or a Lige∣ment which ties Bones together, or a Muscle be transversly cut asunder, motion is hindred.

Fifthly, when the Glarea, or the substance which is found in the great Joints to moisten them, re∣sembling the Whites of Eggs, is let out by a Wound, the Joint grows stiff; and so the motion is impaired.

CHAP. II.

Of Symphysis and Syssarcosis, and the means of staying an immoderate Flux of Blood in a Wound.

HAving in the former Chapter set down the two first Points of the general Doctrine of Wounds, to wit, the Nature of a Wound, and the Fountains from whence Prognosticks of Wounds are fetch∣ed; and having by propounding some Examples shewed the Pra∣ctice of them: Now I am to set down the third general Point, which is the last scope and end which the Chirurgeon proposes to himself, when he goes a∣bout to cure any Wound; and that is the Unition of the parts joyned.

First, then I will set down the divers sorts of Unition or Union of the parts; then the Causes which procure this Union.

Of Union then there are two kinds; the first is called Symphy∣sis, or Agglutination, or Concreti∣on. The second is named Syssar∣cosis, Colligation, or Concarnation. Symphysis is the Ʋnition of parts

disjoyned, no middle substance con∣carring.

This kind of Union is said by Chirurgeons to be performed by the first Intention. And if the team of the first Intention or Scope were not so to be taken, that would be absolutely false, which Hippocrat. 6. Aphorism. 19. af∣firms, that the Praeputium or Fore∣skin being cut asunder, doth not admit Unition. But it is not to be doubted, but that it will admit Consolidation by a fleshy substance ••••iting the parts disjoyned: tho this cannot be done by meer Ag∣glutination. And whereas Galen, 90. Art. Medic. avers Union in the instrumental parts to be im∣possible; to make this good which he affirms, we must observe one thing, that in this place an instru∣mental part is not taken in its amplest signification, by which it comprehends all parts that are mi∣nisterial to other parts: and so Veins and Arteries are instrumen∣tal parts; because they serve the the Heart for distribution of Blood and Spirits for the maintenance and good of the Body. But an in∣strumentary part is here taken as it is opposite to a simple part: for all the parts of the Body are either simple, as the Flesh, Veins, Fibres, &c. or compound or in∣strumental, as a Finger; and so instrumental parts taken in this signification are not united by Sym∣physis, they being wounded; but by Syssercosis, that is, not after the first, but second Intention. And so Galen in 91. cap. following ex∣plains himself: where talking of a Wound in a Bone, he says, But if a Bone suffer Solution of Ʋnity, it cannot be united, as I said: And he addeth this Clause, Yet may be united by the second Scope. He means by the growing of a fleshy substance between the parts of the Bone severed.

But you may demand of me, what parts admit Unition by Sym∣physis, or the first Intention?

I answer, that the fleshy parts disjoyned admit this sort of Conso∣lidation in all the Periods of Life, and the Spermatick Parts before the seventh year be expired, a Bone being excepted: but they are only united by the second In∣tention after the seventh year ex∣pired.

The second kind of Unition of parts severed by a Wound is called by Galen de comp. Med. secund. loc. cap. de plaga, Syssarcosis: and it is nothing else but the Ʋnion of parts disjoyned, by a middle sub∣stance. Now this Substance is sometimes like the parts which it unites, as in Wounds in fleshy parts: or it resembles not the part which it unites, as in Wounds of the spermatick parts after the se∣venth year.

Having delivered unto you the two kinds of the Union or Con∣solidation of parts separated by a Wound, now I come to the Causes of Unition or Consolidation of the parts separated. These Causes are either efficient Causes, or instru∣mental. The efficient Causes are two, to wit, Nature, and the Chi∣rurgeon. Nature out of doubt is the chief efficient Cause; for she ever labouring to preserve her self, sends unto the parts of the Body so much of the natural Balsam of it as is sufficient to unite the parts

disjoyned. If you would know what I mean by the term of the natural Balsam, I mean the Radi∣cal and Alimentary Moisture, the seat of the natural heat, by which two every individuum or singu∣lar person is maintained, and sub∣sists.

Now there are four things which may hinder Nature from effect∣ing of the Union of parts disjoyn∣ed: The first is an evil Conforma∣tion; as when the brims of a Wound are not proportionally and handsomly united and set together. The second is the continuance of this ill Conformation. The third is an unnatural Body remaining in the Wound: this unnatural Bo∣dy is either unnatural by Event, as a shiver of a Bone separated from the whole, or by its own Na∣ture; as when a piece of the Wea∣pon which wounded doth stick in the Wound. The fourth is the Distemperature of the wounded part: for if it be either too hot, or too cold, the Distemperature must be removed, and the natu∣ral Temperature restored, before Unition can be expected or pro∣cured.

The second efficient Cause of U∣nition of parts severed by a Wound, I affirmed to be the Chi∣rurgeon: he is the Minister, not the Lord of Nature, and is only to further her designs, and to la∣bour to remove the Lets and Im∣pediments which may hinder her from attaining her purpose, which is the Restitution of the parts dis∣joyned to their natural Union. The Chirurgeon then is to perform some Duties. Now these Duties are ei∣ther common to both kinds of U∣nition, to wit, Symphysis and Sys∣sarcosis, or they are proper to each. The common Duties are in num∣ber seven, First, the staying of Blood. Second, the removing of strange Bodies from the Wound. Third, provision that no such Bo∣dies fall into the Wound. Fourth, that he maintain the natural Tem∣perature of the part. Fifth, that ••e restore it, if it be lost. Sixth, the consideration of the Quittour and Excrements, which flow from the Wound. Seventh, is the removing of general Acci∣dents.

In the staying of Blood the Chi∣rurgeon is to set two things before his Eyes: The first is, how much Blood he is to suffer to flow be∣fore he stay it, if the wounded person must lose any Blood? The second is, by what means the Blood is to be stayed?

As for the quantity of Blood which is to be suffered to flow; you may suffer it to flow plenti∣fully, if the party be of a sanguine constitution, have a sleshy habit of the Body, if the Veins be large, and if the Season be hot; for this hinders Inflammation to ensue. If you find Indications contrary to these, then it must flow but sparingly; for it is the Treasure of Life.

The means of staying of the Blood are in number eight.

The first is, the application of Pledgets, or Dosils of Lint or ••••ow mo••stned either in the Whites of Eggs beaten, or in Vinegar and Water, taking in tender Bodies one part of Vinegar, and three of Water; but in hard Bodies you

may take one part of Vinegar, and two only of Water. This mix∣ture is called Posca: it must be applied warm; for cold Applica∣tions are hurtful to Wounds. Ap∣ply not dry Lint, or Two dry, to a Wound bleeding in any way; for they cleave so firmly to the brims of the wounded parts, that they procure often a new flux of ••ood, when they are removed: see∣ing they must with some force be remored: Unless Fomentation with some moistning and malaxing ••••••or be used, as with Milk or ••••tter, and Beer warmed: which ••e not to be used in Wounds in ••e fleshy parts.

The second is the Deligation of the Vessel, which sends forth ••ood, whether it be a Vein or Artery: This is to be used when geat Vessels are wounded. Am∣••••se Parey lib. 11. c. 20. would ••••••e this mean to be used after the Amputation of a Member, 〈◊〉〈◊〉 you may read: but in my ••••dgment his practice is but a ••••blesome and dangerous toy: a be shall find, who shall go to ••de trial of it. In the Deligation 〈◊〉〈◊〉 a Vessel, two things are to be ••••fidered.

The first is, that if a Nerve ac∣••••pany the Vessel, which sends ••uth Blood, (as you may see in the 〈◊〉〈◊〉 Artery, which hath the ••••••rent Nerve annexed to it,) 〈◊〉〈◊〉 are with your Nails to sepa∣••••e the Nerve from the Vessel; 〈◊〉〈◊〉 the part into which the ••e••e is inserted shall be deprived 〈◊〉〈◊〉 ••••••ing, and feeling; and ex∣••••••dnary pain will be caused.

The second thing to be consi∣dered, in the deligation of a Vessel is, that the binding be not too strait, because so the Vessel shall be cut asunder too soon, and so a new fluxion shall be pro∣cured.

The Thread, wherewith the Vessel is bound, must be either of strong Silk or Steel-hemp, as they term it, such is sealing Thread: For these are not so subject to pu∣trefaction, and so there is less fear of a new Hemorrhage, which would prove more dangerous than the first.

The third mean to stay bleed∣ing, is the application of Sarco∣tical, or Incarnative Medicaments. Such is that which Galen prescribes, 5. Method. 4. of Aloes, Frankin∣cense, the Down of a Hare, and the White of an Egg, all being brought to the consistence of Hony. In tender Bodies, take one part of Frankincense, and two of Aloes: In hard Bodies, one part of Aloes, and two of Frankincense. In those, who have a mean habit of Body, use equal parts of both. Olibanum in guttis is better than Frankin∣cense. Apply this Medicament up∣on Pledgets or Dosils of Lint or Two. The manner of dressing is this. Couch the Vessel with the Finger, then cleanse the Wound from the clotted Blood, and all moisture, with a piece of Sponge wet in red Wine, or any astringent Decoction. Afterwards besprin∣kle the parts of the Wound about your Finger, with the Powder of Aloe and Frankincense. Then ap∣ply a Pledget or a Dosil armed with the forenamed Medicament, which presently press down with

your Finger. Last of all, keeping down the Applications either with your Finger, or with a Probe, fill up the Wound with Pledgets or Dosils armed. This being done, nothing remains, but to apply a double Cloth moistned in some astringent Liquor, and wrung, to the wounded part, and to roul it up; begin to roul below the Wound; when you are come to the Wound, compass it with three or four Circumvolutions: Then ascend and roul the part above the Wound, to press the Blood out of the Vessel, and so the flux of Blood will be stayed. You are not to open the Wound afterward, but either upon the third or fourth day. Then all the Pledgets or Dosils, except the last, which im∣mediately cleaves to the Vessel, are to be taken away, and new ones to be applied; the wounded parts having been besprinkled with more of the Powder. Thus you are to dress the Wound every o∣ther day, until the part be incar∣nate, and no fear be left of any more bleeding.

The fourth way to stay bleed∣ing, is the injection of astringent Medicaments; if we cannot come to reach to the Vessel with the Finger, by reason of the depth of the Wound, such are Bole Arme∣nick, terra sigillata, marking stone, Hypocystis, sanguis Draconis, new Galls, Juice of Sloes, Plantain, Comfrey, Knotgrass, Milfoil, Horse∣tail, and Leeks; of these you may frame such Compositions as this is: ℞ Succi consol. Major. Poygon. Equiseti an. ℥ss. Succi fol. porri ℥j. Bol. Oriental. ʒj. Sanguin. Dracon. ℥ss. Misc. Such Medica∣ments are powerful, when the Menstrual Courses in Women flow immoderately.

The fifth way to stay bleeding is in the tranverse section and cut∣ting asunder of a great Vessel, which pours out the Blood. When∣soever a horrible essusion of Blood follows after a Wound, you may gather that the Vessel is not cut asunder tranverse, unless there be an enormous separation of the parts wounded, not differing much from dismembring: for if the Ves∣sel be cut tranverse wholly asund•••• by a sharp Weapon, that part o•• it which is next to the radication of it, shrinks up towards its be∣ginning, and is covered with th•• flesh of the adjacent parts. If suc•• a case be presented to you, follo•• Gal. his counsel, who 5 Meth. •• advises, that you lift up the Vess•• from the subjacent parts with 〈◊〉〈◊〉 silver Hook, and so divide it being separated; and that afterward yo•• twist the upper part of the Vesse•• which is easily done by laying ho•• of that part of the Vessel which without the Hook. That kind 〈◊〉〈◊〉 silver Hook which is used in Anat••∣mical dissections, is sittest: for th•• wreathing of the Mouth of th•• Vessel hinders the effluxion 〈◊〉〈◊〉 Blood.

The sixth way to stay Bleedi•• in a Wound, is to cause an Esch•• Now this may be done either 〈◊〉〈◊〉 an actual Cautery, or by an 〈◊〉〈◊〉 charotical Medicament: But 〈◊〉〈◊〉 ought not, but upon great nec••∣sity, to have recourse to Usti•••• First, because it is horrible to t•• sight and apprehension; for it do•• in a manner exanimate cowar•• persons. Secondly, because the be••

fit of it is uncertain: for often∣times after that the Crust or Es∣char is fallen, a new Hemorrhage ••••sues. If you be driven to use the actual Cautery, then you are to observe two things in the Acti∣on: The first is, that you cleanse the Wound from closted Blood, that the Vessel may plainly ap∣pear, otherwise you having burned only the coagulate Blood, you shall think the burnt Blood to be a Crust caused in the Vessel, which is not so; and so the next day it being ••••ffolved, will give way to a new f••••••ion. The second is, that you apply the Actual no more than ••••ce, or twice at the most: for by the first impression of the Cautery, the Vessel shrinks together; but by the second it is wrinkled, if you apply the actual Cautery a third time, it is turned into a Coal, which being dissolved by the ••••istore of the Blood in the Vessel, will fall away, and so ••••ke way for a new fluxion of ••••ood.

The Medicaments which stay ••••eeding by causing of an Eschar, ••ethese, Vitriol, Alume, Ae••yptia∣•••• sharpened with calcined Vi∣••••••, Oyl of Vitriol, and Oyl of S••phur, Aqua Fortis, and Aqua 〈◊〉〈◊〉, the Trochises of Minium ••••••bed by Vigo. But a Medica∣tant made of Umber, an Earth, which the Painters use, and Calx 〈◊〉〈◊〉, exceeds all these: for it c••••ses little pain, and mighti∣ly closes the Mouths of the Ves∣sels.

About twenty years ago return∣••••g from the Bath in Sommerset∣scare to the Howlt five Miles from Chester, where then I remained, having lodged in Newport in Shrop∣shire by the way, I was called by the Lord Gerrard to Gerrards Bram∣ley, to take a view of his Taylor, who had fractured both the Fo∣cils of the Leg, a little below the Knee, about the breadth of a palm, When I beheld a Fracture with a Wound, and an extenuati∣on of Body (for the Accident fell out ten Weeks before) neither were the Bones united; and be∣sides, there was a great Tumor in the Knee; I pronounced a lingring death to the party, unless he were out of hand dismembred above the Knee. Being intreated by the sick party and the Earl, to perform this Operation, I yielded unto their request; but having by me neither Instrument nor Me∣dicaments, thus I supplied the de∣fect of both: I made a Medica∣ment of Umber and unslaked Lime, taking equal parts of both, which I found there, the House then being in reparation; I used a Joyners Whip-saw newly touched: And in the presence of two Chi∣rurgeons, Mr. Cole, who dwelt in L••chfield, and Mr. Heywood, who dwelt in Newport, I dismembred the Lord's Taylor, to whom the Lord gave ten pounds a year during his life time; who lived many years afterward. When I dressed the Wound the fourth day, I found the Mouths of all the Vessels shut by incarnation, so powerful was the restrictive Medicament, made of equal quantities of Umber and unslaked Lime, rubbed to a fine Powder, and reduced to the form of a Liniment by the addition of the Whites of Eggs beaten, and the Down of an Hare. Fallopius in

his Book of Wounds hath an in∣genious device, which is this. He will have you to take a Reed, which in bigness is answerable to the capacity of the Wound. The one end being stopped with a Cork, he will have you to fill it with German or Hungarian Vi∣triol melted; when the Vi∣triol is cold, it is to be thrust in one end an inch without the Reed, and to be kept to the Vessel for the space of an hour; in which space of time the Mouth of the Vessel will be shut firmly.

Seventhly, a Flux of Blood is stayed by opening of a Vein in the opposite side, tho much Blood hath been lost; but the Blood must be drawn leisurely; Besides this, the extremities of the Body must be bound with reasonable strait Ligatures, where it shall seem best to the skilful Chirurgeon.

The eighth way to stay Blood, is to cool tho whole Body: for so the Blood is congealed, and made unapt to flow: This is performed two manner of ways: First, in letting down the wound∣ed party, laid in a Sheet, into a Bath of extreme cold Water, to procure a Lipothymy or Fainting; and by this the Spirits return from the extremities of the Bo∣dy to the Center. Secondly, this is performed by Narcotical Medicaments: Receive this one as a Pattern: ℞ Diascord. ℈ iij. Philon. Persici ʒ ss. Syrup. Papav. albi ℥ j. Aq. Papav. errat. aut spermat. ranar. ℥ iij. Mise. ut si••t P. sumenda frigida: After the Patient hath taken the Potion, let him be kept quiet, and let him compose himself for sleep. Al∣though this Dose of Narcoties may seem too large, yet it may be given again after twelve hours are expired, if need shall require: These two last practices are excel∣lent in immoderate Hemorrhages at the Nose.

CHAP. III.

Of removing extraneous Bodies from a Wound.

THe second Duty which a Chi∣rurgeon is to perform for Nature, in assisting her, in fur∣thering her inclination, and in pro∣cering Unition of the parts sever∣el by a Wound, is, to provide that to external or strange Body be suf∣fered to be in the Wound, which may hinder Unition. In this Point two things are to be set down: First, the differences of strange or extraneous Bodies: Se∣condly, the means by which they ••e removed. As concerning the differences of these Bodies, they are extraneous either by Accident, 〈◊〉〈◊〉 of their own Nature. Those which are extraneous by Accident, ••e of three sorts: for they are ei∣ther soft, as pieces of contused or squ••ted Flesh, and clots of Blood; or they are hard, as pieces of Bones or Cartilages; or they are of a mean substance, as pieces of Membranes, Tendons, Chords and H••••t. Now these Bodies which ••e extraneous of their own Na∣ture, are either soft, as pieces of the wounded mans Garments; or ••••••d; and these are either metal∣l••e, as pieces of Steel, Weapons and Bullets; or not metalline, as 〈◊〉〈◊〉 of Wood, Gravel, and such 〈◊〉〈◊〉

Having described, as it were in a Table, the divers sorts of extra∣neous Bodies (to help the Memo∣ry) which are able to hinder the parts disioyned in a Wound, as long as they continue in the Wound; I am now to deliver un∣to you the ways and means by which they are to be removed, and taken out of Wounds.

First, then, things extraneous accidentally, as clotted Blood, Hair, Dirt or Gravel, they may be wash∣ed away with Claret or white Wine warmed, Aqua vitae, Vine∣gar and Water, Oxymel dissolved in Water: or if you be in the Country, where these things can∣not be had, you may use Milk, or Beer, or Ale warmed. You are not to omit cleansing of the Wound with a Probe armed with Lint. If splints of Bones, or pieces of Flesh, Membranes, Ten∣dons, or Ligaments stick in the Wound, you are to take them out either with your Forceps or Ravens Bill.

Having shewed you, how things accidentally extraneous, which might hinder Unition of the Wound, are to be removed; now I must in like manner set down

how Bodies of their own Nature extraneous, which stick in the Wounds and hinder Consolidation, as pieces of Weapons, Bullets, and such like, are to be taken out. In the extraction of these Bodies, you are to set before your Eyes these two things; to wit, the Cir∣cumstances and the manner of ex∣tracting of them; as for the Cir∣cumstances, these two are to be observed.

First, that you attempt not the extraction of such Bodies as can∣not but with great difficulty, pain and danger be drawn out, and with the which remaining in the Body the Wound may be cured; such are Bullets sticking deeply in the great Joynts, as the Elbow and the Knee.

The second is, that you go not about the extraction of such Bo∣dies, if you see the Wound to be Mortal, and that the Party must Die, the Prognostick of such Wounds I delivered unto you in the first Chapter of Wounds, whither I remit you: for if you draw out the Weapon wherewith a great Vessel of the Liver or Heart is wounded, you shall ha∣sten Death: so the pulling of Feiton's Knife out of the Body of the Duke of Buckingham, the Ar∣teria Venusa having been wounded, procured speedy Death. So much then of the Circumstances to be ob∣served, before the drawing out of extraneous Bodies.

Now I will acquaint you with the means, by which they are to be removed: The means are two: Medicaments and Instruments. We use Medicaments; First, when the Extraction cannot easily be per∣formed; as when we cannot lay hold upon the extraneous Body by any fit Instrument: Secondly, when there is no suspicion that the Wea∣pon was poysoned, or that Aposte∣mation is not like to ensue. If therefore a Thorn, or a Needle so stick in a part, that they cannot be taken out, without great p•••••• and large incision of the part, it is best to have recourse to Medica∣ments. I saw one who carried a Thorn, which run into his Leg a∣bove the Tibia, between the Pe∣riosteum and the Skin, (when he thrust through a Hedge in Hunt∣ing,) five years. The Medica∣ments which have a faculty of drawing out those Bodies, which of their own Nature are extraneous, are of two sorts: for they are ei∣ther Simple or Compound.

As for the simple Medicaments, they are of three sorts: for some effect this by an hidden or occult faculty: Of such Paulus Aegi∣neta, lib. 4. cap. 52. writes thus: Pieces of Weapons, Ar••••u••s and Thorns, which stick in the Body, these things under written 〈◊〉〈◊〉 out; Both the Pimpernels, the Root of Aristolochia rotunda, Am∣monlacum, leaves of Henbane stamped, and applyed in form of a Cataplasm, Root of the Reed lea∣ten and mingled with Hony. You may add to these horned Poppy Leaves stamped, and used as Hen∣bane.

Other Medicaments extract such Bodies by an accidental heat pur∣chased by Putrefaction, as Bird∣lime, stinking old Pigeons durg, Leaven, and such like.

The third part of such Medica∣ments are hot in the second or third degree, and of subtil and thin parts, as Onions and Garlick rosted, Pitch, Rosin of the Pine, A••••e Hepatica, Assa foetida, Elemi, Prep••••is or Bee-glew, the green Leaves and Roots of Dittany, Sa∣gap••nam, Galbanum, Euphorbium; but in a small quantity, and min∣gled with other matters.

Of these simple Medicaments, s••••dry Compositions may be fram∣ed: but to omit superfluities, I will only deliver unto you three compound Medicaments, whereof the first two are set down by fa∣mous Fallopius in his Book of Wounds: The third is Empla∣••••••m Sacrum. The first of Fal∣••pius is this: ℞ Propol. rad. re∣ward Diclammi, Sagapeni an. ℥jss. ••••manti. flercoris Columbin. putris, 〈◊〉〈◊〉. ℥ j. Cepam coctam numero u∣ram, Picis liquid. & Mellis an. 〈…〉〈…〉ut comma acquirant formam Cataplasmatis, quae in mortario diligonter claborentur. The se∣cond of Fallopius more strong than this, receives these Ingredients: ℞ R••••••••cent. Dictam. pulv. Dictamni ••••t••ei, Sagapeni, Assae faetidae, Ele∣ni an. ℥ j. Visci ℥ ss. Resin. pim ℥ j. Euphorb. ℈ss. Sulphur. vivi. ℈ ij. P••••••. liquid. & Mell. crud. an. q. 〈◊〉〈◊〉 metur Cataplasm. The third compound Medicament, which I promised to deliver unto you, was Emplastrum Sacrum. The de∣scription of it is this: ℞ Lithar∣ge. lb j. Ol. lb ij. Colophon. lb. ss. 〈◊〉〈◊〉 ℥ iv. Ammon. ℥ ij. Galbani ℥ ss. Aristol. rot. ℥ ij. Thuris ℥iss. ••••••g. ••••d. Dictamni Cret. Alees lepra. squamae Aeris, Propol. an. ʒvj. R••••. Gentum. ℥ j. fiat Emplast. se∣cundum artem. This is an excel∣lent Emplaster also against ma∣lign Ulcers, and drieth moist Bones in Ulcers, wherein the Bones are carious. Paracelsus undoubtedly framed his stictick Emplaster af∣ter this description. Neither is it inferiour to his in Operation, with the which you may furnish your selves sufficiently, seeing it hath so manifold Uses. If you would have greater variety of such Medica∣ments, you may peruse Aetius, lib. 15. cap. 14. and Galen. de Composit. Medicament. secund. loca: But either these Medicaments which I have set down will serve, or else none.

Cornelius Schylander, a Physici∣an of Antwerp in his Practice of Chirurgery, published anno Domi∣ni 1577. De vulnerib. lect. quintà, hath these words: If by reason of the Veins, Arteries and Nerves, the Wound will not admit any dila∣tation, then we are to use Medica∣ments, which digest, relax and draw; or Charms, which he calls Verba Constellata, by which he af∣firms, that all sorts of Weapons may easily be drawn out with the Fore-finger and the Thumb. He professes, that he saw this done; yet the Charm he sets not down. It may be that the par∣ty, whom he saw practising this, did not acquaint him with the Charm.

However, the use of Charms is very Ancient: For Homer, in his Hias, or Poem of the destruction of Troy, shews, that Poda••irius and Machaon, sons to Aesculapius, who went to the Siege of Troy with the Grecians, cured the wound∣ed persons not only with Salves,

but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 with soft words also. Now near 3000 years are expired since the destruction of Troy. But seeing such practices are accompted by the judicious infa∣mous, I will leave them to Em∣piricks.

Having then set down how ex∣traneous Bodies, which stick in Wounds, and hinder Unition, are drawn out by Medicaments, it fol∣lows, that I acquaint you with the extraction of them by the help of Instruments. In this O∣peration I will set down these two Points.

The first shall be of the Occasi∣ons, which may cause you to go about the drawing of these Bodies out of a Wound.

The second shall be of the Cir∣cumstances remarkable in the drawing of them out.

The Occasions are three. First, if the Weapon may easily be drawn out. Secondly, if we fear Apo∣stemation, which may corrupt the wounded part. Thirdly, if we fear the Weapon to be poy∣soned.

The Circumstances are two∣fold: for some are to be noted before you go about the Extracti∣on of these Bodies, and some are to be observed in the Extraction it self.

The Circumstances which are to be noted before the Extraction are in number four.

The first is, that the Chirurge∣on mark the form of that Body which is to be drawn out.

The second, that he observe how deeply the Weapon hath pierced.

The third is, that the Chirurge∣on be a good Anatomist, and know the frame of the part; for so he shall be able to know which way Weapons, or such ex∣traneous Bodies, are to be drawn out.

The fourth, the Symptoms of the part wounded, are to be con∣sidered, as well those which are to ensue, as those which are present: as for Example, if the wounded party find great pain, the extra∣neous Body is without delay to be drawn out. But if a fear∣ful Flux of Blood must ensue after the Extraction, it is to be de∣ferred.

In the Extraction of these ex∣traneous Bodies four things are to be observed.

The first is, when it is most fit to remove these Bodies?

The second is, by what way they are to be taken out?

The third is, the Figure of these things which are to be ex∣tracted.

The fourth is, by what Instru∣ments they are to be drawn out? I will discourse briefly of all these in order.

As for the time fit for Extracti∣on, if the pain be intolerable, the Weapon is presently to be taken out, although we must not add pain to pain; for this being done, all pain will cease.

Secondly, we must not defer the Extraction, if the Weapon be poisoned, or cankered, although we must divide the Muscles, Ves∣sels and Nerves: for we are to

have a greater care of the whole, that it miscarry not, than of a part. Neither need we fear the Applica∣tion of a Cautery: for Fire con∣sumes Poison, and takes away all fear of a Convulsion: How you may conjecture the Weapon to be poisoned, I will amply and plainly declare in the proper place. In five Cases you are to delay the Ex∣traction of the Weapon.

First, if there be a fear of a great Flux of Blood, which may en∣danger the life of the wounded party: This doth fall out, if the Wound be inflicted, where great Veins and Arteries are placed by Nature.

Secondly, if fearful Symptoms, as horrible pain, a Convulsion, a sharp Fever, or a Syncope, are like to ensue.

Thirdly, if the Weapon be round, we may more securely leave it in a Wound, than if it were flat: for the edges of it will cause pain of a recessity, whereas the other will not procure a pain so great.

Fourthly, if the Orifice of the Wound be made narrow by an Inflammation or a Tumor, we are to defer the Extraction of the Wea∣pon, until those Accidents be re∣moved: otherwise we shall tor∣ment the Patient, and procure f••oonings, and a Fever, and it may be a gangrene or sideration of the part.

Fifthly, let us not attempt the Extraction of any Weapon, or part thereof, unless we have at land a sit and convenient In∣strument: Otherwise we shall vex the wounded party, without ••ny fruit, and make him the more unwilling to suffer, when we are better prepared for the A∣ction.

The second thing to be observed in the Extraction of these Bodies, is the way by which they are to be drawn out. In three Cases the Weapon may be thrust out the contrary way.

First, if it be almost through, but chiefly towards the depending part: for so less pain will be caused, and the Quittour will more promptly flow from the Wound.

Secondly, if the Figure of the Weapon will not suffer it to be drawn out the same way, by which it was sent in, as appears in barbed Arrows.

Thirdly, if there be no fear of cutting great Vessels, or Nerves, In other Cases we are to draw out the Weapons the same way they went in.

But you may demand of me, whe∣ther it be safest to draw them out whole, or by piece-meal.

I answer, that all things brittle which stick in a Wound, as Glass, and Bones, are to be drawn out whole, if it may conveniently be done: But if they cannot be pulled out whole, but with pain and fear of Symptoms to ensue, they are to be broken, and then taken out. As for Weapons, which cannot be broken, and are like in their Ex∣traction to procure some mis∣chief, as barbed Arrows, you are to take them out with such an In∣strument as is able to desend the wounded parts from harm; Of which I will speak by and by.

The third thing which I wish∣ed you to observe in the Extracti∣on of strange Bodies, was their Fi∣gure: for the Observation of this Point is requisite: Because the Fi∣gure oftentimes makes the Extra∣ction more easie or difficult, as has been exemplified in a round and flat Weapon.

Now the fourth thing observable in Extraction of extraneous Bo∣dies was by me said to be the di∣versity of Instruments. Of them I could make several Treatises; but I mean not so to mispend pre∣cious time. Necessity and Obser∣vation invented them at the begin∣ning, when Man being enraged by the Instigation of the Devil, and the Perturbations of his own Mind, not contented with his own Mem∣bers, which Nature had granted him for offence and defence, found out a mean, compendiously to send his Brother (the Image of God) to dwell with Pluto for all eternity, and to be estranged from his Creator. O that we could pack up injuries for the present, untill the Day of Judgment, the great Assises come! Then we should see a number of injured persons sufficiently avenged of their Oppressors (whom we shall see ad∣judged to Eternal Torments) be∣cause they bid Patience farewel, and would by entertaining Revenge be∣come Judges of their own Causes, and deny God the Trial and Re∣venge. Many Instruments used in our Fore-fathers time, are become now out of use. Man in every Age doth devise new Instruments of Death. A Compendium we have in our Age, Gun-shot, the imitation of God's Thunder; but the Ex∣ample is more fierce, and sends more Souls to the Devil, than the Pattern: Of Instruments, I will but only point at a few, as necessa∣ry, referring the rest to the indu∣stry of judicious Chirurgeons, which shall be employed in Military Af∣fairs.

First, you must have a Blant book to lift up a Vein, Artery or Nerve, when a Bullet or Arrow∣head is to be taken out of a Muscu∣lous part.

Secondly, you must have a pair or two of Forceps, hollow, strong, and of good Steel, to lay hold on barbed Arrows, or such Weapons as may hurt the parts, as they are drawn out.

Thirdly, Goose-bills round and hollow at the points, double and single, to take out Bullets in like manner.

Fourthly, the Ravens-bill, strong to squeese and take out Arrow∣heads, Bones, and such like.

Fifthly, the Forcipes incisorii, which cut being dilated on each side: These must be of good Steel, well tempered, and very sharp Some which are sold in the Shops, are worth nothing. These may have use, when a Wound is to be incised, to draw out of it any ex∣traneous thing.

CHAP. IV.

Of the preservation of the Temperature of the Part, by the right ordering of things not natural.

IN the former Chapter I dis∣coursed of the second and third Duty, which the Physician or Chi∣rurgeon (called to cure a Wound) 〈◊〉〈◊〉 to perform for Nature, and Those were his care that no extra∣••••ous Body should be suffered to stay in the Wound to hinder the Union of the Parts: and if it by Fortune were there found, it should by his skill be re∣moved.

In this Chapter, I am with the ••••e brevity and perspicuity to de∣liver unto you the third and fourth Duty, which belongs to a Chirur∣••••••geon or Physician, Natures friends, in assisting her in preserving her self, and labouring to shun wrongs offered by her adversary, which hath done the best to pro∣cure her overthrow and dissolution, by disjoyning parts united. These Duties are two; to wit, that the Physician and Chirurgeon first la∣bour to preserve the natural tem∣perature of the part wounded: And secondly, that he labour to restore it if it be lost.

The natural temperature of the Body, is preserved by two means. The first is, the right ordering of those things which are called not natural: The second is the Appli∣cation of convenient Medicaments. But before I go about to deliver unto you the means, either to pre∣serve the natural Constitution of the part wounded not being altered, or how it is to be restored when it is lost; I must describe unto you the natural Constitution, that knowing it aright, you may be a∣ble, using it as a Rule to see, as it were in a Glass, the defects which have seized upon Nature, and the degree of their declination from that which is secundum naturam, or according to Nature.

Now the natural temperature of the part is Naturalis ejus siccitas, or the convenient siccity or driness of it. So much we may collect out of Hippocrates, who in that Treatise which he hath left to us, de Ʋlceribus, or of Ulcers, affirms that siccum est sano proximum, that is, that which is dry comes near to that which is whole. In your practice by observation, you have learned to prognosticate to your selves health to every Patient having either Ulcer or Wound, when you see small store of

laudable Quittour to flow from the Sore.

But you may doubt, and not without cause, why Hippocrates did ascribe the natural tempera∣ture of the Body to driness, a pas∣sive quality, and not to heat or coldness, which are active quali∣ties?

I answer, that this cause moved him to think so; because if the natural siccity or driness of the part doth continue unviolate, the natural degrees of heat and cold∣ness are preserved in the Body; But on the contrary you have observed, that if in the part wounded, by reason of pain, superfluous Humi∣dity be attracted, and extraneous heat be increased, that the natural heat oftentimes is corrupted, and corruption of the part ensues; or else that it being more than the na∣tural heat can rule and dissipate, doth cause a Schirrhus of the part, either wounded or ulcerated; for so you see, if the natural driness of the part wounded be maintain∣ed, that neither the natural heat is corrupted, nor the natural cold∣ness is increased.

When I speak of natural cold∣ness, I would not have you to think that I speak of an absolute cold∣ness, which quite extinguishes the natural heat, and causes sideration or death of the part: but of a com∣parative coldness found in some parts, which is so great in them, that if it be compared with the heat of other parts, it may seem a privation of heat, thô not perfect. Such are the spermatick parts, if they be compared with the fleshy, and amongst those the Bones, if they be compared with the Muscles, your Senses will teach you so much. Having spoken thus much of what is meant by the terms of a natu∣ral temperature of a part wound∣ed, as is needful for a Chirurgeon to know; I must labour to per∣form that which I promised in the beginning of the Chapter, and that was the setting down of the means by which it is preserved. I affirmed them to be two; to wit, the right ordering of things not natural, and the convenient use of local Medicaments.

As concerning the first point, re∣ceive these documents. Seeing then a special care is to be had of the Air, Diet, Evacuation, Rest, and Exercise, Watching and Sleep∣ing, and last of all; of the Passi∣ons or perturbations of the Mind, which he that is dangerously wounded is to observe, if he be presented to you to be cured; I will briefly set down how every one of these is to be ordered.

As concerning the Air: That Air which is temperate, and so proportionate to the temperature of the parts of the Body, is most fit for wounded parts: Neverthe∣less some require both a hotter con∣stitution of the Air, and warmer applications than others do. Will you know which these parts be? Hippocrates shall resolve you, Aphor. lib. 5. Aphor. 18. in whom these words are found: Cold is an enemy to the Bones, Teeth, Nerves, Brain, the spinal Marrow; but heat is pleasing to these. Heat principally delights the Joints, be∣cause naturally they are cold, be∣ing framed onely of spermatick, parts, as Tendons, Membranes, Ligaments, Cartilages, and Bones,

and that as well in the Summer as in the Winter. A temperate Air is most convenient for other parts.

If any parts may endure cold, these are the Ventricles, according to Hippec. lib. de Ʋlceribus: for the confirmation of this his opini∣on, two reasons may be yielded.

For First, external Cold increa∣ses the natural heat, by keeping it in, by sealing up the Pores, by which it might breath out; and so it causes the better concoction, and makes them more able to expel all Excrements; but immoderate heat eliquates or melts the Humors, in∣duces an unnatural heat, which dissipates the natural heat, and so makes the Ventricles unapt to ex∣coute their Functions.

Secondly, in the Ventricles there are great vessels, that contain plen∣ty of Blood and Spirits, which are able to resist any cold impression. In the Breast you have the Vena cava ascending, the Vena arterialis, the Arteria venalis, and the Aorta. In the lower Ventricle you have the mesaraical Veins, the Vena portae, the radication of the Vena cava, and the Aorta descending. What I have spoken of the Air, I would have to be understood of the Chi∣rurgeons Hand, the Medicaments, and Linnens which are to be used about the dressing of the wound∣ed party. If the season of the year afford not unto you an Air answerable to your desire, you are to procure it by Art.

Now it follows that I appoint a convenient Diet for persons wounded: As concerning the Di∣et, receive these Aphorisms. First, in great and fresh wounds, and in such as threaten an Inflammation, which happens most usually if the Body be Plethorick, a slender Diet is to be prescribed. Secondly, in wounds of the Ventricles and Joints, and in those which have been stitched, the like Diet is to be used. Two Questions here may be moved.

The First is, what Victus tenuis or a slender Diet is?

The Second is, How long this Diet is to be continued?

A slender Diet is that which af∣fords but little nourishment, and cools; for such a Diet is most fit for contemperating the heat of the Humors, and staying the in∣flux of the same.

This Diet is to be continued until the Seventh day be past, which is the first critical day in sharp diseases. Then the use of Wine, Flesh, and Eggs is to be forbid∣den: Let the wounded party take thin Broths altered with Lettuce, Spinage, Purslain, Endive, Succo∣ry, the common and Wood-Sor∣rel, adding the emulsion of the seeds of Musk-melon, Pompion and Cucumber. Thin Panadoes, and Oatmeal gruels are fit. Sallets of the aforenamed Herbs, boiled and dressed with Vinegar and sweet Butter, may be permitted: Apples and Pears, either roasted or baked, cold, may be granted. Let the Drink be small Beer or Ale to those who have used them in their health: But if you have in cure one, who cannot abide this Liquor; then you are to appoint for him Water boiled with the bottom of a Wheaten-loaf ming∣led with Oxysaccharum, or the Sy∣rup of Endive, Succory simple, or

Violets, taking three Ounces of Water, and one of Syrup. Receive the description of a parable Julep, which will serve all persons; ℞ aq. font. lb iij. vini albi ℞ j. avenae mundat. ℥ iiij. Bulliant ista ad consumpt. lb j. ac coletur decoctum, cui admisce aq. ros. cochl. iij. sac∣char. opt. ℥ iiij. ut paretur julapi∣um clarum. In Wounds wherein there is no fear of 〈◊〉〈◊〉 accidents, you may grant poched Eggs, so that the wounded party eat as well the White as the Yolk. Ha∣ving shewed unto you what Air and Diet are most convenient for wounded persons, I am in like manner to talk of Evacuation. Of it there be two kinds, Phlebo∣tomy, and purgation by siege. As for Phlebotomy, the end of it is to procure siccitle, or driness to the wounded parts, according to Cels. lib. 6. cap. 16. Whether Phlebotomie be to be used or no, these things following will shew you: The wound it self, the habit of the whole Body, the passions of the Mind, and the Air it self: From the wound it self, in this operation receive these Canons.

First, in great Wounds from whence small store of Blood hath issued, and when weak parts are wounded, as the Joints (whither superfluous Humors may be turn∣ed) Phlebotomy is necessary. The reason of the first part of the Canon is this: If the Wound hath bled but little, the part not being suf∣ficiently dried, Fluxion and In∣flammation may be caused.

Secondly, If in a Wound, either deep or many stitches have been taken, a Vein is to be opened: for the pain which is caused by reason of the stitching, is like to procure attraction of Humors, and an In∣flammation.

Thirdly, in Wounds wherein there is no great pain, and in which nei∣ther deep nor any stitches have been taken, you may spare Phle∣botomy.

Fourthly, in Wounds of the fleshy parts which are strong, as also in those parts unto which a Humor can hardly be carried, as in the hairy Scalp and Face, you may ab∣stain from blood-letting.

As for the habit of the Body, take this Aphorism: if the Body be Plethorick and Feverish, if Cho∣ler abound, boldly open a Vein; but not so, if the party be me∣lancholick; for this Humor can neither be so easily inflamed, nor flow, to cause any Inflammation. You are in like manner to note the passions of the Mind. If the party wounded be furious and ha∣sty, if he sleep not well, if the Spirits be extraordinarily moved, open a Vein; but if the wounded party be of a dejected Spirit and fearful, and be but little moved, you may spare Blood-letting.

Last of all, you are to observe the constitution of the Air: in hot weather then you may more bold∣ly use Phlebotomy than in cold; and so rather in the Summer ser∣son, than in the Winter; for in hot weather the Humors are h••∣ter and thinner than in cold, and so more apt to flow to the wound∣ed part.

As for purgation by Stool, it is appointed for staying of Humors from flowing to the part wounded. But seeing the symptomes which arise by reason of a Fluxion, are

most commonly two, a Phlegmone or Erysipelas, it is evident that those purgative Medicaments which evacuate Choler, called cholagoga are most fit: such are manna, ta∣marinds, cassia, Syrup of Roses and Violets solutive, Electuarium lemtivum, elect. de succo rosarum, Dicatholicum, Diaprunum, &c. In five eases such Medicaments are to be ministred: First, in wounds of the Ventricles. Secondly, in wounds of the Joints. Thirdly, if the part wounded be troubled with an Inflammation, or Erysipe∣las. Fourthly, if the wounded part hath been stitched. Fifthly, if either incision, dilatation, or rasping of the Bone have been used.

As for Rest and Motion, receive these admonitions: First, as in wounds of the lower Limbs, it is ill to walk or to stand; so in wounds of the upper Limbs, it is hurtful to exercise them. Secondly, if either the superior or the low∣er parts receive a great Wound, it is good to keep the party in Bed: but let the wounded party be pla∣ced in that posture, as is like to afford greatest ease. As for ex∣ample: If the Hand or Foot be wounded, let them be placed some∣what high, to hinder flowing of Humors to them. If the member must be kept unmoveable, the use of it will shew the best situati∣on: for some parts must be kept bended, as the Elbow and Fingers: but others must be extended, as the Knee and Foot: and from hence sprung this observation, Cubitus ad collum, crus ad lectum, the El∣bow is to be tyed to the Neck, but the Foot to the Bed.

As for Watching and Sleeping, seeing Watching dries the Body, as Sleep moistens it, according to Hippoc. Aphor. it is not good for the wounded party to take im∣moderate sleep, in two cases: First, if we fear that Humors will flow to the part wounded, which we may conjecture they may do in plethorick Bodies. Secondly, if a wound fall out to be in a Joint; for Sleep cools the Joints: but if the pain be great, then it is good to suffer the wounded person to sleep; yea, to procure it by ano∣dyne means, inwardly ministred, and outwardly applyed, if you see Nature of her self inclined to sleep; for so the Spirits being retired into the center, the faculty is at rest, and so the pain is eased.

Last of all I will conclude by speaking but sparingly of the Mind: we must labour to remove all per∣turbations of the passions of the Mind from those who are wound∣ed. Wherefore no ill tidings are to be brought to those, who are come to the years of discretion, and Children by all means are to be kept from crying and weeping.

Above all other things, let Ve∣nus be abandoned: for it exceed∣ingly hinders Consolidation: for by it the Blood and Spirits are infla∣med, and by motion noxious Hu∣mors flow to the part: There are few Artists who have not by expe∣rience in Patients observed the in∣commodities of this action.

CHAP. V.

Of the fifth and sixth Duties belonging to a Chirur∣geon in curing a Wound.

IN the former Chapter I shewed you as briefly and plainly as I could, how the natural Tempera∣ture of a wounded part is to be preserved by the right ordering of those things which are called Non naturales, or not natural. Now I am to shew you how this same is to be effected by the application of local Medicaments: for in Plethorick or Cacochymical Bodies, all means be∣ing used according to Art, will sometimes, but with difficulty pre∣vail.

Seeing, as I shewed you, that the natural Temperature of the part is nothing else but the natu∣ral siceitie or driness of it: It is out of all controversie, that the Medicaments which are to be ap∣plied to wounded parts, ought to be siccantia or drying.

But seeing there are sundry de∣grees of drying Medicaments, ••on may demand of me, in what de∣gree of driness those Medicaments ought to be, which are to be ap∣plied to wounded parts?

I answer, that both the Tem∣perature of the whole Body, and of the part affected, will declare this unto you. One thing is to be no∣ted, that the Medicament which is to be applied to a wounded part, ought ever to be somewhat driet than the part it self.

As for example, if the Cheek of a Boy or Girl be wounded, you are to apply Medicaments which are drie in the first degree, at St. John's-wort, Avens, Chamae∣mil, Melilot, Saffron, Barley and Bean-meal: But if a Boy be wound∣ed in a Joint, or Nerve, you are to apply such things as are dry in the Second degree. If these things happen to an aged person, or a strong clown; then you are to ap∣ply such Topicks as are drie in the Third degree. Wherefore in seft parts wounded, as in the bellies of Muscles, and fleshy parts, a Medi∣cament is to be applied, which is of the strongest in the First degree. In parts which are hard, as in the Tendons, or Cartilages wounded, you are to apply to the parts wound∣ed such Medicaments as are strong∣est drying in the Third degree. But to parts wounded, which are of a mean Temperature, neither too soft nor too hard, you are to ap∣ply

for Medicaments the strongest Deficcatives in the Second degree.

From what has been said you may gather, that neither Spring-wa∣ter nor Oil, are fit to be applied to wounds: because both do moisten and relax too much. Besides this, if cold Spring-water be applied, it may procure a Gangrene by too much refrigerating the part, and quenching the natural heat. Let me warn you of one thing, that these desiccative Medicaments must have a moderate astriction: for so the Blood being ingrossed, more shall fot flow to the part than is requi∣site for the nutrition of it. See∣ing I have made mention of such simples as are fit to be ap∣plied to Wounds, to procure their unition, you will expect (no doubt) Thrief enumeration of such as are accounted the most effectual. I kill only name them, leaying their description and other effects, to be gathered out of the Monu∣ments of such as have published Herbals, and have discoursed of Animals or living Creatures, and Minerals, from whence these means are fetched.

If you are desirous to know the nature of Plants, have recourse a∣mongst the Ancients to Dioscori∣des, who was a stipendiary Soldier under Cleopatra Queen of Aegypt, who was overcome by Augustus Caesar in Fight by Sea at Actium the Promontory, about 42 years before the birth of Christ. As concerning Minerals, Fallopius hath left a Treatise of them, who hath delivered so much of them as is re∣quisite for a Chirurgeon to know: If you have a mind to know what ••••fiety of living Creatures there be, peruse the Monuments of Conradus Gesnerus, Ʋlysses Aldrovandus, and Rondeletius, who have written of these Subjects. The Simples then which are most effectual for the consolidation of Wounds, are de∣duced either from Vegetables, Animals, or Minerals. As for those which are taken from Vegetables, I commend unto you these; St. John's wort, St. Peter's wort, Betonie, Agrimony, Birthwort, Vervein, both sorts of Avens, Pome∣granate-flowers, Horse-tail, Plan∣tain, Knot-grass, Milfoil, Lunaria the greater and lesser, Shepherds∣purse, Perwincle, Larks-heel, both the Centauries (but the greater is more effectual) Dittanie, Com∣frey, Ladies-mantle, Self-heal, Clowns All-heal, Serpentaria, Ad∣ders-tongue, Loose-strife, Hore∣hound, Myrtil, Red Rose, Myrrhe, Mastick, Elemi, Olibanum, Frank∣incense, Solomon's Seal, Turpen∣tine, Pitch, Rosin, Willow, Rue, Sarcocol, Borax, Ladies-Torch, Birdlime, wild bastard Saffron, Carduus benedictus, and Tobacco. Of these Simples taking the Juices and the Herbs stamped, you may make Balsams; and if you add Swines-grease, Wax, Rosin, and Gummt Elemi, you may make Unguents effectual for the cure of Wounds.

Living creatures put to their helping hands: of them you have Mummia, Earth-worms, Snails, the fat of a Horse, Sheeps Suet, Swines Grease, Deers Suet, Goats Grease, the extract of Mans Blood, the Spiders web, Bones burned to white ashes, and Harts-horns cal∣cined; if they be brought to an impalpable Powder, being grownd

upon a Painters stone, and made up into the form of Trochisces, with the distill'd water of Snails, and then being beat to powder, and mingled with Ʋnguentum Basili∣cum, or aureum, they exceedingly further the curing Wounds of the Joints, Nerves, and Tendons.

The Minerals also are no nig∣gards in this case. The Litharges present themselves first, without which hardly can any Emplaster be brought to a laudable consist∣ence. That which is called Li∣tharge of Gold, affords a brighter colour to Emplasters, than that of Silver: yet the effect is all one. Copper affords Aes ustum, Squam∣ma aeris, and Aes viride, all very useful in the practice of Chirurge∣ry. Jupiter or Tin, yields his flow∣ers by sublimation, or if he be dis∣solved in a convenient Liquor, Cry∣stals: which being dulcified and brought to Powder, and mingled in a due proportion with conveni∣ent Unguents or Emplasters, fur∣ther exceedingly the healing of Wounds and Ulcers. Mars or Iron affords unto us his Crocus, as 'tis termed: How powerful it is not only to hasten Consolidation of solution of Unity; but in loos∣nesses, Gonorrhaeas and other diseases also, there is none ignorant, who hath had but a reasonable practice in Physick or Chirurgery. What shall I speak of Minium, both the Corals, Tutia, Calaminaris, and the Load-stone. By the enume∣ration of these few means taken from Vegetables, Animals, and Minerals, for the curing of Wounds, you may perceive how bountiful Nature is to Mankind in supplying his wants. O that he were not wanting or deficient to himself▪ If we would take pains only to prepare those things, whereof Na∣ture hath left us no small store, and judiciously according to the prescript of Art apply them, we should find in our practice a bet∣ter success than sundry times falls out: Neither should we have need to blame the irregularity of Pati∣ents, and the ill correspondence of those things, which are called Non naturales, or not natural. Whoso∣ever thinks that he may without any stop or stay, go through the curing of all wounded persons, in what part soever the Wound is in∣flicted, with the ordinary Un∣guents, carried about in Salvato∣ries, he deceives himself.

These for the present use must be in a readiness; but if he find these after application not to an∣swer his expectation, he must have recourse to others. Which Medi∣cantents are sittest, the collation of the part wounded, and the To∣picks will shew, as I have told you before.

Having delivered unto you, how the temperature of the part is to be preserved by the right order∣ing of those things, which are called Non naturales, or not natu∣ral, as Air, Meat, and Drink, Eva∣cuation and Retention, Sleeping and Watching, &c. As also by the application of fit Topicks to the part, you may require according to my promise, how the natural temperature, if it be altered, may be reduced to its own tenor again? Let me tell you, that by the same means, it is to be reduced, by the which it is preserved. Only this is to be observed, that the means

which cure, must be more forcible, and more intended in their quali∣ties, than those are, which are ap∣plied to maintain the natural Temperature.

As for example, if a wound prove very moist, and send out much Quittour, you must labour strongly to drie the habit of the Body, by Bleeding, Purging, a slender Diet, Watching, and such like, and by applying to the wounded part Medicaments, which strongly dry, and are endued with a certain astriction. If other elementary qualities, as heat, cold, driness appear, they are to be re∣moved by their contraries, but intended in their qualities above that degree which was sufficient to maintain the natural Tempe∣tature of the part wounded.

Now the sixth Duty, which I affirmed to be required of the Phy∣sician or Chirurgeon, when he is called to cure a wounded person, was the observation of the excre∣ments, which flow from the wound, and their true and natural causes: I will deliver first unto you the diversity of Excrements or Quit∣tour, which a wounded part sends out, and then I will shew unto you the causes of them.

The Excrements which flow out of a Wound, are in number three; liber, Sordes, Pus: Ichor is a thin Excrement. The cause of it is In∣coction. Of it there are two kinds: for either it is an Excrement, issuing from the Veins themselves or else it proceeds from the wound∣ed part: If it issue from the Veins, then it is a waterish and thin Hu∣midity, flowing from the capillary Veins not altered, and without my noisome smell, by its colour shewing which of the four Hu∣mours has dominion in the mass of Blood. Wherefore if the Blood be very pure, it has a certain bright redness representing Water, where∣in flesh has been washed. If yel∣low Choler be predominant, then the Ichor is of a bright yellowish colour: If Phlegm abound, then the Ichor is whitish: if Melancho∣ly surpass, then the Ichor or thin Humidity is of a darkish swarth colour. If this thin Humidity spring from the part wounded, be∣cause it is altered and corrupted by the part which sends it out, it has an unpleasant smell, being an Excrement of the part. As the first kind of Ichor is called serum Sanguinis, the waterishness of the Blood, which is mingled with the Blood, that so being made more fluxible, it may the more easily be distributed to the habit of the Body, to nourish it; so the Ichor which is an Excrement of the wounded part, is called Sanies and Virus, and according to the degree of the corruption of the part, it is more or less stinking. If it flow from a part possessed with a Cancer, it is wonderful ma∣lign and stinking: If it issue out of a part siderate or mortified by reason of a Sphacelus, it is cada∣verous. By the exhalation which is breathed out of the pores of the Skin, raised from the serum San∣guinis by the natural heat, Dogs find out their Masters, and will constantly hunt after that game, which they are first set about: This be wrays the complexion of the Individuum; but Sanies and Virus shew the corruption of the part.

The Second kind of Excrement is called Sordes: This is a compact and viscous Excrement, so cleaving to the wounded parts, that it will not be removed without the use of a firm instrument: for lint upon a probe will not bring it away.

Of this thickness three causes may be assigned: the First is the drie constitution, both of the whole Body, and the wounded part also: the Second cause may be the error of the Chirurgeon, who hath applied too drying Me∣dicaments to the affected part: the Third cause may be the cold Air, which having been let into the Wound, by the carelesness of the dresser of it, hath condensed, and thickned the Pus.

The Third Excrement which wounded parts fend forth is called Pus. This is an Excrement white, smooth and equal or uniform, without any grumous or knotty substance, having no ill sinell, not so liquid as Sanies, nor so thick and viscous as Sordes. See Hippo∣crates lib. de Praedictionibus. Galen. 2. ad Glaucon. 8. & 5. Method. 10.

Now to come to the causes of the Excrements which are sent forth from Wounds, which was the Second point propounded con∣cerning these Excrements, note these Aphorisms. First, the cau∣ses of these three Excrements are either the efficient or material causes. Secondly, the efficient causes are two, the natural and unnatural heat. Thirdly, the na∣tural heat is the cause of con∣coction, whereby a laudable Put is engendred: but the unnatural heat working upon Humidity, causes putrefaction, and an evil smell. Fourthly, the material causes are two, to wit, contused Flesh, which by digestives must be turned to Quittour, and a Hu∣mor, which most commonly sym∣bolizes with the complexion of the party wounded, whether it be na∣tural or accidental. If then the natural constitution of the party wounded be good, the Pus is lauda∣ble: but if by reason of errors committed in the use of those things which are called Not Natural, in the course of life a sickly Com∣plexion be acquired: As for exam∣ple, if one become Hydropick, Pocky, or Leprous; then the Wound is like to cast out no good Excrements; but either Sanies, Virus, or Sordes.

CHAP. VI.

Of the common Symptomes of Wounds.

AT last I am come to the last general Duty, which the Chirurgeon is to discharge to Na∣ture in assisting her, in joyning dis∣joined parts procured by a Wound, and that is the Seventh Duty in number, as I set down in the Se∣cond Chapter concerning this sub∣ject of Wounds. This I affirmed to be the removing of some gene∣ral accidents which ensue, and of∣tentimes invade the wounded par∣ly, after that a Wound is inflicted: Now these are in number two; Pain, and Swooning, or fainting; I call them general, because they may accompany all forts of Wounds as well Simple as Compound. As for Pain, no Wound can be inflicted without causing some pain, either more or less: This is certain, in all compound Wounds, and agree'd upon by the unanimous consent of all Authors who have left Trea∣tises of this Subject to posterity: besides this, seeing the Skin at the least must be divided in simple Wounds, who can imagine this can be done without pain, seeing the Skin is the instrument of touching and feeling? As for Fainting and Swooning, it also often falls out in both Simple and Compound Wounds: And in Simple Wounds daily observation doth evince this to be most true. Scarce an Artist hath been employed a∣bout Blood-letting, who has been so careful and Fortunate in performing the Operation, but that he has had sundry who have fainted under his Hand, be∣fore any remarkable store of Blood hath been drawn. Now what Wound can be account∣ed more simple, than that which is made with the Lancet or Flegm, which will be united within the space of a few hours after that the Vein is shut and bound up? It fell out once that I sate at the Table with sundry Gen∣tlemen, amongst whom there was one noted for his Valour; he having but lightly cut his Finger, and by the advice of one, who sate next unto him, ap∣plied a little Salt to the part in∣cised, with his knife, presently sunk down from the Table, and was carried away.

Of these two Accidents, I will first discourse of Pain, because it extends it self farther than Faint∣ing or Swooning do; for no Wound, whether it be Simple or Compound, can be without more or less pain, when it is first in∣flicted, for the reason which I yielded a little before. Whereas sundry have received grievous Wounds, and yet have not fainted; for it must be not a small matter, which will cause a stout or mag∣nanimous Person to faint: Besides this, pain very often is the cause of fainting; now the cause by Na∣ture hath the priority of the effect. Pain then in Latin is called dolor, which is deduced from the Verb doleo, which signifieth to grieve or to feel pain. First, I wil describe unto you what pain is; Secondly, how this Accident is removed from the wounded party, as by the Ap∣plication of convenient local means, which most properly is the Office of a Chirurgeon.

Pain is described by Galen to be tristis sensatio, a grievous feeling; this description of Galen rather shews how Pain is caused, than what it is; for Pain is procured by some offending Object, moving the Instrument of Touch: And in truth we must acknowledge, that Pain is not the feeling it self sim∣ply; wherefore Galen did not call Pain feeling absolutely, but feeling with a grief. In Pain two things are to be noted: First, the appre∣hension of the sensible Object, as it is sensible: The second is the ap∣prehension of the same, as it is pleasing or unpleasant. If we fur∣ther inquire in which of these two the nature of Pain doth subsist; we must confess, that Dolour or Pain is not the very apprehension of the sensible Object, but the Grief which is caused by the ap∣prehension of the unpleasant sensi∣ble Object, and the corruption of the Organ. Wherefore, Pain may thus fitly be described; It is a grievousness, which is felt in the In∣strument of the Sense of Touching, caused by those things which make a Solution of Ʋnity.

In this description, three Argu∣ments of Logick are to be mark∣ed. The first the Genus, which is said to be molestia, or grievous∣ness: for there are Griefs as well of the Mind as of the Body; as En∣vy at the Prosperity of another, which is Diabolical; and rash An∣ger, which is Bestial: but Pain is a Grief of the Body. The second Argument is the Subject wherein Pain is seated, and that is the Organ of Touch. The Causes make up the third Argument; and those are thought to be such things as cause Solution of Ʋnity in the Instrument.

Here a Question may be moved, whether Pain may not be felt in the Instruments of other Senses, as the Hearing, Seeing, &c. as in the Instrument of Touch∣ing?

To this I answer, that two kinds of troublesomeness may be depre∣hended in every Sense, besides Touching. The one is, when the Instrument of Touching it self is offended, which is imparted unto all the rest of the Senses: The other is, when the proper Sense it self is offended; as when a Scholar meditates and is hindred by the ringing of Bells; or when one

having composed himself to sleep, it troubled with the unpleasant howling of Dogs, noises of Carts and Coaches, and clamors of Drunkards, which is frequent e∣nough here in London, where the Hearing is offended; or when one with grief and commiseration be∣holds his dear Friend extinguished with an Apoplexy, who sat with him at Table immediately before his fall, which hath been often seen, where the Sense of Seeing is trou∣bled. But there is a great diffe∣rence between the pain in the Or∣gan or Touch, and these trou∣blings of the other Senses: The first truly deserves the name of Pain; but the second may be termed aversations or dislikings of the Objects, rather than Pains. This moved Galen to say, 1. desympt. caus. 6. Delight and Grief hap∣pen to all the Senses, but not with the like evidence. But as concerning Pain, which offends the Instruments of Feeling, thus he writes, de different. sympt. c. 3. The Sense of Touching, above all other Senses, hath obtained a most remarkable Symptom, to wit, Pain in its Action. And tho other Senses may feel Grief, yet this Grief only proceeds from their external proper Objects; but Pain may happen unto the Sense of Touch∣ing, not only from external, but from internal affections also resting within the Body, which sometimes have been so vehement, that sun∣dry Persons have dispatched them∣selves. I will not go about to con∣firm this last Point, affirmed by Galen, seeing I am to deliver Chi∣turgical Doctrine, and not Histo∣rical Narrations. But who will give himself content, let him pe∣ruse and turn over the Volume of Schenkius his Observations, where he shall read Examples more than enough. Thus much I thought good to deliver concerning the na∣ture of Pain, which is an Accident proper to the Organ of Touching: and although it be somewhat Phi∣losophical; yet it cannot but be profitable for you, seeing it is able to enrich your Understandings, that you may be able to express what is meant by Pain, when it is named, and to discern when it is a proper Symptom of the Instru∣ment of Feeling, and when by rea∣son of the Instrument of Feeling it is communicated to other Senses. It is now full time to set down such topical Medicaments as are effectual to asswage Pain. These Medicaments are of two kinds: for either they are Narcotical, or Anodyne. Anodyne Medicaments by the Grecians are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and by others 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, asswe∣gers of Pain. These Medicaments are temperate, answerable to the constitution of our Bodies: and therefore they maintain the sub∣stance and natural heat of the Bo∣dy: By their pleasant heat they gently open the Pores of the Bo∣dy; by the subtilness of substance they enter into the pores, and make all the Humors uniform, they soften and loosen the part, and so it becomes less apt to receive Pain: And if they exceed in heat a little, they open the Pores more effectu∣ally, and discuss some of the thin∣nest part of the peccant Humor, which is most fierce, and so abate somewhat the cause of the Pain, The Simples of this order are

Chamaemil, Melilot, Dill, Elder, Wall-wort, ordinary Mallow, Marsh∣mallow, Roots and Flowers of Lllies, Fenugreek, Linseed, Barley, sweet Sallet-Oyl, Oyl of sweet Al∣monds, Mans-grease, Capons-grease, Swines-grease, Goose-grease, But∣ter without Salt, Marrows, Cream and sweet Milk. Of these Oyls and Cataplasms may be framed fit for your purpose. This parable Medicament I commend unto you, Reducatur Ʋnguentum album Ca∣phuratum in formain linimenti Oleo Lil. Anethino, aut Chamaemelino, & applicetur.

Narcotical Medicaments neither take away the cause of Pain, nor asswage Pain; but stupefie the Part, that it cannot feel that which is painful: such Medicaments are cold in the end of the third De∣gree, and in the fourth, which drive away the natural heat and spirits from the part. Of this sort are water-Lily, Henbane, Hem∣lock, Deadly Night-shade, Man∣drake, Apple of Peru, black Poppy and Opium, Darnel, and the Seeds of the former Simples, of which Simples you may make both Cataplasms and Oyls. In stead of all others you may use this liniment, ℞ Ʋnguent. Popul. & albi Caphurat. an. ℥ j. Ol. Hy∣oscyami & Mandragor. an. ʒjss: Misc. ut siat linimentum applican∣dum parti vulneratae.

Now comes the second general Symptom, which follows after that a Wound is received, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 fainting or swoon∣ing: Syncope is derived from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 concrdo, to cut together; because in it both moving and reeling are taken from the Body, so that it lies for a time as if it were dead. Lipothymia differs from it only in vehemency; for in this the party loses not altogether feeling, and cold Sweat bursts out. Because that which cures the great Grief, is able to cure the less in this same kind. I will only dis∣course of a Syncope, because the nature of it being known, and the Cure of it learned, the less Grief, Lipothymy or Fainting, is easie to be dealt withal.

Syncope then is a sudden decay 〈◊〉〈◊〉 abolition of the strength of the Bo∣dy, according to Galen, 12 Me∣thod. cap. 5. As Lipothymia is on∣ly an imminution of the same: the part affected is the Heart.

As for the Causes, receive these Aphorisms. First, a Syncope may happen when there is not Matter ministred for the generation of Spi∣rits, as in Famine. Secondly, it may happen, when the constituti∣on of the Heart is altered by rea∣son of some Disease, as in Pesti∣lential Fevers. Thirdly, when a malign Matter is communicated to the Heart, as it happens in a dead∣ly mortification of a Member. Fourthly, when the Spirits are spent, and dissipated by too great Heat, Watching, Travel, or im∣moderate Evacuations. Fifthly, it may happen by Antipathy, so it hath been noted that some have swooned at the smell of a Rose. Sixthly, Fear also may be the Cause. Seventhly, it happens when the Spirits are suffocated by crude Humors or Vapors. Eighth∣ly, it may invade, when a malign Vapor is sent from another part of the Body to the heart, as in Fits of the Mother. Ninthly, the

sensibleness of the part wounded may be the cause, as if it be a Joint, Nerve, Tendon, or Membrane.

The Signs of a Syncope are these: First, the Face grows Pale, the Pulse is small, slow and un∣equal, a green or yellow colour is represented to the Sight, then the Sight becomes dim, the Hands and Feet become cold, Sweat breaks out about the Forehead, and at last the Pulse altogether ceaseth; Moving, Feeling and Speech are taken away, and the Body ••es for a while, as if it were dead.

As for the Prognosticks, receive these: First, if a man come not to himself again after that he is rubbed with Rose Water or Aqua Vitae, hath Wine or strong Wa∣ters poured into his Mouth, and hath had strong sneesing Medica∣ments blown up into his Nose, the Syncope is accounted deadly. Se∣condly, if a Syncope surprise one, who before was feeble and weak, it is dangerous. Thirdly, a Syn∣cope proceeding from an inward cause, is more dangerous than that which proceeds from an outward cause. Fourthly, a Syncope which proceeds from oppression of the Spirits is more easily cured, than that which proceeds from the dissipation of the same, by reason of inanition. Fifthly, they who often swoon without a mani∣fest cause, at last die suddenly. Hipp••c. 2. Aphor. 41. Sixthly, that Syncope which is a primary affection of the Heart is more dan∣gerous than that which happens by the consent of the other parts. Seventhly, when a Syncope happens by reason of immoderate evacuati∣on of Blood in Wounds, we have no cause to despair, chiefly if the wounded party be of a good con∣stitution: for Blood by a good Diet is easily restored. Eighthly, when one comes to himself after Swooning, if the Pulse and fresh Colour return not, he is like im∣mediately to fall into it again. Ninthly, who goes not about to prevent a Syncope, when he sees a Lypothomy to have possessed the wounded party, he is to be ac∣counted accessory to the death of him, according to some Au∣thors.

Now as concerning the The∣rapeutical Point of this Discourse, expect not whatsoever may be said of it: for many things delivered would be impertinent, no way be∣longing to the Practice of Chi∣rurgery: I therefore will acquaint you with those means only, which your Duty requires. The curative means then are either External or Internal. As for the External, these which follow are accounted most effectual: First, the Tem∣ples and Nose are to be bedewed with Odoriferous Liquors. If the party be hot, apply such as are ei∣ther temperate or not very cold, as the Water of Orange Flowers, the Waters of Medow sweet, Balm, Roses, the ordinary sweet Waters. If the party be cold, apply the Spi∣rits of Balm, Mints, Wormwood or Angelica. If the party wound∣ed be a Woman, you are not to rub these parts with things Odo∣riferous, lest you bring on the Mother. To these then use the Spirit or Extract of Castoreum and Rue, which are excellent. Se∣condly, use shaking of the Body, frictions of the extremities, hard

pressing the parts adjacent to the Joints of the lower Jaw under the Lobes of the Ears, shouting into the Ear, and calling upon the party by his own name, moistning of the Tongue with Theriaca An∣dromachi dissolved in Cinnamome Water, having added a few drops of the Oyl of Sage and Amber. See Paraeus lib. 8. de Ʋulnerib. c. 14. Sennertus pract. l. 2. part. 4. c. 6. If it be a strong Syncope, it will not be amiss to pull hard the Hairs of the Temples and Neck.

As for the Internal means, a Sop in strong Wine, as Aligant, Malmesey, Canary Wine, or white Bastard, is very good, so that the Wine be drunk together with the Toast. Confectio Alkermes dis∣solved in Cinnamome Water, or Treacle dissolved in Aqua Coelestis and ministred are effectual. If these Medicaments be not at hand, give Aqua Coelestis, Wormwood∣water, Balm-water••, Mint-water, yea, the common Aqua Vitae must serve. I commend unto you this Composition. ℞ Aq. Card. Benedict. ℥ iv. Aq. Theriacal. & Cinamomi an. ℥ss. Confect. Al∣kermes ʒ ij. Diamargariti calid. ʒiiss. Lap. Bezoar oriental. ℈j. Syrupi Acetositat. citri ℥ ij. Aq. Ros. Odorifer. cochl. 3. Misc. ex l. a. Exhibeatur cochl. 1. 3^ti• quâque horâ post agitationem. If these means prove not effectual, seek for no other; for you shall lose your labour.

CHAP. VII.

Of the Stitching of Wounds.

IN the second Chapter of this Subject of Wounds, I affirmed the last scope and end which a Chirurgeon proposes to himself when he goes about the curing of a Wound, to be the reunition of the parts disjoyned by an external Instrument. I set down also the differences of Unition, which were 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or agglutination, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or concarnation: give me leave to use these terms to ex∣press the Greek words.

Agglutination, I said to be the Ʋnition of parts separate, no mid∣dle substance concurring. This kind of Union Chirurgeons aver, to be performed by the first Inten∣tion.

Concarnation, I desined to be the Ʋnition of parts disjoyned, by the intervention of a middle sub∣stance: This is said by Chirurge∣ons, to be done by the second In∣tention: for the better procuring of Unition in Wounds, I proposed seven Duties, which a Chirurgeon is to perform to Nature, to further

her endeavour in this Action: which I hitherto have prosecuted in six several Chapters. Now the Order of Doctrine requires, that I shew, by what means Unition is procured in Wounds.

First of all, I will shew, how Agglutination is brought to pass. Then I will shew how 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 be Concarnation is procured. And this Order I have chosen, for sun∣dry reasons moving me thereto: For first, Agglutination is a more simple kind of Unition, because it is performed without any middle coming between the wounded parts severed. Secondly, because it is more speedily performed than Concarnation: Thirdly, because in it there is neither such Art and Skill, nor such choice of Me∣dicaments required, as are in 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

Now to bring 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Ag∣glutination, the first kind of Uni∣on, to pass, three curative Indi∣cations offer themselves: First, the brims of the Wound are to be joyned together. Secondly, the parts joyned together must be so kept. Thirdly, Agglutinative Medicaments must be applied.

The first Indication is to be performed by the Chirurgeon: for he is to bring together with his hand the Brims or Lips of the Wound gaping: In bringing of the gaping Lips of the Wound together, five things are to be ob∣served.

First is, that he bring gently, and by degrees, not violently or sudden∣ly, the parts severed.

The second is, that the parts disjoyned be equally brought to∣gether, not stretching one more than another, unless one part will not admit dilating: as when it cleaves to a Bone, the other being fleshy for a great distance, and at liberty.

The third is, that if the Brims of the Wound have become stiff, by reason of the cold Air (they having for a space remained un∣covered) they be fomented with Hydrelaeum, a Medicament made of Oyl and Water. The propor∣tion of the Oyl and Water is to be conjectured from the constitution of the whole Body, as well as from the temperature of the part af∣fected. As for Example: If the party wounded be of a dry and thin habit of Body, more Oyl than Water is to be taken, as one part of Water, and two of Oyl; but if the habit of the Body be fleshy succulent, more Water is to be used than Oyl.

Fourthly, in this Conjunction equality must he observed. So the Supersicies of the one part of the Wound must exquisitely an∣swer the Supersicies of the other part: and there must be a due cor∣respondence between the inner side: Otherwise the Cicatrix will be ugly and unequal.

Fifthly, no Dosil or Pledget must be put between the parts of the Wound separated, when you mean to consolidate the wound∣ed parts by the first Intention, for then you shall cause flesh to grow, and procure the Unition of the parts according to the second In∣tention.

As for the second Intention,

which is the keeping of united parts together, it is performed by three means. The first is by La∣queatio or dry Stitching, as it is termed: The second is by Su∣tura, or Stitching with a Needle: The third is Fascüs, by Rolling, Laqueatio or dry Stitching is, when pieces of Cloth being placed on each side of the Wound, the parts of the Wound disjoyned are brought together, by drawing the pieces of the Cloth with a Needle and Thred.

This kind of Stitching we use in three Cases: First is, if we can∣not come conveniently to roll the wounded part, as in transverse Wounds. The second is, when the external Beauty is like to be impaired, by making of new Scars, as it happens in Wounds of the Face. The third is, when the parties wounded will not admit Sutura, or Stitching with the Needle; as Women, and eminent Persons.

In the Application of the dry Stitch, three things are to be ob∣served. The first is the preparati∣on of the pieces of Cloth. The second is the means by which they are to cleave to the wounded part. The third is the form of them.

As for the first; the pieces of Cloth must be strong, that they yield not unto the Thread, when they are drawn. Secondly, one must answer another: Thirdly, they must be hemmed, or doubled to∣wards the Wound; but they must be ravelled where they are furthest from the Wound.

As for the second: The means by which these Clouts are to cleave to the Skin firmly, ought to be wonderful emplastick Medica∣ments: I will set down a few Ex∣amples of such.

The first shall be this; Dissolve Isinglass in Vinegar, and by boil∣ing, bring it to the consistence of Glew.

The second shall be this: ℞ Farin. volat. Mastiches, Gypsi, cocti, Armen. Aloes, Gummi, Tra∣gacanth. & Arab. an. ℈j. fiat ex omnibus pulvis, qui ovi allu∣mini admistus consistentiam mellis referat.

The third shall be this, ℞ Ma∣stich. ʒ ij. Bitum. Judaic. Carals. an. ℈ j. Colophon. ℈ j. Ad ecto pauco Vernice, paretur emplastrum d••∣rum, quod igne liquescat, quum usus venit.

The fourth shall be this: Agi∣tetur exactè albumen ovi in patina stannea: pestea ita aspergat••r pal∣vis calcis vivae albumini agitato, ut vix appareat. Si pulveris plus satis d••ciderit, spiritu oris dif∣sletur: Imbuantur telae medica∣mento, ae partibus vulneratis ap∣plicentur.

As concerning the third, to wit. the form of these Clouts, let them be of the form of the wounded part. If therefore the part be Triangular, let the Clouts be Tri∣angular. However, let the form be such, as is fittest to draw the wounded parts together. As for Example, if the Cheek be wound∣ed transversly, because the upper Cloth must not be Quadrangu∣lar, (for so it should cover the Eye) it must be cut Triangular, and reach to the Temple of the Head.

Now the tyings of the Threads ought to be distant one inch from another: So much I have thought good to deliver unto you con∣cerning Laqueation or dry Stitch∣ing. Now I am, according to the order of Doctrine, set down by my self, to discourse briefly de Su∣••••ris or Stitching with a Needle or Needles.

Of Stitching with Needles these five Points are to be observed. First, what is meant by this Stitch∣ing: Secondly, the divers Kinds of it: Thirdly, the Uses of it: Fourthly, the Instruments which are used about this Operation: The last Point shall contain the Documents, which shall inform you, how this Operation is to be performed according to Art.

Sutura then or Stitching is the beinging together of the Lips of a Wound by a Needle threaded, and the keeping of them together by these two means.

Of Stitching there are two dif∣ferences; for either the Brims of the wounded parts are kept toge∣ther by the Thread only, or else the Needle also is left in them.

Of the first sort of Stitching there are three kinds. 1. Is Su∣tura continuata or the Glovers Stitch: This kind of Stitch we use in the wounded Guts, when the Excrements come out of the Wound, and the Guts must be stitched. We use it also when great Branches of the Aorta and Vena cava are wounded, and there is a great Flux of Blood; if we can conveniently come to the Ves∣sels wounded.

The second kind of Stitching is Sutura non continuata: This kind is performed by taking, di∣vers stitches each being distant from another, so far as the large∣ness of the Wound shall re∣quire, and the Chirurgeon shall think fit: So many such stitches may be taken, as shall be able to bring the Lips of a Wound to a proportionate smoothness and e∣quality of the Skin. In every Stitch the ends of the Threads are to be cut off near to the Knots, that they stick not to the Emplaister.

The third kind of this Stitching is called Gastroraphia: This is used when the great Muscles of the Belly, and the Peritonaeum are di∣vided by a large Wound. Of this I will discourse, when I come to the Wounds of the Ab∣domen.

The second kind of Stitching is, when both the Needles are left in the Wound, and the Thread also is used. In this kind of Stitch∣ing when the Needles are passed through the Lips of the Wound, and they are brought together, the Needles are left there, and twist∣ed about both the ends as Tay∣lors do when they fasten their Needles to their Sleeve: This Stitching is to be used in the cure of the Hare-lip, and when the Trachea Arteria is wounded. In stead of Needles we may use Sil∣ver or Brass Pins: And when they are twisted about, their ends may be cut off with a pair of small Nippers, made for such a purpose, to avoid the cumbersomeness of the sharp ends of the Pins.

The uses of Stitching are three; for either we use Stitching to pro∣cure a quick Agglutination of the Wound: therefore it is called Su∣tura

incarnativa. And in this kind of Stitching the Brims of the Wound are to be brought near to∣gether.

Or the second use of Stitching is to keep the Brims of a Wound in a reasonable distance one from another. And it is called Sutura retentiva: this kind of Stitching we are to use when a Wound can∣not be united after the first, but second Intention; wherefore in this the Lips ought not to be too far asunder, lest the Air cool the parts too much; nor too near, be∣cause the Agglutination is not to be expected.

The third use of Stitching is to stay Bleeding, as when a Vein or Artery is wounded. This kind of Stitching is called Sutura sup∣pressiva.

Now the Instruments requisite for Stitching are Needles, Thread, and the Stitching-Quill. As for the Needles, they ought to be ei∣ther of Steel or Silver. Those of Silver will bend best, but then they must not be hardned by beat∣ing upon the Anvil. The Steel Needles you may distemper by holding them lapped in brown Paper wet for a while in the flame of a Candle. But it is good to have still some in readiness crooked as well as streight.

Their Points may be round, slat, three square, or four square. The square-pointed Needles pierce best. They ought to have good Eyes, and well grooped, that they may re∣ceive the Threads readily, and couch them the better.

As for the Thread, we use most commonly White, or Crimfon∣silk Thread: black is to be re∣jected; for it is most commonly rotten, and frets. But the Low-Country white Thread made of the best Hemp hath no fellow: for it swells in the Wound, and cuts not as Silk does, which grows small, and cuts too speedily.

The Stitching-Quill, called in Latin Canaliculus fenestratus, ought for the credit of the Chirurgeon to be of Silver. It hath two Uses. First, it keeps the Needles. Se∣condly, it stays the opposite part of the Wound, that the Needle may the more readily pass through the adverse Lip. Now it only re∣mains that I set down, according to my Proposition, some Docu∣ments, which teach what remark∣able things are to be observed, when you go about to stitch. These are in number thirteen.

1. We are to labour to stitch with the greatest ease that may be, that the Patient may the better en∣dure it.

2. Let the Lips of the Wound be with moderation brought toge∣ther: for if they be too straitly drawn together, the flowing of the Quittour will be hindred, and so a Tumor will be procured: But if they be left gaping, the inner parts will be cooled by the Air.

3. The Knots of the Threads must be sure: otherwise they may loose, and so we must be inforced to stitch the second time, which will be more terrible to the Patient than the first.

4. In Stitching we must beware of the Chords and Nerves: for if they be touched, great pain will ensue.

5. If Ligaments be cut asunder,

we are not to stitch them, for it is but labour lost, because they are only united by the second Inten∣tion.

6. In all parts of the Body the Skin may be stitcht, yea even in the Joints, deep Wounds, and Wounds of the Bones, after they have been smoothed with the Ra∣spatory: for by this means the Sper∣rutick Parts are covered, defended both the Air, the natural Heat is lept in, and the Cure is better performed.

7. A reasonable quantity of the Brims of the Wound is to be taken by the Stitches, otherwise if the Stitches break, we shall cause filth∣ly tranverse Scars.

8. Let the Stitches be distant by the distance of the breadth of the Fore-finger; or the least Finger at the least: for if they be too thick, they will cause the more pain; if they be too thin, they will hinder Unition.

9. In deep Wounds of fleshy perts, we must take deep Stitches; for if the Skin only be stitched, the Wound will only superficially heal; and the Quittour setling in the bottom, will cause Apostemation and a hollow Ulcer.

10. In streight Wounds of the limbs we may spare Stitching: for the Lips may be brought toge∣ther by Laqueation and Rolling: But if the Wounds be transverse, we are always to use Stitching, be∣cause the Flesh and all other Parts in such Wounds shrink towards the sound Parts, and so gape much.

11. If Wounds be in the Joints; we are to draw a good quantity of Blood. First, because the Joints are weak, and so apt to receive the influxion of Humors. Secondly, because they require strong Desic∣cations. Thirdly, because the Joints being weak, it may be fear∣ed that too much Blood may cause a suffocation of the natural heat.

12. In Wounds of the Ventri∣cles Phlebotomy is not so necessa∣ry. First, because they require not great Desiccation. Secondly, be∣cause if we use large Phlebotomy in them, we take away the fewel of the natural heat, wherewith they abound.

13. In long Wounds we are to begin from one of the ends; but in short Wounds (as in curing the Hare-lip) we are to begin at the middle; for so we shall shun pursing together of the Lips of the Wound, which will cause inequa∣lity in the Skin, and so deformity.

CHAP. VIII.

Of Agglutinative Medicaments, and Rolling.

IN the former Chapter I affirmed, that the Lips of the Wounds, which are to be united by Aggluti∣nation, ought not only to be brought together, but to be kept so also: I set down in like man∣ner three means by which the Brims are kept together, to wit, Laqueation or dry Stitch; Sutura, the Stitch with Needle and Thread; and Fasciae, Rolling.

Having amply discoursed of the first two, now I am to speak of the third mean, to wit, Rolling. Fasei∣atio aut deligatio per fascias, is when we labour to keep the Lips of the Wound, that they may the sooner and more firmly be united together by the means of Rolling. As concerning this mean, which industrious Chirurgeons have de∣vised, to attain to their end and scope, which is the Unition of the parts disjoyned, I will set down these three Points: The first shall be of the matter of Rollers. The second shall be of the divers kinds of Rolling in Wounds. In the third Point I will shew how they are to be applied according to Art.

As concerning the matter of Rollers, they ought to be of Lin∣nen: for woollen Rollers are apt to admit stretching, and so can∣not make such constriction as those of Linnen do. Secondly, they cause itching, and heat the part too much, by which means attracti∣on of Humors is caused, which al∣ters the natural temperature of the part, and so hinders the Unition of the parts of it severed.

Now the Linnen Rollers must not be of Cloth too new; for then they will be too stiff and hard: nor of Cloth too much worn, for then they will be too weak. Neither must they be of Cloth too thick, for then they will be too heavy and boisterous; nor too thin, for then they will be most apt to re∣ceive wrinkles, which is unseemly. They must also be of even Cloth; not having unequal Threads; for so they will cause Pits in the Skin. Besides this, they ought to be clean; for filth in Rollers stops the Pores, and hinders the Perspiration, and so may bring Inflammation.

As concerning the Dimensions of Rollers, those which are appointed for the Trunk of the Body, ought to be broadest: Then those which are ordained for the Thighs: Next unto these those that are to be ap∣plied to the Arms: The nar∣rowest are most fit for Fingers and Toes. As for the length, it is to be found out by the number

of Circumvolutions as shall be found fit and requisite.

As concerning the divers sorts of Rollings, Galen hath left a whole Treatise of them; by his Pains and Labour he hath deserved a thankful Commemoration from all Posterity. But all what he hath set down, cannot be applied to this Subject which we have in hand: Only four kinds do serve our pur∣pose, to wit, Incarnativa, Reten∣tiva, Expulsiva and Aequans.

Fascia Incarnativa, or the man∣ner of Rolling, appointed for Ag∣glutination, is of two sorts.

The first is performed by a Roller with two ends. Now in this sort we must begin to roll in the sound part, opposite to the Wound, and roll upwards, and so return to the wounded part with one end; with the other end we are to roll downwards, crossing the former, that the Lips of the Wound may be artificially brought together. In this kind of rolling, the Wound must be twice as broad as the Roller, because by this kind of rolling, the Roller draws the Wound together two times: Once rolling upward, and once rolling downward, and so to avoid wrinkling, the Roller ought not to be as broad as the Wound.

The second kind of aggluti∣native rolling, is performed by one Cloth, which must be broader than the Wound. The middle of it we apply to the sound part, that the sides may meet above the Wound; then we are to sow the sides of the Roller together with a transverse Stitch: But this kind of Rolling is not so ready as the first, because at every dressing we must cut the former Stitches and use new.

Fascia retentiva, is that kind of Rolling, which is used to keep close to the wounded part, the Ap∣plications, as Pledgets, Emplasters, Boulsters, Clouts, and such like. A simple Roller will serve for this purpose. This kind of Rolling ought to be no stricter than is sufficient to stay the Applications; other∣wise it may hinder the influence of the nourishment to the part, and so procure a sideration or mor∣tification of the wounded part.

The third kind of Rolling is called Fascia expulsiva, or the repelling kind of Rolling. This manner of Rolling suffers not any thing to lodge in the cavity of the Wound. Now seeing defluxions most commonly invade the depen∣dent parts, in this case, we are to begin our Rolling in the sound parts below the Wound, and so to proceed to the wounded part; whither when you are come, you are to use fewer or more loose Circumvolutions, and so to ascend to the sound part above the Wound, and then to use more strict rolling to hinder the descent of any Hu∣mor; and so by this same kind of Rolling we wring out the Matter which hath already flowed, and hinder the influence of any new Matter.

Fascia aequans, or a smoothing Rolling, is that which reduces un∣equal parts, whereof some are high, some low, to a decent equality: this is brought to pass by Boulsters and a simple Roller.

There are other sorts of Rollings besides these; yet either not so

necessary, or belonging to other operations in Chirurgery, as fascia prohibitiva apostematis, that kind of rolling which hinders Aposte∣mation. In this case we are to be∣gin our rolling about the Wound, and to go upward to the joint of the sound part. Contrary to this is fascia apostematis factiva, that kind of rolling which causes Apo∣stemation. There is also fascia disjunctiva, that kind of rolling which keeps parts asunder, and fascia directiva, that sort of roll∣ing which reduces distorted and crooked Members to their natural Figure: Of these I will discourse, when I treat of those points where∣in they are required.

Now concerning Rolling, this only remains, that I set down some Duties which are required of a Chirurgeon when he goes about to roll. The First is that he be nimble and quick in dis∣patching, that the Patient be not wearied. The Second is, That he carry a light Hand; for so he shall not hurt the Patient. The Third is, That he roll handsomely to content the Eye. To per∣form this, we are to have a care that threads hang not at the Roller, lest we might seem to have robbed Beggars of their rags.

In the former Chapter I affirm∣ed that 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or agglutination was performed by three Intentions: to wit, by bringing of the lips of the Wound together, by keeping them together, and by applica∣tion of agglutinative Medicaments. Having set down how the two first Indications are artificially to be done; now am I to deliver unto you what agglutinative Medica∣ments are sittest to procure agglu∣tination.

Of these Medicaments I will de∣liver these three points: the First shall be of their Matter: The Se∣cond shall be of the divers kinds of them: The Third shall set down the artificial application of them. As for their Matter, they ought to be cooling or temperate, to hinder Inflammations; and a∣stringent, to resist the Influxion of Humors; and drying, to ha∣sten consolidation. These Medi∣caments are of two sorts; for they are either simple or compound. These which follow are to be ac∣counted simple: Hypericum, Side∣ritis Achillaea, Polygonum, Bursa pastoris, Equisetum, sigillum Salo∣monis, Consolida major, Bugula, Ophioglossum, Valeriana, Panax coloni, Contaurium utrumque, so∣lidago Saracenica, Plantaginis species, Pontaphyllum, Tobacco, Car∣dnus Benedictus, Sanicula, Alch∣milla, Cavyophyllata, Lunaria mi∣nor, Vinuin rubrum astringens, rhus coriaribrum, aqua Aurifabrorum, Albumina ovorum clarificata, Hu∣mor melleus vosicis, quae lateribus foliorum Ʋlmi monse Maio adhe∣rent, conclusus. It heals Wounds very speedily; thus it is to be prepared: Fill a glass with this Liquor, then stop it well; then bury the Glass a Foot deep in the Ground, and cover it with Salt; suffer it to remain there for the space of twenty or five and twen∣ty daies; last of all, separate the clear Liquor from the Faeces. Na∣tural Balsame is excellent; Of this kind are Burnet, Periwinckle, Bole, Terra sigillata, Lapis haema∣tites,

Coralium utrumque, Gallae immaturae, Mrrtus, sanguis Dra∣cons, omnes Resinae, gummi Ele∣mi, Sanguis Draconis. Of these you may frame unto your selves com∣pound and effectual Medicaments. The compound Medicaments are either in form of Oils, which are called Balsanies, or in the form of an Unguent, or in the form of an Emplaster. I will acquaint you with some patterns of all the three forms: The efficacy of them shall recompence the paucity. This shall be the pattern of a Balsame: ℞. Ol. oliv. lb ij. succi Nicotianae lb. ss. gemmarum Hyperici, Sani∣c••••e, Alchymillae, sigill. Salomon. Caryophylat. hortens. Ophiogloss. Py∣r••. Valerian. Panac. colon. an. man. j. Herbae minutim incisae ad∣••isceantur oleo, & succo Nicotianae: p••steà coquantur omnia lento igne 〈◊〉〈◊〉 consumptionem humiditatis a∣queae, & coletur Balsamus, cui admisce ol. lumbricorum ℥ iiij. tere∣binthinae & vernicis clarae an. ℥ iij. Servetur Balsamus in vase stanneo 〈◊〉〈◊〉 vitreo, sc. mundo. I need not commend this Balsame unto you, seeing the ingredients themselves do shew of what efficacy it is in consolidating Wounds, Fabricius ab aqua pendente exceedingly com∣mends the green Spanish Balsame; But I mean not to mis-spend time in setting it down, seeing you may find the description of it in his Se∣cond part of Chirurgical Discour∣ses. As concerning Unguents, of all that you use, Franciscus Ar∣c••us his Liniment is the best. For this purpose: The Learning of the Author, and his extraordinary skill in the practice of Chirurgery, doth (I make no doubt) perswade you of the efficacy of the Medicament. Nevertheless this shall not hinder me from setting down the form of Unguents composed of the Simples before-named by me, which you shall find effectual, not in Wounds only, but in Ulcers also: I desire not to be credited, before experi∣ence shew the excellence of the one above the other: The de∣scription of the Unguent shall be this: ℞ Axung. porcin. lb. j. Co∣lophon. ℥ vj. cerae ℥ iij. gummi. Elemi ℥ ij. succi Tobaccae ℥ ix. Sa∣nicul•• Alchymill. gemmar. Hyper. Card. benedict. Ophiogloss. vinc. pervinc. sigil. Salomon. Pim∣pinell. Valer. Centaur. maj. & mi∣nor. an. man. j. Herbae incisae mis∣ceantur cum praedictis: postea coq. omnia lento igne ad consimptionent humiditatis aqueae, & coletur un∣guentum: cui admisc. vernicis cla∣rae, ac terebinthin. Cypr. an. ℥ j. Tandem reponatur unguentum do∣nec usus poscet. The ingredients will shew you, what benefit is to be expected from the application of it to wounded parts.

As concerning Emplasters, I mean not to set down any curious description for the curing of a Wound by the first intention, seeing a familiar one will serve the turn; receive this then: ℞ resin. abiet. lb. iiij. cerae. lb. j. sevi ovilli ℥ iiij. gummi Elemi ℥ iij. succi Nicot. & melilot. an. lb ij. Nicotian. con∣tus. man. ij. siat emplastrum secun∣dum artem. This is not a little better than the common Melilot, cheap, and parable. As for other ways of curing, know first, that cold water is not fit to be used; although Celsus lib. 5. c. 26. af∣firm, that it may serve for such

Wounds as Nature her self is able to cure. For First, Cold is hurtful for Wounds: Secondly, it may procure a Gangrene in Bodies which have small store of natural heat. Oil in like manner is not convenient, if it be simple, because it moistens too much. The whites of Eggs also are to be rejected, when we mean to glutinate a Wound: First, because they spee∣dily dry: Secondly, because they do not penetrate; yea, if glutina∣tive Powders be mingled with them, they hinder their penetra∣tion. But what shall we say of hal∣lowed clean Clouts? I Answer, that they also are not to be used because they only drie the Super∣ficies, and pass not to the cavity of the Wound: As for the hallow∣ing or blessing, it is but a device of crafty knaves, abusing the cre∣dulity and simplicity of the com∣mon people.

Now, to speak a word or two of the application of these Medi∣caments, which was the last point proposed by me to be handled, concerning Medicaments: If the Wound afford but small store of Matter, it is only to be dressed every other day: but if plenty of Matter, it is to be dressed once every day: but never twice a day, for then the Air will do more harm than tho Medicament good. Where∣fore they palpably erre, who think often dressing to further Consoli∣dation. Secondly, if you perceive the Lips of the Wound to be con∣solidate or agglutinate, straight∣ways cut the stitches, whether this happen the Second, Third, or Fourth day: For unition after the first intention is most commonly performed in this time: The next day following, when you see the Lips firmly to cleave together, pull out the threads with your Forceps or Fingers.

CHAP. IX.

How a Wound is to be cured after the Second Intention.

IN the former two Chapters, I have shewed you, how Wounds are to be handled, which are to be cured by Agglutination, or the First Intention: Now order of Do∣ctrine admonishes me to go on, and to teach in like manner, how Wounds are to be dressed, which are to be united by the Second In∣tention, called by the Grecians 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which may be ex∣pressed by this word Concarnation. It is not amiss sometimes to coin vocables of Art to express the matter which is in hand.

Now to cure a Wound after the Second Intention, three curative Indications do offer themselves. The First is, to procure the filling of the Wound by new flesh. The Second is, to abate the Flesh, if it become superfluous: And the Third is, to skin the part wound∣ed, when sufficient flesh is grown.

As for the First Indication, which is the filling of the gaping of a Wound with flesh; of it you are to consider the Motives, which in∣duce you to go about this manner of unition, and the means by which it is brought to pass. In five cases you are to go about the con∣solidation of Wounds by the Se∣cond Intention.

1. The First is, If there be loss of substance, whether it be flesh, or any other substance, as Bone, Cartilage, or Ligament. Neither is this a general rule: for if the parts be loose and flaggy, they may admit unition after the First Intention: as we may per∣ceive in the curing of the Hare-lip, and Wounds of the fore part of the Neck.

Secondly, you are to attempt this kind of Cure, where you can∣not conveniently bring the lips of the Wound together by stitching or rolling: as in great wounds of the Joints, and when the Liga∣ments are cut asunder, as the great Tendon, which is called Nerv••s Hectorius, and is inferted into Os calcis.

Thirdly, this is to be done when we look upon the scaling of a Bone, or the scparation of the piece of a Ligament or Carti∣lage.

Fourthly, we are to take this course, when otherwise a great and dangerous Flux of Blood cannot be avoided, as in wounds of the Neck, where the internal jugular Veins and soporal Arteries are di∣vided.

Fifthly, we are to address our

selves to this manner of Unition, when great store of Quittour is like to flow to the wounded part; and this falls out in four cases.

The First is, when we cannot hinder the influxion of Humors by rolling, as in wounds of the Arm∣pits and Joints.

Secondly, in cacochymical Bo∣dies.

Thirdly, in persons who have a scirrhosity in the Liver and Spleen.

Fourthly, if the wounded party have a contagious Disease, as the Pox. In these cases we are rather to attempt Unition by the Second, than First Intention, especially if we fear no deformity by reason of a scarr: As it happens in wounds of all the parts of the Body, if you except the Face.

The causes which ought to in∣duce you not to attempt Uni∣tion after the first Intention, when there is loss of substance, are these: First, Pain and Inflammation will ensue, by reason of the violent bringing of the lips of the Wound together: Secondly, there will re∣main a great deformity in the part wounded, after that is cured. So much then concerning the oc∣casions, which are to admonish a Chirurgeon, when he is about to cure a Wound, whether he ought to perform this by the Second In∣tention. Now I am to shew you, what means are most apt to ge∣nerate new flesh: These means are in number three: the principal ef∣ficient cause: The causes adju∣vant: The material cause.

The principal efficient cause is the natural Temperature of the whole Body, and of the parts af∣fected also, which ought to incline to driness: If it be present it is to be maintained; but if you find it not, you are to procure it by Phle∣botomy, Purgation, and the right ordering of those things which are called not Natural. But seeing I have amply discoursed of these points, when I set down the methodical cure of Ulcers, I will remit you to that Treatise, and will not trouble you with a fruitless repetition of the same things.

The adjuvant causes are two, to wit, the Chirurgeon, and conveni∣ent Medicaments. As for the Chirurgeon, he ought to dress the party with as much ease as may be. Secondly, he ought to have a care that the applications be ap∣plied to the Wound very neatly: for by want of this, a slubberer and sloven is discerned from a cleanly workman. This the Chi∣rurgeon can hardly perform, if he be not cunning in fitting of Lini∣ments, upon which the Medica∣ments are to be laid, which are to be applied to the wounded part.

Now the Liniments are of three sorts; Turundae, Tentae, and Sple∣nia. Turundae or dosils represent in Olive in Figure Tentae or Tents are long, and somewhat small. Splenia or Pledgets ought to represent the Spleen of living Creatures, from whence they have their denomination.

The Pledgets, which are appli∣ed, ought first to be somewhat larger than the Wound: Secondly, they ought to be armed with Me∣dicaments

which have a moderate tenacity or clamminess, and which ought to have a faculty to stay an Inflammation, to asswage pain, and to repell Humors, which might flow to the part. Such are Dia∣palma dissolved in Oil of Myrtles, Quinces or Roses, Ʋnguentum de Tutia magistrale, Ʋnguentum de Minio. If for the present you be destitute of these compositions, you may use the red astringent Wine, or Tanners Woose, or Smiths wa∣ter clarified, mingled with one of the Oils befor-named: and then it is good to moisten the Rollers in this Medicament. These Lini∣ments are to be made of Lint or Tow; the Tow ought to be with∣out shivers: It dries more than Lint, if it be of Hemp.

The material cause of the gene∣ration of new flesh is laudable Blood, answering the temperature of the part wounded. So if a sper∣matick part be wounded, the Blood ought to be somewhat cold, thick, and dry, which is to gen∣der a mean to unite the parts se∣vered. But if a fleshy part be wounded, the Blood is to be hot∣ter and more humid. Having set down the part of the Chirurgeon, whom I affirmed to be the first adjuvant cause, in producing new flesh, now am I to to acquaint you with those Medicaments which are termed by Artists Sarcotical, or apt to engender new and tender flesh.

All Sarcotical Medicaments, as they ought to be of a dry∣ing faculty, so they ought to be void of a sharp and biting quality. The differences of dry∣ing Medicaments are either ta∣ken from the degrees of their dry∣ing quality, or from the diver∣sities of their kinds. From the degrees of drying, these three dif∣ferences are drawn: For either they are of a mean operation, and these will serve when the Quittour is Album, Leve, and Aequate, white, smooth, and of an equal substance, one part of it not being thin, and the other grumous. Or they are somewhat stronger, as when the matter which flows from the Wound is thin and ichorous; for then stronger desiccatives are re∣quired to incrassate or thicken this thin matter. The Third degree comprehends the strongest desic∣catives: As when Sordes or a Sluch appears in the Wound, these Me∣dicaments are called Medicamen∣ta detergentia the Chirurgeon's Mundificatives; and those Medica∣ments according to Gal. 1 meth. 12. ought to be of a drying and penetrating faculty; For those things which are united in the bo∣dies of living Creatures, are uni∣ted by moisture: wherefore dri∣ness spending the Humidity, they are again separated; as we may for an example see in a Table glued together, if it be too much dried by the fire.

Now there be two kinds of these drying Medicaments, for either they are simple or compound. The simple drying Medicaments, ac∣cording to Gal. 3. Meth. 3. are of three sorts.

The First, dry in the first De∣gree, for those who have had but a tender and soft constitution of Body, as are Children and young Gentlewomen. Children are esteem∣ed to be of this constitution, un∣till

they attain the Fourteenth year of their age.

The Second sort is of such as are dry in the end of the First degree, and the beginning of the Second.

The Third sort is of such as are drie in the end of the Second de∣gree: and as these befit bodies of very hard and firm constitution of Body, such as Sailers, and Artifi∣cers of hard Trades have, as Smiths and Felt-makers: So the Second sort of Desiccatives are fittest for such as are of a mean habit of Bo∣dy, neither too loose nor too hard, as Gentlemen in their consisting age.

Unto the First degree of De∣siccatives these may be referred: Thus, Farina Hordei, & Fabarum, ut & Zeae utriusque, Mastiche, Oliba∣num in guttis.

To these of the Second degree you may refer all sorts of Resines, as the yellow, the black Ship-Pitch, and Elemi, clarified Honey, Fari∣na Cicerum, & metallica quaedam; ut Mintum, Lithargarus, Phanbum vstum; sed omnia lota.

To the Third degree you may refer: Farina Orobi amari, Lupi∣norum, Iris, Aristolochia utraque, Myrrha, Sarcocolla, Lapis calami∣naris, Tutia, Aesustum.

Thus those Simples which are drying in the First degree, serve for those who are of a soft habit of body: Those which are in the Se∣cond degree, serve for those who are of a mean habit: but those which are of the Third degree, are fit for those who are of a chur∣lish habit of Body, as I have no∣ted. Now what I have spoken of the habit of the whole body, I would have you to apply it to the habit of every several part: So the fleshy parts are softest, althô there be degrees: amongst them: The Lips are softest of all: The Sinews and Membranes are of a mean hardness, but the Cartila∣ges and Bones are hardest of all.

Of these simple Sarcotical Me∣dicaments, you may frame unto your selves sundry compositions, as occasion shall move you: Only I will set down one for a pattern, and it is this: ℞ Balsam. Hyperic. simpl. lb. ss. Resin. ℥ vj. Cerae ℥ iv. Picis navalis. ℥ iij. gum. Ele∣mi. ℥ ij. Vernic. & sevi ovil. an. ℥ iij. Terebin. Cypr. ℥ iss. Olib. & Myrrh. pulveriz. an. ℥j. This I have termed my Basilicum Ma∣gistrale; I will not stand much up∣on the commendation of it; the ef∣fects will praise it: If variety of such compound Sarcosical Medi∣caments doth delight any one, let him have recourse unto the dis∣pensatories of sundry Men, and Nations: If he be not by them sa∣tissied, I shall think that he hath an Appetitus caninus of the Ima∣gination.

One thing is to be noted, that cathaeretick Medicaments, as Alu∣men ustum, A••s viride, and Vitri∣olum calcinatum, may become Sar∣cotics, if they be mingled in com∣positions with Sarcotics in a small quantity.

It is not enough in curing by the Second Intention to procure the growing of new flesh in Wounds; but we must be wary that it do not overgrow. If this happen, we must take order with it. The cause of superfluous flesh is too much Blood sent unto the

part. This is abated by appoint∣ing a strict Diet, and the use of Aliments, which do not feed much. Secondly, cooling and astringent Medicaments are to be applied to the sound parts adjacent to the Wound. Thirdly, we are to use hard Frictions and strait Li∣gatures to the opposite part: for by all these means the im∣moderate influence of Blood is stayed.

Now superfluous or proud Flesh is taken away three manner of ways. First, by an Instrument, as an Incision-Knife or a Rasor, Se∣condly, by rubbing it away by a rough Linnen Cloth. Thirdly, it is removed by Cathaeretical Medi∣caments: such are Alumen ustum, Vnriclum calcinatum, Mer. prae∣cititatus. If the party wounded be of a tender habit of Body. Merc. lotus will serve, being thus mingled: ℞ Ʋng. Basilic. magi∣siral. ℥ j. Merc. praecipitati loti ʒ j. exquisitè misceantur: But if he or she be of a hard and stub∣born habit, let this Medicament be made: ℞ Merc. praecipitat. non liti ʒ ij. Aluminis usti ʒ j. Super ••ar••••••r Pictorum levigentur: po∣stea. ℞ Hujus compos. ʒ j. Ʋng. Basilici magistral. ʒ vj. Optimè Misc. If you apply the aforesaid Powders unmingled with an Un∣guent they will cause an Eschar if need be. Whoever he be that has brought a Wound to that pass, that the supercrescent Flesh requires a stronger Ca∣theretical Medicament than these, he must be a novice in his Art.

The Wound being thus suffici∣ently incarnate nothing remains, but to cicatrize it. Concerning Cicatrizations these three Questi∣ons may arise. First, what manner of skinning is most laudable? Se∣condly, when we are to go about skinning? The third shall be of the causes which procure skin∣ning. To the first I answer, that the Cicatrix which in colour and conformation best represents the natural Skin, is most laudable. To the second Question I answer, that we are not to go about the skin∣ning of the Wound before the Flesh be somewhat higher than the natural Skin: for otherwise the Cicatrix will be hollow, which is unseemly. If a piece of a Bone ei∣ther be taken out or cast, we can∣not shun a hollow Cicatrix. As for the Causes;

The efficient Cause is a faculty resident in the sound Skin, adjacent to the Wound: So we see skinning to begin from the Brims of the natural Skin.

The material Cause is Flesh hardned.

The adjuvant Causes are E∣pulotical or skinning Medica∣ments.

As concerning the Medicaments, we are first to consider their fa∣culty; Secondly, to set down their kinds. As for their faculty, they ought first to dry strongly, and to reach the end of the third degree of Desiccation; because such Medi∣caments ought not only to consume the extraneous Humidity, but the natural also. Secondly, seeing they

are to stay the influxion of more Blood, which might ingender more new Flesh, they ought to be very astringent, so that it may be discerned by the Tongue and Palate. Yet they are to have no Acrimony, for then they would ••rode.

These Medicaments are of two sorts; for they are either Simple or Compound. For wounded Per∣sons of a soft Habit, these will serve; Frankincense, the bark of the Pine-tree, Lead calcined and washed, Oyster-shells burned and washed: for those who have a mean habit of Body these will serve, which are drying in the be∣ginning of the third degree; as are unripe Galls, the Flowers and Rinds of wild Pomegranates, Su∣mach, Myrtil berries, Sanguis Dra∣conis, Terra Ʋmbra, Rubrica fa∣brilis. For those who have a very hard habit of Body, use Aes ustum, Alumen ustum, Capue mortuum Vi∣trioli distillati ablutum.

The compound Epuloticks are in like manner of three degrees: For some are for tender Bodies, as Ʋnguentum de Minis, Ceratum de Minio, Ʋnguentum de Tutia: Some are for Bodies of a mean habit; these will serve for such: Diapalma, Ʋnguentum de Tutia magistral. cujus haee est composi∣tio: ℞ Ol Ros. ℥ xij. Ol Myrtin. & Ʋng. Popul. an. ℥ iij. fol. Plan∣tag. & Solan. hortens. contus. an. man. ij. evaporet lento igne humi∣ditas aquea, atque instituatur co∣latura, in qua liquescat cer. alb. Quum incipit Medicamentum fri∣gescere, insperge Litharg. auri ℥ vj. Tutiae praepar. ℥ j. Ce••uss. ℥ ij. Minii ʒ vj. Caphur. ʒ j. Omnia haec pulverizentur. Ducatur hoe Ʋnguentum per hor. 2. in morta∣rio plumbeo. For those that are of a hard habit of Body, use this Ʋn∣guentum de Tutià magistrali, add∣ing to every ounce of it, Abis usti ʒ j. or Vitrioli. ad rubed. cal∣cinati ʒss. You have in the Apo∣thecaries Shops Ʋnguentum de bolo Armen.

CHAP. X.

Of a Convulsion in Wounds.

HItherto I have delivered unto you such Precepts as con∣cern all Wounds in general. Now the Method which I proposed unto my self in the beginning of this Treatise of Wounds, doth require that I set down in like manner such Points as concern all particu∣lar Wounds.

The Differences of Wounds are taken from three things. The first from their Accidents: The second from the Nature of Wounds: The third, from the parts affect∣ed From the Accidents, Wounds may be said either to have been known unto the Ancients, or not to have been known unto them. From the Nature of Wounds these Differences are taken: Wounds are either Simple or Compound. A simple Wound is that which hath neither any cruel Symptom, 〈◊〉〈◊〉 any other kind of Grief, which may draw the Chirurgeon from going about the curing of it, ac∣cording to the intention set down in the general Doctrine of Wounds. Thither then I send you: for I mean to avoid fruitless repetitions. A compound Wound is, that which hath either a cruel Symptom, or same Disease, or both annexed.

The Symptoms are in number five: Pain, Fainting, a Convulsi∣on, a Palsie, and Crudity. Of Pain and Fainting, I have dis∣coursed already; because they hap∣pen often, as well in simple as compound Wounds, as hath been shewed, Cap. 5. Wherefore I am only to speak of the last three: of which a Convulsion is the first: If you require a Description of it: receive this: A Convulsion is a contraction or drawing together of the Muscles or Parts which are appointed for voluntary Motion towards their beginning; which are either the Brain, or the Spinalis Medulla or Chine of the Back.

A Convulsion is two-fold: for it is either natural or unnatural: A natural Convulsion happens when one of two Muscles appoint∣ed for Motion is contracted, the other being tranversly wounded. This is to be seen in Wounds of the Head, when one of the tem∣poral Muscles is transversly cut a∣sunder; and in Wounds of the Fingers: for if the inner Muscle of a Finger be cut asunder transversly, the outward Muscle is contracted. An unnatural Convulsion is that which happens not because one of two Muscles, ordained to perform this same action, is tranversly

wounded. This is two-fold, Mo∣tus convulsivus, and Convulsio vera. Motus convulsivus, or the con∣vulsive Motion, is caused of a thin and halituous Matter, moving too and fro, tossing the Nerve: And it doth not continue long, for the Matter being kept in the part af∣fected, the Brain and the begin∣ning of the Nerves are so affect∣ed that they lose their Action; from whence ensues the Palsie on that side: then a malign Vapor being raised from hence, and pas∣sing to the beginning of the Nerves of the sound part not alto∣ther spoiled, the Nerves are sha∣ken, and so Motus convulsivus is caused.

If any man demand, why a malign Vapor resting in the Brain procures not only a stupidity, but a Convulsion, if the beginning of the Nerves be affected?

I answer, that this happens, be∣cause no Body can have Motion in it self, which is not Fibrous: See∣ing then the Brain is not Fibrous, it cannot have Extension, and Con∣traction: But the beginning of the Nerves may, although they be soft: for they are framed of many Filaments covered with a Membrane. Not unlike to this is Spasmus flatulentus or the Cramp. This is caused of a thin Humor or Flatuosity nipping the beginning of the Muscle: so you may observe, that they who are troubled with a Quartan Ague, or who increase windiness in the Body, are most subject to this Grief. This very often is a forerunner of a true Con∣vulsion: Wherefore it seems only to differ from a true Convulsion, that in this the Matter is less sharp, and the Contraction endures not so long.

A true Convulsion is that which is caused either of a plentiful greasie Matter stopping the Nerves, or of a driness pursing of them; or by consent, a noisome Vapor being sent to the beginning of the Nerves of the Muscles, and nip∣ping them. Of a true Convulsion there are four kinds, Emprostlxto∣nos, Opisthotonos, Tetanos and Spas∣mus cynicus. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is when not only the Neck, but the rest of the Body also is drawn for∣wards, so that the party cannot stand upright, the Nerves of the Neck, and of the rest of the Spina, which move the Body forward, being ill affected. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is when the whole Body is bent backward, so that it cannot be brought for∣ward; which happens when the Muscles which bend the Body backward are hurt. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 is when all the fore and back parts of the Body are equally contract∣ed, and so kept. This happens when all the aforesaid Muscles are kept at a stay. In this kind of Convulsion the Body remains stiff as a stake, so that it cannot bend it self to any part 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Seu oris tortura, aut oris di∣stortio, according to Celsus, lib. 4. c. 2. is when the Mouth is pulled awry; 'tis caused by the contra∣ction of the Muscles of the Face. Now the chief Muscles of the Face are those of the lower Jaw, the Nostrils, Lips and Cheeks, which have their Nerves for the most part from the third Conjugation.

As for the Signs of a Convulsion, it is easily discerned: for in it the Nerves and Muscles being drawn to∣wards

their beginnings against the Will, cause the Member also, which they move, to follow this depraved Motion, so that it continues stiff, and cannot be bent as the diseased person 〈◊〉〈◊〉. This is the only Pathognomi∣•••• sign of a true Convulsion. In a convulsive Motion this distension is not performed at once, and so con∣tinueth; but it comes and ceases then, and shakes the part sundry ways.

The Causes of a Convulsion are three; Fulness, Inanition and Con∣••••t.

Plethora or Fulness, is thus dis∣cerned: The habit of the Body is ••ick and fleshy, the Vessels ap∣pear full, the Pulse is strong, a constant Age, the Spring time, a temperate Region, a full Diet of much nourishing Meats, a ruddy colour of the Chin, and if the party bleed little at the Wound, shew the same: the sleep is sound and long, dreams of red things and blood present themselves: In motion the Body is not nimble, the Urine is laudable, and plen∣tiful.

To cure such a Convulsion, both Physical and Chirurgical means are required: As for the Physi∣cal means, first, Bleeding is ne∣cessary: In Phlebotomy, what quantity of Blood is to be drawn, the Strength of the party, the Part affected, the Age, the Season of the year will shew, if no Phy∣sician be at hand to direct. A slender Diet is also requisite: for little Meat takes away Lassitude or Heaviness, and asswages Thirst, as it is noted. 6. Epid. com. 3. Text. 28. Purgation is not to be admitted: Begin first with Cly∣sters, which must be reasonable strong, and have Anodyne Oyls mixed with them. Receive this as a Pattern: ℞ Diacathol. ℥ j. Confect. Hamech. ℥ss. Spec. Hier. Picr. ℥ ij. Ol. Lil. alb. & Chamae∣mel. an. ℥ j. decoct. communis pro clysterib. ℥ x. Misc. ut fiat clyst. If you be enforced to use Cathar∣tical means, use these two, the descriptions of which are these: ℞ Caryocostin. & Elect. de succo Ros. an. ʒ iij. Syrup. Ros. solut. cum Agarico ℥ j. Aq. Lil. convall. flor. Tiliae, vel Ceras. nigror. ℥ iij. Misc. ut fiat potio. 2. ℞ Diaphoen. Elect. de succo Ros. & Caryocostin. an. ℥ ij. Antidoti convulsivae ℥ ij. Tur∣pet. alb. & rad. è Salv. major. an. ℥ss. Diagryd. ℥ iij. Castor. ℈ ij. Costi Zinzib. Caryophyl. an. ʒ j. semin. Cumin. Rut. Croci an. ℈ j. Cum syrup. Ros. sol. cum Agarico s. q. fiat Elect. s. a. dos. ℥ss. in praedict. aquarum ℥ iij. The Com∣position of Antidotus convulsiva is this: ℞ Rad. Paeon. maris conve∣nienti tempore erutae, & Visc. quercin. an. ℥ j. Castor. ʒ iij. Salv. ℥ v. Baccar. Lauri. Cranii humani an. ʒ j. Theriac. Andromach. & Mithridat. optimi an. ʒ vj. Cum Mellis despumati ℥ xij. Fiat Ele∣ctuar. dos. ʒ ij. In aq. Salviae, Rorismar. Lavandul. aut aq. Epi∣lept. Langii. aut aqua Hirundi∣num, cujus hanc accipite descripti∣onem. ℞ Pullos Hirund. numero 50. Forfice auferantur extremitates pennarum major. semin. Sesel. Card. benedict. an. ℥ss. Calam. aro∣mat. Cyperi. an. ʒ ij. Fol. Majo∣ran. Rut. an. man. ss. Flor. Til. & Lil. convall. an. pug. ij. Visc. quercin. rad. Paeon. lunâ decrescente collect. an. ℥ j. Castor. ʒ vj. Infun∣dantur

isti per dies iij. in vini Malvat. lb viij. Postea institua∣tur distillat. in B. Mariae: dos. ab. ℥ss. ad ℥ j. in aq. praedictarum ℥ iij. Give also ℈ss. Extracti. Ca∣storei in aq. Salviae, Electuarium ad Spasmum. This following E∣lectuary is excellent: ℞ Castor. Sagapen. Opopanac. an. ʒ j. succi Laseris vel Assae. faetid ʒiss. Acori, Scord. an. ʒ ij. Trium Piper. Schae∣nanthi. Carni. an. ʒ ij. Asari. Scillae assat. an. ʒiss. Rad. Irid. semin. Apii. Mastich. an. ʒ j. Stae∣chad. ʒ iij. Cum. Mell. despumat. & Mellis anthosati an. ℥ v. fiat Elect. dos. ʒ j. singulis diebus in aq. mulsa. Cardanus de curdt. ad∣mirand. c. 15. affirms that he cured one troubled with Opisthonos thus: He caused him to refrain from Flesh, Wine and Eggs: he applied to the Neck, the whole Spina, and parts convelled, Clothes moistned in Oyl of Chamaemil and Lilies. Inwardly he ministred Mi∣thridate with the Electuary of Musk, with the which he mingled Pearls, the Jacynth and Emerauld prepared. These things being done, we are to come to the To∣pical means: These must resolve and discuss: such are Oyls, Lini∣ments, Unguents; Fomentations, Bathes. Ʋtendum his Oleis, Ʋul∣pino de Castor. de Catell. pinguibus, Philosopher. Juniper. Laurino, Rutaceo, Terebinth, Petrol. de Spi∣ca, Lumbric. Hyper. cum Gummi, de Costo. Irine, Lil. albor. Chamae∣mel. pingued. Ʋulp. Taxi. Anse∣rum sylvest. humano, & ursino. As for Ʋnguents you have Aregon. Martiation, Dialthaea cum Gum∣mi: of these and the Oyls you may frame unto your selves Liniments: as ℞ Axung. humanae, ursi, taxi, anser. sylv. an. ℥ j. Ʋng. Di∣alth. ℥ ij. Ol. Lumbric. Ʋulpin. Hyper. cum Gummi. Lil. alb. & Castor. an. ʒ iss. fiat linimention s. a. If great Desiccation and Dis∣cussion be required, you may use this Liniment: ℞ Ʋng. Aregon. & Martiat. an. ℥ j. pingued. human. & ursin. an. ʒ ij. Ol. Terebinth. Philosoph. & Petrol. an. ʒ j. Ol. Salv. ℈ j.

As for the Fomentations, boil Mallows, Fenugreek, Scordium, Sage, Lavander, Tansey, German∣der, Thyme, Chamaemil, Dill, Bay-leaves, Flowers of white Lily, Woodbind, and Betony, in Sack and Muscadel, taking equal mea∣sure of each.

Bathes you may make also of these Simples, boiling them in Wa∣ter and Milk. Last of all, let the parts be lapped with Fox, wild Cats, Conies, or Hares skins dressed.

Having discoursed of a Convul∣sion proceeding from a Plethora or Plenitude; I am to shew how a Convulsion from Inanition is to be dealt with: whether it proceed from Inanition or no, you are to exa∣mine those Signs which I set down to find out a Convulsion caused of Fulness. If you find in the part wounded Signs opposite and ad∣verse to those, you may boldly pro∣nounce that it proceeds from Inani∣tion.

In such a Convulsion abstain from Phlebotomy and Purging; only keep the Body soluble with emol∣lient Clysters, as this: ℞ Lactis, cui incoxeriut Althaea, Violae, Pa∣rietaria, Rosae pallidae, bonus Hen∣ricus mercurialis, ℥ x. Ol. Viol

& Lini an. ℥ j. Sacchari rubri ℥ ij. Misc. ut fiat clyster. As for local Medicaments, they must be of a remollient and moistning quality.

The Oyls of this kind are, the Oyl of Violets, Linseed, Quinces, Reats-foot and Trotters, Eggs, of ••••eet Almonds, new Sallet-oyl, you may use also May-Butter, new S••ines-grease tried: Of these you ••ay make Liniments; take this Discription as a Pattern: ℞ Butyri ••••••••lis & Axungiae Porcinae re∣••••tis an. ℥ ij. Ol. ovor. Cydon. 〈◊〉〈◊〉 Viol. an. ℥ss. Misc. ut fiat lini∣••••••tum.

As for Baths, you may boil in 〈◊〉〈◊〉 and Water a Sheeps Head and feet, Mallow-leaves and flowers, ••••••et-leaves and flowers, Pellito∣••y of the Wall, Linfeed and Fe∣••greek: when the Bath is ••••de, you may add to it some 〈◊〉〈◊〉 Neats-feet Oyl, and Oyl of Trot∣••ers.

Now last of all, a Convulsion 〈◊〉〈◊〉 consent offers it self: This ••ay happen three manner of ••ays:

First, by a malign Vapor offend∣•••••• the beginning of the Nerves, as 〈◊〉〈◊〉 happens in poisoned Wounds. 〈◊〉〈◊〉 these the Wound is to be di∣••••ed, that the venomous Matter ••ay have a free vent. Then ••••pping-Glasses are to be appli∣••••, to stay the ascent of the Va∣••••••s.

The Medicaments which are to 〈◊〉〈◊〉 applied to such Wounds must 〈◊〉〈◊〉 a liquid substance, that they may the more readily pass to the bottom of the Wound. They must also be of a drying and digesting quality, to resolve and draw out the virulency of the Matter: such are Theriaca Andromachi, and Mi∣thridate dissolved in the Spirit of Wine, or Aqua Theriacalis. It is not amiss to add some of the Pow∣der of Mercury precipitate well washed in Plantain and red Rose Water: for in such Wounds it is an excellent Antidote. Now I only point at the Cure of such Wounds, setting down but a few general Indications of Cure, be∣cause hereafter I am to discourse of all sorts of poisoned Wounds in particular.

Secondly, a Convulsion by Sym∣pathy or Consent happens, the Nerves drawing themselves towards their beginnings, by reason of the great pain, which is felt in the wounded part: In this kind of Convulsion Anodyne Medicaments, or such as asswage Pain, are to be applied. But seeing I have at large discoursed of such, Chap. 6. I will remit you thither, not will∣ing to use idle repetitions.

Thirdly, a Convulsion by Con∣sent may happen by reason of immoderate Cold, making the Nerves stiff. In curing of this Symptom. 1. You must keep the wounded party in a warm Room; 2. You are to use warm Medica∣ments, as Oyl of Chamaemil, Dill, Rue, Bayes, Lilies, Rape-Oyl, Dogs grease, Bears grease, Horse grease. Of these you may frame unto your selves Liniments, as this: ℞ Pingued. caninae, ursi, & equinae an. ℥ ij. Ol. Raporum, Cha∣maemelin. & rut. an. ℥ss. Misc.

ut paretur ••nimentum. In this case it is excellent to foment the part with the decoction of Tur∣neps being very warm; for it is a superficial Medicament in this case.

Before I end this Chapter, I will set down a few Aphorisms concerning Convulsions in Wounds, which will serve for Progno∣sticks.

The first shall be this: A Con∣vulsion or Raving, which ensueth after immoderate bleeding, is ill, according to Hippocrat. Aphor. 3. not only because the Nerves are dri∣ed, but because Choler and cor∣rupt Humors offend the begin∣nings of the Nerves after the evacu∣tion of Blood.

Secondly, if a Convulsion ensue af∣ter a Wound, it is most commonly deadly 5. Aph. 2. partly because sharp Humors nip the Nerves: part∣ly because the Nerves must be en∣flamed. Heurnius writing upon this Aphorism, sets down a dainty Medicament in this Case, which I thought good to impart to you; and it is this: first, press out the Oyl out of the Seeds of Saint Johns-wort; next infuse the Flow∣ers of the Herb in the same Oyl, This Oyl apply warm.

Thirdly, whosoever are taken with a Tetanos, they die within the space of four days; but if they pass these, they escape, 5. Aph. 6. For first it is a most sharp Disease, and such do end the fourth day: Second, Nature cannot longer en∣dure the horrible pain, which is caused by the strong Tension of the Nerves, both of the fore and back part. One thing is to be noted, that they which die of a Convul∣sion, remain long hot, because they die being stifled, the Muscles appointed for respiration being al∣so convelled: for the Muscles of the Neck being distended, the Septum transversum also must suf∣fert; for Nerves springing from the fourth Vertebra of the Neck are inserted into the Midriff, and so the Neck suffering a Convulsion, Respiration is hindred.

CHAP. XI.

Of a Palsie, and crudity in a Wound.

HAving delivered unto you in the former Chapter so much as was fit for a Chirurgeon to ••••ow concerning a Convulsion, in the first proper Symptom of a compound Wound: now I am 〈◊〉〈◊〉 descend to the second, which 〈◊〉〈◊〉 a Palsie, a Symptom opposite to the other. Paralysis is deduced from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which is to be resolved; because the Nerve, and the Muscle into which the Nerve 〈◊〉〈◊〉 inserted, are so resolved, loosened and weakned, that they become ••••fit Instruments for volun∣tary Motion: This Particle 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 doth in this composition sig∣nifie a Diminution; so that 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 may be termed such as are taken lame in one side, or any ••••ce part: but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, such as are taken through∣out the whole Body with such a Grief; such are Persons taken with an Apoplexy, or are a dying: of which Hippocrates speaks, 2. Aphor. 47. It is called by Avicen and his Interpreters Mollificatio, because the Nerves in this Grief seem to become softer. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 torpor aut stupor, Numness comes near to this Dis∣ease. And tho this affection seems ••••ly to be a Dulness in Feeling, yet it is taken for a Passion com∣pounded of the difficulty as well of Moving as Feeling. It is often a fore-runner of the Palsie, and only differs in the degree of the Cause, it being milder. Paralysis, or a Palsie, is the privation of Mo∣tion always, and sometimes of Feel∣ing also in one or more Parts, proceeding from the stopping or intercluding of the animal Spirits, which are the efficient Causes of voluntary Motion. By those who have written of this Disease a Que∣stion is moved:

How it comes to pass that in a Palsie, sometimes both Moving and Feeling are taken away; some∣times the Motion and not the Feel∣ing, and sometimes the Feeling and not the Motion?

In those parts wherein there are divers Nerves serving for Motion and Feeling, the Answer is easily made; for in such parts if the Nerves appointed for Motion be only affected, then the Motion is hindred, the Sense remaining sound, and if the Nerves appointed for the Sense be affected, the Sense is hindred, the Motion remaining: So in the Eye, if the Optick Nerves, the first pair be hurt, the Motory, the second pair being safe, the Sight is taken away, the mo∣ving of the Eye remaining; and

in the Tongue, if the third and fourth Conjugation of Nerves of the Brain be offended, and the se∣venth pair be found, the Taste is offended, the Motion of the Tongue continuing, and on the contrary. If the same Nerve do afford both Moving and Feeling unto a Part, the Matter is not so plain. Authors do ascribe this to the defect of the Animal Spirits; so that Moving may be abolished, Feeling remaining: for fewer Spi∣rits are required for Feeling, than Motion, which must have greater strength of the Faculty; and there∣fore if Feeling be abolished, the Motion cannot be safe: for it is not likely that the weaker Opera∣tion being taken away, the strong∣er should remain. If a Nerve in∣serted into a Muscle be so affected, that the influence of the Animal Spirit is stayed, it may fall out that both Feeling and Moving may be taken away: but if a Nerve being inserted into a Membrane or into the Skin, be so affected, the Feel∣ing may be abolished, the moving of the Member remaining; for these similary Parts are not appointed for Motion.

The immediate cause of a Pal∣sie, I reckon to be some unna∣tural affection of the Nerves, which are inserted into the parts, which are by Nature destinate to voluntary Motion: for from the Nerve every Muscle hath the facul∣ty of moving, which carries to it Animal Spirits.

Now a Nerve hath a two-fold consideration; for it may be con∣sidered, first, as it is a similary part concurring to the composition of a Muscle; or secondly, as it is an organical part carrying the Ani∣mal Spirit from the Brain to it, which is the principal efficient cause of Motion.

As it is a similary part, it may suffer Distemperature, this Distem∣perature all Practicers agree to be a cold and moist Distemperature; for such a Distemperature relaxes the Nerve, and makes it altogether unapt to receive and carry the Ani∣mal Spirits.

The external Causes of this Di∣stemperature may be the cold Air, the North wind, immoderate Venus, narcotical Medicaments, lying in Snow, or in Water, Ga∣len 4. de Loc. affectis, c. 4. af∣firms that one who in the Win∣ter Season, in cold and rainy Weather, had lapped his Neck with a wet Cloak, and kept it somewhat too long, became para∣lytick in one hand, the Nerves of the fifth, sixth and seventh Ver∣tebrae of the Neck having been of∣fended.

The internal Cause which brings a Palsie, is a phlegmatick, moist and cold Humor; moistning and cooling the Nerves too much, and relaxing them, and so altering their natural temperature, and making them unfit either to receive th•• influence of the Animal Spirits, o•• to bring them to the Parts ordain∣ed for Motion. If the Nerves 〈◊〉〈◊〉 the Spinalis Medulla be so altered it is to be thought that the Hu∣mor primitively falls from th•• Brain; for the Spanalis Med•••••• is nothing else but a prolongatio•• of the Brain. So we see that 〈◊〉〈◊〉 Appoplexy which kills not, end in a Palsie of one side, the Humo•• being turned down from the Hea••••

to the cavity of the Vertebrae of the S••i••n, wherein the Spinalis Me∣dulla is contained, and moistning the Nerves which proceed from ••••ence. Neither is it to be denied, fort the Marrow of the Back hath two parts, as the Brain it self, from whence it proceeds, to wit, the right and left, and that one ••••••e may be affected, the other re∣taining sound. This Humor doth primarily affect the Nerves, and secondarily the Muscles.

Nothing doth more promptly p••create this Humor, than fre∣quent Ebriety, chiefly if it be pro∣••••ed by Wine. One Ralph Fea∣••estone an Atturney at Law, by once being drunk with Wine, the second day afterward became Pa∣••••ytick in his right side, and so continued as long as life did last. ••••••cletius thinks Wine to pro∣••••••e this effect, because it is hot, and of subtil parts, and so is able 〈◊〉〈◊〉 dissolve such Humors, and to ••••ing them to the Nerves: Rudi∣•••• thinks this to come to pass, be∣cause the Wine becomes sharp and ••••ger in the Nerves. Platerus is 〈◊〉〈◊〉 this opinion, that Wine hath a ••••cotical faculty in it, and Fernel. ••5. de part. Morb. & Symptom. up. 8. affirms, that he saw one those whole Skin became stupid by drinking himself drunk with Wine, and sleeping long. In the 〈◊〉〈◊〉 the Limbs become lazie, because the Nerves and Muscles are no much moistned with a thin and ••••terish Humor.

Now if you consider a Nerve 〈◊〉〈◊〉 an organical Part, appointed 〈◊〉〈◊〉 the carrying of Animal Spirits to the Muscles, the Instrument of ••••ntary Motion, it may be the cause of a Palsie, if it become thicker and narrower, and so un∣apt to receive the Animal Spi∣rits.

This narrowness may be induced three manner of ways: By Ob∣struction, Compression, Densati∣on, and Solution of continuity.

By Obstruction it may come to pass, when as by a thick and a tough Humor the Nerve is so stopt, that the Animal Spirits cannot pass.

The Causes of a Compression of a Nerve are sundry. First, from Humors bearing down the Nerve. Secondly, from a Tumor doing the like. Thirdly, from a Con∣tusion. Fourthly, from a Laxati∣on; yet if this Laxation, be not suddenly performed, but by de∣grees, it brings not a Palsie, as we may see in those which are Crook-backed. Fifthly, from a strait Li∣gature. Sixthly, too long lean∣ing upon a part, as when we Sleep leaning our Head upon the Palm of our Hand. Seventhly, Cold may be the cause; for if it be a∣ble to bring a Mortification of a Part, it may more easily cause an Infirmity or Weakness of the same.

Densation or thickning may be procured by two means; First, if the party hath been nourished by thick and slimy Meats: Se∣condly, if immoderate Cold hath congealed it.

Last of all, a Palsie may be caused by Solution of Unity, when the Nerve, which brings the Animal Spirits to the Part, is either cut transversly, or torn, or eroded with a sharp Humor.

The Signs of a Palsie are ma∣nifest,

to wit, the privation of Moving, and sometimes of Feeling also.

The part primarily affected is not so easily found out: But that you may attain to this, receive these Aphorisms.

1. If one side of the Face be af∣fected, and the Speech hindred, as well as one side of the Body, both the Brain and the Spinalis Me∣dulla are affected.

2. If only one side of the Face be troubled, the rest of the Body being untouched, the Cause is only in the Brain.

3. If all the parts of the Head being sound, either of the sides be Paralytick, the Cause is in one of the sides of the Spinalis Medulla.

4. If the Arms only be Paraly∣tick, the Cause is in the fifth, sixth and seventh Vertebrae of the Neck.

5. If the Disease be only resi∣dent in the Legs, then you are to conjecture that the Cause is in the Vertebrae of the Loins and Os Sa∣crum.

6. If any several Part be Paraly∣tick, then the Cause is not in the Brain, or the Spinalis Medulla, but in the Sprig of some Nerve in∣serted in that Part.

As for the Differences of a Pal∣sie; it is either Universal, when all the Parts under the Head are seised upon; or of one side only, and then it is called Hemiplegia.

As for the Prognosticks, receive these.

1. If a Palsie happen because the Nerve is transversly cut asunder, it is incurable; Hippoc. 6. Aphor. 19.

2. Every strong Palsie proceed∣ing from an inward Cause is hard to be cured; because it is caused of a gross, cold and viscous Hu∣mor, which hardly can be re∣moved.

3. A Palsie taking an old Per∣son in the Winter, is hardly cured; because Diseases in the Winter are more rebellious, and the natural heat in such persons is weak.

4. A Palsie which follows after an Apoplexy is hardly cured, be∣cause the Cause is vehement, the Parts are weak, and there is still a fear of relapse.

5. A Palsie wherein both Moti∣tion and Feeling are taken away is more dangerous, than that where∣in only one of these Symptoms happens.

6. A Palsie ensuing after a strong and sudden Luxation of the Vertebrae of the Spina, is dangerous; because the Nerves are much bruised: and by reason of the In∣flammation following, they hardly can be reduced.

7. A trembling after a Palsie is good: for it shews that the pas∣sage of the Nerves by which the Animal Spirits do pass, is some∣what pervious.

8. If the Paralytick Members be actually hot, there is some hope of cure.

9. If the Paralytick Member be extenuate, and the fresh colour thereof be changed, it can hardly be cured; because the Spirits must be few and the natural heat weak.

10. If the Eye of the Paralytick side be weak, the Disease is in∣curable: for this argues the defect of the natural heat, and of the Ani∣mal Spirits.

11. A Fever following after a Palsie gives good hope of Cure, be∣cause it warms, dries and discusses the Matter.

12. A Flux of the Belly hap∣pening by the benefit of Na∣ture may further the cure of a Pal∣se; it discharging the Nerves of Matter impacted.

In the cure of a Palsie, you must set down a convenient Diet: It must be such as dries and warms the Body: The decoction of Gua∣••••••on is good, used in stead of ordinary drink, for it digests and discusses the material Cause: 〈◊〉〈◊〉 the Party like not this Drink, let a Bag be hung in good Beer or ••••e stuffed with Herbs, which strengthens the Nerves, as Cowslip-lowers, Chamaepitys, Sage, Rose∣mary, Stoechas, Betony, Hypericon, Calamint, the lesser Centaury, Nut∣••egs, Cloves, Cinnamome, and Calamus Aromaticus. Metheglin ••••d Meath may be permitted. Wine is not convenient, for ac∣cording to all Authors, it is of∣fensive to the Nerves. Let the bread be Biscoct: the flesh of Par∣tridges, Phesant, Chickens, Pige∣••••s, and of other Mountain Birds r••sted, is good, Sauce being made with Cloves and Cinnamome.

Phlebotomy hath here no place, because Paralytick Persons are ••ost Cold and Phlegmatick: and because they are subject to costive∣••ess, Clysters are to be admini∣••••ed: In this case then dissolve D••phoenicum, Benedicta laxativa, 〈◊〉〈◊〉 Hiera Diacolocynthidos, in the ••••coction of Sage, sweet Majoran, dissop, Calaminth, the lesser Cen∣••••ry, Bay-berries, Cumin-seeds, the Flowers of Stoechas, Melilot and Chamaemil. It is expedient that the Paralytick be purged some∣times; but first you are to prepare the Matter by ministring the Sy∣rups of Stoechas, de 5. Radicibus, Bizant. de Hyssop. with the de∣coction of Paeony, Ruscus, Aspa∣ragus, Iris, Betony, Sage, Savory, Peny-royal, Chamaepitys, the flowers of Sage, Rosemary, and Cowslips, a∣romatized with Nutmegs, Cloves and Cinnamome. Then purge with Pilulae de Hiera, de Agarico, As∣saiereth, Aloephanginae, Masti∣chinae. If you would use stronger, give Pilul. Cocciae, and Faetidae, and extractum Panchymag••gon. If the diseased party require Potions, minister Diaphoenicum, Diacar∣thamum, Hiera Diacolocynth, cum Agarico trochiscato. Inwardly, to strengthen the party, give the Con∣serves of Rosemary Flowers, Sage Flowers, Betony Flowers, Cowslip Flowers, Paeony Flowers, and the Clove-gillover, Nutmegs preserved, Ginger preserved, Diambrae, Mi∣thridat. Of these you may frame Electuaries, adding the Syrup of Stoechas.

As for local Medicaments, ever rub the affected part with warm Cloths; but gently, lest the Spirits which are attracted be dissipated. Secondly, apply Ventoses to the head of the Muscle of the affected part; but let it be but narrow, and stay but a little while. Third∣ly, apply an Emplaister of Pitch and Resin of the Pine-tree. Fourth∣ly, touch the stupid Parts with quick Nettles. Fifthly, rubefying Medicaments may be applied, to attract the Spirits. Sixthly, Fo∣mentations of the Nervine Herbs

above specified may be used. Se∣venthly, you may embrocate the part with these Oyls following, Ol. Ʋulp. Lumbric. Chamaemel. Lil. alb. Rut. de Euphorb. Castor. Spica, Oleo Juniper. Cerae, Succin. Salv. Rorism. Thymi, Lavend d. Cariophyll. Chymico. Ol. de lateri∣bus, sinapi per expressionem fa∣ctum. Eighthly, apply Ʋnguen∣tum Martiatum, Aregon, Agrippae; then apply the Spice, Emplaster, or any one of that faculty. Last of all, lap the Member in hot Furs. Many commend the hold∣ing of the Paralytick Member for the space of an hour every Morning, for the space of sixteen days, in the Husks of the Grapes, left after the Wine is pressed out, in Harvest time. They in this Country use instead of these, warm Grains, and Oxes Bellies newly killed. Natu∣ral sulphureous and bituminous Baths are excellent in this case: This Country ought much to ex∣alt the benignity and bountifulness of God, who hath furnished it with the Waters of the City of the Bath profitable in this and other Griefs.

Of crudity in Wounds.

The second thing which hinders the Unition of a Wound and makes it compound, I affirmed to be eru∣dity in a Wound. A crude Wound I call that which doth not afford laudable Quittour, which must be white, smooth and uniform: This happens by six means. First, by reason of a continual flux of Blood. Secondly, by an Instrument brui∣sing, as in Wounds made by Gun∣shot. Thirdly, by reason of the Nature of the Parts, such as deep Wounds in the Joints. Fourthly, by reason of the coldness of the Air. Fifthly, by the Application of unfit Medicaments, as cold Wa∣ter, Bole, &c. Sixthly, by reason of too strait binding. How Blood is to be stayed, I have declared in the second Chapter of this Subject. Contused Wounds are to be di∣gested: Medicaments drying with∣out mordication are to be applied to the Joints, to preserve the tem∣perature of them: The Air is to be corrected: Fit Medicaments are to be applied to the wounded part: And a mean Deligation neither too strait, nor too slack, is to be used. Of all which seeing I have already discoursed amply, I will repeat no∣thing.

Of the Disease complicate with a Wound.

The last thing which makes a Wound compound, is a Grief com∣plicate with a Wound, as the Drop∣sie, French-Pox, and Leprosie; but seeing they belong to the Practice of Physick, I will leave them to those who have written, and list to write of that subject, lest I might seem to reap the Corn of another mans Field.

CHAP. XII.

Of a Wound made by a poisoned Weapon.

HItherto I have delivered you the Intentions which serve for the cure of mild compound Wounds. Now am I to acquaint you with the means by which ma∣••gn compound Wounds are to be cured. Such Wounds are com∣monly termed poisoned Wounds. But before I descend to the hand∣••••g of the particular Differences of them, it will not be amiss to speak of Poison and poisonable Diseases ingeneral: for this will make way for the better understanding of the particulars.

Venenum is nothing else but Me∣d••••amentum mortale, a deadly Me∣deament. The Greek Authors call it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Hippoc. 6. Epidem. C••m. 6. text. vocat 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ma∣leficum, a mischievous Medica∣ment: In his Oath he calls it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 deadly: Theophrastus, Dioscorides, and Galen call it some∣times 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, modo 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, modo 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, cer∣••••pt••rium, or letale. Aristot. 1. Probl. 36. calleth Poisons 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Medicaments which procure death. It may be thus described.

Venenum or a Poison is a com∣pound Substance, not a natural, ad∣verse to the Heart, and which cor∣rupts the nature of Man. In this description it is called a Substance, and so it is: for contraries are con∣tained in this same Predicament: Now seeing alimentum or a nou∣rishment is in the Predicament of substantia, venenum or a Poison must be in the same, seeing it is contrary to nourishment: for this maintains the nature of Man, the other destroys it. Gal. 3. de tem∣per. 4. assigns this difference be∣tween these two, that alimentum is that which is overcome by Nature, and turned into its Substance; but Venenum or a Poison is that which overcomes Nature, and destroys it. In the description it is said to be a compound Substance: for seeing ac∣cording to this Philosophical axi∣om, actiones sunt compositorum, actions are produced by things com∣pounded; a Poison must be a thing compound, seeing the actions of it are manifest. It is a folly to think that a Poison is only an Accident, for an Accident may either be in the Subject, whereof it is an Ac∣cident, or absent from it without the destruction of it, which can∣not be affirmed of a Poison; for being ministred it kills the Party, unless it be hindred by Antidotes. One may think that the Poison by the biting of a mad Dog, or by the stinging of a Scorpion, are Qualities, rather than Substances:

but in truth they are compound substances, thô the Body seem small, and scarce to be discerned by our Senses. Gal. 6. de Loc. af∣fect. cap. 5. seems to intimate so much to us, when he saith, that the poison of a Scorpion is most forcible in efficacy, thô it be but small in quantity.

In the description, a poison is said to be a substance not Natural, or Preternatural: for things natu∣ral are always good; but things called preternatural are always of their own nature ill, as Diseases, and the Causes of them. Poison is said to be adverse to the Heart; because it aims chiefly at the Heart: for as soon as one has either taken poison inwardly, or is outwardly touched with it, he presently is ta∣ken with a palpitation of the Heart, weakness of the same, and last of all Swooning and Fainting. In this they differ from purgative Me∣dicaments, because these only of∣fend the Stomach: wherefore their correctives ought still to be ming∣led with them. Last of all in the description of a Poison, it is said to corrupt the Nature of Man, for whether Nature according to Ari∣stotle 2. Physic. be taken for the matter, form, or the whole frame of Man, it corrupts all. The ma∣terials of the Body of Man are the Humors, the Spirits, and the solid parts: that these are corrupted by poison, no Man doubts. If in a Man you take the form to be the Temperament, or what ever is dif∣ferent from the Temperament, it is overthrown in like manner by Poison.

Last of all, a Man by Poison being deprived of Life, becomes a Cadaver, or a dead Carcase.

But here a doubt arises, to wit, How it comes to pass, that some are not hurt by Poison?

Sundry reasons may be alledged for this. The First, is the proper∣ty of some particular persons: for some have obtained such a consti∣tution from Nature, that hardly any thing can hurt them. 〈◊〉〈◊〉 Empiricus. 1. Hypot••••se•••• ••onpi∣ricarum writes, That there was an old Woman, who without recei∣ving any harm, could take ℥ xxx of Hemlock at one time; and that there was one Lysides, who would eat half an Ounce of Opium safe∣ly. Athenagoras was not hurt by Scorpions. The black Moors, who dwell by the River 〈◊〉〈◊〉, are said to feed upon Scorpions and Serpents, without taking any harm; which falls out by reason of a strange and hidden constitution of the Body.

The Second reason may be the preparation of the Body by Anti∣dotes: So Mithridates King of Pontus could not be poisoned; be∣cause he armed himself against Poison, by often taking the Mithri∣datical Confection.

The Third reason may be the taking of slimie or fat Meats, or Drinks, before the taking of the Poison; for these are apt to keep in Poisons, and to abate much of their strength.

The Fourth reason may be the vomiting of the Poison before it could take hold.

The Last reason may be the small quantity of the poison; for Galen 3. de simp. Medicam. cap. 23. writes, That all Medicaments whether they be deadly or purga∣tive,

require a certain measure for the effecting of their operations. We are to consider also why some poisons kill presently, some slowly?

The First cause is the strength of the poison it self. Nicolaus Flo∣••ertinus, serm. 4, tract. 3 summa 2. c. 9. & tractat. 4. c. 6. writes, that one Franciscus Ordelaphus, a Captain, had a certain kind of poi∣son, which if it had been cast up∣on burning Coles, presently did 〈◊〉〈◊〉 all the standers by.

The Second reason is the dispo∣sition of the Bodies; for they who have but a weak Heart, are more easily killed by poison. They in 〈◊〉〈◊〉 manner who have hot bodies 〈◊〉〈◊〉 soonest offended by poison; for they have wide and large pas∣sages, and so the poison passes more promptly to the Heart.

The Third reason may be the quantity of the poison ministred, for a great quantity sooner dis∣patches than a small.

The Fourth reason may be the time when they are gathered. The∣ophrast. l. 9. de hist. plant. c. 15. writes, that poisons gathered in the Summer time, are stronger than those which are gathered in the Spring time.

The Fifth reason may be the taking of a poison fasting; for then it killeth sooner, than when the Body is full.

The Last reason may be the composition of the poison. All Medicaments set down in Dispen∣satories shew, how requisite the manner of composition is: so The∣••ph••ast. in the aforesaid Book and cap. 17. rejecting the composition of Hemlock, which the Inhabi∣tants of the Istand Chi••s used for poisoning, sets down a more sure and quick way,

There is a question moved by those who have written of poisons, whether a poison may be made, which not suddenly, but slowly, and at a determinate time may kill, as within the space of a Moneth, or a quarter of a year, or a whole year? Some are of opinion, that such a poison may be composed: as Theophrastus lib. 9. de hist p••ant. cap. de Aconito: who writes, that it was wont so to be prepared, that it was able to kill within the space of a Moneth; sometimes within the space of two or three Moneths; yea, after a year expired.

For the determination of this question, it cannot be doubted, but that a poison may be so prepared, that it may either sooner or more slowly kill; but that it may kill at a determinate time, it seems al∣together absurd: for actions which are produced at a determinate time, proceed from a faculty that works by discourse and judgment: But who can affirm that there is any such faculty in poisons? Se∣condly, seeing poisons are contra∣ry to the nature of Man, I see not how they can be contained any long space of time within the bo∣dy of Man, not doing him any harm. Thirdly, it is more likely that a purgative Medicament could be ministred to work at a definite time, seeing it is more mild than a poison, but no such Medicament could ever hither to be found out. Only then poison may be dressed to 〈◊〉〈◊〉 more spee∣dily or slowly. This we may per∣ceive in the biting of a mad Dog, and in the Pox, which in some

bodies shew their forces speedily, in some slowly.

It may be, that you may ask by what means these Poisons and De∣leteries do kill?

I Answer, that they neither kill by their excessive qualities, seeing we use Medicaments hot in the Fourth degree, as Euphorbium, and Cantharides; nor by their Tempe∣rature, resulting from a certain mixture of the Elements; but they work by a more hidden and secret form, and by a certain na∣ture or form infused after the Temperature, which is not known to us by the constitutive causes, but by the effects, as many other things are. This Nature (what∣soever Philosophers say) they had from the Creation, and not from the Stars, or any new celestial In∣fluence, as Aponensis lib. de ve∣nenis.

If you demand what things in Man they chiefly assault?

I reply, that those things are chiefly the natural heat, and the radical moisture; for they extin∣guish the First, and corrupt the Second. One then would think it a strange thing, that the natural heat of the body of Man should stir up this propriety of poisons, its professed Enemy, to quench it self. But Nature has ordained, that the natural heat must go about the elaborating of every thing which enters into the body of Man, to find how it may be made pro∣fitable for preservation of the life of Man. Wherefore it finding poi∣son, goes about to digest it, not by the intention of Nature, but by the necessity of its action; for it cannot be idle.

Now the subjects wherein this deletery Property is lodged, are three: a Vapour, a Juyce, an Hu∣mor, or a terrestrial substance; for what ever poisons are taken either from Plants or Minerals, or living creatures, they are resident in one of these three substances.

Now as for the divers kinds of poisons; some are artisicial, some natural: If I could shew the in∣numerable differences of both the kinds, I would not: for it were a hainous crime to further the wick∣ed intentions of some malicious persons of this desperate age, in this business.

One may wonder why God and Nature have ordained and brought forth poison. This wonder we may easily qualifie, if we say, that poisons may be considered two manner of ways.

First, as they are natural Bodies, and so they concur to the consti∣tution of the World, and they have good uses. First, they are requi∣site in some Crafts or Trades, espe∣cially in Painting and Dying. Se∣condly, they are appointed for the feeding of some Creatures: So Starlings feed upon Hemlock, Swallows upon Cantharides, the Quails upon Hellebore. Third∣ly, they serve for the curing of some Diseases in Man; so Helle∣bore cures Madness, Libbards-bane the stinging of a Scorpion; Cakes made of Arsenick are used in the Plague-time.

Secondly, poisons may be con∣sidered as they are adverse to our Bodies, and deadly, and so they have no use; but are abused by perverse and wicked persons: Thus innumerable sorts of weapons are

made of Iron and Steel, devised by the wit of Man, furthered by the Devil, the enemy of Mankind, for the killing and dispatching o•• Man.

As for the signs of poison, Ga∣l••n 6. de loc. affect. c. 5. expres∣ses them briefly in these words:

When a Man having sufficient store of good Humors, and li∣••ing healthfully, dies suddenly (as it falls out when one hath ta∣••en a deadly poison,) and that afterward his Body becomes of a livid colour, or black, or spot∣ted, or that it runs by reason of moisture, or sends out a noi∣some smel, they say that such a man hath taken poison, and not without cause.

Mercurialis de ••••rb. venenos. & venen. lib. 1. c. 16. adds these;

Fainting, a panting of the Heart, filthy Vomits, cast∣ing of black Blood, the Hicket, Trembling, Stupidity, retention of Urine, a weak Pulse, burning in the whole Body, a little be∣fore death Coldness, and casting of cold Substances, Spots throughout all the Skin, Pustules, Tumors, gnawing in the Sto∣ma••h; griping in the Guts: These are signs of poison taken within the Body.

As for the Prognosticks of poi∣s••n, two shall suffice: First, if the poison cannot be driven out of the Body, either by Vomit or siege, 〈◊〉〈◊〉 remedies prevail nothing, but that the symptomes continue, as 〈◊〉〈◊〉 Fainting continue, the whole Body grows cold, Cold Sweats break out, and the Pulse ceases, and the whites of the Eies turn up, ••••co••ding to Arist. 4. Probl. 1. there is no hope of escaping, and death it self approaches. Secondly, if the poison be expelled by vo∣miting or siege, if Antidotes bring ease, and the Symptomes cease, then there is hope that the poison'd par∣ty will escape.

Besides these poisons, which do kill, being inwardly taken, there are some which offending first the external parts, by degrees pass from thence by the Veins to the Heart, and bring at last those sym∣ptomes, whereof I have spoken, and death it self. There are two sorts of these external poisons, which properly belong to the sub∣ject which we have ••n hand, to wit, Wounds: which are solutions of Unity by a poisoned weapon, and by the bitings and stingings of ve∣nemous Beasts.

Wounds inflicted by poisoned weapons, are thus discerned: First, they cause unaccustomed and into∣lerable pain in the part wounded. Secondly, strange Tumors appear. Thirdly, the part wounded be∣comes discoloured, of a livid, black, or spotted colour, the part not∣withstanding having not been con∣tused. Fourthly, the part putre∣fies in progress of time, and sends out a stinking sanious Quittour. Fifthly, having passed from the af∣fected part to the Heart, those fearful Symptomes which I have set down do ensue.

As for the presages, no Wound made by a poisoned weapon can be secure; for poison of its own proper nature is so adverse to the nature of Man, that it ever threa∣tens destruction. Secondly, if af∣ter the using of methodical and convenient means the Symptomes begin to be abated, there is

some hope of recovery left.

If you would know what these means are; If the poison hath not passed further than the part wound∣ed; if the party be not of an emi∣nent quality, tender or fearful, it is good to use the actual Cautery, for it doth much stay the activity of the poison. But that the Eschar may speedily fall, you are to use deep scarifications, which must reach to the sound part: Then you are to use Medicaments, which are fit to procure the fall of the Eschar, that the poison may have vent to issue out. If the poison hath passed deeply into the Body, beware of using of the actual Cau∣tery; for this were to add grief to grief. If the party be tender and fearful, use Ventoses after scarifica∣tion. To the part use convenient Medicaments, such as Ʋnguentum de paeto is, or the Basilicum descri∣bed by me: But with these you must always mingle Mercury pre∣cipitate, or Turbith Mineral wash∣ed, with some Theriaca Androma∣chi, or Mithridate or Antidotus de sanguinibus, or Athanasia, or Electuarium de ovo. To the parts adjacent, apply attractive Empla∣sters, as Oxycroceum, and such as receive the hot Gumms, as Galba∣num, Opoponax, Elemi, &c. This do, unless the wounded part be so hot that it threatens a Gangrene: for then you must go about to obviate this Symptome, leaving the cure of the Grief for a while.

In these Wounds, until three days be expired, you are to refrain from Bleeding, Purging, Vomit∣ing, and Clysters: The Party must sleep sparingly, and use a mode∣rate Diet, eating such meats as are of easie Digestion, and afford a good juyce. During this time you are to minister every day, Morning and Evening, one of the Electu∣aries afore-named, giving a drachm or more, according to the person of the party, in some convenient Liquor, as Carduus-water, Straw∣berry-water, or Black-cherry-wa∣ter, adding some Aqua theriacalis.

CHAP. XIII.

Of a Wound by the biting of a mad Dog.

IN the former Chapter, having first discoursed of Poison in ge∣teral, I set down the method of curing such Wounds as are made by a poisoned weapon. Now am I therefore to descend to the o∣ther branch of malign compound Wounds, which are procured by the biting or stinging of vene∣mous Beasts: of these there are two sorts; the biting of a mad Dog; and the biting or stinging of Serpents.

I will then first begin with a Wound caused by a mad Dog; be∣cause it most frequently happens in these parts, and Physicians and Chirurgeons are oftenest employ∣ed about the curing of this kind of a Wound. And thô other Beasts besides Dogs may be mad, as Wolves, Foxes, Cats, Horses, and sundry other, and by biting kill a Man; yet by most who have written of this subject, this kind of poison hath its denomination from the Dog, because he, of all other Beasts most frequently runs mad. This poison, which is the cause of the Madness, doth not con∣sist in the first qualities heat or cold, moisture or driness; for Dogs and Wolves run mad, as well in ex∣tream cold weather, in the middle of Winter, as in the Summer in the Dog-daies.

Wherefore it must be a specifi∣cal kind of poison which most fre∣quently is engendred in a Dog by a peculiar property, and inclinati∣on to this kind of madness,, and to communicate it to other living creatures. Baccius in tractat. de venen. writes, that he saw a Man killed by a mad House-Cock.

This poison is communicated two manner of waies: First, by biting and the slaver: Secondly, by slaver without biting: This sla∣ver is easily imparted by kissing any mad Beast; for the skin of the Lips of Man are very thin and ten∣der, and so apt to admit this kind of poison; yet, sometimes this poison is received by the thick skin of any part; Matth. de grad. consil. 82. affirms one named Jo∣hannes Coquinartus, by putting his Hand in a mad Dogs mouth, after many daies to have become mad.

After that this poison is recei∣ved, some sooner, some more slowly become mad; for some rage within the space of a few daies, or a week; some a long time af∣ter. Brassav••l. lib. 2. Aphor. com∣ment. 23. writes, that in some this poison hath lurked Seventeen

years, Guainerius in tract. de v••∣nen. cap. 12. protests, that he heard of one of credit, that one was taken with madness the eigh∣teenth year after the poison was received; yea, Alzaharavius af∣firms, that he found by experience this poison to have lain lurking in the Body Forty years.

The reasons which may induce us to believe this to be true are sundry. First, the variety of the parts offended: As for example: If a Nerve, Vein, or Artery be hurt, the poison may more prompt∣ly be communicated by these conduits to the noble parts, from whence they spring, than by other parts ignobler, which have no such consent with them. The Second, is the nature of the poison it self, which sometimes is stronger, some∣times weaker, and so more or less active. The Third, is the weak∣ness or strength of the party bitten: and so if sundry persons about the same time be bitten by the same Dog or Wolf, neither do they all sustain the like harm, neither do the Symptomes appear about the same time in all, because the bo∣dies of some are stronger, and of some weaker to resist the poison.

The Fourth is, because the poi∣son is more fierce in one Beast, than in another: and so two being bit∣ten by two several Dogs, the one may sooner die than the other, by reason of the vehemencie of the poison. Fifthly, the season of the year, and the constitution of the climate may much further, or hin∣der the Symptomes: And so the poison of Serpents in hot Coun∣tries, and in the Summer time is most fierce. Sixthly and lastly, the Diet of the diseased party may much further or hinder the appear∣ing of the Symptomes: for if he use a Diet which abates the force of the poison, they must of a necessi∣ty appear more slowly.

That the Dog that bit is mad, you shall know by these signs; A mad Dog doth refuse both Food and Drink; much slaver issues out of his Mouth and Nostrils: He looks wild, his Eies are red and fiery: he barks but little, and that hoarsly: he becomes lean: he car∣ries his Tail under his Belly: he hangs his Tongue out of his Mouth, which appears either Yellow, as if it were dried with choler, or black∣ish, or reddish: other Dogs shun them: sometimes they run main∣ly, sometimes they stand still: in running oftentimes they strike a∣gainst Trees or Blocks: He knows not his owner, but runs fierc••ly upon all indifferently.

If we cannot have the Dog to examine whether he be mad or no, Authors have set down some means to find this out by the Wound it self. The First is, we are to beat some Walnuts, and to apply them to the Wound, and to suffer them to lie to it for a nights space: when they are taken away, they are to be given to a Cock or a Hen. If the Dog hath not been mad, they shall live; but if he was mad, they shall die the day af∣ter. Secondly, others lay Wheat to the Wound: others draw Blood and Quittour from the Wound, and adding to it flower make a paste, which they give to a Hen; If the Dog was mad, the Hen dies. Thirdly, Avicen and Rhases advise us to rub the Wound with the

crum of a loaf, that it may imbibe the Blood and Quittour of the Wound, and to offer it to a Dog; if the Dog refuse to eat it, or to smell unto it; and if after eating of it he become mad or die, it is ••kely that the Dog was mad.

Having set down the means by which we may find out whether a Dog which hath bitten a person, was mad; it is requisite also that I set down the Signs by which you may find out, whether the party bitten is like to be mad.

The signs of madness beginning are these: The party becomes dis∣contented and angry without any just cause; he feels a gnawing and heaviness in the Stomach: he com∣plains of unseasonable weather, al∣though it be fair, his Body be∣comes heavy and lumpish: he is given to watching; and if he do sleep, his sleep is troublesome, he fears without cause: he drinks less than he was wont: he begins to murmure, and to speak to him∣self: he desires Candle-light by day: In the part wounded, thô skinned, a pain will be felt, which mounts up towards the Head: whither when it is come, a giddiness is cau∣sed, that the party cannot walk steadily forward. When these last signs appear, be assured that mad∣••ess is at hand.

These are the signs of madness confirmed: the Face and Body become red: the party becomes troublesome, he foams at the Mouth, he hath wild looks, he spits upon those which stand by: amongst such persons some do bark like Dogs, and offer to bite: It is common to all those who become and by the biting of a mad Dog, to hate water, and all liquid things: the true cause of this, is the an∣tipathy between this poison and liquid things: for by such things it becomes more fierce, and the di∣seased parties are more offended, the Pulses of such are small, and inordinate: their Members become more and more lumpish; they be∣come costive: Their Urine comes away by dropping: their voice be∣comes hoarse: they are troubled with difficulty of breathing; they put out their Tongues; when the grief increases they vomit either yellow or black Choler: A day or two before they die, some of them are troubled with the Hicket, and a little before death with Convul∣sions, and a fearful gnashing of the Teeth.

As for the Prognosticks of such Wounds, receive these: First, if the Wound be not deep, and hath not offended a Nerve, Vein or Ar∣tery, there is great hope that it may be cured, if Art be used. Se∣condly, if the party bitten become mad and fear water, there is small, or rather no hope of his reco∣very.

As for the Cure, the Chirur∣geon is to set three Intentions be∣fore his Eies: First, that he labour by all means to draw the poison out of the Wound, that it go not deeper into the Body. Secondly, the principal parts are to be strength∣ened, that they may the better with∣stand and repell the poison. The Third is, that he labour to over∣come the malignity of the poi∣son.

The First he shall attain to, if first he apply a Ligature three or four Inches above the Wound; yet

Celsus lib. 5. cap. 27. will not have this Ligature to be too strait, lest the part be benummed: But if the part will not admit a Ligature, then is he to apply a Defensive to the parts adiacent made of Bole, Terra sigillata, Sangu••s dracenis and such like; tempered with the whites of Eggs. Secondly, he is to scarifie the Wound, if it be not large enough already, and to ap∣ply Cupping-glasses with a large flame to make the stronger attra∣ction: If the part cannot be cup∣ped, yet it is always to be scarified, and the Blood to be drawn by a dry Sponge, not wet in water. Thirdly, it is not amiss to pull the feathers from the vents of Hens or Cocks, and to apply them often to the wounded part, or to apply young Pigeons or Chickens hot being cut asunder.

After this he is to apply attra∣ctive local Medicaments, as cata∣plasms made of Garlick, Onions, Pigeons-dung, Mustard, Walnuts, Treacle, Rue, Leaven, Salt and Honey. Gal. lib. 2. de antidot. c. 1. highly commends an Emplaster made of Pitch, Opopanax, and Vinegar, and affirms that he never saw any that died, unto whom this Emplaster was applied: the composition is this: ℞ Picis lb j. liquescat, cui adde opopanacis in aceto acerrimo soluti, atque ad ju∣stam consistentiam reducti ℥ iij. for∣mentur deinde m••gd••leones. These attractive Medicaments are to be applied before a week at the fur∣thest be expired, otherwise they will prove unfruitful. See Dio∣scorid. l. 6. c. 39. & Paulus Aege∣neta l. 5. c. 3. You shall know the poison to be overcome, if you use the Experiments set down by me to know by the Wound it self, whether the Dog was mad.

Bleeding is not to be used, be∣cause it weakens the Patient, and stirs the poison.

Purgation in like manner in the beginning is not convenient; for it is like that it will draw the poi∣son to the inward parts: If the poison hath possessed the inner parts, then it will not be amiss to use evacuation sundry times before the 40th day be expired: for Wounds caused by the biting of mad Dogs, must be kept open 40 days at the least. The purgative Medicaments which are to be used in such cases, ought to be strong according to all Authors: as An∣timonie, white Ellebor, Mercuri∣us vitae, pilulae de lapide lazuli, con∣fectio Hamech, hiera diacol••cynth. Electuarium Indum majus, &c.

I affirmed that the Second Inten∣tion of the Chirurgeon in curing of these Wounds, was to strength∣en the principal parts for the re∣pelling of the poison, with Anti∣dotes contrary to this poison: in the exhibition of these, you are to give twice as much in curing as preventing. In the shops you have always in readiness Theriaca Andromachi and Mithridatium. You may minister every Morning; ʒiss. of either of them for the space of 40 days in the Morning; but Theriaca is most effectual: At night you may minister some other Antidote: I will only set down three approved ones.

The First is Scaliger's the Father ℞. Mithridat. & pulv. rad. ari∣stoloch. rut. an. ℥ ij. terr. sigil. ℥ss. muscas quae de napelli fructibus

victum quaerunt num 20. cum siaeci succi recentis s. q. fiat mistura. dos. ʒiss.

The Second is set down by Pal∣••••lus lib. de morb. contag. thus: ℞. fol. Rut. Verben. Salv. Plantag. P••••p••d. Absinth. Vulgar. Menth. Ar∣••••••s. Melyssophyll. Beton. hyperic. Centa••r. min. singul. aequale pon∣••••s. colligantur justo tempore, ac s••centur, postea in pulverem redi∣g••tur. d••s. ʒiss. in principio sin∣g••••is diebus ʒ horis ante cibum, sed ʒij. aut iij, si post septimanam voce∣••ini. This is a parable and effe∣ctual Antidote. He advises also to foment the Wound with Wine or Mead, wherein ʒiss. of this powder hath been dissolved, and then to apply your other local means. He adds in like manner, that neither M••n nor Beast ever died which 〈◊〉〈◊〉 this Medicament, although it were ministred long after the Wound was received; so that the Wound was not in the head or those parts which are above the Mouth, and not washed with cold water as soon as it was received.

The Third is Antidotus de can∣•••••• ••l••••••tilibus, commended by 〈◊〉〈◊〉. li. 6. c. 37. and Galen 2. 〈◊〉〈◊〉 Antid••t. cap. 11. 〈◊〉〈◊〉. 11. de s. 〈◊〉〈◊〉 facul. Galen affirms, that none 〈◊〉〈◊〉 dyed who used the powder of these Crabs rightly. They must be gathered after the beginning of the Dog daies, when the Moon is 〈◊〉〈◊〉 daies old, and calcined in a F••ying-pan of red Copper: then t••ey are thus to be ministred, ℞ ci∣••••••. cancror. ʒ lj. pulv. gentian. ʒ j. 〈◊〉〈◊〉 merac. cyathos iiij. Misc. ut f••t petio bibenda singul. dieb. ma∣•••• per dies xj. See Galen. lib. 11. 〈…〉〈…〉 facult: These Antidotes may be ministred not only in Wine, but in Posset-drink, and Broths also to give the Patient content.

Hildanus Obs. Chirurg. 78. Cent. 1. relates, how Anno 1602. Jul. 30. a young Man was wounded in the Arm by the bite of a mad Dog, and cured.

The young Man (says he) came to me the First of August. First of all I scarified the bite, and applyed a Cupping-glass with much flame, and extracted as much Blood as I could: Then I washed all the Arm in Posca, wherein Trea∣cle and a little Sea-Salt was dis∣solved. For the slaver of a mad Dog, if it drie upon any part of the Skin, unless it be quickly and carefully washed, and wiped off, may cause madness. After this I cauterized the bite all over ve∣ry deep with an actual Cautery. And by the way I would advise young Chirurgeons to take spe∣cial care, that they cauterize not such bites only superficially, but rather to erre in excess than in defect. For since it is a desperate Disease, it must have a desperate Cure: I speak by experience; For the Daughter of Sebastian Cuisner received no benefit by an old Womans applying a Cautery to her; because it was not im∣pressed deep enough. But to the case in hand. After burning, I was not so very solicitous to as∣swage the pain; because unctu∣ous things, and such as relax the Eschar, as Butter, Oil, &c. (much less cooling and repelling Medi∣caments) are not much appro∣ved by me in such Ulcers. For they hinder the evaporation of venome, and these repell the

Blood, and with it the venome to the noble parts. But since pain (as Galen testifies) attracts the Blood and Humors out of the Body to it self, it is probable that pain, if moderate, may do good in such Ulcers. Therefore after burning I applied Cotton wet in Aqua vitae, wherein Treacle was dissolved, to the Ulcer. After∣wards I laid the following Pla∣ster to it, spread upon a Cloth. ℞ Cep. aliquantùm sub prunis coct. Ferment. Farin. Sinap. an. ℥ ij. Theriac. ℥ss. fol. Rut. Scord. an. M. ss. Misceantur in Morta∣rio, addendo parum mellis. The next day I cut the Eschar every where, as much as might be, then I repeated the applications of the foresaid Medicines: and so I proceeded, till the fall of the Eschar. Afterwards, lest the lips of the Ulcer might close, I put Pease in it twice a day, as we do in Issues, and applied the prescribed Plaster: And thus I kept open the Ulcer for three Months. Yet in the interim twice or thrice a week I strewed the fol∣lowing Powder upon the Ulcer; ℞ Pulv. praecip. lap. Bezoardic. pulv. rad. Angel. an. ℈ j. Misce. For it wonderfully attracts the malignity from within to it self. Inwardly I gave Alexipharmacks, Treacle, Mithridate, burnt Harts∣horn, Bezoar, and the following powder in Bugloss and Borage water, which is highly com∣mended by ancient and modern Physicians. ℞ Ciner. Cancrer. Fluviat. ℥ x. rad. Gentian. ℥ v. Oliban. ℥ j. M. f. Pulvis sub∣tilissimus. I neither Bled nor Purged him, lest I should draw the Poison inward. Thus by Gods blessing he was cured, and continues well till this day. By the same means I cured this young man's Brother, who was bitten by the same Dog, and li∣ved in health a whole year after; and then died of a Pleurisie.

CHAP. XIV.

Of a Wound made by the biting of an Adder.

I Have told you, how Wounds made by the biting of mad Beasts were to be dealt withall: In this Chapter I will shew how Wounds caused by the bitings and stingings of Serpents are to be cured. God hath created a strange variety of them: who, as they serve for the perfecting of the Ʋniver∣s••n or frame of the World; so they are employed by God for the punishing of sinners. Read a me∣morable Example of this, Numb. 21. vers. 5. ad. 9. where it is set down, that for the murmuring of the People of Israel, God sent a∣gainst them fiery Serpents, by the biting of which much People died, untill at last Moses set upon a Pole the brasen Serpent, by the com∣mandment of God; by behold∣ing of which, the bitten persons were kept alive: This brasen Ser∣pent was a figure of Christ cruci∣fied, as he himself testifies, John 14.15. in these words, vers. 14. As Moses lifted up the Serpent in the wilderness: Even so must the Sin of man be lifted up; vers. 15. That whosever believed in him s••ould not perish but have eternal life; for according to Isaiah, c. 53.••.5. He was wounded for our trans∣gressions; he was bruised for our iniquities: The chastisement of our peace was upon him; and with his stripes we are healed: Lucan the Poet in the ninth Book of his Pharsalia sets down the journey∣ing of Cato and his Souldiers through the desart of Lybia, where, out of Nicander the anci∣ent Greet Poet and Physician in his Theriaca, he makes mention of sundry Serpents. Lucan's Verses are thus turned into English Metre by Mr. Thomas May, an eminent English Poet of his Age.

First from that dust so mixt with poison, bred Rose the sleep-causing Aspe, with swelling head, Made of the thickest drop of Gor∣gon's goar, Which in no Serpent is compacted more. In scaly folds the great Haemorrhous lies; Whose bite from all parts draws the flowing blood. Cherfydros then, that both in land flood Of doubtful Syrtis lives; Chelydrt too, That make a reeking slime where are they go.

The Cenchrys creeping in a tract direct, Whose speckled belly with moe spotts is deckt, Than ere the various Theban mar∣ble takes. Sand coloured Ammodites: the horned Snakes, That creep in winding tracks: The Scytale, No Snake in Winter casts her skin but she: The double-headed Dipsas, that thirsty makes; The water spoiling Newt, the dart-like Snakes. The Pareas, whose way his tail doth guide: The Prester too, whose sting distend∣eth wide The wounded's foamy mouth; The Seps, whose bite Consumes the bones, dissolves the body quite. The Basilisk, whose hiss all Snakes doth scare, You Dragons too, &c.

O, fearful Brood armed against the sinful sons of Adam! We who are born in these parts ought to glorifie God, who hath freed the Soil of such mischievous Creatures. I mean not to insist on the de∣scription of every one of these Ser∣pents, the Symptoms which ensue after the Biting, and the manner of Cure, because it would be a fruit∣less labour, the Land being free from them, and so from their harm. In this Country only the Adder, and the Slow-worm are found, which oftentimes do great hurt. Of these then I will dis∣course, as also of the Toad, be∣cause here is great store of them, and their Poison is able to procure Death.

I will first deal with the Adder. It is called Coluber in Latin, either quia colit umbras, because it haunts shadowy places, or à lubricis tra∣ctibus, from her winding pace or path. It is long like an Eel, black on the Back, having yellow spots on the Belly: the Head is more flat than the Snake's Head. It is a crafty and venemous Serpent, bi∣ting suddenly those that pass by: whereupon Jacob in his Testament, or last Will, Gen. 49. v. 17. calls Dan, by reason of Sampson, who was of that Tribe, coluber in vià, an Adder in the way.

When the Adder hath bitten a Man, the part becomes of a leaden colour, and very painful, and if it be not presently cured, much black and stinking Quittour doth issue out from the Sore, like to that which flowes from Ʋlcus depascens, a fretting Ulcer. If it bite any Cat∣tel, very often they die.

When I was in the City of Bathe in Sommerset-shire, nine years ago, a little Land-Spaniel bitch belonging to one Mr. Lloyd who dwelt three Miles from thence, being bitten by an Adder by the way, died the next day, having in∣tolerable pain and swelling of the whole Body.

The Poison of it is hot, for an Adder is more hot than a Snake; which is not poisonable here with us, though it be in hot Coun∣tries, as Italy. The Adder hisse•• and most nimbly moves the fork∣ed Tongue, as the Snake doth.

As for the cure of the biting of an Adder, the Ancients have set down many Medicaments, both

Simple and Compound for the cure of Wounds inflicted by vene∣mous Beasts: you shall find great store of Simples in Dioscorides, throughout the whole seventh Book, and Nicander in his Theria∣c••, and Alexipbarmaca. Grevinus, l. 1. de Venenis, c. 36. and 37. hath gathered them together, whom you may peruse. Petrus de Abano in l. de Venenis, c. 4. sets down seven Herbs effectual against Poison, and the bitings of vene∣mous Beasts, which are these, Hy∣pericum, V••ncetoxicum, Enula cam∣pana, Raphanus, Dictamnus, Ari∣st••••••chia longa & rotunda. He af∣firms these to have equal faculty with Treacle it self against Poison. The Ancient Physicians only used these and such like, before Trea∣cle and Mithridate were invented. The Juices or the Powders of the Herbs they gave inwardly, to the Wounds or Sores they applied al∣so the Herbs. As for compound Medicaments, you may use Mi∣th••••date, Theriaca Andromachi; Theriaca magna Esdrae, Diatessa∣ren, Electuarium Orvietani.

If you be called to cure one bit by an Adder: First, apply Ligatures three or four inches above the bit∣ten place; hold up the Member as high as may be, scarifie the part, and apply Cupping-Glasses: If you cannot apply them, apply defen∣sives above the part.

Dress the Wound with Treacle dissolved in the Oyl of Scorpions, inwardly minister Treacle it self in Carduus, and Treacle Water, or Theriaca magna Esdrae, which he is said to have brought from Ba∣b••lon, when he returned from his exile with other Jews to their na∣tive Country; Electuarium Orvie∣tiani. The Juice and Leaves of the Ash are highly commended.

It is a very strange thing, that if a Viper be compassed with the Leaves of the Ash on the one side, and Fire on the other side, she will rather go towards the Fire than the Leaves of the Ash. Such an antipathy is between the Viper and the Ash.

Ambros. Pareus, lib. 20. c. 23. shews how he cured one bitten by an Adder: because the History is memorable, I thought good to set it down.

At what time (saith he) Charles the Ninth lay at Melines, I and Doctor le Fure, the Kings Physician, were sent for to cure a Cook of the Lady of Gastroperses, who was bitten by an Adder, as he was gathering wild Hops in a Hedge. The Cook as soon as he was bitten in the Hand, sucked the Wound with his Mouth, think∣ing thereby to mitigate the pain, and draw out again the Poison. But as soon as the Tongue touched the Wound, presently it so swelled that he could not speak. Besides this his Arm even to the Shoulder blade did swell, and caused such sharp pain, that he swooned twice while I was by him, his countenance becoming yellowish, and of a livid colour like to a dead man: and al∣though I did despair of the re∣covery of the man, yet I for∣sook him not, but washed his Mouth with Treacle dissolved in white Wine, and ministred it to him, adding Aqua Vitae. I sca∣rified the Arm with many and deep scarifications I suffered the

Blood which was waterish and sanious to flow plentifully from the parts about the sore; I wash∣ed the scarifications with Mi∣thridate and Treacle, dissolved in Aqua Vitae: the sick Person I laid in his warm bed, and caused him to sweat, but forbade him to sleep, lest the Poison should have been drawn to the inner parts. By these means I so pre∣vailed, that the next day all the malign Symptoms ceased. Where∣fore to finish the Cure I thought good that the Wound should be long kept open and washed with Treacle: Neither was I deceived, for within a few days he recover∣ed. By it you may observe, that whether Poison be inwardly ta∣ken, or externally impressed, it is good to watch untill the force of the Poison be abated, lest it seise upon the inward part.

They who catch Adders, apply the Powder of them to the part affected, if they be bitten, and take this same Powder inwardly; as they who catch Vipers use the Powder and Trochiscs of Vipers. Others commend the Powder of Tin, and commend it as a secret and specifical Medicament. But the Method set down by me is the safest way to cure: If you would make trial of the Powders of Adders, or Tin, I would advise you to mingle them with Theriaca. Now a days the Adder and Viper-Wines are in great request: But a Question may be moved, whether they be wholesome.

Nicolaus Florentin. 1. de Venen. following Rabbi Moses, and others, writes that Viper-Wine being of∣ten drunk, is effectual against Poi∣son. Galen also Sect. 6.6. Epid. Text. 5. affirms both Wine, and Viper the Flesh to be good against Poi∣son: So that Viper-Wine by these Mens Judgments, cannot but be good for healthful persons. When I travelled in Bohemia, I observed that the Earl of Rosenberg the younger, during the Summer time did eat the flesh of Adders, for preserving the sight, and staying of old Age: But Dioscorides and others give advice that care be had, that Serpents be not suffered to have access to Wine Vessels, lest they poison the Wine; which if they do, then surely the Wine is like to make a speedy way for the Poison to assault the principal parts.

This doubt I think may be thus resolved; If by chance Vipers or Adders be drowned in the Wine; because the whole Body lieth in the Wine, neither Head, Tail, Guts nor Gall being taken away: and no time of fermenta∣tion being granted, undoubtedly the Wine must be venomous: But if it be made by Art, these parts being taken away, and the flesh well prepared, and fermentation permitted; such a Wine must be wholesome, if a skilful Physician, unto whom Diseases and Complexi∣ons are known, do order the man∣ner of taking it.

It is now time to come to the Slow-worm: it is called in Latin Coecilia and Coecula, because it is blind; and by Nicander 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

It is a little slender Serpent, it hath a hard Skin of divers co∣lours, For it is partly of a blewish, partly yellowish, partly of a light

purple between these: It hath small Eyes, and covered with a thin Skin. It hath very small Teeth, but more to be seen in the lower than upper Gum. Its Tongue is cloven: It hath a chink in the Belly, which being opened it layeth Eggs: after the Eggs are laid, the chink doth con∣solidate again. They are in length about a span, and about the thick∣ness of a Mans Finger; towards the Tail it is more slender: The Female is more black than the Male: The passage of the Excre∣ments, and place of conception, is transverse: It comes abroad in July: It is harmless, unless it be hurt: It is seen most often in hilly places: In the Winter it lies in the cliffs of Rocks, and cavities of the Ground. Storks do much prey upon them.

It is very venomous, the bitings of it are very small, and scarce ap∣pear. The place bitten is red, and the whole Body becomes en∣flamed.

As for the Cure, you are to scarifie the part, and to apply a Ventose. Then you are to apply Mithridate, Treacle, or Terra sigi••∣lata, mingled with Oyl made of Vipers or Scorpions. Platerns affirms, that a Treacle made of the Trochiscs of it, instead of the Trochiscs of Vipers is effectual a∣gainst the Plague.

I will conclude this Chapter with setting down of the Cure of the Poison of a Toad. In Latin it is called Bufo: The colour of it is blackish, mingled of black and a dark yellow; the black is bunched and full of knobs; the Skin is very thick; the Head is broad and thick, and the colour thereof about the Neck is some∣what pale; the Heart is in the Neck, and therefore it is not quick∣ly to be killed, unless the Neck be cut asunder, or deeply pierced: Its Eyes are of a flaming yellow colour, like those of a Goshauk: It leaps not as Frogs, but creeps slowly, partly by reason of its short Legs, partly by reason of its sluggish Body; it is altoge∣ther dumb; it couples not only with Toads of its own kind, but Frogs also; it delights in dry places, as in Stables, Dung, Beds in Gardens, and Caves of the Earth; it feeds upon the Slime of the Earth, Earthworms and Bees, which it draws out of the Hives by its venomous Breath: It delights much to be in places where Sage is planted. It not only infects all things over which it passes by its poisonous pis∣sing, but by bespattering He••bs with its venomous slaver. Where∣fore, it is not to be wondred if Men die, who have eaten un∣awares Herbs, Strawberries, and Mushroms infected by Toads: If one do move it, it Swells, and looks ugly with flaming red Eyes, expecting opportunity to dart out virulent pissing, and a white Juice out of the Mouth; yea, if it can touch one, it doth bite by the hard brims of the Lips: Being pricked thorow the middle, it will live some days; and from it will drop a bloody Poison mingled with a yellow Water.

The Enemies of the Toad are the Cat, the Polecat and Viper.

If one be infected with the Poi∣son of a Toad, these Symptoms ensue. First, the colour of the Body is changed to an ugly pale colour, which is seen in Box Wood; the Party hath difficul∣ty of breathing, the Breath stinks, the Seed flows sometimes against the will, the Hicket is trouble∣some: Caspar Schwenck feldius, in Theriotrophio Siles. tractat. d. Reptilibus adds a sudden Gid∣diness, Convulsions now and then, blackness of the Lips and Tongue, a froward Countenance, much Vomiting, dimness of the Sight, a Dysentery, loathing of Meat, raving, the falling out of the Teeth, a numbness of the whole Body, a deep sleeping, a cold Sweat, and at the last Death.

As for the Cure, Diosc. loco citato commends Vomiting, the drinking of strong Wine, run∣ning, and quick walking, and two drachms of the Root of the Reed or Cane; whereby we may gather, that both the tempera∣ment of the Toad and the Poison is cold. Schwenckfeldius loco ci∣tato, commends Womens Milk, Treacle, Mithridate, Harts-horn, Aqua Theriacalis; Oyl of Vi∣triol, Turbith Mineral, the infu∣sion of Stibium. The Body is to be washed with such a Laxi∣vium as is prescribed against Gan∣grenes: Often bathing is good, made of Sea-water, wherein Scor∣dium, Hypericum, Art••misia, Worm-wood, Germander, Lavan∣der, Thyme, Sage, Tansey, and such like have been boiled. It is not amiss to apply dried Toads to the Arm-pits, the region of the Heart, and to the Wrists. Ma∣ny think the wearing of the Toad∣stone, and rubbing of venomous Wounds with it to be very effe∣ctual.

CHAP. XV.

Of Wounds made by Gun-shot.

HItherto I have discoursed of Wounds, which were known to the Ancient Physicians and Chirurgeons: now I am come to ••eak of Wounds made by Gun∣••ot, not known to them. Ber∣••••••••us Niger, Schwartz, or Black by sirname, anno 1380. a Fran∣••••can Fryer, and an Alchymist, ••••und out the making of Gun∣powder, and Ordnances which ••ow are in use: He only perfect∣ed this mischief: for the use of Guns, although rude, was before: For in the time of Carolus Mag∣n••, Gamescus King of Frisland, ••illed the Count of Holland, and two of his Sons, with a Peece. And Rog••r Bacon, who died about the year of our Lord 1284. makes mention of Gun-powder. Na••∣••••••us affirms Powder and Ord∣••ance to have been invented in the days of Otho the fourth, and In∣••centius the Third, in the year ••f the Redemption of Mankind, 1213. Froissard anno 1340. and 1353. makes mention of Guns. Petrarcha, who died anno 1374. doth the like. You may read in the History of Alphonsus King of Castile; when he besieged Algezia, a famous Town of the Moors, 3. August. anno 1342. that they in the Town shot out of it Bullets of Iron out of Ordnances, accord∣ing to Mariana. Yea, Petrus Matterus affirms, that Brass Ord∣nance have been used by the Chi∣noyse many ages ago: So that the Fryer was not the Inventer, but Perfecter of Guns and Gun-pow∣der.

As for the Wounds which are made by Gun-shot, these Points concerning them shall be set down; First, their Nature; Secondly, their Differences; Thirdly, their Signs; Fourthly, their Symptoms; Fifthly, their Prognosticks; Sixth∣ly, the Cure of these Wounds.

The Nature of them I will set down in these three Propositions: First, Wounds made by Gun-shot are not poisoned, if in the melting of the Bullets nothing be added to the Metal. This is the Opinion of all Authors, if you except Vigo, Alphonsus Ferrius, c. 8. and Fran∣ciscus Rota Bononiensis. This Proposition thus I prove: Nei∣ther the Gun-powder, nor the Bul∣let is poisonous; therefore the Wounds caused by them are not poisoned. As for Gun-powder, it is not venomous, whether you con∣sider each Simple whereof it is made severally, or them all jointly

in the Composition: For first of all, the Brimstone is not venomous, Galen. 9. simpl. 36. affirms it to be effectual against the Itch, and daily experience proves this to be true: It is good also in Diseases of the Lungs, according to Dioscorid. lib. 5. c. 73. Saltpeter is used in the cure of burning Fevers, there is none such a Novice in the Pra∣ctice of Physick, unto whom the faculties of Lapis Prunellae are not known; yea, it may be safely used instead of ordinary Salt to Meat. The Coles either of the Willow, or Stalks of Hemp are only dry, and have subtil substance, whereby they are easily set on Fire, by the Match or Sparkles of Fire. Neither is the whole composition Poison, as Aqua Fortis, or Aqua Regis are, whose ingredients, severally used, are not venomous, for it may be ministred in Milk to kill Worms in Dogs or strong Children; yea, the German Soldiers will drink it before they Fight; and it is good to be applied to Scald Heads. As for the Bullet, it is in like manner harmless; for the Powder made of it is good against malign Ul∣cers, and if it be beat out into a Plate, it will stay the increase of Tumors in the beginning: Besides this, Bullets have lain long in the Bodies of some Persons, not procuring any harm.

The second Proposition: Such Wounds are never without Con∣tusion in the Flesh, seldom with∣out tearing of Tendons and Nerves, and often cause fractures in the Bones, by reason of the violence and blunt hard substance of the Bullets. This Proposition needs no confirmation: for these effects offer themselves to the Eye in these Wounds.

The third Proposition: A Bul∣let may be so made, that it may cause a poisoned Wound: it is the Opinion of Quercetan, Tractat. de his Ʋulneribus, c. 1. And it may be made good by three Reasons: First, Weapons made of Steel, the hardest of all Metals, may be made poisoned: much more than Bul∣lets made of Lead or Tin, soft and porous Metals. That Steel Wea∣pons may be poisoned, these Au∣thors witness: Homer. 1. Odyss. Theophrast. lib. 9. de hist. plant. c. 15. de Scythis idem affirmat. Plin. lib. 12. cap. 53. de Dabnatis & Dacis. Aeginet. lib. 6. cap. 88. & generaliter de Barbaris Dioscorid. lib. 6. cap. 20. Secondly, experi∣ence teacheth us, that Metals may sundry ways be altered by mingling some things with them, or quench∣ing of them in some Liquors: so Brass is made of Copper, Lead may be hardned, and Tin may be caused to leave its crackling, and Copper be made white by additi∣on of Arsenick, and Iron may be hardned, if it be quenched in Vi∣negar, and the Juice of the Radish, or Smith's Water: It will on the contrary be made soft, if it be quenched in the Juice of Hemlock, and common Mallows, if a little Soap be added. The third Rea∣son is this: poisonous Spirits, and Oyls drawn from Minerals, may be mingled with Metals, so that they may participate of their venenosity-Wherefore, if Bullets imbibe such, if they stay long in the Body, doubtless they may cause a poi∣soned Wound; for the heat which the Powder causes in the Bullet,

is not able to separate them: such is the Oyl of Mercury sublimate rectified from Arsenick: And though this be true, yet it is strange that any Man should think every Wound made by Gun-shot is poisonous; seeing experience te••cheth that they may, yea and are cured by means which have nothing effectual against Poison, as s••all be declared anon. Besides this, they are not accompanied with s••••h fearful Symptoms as veno∣mous Wounds are.

The differences of these Wounds are taken from the diversity of the similary parts which they of∣fe••d; for either they make a So∣l••tion of Unity in the fleshy parts, or in both the fleshy and sperma∣tick parts: The spermatick parts are either soft or hard: The soft are Nerves, Tendons, Ligaments and Membranes: The hard are two, Cartilages and Bones; the Nerves, Tendons and Ligaments are contused and torn, the Mem∣branes are divided and bruised. If the Bones be affected, we are to consider what manner of fracture is caused by these Wounds. Then according to Avicen. fen. 5.4. Tra∣ct••t. 2. c. 1. there are three kinds of fractures; Transversalis, when a Bone is transversly broken, as it ••appens in fractures of the Arms ••nd Legs: Fissuralis, when a Bone is broken according to the longi∣••de of it, as appears in chinks of the Scull; and Frustalis, when a bone is broken into small pieces •• shivers. Now it is manifest that the third kind of fracture is most commonly seen, when a Bone is fractured by a Gun-shot; see∣ing the Instrument causing the fracture is blunt, and very forci∣ble.

As for the Signs of these Wounds; they are taken first from the Fi∣gure: for these Wounds are al∣ways orbicular: Secondly, from the colour, for the part is either of a livid colour, or of a blew colour mingled with green, or of a violet colour; sometimes the Wound is black, and the adjacent parts livid: Thirdly, from the feeling of the Blow: for when one is wounded he feels as he thinks a Stone, or a piece of some heavy and blunt In∣strument entering into the part. Fourthly, from little Blood issuing out: for the part being contused, the brims quickly afterward so swell very often, that Blood is stayed from flowing. Fifthly, from the heat of the part; which hap∣pens by reason of the quick and vehement passing of the Bullet, or grievous contusion of the parts wounded. Sixthly, from the ad∣juncts, as if burning appear: this is discerned, if Pustules do appear, if a scorching heat, driness, wrink∣ling, hardness of the Skin, and burn∣ing of the Cloaths do offer them∣selves to the sight; burning is caused if the piece be discharged not far from the wounded party. These are the Signs of Wounds made by Gun-shot, if the Bullet be not poisoned.

If the Bullet be poisoned, these Signs will appear. First, an ugly colour will appear, as if it tended to mortification. Secondly, hor∣rible pain, and pricking. Thirdly, great inflammation. Fourthly, a heaviness of the whole Body. Fifth∣ly, a sharp Fever. Sixthly, Faint∣ing. Seventhly, Raving, and espe∣cially

if no evident Cause can be given for these Accidents. Eightly, the Bullet it self will shew the Poi∣son; for if you put the Bullet in∣to a sublimatory Vessel, and put a strong Fire under it, a black stink∣ing smoak will rise from the Me∣tal, and the upper part of it will be of a blackish or livid colour. If you cannot have the opportunity to do this, then cut the Bullet a∣sunder; if it be poisoned, it will be of a violet colour.

The Symptoms of ordinary Wounds made by Gun-shot are these; Contusion, Pain, Inflam∣mation, Convulsion, Heat, Palsie, (if the Instruments appointed for Motion be torn) the natural co∣lour of the part altered, and some∣times a Gangrene, and a Mortifi∣cation, if the Wound be great, and in or near to a Joint. If the Bullet be poisoned, all these Signs and Symptoms will appear; but sooner and more vehement, than if it were not. But because I have discoursed of most of these Symp∣toms in the general Doctrine of Wounds, I will remit you to the Chapter wherein they are handled; of a Gangrene and a Sideration, because they are Symptoms which may ensue after all sorts of Soluti∣on of Unity, I will handle them when I have spoken of Fractures and Luxations in their proper place.

As for the Prognosticks receive these, First, if a fleshy part be on∣ly wounded, and the Constitution of the party be laudable, and the Air favourable, the Wound may be cured without any great diffi∣culty. Secondly, If the Sperma∣tick Parts be violently torn or broken, if the Temperature of the party be not laudable, but Caco∣chymical; if the Air be hot and moist, which falls out when the South-wind blows; and if Signs of Poison do appear, it is to be fear∣ed that a Gangrene and Mortifica∣tion will ensue. Thirdly, these Wounds yield a stinking Sanies, if the parts be much torn, and much Humor be sent to the wounded part, which quenches the natural heat. Fourthly, these Wounds are harder to be cured than those which are made by other Weapons, by reason of the Contusion which still doth accompany them. Fifthly, these Wounds come more slowly to Suppuration than others do; partly because the natural Heat is much abated, and partly because the Spirits are much dissipated by reason of the great Contusion.

It is now time to come to the cure of these Wounds. The first intention of cure is to remove from the Wound all extraneous Bodies, as the Bullets, pieces of Garments, Paper, pleces of Wood, or Metal, contused Flesh, clotted Blood, shivers of Bones, and such like: But seeing I have shewed in the third Chapter concerning this Subject, which I now have in hand, how extraneous Bodies are to be taken out of Wounds, let me desire you to have recourse thi∣ther.

The second Intention is to ap∣ply convenient Medicaments to the part affected. Joubertus commends this Topick, ℞ Axungiae suill. de∣purat. vel Butyri recentis ℥ viij. Praecipitati l••ti, ac in tenuem pul∣verem redacti ℥ j. Caphurae in aq. vitae solutae ʒ ij. exq••isitè miscean∣t••.

If instead of the Axungia you take Arcaeus his Liniment, the Redicament will be more effectu∣al: yet the Medicament seems to be proper, for Axungia and But∣ter are suppurative, and Precipi∣tate furthers Suppuration, causing little or no pain, and the Camphore helps Penetration, and resists Pu∣••••••ction.

Ambrose Parey commends Ole∣•••••• Catulorum, or the Oyl of Whelps, cujus haec est descriptio, ℞ Ol. Lil. lb ij. Catulos Caninos d••s vivos, coq. haec simul quoad 〈◊〉〈◊〉 ab ossibus abscedat, mox in∣jiciatur vermium terrestrium in ••••o mundatorum lb j. qui eous∣••aelixentur quoad arefacti omnem ••••on in ol••o deposuerint: tan∣d•••• fiat colatura olei, cui admisce ta••••in. Venetae ℥ vj. Aq. vitae ℥ ij. ••••um si partes nervosae aut arti∣••••s vulnerentur, plus terebinth. q••••m olei usurpandum est, quia putes istae majorem quàm carnosae d••••cati••nem requirunt.

In the dressing of these Wounds se••en Cautions are to be had.

First, we may use moderately, ••••cined Vitriol dissolved in Aqua Vitae if the Southwind blow, and we sear putrefaction; for although it be not Suppurative, yet it resists Patrefaction.

Secondly, we are to shun Escha∣••••tical Medicaments, for three C••uses. First, because they pro∣care Pain, Inflammation, Fevers, as••angrene, and such fearful Symp∣tems. Secondly, because they hin∣der Suppuration. Thirdly, be∣cause the Eschar doth keep in putrid Vapors, which may pass 〈◊〉〈◊〉 the lesser to the greater Ves∣sels, and to the principal parts, and so cause a Fever.

Thirdly, the Tents at the first are to be made greater and longer, that the Wound may be sufficient∣ly dilated.

Fourthly, if the Contusion be memorable, and possess much of the adjacent parts, they are to be scarified to discharge the part of congealed Blood, which is apt to putrefie.

Fifthly, if there be any burning, such Medicaments are to be used as are good against burning, such is this: ℞ Ol. Lil. albor. & lini an. ℥ ij. Infrigidantis Galeni. ℥iss. Ol. Laurin. ℥ss. Fol. Sempervivi Major. Plantag. & Cort. interior. Sambuci. an. man. j. Pingued. Ran. ℥ss. Bulliant omnia lento igne ad succorum cousumptionem, ac cole∣tur Medicamentum, cui adde flor. aeris ʒj.

Sixthly, cooling and astringent Medicaments are not to be used after the first dressing, because cooling Medicaments quench the natural heat, and hinder Suppura∣tion: and astringent Medicaments keep in putrid Vapors, which may bring a Gangrene. Wherefore Me∣dicaments Anodyne, emollient, and suppurative are convenient: as this; ℞ Mic. pan. trit. ℥ iv. Lact. re∣cent. lb j. Flor. Chamaemel. & Me∣lil••t. an. pug. j. Farin. Hord. & Fab. an. ℥ j. Coq. omnia ad Ca∣taplasmatis consistentiam: tum adde vitellos ov••rum ij. Ol. Viol. & Ros. an. ℥iss.

Seventhly, it is sufficient to dress the Wound once in the space of twenty four hours. If much Quit∣tour flow, or if the party be se∣verish and feel great pain, it is to

be dressed every twelfth hour; when little Quittour issues, it is sufficient to dress it once a day. We may besides these Topicks use to these Wounds the Oyl of Linseed, Lilies, Eggs, Saint Johns-Wort, El∣der, Earth-worms, and Chamaemil, with Yolks of Eggs and some Saf∣fron, until the Wound come to di∣gestion, which will be the fourth or fifth day. Then use abstersive Medicaments, as Paracelsus his Mundificative, or Mundificativum de Apio: the Wound mundified in∣carnate, and last of all skin it with Epulotical Medicaments, proceed thus, if the Wound hath only of∣fended the fleshy parts.

If the Spermatick parts be wounded and torn, this Medica∣ment is effectual: ℞ Terebin∣thinae Venetae, Ol. Terebinthin. & Hyperic. an. ℥ ij. Turbith. flavi ʒss. Tutiae, Euphorb. & Calcis vivae, an. ʒ j. misc. If the hard Sper∣matick parts, as the Cartilages and Bones be shivered: ℞ Praedict. composit. Terebinth. Ol. Hyperici & Terebinthinae ℥j. Pul. Cephal. ʒjss. applicetur medicamentum calefa∣ctum. This Medicament will fur∣ther Suppuration, and procure the scaling of the Bone, if it must be so, and will save that which is found from cariosity.

If you perceive by the Signs set down by me, that the Bullet hath been poisoned, and so have caused a poisoned Wound; the brims are deeply to be scarified, Ventoses to be applied, and Mithridate and Treacle inwardly to be ministred in Carduus, Strawberry or black Cherry-Water, taking of Mithridate and Treacle an. ʒss. aquarum prae∣dictar. ℥ iij. Let the Wound be dressed with this Aegyptiacum ma∣gistral. ℞ Decoct. Lupinor. ac Len∣tium an. lb iss. Aceti lbj. Salis communis, Aluminis an. ℥j. vi∣rid. Aeris ℥ss. Mellis lbss. coq. omnia ad Mellis spissitudinem, 〈◊〉〈◊〉 adde Theriacae ℥. ss. Apply this Medicament, either upon Tents, or by way of injection, as you shall think fit. This Medicament is good in putrid Ulcers: Use this Medicament untill all fearful Symp∣toms cease: Then proceed with those Medicaments, which I have prescribed for such Wounds. In poisoned Wounds you are neither to purge, nor to use Phlebotomy, untill the force of the Poison be abated: but in ordinary Wounds made by Gun-shot, you are to open a Vein, if the party be Ple∣thorick; and to use purgations, if the party wounded be Cacochy∣mical.

CHAP. XVI.

Of the means to avert Humors from the wounded Head.

AT last I am come to the last Point, whereof I intended to discourse concerning Wounds; which is, the cure of the Wounds of particular Members, which re∣qaire any special consideration dif∣fering from the canons of Wounds in general set down by me hither∣to. These Wounds are either of the Ventricles, or Extremities, or ••••mbs, the Ventricles are three, the Head, the Breast, and the lower B••••y. Now Wounds of the Head either cause Solution of Unity in the very seat of the Brain, or in other parts appointed to be Or∣gats of the Senses. As for the Wounds, which are inflicted into the seat of the Brain, which is call∣ed the Hairy Scalp, they shall be dispatched in setting down three Points. The first Point shall be spent in discoursing of these things which are common to most of these Wounds. The second shall set down the particular explication of these Wounds. The third shall shew what symptoms ensue after fractures of the Scull.

The things which are common to most of these Wounds are in number four. First, the aversion of the Humor from the wounded part. Secondly, the general Prog∣nosticks. Thirdly, the descripti∣on of fit Topicks, which are to be applied to asswage Pain, and stay any Inflammation. Fourthly, shall be set down the manner of Rolling.

Aversion of the Matter which ei∣ther hath already brought Symp∣toms, or is like to procure them, is performed by three means, to wit, by Blood Letting, Purging, and the right ordering of the six things not natural.

Phlebotomy is either universal or particular. The universal is performed by opening of a Vein. Of this kind of Phlebotomy these things may be demanded. First, whether a Vein is to be opened, and Blood drawn? Secondly, how much Blood is to be drawn? Third∣ly, which Veins are to be o∣pened?

As concerning the first demand, Blood ought to be drawn in three Cases. First, if a competent quan∣tity of Blood did not flow out of the Wound, when first it was in∣flicted. Secondly, if it be a great Wound, and the party be strong.

Thirdly, if a great Inflammation hath invaded the part, or a Fever hath seised upon the party.

As concerning the quantity, Blood is drawn either so much at one time as is requisite, or at di∣vers times. If you go about to draw so much Blood at one time as is requisite, you are to stop the Vein. First, when the Pulse ap∣pears smaller, and flower. Second∣ly, when a faint Sweat issues out at the Forehead. Thirdly, when the colour of the Face is changed, and the Lips grow pale. Fourthly, when a pain of the Heart doth draw on, with yawning, and a desire to Vomit, or to go to Stool. If you are to draw Blood sundry times for this same Grief, you must continue the doing of this, untill all ill Symp∣toms, as Inflammation and Fever cease. See Parey lib. 9. cap. 14. Fallop. in Hippoc. de Valner. Ca∣pitis, c. 26.

As concerning the Veins which are to be opened, you are to take those of the same side, and those must be either the veins of the Arm, or the Veins near to the wounded part, as the Vein of the Fore∣head, the Veins of the Temples, and those which are under the Tongue. See Parey in the place be∣fore cited.

A particular detraction of Blood is when we take Blood from the part affected. This is performed by scarifying the brims of the Wound, applying Ventoses, or by laying to Leeches idem ibid. If the party be timorous, and loath to admit any kind of Bleeding, then you may use strong frictions of the whole Body, with course Linnen Cloths, or of other parts of the Body, the Head excepted: for these will discuss the superflu∣ous Matter, and turn it into a halitus or Slime. For superflui∣ties must increase, the wounded party omitting the accustomed ex∣ercises.

As for Purging, it is procured three manner of ways: First, by Cathartical Medicaments given by the Mouth. Secondly, by Cly∣sters. Thirdly, by Suppositories. And as concerning solutive Medi∣caments which are ministred by the mouth, these Points may be asked. First, whether purging is to be used? Secondly, when such Medicaments are to be exhibited? Thirdly, of what hidden faculty they must be? Fourthly, of what force they must be?

As for the first demand, a pur∣gative Medicament is to be mini∣stred in three Cases. First, if the party have the Head••ach or Lum∣pishness. Secondly, if a Tum•••• or Inflammation appear. See Fal∣••op. in Hippoc. de Vulner cap. 27. Thirdly, if the Body be Cacothy∣mical, so that there be strength, matter prepared, and the Body open and passable.

As concerning the time which was the second demand, Purgative Medicaments are to be minisied in the beginning. First, lest strength decrease. Secondly, lest the Fever increase. Thirdly, to hinder the Humor stirred from ascending to the Head. This H••∣pocrates advises in sharp Diseases, 4. Aphor. 10.

As for the third demand, those Medicaments which purge Choler, seem most fit in Wounds of the Head: Because the Symptoms

which ensue after these Wounds, as Inflammations and Fevers, seem to be the effects of yellow Cho∣ler.

As for the fourth demand, we are to shun strong and eradicative Medicaments chiefly in the begin∣ting, lest that by too strong a com∣motion of the Humors, a Pain, a Fever, and Inflammation be pro∣cured. See Parey lib. 9. cap. 14. Wherefore we must use gentle Molicaments, and which do not increase heat. Such are the infu∣sion or decoction of Myrobalans mingled with Electuarium Leni∣tivum, or de succo Rosarum, aut Dieprunum Solutivum. The Dose must not be great, you may mi∣nister also the infusion of Rhu∣b••rb, and Myrobalans, with the Syrup of Roses solutive with A∣garick. Myrobalans strengthen the Stomach and Head, as also the Veins. See Fallop. in Hippoc. de Vidner. cap. c. 27. Arcaeus, lib. 1. c. 4. prescribes such a form. ℞ Syrup. Ros. Solut. ℥ ij. Aq. Plantag. ℥ iij. Ʋiere ut ars praescribit. He is of opinion that no other purgative Medicament is to be ministred, and that procuring Evacuations by Clysters or Suppositories will suf∣fice: But you need not fear to give the Medicaments which I have set down.

Having delivered so much as may seem sufficient to clear the doubts which may arise concern∣ing Bleeding and Purging: now am I to shew you how those things which are called not natural, are to be ordered; for the observation of this Point doth greatly further the Cure.

First then, as concerning the Air, it ought to be temperate, and thick, according to Fallop. in Hip∣poc. de Vulner. cap. c. 25. For a hot and thin Air doth eliquate and melt the Humors, and so makes them more apt for Fluxion. A cold Air is hurtful for the Brain, the Bones, the Nerves, and the Spinalis Medulla, or Marrow of the Back-bone. If then the Air prove cold, when you dress the Patient, hold at a convenient di∣stance a Chafing-dish with Coals above the Head, to hinder the impression of the cold Air. See Parey lib. 9. cap. 14. Then apply the Medicaments being made 〈◊〉〈◊〉 luke-warm. If the Air be very 〈◊〉〈◊〉 then the room is to be cooled by hanging it with Sheets, and moistning them with cold Spring∣water, or you may garnish the Windows with Medow-sweet, Gaul, Burnet, Borage, Violets, Pri••••∣roses, Cowslips.

One thing is to be noted, that Wounds of the Head are sooner and more safely cured in the Win∣ter than in the Summer: and so concoct the Humors the better: whereas on the contrary, in the Summer time the Humors are apt to be made thin, Fuliginous Va∣pors are raised, and Inflammation doth invade.

As for the Meat and Drink, Wine is not to be granted before fourteen days be expired; for with∣in this space all Symptoms usually cease.

In hot Regions where no Beer or Ale is, Barley Water is to be prescribed. If the wounded party be of a queasie Stomach, or weak or aged. Sugar may be added, or Oxysaccharum, or the Syrup of

Violets, or of red Roses Simple, or of the Juice of Limons or Citrons. Small Beer and Ale will suffice in those Countries, where they may be had.

If there be a Fracture, neither Flesh nor Fish are to be permitted the first seven days. First, because the wounded party must keep his Bed; and so being deprived of wonted exercise, cannot so well concoct or digest the Food. Se∣condly, to avoid fluxion of Hu∣mors to the affected part. Vide Fallop. & Paraeum, lib. 9. c. 14. Let the wounded party eat Paua∣does and Ptisans; use not Al∣monds, because they procure the Head-ach by filling the Head with Vapors: stewed Prunes, Raisins of the Sun, Mallows, Asparag••s, Spi∣nach, Succory, Endive, are good boiled. Lettuce tho it be not good for the Head, yet it may be granted, because it hinders the ascending of Vapors to the Head. After Meals it is good to take some of such things as hinder the mounting up of hot Humors, by shutting up and strengthening the Mouth of the Stomach: as old Conserve of red Roses, Marmalade of Quinces, or Quinces preserved, Saccharum Violatum, Boraginatum, Buglossatum, Pears stewed or baked; Coriander and Aniseeds, with one covering of Sugar, are good to be eaten with Quinces and Pears. If Flesh be permitted, then the Flesh of these Creatures fol∣lowing is to be eaten, Chickens, yoling Pigeons, Veal, Mutton, Kids, Leverets, Mountain-Fowls and Birds, as Partridges, Pheasants, Turtle-doves, Black-birds, Thru∣shes, Larks, and such like. If the wounded party eat of these boiled, then you may boil with them Spinach, Lettuce, Purselain, Sorrel, Borage, Bugloss, Endive and Succory; but if they will feed upon them rosted, then make Sip∣pets unto them of Verjuice, the Juice of Oranges, Limons, Citrons, Pomegranats, or Sorrel with Su∣gar. If the party will needs eat Fish, then let him have Trouts, Pickrels, Smelts or Whiting-maps.

As for sleep let it be taken in the night time, and not by day, un∣less an Inflammation hath possessed the Brain, or the Meninges. The Signs of this you shall have deliver∣ed in its own proper place; for seeing according to Hippoc. 2. E∣pidem. Blood rules in the Spring, and in the Morning, in this case it will not be amiss to sleep from three a Clock in the Morning, till nine a Clock in the Forenoon: for so the Blood shall be staied, and kept from any extraordinary moti∣on, which otherwise would ascend to the Head, and encrease the In∣flammation.

If too much watching be trou∣blesome, which corrupts the tem∣perature of the Body, procures crudity, and causes heaviness and pain of the Head, and makes the Wounds dry and malign; then the Head, the Temples, the Ears and Nostrils are to embrocated with such Medicaments as cool and moisten, according to Galen. 13. Method. such are Ʋnguentum Pe∣puleum, Rosatum, Oyl of Poppies, Henbane, Mandrake, Oyl of Roses beaten together, taking two parts of the Oyl, and one of the Vine∣gar. Inwardly you may give an ••mulsion of white Poppy Seeds in

Barley-Water, sweetning it with Saccharum Violatum, Buglossatum, or Boraginatum: you may give also an ℥ and a half of the Syrup of white Poppy, in two ounces of Lettuce-Water, l. 13. c. 14. This is to be done four hours after Meat, to procure sleep; for sleep furthers concoction, repairs the loss of the triple Substance caused by watch∣ing, asswages Pain, refreshes the Weary, mitigates Anger and Grief, and restores reason trou∣bled.

To this end you may minister also a small dose of Laudanum, but this must be done discreetly, and warily. First, because the Opium (if the Dose be often ite∣rate) may cause a Stupidity or Le∣thargy. Secondly, because the Spices which are added to correct the Narcotical Simples in the La••∣d••um, by eliquating the Humors may offend the Head.

The room wherein the wound∣ed party lieth, must be somewhat dark; for too bright a light dis∣sipates the Spirits, increases Pain and the Symptoms, and strengthens the Fever. Let his Lodging also be far from places wherein there are immoderate ringing of Bells, roses of Carts and Coaches, and all sorts of Smiths.

Rest and quietness is most con∣••••ient; for immoderate exer∣cise moves and agitates the Spirits, weakens the Body, and troubles the wounded party; Wherefore soft walking will serve the turn.

Perturbations of the Mind are altogether to be abandoned; for the contraction and dissipation of the Spirits cause great alteration of the Body.

Venery above all other things is to be shunned in Wounds of the Head, chiefly if there be a Fracture; and that not only while the Wounds are in curing, but also long after they are cured: for great store of Spirits are contained in a small quantity of the Seed, the greatest part whereof flows from the Brain: Hence therefore all fa∣culties, but chiefly the Animal are resolved and weakned. Parey in the place before quoted affirms, that he hath known death to have ensued in small wounds of the Head (even when they have been cured) by reason of Venery.

As for the Excretion of the Ex∣crements, the Body must still be kept soluble, lest, if these should be retained, corrupt and noisome Vapors should ascend to the Head: wherefore if Nature be dull and slow, Evacuation must be procured by Suppositories and Clysters. If cathartical or purging Medica∣ments must be given by the Mouth, such as I have set down in the beginning of this Chapter, are to be ministred, whither I remit you.

CHAP. XVII.

Of the rest of the points common to most Wounds. of the Head.

THe Second general point con∣cerning Wounds of the Head, shall be dispatched by setting down the general Prognosticks of them, which are these that here ensue.

1. Nulla capitis vulnera quan∣tumvis exigua: No Wounds of the Head although they seem small are to be slighted and neglected; for oftentimes it falls out, that when a Wound is received with∣out a fracture in the Head, a man may die, if fearful symptomes or accidents appear: as a Convulsion, a Palsie of one Arm or Leg, a Fe∣ver, Raving, Vomiting, faltring of the Tongue, Valeriol. lib. 3, obseiv. 1. ••ungius tom. 1. ep. 10.

2. Wounds of the Head often become 〈…〉〈…〉 easie or hard to be cured, bit reason of the Coun∣tries 〈◊〉〈◊〉 Ch••••••tes.

This happens either because the Air is hurtful by its elementary quality only, as when it is cold and moist, as in Florence and Bononia, according to Amat. Lusitan. Cent. 6. Curat. 100. Quercet. de Vul∣nerib. Sclopet. cap. 3. and in Paris, according to Parey, lib. 10. cap. 8. Or this happens when the Air uffends by a malign quality, as is observed in Gallia Narbonensis, and those parts of Italy, which lie near to the Mediterranean Sea, by rea∣son of malign Vapours raised out of the Sea, and dispersed through the Air.

3. Wounds of the Head recei∣ved by persons who have the Pox, Leprosie, Dropsie, a Cough of the Lungs, a Hectick Fever, a Con∣sumption, or ill habit of Body, are hardest to be cured; partly be∣cause the Blood is not sit for uniti∣on, being corrupt, as in the Pox and Leprosie; partly because there is not a sufficient store of it, as in a Hectick, and Extenuation of the Body.

4. Wounds of the Head in Chil∣dren prove sometimes rebellious; partly because they are of a hot and moist constitution, which is most apt to admit putrefaction; partly because the habit of their Body is thin, and so ministreth occasion to the breathing out of the Spirits.

5. In deadly Wounds of the Head, the parties live longer in the Winter, than in the Summer: for in it unnatural heat is not so easi∣ly raised as in the Summer.

6. If in Wounds of the Head a

Swelling suddenly doth vanish away, it is an ill sign, unless some e••aeuation hath gone before, or discussive Medicaments have been applied.

7. A Fever which invades while Suppuration is procured, that is, before the Seventh day, is less dan∣gerous than that which invades af∣ter the Seventh day: for about that time all accidents use to cease.

8. If a Fever in these Wounds do appear the Eleventh or Four∣teenth day, with a cold and groo∣••ing, it is dangerous, because it is to be feared lest some putrefaction bath possessed the Brain, the Me∣rurges, or the Scull; which a pale 〈◊〉〈◊〉 yellowish colour of the Wound, or like to Water, wherein raw flesh hath been washen, will dis∣cover.

9. Wounds contused are more flowly cured, than those which are ixised, because they require great∣er Suppuration.

10. Symptoms do sooner appear in the Summer, than in the Win∣ter; for in the Summer we look for them the Seventh or Four∣teenth day; and the reason is, be∣cause in the Summer the Humors admit sooner putrefaction, the un∣natural Heat being more readily stirred up. Vide Hippocrat. 1. Aphor. 15.

11. It is an ill sign, if the flesh of the brims look livid, for that is a sign of the decay of natural heat: See Hippoc. Sect. 7. Aphor. 2.

12. If in Wounds of the Head Reason fail, if Speech cease, if Sight be lost, if the party labour to tumble out of the Bed, when he is not able to move the parts of his Body, if he have a continual Fever, if his Tongue be black and dry, if the brims of the Wound be blackish or dry, if he have an Apoplexy, Palsie, with an involun∣tary excretion of his Excrements, or an absolute suppression of Excre∣ments and Urine, a Phrensie, or Convulsion, then you may pro∣nounce death to attend at the Door.

13. Wounds of the fore-part of the Head, are more dangerous than those of the hinder-part. First, because greater store of Brain is contained in the part. Secondly, because the containing parts are thinner there. Thirdly, because the Meninges have Sinuosities or Cels in the fore-part, but not in the back-part: wherefore this in∣equality cannot but endanger the Membranes, which cover the Brain, to be offended, if the Wound pass thorow the Scull, or if the Tre∣pan be to be applied. Fourthly, because if Wounds of these parts be deadly, he who hath a deadly wound in the fore-part of the Head, dieth sooner than he that hath a deadly Wound in the hin∣der-part. Fifthly, because more noxious Matter may be gathered in the fore-part, which may offend the Brain, than in the hinder-part, by reason of the multiplicity of the Cells. Sixthly, because the fore-part hath more Sutures than the hinder-part. See Fallop. in Hippocrat. de vulner. capitis, cap. 7, & 8.

14. Wounds of the Temples are very dangerous, First, because the motion of the joint of the low∣er Jaw, while we speak, eat, or drink, doth hinder unition. Se∣condly, because the passage of

Hearing is in the Temples: now the instruments of the Senses are very sensible. Thirdly, because vessels of Moment, as the branches of the jugular veins, and soporal Arteries are distributed there: Fourthly, because the temporal Muscle is placed in the Temple, whose offence is not to be neglect∣ed. See Fallop. in Hippoc. de cap. vulnerib. c. 9.

15. A Wound in a Suture is dan∣gerous: First, because the Scull is there parted, and so more apt to opening than one solid Bone. Secondly, because in the Suture there is a Ligament, by which the Memnges are tied to the Pericra∣ni••m: Wherefore a Wound being inflicted there, an Inflammation may easily be communicated to the Meninges. Vide Fallop. in Hipp. de c. vuln. cap. 12.

16. Blackness in the parts near to the Wound, a Convulsion, Palsie, loss of Appetite, much watching, and colduess of the ex∣tremities of the Body, portend an evil event.

17. In these Wounds, if the brims tumesie not a little, it is an ill sign, according to Hipp••c. 5. Ap••••r. 66. If the tumefaction be soft, it shews concoction; but if it be hard, crudity. Secundum eun∣dem 5. Aphor. 67.

18. Flesh is easily regenerate in all wounds of the Head, if you ex∣cept those wherein there is a fea∣cture of the Scull a little above the Eye-brows: Three reasons may be yielded for this: First, because in those places there is a Cavity be∣tween the two tables of the Scull, which passes to the Sieve-like bones of the Nose, full of Air, by which the generation of flesh is hindred; for if you cause him, who hath a Wound with a fracture, there to breath strongly, his Mouth and Nostrils being shut, the breath which comes out at the Wound will blow out a reasonable Candle held to it. Secondly, because the thickness of the Bone will not suffer so much bloudy juice to breath out, as is sufficient for the generation of flesh. Thirdly, be∣cause there is a great affluxion of Excrements to the part, which otherwise would be discharged by the Eies and Nose, which hinder the desiccation of the Wound, and so cicatrization. Vid. Par. lib. 10. cap. 12.

19. In wounds of the Head you may hope well, if the Patient hath no Fever, if he be in his right mind, if he finds himself well when he takes any thing, if he sleep well, and have his Body soluble, if the Wound look with a fresh and live∣ly colour, if it yield laudable Quittour, and if in fractures the Dura Mater hath its motion free, and be not discoloured.

20. In wounds of the Head with a fracture, we must not think that danger is past before an hundred daies be expired.

21. The Callus, whereby the parts of the Scull are united, thô it be sooner induced in young, than in old persons; yet most com∣monly it is procured in the space of 40 or 50 daies.

The Third common point to be observed in Wounds of the Head, I affirmed to be the appointing of Topicks fit for the asswaging of pain, and the removing and hin∣dring of an Inflanmmation. Sundry

Authors have set down sundry de∣scriptions of such Medicaments, which if one should gather toge∣ther and set down, a reasonable Book might be compiled.

To avoid tediousness, and not to leave you altogether unfurnished without the description of any such effectual Medicament, I will set down the Receipts of such Medi∣caments which will answer your expectation, and ease the Patient.

The First shall be this: ℞ farin. herd. ℥ iiij. poscae ℥ vj. coq. ad ca∣taplasmat is consistentiam: tune ad∣d••ntur ol. ros. ℥ ij. fiat Cataplasma s. a. Si desit posca, substituendi in ••••ius locum acetum & vinum Ru∣beum, sumantur partes duae vini & 〈◊〉〈◊〉 aceti: Acotum rosaceum aut simbucinum praest antius est vulgari. This Medicament of Hippocrates Fallopius extolls above all others, 〈◊〉〈◊〉 lectionib. in Hippoc. de capitis ••••lnerib, c. 39. Let this Medica∣ment be used until the Seventh, or Fourteenth day, as you shall per∣ceive cause; Then apply other Medicaments, whereof I will speak when I come to discourse of the Cure of particular wounds of the Head.

The Second shall be this: ℞ Fa∣rin. bord. & Fabar. an. ℥ ij aceti res. ℥ vj. ceq. ista ad Cataplasma∣us. consistentiam: tum addantur ••. ros. ℥ ij. This Cataplasm cools, repells, dries, asswages pain, mi∣tigates Inflammation, and hinders the affluxion of Blood or hot Hu∣mors.

The Third shall be this: ℞ Me∣dullae panis albi ℥ iiij. lactis recen∣tis ℥vj. coq. ista. ad cataplasmatis consistentiam, tandem adae un∣guenti popul. ℥ ij. croci pulv. ℈ ij. This Cataplasm is effectual, if the Inflammation and Pain be great, if the party be of a dry and hot Complexion, or be any way Fe∣verish. These Cataplasms are to be applied above the Medicaments wherewith the Wound is drest, the hairy Scalp having been shaven for a reasonable compass about the Sore or Wound.

The last general point concern∣ing all wounds of the Head, set down by me, was of dressing up of the Head after the application of the Medicaments. In the dres∣sing two things are to be observed; the covering of the Head, and the rolling: As for the covering, A Cap must be made of a soft Lin∣nen-cloth, basted with fine Chi∣rurgeons Tow, but not quilted; and it must be of that bigness, that it may compass the whole Head: it must not be too thick, too heavy, or too hard; because the Head requires light, soft, and easie applications; yea, Topicks which are applied to Wounds of the Head must not be stubborn, as firm Emplasters; nor too viscous: because the First will cause pain, and the Second will not easily be taken off.

As for the rolling, it differs from the rolling of other parts because the Head is somewhat spherical or round.

Of the Rollers these doubts may be proposed; First, of what Mat∣ter they ought to be made? Se∣condly, of what breadth and length they ought to be? Thirdly, of what Figure they ought to be? And lastly, what mediocrity of con∣striction is to be used in the appli∣cation of them?

As for the First, to wi••, the matter whereof the Rollers are to be made; it ought to be of Flax and not of Wooll, because it would be too hot, and cause itching, which inconveniences would trou∣ble the Patient. The Linnen∣cloth whereof the Rollers are to be made, must not be too new, for then it would be somewhat too rough; nor too old, for then it would be subject to tearing: nei∣ther ought it to be too thick, for then it would be heavy and boisterous, nor too thin, for then it would be too weak.

As for the Second doubt, the Rollers ought to be three Inches in breadth, and of a Fathom and an half in length, or of such a length as is sufficient to compass the whole Scalp after manifold Circumvolutions and Rollings; for the Roller must keep on the local Medicaments, and make some constriction of the Head.

As for the figure of the Rol∣lers, they must have two ends, that when they meet they may by natural linking be strength∣ened and kept from slipping.

As for the mean of Constricti∣on to be used in applying the Rol∣lers (which was the last doubt:) The Roller ought not to be too loose; for then it could neither keep to the Medicaments, nor any way bind the Head: Neither ought it to be too strait, for then these inconveniences might follow: First, the pulsation of the Arteries would be intercepted. Secondly, fuligi∣nous Exhalations could not breath thorow the Sutures. Thirdly, the Blood would be driven from the wounded part to the Meninges and Brain, from the outward to the inward parts: from whence would ensue Pain, Inflammation, a Fever, Apostemation, a Con∣vulsion, Palsie, Apoplexy, and last of all Death. Neither wonder at this; for Galen. lib. de Fasciis, re∣lates, that one by too strait deli∣gation of the Head, lost both his Eies; howsoever, great skill and circumspection is required to dress the Wounds of the Head artificially.

CHAP. XVIII.

Of Wounds of the parts placed above the Skull.

HAving set down those points which concern all Wounds of the Head in general, I must now according to my intenti∣on descend to the handling of every particular Wound of the same.

Wounds of the Head either of∣fend the parts containing, or the parts contained also. The parts containing are either common or proper. The common parts are these, the Cuticula, the Cutis, and the Panniculus carnosus. The proper containing parts are these; The Muscles, the Pericranium, and the Cranium. The parts a∣bove the Cranium are subject to these offences, a Contusion, a Wound, and a Contusion with a Wound.

A Contusion is caused by a hea∣ry and obtuse, or a blunt instru∣ment, as a Cudgel, or by a fall from an high place, the Head a∣lighting upon some blunt Body: It is discovered by the Tumor without a Wound, and often a blackness or blewness: If the Blood, by the violence of the Con∣tusion, be poured out between the Skin and the subjacent parts, it is called Ecchymosis.

If a Contusion without effusion of Blood be presented unto you, shave the Hair, and apply this Me∣dicament: ℞ Albumen ovi unius, ol. myrt. & pulv. myrtin. an. ℥ ss. Misc. This Medicament is to be used until the part come to its own temperature and confirmati∣on. Dress the party twice a day: See Arcaeus, lib. 1. cap. 1.

So you see, that repelling and astrictive Medicaments are in this case first to be applied: For First, by these means Veins and Arteries are straitned, and closed up. Se∣condly, the Defluxion is hindred. Thirdly, the part it self is strength∣ened. You may use also this Me∣dicament of Ambrose Party, l. 12. c. 4. ℞ Album. Over. num. iij. ol. Myrtin. & ros. an. ℥ j. bol. Armen. ℥ ss. Sanguin. Dracon. ʒ ii ss. nuc. Cupres. Gail. Alum. usti. an. ʒ ij. aceti rosac. satis, ut paretur li∣nimentum. If after the pain is gone, and the flux of Humors ceas∣ed, a Tumor remain, use discus∣sive means, such as this: ℞ Em∣plast. de Mucilag. ʒ ij. Oxycroc,

& Melilot. an. ʒ j. ol. Chamaemel. & Anethin. an. ʒ ij. fiat ex his ceratum. s. a.

If by the application of these Medicaments the Tumor vanish not away, because the effusion of Blood under the Cutis Musculosa hath caused a separation of the upper parts from the Cranium, which you shall discern by the fluctuation of the Tumor and a fixt pain in the part: First incisi∣on is to be made; then if the Skull be found, you shall finish the cure by moderate compression, and the application of Medicaments which dry and mundifie; for moist Me∣dicaments are not to be applied to Bones, because they cause cari∣osity; use then such a Medicament as this is; ℞ Swup. è ros. rub. sic∣cat. & de absinthio an. ℥ j. tere∣binthin. ℥ i ss. irid. Aloes, Myrrh. Mastich. & Farinae hord. an. ʒ ss. Misc. ex praes. art. If the Scull be not sound, which you shall per∣ceive partly by the sight, for it will appear yellowish, livid or black, partly by the Probe, or Finger, for you shall find it rugged and une∣ven, whereas it should be smooth and slippery: First, you are to smooth it with the Raspatory: then to procure a thin scale, apply this excellent Powder following. ℞ Rad. Irid. Gentian. Aristol. rot. Dictamni, Farinae hord. an. ℥ ss. Aloes hepat. Sang. Drac. Myrrh. Mistich. Sarcocoll. an. ʒ ij. fiat. ex∣emnib. pulv. s. a.

In great Contusions sometimes Gangrenes ensue, by reason of the extinction of the natural heat, which you shall conjecture if the part grow hard, and become to be of a livid and black colour; then thus you must go to work: First, the part is to be scarified. Second∣ly, Cupping-glasses, or Horns, are to be applied. Thirdly, such Fo∣mentations and Topicks are to be applied, as are prescribed for a Gangrene, whereof I mean to dis∣course in a particularity, when I have made an end of Fractures and Luxations; for it is a Symp∣tome, which most commonly ac∣companies solutions of Unity of all sorts. It shall suffice to have spo∣ken so much concerning a Conte∣sion of the parts placed above the Skull, now it follows, that we discourse of Wounds of the same parts.

Wounds then in the parts above the skull, are of two sorts: for in some of them the Skull is not laid bare, and in some of them it is ba∣red. You shall know that the Skull is not bared, partly, by the Finger: if the Wound be large enough; partly by the Probe, if no hard substance can be felt, and if the Probe slip and slide, meeting with the Pericranium. As for such Wounds the observations, which I set down in the point concerning the general Cure of Wounds, will suffice for the curing of these.

Nevertheless, Wounds in the temporal Muscle require a special consideration, by reason of the fearful Symptomes, which ensue sometimes after it is wounded. The temporal Muscle then may be wounded three manner of ways: First, by a puncture: Secondly, by being divided transversly: And Thirdly, by being wounded ac∣cording to the length.

If the puncture be deep, or the

transverse Wound in like manner, it is a dangerous Wound, and so •••• be••accounted by the Chirur∣gon at the first, lest his security king unto him discredit, and fruit∣less repentance at the last: for ••••ch wounds bring Vomiting, a Convulsion, and deep Slumbering, recording to Fallop. in Hippoc. de 〈◊〉〈◊〉 vulner••b. c. 9. The temporal Mascle being out athwart, it loses its proper action, which is to move and lift up the lower Jawe; and then the opposite temporal Muscle, being sound and whole, using its strength the wounded Muscle not being able to use any resistance, it draws the lower Jaw to it; whereby the Mouth, and all parts of the Face are drawn awry, and suffer a Con∣vulsion towards the found part, the other being resolved and falling; for as often as the Muscles of one kind are equal in number, bigness, and strength on each side, the re∣solution of the one part causeth the Convulsion of the other. Be∣••••les this, when we eat or speak, this Muscle is in perpetual motion: whereby it comes to pass, that be∣ing once cut, it hardly will admit unition; and the scaly Suture, Su∣tura squam••sa, which is the joyn∣ing of the Ossa petrost, or stony bones, so called from their hard∣ness. If therefore there be a fra∣cture in this Muscle, let not the Chirurgeon be too hasty to dilate it by incision, for the reason above specified; but let the Hair be sha∣ved, and the Wound dressed with the Oil of Hypericum, and the Oil of Earth-worms mingled together, with some spirit of Wine, all being made warm. Take two parts of the Oil of Hypericum, and one of Oleum lumbricorum. If the tem∣poral Muscle be transversly cut, then the brims are to be brought together, by using stitchings in the skin. Afterward dress either with the Medicament, prescribed in a puncture, or with Arcaeus his Li∣niment melted: above these wounds apply Paracelsus his stictick Em∣plaster, or Diachylon magman, brought to the consistence of a cerate, by dissolving of either of both in some good and approved artificial vulnerary Balsame. Al∣though the wounded party be like to die, yet according to Celsus his counsel, the miserable Patient is not to be altogether left comfort∣less: for it is better to try a doubt∣ful Medicament, than none at all•• you may avoid scandal to the pro∣fession, and free your selves from discredit, by acquainting his friends, or whom it most concerns, with the danger wherein he lies.

If the temporal Muscle be wounded according to the length, then when you are called, you are to perform two offices; First, if the Hemorrhage be of moment, then you are to slay the bleeding, and then you are to unite the brims by ordinary stitching. If the bleeding will not be staied by the application of ordinary means, (whereof I have set down some choice in a proper place) then you are to pass a needle through the musculous Flesh into the Wound, and from thence to the outward part of the Wound, compassing the great vessels with a double thread in the needle: between the thread and the vessels you are to put a little dosil of Lint, to shun the cutting asunder of the parts

compassed with the thread, and to avoid pain. This being done, cast a decent knot upon the thread, before you sow the Wound; First, cleanse the Wound from the gru∣mous or clotted Blood, and all extraneous Bodies, and then few it, lest the part wounded be cool∣ed by the Air, and a Convulsion do ensue: when you have dressed the party, let his Head be raised somewhat high with a Pillow.

It follows now, that I speak of wounds of the parts above the Skull, wherein the Skull is detect∣ed, or laid bare. In these Wounds the Skull is either not hurt, or hurt. If the Skull be not hurt, the Wound may be cured two manner of ways, to wit, by Agglutination, or by Incarnation: If you mean to cure the Wound by Agglutination, go thus to work: First, stitch the Wound according to Art, then apply Pledgets moistned in the white of an Egg. The next day anoint the brims of the Wound with Arcaeus his Liniment, or some good Balsame, warmed in a spoon; use neither Tents nor Pledgets: for these hinder conso∣lidation. If the Wound yield much Quittour, dress it twice a day, un∣til the Quittour abate; continue this manner of dressing until the Wound be agglutinate, which will fall out sometimes the fourth, some∣times the sixth day. See Arcaeus, lib. 1. cap. 1. If you intend to cure such a Wound by Incarnation, or filling of the solution of the Unity by ingendring new flesh: First, besprinkle the Bone with the Ce∣phalick powder set down by me before. Secondly apply dry Pledg∣ets; Thirdly, fill up the Wound with some Sarcotical Unguent, as Aureum, Basilicum, or Arcaeus his Liniment. It is far better to cure such Wounds by Agglutination, than by Incarnation; for the scar will be less, and the cure will be finished in a shorter time.

If the Skull be hurt, it falls out three manner of waies. First, if it be made extraordinary dry by reason of the Air, which will fall out, if the Skull lie bare two hours. Secondly, if the upper portion of the Cranium be divided from the lower, and cleave to the Cutis musculosa. Thirdly, if both the Tables of the Skull be cut, and cleave to the Cutis musculosa, not separate altogether from the parts adjacent. If the Scull hath become dry superficially only, which you shall perceive if it bleed not, be∣ing scraped with a Raspatory; this upper Superficies is to be re∣moved with the Raspatory, that Blood may come from the found Bone: then the Wound is to be stitched, and the cure to be per∣formed by Agglutination. If on∣ly a portion of the Cranium sepa∣rate from the rest, stick to the Cu∣tis musculosa, it is to be takena∣way, and the Wound to be cured either by Agglutination, or Con∣carnation, as you shall see cause. If a portion of the whole Crani∣um be divided from the rest, so that the Dura mater offers it self to the view, and sticks to the Cutis musculosa, that portion is not to be separated from the Cutis mus∣culosa, lest the Brain be deprived of its cover: but must be reduced into its place, and there kept, by bringing together the brims of the Cutis musculosa with so many

deep and strong stitches as shall suffice.

I cured a Warrener of Mr. Hol∣land's of the Verdry, Thirty two years ago, of such a Wound, by these means within a few daies. Bones of the Head will suffer uni∣tion being separate, as well as Bones of other parts of the Body.

At last I am come to the Third kind of Wounds, which happens to parts placed above the Cranium, which is a Wound with a contusi∣on. Of this sort of Wounds there be two kinds; For either they are ordinary or extraordinary. These I call ordinary, which are not ac∣companied with strange Sym∣ptomes: Such Wounds thus you shall dress. First, you shall wash and soment the Wound with the spirit of Wine; having drawn in∣to it self the tincture of Myrrh and Frankincense. Then if the Wound be great, stitch it with Needles: If it be not great a dry stick will serve. Dress the Wound either with Arcaeus his Liniment, or some good artificial vulnerary Balsame warmed. If the Wound be deep, a Tent must be kept in the depending part until it yield laudable Quittour, and then it is to be taken out: Then an Em∣plaster is to be applied: Empla∣strum de gratiâ Dei will serve the turn.

An extraordinary Wound is such an one as is accompanied with strange, and unaccustomed Sym∣ptomes: such are a Fever, an In∣flammation of the whole Head, Neck, and Shoulders; as also the Breast: the brims of the Wound swell much, and are of a livid colour. The Wound casts forth a virulent, sharp, black, and stinking Sanies, The party feels a great and pricking pain: Such ac∣cidents commonly ensue after the bitings of Men or Beasts, which impress a malignity into the Wound.

In such a case two things are to be done: First of all the maligni∣ty is to be drawn out. This is per∣formed by scarifying deeply the brims of the Wound, and then ap∣plying either Leeches or Cupping∣glasses. Then the Wound is to be washed and fomented with this Medicament: ℞ Theriac. Andro∣machi ʒ ij. Mithridat. ʒ j. aq. Card. Benedict. ℥ ij. Aq. vit. ℥ j. Misc••ex Art. Let Medicaments be applied hot. With all the Medica∣ments wherewith you dress such wounds, mingle still some Treacle and Mithridate, until all the afore∣specified Symptomes cease, and the wound yield a laudable Quit∣tour: Then finish the Cure with ordinary Medicaments.

Secondly, in such Wounds you are to strengthen the principal parts, (that they may be the more able to repel all malign vapours) with cordial Medicaments. Take this as a pattern: ℞ Ther. Androm. ℈ ij. Mithridat. ℈ j. conserv. Ros. Rub. & Bugloss. an. ʒ ss. Aq. Ox∣alid••s minoris ℥ iij. Misc. ut fiat potio. In ministring internal Me∣dicaments you must have a care of the age and strength of the Pati∣ent. You must not forget to ap∣ply to the region of the Heart cor∣dial Epithemes. Let this be one example; ℞ Aq. Ros. Rub. & Nenufaris an. ℥ iv. Acet. Scyllit. ℥ j. Coral. Rub. Sant. Alb. & Rub. Ros. Rub. Pulverizat. an.

ʒiss. Flor. Cordial, Pultorum pug. ij. Croci ℈j. Mithridat. & Theriac. an. ʒj. Misc. Apply double Cloaths wet in this Me∣dicament to the region of the Heart.

CHAP. XIX.

Of the general points to be observed in Wounds of the Scull.

IN the last Chapter I delivered unto you the method of cu∣ring such Wounds as may happen in those parts which are placed and lie above the Scull; now I am to shew how solutions of unity in the Cranium or the S••ull it self are to be handled. A solu∣tion of unity in the Scull is by all practicers called a Fracture by a peculiar denomination.

I will first set down the things which are common either to all or most Fractures, and then those things which are to be perform∣ed in every Fracture in special. The things common are two, to wit, the signs of a Fracture, and the Presages.

As for the signs, they are either found out by the Sense, or conje∣ctured by Reason.

The Sense, (if the Fracture be not presented to the view at the first) doth find out a Fracture by two instruments, to wit, the Fin∣ger, if the Wound be large e∣nough, and I a Probe. If then you perceive either by your Finger or a Probe an inequality, depression or ruggedness in the Scull, you may suspect that there is a Fra∣cture. Ruggedness may deceive you, if the Sutures of the wound∣ed party do vary from the ordina∣ry, as if the sagittal Suture do reach to the Ossa cribriformia or Sieve-like Bones of the Nose. Some Idiots imagine the Sculls of Wo∣men in this point to differ from the Sculls of Men: but their imagina∣tion is erroneous: for this event is rare in either of both. That the Suture may deceive one. Hip∣pocrat. Sect. 6. de vulnerib. capitis. acknowledgeth in these words: The Suture may deceive, being rougher than the rest of the Bone. So that it is not manifest whether there is in that place a Suture, or the point of the weapon, unless this be left somewhat large.

As for the signs which are sound out by reason, or rational con∣jecture, they are taken from four things: to wit, First, from the efficient causes. Secondly, from the manner of Wounding. Third∣ly, from the wounded person. And last of all from the Sym∣ptoms.

To the efficient cause are re∣ferred,

First, the party who hath inflicted the Wound. So that if he be strong, and in his fury did in∣f••ct the Wound, it is likely that there is a Fracture, if the Wound hath reached to the Skull. Se∣condly the instrument is to be re∣serred to the efficient cause, whose leenness and weight are to be con∣sdered. Thirdly, a fall upon a ••ard body from a high place, fourthly, a strong dashing of the Head against a hard body.

As for the manner of wounding, it is to be considered whether it was done violently, or moderately: For if the Wound was inflicted violently, it is probable that a Fracture was procured; but if it was done with deliberation and moderation, there 〈◊〉〈◊〉 less fear of a Fracture. As for the signs taken from the wound∣ed party, you are diligently to con∣sider; First, whether he received the Wound being bare-headed. Secondly, whether the Skull be thin and weak, as it is in Children, and so apt to receive a Fracture. As for those signs which are ta∣ken from the Symptomes, they are of two sorts: for they are ta∣ken either from the Symptomes conjunct, or those which after en∣sue.

The Symptomes conjunct are these: 1. A singing of the Ears after that the Wound is received: 2. Falling after the blow: 3. Swooning for a time: 4. Slum∣bering after the Wound is recei∣ved: 5. A dazling of the Eies: 6. A giddiness: 7. An issuing of Blood from the Nose, Ears, Eies, or Mouth. 8. Vomiting, peruse Hippoc. l. de vulner. cap. ac Fallop. on cundem c. 18, Paraeum lib. 9. c. 2.

The signs which are fetched from the after following are these: 1. A constant pain of the wounded part, so that the Patient often offers to touch it with his hand: 2. A vomiting of Choler with a Fever: 3. A Convulsion: 4. Palsie of one of the Arms and Legs: 5. Ra∣ving: 6. A faltring in the Speech: 7. Deafness: 8. The empairing of the Memory: 9. Dulness of the Understanding: 10. Weak judg∣ment. Coiter. lib. observ. Anatom. & Chirurgicar. Fallop. in Hipp. de de vuln. cap. 45. 11. An Apo∣plexy, Par. lib. 9. c. 8.

Those signs that are taken from the crashing, which Hipp. affirm•• the Patient to feel, if he chew Pa∣per strongly with both the sides of the Gums, and from holding of a pack-thread strongly between the Teeth, if after jirking of it the party wounded feel pain in the part: As also those signs which are taken from the moisture of Emplasters, applied to the wound∣ed part shaved, are all uncertain. See Fallop. in Hippoc. lib. de vuln. cap. c. 23. But it the Hair be cut asunder, and stick up in the Wound, the Skull of a necessity must be hurt; for it could not be cut asunder without the resistence of the Skull. See Hipp. in his former Book, and Fallop. upon him, cap. 18. & Parey lib. 9. c. 8.

It is sufficient to have spoken so much of the signs of Fractures of the Scull, I will deliver unto you the Prognosticks, by which you shall be instructed to foretel the event which is like to ensue after a Fracture procured in the Scull.

1. If one hath received a Fra∣cture in the Scull, pronounce not

all danger past before 100 dayes be expired; for many such wounded persons by experience have been found to have died about this time, when as all things might have been thought to have been secure. See Par. l. 9. c. 13. & Fall. in. Hipp. de vulner. cap. c. 48.

2. Every wound of the Head ac∣companied with a Fracture is dan∣gerous, although no fearful Sym∣ptome doth at the first for many daies appear and discover it self: for the strength of the party, the uncleanness of the Body, an exqui∣site Diet, and the wholsomeness and temperateness of the Climat, are able to stay for a long time the appearing of ill accidents.

3. If a Fever ensue, after a Fra∣cture; if the Head become very hot, if it hath been subject to di∣stillation, if the party hath often been troubled with an Erysipelas, pronounce danger: if the brims of the wounds in the second dressing grow flat and do not swell, there is yet more danger: But if the Scull at the very beginning of the Cure appear blackish, and the Pa∣tient having a cacochymical Body cannot sleep, Death is like to en∣sue. See Fallop. in Hipp. de vuln. cap. c. 24.

4. When the reason is weak, the Memory impaired, the Tongue falters, the Eies grow dim, the Ears become deaf, if the party ei∣ther cannot move himself, or falleth still from the head of the Bed, when a continual Fever with raving holdeth the Patient; if either the Tongue grow black, or clefts or pustules appear upon it; if the wound grow drie, and yield no Quittour, or becomes of a livid colour; if the Excrements be sup∣pressed; if a Convulsion, Palsie, or Apoplexy do ensue; if the wounded party often faint and have a weak Pulse; if (I say) all these Symptomes, or most of them do appear, you may boldly progno∣sticate that death will ensue. These Symptomes, if they shew them∣selves even quickly after that the wound is received, they shew that the substance of the Brain it self is hurt: But if they appear about the Fourteenth day, or after, they proceed from the Inflammation of the Brain, and a Phlegmon of the same, by reason of the pour∣ing of putrefied Blood upon it. See Parey lib. 9.12.

5. If one who hath received a Fracture of the Scull be altoge∣ther void of a Fever, if he digest his Meat well, if he Sleep well, if the Excrements be discharged, no waies offending in colour, quanti∣ty, time, other qualities, and the manner of discharging: if the Wound appear of a fresh and live∣ly colour, if it yield laudable Quittour, if the Lips of it swell a little, and be somewhat soft, if the motion of the Dura mater be re∣gular, you may hope well of the recovery of the Patient, Parey lib. 9. c. 13.

6. If the Scull be fractured, the parts above must suffer a solution of continuity, only this exception is to be admitted, if that kind of Fracture fall out which is called Resonitus or Contrasissura, a coun∣tercleft, which seldom happens, whereof I will speak when I shall deliver the manner of curing par∣ticular Fractures. Vide eund. lib. 9. c. 10.

7. If much Quittour appear upon the Cranium fractured, if Pustules appear upon the Tongue, by reason of a sharp Sanies falling upon it, having been sent down from the Brain through the holes of the palate of the Mouth, there is small hope of recovery, especi∣••lly if these accidents continue, and cease not. ••id ibid. for these do snew, that the Brain it self is ill-af∣fected.

8. If the flesh about the Scull scactured do appear of a leaden colour, it is an ill sign, according to Hippoc. 7. Aph. 2. for it is an argument, that the natural heat 〈◊〉〈◊〉 the part is extinguished, by reason of a malign Humor, which hath caused a putrefaction of it, or that it is quenched by a vehe∣ment Inflammation or Phlegmon: if it hath not fallen out by reason of the greatness of the Contusion, if it become of a leaden colour by reason of the Contusion, it is not so dangerous, for it may be remo∣red by suppurative Medicaments.

9. If in like manner the flesh about the Scull fractured be of a Rack colour, become drie, and afford not Quittour according to the amplitude or largeness of the wound, it promiseth no good: for it is a sign of the mortification or the part.

10. The Nowl-bone, and the O•• petrosum or stony, or hard B••me, behind the Ears, are less subject to injuries, and so if they be wounded or fractured, the dan∣ger is the less: First, because the Nowl-bone doth only contain the Cerebellum, which is not so noble as the Brain. Secondly, because less store of Brain is contained in those places, than in other parts of the Scull. Thirdly, because the Bones in these parts are thicker. Fourth∣ly, because they are more firmly covered, for the Skin in them is thicker, the flesh more plentiful; the chords more in number, and the Ligaments strong to strengthen the Bones.

11. The callous flesh, by which the portions of the Scull separate, are joyned together and united, doth require the space of 40 or 50 days for the strengthning and hardning of it. Yea, the age and temperament of the wounded par∣ty have great force in hastening and staying the confirmation of the same. See Par. lib. 9. c. 13.

12. Why some escape of grie∣vous Wounds, and some die of light wounds, if falls out by reason of the differences of parts wound∣ed; for some are more sensible than others. Secondly, by reason of the diversity of Bodies: for some are strong, some weak. Third∣ly, by reason of the diversities of the Symptomes: for in some Wounds the Symptomes are more mild, in some more fierce and fear∣ful. See examples in Hippocrates lib. 7. Epidem. peruse Bernhardus Suevus, in his Treatise de Vulneri∣bus cap. 2. Where you may read sundry examples of those who di∣ed of very small hurts, and of sun∣dry who escaped of grievous wounds.

13. The progressions or order of the Symptomes afore-mention∣ed is this: First, pain is caused by reason of solution of unity. After pain follow Watching, loss of Ap∣petite, Weakness: Pain causes af∣fluxion of Humors: affluxion of

Humors causes Inflammation: In∣flammation procures a Fever, sometimes a Convulsion, some∣times a Gangrene, and last of all a Mortification, if prevention be not used.

14. Wounds with a fracture of the Sinciput, or Bone of the Fore∣head are more dangerous than those of the Occiput, or Nowl∣bone. Six reasons may be yield∣ed for the confirmation of this presage. First, because the Bones of the Forehead are thinner than those of the Occiput, and weaker, and so may be more easily contu∣sed or fractured. Secondly, be∣cause most Brain is there contain∣ed. Thirdly, because in the Bone of the Forehead there are sundry vaultings, so that the Brain may easily be wounded, if it pass through both the tables of the Scull. Fourth∣ly, because the skin in this part is thinner than in other parts of the hairy Scalp: so that the Bones and the Meninges may the more easily be hurt. Fifthly, because there are many and large Veins in the Forehead, so that the greater Hae∣morrhage may there be procured. Sixthly, because in the fore-part of the Head there are two Sutures, Coronalis and Sagittalis: So that the Scull may there easily be fra∣ctured, and the Dura mater hurt, which sends Filaments through the Sutures to make the Pericranium.

15. Next to these the Parietal or Ossa temporum are most dan∣gerous. First, because these Bones are thin and weak. Secondly, be∣cause there are remarkable Veins, Arteries, and Nerves. Thirdly, because the Pericranium doth clip the temporal Muscle, and the Muscle it self hath in the middle a Tendon of exquisite Sense. So that the wounds in the sides of the Head may by consent offend the Meninges, Brain and Nerves spring∣ing from thence.

16. Wounds without or with a fracture in the Sutures, are most dangerous. First, because the Bones are not solid there, but divided, and so least able to resist injuries. Se∣condly, because Quittour bred there may easily fall upon the Meninges. Thirdly, because in the Sutures the Dura mater may promptly be offended, which sends Filaments through them, for the framing of the Pericranium.

Of what moment certain pre∣dictions are, I will acquaint you with Hippocrates his words, lib 2. Prorrhet. I advise you that you carry your selves wisely in every point of the Art, and in the presaging part also, and that you call to mind, that if the event fall out according to the Prediction, you shall be had in admiration with the Patient; but if you do erre, you shall be both despised, and accounted fools. Wherefore I command, that you use discretion in these Predictions.

CHAP. IX.

Of the Section of the hairy Scalp, and opening the Scull.

HAving discoursed of the two general points to be obser∣ved in Wounds, accompanied with a Fracture of the Scull, what were the Signs and Prognosticks; hereafter I am to shew how every sort of such Wounds in particular is to be handled according to Art. Now the primary difference of Fractures of the Scull, is taken from the subjects, which are the wound∣ed parties. These are either Chil∣dren, which have not passed the seventh year of their age, or those of mature and ripe age.

Fractures then of the Cranium in Children, are either without a Wound, or they are accompanied with a Wound. If they be both without a Wound and a fearful Symptome, thus you shall go about to cure them. If then the Crani∣um be depressed, and Blood ex∣pressed out of the Veins, doth wave up and down under the Skin when it is compressed, (which sometime falls out in hard labour when the Midwise deals roughly with the Woman that is to be de∣livered) First of all the Hair is to be shaved off: then a triple or fourfold soft Linnen cloth, well moistned in the Oil of Rosos, ming∣led with the whites of Eggs bea∣ten, and a little Vinegar is to be ap∣plied to the part: which must not be removed before 24 hours be ex∣pired. In the Summer time apply this Medicament cold, but in the winter time warm; for by this means the afflux of Huntors will be staied, and a part of those which have flow∣ed already to the part discussed.

After this until the Eleventh day, this Cataplasm is to be ap∣plied warm: ℞ Ros. Rub. baccarum Myrti an. ℥ ij. Farin. Hord. & Fabar. an. ℥ j. Absynthii & Beton. an. ℥ ss. Semen. Cumin. ʒ ij. pidveri∣zandis pulverat. coq. omnia in vini Rub. astringentis ℥ xij. ad Cata∣plasmatis consistentiam, tandem addantur Ol. Ros. ac Chamaemelin. an. ℥ j. mellis ℥ ij. ut paretur Cataplasma ex A. P. It must be applied Warm, and fresh, Morn∣ing and Evening. It must be ap∣plied large enough, that it may cover somewhat of the parts ad••a∣cent. In the application let this moderation be used: Apply not too little of it, lest it grow too dry; nor too much, lest it offend the affected part with the weight. From the 11th to the 20th day, apply Diapalma softned with some

Oil of Lilies, taking ℥ iiij. of the Emplaster, and one of the Oil. From the 20th. day till the Cure be performed, apply Stictick Empla∣ster relented in Oil of Chamaemil, taking the afore-specified quantity of the Emplaster and Oil.

Caesar Armitius in lib. Hipp. de vulner. c. & Arcaeus l. 1. c. 5. do advise us to dress Childrens Heads in this case, after this manner; for the first dressing they will have this Medicament to be used, ℞ Farm. Hord. & Fabar. an. ʒ iij. pulv. Bac. Myrti ℥ ss. Aceti ℥ ij. coq, ad Cataplasmat. consistent, tum adde albumen ovi umus un•••• cum vitello conquassata. Ol. Ros. & Myr∣tin. an. ʒ ij. Misc. Afterward they will have to be applied a Ce∣rate made of Wax, Honey, Lapis haematites, Cumin-Seeds, Worm∣wood, the Pumice-stone and Bran beat to powder. But instead of this you may use Diachrlon mag∣uum relented in Oil of Lilies: These Medicaments are to be ap∣plied as the former.

If there be a Wound with a Fracture, but no fearful symptom, Arcaeus will have no shiver, or part of the Cranium taken, if the Por∣tions of it cleave together; but only the Fracture to be anointed with his Liniment warmed, and applied by three or four Feathers stripped, until you come within an Inch of the points of them, and tied together with a thread.

If fearful Symptomes, as a Con∣vulsion, a Fever, vomiting of Cho∣ler, or a Palsie, &c. do appear, which shew an offence to be com∣municated to the Brain by the Cranium, then it is requisite that the Scull be opened. Vule Lang ep. 5. tem. 1. & Fallop. in Hippoc. de vuln. cap. c. 47.

The Scull being opened, chil∣dren are no other ways to be dres∣sed than Men are. How they are to be dressed, I will shew hereaf∣ter. It shall suffice then to have spoken so much concerning the cure of Fractures in the Sculls of Children.

Now I will declare unto you how these are to be cured in per∣sons of ripe age. In handling of this matter, I will set down two points. The First shall contain those things which are common to every kind of Fracture. The Se∣cond shall deliver those things which are proper to every sort of Fracture. Those things which are common are two: the First is the Section of the soft parts pla∣ced above the Scull: The Second is the opening of the Scull.

As for the First, it is an artifici∣al separation of the soft parts above the Scull, that we may come to dress the Scull fractured, to pre∣vent the coming of ill accidents, or to remove ill Symptoms pre∣sent. Of this Section these things may be demanded. 1. Whether it ought to be done. 2. Why it is to be done. 3. In what parts it is to be made. 4. Of what form it ought to be. 5. What is to be done after Section.

As for the First, three Reasons may induce us to administer it sometimes. 1. The Authority of Hip. in lib. de vulnerib. c. and of all other rational Physicians and Chirurgeons. Secondly, necessi∣ty it self: for if either Blood or Quittour descend to the Meninges or Brain, inevitable death will

ensue, if way be not made for the expurgation of them, by making Incision in the soft parts, and open∣ing of the Scull it self. The third Reason is daily experience, which shews by the death of sundry, who by reason of the omission of these Operations end their lives, that they are to be administred.

The Causes which admonish us, that Section is to be administred, are two, First, that the Cranium ••ay be discovered, if dangerous Symptoms do appear, that the Chi∣rurgeon may see whether it be hurt or no. Secondly, that way may be made to remove such things as offend the Meninges and Brain, as Blood or Quittour setling upon them, and pressing them down, as also pieces of the Instruments wounding, or portions of the Scull wounding or pricking these parts.

As concerning the places where∣in Section is to be administred safely, receive this Proposition: Section may be made in all parts of the Hairy Scalp, if you except the Sutures and the temporal Muscle.

For first, Section is not to be made in the Sutures; because those filaments by which the Meninges are tied to the Pericranium, are of an exquisite sense, and being torn, may be inflamed, and com∣municate the Inflammation to the Meninges and Brain. See Hippoc. vulner. cap. & Fallop. upon him, cap. 19.

Secondly, Section is not to be made in the temporal Muscle, but chiefly a transverse Incision is dan∣gerous.

First, because a resolution of that side of the Head, which is wounded is caused, and a Con∣vulsion of the other side. By which an ugly distortion of the parts of the Face is caused. The cause of this Symptom is this. Whensoever one of the two bro∣therly Muscles, appointed for sun∣dry motions of the same part, is transversly wounded, that which is wounded, must suffer a resoluti∣on, and that which is not cut a Convulsion.

Secondly, we must be wary in incising the temporal Muscle trans∣versly; because it is still in motion, when we Talk, Drink or Eat.

Thirdly, because the Sutura squamosa, or the Scaly Suture lieth under it; but it wants not danger to make Incision in the Suture, as hath been said.

Fourthly, seeing many Veins, Arteries, and Nerves, are spread throughout it, it being transversly cut, many grievous Symptoms must ensue, as a great Haemor∣rhage, Pain, an Inflammation, a Fever, a Convulsion because of the inanition of the Vessels appointed for the containing of the vital and animal Spirits; to wit, the Veins, Arteries and Nerves being tranversly cut asunder. Vide Par. lib. 9. c. 19. Fallop. in Hippoc. de vulner. cap. c. 38. As for the form of Section, it is either streight, triangular, or cross ways.

One thing here is to be observed, that we make no tranverse Incision a little above the Eye-lid, lest the frontal Muscle being transversly cut asunder, a Palsie of the Eye-lid do ensue, the Muscle not being able to elevate or lift it up, wherefore the Incision in these places must be

either streight or oblique, not transverse. See Fallop. in Hippoc. lib. de vuln. cap. c. 23.

Now this remains wherewith you are to be acquainted, that I shew unto you what is to be done after that Incision of the soft part is performed.

First of all, the pericranium is to be separated from the cranium, ei∣ther with the Nails or the Splat∣ter: you are to begin the sepa∣ration from the Points of the In∣cision.

If the pericranium be not sepa∣rate, it will procure great Pain, an Inflammation, yea, and a Fe∣ver, if it be torn either with a Ra∣spatory or Trepan. See Par. lib. 9. cap. 4. Fallop. in Hippoc. de vul∣ner. cap. c. 38.

Secondly, the brims of the In∣cision are to be kept asunder by Dosils and Pledgets of Lint, arm∣ed either with Medicaments apt to stay Bleeding, if it offer to flow plentifully, or only with the white of an Egg beaten, according to Arcaeus, lib. 1. cap. 4. or with both the White and the Yolk to asswage. Pain, according to Fallop. in Hip∣poc. de vulner. cap. c. 29. if there be no fear of any remarkable ef∣fusion of Blood. The Wound so dressed, must not be dealt withal, until four and twenty hours be ex∣pired.

Having delivered unto you those Points which are considerable in making Incision, to come to Fra∣cture; now I must set down those things which are to be noted, when the Scull is to be opened artifici∣ally with sit Instruments, that you may come to remove such things as may offend the Meninges and the Brain. Concerning the ope∣ration these things may be asked: First, why it is to be opened? Secondly, when it is to be opened? Thirdly, what quantity of it is to be taken away when it is to be opened? Fourthly, with what Instruments it is to be taken a∣way?

As for the first, the Cranium is to be opened in five Cases: First, that pieces of the Weapon may be taken away: Secondly, that a portion of the Scull may be re∣moved, which is altogether sepa∣rate, or offends the Meninges, if it cleave to the rest: Thirdly, that a part of the Scull depressed, which bears down the Meninges, and causes a stupidity, may be either reduced to its own place, or whol∣ly taken away: Fourthly, that ei∣ther coagulate Blood or Quittour may be removed, which hath fal∣len upon the Membranes, by reason of a breach of some Vessel. Fifthly, that way may be made to apply convenient Medicaments to the Fracture. See Fallop. in Hippoc. vuln. cap. 31. and Par. lib. 9. c. 4.

As concerning the second, it is good to open it before the fourth day, Fallop. ibid. c. 34. and Ar∣caeus. lib. 1. c. 4. and Par. lib. 9. c. 4. Yea, it may with good success be opened after the seventh day, both in Summer and Winter-sea∣son, if grievous Symptoms urge not. If therefore any one of you be called to one who hath a Fra∣cture in the Cranium on the fourth day, (if ill Symptoms will permit) you may defer the opening until the seventh day be past; yea, the ninth: for on the

fourth day the Putrefaction of the Humors begins, as also the insult of Nature against the Disease, and so it is not good to hinder the mo∣tion of Nature: But if for reason∣able causes you fear lest delay will breed danger, you are presently to open the Scull, even on the Criti∣cal day.

As concerning the quantity which is to be taken away, either the whole fractured Bone is to be taken away, or only a part of it. The whole Bone is to be taken a∣way: First if the Fracture be in an upper part, as the Crown of the Head, where no depending vent may be made to discharge the Blood or Quittour from the Meninges. Secondly, in a Fissure, or Sedes, if it be not wide enough, the whole Bone that you see is to be removed, at least to the second Table. Thirdly, all the shivered Bones which cleave not together, are to be taken away. Fourthly, so much of the Scull is to be taken away, as covering the Dura Mater becomes black, that way may be made for the application of con∣venient Medicaments.

In Fractures, wherein it will be sufficient to take away only a por∣tion of the fractured Scull, to make way for the discharging ei∣ther of Blood or Quittour, or re∣moving of other hurtful things, let it be done in the depending part; which Rule notwithstand∣ing is to be omitted in two Cases.

First, if you perceive that the Meninges are like to be inflamed: for then they should more readily swell above the Cranium in a de∣pending part.

Secondly, if the Brain appear, the Membranes being wounded, we must shun opening in the de∣pending part; for according to Ga∣len, 6. Method. seeing the Brain is of a soft and fluid substance, it would easily fall down to the de∣pending part. Vide Fallop. in Hip∣poc. de vuln. cap. 35.

The chief Instruments with which we open the Scull, are these: Raspatories, Levatories, Gemlets called Terebellae, the Trepan, and the Head-saw. Of the sundry sorts of Raspatories, you may see choice in Par. lib. 9. c. 4.

When you will use Raspatories, you must observe some things before the Application, some things in the Application, and some things after the Application of them. Before you use them, First, you must place the Patient in a good posture. Secondly, his Head being lapped in foulded Clothes, is to be staid, and kept immoveable. Thirdly, the Ears are to be stopped with Cotton, or Wooll, that the noise offend not the Instruments of Hearing. Fourth∣ly, the brims of the Wound are to be covered with pieces of Linnen Cloth; First, to keep them from the Instruments; Secondly, to de∣fend them from the Air, which o∣therwise would cool them.

In the using of Raspatories: First, we must begin with the broadest, and then the less broad, and lastly the narrowest. Second∣ly, they are often to be moistned with the Oyl of Roses; first, that

they may serape the more lightly, secondly, that they heat not the Cranium: If Blood trouble the Work, use Vinegar and Water. After you have used the Raspato∣ries, use these same Topicks which are used after the Application of the Trepan.

Raspatories are to be used in Fissures or Chinks, and in a Sedes, when the print of the Weapon is narrow. The second Instrument is the Gemlet, or Terebellum: Coopers use the like Instrument to raise up the Staves of Vessels, the point of it must be scrued. This hath a two-fold use; First, it serves to take out the Bone cut by the Trepan, whereas it is not safe to cut the whole Bone through, as in the Bones of the Forehead. Secondly, it serves for reducing a depressed part of the Scull into its own place, by first making a small hole in the Cranium with the Pin of the Trepan, and then scruing it in.

As concerning Levatories, you may see divers fornis in Parcy, lib. 9. c. 5. & 5. When you use them, have a care that you lift up equally every part of the Bone; for if any part be depressed, it may hurt the Meninges.

As for the Head-saw, First, it may be used when there is a de∣pression or a Fracture on one side of the Bone; for one side be∣ing by a streight line divided by it, both there will be way made to the taking away of the Bone, and the discharging of Quit∣tour, or Blood, with small loss of substance of the Cranium. Se∣condly, it will serve to cut asun∣der the distance of the Cranium, left after Application of the Tre∣pan in divers parts.

The last Instrument: It remains now then, that I speak of the Trepan: Concerning it, these things may be demanded: First, to what end it is to be applied? Secondly, in what places it is to be applied? Thirdly, what is to be observed in the Application of it? Fourthly, what is to be done af∣ter the Application of it?

As for the first, the Applicati∣on of the Trepan hath a three∣fold use: First, it serves for the raising up of a Bone depressing the Meninges and Brain. Se∣condly, it serves for removing of all things which hurt the Mem∣branes and the Brain, whether they be Quittour, Blood, Splints of the Cranium, or pieces of the Wea∣pon. Thirdly, it makes way for the Application of sit Topicks. As for the places, it must not be ap∣plied, First, upon the Fracture; for this will increase the evil, chiefly if the fractured portions be sever∣ed. Secondly, it is not to be ap∣plied upon a Suture, because the Nervous Fibres, and the Veins and Arteries, by which the Dura Mater is annexed to the Perieranium, and gives it nourishment, should be torn: from whence would arise Pain, Inflammation, and flux of Blood; which might be commu∣nicated to the Membranes, and Brain it self. Thirdly, neither is it to be applied to the places a lit∣tle above the Eye-brows; for the Wound ever afterward would re∣main unskinned. Fourthly, it is not to be applied to the Temples, First, by reason of the temporal Muscle. Secondly, by reason of

the Sutura squamosa. Fifthly, it is not to be applied to the lower parts of the Scull, if the Me∣ninges be wounded, lest the Brain fall out through the hole. Sixthly, it is not to be applied to the Sinciput of Children, which are not above seven years old, seeing it is dangerous even in these who are of ripe Age, unless great ne∣cessity urge.

In the Application of the Tre∣pan, these things are to be obser∣ved: First, that you take out the Pan, when you are come to the second Table. Secondly, it is be moistned with Oyl, that it may cut the better. Thirdly, the print of the Trepan is to be moistned now and then with cold Water, lest the S••ull be lieated by the rubbing of the Trepan. Fourthly, seeing it is impossible to cut all the parts equally, the Scull being of a Sphe∣real Figure, you are to remove the Blood, that you may perceive which part is most deeply cut, that you lean more to the other. Fifthly, when the part cut by the Trepan begins to shake, it is the sifest way to lift it up with the Le∣vatory. Sixthly, if any ragged pleces appear, which may hurt the Meninges, you are to take them away by Scalper Lenticulatus, and the Mallet of Lead, after that the Trepan is applied above the Durd Meter, apply a piece of Tafety or S••ttin, of a white or crimson co∣lour, moistned in Mel Resatum, and Oleum Rosatum, until the se∣venth day; afterward use the Oyl of Roses, and the Oyl of Hyperi∣tum mixed; let the Crantum be anointed with Are••eus his Lini∣ment melted; sill up the hole with Dosils and Pledgets, laying above such Topicks as heretofore I have set down.

If in the Application of the Tre∣pan, any remarkable Bleeding en∣sue, some Vessel being cut, which did cleave to the second Table, then apply this Medicament of Galen. 6. Method. ℞ Alce. ʒ ij. Thuris, Mastiches, an. ʒ j. ex ist is pulverizatis, Pilis. Leporinis, & ov. Album. siat linimentum, quod applicetur. The Scull will scale, according to Arcaeus lib. 1. c. 4. within the space of four and twen∣ty or five and twenty days, if his Liniment be applied to the Bone. But according to Parey, not be∣fore forty or fifty days, but in truth no certain day can be ap∣pointed, Hieron. Fabric. ab aq. pendent. part. 2. lib. 2. de vulner. cap. 18. counsels first to apply the Oyl of Roses to turn the Matter which falls upon the Dura Mater into Quittour; for Galen, lib. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, c. 2. affirms, that we ought to use Oyl of Roses, when we mean both to repell and sup∣purate. It will be the more sup∣purative, if it be Oleum Rosaceum Completum. He advises to mingle some Rosin with the Oyl of Roses; for in Digestives, according to Ga∣len, lib. 5. Simp. cap. 19. there ought to be an Emplastick faculty, which the Oyl of Roses hath not of it self, but of the Rosin. In the first dressings, and in the Sum∣mer time, more Oyl of Roses, and less Rosin is to be used; but after∣wards when we mean to dry and mundisie, as also in the Winter, more Rosin and less Oyl is to be ta∣ken. When the Wound is dressed, embrocate the parts of the Head

with Oyl of Roses warmed, as also the Neck, chiefly where the jugular. Veins are, partly to asswage Pain, if any be; partly, to contemperate the heat of the Blood.

CHAP. XXI.

Of the cure of Fractures appearing in the wounded part.

HItherto I have dispatched those points which frequent∣ly are common to all sorts of Fractures, which do happen to those who are of ripe Age: now it remains that I shew unto you how all sorts of Fractures in such persons are to be cured.

Now a Fracture in these persons is two-fold: for it is either in the same part which hath suffered So∣lution of Unity, or in another part. If it be in the same part, it is either Simple, Compound, or Complicate.

A simple Fracture is, when one only kind of Fructure hap∣pens. Of these there are three sorts; Rima, a Chink or a Cleft, Contusio, a Contusion of the Scull; and Sedes, a Sitter, when the print of the wounding Instrument is left in the Scull.

Rima, or Fissura, a Chink or a Cleft, is two-fold; for it is either Conspicua, easily to be discerned by the sight, or Inconspicua, ei∣ther hardly to be discerned by the sight, or not at all; which is cal∣led Capillaris, a hair-like Chink. Now a conspicuous Chink passeth through either one or both the Tables of the Scull. If it pass not deeper than to the spongy part between the two Tables, the Chink it self is so far to be dilated. If the Cleft pass through both the Ta∣bles, then the Chink is either to be dilated through both the Tables of the Scull, even to the Dura Ma∣ter, or through the first Table at the least, making way through the second Table also, leaving a com∣petent apertion for the discharging of clotted Blood, or Quittour, for the depending part of the Head, through the second Table. Now the depending part is not to be taken from the situation of the parts of the Body, but from the position or posture of them.

You must deal after this same manner with Rima inconspicua, or Capillaris, or an obscure Chink. But it is not an easie matter to find it out. If therefore you cannot discern it either with the Eyes, or the help of a magnifying Glass,

cuse the Patient to hold in his breath, and to stretch his Breast. If this be done, either a thin Hu∣mer, or a bloody Sanies do issue out, it is an excellent Sign: if this do not appear, then apply to the part most suspicious, Ink, made thin with a little Vinegar, to make it pierce. The next dressing, dry the Scull with a wet Rag or Sponge, and if you see any print of the Ink to remain in the Scull, follow the besiness untill you come to the uttermost of the impression of the Irk, although you must discover the Dura Mater. Now Chinks must not be dilated by the Tre∣pan, but by Raspatories: for we ought not to take away more of the Scull than necessity urges. Pe∣ruse Par. lib. 9. c. 4. and Fallop. con. in lib. Hippoc. de vulnerib. cap. c. 3. When the Rima is dilated, dress the Wound, as you do after the Application of the Trepan; whereof I spake sufficiently in the former Chapter.

Sedes, or a Sitter, is a Fracture caused by a sharp Instrument, which leaves the print of it in the Scull: if it pass through both Ta∣bles, and no Splints of the Bone prick the Meninges, and sufficient way be made by the Weapon for the discharging of the Quittour, no further Apertion is to be made; but the Wound is to be dressed, as I prescribed, after the Application of the Trepan. But if either Splints of the Bones do offend the Dura Mater, or the passage be too narrow for the discharging of the Quittour, a further Apertion of the Scull is to be made by such Instruments as shall seem most fit for this Operation. If the Sedes pass not further than the first Ta∣ble, the Cranium is to be smoothed with Raspatories, lest the Quittour setling in the Sedes cause a deeper cariosity. Then the Wound is to be dressed with Arcaeus his Lini∣ment relented in a Spoon: It falls out many times, if the constituti∣on of the wounded party be good, that the Cranium doth cast no Scale.

The third kind of a simple Fra∣cture called Contusio, a Contusi∣on of the Scull, resteth to be spo∣ken of.

A Contusion is a Solution of cen∣tinuity in the Cranium, when as by the violence of an external In∣strument, the small portions of it are brought nearer together than Nature hath placed them, yet have returned to their own posi∣ture after that this compression is caused.

This kind of Fracture is espied in the beginning, or in progress of time. In the beginning it is found out by the alteration of the colour of the Scull: The colour of a lively Bone is of a whitish colour, mingled with a lively ruddiness; but if it be mortified, it will be whitish without any redness: if it be carious or rotten, it will be of a livid or blackish colour. If there∣fore such a kind of Fracture hap∣pen, the pleasant ruddiness of the Scull will be gone, and white pat∣ches will appear in it, such as are seen in the Nails of some Persons Fingers. In process of time, if it be left untouched, it will become of a livid or blackish colour, being carious: In this kind of Fracture you are to take so much of the Cranium as is mortified by the

Contusion with Raspatories, and then to heal the Wound by In∣carnation. So much then of the three sorts of simple Fractures.

A compound Fracture is when some further inconvenience is an∣nexed to the Solution of Unity in the Scull, as the loss of sub∣stance, or removing of some part of it from its own place.

Of this there are three sorts, De∣pressio, a depression, Concameratio, a vaulting, and Excisio, or an ab∣solute division of some part of the Cranium from the rest.

A Depression is, when as the Scull is beaten down; in this kind of Fractures, shivers of the Scull are quite separate from the hole sometimes: Again, sometimes they cleave to the hole in one part, and are separate from the other. Those which are altogether separate, you shall remove with Levatories: If the fractured part cleave to the hole in one side, and if you can∣not elevate it with a Levatory; then you are to apply the Trepan as near to the fractured part as you can, that as little as may be of the Cranium be taken away. After∣ward either reduce the depressed part to its own place, or altoge∣ther remove it, as you shall think most expedient. In performing these actions, you are to use great caution, that the Meninges be not hurt by the sharp Splints of the Bones fractured.

Contameratio or vaulting is, when as the Scull by a sharp point∣ed Weapon with force being pierced, and with might being pulled out is pulled upwards, leaving an empty space or vacuity beneath. If this kind of Fracture go no further than through the first Table, you are to smooth the Scull, and to heal the Wound according to the Me∣thod set down before. But if it pass through the second Table, you must open the Scull in the most depending part with the Trepan, to make way for the discharging of the Quittour: for Sanies must of necessity be lodged in the lower vacuity, or void space, if the Weapon it self hath not made sufficient way: if any rug∣gedness prick the Dura Mater, you are to remove the whole Fra∣cture, compassing it with a large Head of a Trepan, and then to cure the Wound as hath been taught.

Excisio is, when the part of the Scull wounded is altogether sepa∣rate from the hole; if the frag∣ment cut away stick to the Cutis Musculosa, and the Wound go no deeper than the first Table, it is to be separated from the Cutis Musculosa, and the Crantum is to be smoothed with a Raspatory: But if both the Tables of the Scull cleave to the Cutis Musculosa, they are not to be taken away, but to be reduced to their own place, the Wound having first been cleansed with Wine or Spirit of Wine warm∣ed. Then the Cutis Musculosa is to be fastened to the rest, with so many stitches of four twists of Silk or Thread drawn through with a rolling Needle. See an Example of this in Parl. l. 9. c. 7.

A complicate Fracture is, when either sundry Fractures of one fort do concur, or more of divers kinds. Many Fractures of the same sort may happen, as sundry Chinks. So many Chinks as are perceived

by the Eyes are to be dilated with Raspatories. In like manner sun∣dry Fractures of divers kinds may meet, as a Chink with a depression. I•• such complicate Fractures you are to proceed no other ways, than have been shewed in solitary Fra∣ctures; for a Chink is ever to be dilated if it be conspicuous, and the part of the Scull depressed must either be wholly taken away, I the Asperities of the second Ta∣ble prick the Dura Mater, or if they do not, it is to be reduced to its own place, if it be not whol∣ly separate from the sound parts of the Cranium, According to these Canons curative you may proceed hall Fractures of the Scull in what part soever they happen, if you ex∣cept the Sutures, and that part of the Scull which lies under the tem∣poral Muscle.

A Suture may suffer a Solution of Unity three manner of ways: by Separation, Depression, and Collisi∣on. Of a Depression I have spoken sufficiently already.

A Dissolution of a Suture is, when as those parts of the Crani∣um which are united by the Su∣ture, gape, being separate by some external violence; if this separati∣on be large, the Nervous Fibres, which make the Ligament by which the Dura Mater is tied to the Pericranium, must be torn, tho this appear not to the sight: from whence often ariseth Inflam∣mation, and danger of death.

A Collision is a Contusion of the brims of the Suture, and of the Ligament which passeth through it, caused of a violent compressi∣on of the brims of the Suture. In these Cases if fearful Accidents, as a Fever, Vomiting, or a Convulsion, &c. do perswade you that the Scull must be opened, then you are to apply the Trepan on either or both sides of the Suture: for if you should set it upon the Suture, hor∣rible Symptoms first would appear, and at last death ensue.

If a Fracture under the tem∣poral Muscle be accompanied with a Wound, this Wound is either a Puncture, or an Incision, trans∣verse, or according to the length: if it be a puncture, or transverse, it must prove dangerous, as hath been shewed. If the wound be in∣flicted long ways, it is to be di∣lated by Dosils or Sponges: If the Fracture be a Chink, it is to be dilated by Raspatories. But if it be a great Fracture, wherein the Asperities do prick the Meninges, or the depression of the Scull bears down them by its weight, then a triangular Incision is to be made a little above the Fractures, shunning the temporal Muscle, and the Trepan to be applied; then the shivers which are altoge∣ther separate from the sound Scull, are to be taken away, and the rest which are not separate to be re∣duced to their own positure.

After this, as often as you dress the wounded person, you are to cause him to bend down his Head, to stop his Mouth, and Nose, and to labour to breath strongly, that the Sanies may be expelled out of the Wound. When this is done, you must make Injection of a mundifying Decoction with a Sy∣ringe to wash out all impurities, which otherwise would lodge there. See a memorable Example of this in Parey, lib. 9. cap. 19. He

advises to keep a leaden Pipe in the Wound, but seeing this by reason of the hardness must cause pain, and is not fit for the dilation of the Section, a Sponge com∣pressed is far better: for first it is soft. Secondly, it sucks into it self the impurities: Third∣ly, it dilates powerfully the Wound, and keeps it open un∣till the shivers of the Cranitan cast.

CHAP. XXII.

Of Fractures in other than in the place wounded, and those which happen when the Cutis Muscu∣losa is not wounded.

IN the last Chapter I discoursed of Fractures, which may fall out in the parts wounded: now I am to shew, how Fractures in other parts than those which are wounded are to be handled, when they fall out.

Now Fractures, which fall out in the Cranium in another part than that which is subjacent to the Cutis Musculosa wounded, are ei∣ther in a part of the Cranium adja∣cent to the Solution of Unity of soft parts of the Scull wounded, or in a part somewhat distant or remote.

If a Fracture fall out to be not in the part wounded, you shall find it out by these seven Signs. First, the Wound of the Cutis Musculosa, which covereth the Fracture, will not admit Cure in that part which is near the Fra∣cture, whereas in the other parts it will admit Cicatrization. Se∣condly, out of the part near to the Wound, you shall perceive a thin and ichorous Matter to flow. Thirdly, more copious Matter will flow out of the Wound, than the bigness of the Wound can seem to afford. Fourthly, the Flesh which grows near to that part is spongy and loose, not firm. Fifth∣ly, now and then the party wounded will be feverish. Sixth∣ly, if you thrust your Probe be∣tween the Cranium and the Cutis, you shall find the Cutis separate from the Cranium. Seventhly, some tumor and softness will ap∣pear in the cutaneous part, which is placed above the Fracture.

A Fracture in a remote part, or much distant from the wounded part, is called Resonitus, or Con∣tra-fissura, a counter-cleft: This falls out, when the Cranium is stricken upon one part, and fra∣ctured in another: This happens

other in the self-same Bone, or in fivers Bones: If in the self-same Bone, it may fall out two manner of ways; to wit, either laterally, a when the right side of Os Fron∣tis is beaten, and the lest side cleft or contrariwise; or perpen∣dicularly from the upper to the lower part, as when not the up∣per Table which received the blow, but the lower is fractured. If a counterclest happen to be in civers Bones, this may fall out two manner of ways: First, if the right side be beaten, and the lest fractured, as if the right Parietal receive the blow, and the left be deft; or contrarywise. Secondly, this may happen, if the forepart be stricken, and the hinder part cleft, as if the Os Frontis be bea∣ten, and the Os Occipitis be cleft, and contrariwise. This kind of Fracture which happens in the Cranium in a part opposite to the Solution of Unity, doth chance to to those, who either have no Su∣tures at all, or such as are very ob∣kure and very close; for in such persons the Air may be carried more compact, and with greater nolence from the part contused, or wounded, to the opposite part: for when the Air which is within the Scull is strongly moved by a blow, and on every side is driven by the force of the blow, it is en∣tirely carried through the sub∣stance of the Brain to the oppo∣site part: when it meets with the Scull, which by reason of its firm∣ness cannot yield, causeth a Fra∣cture in the Scull; even as two men in a violent race meeting to∣gether are by this violent meeting beaten back. This is often seen in a Glass, which being knocked in one side is cleft in the opposite part.

That the Sutures are not uni∣form, these Authors bear witness: Vesal. lib. 1. c. 6. de human. corp. fabricâ. Sylv. comment. in lib. Ga∣len, de ossib. Columb. lib. 1. c. 5. Par. lib. 4. c. 3. Hippoc. lib. de vuln. cap. & Fallop. in eund. c. 5. & in lib. Galen. de ossib. c. 13. That Sutures again are either hard∣ly seen, being obliterate and worn out, or not at all, these Authors do affirm, Arist. de histor. animal. lib. 3. c. 7. Cels. lib. 8. c. 1. Aley Benedict. anatom. lib. 4. c. 7. Vel∣sal. lib. c. 6. and Hippoc. and Fallop, in the place before specified.

And although Paul. Aeginet. lib. 6. c. 90. and Guido with o∣thers more, deny that a Resoni∣tus or Contra-fissura can happen; yet these Authors against which it were temerity to except, do affirm that it may happen, Cel. lib. 8. c. 4. Nicol. Florent. Sermon. 7. Summa. 2. tractat. 4. c. 1. Vale∣riola append. loc. commun. c. 5. Hippoc. lib. de vulnerib. cap. Fal∣lop. commentar. in eundem. c. 14. Par. lib. 9. c. 8. Although it be a hard Matter to find out this kind of Fracture, yet you shall go about to find it out by these means. First, if signs of a Fra∣cture do appear; as a Fever, vo∣miting of Choler, and such like, and no Chink appear in the wound∣ed part, then you are to take a view of the opposite part. If a Tumor or Softness do appear in any part of it; then you may be assured that the Fracture is in the Scull, subjacent to that part. Secondly, if no Tumor or Softness appear in the opposite part, shave the Head

and apply this Emplaster following, ℞. Pic. Naval. & Cer. an. ℥ iij. te∣rebinth. ℥ j. Mastich. & irid. pul∣verizat. an. ʒ ij. fiat Emplast. s. a. Draw this Emplaster upon Leather, and apply it to the opposite part, and let it lie 24 hours. If after you have taken it away, the Cutis mus∣culosa appear in any place more moist, soft, and swelled than the rest of it is, it is likely that there the Fracture is. Thirdly, if the grieved person do often touch with his hand the part opposite to that, wherein the solution of unity is, not thinking upon any hurt done to it, you may suspect that the Fracture is where he toucheth. If the Second Table be fractured, the first remaining whole, then you must apply the trepan, partly that you may come to take away splints, which do prick the Dura mater, partly to make way for the dis∣charging of coagulate Blood, and the Sanies. If any Patient having such a Fracture do die, the Chi∣rurgeon is not much to be blamed: for a Chirurgeon may be excused, if the Patient die, in Four cases. First, if the Cranium by a violent Contusion be depressed, and the Scull presently return to its own place. Secondly, if the chink be only capillar, and hard to be seen. Thirdly, when the Second Table of the Scull is broken, the First remaining whole. Fourthly, when a Fracture happens in the part op∣posite to that which is wounded. In these cases the Chirurgeon may be excused, seeing the most skilful Artist may be deceived in these ca∣ses. If you find out a Contra-fis∣sura, if it be but a meer Rima or chink, after you have made incisi∣on through the soft parts lying above the Cranium, dilate the chink with the Raspatories, that way may be made for the discharg∣ing of the coagulate Blood and Sanies: for these will be gathered, out of all doubt, in all chinks.

I have shewed how Fractures in a Wound happening in persons of ripe age are to be cured: now I am to shew you how Fractures in the Scull are to be cured, when as the soft parts above the Cranium are not wounded; yet the Cranium offended. If therefore by a con∣tusion the Scull be fractured, the Cutis musculosa not being divided, you are to ask of the party offend∣ed, whether he hath vomited cho∣ler, whether he lost his sight, whe∣ther he could not speak, whether Blood did issue out of his Nostrils, and Ears, whether he seemed to be in a trance, whether he percei∣ved a giddiness after the blow these Symptoms do shew that there is a Fracture. And although no ac∣cidents do discover themselves, yet you must not be secure, but ask whether the Patient in former times hath not had the Head-ach, for then there is less danger, or whether he was struck with a hea∣vy weapon, by the hand of a strong man enraged, or whether he felt a noise in the Brain when he was strucken? If these signs appear, you must suspend your Prognosticks towards the best event. In this case so you are to go on. If no fearful symptomes after the blow received do continue; then shave that part of the Head where the blow was received: Then apply a Medicament which asswages pain; dries, and is astringent: These In∣tentions

a Cataplasin furthereth made of Barley-meal, Vinegar and Water in the Summer, but Vine∣gar and Wine in the Winter, ha∣ving added the powder of red Ro∣so, Myrtle-berries and Mastick, and some Oil of Roses, when the Cataplasm is brought to a consist∣ence: Secondly, you must minister a Medicament which doth purge Choler, as this: ℞ Caryocostin. & Elect. de succo ros. an. ʒ ij. Syrup. de Cichor. Cum. Rhab. ℥ j. Aq. Endiv. ℥ij. Misc. ut paretur potio. Thirdly, the cephalick Vein of the same side is to be opened, or Cup∣ping-glasses with scarification, or Leeches to be applied. Fourthly, Oil of sweet Almonds is to be drop∣ped into the Ears, that the Quit∣tour which is gathered there may be discharged. In like manner the passages of the Nose are to be moist∣ned with this same Oil. About the fourth day you are to use Gar∣garisms made of the decoction of Barley, red Rose-leaves, Cowslip∣flowers, Betony-flowers, Eye-bright Stoechas, and some Rue: With the decoction you are to mingle Mel rosatum and Oxymel simplex. About the seventh day you are to use discutient Medicaments, as Di∣achylon ireatum, or Emplastrum de Betonica, made soft in the Sum∣mer with Oil of Roses, and in the Winter with Oil of Dill. If having used these means, fearful Symp∣tomes do appear after the 7th day you must not deferre the incision of the Cutis musculosa, and the opening of the Scull: for then it is not to be doubted but that Blood and Quittour are fallen upon the Dura mater.

Although the soft parts above the Scull be not divided, yet in three cases you must make incisi∣on, and open the Scull. First, if clotted Blood or Quittour be lodged between the Cranium and the Dura mater, which you shall perceive, if Blood did issue out of the Ears or Nostrils, after the blow was received, if he be sleepy, stupid, or have a heaviness of the Head. Secondly, these things are to be done when splints of the Scull do prick the Menin∣ges, which the pain in the part doth discover. Thirdly, when a depression of the Scull remaining, bears down the Meninges, and cau∣ses a stupidity, and a pricking pain, when the party blows his Nose.

CHAP. XXIII.

Of Wounds of the Meninges and the Brain.

HAving delivered unto you in the last Chapters the me∣thod of curing those Wounds which may befall the external parts containing of the Head; now I intend to shew you, how Wounds in the internal containing parts, and the contained parts are to be cured.

The internal parts containing are two; the two Meninges, or Membranes, which compass and environ the Brain called by the Ara∣bians Dura & piamater. In wounds of the Dura mater, there is al∣waies a vehement pain. Five in∣conveniences may happen to the Dura mater, to wit, a Wound, Pain, Inflammation, Apostemati∣on, and Discolouration.

If you perceive that there is an immoderate flux of Blood, the Membrane being wounded: then immediately you must make way to come to the Membrane, if the wounding instrument hath not made way enough; and Galen's powder set down 6. Meth. Medend. made of Aloe, Frankincense, Ma∣stick, the white of an Egg, and the Down of a Hare is to be appli∣ed.

If in a puncture of the Dura mater or after unskilful dressing drowsiness and sleepiness seize up∣on the wounded party, death short∣ly will ensue. See Dodon. ebserv. medic. cap. 3. Now seeing great pain follows the Dura mater being wounded, you must with all ex∣pedition go about to asswage it.

In this case first Narcotical Me∣dicaments have no place: for so both the Membrane it self, and the whole Body would become stupefied; Secondly, unctuous Me∣dicaments which mollifie are not to be used; because these will cause the Membranes to become dull, to swell, and last of all to putiefie. Wherefore Oil of Roses warm is to be poured upon the Membrane, until the pain be mi∣tigated, and Quittour appear in the Wound. Then Mel resation, or Syrupus è Ros. Rub. Siccat. are to be mingled with Oil of Roses, in equal quantity, until the Wound be perfectly digested. Last of all, the Dura mater is to be mundifi∣ed and dried with fit Medicaments. Such are Mel rosatum, Syrupus è Ros. Rub. Sice. Syrupus Myrtin••, or Sanativus alone, having no Oil mingled with them. And although the Pia mater, by reason of its softness, may be united and aggle∣tinated; yet the Dura mater, be∣cause it is hard, nervous and thin, will not admit agglutination: for in agglutination the brims of the wounded part must be brought

and kept together, which is per∣formed by rolling and stitchings, which in this case cannot be used. Wherefore it must be cured by In∣carnation, or procuring of flesh to unite the parts dis-joyned.

An Inflammation is a red Tu∣mor of the Dura mater with a distention of the vessels of the s••me, so great sometimes, that it fills the hole of the Cranium, and grows above it. This accident is dangerous.

Wherefore, First of all, Phle∣botomy is to be administred, and a slender Diet appointed: then the part is to be fomented with a de∣coction of Marsh-mallows, Lin∣seed, and Fenugreek, adding groundsell, and Violet-leaves, as also other Herbs which are to be applied to a Phlegmon, if occasion shall require. This being done, the Oil of Roses, Myrtils▪ or Quin∣ces is to be applied. If you pre∣vail not by the application of these means, but you perceive that the Tumor rather increases than di∣minishes, then you are to dilate the Scull, by taking away more of it.

If Quittour be contained within the Dura mater, which you shall perceive by the extraordinary whiteness of some part of it, as in pustles of the Skin, then you are warily to open it, that you in no ways touch the Brain. Then you are to apply drying and ab∣stersive Medicaments, as Mel. ro∣sation, & Syrupus è Rosis siccis. Vide Fallop. Comment. in lib. Hip∣p••c. de vulnerib. cap. c. 43. & Pa∣rae••on lib. 9. c. 21.

Discolouring or blackness may proceed from five causes, viz. From the violence of the Contu∣sion; From coagulate Blood; From the coldness of the Air; By the application of unproper Me∣dicaments; Last of all, from Putre∣faction.

If the blackness proceed from the violence of the Contusion it sel∣dom continues above four daies. In this case use Oleum rosacetom, and Mel rosatum; or the Oil of Eggs, with a little Aqua vitae, and some of the Pulvis cephalicus, with a few grains of the powder of Saffron.

If congealed Blood hath caused a blackness, then apply this Medi∣cament: ℞ Aq. vit. ℥ ij. Pulv. Gran. tinctorum. ℥ ij ss. Croci. ℈ j. Mellis. Ros. ℥ ij ss. Sarcocoll. ʒ. iij. leniter bulliant omnia: colaturà utimini donce evanuerit nigredo.

If unproper Medicaments have caused the blackness of the Dura mater, then it is to be cured by the application of such Medica∣ments as are in faculty contrary to those which have been applied; so if humid; unctuous, or fatty Medicaments have been used, you are to change these, and to apply those which are drying, as the Cephalick powders mingled with Mel rosation, Oleum rosation, or both mingled together. If sharp Medicaments have been applied, instead of these, mild and lenient Medicaments are to be used, as the Oil of H••pericum, or of Earth∣worms, with a little Saffron: for it is certain that moist Medica∣ments may cause blackness by in∣creasing filth; and sharp Medica∣ments by their immoderate heat, may cause the same.

If blackness proceed from pu∣trefaction, which you may discern

by the strong scent of the Sanies flowing from the wounded part, then use these Medicaments which follow: ℞ Aq. vitae ℥ i ss. Syrup. Absrnth. & Mel. Ros. an. ʒ lj. Ʋnguent. Aegypt. ʒ ij. Sarco∣coll. Myrrh. Alees an ʒ j. Vini albi potent. ℥ j ss. bulliant om∣nia leniter, colentur, ac serven∣tur ad usum. It. ℞ aq. Plantag. ℥ j. unguent Aegyptiac. ʒ i ss. praecip. Mertur. ℈ i. Mise. applicetur istud Medicamentum calefactum post agitationem. If by these means the putrefaction cease not, but persevere, and the Tumor in∣crease and grow above the hole of the Scull being immoveable, black, and dry; If the Eies of the Patient appear of a fiery co∣lour, bunch out, and be still mo∣ving; if the party still tosseth and tumbleth himself in his Bed, and rave, the sick person will die, and the sooner if these Symptomes con∣tinue constant and uniform. This must of necessity ensue, both by reason of the. extinction of the natural heat, and likewise the Gan∣grene of a noble part: Vide Fallop. loc. cit. c. 41. & Par. lib. 9. c. 21.

The Pia mater is very thin, and cleaves so fast to the Brain, that it cannot be wounded, unless the Brain also be offended. Wherefore such Wounds for the most part are deadly; for the Brain being laid open unto the Air, easily is corrupted, by reason of the ex∣ternal cold, which extinguishes the weak heat of the Brain, and by reason of the moisture which both falls upon the Brain, and is gathered in the substance of the Brain it self, by reason of its weak∣ness.

First then, if any memorable flux of Blood happen by reason of the multitude of Veins which are in the Pia mater, it is to be staied with Galen's Medicaments set down by him. 5. Method. cap. 4. whereof I have spoken heretofore. Then the part is to be cured with Medicaments warming and drying, which I have sot down in the cure of the Dura mater wounded.

Now Wounds which happen in the parts contained in the Head, are to be handled: These are two, Cerebrum and Cerebellum. To the Brain these griefs may happen; a Wound, Apostemation, Putrefa∣ction, Sideration, a Concussion, a Fangus, and a Tumor by reason of Flatuosity.

Now as concerning Wounds of the Cerebrum, or Brain, these five points may be demanded: First, which are the signs of the Brain wounded? Secondly, what Sym∣ptoms do ensue? Thirdly, whe∣ther Wounds of the Brain be cu∣rable or no? Fourthly, how they are to be dressed? Fifthly, what Symptomes usually remain after that a Wound of the Brain is cu∣red? Of these I will speak in order.

As concerning the First, the signs of the Brain wounded, are these which follow: First, a Fever, and vomiting of Choler. Hippoc. Aphor. lib. 6.50. saith, if any have the Brain wounded, they must have a Fever, and vomiting of Choler. The same he repeats, Coac. praenot. 500. & 507. This same Celsus de∣livereth in most cloquent words lib. 8. cap. 4. Secondly, loss of Speech. Hippoc. Sect. 7. Aphor. 58. They who have suffered a vehe∣ment Concussion of the Brain, im∣mediately

become dumb. Thirdly, a fall and slumbering. Coac. prae∣not. 499. Fourthly, Sensleiness, dimness of the Sight, Giddiness. 2. Prorrhet. & lib. de vulner. cap. Fernel. lib. 7. Pathol. c. 8. hath these words: If the substance of the Brain be hurt, the Reason be∣comes weak, and all Symptomes increase, and oftentimes a portion of the Brain comes out, not with∣out danger of life. Fifthly, you shall pronounce the Brain to be wounded, if the Meninges be∣ing divided, a substance like to fat come out; which not withstanding doth neither swim above the Wa∣ter, neither doth melt with the Fire, as fat doth. See Parey lib. 9. cap. 22. Sixthly, if the Bram be hurt, the Quittour will be thick, round, and like a Marrowy substance.

As concerning the Symptomes which ensue, the Brain being wounded, these are they; Foam∣ing at the Mouth, Darkness of the Sight, Giddiness, a Convulsion, a Fever, Vomiting of Choler, Stu∣pidity, Loss of Reason, Deasness, Dumness, a Palsie, a Lethargy, and last of all, an Apoplexy.

As for the third demand, all wounds of the Brain are dange∣rous at the least, and that for these reasons. The First is the Noble∣ness of the part, and the necessa∣ry use of the Functions of it. The Second is Motion of the Brain; but a wounded part requireth Rest, if it be to be cured. Hip. l. de Ʋl∣cerib. circa principium. The Third is the Humidity of the Brain; but the cure of Ulcers and Wounds is performed by Exsic∣cation, according to Galen, lib. 4. Meth. Med. c. 5. The Fourth is the Coldness of the Brain, which engendreth many Excrements, and the more when a wound happens which weakneth the part. The Fifth is the Consent of the Nerves which spring from thence. The Sixth, because Remedies pass not readily to the Brain wounded. Three causes may be alledged, why some per∣sons escape sometimes, having re∣ceived great wounds in the Brain. The First is, the wholsome and strong Constitution of the Body. The Second is, the artificial dres∣sing of the Wound. For as sun∣dry recover of great Wounds, if they be dressed according to Art; so many die of small Wounds, if they be negligently or ignorantly dressed. Thirdly, such strange events are to be ascribed to the providence and mercy of the Al∣mighty God, who of his infinite Goodness by his secret Judgment prolongeth the lives of some, as he shortneth the days of others.

Although all wounds of the Brain be dangerous, for the reasons which I have alledged, yet great and dangerous Wounds have been cured. That this assertion is true, I will prove by the Testimonies and Experiments of famous Wri∣ters, both Ancient and Modern. Amongst the Ancients, Galen shall be the Ring-leader: He then writing upon the 18th. Aphorism of the 6th Book of Hippocrates, affirms that he saw one healed who had a remarkable wound in the Brain, in Smyrna of Ionia, while his Master Pelops was alive; he affirms this indeed to be very rare, l. 10. de usu part. He makes mention in like manner, of a young Man, who recovered when he had

received a wound in one of the fore Ventricles of the Brain. Pau∣lus Aeginaet lib. 6. c. 88. affirms, that sundry have escaped death, and have recovered their health, when they have been wounded in some principal part, above all expectati∣on. Christophorus à Vega, Comment. in Aph. 15. lib. 6. Hippocratis, hath these words;

Wounds of the Brain, if they reach to the Ventri∣cles, they are not cured; but we have seen many others cured, which passed to the substance of the Brain, and out of which some portion of the Brain came out.

Herat. Augenius l. 9. Epist. 2. writes thus;

We saw once the whole substance of the Brain wounded, and the Ventricles cut asunder, and that a portion of the Brain came out of the wound as soon as it was made, and that notwithstanding the party was cured.

The cause of this event was the strength of the Body Gem. ma l. 1. c. 6. Cosmog. saith, It greatly concerns Physicians to note, that even weak persons sometimes escape of grievous diseases, where∣in the signs threaten imminent danger. So lately, an ordinary person was by our help healed, when as a shiver of the Scull pas∣sed through the Meninges, and some of the substance of the Brain came out. Joan. Andreas à cruce, l. 1. Chirurg. c. 14. a Venetian af∣firms, that he cured sundry whose Brains were wounded, and names sundry witnesses. Fallop. c. 45. de curatione vulnerum c. hath these words:

A great portion of the Brain may come out, and yet life remain: Wherefore forsake not the wounded persons, for I my self have made trial of strange things.

Carpus tracta∣tu de fracturâ cranii affirms, that he saw six persons who recovered, when as a notable quantity of the Brain came out of the wounds, and that They only deny such good events who have seen but a little. Brasavola in comment. ad Apher. 18. l. 6. Hippocratis, affirms, that he saw two who escaped after that their Brain was wounded. Nicol. Mass. com. 2. Epist. 11. hath these words:

I take God to witness, and many yet alive can witness, that I have cured sundry by con∣venient Medicaments and Art, whose Sculls, Membranes, and Brains have been wounded,

and immediately he nameth sundry. Theedoricus lib. 2. cap. 2. Chirur∣giae, affirms boldly, that he was as sure that wounds of the Membranes, the substance of the Brain and Ventricles may be cured, as he was of death. Volober. Coit. lib. Observ. Anatom. & Chirurgiear. brings sundry instances that wounds of the Brain may be cured. The like hath Iacotius Comment. ad Apher. 3 lib. 1 Sect. 3. coac. Hippocrat. Peruse also Arcaeus lib. 1. cap. 6. who doth alledge four examples of this truth; And Ambrose Parey, lib. 9. cap. 22. alledgeth some. And, Gulielmus Fabricius Observ. Chirurg. Cent. Observ. 13. sets down four. The Testimonies and Experiences of so many famous Authors may perswade any man, not contentious, that wounds of the Brain sometimes have been, and yet may be cured, or else none will.

Seeing I have laboured to per∣swade you, that the wounds di∣viding

the substance of the Brain it self, may be cured; I think my self bound to acquaint you with the means, by which so dange∣rous a Cure is performed; which was the fourth point which I set down to be discussed concerning wounds of the Brain. Joan. Andreas à cruce Chirug. l. 1. c. 14. Until the 14th day be past, he will have Oil of Turpentine, and Spirit of Wine to be applied: then he will have the Wound to be filled with this Liquor following: ℞ Vim Montan. ℥ xx. sucet Beton. ℥ iiij. sucei Calaminth. ℥ ij. Myrrh. Oli∣ban. Aloes, Sang. Dracon. Centaur. min••r. Semin. Hyperic. an. ʒ j. con∣umdead. contusis, macerentur om∣tia in vase probè occluso: tum lento et claro igne exhalet tertra pars, ac¦coletur decoclum, cui admisce spir. Vici. ℥ vj. Ol. Terebinth. ℥ iiij. Reponatur Medicamentum in vase ••trco probè obturato. Above this Liquor apply Pu••is Cephalicus, and cover all with some fit Em∣plaster, Coiter. l. Observ. Anatomic. & Chirurg. counselleth to foment the Brain with a convenient De∣coction: such an one is this which is made of Betony, Calamint, St. Johns-wort, Chamaemil, Dill, Eye∣bright, &c. boiled in red astrin∣gent Wine. The Wound he will have to be dressed either with the natural, or some good artificial Balsame, whereof I have spoken sufficiently before. Fall. Comm. in Hipp. de vuln. cap. c. 45. will have Oil of Roses mingled with Oil of Turpentine to be pou∣red into the Wound; and that not without cause, for the Oil of Roses is Anodyne, and the Oil of Turpentine warms and dries. This Medicament he will have to be ap∣plied until the 7th day be expired; about which time most commonly appears a sequestration of the cor∣rupt portion of the Brain from the sound. If the substance of the Brain, it being wounded, seem to be of a livid colour, and a stink∣ing Sanies flow from the Wound, then those Medicaments which are dry and warm, are to be applied, such is this which follows: ℞ Mel. Ros. & Ol. Ros. an. ℥ j. Aq. vit. ℥ ij. Misc. When the Wound yields a laudable Quittour, then the Oil of Roses is to be admitted, and only Mel. Resar. or Srrupus Myitinus, or Syrupus è Ros. Rub. siccatis, mingled with Aqua vitae, are to be used. As it is an evil sign if the substance of the Brain be of a livid colour; so if the portion which must be separate, represent whitish Hailstone, and have not a very stinking smell, it sheweth that Nature is strong. Huron. Fab. ab aq. pend. part. 2. Claring. oper. lib. 2. c. 20. delivers this Medica∣ment as an experiment of his own: ℞ Farin. Milii ℥ ss. Ol. Hispani ℥ j. Mithridat. ℥ vj. Balsami ni∣gri navalis ʒ iij. Aq. vit. ʒ v. Ol. de Chalcantho ʒ i ss. Misc. This is undoubtedly a good local Medi∣cament, because the ingredients powerfully dry and resist putrefa∣ction.

This Medicament I dare com∣mend unto you: ℞ Balsami ni∣g••i, Vernicis alb. & Ol. Hyperic. ••••bicundi facti ex mnltiplici infu∣sione florum Hyperici an. ℥ ss. Misce. This Topick will warm, dry, resist putrefaction, and hin∣der the entring of the Air.

Now the fifth point concerning

wounds of the Brain is to be touched, which is to shew what Symptomes remain most common∣ly after that a wound of the Brain is cured. These then are they; The faltring in Speech, and a Pal∣sey in the Arms. Joan. Andr. â Cruce Chirurg. lib. 1. c. 14. Deaf∣ness, Par. lib. 9. c. 22. Decay of Memory, Stupidity, and a weak judgment. Coiter. lib. Observ. Ana∣tom. & Chirurg. Et Fallop. lib. praedict. cap. 45. Brassavol. ad Aph. 18. lib. 6. Aphor. Hippoc. The yel∣low Jaundice. Ar. lib. 1. c. 6.

The Second inconvenience which doth happen unto the Brain, is an Apostemation. That this may happen, these under-written Au∣thors do affirm; Valeriol. lib. 3. Observ. 8. Coiter. in Observ. Ana∣tom. in Chirurgicis. Fernel de lue Vener. c. 7. Par. lib. 9. c. 8. And although most Authors do pro∣nounce this event to be desperate; yet Arcaeus lib. c. cap. 6. relates of one, upon whose Head a stone of a Cubit in breadth and length, and in thickness twelve Inches, but in weight four and twenty lb. fell from the Engine, as it was hoisted up to the building of a Tower in Valverda, and bruised, depressed and shivered the Scull: when this Patient had lain desperate seven dales, the eighth day three Apo∣stemes brake out, and within the space of four Months the party was perfectly cured, and afterward was married, for then he was but a young Man.

Putrefaction and Sideration are deadly Symptomes, which are not discerned but by opening of the Scull, and that for the most part when the party is dead.

The first accident which hap∣pens to the Brain is a Concussion or a commotion of the Brain: If it be vehement, it is alwaies dan∣gerous, and sometimes deadly: If the commotion be violent, the party becomes speechless, accord∣ing to Hip. lib. 7. Aphor. 58. where he saith; They who have suffered a strong Concussion of the Brain, must of necessity become dumb: read Galen in his Commen∣tary upon this Aphorism. It is no other way to be dressed than a Fracture, when the Cutis Muscu∣losa is whole. Guliel. Fab. Obs. Chi. rurg. Cent. 1. Observ. 7. in this case anoint the whole Scalp with Oil of Roses and Myrtils mingled together: open a Vein in the Arm, and inject sharp Clysters. After that a Concussion is cured, sometimes impediment of Speech, and Forgetfulness, may remain during the residue of Life, as wit∣nesseth Parey, l. 9. c. 22. He will have Blood to be drawn plentifully out of the Cephalica vena, accord∣ing to the strength of the wound∣ed party, to asswage the Symptoms present, and to prevent the coming of more grievous. The Head he will have to be shaved: then he adviseth to apply a Cataplasm made of things cold and moist, as a Ca∣taplasm of Barley-flower, Oil of Roses and Oxymel. Those Medi∣caments which are very astringent, as Ʋnguentum de Bolo, &c. are not to be applied, because they hinder the breathing of the fuligi∣nous vapours thorow the Sutures, and other places of the Scull; and so they are so far from hindring of an Inflammation, as that they in∣crease it, if it hath seized upon the

part already, and bring one, if there be none: sharp Clysters he will have too injected to draw sharp Vapots from the Head, and to binder the ascent of them to the same, and the Vein of the Fore∣head, and those which are under the Tongue, to be opened after the second day, if Blood abound. He adviseth that strong Frictions be used downwards, and that Cup∣ping-glasses be applied to the Shoulders. He will have the cool∣ing and moistning astringent Me∣dicaments to be used; of which Medicaments I have set down sun∣dry forms oftentimes heretofore. If you apply discutient Fomenta∣tions, then see that you heat not the Head too much, lest you cause Pain and Inflammation.

The fifth inconvenience which may happen after that there is a Solution of Unity in the Brain, is a Fungus, or the Mushrome of the Brain.

This is a Tumor sometimes hard, without Blood, and of small sense; sometimes soft, of an ex∣quisite sense, and of an ill smell, beneath narrow, and above broad, a kind of a malign wart growing of the glutinous and thick Hu∣mors which are half rotten, con∣gealed in the part, partly by rea∣son of the Air, partly by reason of the coldness of the Scull, the Scull being opened, and the Brain wounded: even as Mushromes grow upon Trees by a Juice which doth sweat through the Bark, Ga∣len, lib. 1. de loc. affectis, doth make mention of this Symptom; & lib. 3. Ep. saith, that those Excrescences which grow in Wounds, and are called Fungi, are caused by the thickness of the Humor issuing from the affected parts.

Although it fall off of it self sometimes, which Coiter. lib. Ob∣serv. Anatom. & Chirurg. affirms that he saw the Flesh growing un∣der it, depriving it of nourish∣ment, yet if it increase, as it of∣ten doth, even to the bigness of an Hens Egg in one Night, as hap∣pened to Guliel. Fabric. as he wit∣nesseth, Observ. Chirurg. Cent. 1. Observ. 15. you must go about to remove it with Medicaments, which strongly dry, and mildly fret; such are the Powder of Savin, Ocre, Hermodactyls burned, the Juice of Purselain; Powder of yel∣low Turbith, warily applied, sur∣passeth all these. If it grow a∣bove the Cranium about the big∣ness of an Hen-egg, then with a strong Ligature you are to bind it, to procure the fall of it; then that which remains is to be con∣sumed with the means above spe∣cified. Beware that you use no strong Cathaeretical means. See Par. lib. 9. c. 19. Gulielm. Fa∣bric. cured the Fungus, which happened to his Patient, within the space of fourteen days, with a Fomentation, and a Powder. The description of the Fomentation is this: ℞ Flor. & Folior. Beton. Salv. Chamaemil. Melilet. Aneth••, Ros. fol. Major. Rorisinar. an man. ••. semin. Anis. & Faenugr. an. ℥ j. coq. ista lento igne in aq. font. & vini rub. astringent. an. lb iv. ad consumptionem lb iv. deinde cole∣tur decoctum. The description of the Powder is this: ℞ Rad. Ca∣ryophyllat. Angel. Calam. aromat. an. ʒss. rad. Aristol. rotund. Irid.

Guajaci. an. ʒ ij. Salv. Rorismar. Major. an. ʒ ss. fiat ex omnibus pulvis.

The seventh and last Accident which happens when the Brain is offended, and the Scull fractured, is a flatuous Tumor. Of it Gu∣liel. Fabricius in the place afore∣named so discoursed: A Tumor may be caused like to a Fungus of flatuosity. If the weak heat of the Brain go about to concoct the Matter in and about the Wound, it doth raise up flatuosity, and see∣ing it can breath out through the Pia Mater, it doth puff it up; For, I observed (saith he) that in all those in whose Wounds a Fungus grew, that the Pia Mater was whole, and only the Dura Mater torn; for when the Dura Mater is divided, Nature out of hand goeth about to engender Flesh up∣on the Pia Mater, to defend it from the Air: wherefore, if super∣fluous Humors and Flatuosities ga∣ther about the Wound, they lift up the Pia Mater and this Flesh, so that a Tumor like to a Fungus is caused: so he.

If you demand how it is to be cured? I answer, that the Fo∣mentation and Powder, set down by him to cure a Fungus, will serve.

Now to put an end to my Dis∣course, concerning Wounds of the Hairy Scalp, seeing I have made mention of sundry Symptoms which ensue upon them; I will set down the Causes of the chiefest of them, and so conclude.

Of these, the first is a Fall; this hath two Causes: The first is the violence of the Instruments which do wound: The second is the privation of the faculty of moving, with the which Instru∣ments of moving ought to be en∣dowed.

The second Symptom is a Ver∣tigo, or giddiness: this proceeds from the Circulation, or Circum∣volution of the animal Spirits; so when the Clouds are driven, the Sun and Moon seem to move swiftly.

The third is dimness of Sight: the cause of this also is the dissipa∣tion of the animal Spirits.

The fourth is Slumbring: the cause of this also is the dissipation of the animal Spirits; but it must be both greater, and more durable than in dimness.

The fifth is Vomiting: this is caused by the communion of Ves∣sels; for the Brain being troubled, the affection is communicated by the Nerves of the sixth Conjugation, which proceeding from the Brain, are dispersed through the whole Body of the Stomach. So the offence being communicated to the Stomach, it is drawn inward and pursed, and turned upwards: from this Inversion of the Stomach; first, those things which are con∣tained in the capacity of it are re∣jected by vomiting; then those Humors which are drawn from the Liver and the Cystis Fellis; and seeing Choler is most light, it offers it self first, and is first ex∣pelled.

The sixth is a Fever; this is caused by an Inflammation, which hath seised upon the wounded part. This being communicated to the Heart by the connexion of the Arteries, it is sent from thence

to the whole Body by the same Vessels.

The seventh is Torpor, or Stu∣pidity; this is caused of ill Vapors, which by reason of Putrefaction, or some other ill quality, assault the Brain, and dissipate the animal Spirits.

The eighth is a Convulsion: this is caused of corrupt Vapors, which nip the beginning of the Nerves, which either a putrid or malign Matter hath sent out: in this case the Neck, and the whole Spinalis Medulla, is to be anoint∣ed with a convenient Medica∣ment, such as this: ℞ Rut. Mar∣rub. Rerismar. Ebuli, Salviae, herbae Paralysis an. man. ss. Rad. Irid. Cyper. Baccar. Lauri an. ʒ j. flor. Chamaemel. Meliloti & Hyper. an. pug. 1. Macerentur haec per noctem in vini potentis, lib. vj. deinde coq. cum Ol. Lil. albor. Lumbricor. & Terebinthin. axung. anser. & hu∣man. an. ℥ iij. ad consumptionem vini, igne lento, postea instituatur colatura, cui adde Terebinthinae Venetae ℥ iij. aq. vit. ℥ j. cerae flavae ℥ ij.

The ninth is a Palsie; this hap∣pens, when as by a Matter kept in the part offended, the Brain and the beginning of the Nerves are so affected, that all motion is taken away.

CHAP. XXIV.

Of the cure of Wounds of the Face.

HAving, delivered unto you, with what diligence I could, the Cure of the Hairy Scalp. Now I am to shew you, how Wounds happening in the parts, which are not so garnished with Hair are to be cured. These are two, to wit, the Face, and the Instruments of the Senses: By the Face I mean Skin, Membranes, Muscles, and Vessels of the fore and lateral parts of the Head.

And although that might suf∣fice for the curing of Wounds of the Face, which I delivered in the documents concerning the curing of simple Wounds: yet because the Face hath two prerogatives above all other, which are not more principal than it self; it will not be amiss to speak some∣what of the Wounds of it in par∣ticular.

For the Face, first of all, is the seat of Comeliness and Beauty. Se∣condly, it is the surest mark by which one is discerned from ano∣ther. Seeing then the Face doth afford unto the beholders of it such contentments, you ought to have a special care that you leave no foul cicatrix. after the cure of the

Wounds of it, if you be called to cure them.

Wounds of the Face are two-fold; for in them either the soft parts only are wounded, or the Bones also. If the soft parts only be wounded, then they are wound∣ed either according to the length, and the rectitude of the Fibrae of the Muscles and Skin, or they are wounded transversly.

If the Wound of the Face be according to the longitude, the brims of it are to be brought to∣gether by a convenient ligature, and glutinative Medicaments, re∣fraining from stitching with Nee∣dles, for when we use Needles, new Solutions of Unity are procured, and so new Scars, and the Thread doth transversly cut the Skin, and causeth an ill favoured Cicatrix, if it be not speedily taken away; besides pain is caused.

As for rolling, the Roller must not be broad, but narrow, and with two ends, that by sundry cir∣cumvolutions, it may the bet∣ter bring the brims of the Wound together.

As for glutinative Medicaments, or dry stitching, as they are term∣ed. I will commend unto you two.

The first is an Emplaster, the description of it is this: ℞ Colo∣phen. Pic. Naval. & Cerae an. ℥ ij. T••reboith. ℥iss. Mastich. Thur. farin. volat. cale. vivae an. ʒ ij. fine emplastrum secundum ar∣tem.

The second is a Powder, and it is this: ℞ Thur. Mastich. Bol. Armen. Sang. Dracon. Colophon. cale. viv. Alum. far. volat. an. ℥ss. fiat ex omnibus pulvis subtilis. This Powder is to be mingled with the white of an Egg, until it be brought to the consistence of Ho∣ny, and so to be applied.

One thing is be noted, that the Hem of the Cloath, upon which these Medicaments are spred, be applied towards the brims, and the raveled portion to the places distant from the Brims. If the soft parts be transversly incised, and the Wound be long, the brime must gape being far distant asun∣der. In this case you must use stitching with Needles to bring them close together.

In stitching you are to observe these four cautions: the first, that they be as thin as may be: the se∣cond is, that the Thread be rather of Flax than Silk, but smooth, and waxed, that it cut not; the third is, that the Needles be as small as may be, and either of Silver or of Steel distempered, which you may do by holding of them in the flame of a Candle: the fourth is, that when the brims of the Wound do abide together, and the Swelling and Inflammation of the brims are gone, we remove these stitches, and apply the dry stitches, which will fall out the third or fourth day: this you are to do to prevent ill favoured Scare. If the transverse Wound be not long, convenient rolling and dry stitching will serve; for the bringing and keeping of the brims together.

When you go about to cure such Wounds, apply not Powders; for when the brims are brought together, some small distance must of necessity be left, which

most be filled with Flesh: If you then apply Powders which are loth actually, and in faculty dry∣ing, the incarnation will be hin∣dred, the Powders drying both ••o much and too soon, and so the Scar will be unequal being lower than the rest of the Skin.

Wherefore for the agglutination of such Wounds, apply Medica∣ments which in consistence are soft and moist; but in faculty drying; for by Application of such Medi∣caments, Nature hath time equal∣ly to agglutinate the brims, and the Cicatrix will be more fair: which is that you ought to aim at i•• the curing of the Wounds of the ••ace.

Such are Arcaeus his Liniment: The Spanish Balsam, Oyl of Hy∣pericum, having some Turpentine or Vernice mingled with it, and tie natural black Balsam. In the Winter time use the stictick Em∣plaster, but in summer Diapalma, or Emplastrum de minio. If they be too hard, malax them with some of the Oyl of Hypericum. Frocure skinning after agglutina∣ton, with Ʋnguentum de Tutia, de cerussa, aut de bolo Armeno, or eratum griseum.

When the skinning is almost in∣duced, anoint the part with Mans grease: for it procureth by a pe∣culiar faculty a fair Scar. See Aq. pend. part. 2. lib. 2. c. 21.

Now if a Wound be received in the Face, wherewith both the soft Farts and the Bones are incised; we must in this case have a greater care of the security of the wound∣ed person, than of the beauty of the Face. In this case no kind of s••tching hath place, if the Wound be large, and the offence of the Bone great. For the Bone must be smoothed with Raspatories, and the Wound be kept open while the Bone scale, and the part be incar∣nate, even as hath been taught in Wounds of the Halry Scalp, where∣in there is a Fracture of the Scull, I will repeat nothing, because I am unwilling to lose any time.

If any enormous Wound fall out, whereby there is a Solution of Unity in the Jaw-bones, as hap∣pened to Arcaeus in one, whose upper Jaw fell upon the Chin: in this case all parts are to be re∣duced to their own posture, so that Bones answer to Bones, and the soft parts answer the soft; then the parts are to be kept in their natural position, with all manner of stitching, and convenient deli∣gation. Read the Authors in the Book, cap. 7. I have acquainted you with the Methodical manner of dressing such Wounds before; so that now in this case I will be silent.

So much I have thought good to deliver unto you, concerning the Cure of Wounds of the Face in ge∣neral. Now it remains, that I brief∣ly discourse of the Wounds of the Eye-Brows, and Eye-lids, and Lips, before I handle the Wounds which cause Solution of Unity in the In∣struments of the Senses.

Ʋulnus Supercilii, a Wound of the Eye-brow, is either caused by a simple Incision only, or by In∣cision with the loss of some of the substance of the part. If it be by simple Incision only, it is either ac∣cording to the longitude or lati∣tude of the Fibrae, or tranverse.

If the Wound be caused by sim∣ple Incision according to the length, without loss of substance, you may use the Cephalick Pow∣ders, and such as are astringent and drying, having no sharpness to ha∣sten the unition, and procure skin∣ning; for in this case you need not fear an ugly Scar, for the part is decked and covered with Hair.

If the Wound of the Eye-brows be transverse without loss of sub∣stance, then you must have a care that such a Wound be exactly ag∣glutinate: and that the brims of the conjunction exquisitely answer one another: for if these Cautions be neglected, the wounded party shall not be able to lift up the Eye-lid, unless he use the aid of his Fingers, and the Eye shall still re∣main shut. In this case then, you must take deep stitches, and so ma∣ny as shall seem fit. The brims having been thus joyned together, procure agglutination with such Medicaments as are able to reunite the parts severed.

If a Wound of the Eye-brow have caused a loss of Substance: then you must not hasten the con∣solidation of such a Wound: for if you do, the Scar will become so hard, that the Muscle shall pull up too much the Eye-lids, and so the whole Eye shall not be co∣vered. In this case then you are to use such sarcotical Medicaments as are soft in consistence, as artifici∣al Balsom, of which I have spoken sufficiently before.

If this inconvenience happen, that by reason of the hard Cica∣trix, the Eye-lid cannot wholly be pulled down to cover the Eye; then you are to divide the Cica∣trix by a semicircular, or half-moon-like Incision, according to the orbicular proceeding of the Fi∣brae of the Muscle of the Eye, which pulls down the Palpebra.

Neither need you fear to make such a half-moon-like Incision, al∣though it come near to a trans∣verse Incision: for this Muscle lieth within the Orbit of the Eye, near to the Muscles which move the Eye, and so it cannot be hurt by such an Incision; for the Incision must not reach to the internal Tunicle of the Eye-lid; but only divide the Cicatrix and the round Muscle, which motion is not ta∣ken away by such a half-moon In∣cision.

Spigelius, lib. 4. cap. 5. will have two Muscles to shut each Eye-lid, and to be of a semicircular Fi∣gure: the one is seated in the up∣per Eye-lid, and draweth it down, and is called the bigger: the se∣cond and lesser is seated in the low∣er Eye-lid, and pulleth it only up∣ward. The upper Ely-lid is drawn up by the Muscle which proceeds from the upper part of the Fro••s, or Forehead, near to the tempo∣ral Muscle, where the Hairy Scalp ends. It goes directly down, and is inserted into the Eye-brow. This Muscle then being transversly cut asunder, the Eye-lid can hardly be pulled up, unless it be artificially united.

Wounds of the Eye-lids are ei∣ther streight or transverse: Those are streight which reach from one corner of the Eye to the other: because this is the position of the Fibrae of the semicircular Muscles of the Eye, although they may seem transverse, if you behold only

the Figure of the Face. Trans∣verse I call those which reach streight down from the Eye-brow, or supercilium, towards the cavity of the Eye. These Wounds either divide the outward Skin and Muscles only, or they cause a So∣••••tion of Unity in the internal Membrane of the Eye also.

If the Wound hath only divided the external Skin, and the semi∣circular Muscle: you may use stitching, but then the Needle and Thread must be very small, and the Thread well waxed. Agglu∣faction is to be procured by in∣spersion of sarcotical and drying Powders, as Bolus Orientalis, Terra spillata, sargias Draconis, Sarco∣••lla, &c. Thus you may mix them: ℞ Bol. Orient. & Terrae sgllat, an. ʒ ij. sang. Dracon. Sar∣croll. an. ʒ j. siat ex omnibus p••••∣••••s subtilis.

Above the Powders apply a piece of a soft linnen Cloth, that it but not the Eye by its hardness, moistned with the White of an ••••g, which both hinders Inflam∣mation, and staies the Powder. A∣bove this apply Boulsters, moistned with Plantain Water, and red Wine mingled together. Last of all roll up the Eye.

If occasion move you to apply to the adjacent parts Oyl of Roses, or any other, then you are to have a care, that no part of the Oyl fall into the Eye; for Oyls do hurt the Eyes, and cause In∣flammation.

If the Wound cause a Solution of Unity in the internal Membrane of the Eye-lid, which immediately doth cover the Eye, you are to stitch this. For if the Thread should touch the Body of the Eye, it would offend it, and procure an Inflammation. In this case then, a dry stitch is most con∣venient.

Wounds of the Lips either cut asunder only the Skin of the musculous Parts, or the Mem∣brane also which internally cover∣eth the Mouth. If the Skin and the musculous Parts be only cut a∣sunder, then ordinary stitching will serve the turn, and the application of such Medicaments as unite Wounds inflicted in other parts of the Body.

If the whole substance of the Lip be separate, and gape; then you are to dress such a Wound, as a Hair-lip, when as the brims are made raw.

First then, you are to pierce both the brims of the Wound with a Needle, or a Pin, having on each side a thin and small piece of Lead: Through both these pieces of Lead, the Needle or Pin must pass, then the Thread is to be twisted about both the ends of the Needle or Pin.

Last of all, the point of the Needle or Pin is to be nipt off, that it hurt not, with a pair of small steel Nippers well hardned. The Leads suffer not the Needle or Pin, to break through the brims of the Wound: you must take this stitch somewhat deep, and a∣bout the middle of the Wound, that the brims may be the more surely kept together. Two ordi∣nary stitches more will serve, one above the Needle or Pin, the other below.

The Pin you may take out the fourth, fifth, or sixth day, as you shall

see the parts united. If you have Children in hand, it is not amiss to joyn to these the dry stitch, be∣cause they are unruly, and by their crying cause often the stitches to break.

The Medicaments Topical which procure consolidation in these Wounds, are these: The black na∣tural Balsam, and not the yellow; In Winter you may use it alone, but in the Summer tempered with a little of the Yolk of an Egg. The Oyl of Hypericum, or Spa∣nish Oyl mingled either with some Cyprian Turpentine, or the white Joyners Vernice, are excellent. When all parts are agglutinate, then you are to remove all the rest of the stitches, and to procure a comely Cicatrix by anointing the parts, wherein there was Soluti∣on of Unity, with Mans grease (as hath been said) if the wound∣ed parties be Girls or Women: In Boys and Men, because one may have, the other hath Hairs to cover the deformity of the Ci∣catrix, you need not to be so scru∣pulous.

CHAP. XXV.

Of the cure of Wounds which happen to the Instru∣ments of the Senses.

IT is time now to come to those Wounds which offend the Instru∣ments of the Senses; and seeing the Sense of Seeing of all other is most admirable and noble, the Wounds of the Eye which is the Instrument of it, must first be handled: for it apprehends more excellent Ob∣jects, more in number, and of a greater variety, with a greater cele∣rity, than any of the rest of the Senses doth, and in a farther di∣stance. It is necessary for all living Creatures to espy and prevent Dan∣gers and Enemies. Besides this, the eternal felicity of reasonable Creatures shall proceed from the intuitive knowledge of the Sacred Trinity.

As concerning Wounds of the Eye, two points offer themselves to be discussed. First, the dif∣ficulty of the cure of such Wounds. Secondly, the cure it self.

Five things make the Wounds of the Eye of a hard Cure. 1. Is the excellency of the part it self. 2. Is the exquisite sense of it. 3. The consent which it hath with the Brain: which you may easily gather; if either you respect the Optick Nerve, or the Motory, or the Muscles of the Bye, which have

many twigs of the Nerves com∣municate from the first, second, third, and eighth pair of Nerves. Fourthly, the flux of Humors, which promptly falls into the Eye after it is wounded. Fifthly, the continual motion of the Arte∣••les.

In the cure of these Wounds too points are to be delivered. First, the differences of them. Se∣condly, the artificial dressing of them.

As for the differences of them, Wounds of the Eye are either Su∣perficial or Deep. Superficial I from such as pass not through the C••nea: But deep, such as pass strough the Cornea.

In the cure of Wounds of the Eye, these two points are to be diserved in general: First, that you abstain from all Oyls, and fat things, for they inflame the Eye, and cause Pain. Secondly, that ••hen one Eye only is wounded, you roll them up both; First, that the sound Eye may be kept from motion. Secondly, that dark∣ness may every way be procured; for light offends all fore Eyes: Thirdly, that the Cure may be more easie; for when one Eye moves, the other of a necessity must move, and so the wounded Eye being moved at the motion of the sound Eye uncovered, the Cure will be hindred: for Motion causes Inflammation, and protracts Healing. The third is, that the Head lie somewhat high, not lending forwards: let the Pillow be of Turky Leather, filled with Chiff.

To cure a superficial Wound of the Eye, three intentions are re∣quired: First, to prevent all In∣flammation and flux of Humors into the Eye. Secondly, to mi∣tigate pain. Thirdly, to unite the parts separate.

To asswage pain, and repel the ••fflux of Humors, use these things following: Ovi Candidum, aq. Spermatis ran••rum, 〈◊〉〈◊〉 Plantagi Portulac. pluvialis, 〈◊〉〈◊〉, Mucilag. semin. Cydon. Psyllii, Tragaranth. Papaver, hyoscyam. decoct. nuc. Cu∣••ressi, Gallarum, Balaust. Malicor. V••num Granator. Lac. Muliebre, Sarguis Turturum & Pullor. Co∣••••••••ar. ex venis sub alis elicitus. Of these you may have sundry com∣positions unto your selves, as need shall require.

In this case it will suffice to ap∣ply these Medicaments above the Eye-lid, the Eye being shut, un∣less Qulttour abound, and the Eye run much: for the Skin of the Eye lid, the Muscle, and the in∣ternal Membrane, are thin; so that the Medicament may easily pene∣trate. Besides, some will pass be∣tween the Eye-lids. If the former Accidents happen, wash the Eye with Rain or Plantain-Water, wherein a little Alume, or white Vitriol hath been dissolved: then apply Boulsters made of old fine linnen Cloth, because it is softest, moistned in some of the Waters, wherein some of Stef album sine Opto hath been dissolved. If pain urge, use that which hath Opium in it.

To the Forehead, Temples and Cheeks apply some anodyne and astringent Cataplasm: such is this which follows: ℞ Pulp. Pomor. sub Cinertb. coctor. ℥ ij. flor. Cass. extract. ʒ vj. Muccag. semin. Psyl.

Alth. & Cydon. an. ʒ ss. far. Hord. cribrat. Bol. Armen. sang. Dracon. an. ʒ j. Misc. ut paretur cata∣plasma.

One thing is to be noted, that if both the Eye-lid and the Con∣junctiva Tunica of the Eye be wounded, that you have a care that they grow not together, which happens if it be not prevented: You shall hinder this inconveni∣ence, if in tender persons you keep them asunder with some Leaf-Gold, but in other Bodies either with Leaf Gold, or Tin-Foil.

If the Wound be deep, then ei∣ther the Weapon passed through the broad and long Chink about the ends of the Bones of the Or∣bita, through which the Nerves come into the Brain, or it goes not so far.

If the Weapon pass into the Brain, then the Wound is mortal, because by reason of the dissipati∣on of the Spirits, Motion and Re∣spiration are abolished. Never∣theless, he is to be drest, and the Chirurgeon is blameless, because he neither can see the Wound, nor apply any Topical Medicament to the Brain, unless he take out the Eye, which no wise man will at∣tempt, nor can be suffered, in whom the Sense of feeling re∣maineth.

An Example of this I saw in Chester, in a young Gentleman, whose Sirname was Fletcher, who in a Duel being so wounded in the left Eye, died about the four∣teenth day after he received the Wound. He continued well nine days, and the tenth day went to a Play. The eleventh day the left Nostril began to run as if it had been a Still, so that every night and day it wet a Pillow: and so it continued untill he ended this Life.

If the Wound be not so deep, then either the aqueous Humor only issues out, or the others, as the Crystalline and Vitreous also.

If the aqueous Humor come out only, then it cometh out wholly, or in part. If all of it come out, the sight will be lost. If a small quantity only come out, it may be repaired, and chiefly in Chil∣dren, by reason of their moisture, and so the sight remains. This Wound is cured as a superficial Wound.

If the other Humors, as the Vi∣treous and the Crystalline, come out, then the sight must of a ne∣cessity be lost. In the cure of this Wound you are to use sarcotical Powders, but beaten very small, and past through a fine searce, such as Tutia prepared, Calamina∣ris quenched in white Wine, Terra sigillata, sanguis Draconis, Aes u∣stum, Sarcocolla, Sandaracha Grae∣corum, &c. When the Eye is heal∣ed, you may cause an artificial Glass-eye to be set in place of the natural, to avoid defor∣mity.

It falls out sometimes that part of the wounding Instrument sticks in the Eye. If a portion of a wounding Instrument doth stick so fast, that it cannot be pulled out without the effusion of all the Hu∣mors of the Eye, and the pro∣curing of great Inflammation, and that doth not prick the Eye-lids, then it is best to suffer it to remain, and to dress the Wound with ano∣dyne

Medicaments, untill the se∣venth day be past, and then to use agglutinative means. But if the piece cause pain, and a continual weeping, and hurt the Eye-lids, it is to be taken out, and dressed as deep wounds of the Eye. See an Example in Fabric. ab aq. pendent. Chirurg. operat. part. 2. lib. 2. c. 27.

Next to the cure of wounds of the Eye, I will shew how wounds of the Ear, which is the Instru∣ment of Hearing, are to be cured.

The Ear is either wholly cut off from the Temple of the Head, or but in part divided. If it be to∣tally cut off, first of all, it is to be skinned with strong Epulotical Medicaments, as the Cephalick Powder, Ʋnguentum de bolo, de minio, and such like. Then the deformity is to be covered either by wearing a long Lock, or a Cap under the Hat having a side latch. If it be divided but in a part, if the separation be but small, a dry stitch only will serve; but if it be large, a small Needle, and fine Thread must be used, that the part separate may be proportional∣ly brought and kept together. Then strong desiccative Topicks are to be used, because the part it self is for the greatest part Carti∣laginous.

In your stitching you are to ob∣serve two things: First, that the Needle only bring together the parts of the Skin, on each side of the Ear within and without, with∣out wounding the Cartilage; for if this be done, an Inflammation and Gangrene may ensue, as wit∣nesseth, Fabric. ab. aq. pend. oper. Chirurg. part. 2. lib. 2. c. 33. & Par. lib. 9. c. 22.

Secondly, you must observe, that if the Wound reach to the first ca∣vity of the Ear, called Meatus Auditorius, the passage of Hear∣ing, you still keep a Sponge-Tent in it, partly that no spongy flesh grow in it, which might stop it, and so hinder the Hearing; partly that no Quittour fall into it, which might exulcerate the parts internal, and corrupt the Tympanum, and so procure inevitable deafness.

Now I will briefly touch only the cure of Wounds with which the Nose (the Instrument of smell∣ing) may be violated. Wounds then of the Nose may only cause a Solution of Unity in the soft parts, or in the hard parts also.

If a Wound happen in the soft parts of the Nose, a dry stitch will suffice: In these wounds we must, to the uttermost of our endeavour, labour to procure a fair Cicatrix, or Scar: seeing the Nose is the most eminent part of the Face, and but a small Scar will easily be discerned in it: wherefore you are to procure a fair Cicatrix with some Medicaments astringent: such is Ʋnguentum album caphuratum, if it be faithfully dispensed.

If the hard parts be wounded, then this must fall out either in the upper part, and then the Bone must be violated; or in the lower part, and then the Cartilage must be hurt.

Wherefore if a Wound be in∣flicted in the upper part of the Nose, wherein the Bone is cut, then there is a Wound and a Fra∣cture.

In curing of such a Wound, two Indications offer themselves: for, first, the Bones must or∣derly be set; then the consolida∣tion of the Wound is to be pro∣cured.

In placing handsomly the Bones, you must put into the Nose a fit piece of Wood, lapped with soft linnen cloth, which must easily go in to bear up the Bones: then outwardly you are to set the Bones in their best posture with your other hand. This being done, you must put a pipe into the Nose of some light substance, as of the branches of Flder, the pith being taken out, or made of a thin plate of Silver: for the present necessi∣ty you may use a Goose-quill, or a Swans-quill, or a Quill made of a Reed, such as Weavers use. These Quils or Pipes must not be exqui∣sitely round, but somewhat sharp above, and flat below, to preserve the natural figuration of the Nose.

When you use these, you must observe two things: First, that they be tied to the night-cap on each side, that they drop not out: Secondly, that you put them not too far up, lest they cause sneez∣ing, which much hinders the con∣solidation of such Wounds.

These Pipes afford a four-fold use: First, they keep the Bones in their best position: Secondly, they give way to breathing: Thirdly, they discharge the excrements of the Brain: Fourthly, they make way for the sending of the Quit∣tour from the Wound. These pipes must be lapped up in soft linnen Cloth, to hinder the sink∣ing of the consolidating Medica∣ments into the Wound.

The Bones thus set according to Art, you must labour to bring the soft brims of the Wound to∣gether, either by a dry stitch, or with a small needle and thread, according as occasion shall be of∣fered unto you.

This being done, apply a desic∣cative Medicament to the Wound, as Sangais Draconis, and Bole beat to a fine powder, and mingled with the white of an Egg beaten: let the consistence be like to that of Honey.

If such a wound be transverse, First, you must apply to each side of the Nostrils a fine little Boulster of soft, linnen Cloth, moistned in red astringent Wine, and wrong out: then you must stay these Boulsters with a roller; having a hole in the middle to give way to breathing, and to receive the tip of the Nose. This Roller must be sowed to the back part of the Head.

You must have a care of one thing, that it be no straiter than is necessary, for the keeping of the Nose from falling; for if it be too strait, it will procure a Polt-foot-like Nose steering upwards. Hard to the Septum of the Nose apply another very narrow Roller, which bring about to the Neck, as you did the other.

If the lower part of the Nose be deeply wounded, then the Carti∣lage must suffer solution of Uni∣ty; which if it come to pass, then the Cartilage is only divided, or quite out off. If it be only divi∣ded, then Unition is to be proce∣red, a pipe to be used, drying Me∣dicaments to be applied, and the like Rolling to be used, as I set

down in the cure of a wound in the upper part of the Nose, where∣in the Bone is incised. If the Car∣tilage be wholly cut off, then a new Nose is to be framed of the skin of the Arm. Of this Talia∣citius hath written at large, and I will touch this practice in my 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which I made the third part of Chirurgery.

To make an end of this Chapter, I must shew you briefly how wounds of the Tongue the instru∣ment of Tasting are to be cured.

If a portion of the Tongue be altogether cut off, the loss is alto∣gether irreparable: for being once deprived of life, being separate from the rest of the living Parti∣cles, it cannot by any created pow∣er be restored. Our Saviour resto∣red Malchus his Ear cut off by St. Peter; but we know that he was both God and Man, the Lord of Life, able to give it, or to take it from any, according to his good pleasure. If the part separate cleave to the sound part, although it be but by a fleshy thred, so that it doth totter hither and thither, yet beware that you cut it not off, seeing the loss of Speech, (the mean of mutual conference) will so ensue.

Such a Wound is hardly cured; partly, because we can neither use dry stitching nor rolling; partly, because ordinary Topicks, as Bal∣same and Emplasters cannot be Employed.

In this case you are to use stitch∣ing with Needle and Thread. But first of all, the Tongue is to be pulled out, being holden by the hand, it having been lapped with a linnen Cloth, or by hollow and rugged Forcipes armed with cloth. Then so many and so deep stitches are to be taken as shall seem ex∣pedient to keep the parts united. Neither let us be too scrupulous with Celsus lib. 5. c. 26. who thinks that the less flesh the Nee∣dle pierceth, the Inflammation or pain will be the less; rather let us bind sure that we may still find sure. We may easily conjecture how the wounded party will be disheartened if the stitches should break. The Wound being surely stitched; we must first cut off the thread hard by the knot, lest the ends of the thread, being intang∣led between the Teeth, should cause a renting of that which you did sow.

Secondly, we must use astrin∣gent means, such as are Plantain-water, wherein the Syrup of Myr∣tles, or dry red Roses, with some Alum, have been dissolved. A de∣coction of vulnerary Herbs, with Syrup of Quinces: Saccharum ro∣latum holden still in the Mouth, &c. As for his Diet ••he must be fed with liquid things, Almond-milk, yolks of Eggs dissolved in Broths, Gellies, Barley-cream, thin Oatmeal-Gruel, and thin Pana∣does.

CHAP. XXVI.

Of Wounas of the vessels of the Throat.

HAving dispatched Wounds which may happen to the Head, I must now fall to those wounds which may offend the Neck. Now these Wounds cause solution of continuity either in the common parts of the Body, or the parts proper. The parts com∣mon are the Cutis, and Membra∣••a carnosa. The parts proper, are the vessels and the other parts. The vessels are three, the jugular Veins, the soporal Arteries, and the recurrent Nerves. The other parts are the Larynx or Wind∣pipe, and the Gula, or the mouth of the Stomach, and the Spinalis medulla: Of these I will discourse in order, as they are set down. Those Wounds which happen to the common parts, the Skin, and the Membrana carnosa, require no particular tractation; for they are cured by joyning together the parts dif-joyned, and by application of agglutinative Topicks. Seeing these parts are loose and flaggy, you may stitch these parts, althô there be some loss of substance. The rest of the Wounds which befall the other parts of the Neck, requi••e a special consideration.

First then to come to the wounds of the vessels: If the internal ju∣gular Veins, and soporal Arteries, be deeply and largely wounded, the wounded party can hardly escape. First, because the wound∣ed party doth flux to death most commonly, before any Chirurge∣on can come to stay the bleeding. Secondly, because no strait Liga∣ture can be applied to these Wounds, because it might choak or strangle the wounded party. Cels. l. 5. c. 26. saith, Periculosa sunt vulnera ubicunque venae ma∣jores sune: those Wounds are dan∣gerous wheresoever great Veins are. Hip. prorr. l. 2. affirms those wounds to be deadly, whereas the thick, that is the great and large Veins, are wounded in the Neck and Groins. Of the danger of these wounds, Forest. Obs. Chirurg. l. 6. c. 4. thus warneth us: The jugular Veins receiving a great Wound, hardly and very seldom are cured, because they deprive a man of the vital spirit, by reason of the large effusion of Blood; and because these Wounds will not admit such rolling for the staying of bleeding as is necessary. Guliel.

Fabric. Cent. 4. Observ. 2. makes this manifest by an example: When a certain Empirick went about the cutting out of a Stru∣ma in the Neck of a Genevan Maid, which had inclosed the jugular Vein, and the recurrent Nerve, so great a flux of Blood issued, that the Maid died in the very ope∣ration. The like chance happened to one Mr. Blackwell, who going about the like operation in a young Gentlewoman, then lying in Alder∣man-bury, had no better success. Doctor Gwin and I were then pre∣sent. Let these and the like ex∣amples procure wariness when you go about to deal with Tumors in the lateral parts of the Jugulum, or Throat.

In such Wounds, a Wound of the Artery is more dangerous than of the Vein. First, because the Blood of the Artery is more fluxi∣ble and more spirituous: Second∣ly, because the coats of the Artery are hard, and are in continual mo∣tion.

You shall know an Artery to be wounded by these signs: First, the Arterial Blood gusheth out sorcibly and leaping, when the Artery is dilated, but in the con∣striction the Blood is drawn back. Secondly, the Arterial Blood is thinner; but the Venal thicker. Thirdly, the Arterial Blood is of a bright red colour; but the Venal is blacker. Fourthly, the Arterial Blood is much hotter than the Ve∣nal. Fifthly, the Arterial Blood when it issueth out, is more full of spirits than the Venal.

As for the cure of such Wounds, the first scope is to stay the flux of Blood, which is the store-house of the vital spirit: the Second is, to agglutinate the Wound.

The Bleeding is staied two man∣ner of waies; by Medicaments and by Deligation: The Medicaments are either restrictive or escharoti∣call.

This restrictive Medicament may serve instead of all others: ℞ Thur. ʒ ij. Aloes, Sanguinis draconis, Te∣larum aranearum, quae in molis plenae sunt farina volatili, Hypo. cystidis, Mastiches, Sarcocollae, T••r∣rae umbrae, pulveris volatilis Fungo∣rum an. ʒ j. siat ex omnibus pul∣vis subtilis.

The escharotical means are ei∣ther Medicaments which procure a Crust, or an actual Cautery. This Medicament which follows, shall serve for all other escharotical means, ℞ Pul. praedi••l. ʒ ij, Calc. vivae ʒ j. Arsenic, sub••mat. & Au∣ripigmenti. ʒss. fiat pulv. s. a.

These powders, according to Ga∣len, lib. 5. method. c. 4. must be mingled with the whites of Eggs, so that the Medicament be of the consistence of Honey: Then the hairs of a Hare are to be added; you must sill the Wound with do∣sils armed with these Medicaments, and apply large pledgets above the dosils, and about the Wound, armed in like manner with the same.

Seeing you cannot use strait rolling about the Neck for fear of choaking, you are to have in rea∣diness three or four Servants to keep to the Wound the Medica∣ments, that they fall not off by their turns, these Medicaments must lie to the Wounds three days; then when you go about to removo them, when you are come to the

lowermost dosils in the Wound, if they stick, you are not to re∣move them, lest a fresh flux be caused; only the rest of the Wound is to be filled up with fresh stuff.

As for the actual Cautery, it must be red and glowing hot; for then it procures a crust most spee∣dily, and that the thicker. This being done, we are with all expe∣dition to procure incarnation, lest the crust fall before flesh be en∣gendred, and so the breach be∣come greater, and the flux of Blood larger. If you labour to engender flesh above an Artery, you are to use sarcotical Powders, which strongly drie.

When the flesh is engendred, if you by applying your finger feel strong beating, you are to fear lest an Aneurisma ensue: when you have performed all these directi∣ons, it will not be amiss, above and round about the Wound, to apply this Cataplesm: ℞ Fol. Sola∣••••, Hyosc••ami, Mandragor. con∣tus. an. man. j. Far. Hord. & Pulv. Malicer. an. q. s. ut parecur Cataplasma sine ullà coctione.

If these means will not prevail, then you are to bind the vessel which bleeds: First then you are to lift up the vessels from the sub∣jacent and adjacent parts with a small silver hook; then you are to bind them above and under the Wound strongly, and to cut them asunder between the Deligations: This is the surest way, seeing there are innumerable Anastomoses of the vessels in the body of Man, and so Blood may easily flow from ei∣ther side of the Wound: where∣fore it is necessary that they both be bound. Seeing these Wounds are extreme dangerous, you can∣not be too circumspect in curing of them: if therefore a learned Physician cannot be had, you must see that he use a convenient Diet.

His Diet then must be sleader, cooling, glutinous, and somewhat astringent, that no great store of Blood be engendred, that it may be cooled, made thick, and so less apt to flow; wherefore Flesh, Eggs, and strong Drink are to be shun∣ned. The party may eat Lettuce, Purslain, Endive, Spinach, So••el, Barly-cream, Pompions boiled. As for Fruit, he may eat Quinces, Medlars, Pomegranates, Prunes baked or stewed, Sloes stewed. As for flesh, he may eat Calves and Sheeps-feet stewed, Calves and Sheeps-heads boiled, and their Brains with Green-sauce made of the common Sorrel, and Wood-Sorrel, Vinegar of Roses, and a little Sugar; Let the Bread be course and leavened: Let the Drink be Spring-water, wherein Steel hath been quenched, Beve∣redge of Vinegar and Water, the juice of Pomegranates, Barley∣water, Juleps of Roses and Vi••∣lets, Spring-water and Verjuice. If the party be weak, let him, or her feed upon Mountain-birds, poched Eggs, Partridges. In Spring∣water, wherein the bottom of a loaf hath been boiled, dissolve Sy∣rup of Succory, Purslain, red Ro∣ses, Myrtil, and such like: If Wine be required, let it be deep coloured and astringent: such are the red Wines, whereof here they make their Clarets and Allegant. The Body must be kept soluble, and all perturbations of the Mind,

but chiefly vehement anger, are to be abandoned. If the party sleep not well, it is to be procu∣red by Art: this Medicament which follows is very convenient and fit: ℞ Diascor. ʒ j. Philon. Persici ℈ j. Syrup. Papav. albi ʒ vj. Aq. Pa∣pav. cirat. ℥ iij. Misc. ut pare∣tur petio bib••nda fri••ida horâ ix. vespertinâ you may minister this potion every third night.

The third vessel which is to be sound in the lateral parts of the J••gulum, or Throat, which is re∣markable, is the Recurrent Nerve, so called, because it comes down from the sixth pair of Nerves, and returns upwards towards the M••i∣scles of the Larynx, using in the lest part the trunk of the Aorta, and on the right Side, the axillar Artery, as Pulleys. If one of the recurrent Nerves be cut asunder, the voice becomes house, but if both be divided, the Speech is ta∣ken away; and seeing they great∣ly further the Speech, if they be whole, and hinder it, if they suf∣fer solution of unity, they are cal∣led not only Nervi recurrentes, Recursivi, and Reversivi, but Vo∣cales also.

To consolidate these, and the wounds of the Veins and Arteries, this Balsame of Ambrose Parey set down, lib. 10. c. 29. is excellent: ℞ Ol. Hyperic. simpl. ℥ iiij. Gum. Elemi. ℥ iij. Terebinth. Venet. lb. ss. liquescant ista simul ac colen∣tur. Cum frigere incipiunt, adde Boli Armen. Sang. Drac. an. ℥ j. Irid. Florent. Aloes, Myrrh. Ma∣stich. Pulverizat. an. ʒ j. Aq. vit. ℥ ij. Misc. ex. l. a. Apply the Balsame warm. Above the Bal∣same apply Diapalma malaxed in Oil of Roses to hinder all Inflam∣mation.

CHAP. XXVII.

Of Wounds of the other parts of the Neck.

HAving delivered unto you in the former Chapter, the me∣thod of curing Wounds which may happen to the vessels seated in the lateral parts of the Neck; I am to shew you how Wounds, which cause a solution of unity in other parts of the same, are to be cured. Now those members are seated ei∣ther in the fore-part of the Neck, or in the back-part: In the fore∣part the Trachaea arteria, or Wind∣pipe is placed; but in the back∣part the Gula, or the mouth of the Stomach, and Spina dorsi, or Spinalis medulla, the marrow or pith of the Back-bone.

If the Aspera arteria, or Wind∣pipe be wounded thorow: First, the breath will come out at the Wound. Secondly, Blood will issue out at the Mouth. Thirdly, the Speech will be hindred. Fourth∣ly, Coughing will trouble the wounded party.

The Wind-pipe hath three parts: First, the uppermost part of it, called Larynx: The Second, Cau∣dex, or the stump: the Third, the Branches spread thorowout the substance of the Lungs.

Wounds of the Larynx, although they be not mortal of themselves, yet by accident they may become such: First, by reason of the ne∣cessary use, for it doth receive and breath out the Air. Secondly, by reason of the fearful Symptomes, or accidents which accompany such Wounds; for this part is near to the jugular Veins and soporal Arteries: so that it can hardly be wounded, unless these parts be wounded also. It hath also sun∣dry Branches of the recurrent Nerves, and besides sundry Muscles; so that a great flux of Blood, Pain, Inflammation, Pursing or draw∣ing together, and at last strang∣ling may ensue. Thirdly, because this part can hardly be cured; for Medicaments cannot easily be ap∣plied or kept to the part.

Wounds of the Caudex, vel Fistu∣la, or of the Stump or Pipe, al∣though they are not so dangerous as those of the Larynx, for the reasons before alleged; yet they are not without danger, for it is framed of a double substance; for the rings called Anuli are cartila∣ginous, but the substance which ties these together, is membra∣nous. Now a Cartilage cut asun∣der, doth not admit unition, ac∣cording to Hip. Aph. li. 6. Aph. 19. Who saith when the Bone is cut, or a Cartilage, or a Nerve, it neither grows again, nor is united; understand this by a middle of the

like substance. He repeats this same lib. 7. Aphor. 28. Galen subscribes to this Aphorism, 5 Method. Med. c. 7. Three causes may be alleg∣ed for this: First, because a Car∣tilage is a part drie, without Blood, and hard. Secondly, because the cold Air doth continually pass tho∣row the stump. Thirdly, because it is seldom at rest, but still in motion. You may add another reason, because the Air doth not freely pass and repass by it, chiefly if the Wound be deep and large. Of these Wounds thus writes Vidus Vidius de curat. Morb. Membrat. l. 8. c. 6. Wounds which pass tho∣row the Wind-pipe most com∣monly cause speedy death, by rea∣son of the Blood which issu∣ing out of the jugular Veins, fal∣leth upon the Lungs, and hindreth breathing: And Forest. Observ. Chirurg. lib. 6. Obs. 4. thus wri∣teth of them: Large Wounds of the Aspera arteria, chiefly those which divide the cartilaginous substance of it, seldom are cured; for this part is hard, and without Blood: besides this, the wounded party draws breath by the Wound, which hinders consolidation.

As for the cure of such Wounds: if the Wound be transverse, then the wounded party must bend down his Head: if the Wound be streight, according to the length of the pipe, then the party is to hold up his Head, that the brims of the Wound may be brough. together: then the Wound is to be stitched as firmly and artifici∣ally as you can: Pins in this case are best, as also in curing a Hare∣lip, for all kinds of thread will easily rot. This being done, ag∣glutinative Medicaments are to be used. Arcaeus his Liniment is good, and the natural black Balsame: Above apply Dinchylon simplex malaxed with Oil of Myrtils or Quinces. In your dressing you must have a care that neither Blood nor Quittour fall upon the Wind∣pipe, lest it procure choaking; but that they be outwardly dis∣charged in the depending part. If after dressing, the party breath with difficulty, and there is dan∣ger of Suffocation, because the cavity of the Larynx, or Pistul••, is filled with Blood, or Quittour, or both; or because it is straitned by reason of a great Imflammation: then the Wound is to be dilated, and a silver pipe, a little bended towards the point, that it hurt not, to be kept in it, until the wounded party be able to breath freely; then let it be taken out. In this Wound Gargarisms are good: Take this as a pattern: ℞ Hord. mundat. Cochl. iij. Flor. Ros. rub. Pug. 1. Sumach. Flor. Granat. an. ʒ ij. Passulonajor. exaci∣nat. Jujub. an. ℥ ss. Glycyrrhiz. ℥ j. Bulliant ista. s. a. in lib. iij. aq. font, ad consumpt, medietat. ac co∣letur decoct, cui admisce Mell. Ros. & Syrup. Myrtin. an. ℥ ij. utatur Gargarismate calefacto. It moistens the Mouth, asswages pain, agglutinates the parts, and causes the party to breath freely.

Wounds of the Gula, oesophagus, or mouth of the Stomach do fol∣low. That the month of the Sto∣mach is wounded, you shall know by these signs: First, if the Wound be deep, the Meat and Drink will come out of the Wound, Se∣condly, the difficulty of swallow∣ing.

Thirdly, the Hicket and vo∣miting of Choler, Fainting, a faint Pulse, cold Sweats, coldness of the Hands and Feet, according to Fer∣nel. lib. 7. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. cap. 8. Fourth∣ly, the vomiting of Meat and Drink according to Celsus lib. 5. c. 26.

As concerning the variety of these Wounds, receive these kinds of them: First, either the whole Gula is cut asunder, or it is only cut in part. Secondly, if it be cut but in part, then it is wounded near to the Stomach, or far from it. Thirdly, it is wounded either streightly or obliquely.

Concerning wounds of the Gula, receive these Prognosticks. First, all wounds of the Gula are dan∣gerous: First, because they cause difficulty of breathing: Secondly because it can hardly be wounded unless the Wind-pipe, the jugular Veins, the soporal Arteries, and the recurrent Nerves be wounded also. Thirdly, these Wounds which are but small, streight, and remote from the mouth of the Stomach; are less dangerous. Fourthly. Wounds great, transverse, and near to the mouth of the Stomach, ad∣mit no cure, according to G••udo tract. 3. Doct. 1. c. 1. First, be∣cause the passing of the Meat and Drink doth hinder the consolida∣tion. Secondly, because the place is still moist. Thirdly, because its office, which is to carry Meat and Drink to the Stomach, is most necessary for the sustentation of the life of Man. Fourthly, because an Inflammation may easily be com∣municated to the upper orifice of the Stomach, which is very ner∣vous, which the Grecians call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 the Heart, and whose pains are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Fifthly, if it be wholly cut asun∣der, the Cure is impossible, for one part shrinks upwards and the other downwards. As for the cure of these Wounds; The first in∣tention is by stitching, to bring the brims of the Wound together: yet care must be had, that an Ori∣fice be left in the depending part, to be kept open with a Tent, that the Quittour may be discharged, and that Meat stick not there, which might cause Inslammation. Then such Medicaments are to be appli∣ed as I set down for the cure of Wounds of the Wind-pipe.

In these Wounds a special re∣gard must be had of the Diet: seeing then the wounded party can hardly swallow, his Food must be liquid, and it must nourish much. Such are Goats and Asses-milk, wherein Saccharum rosatum, or Violatum are dissolved, Broths made of flesh wherein the yolks of Eggs are dissolved, Almond-milk, and Emulsions of the great cold Seeds drawn with Chicken-broth, &c.

If the party cannot swallow at all, then nutritive Clysters are to be ministred: But first of all the Excrements are to be driven out of the Guts by a purging Clyster. Receive this as an example: ℞ Elect. lenit. ℥ i ss. Mellis rosati ℥ ij. Sacchari rubri ℥ iij. deco••t. commu∣nis pro Clysterib. ℥ x. Mise. ut pa∣••••tur Clyster. Then inject Clysters made of such things as have been set down for the Diet. Minister half a pound at a time, that the party may keep it the longer: Into these nutritive Clysters no Oil must enter, because it will

too much lubrifie the Guts; nor Salt or Sugar, because they will procure too speedy expulsion of the Clyster.

Now I am come to the Wounds of the Spina dorsi, the Back-bone seated in the back part of the Bo∣dy: If the Wound pass not to the Spinalis medulla, sometimes it di∣vides the Muscles, and then the Wound is to be dressed, as those which happen in fleshy parts: If the Bone be hurt also, then it is to be dressed as Wounds of the Head wherein is a Fracture, of which I have discoursed heretofore at large.

If the Spinalis medulla, or the Marrow of the Back-bone be wounded, then it is either wholly cut asunder, or but in part only: If it be wholly cut asunder, then the whole Body is deprived of mo∣ving and feeling, and by conse∣quence breathing it self must be hindred, and so death must ensue. If it be not wholly cut asunder, but wounded only, then a fearful Convulsion must of necessity en∣sue, and so for the most part death.

Celsus lib. 5. c. 26. hath these signs: A Palsie or Convulsion fol∣loweth, Feeling is lost, and after a while the party cannot retain Seed, Urine, or Excrements of the Belly, yea, a total suppression of the Excrements sometimes will ensue. The same signs hath Ferne∣h••s lib. 7. Patholig. c. 8. If the Spinalis medulla (saith he) be wounded, the inferior parts be∣come paralytick, their Feeling, Moving, and Functions are lost; so that the Excrements, Urine, and Seed, now and then come from the party against the will. If the Convulsion happen to the Arms, then it is likely that the Nerves whick spring from the fifth, sixth, and seventh Vertebrae of the Neck are wounded; if the Legs suffer these accidents, then the Nerves of the Vertebrae of the Loins, and Os sacrum are offended.

As for the Prognosticks; seeing the Spinalis medulla is of the same nature whereof the Brain is, Gal. l. 3. de Temperamen. c. 3. and near unto the Brain, lib. 3. al. facult. and is derived from the Brain, lib. 16. de usu part. c. 2. and resem∣bles a compact Brain, lib. 1. de mot. Muscul. c. 1. and seems to be as it were another Brain under the Head and Neck, lib. 12. de Ʋs-Part. c. 11. & 15. The Wounds of it are no less dangerous than those of the Brain. First, because it hath its original from the Brain. Secondly, by reason of its compo∣sition, because 'tis covered with the Dura and Pia mater. Thirdly, by reason of the Nerves which spring from it. Fourthly, by rea∣of the consent which it hath with the Brain. Fifthly, by reason of its action and use, because it doth communicate moving and feeling to the parts Sixthly, by reason of the situation of it: for it lies deep in the Body, so that the force of the Topicks can hardly reach to it. Seventhly, by reason of the Symptoms; for it being wounded, a Palsie, Convulsion, and privation of moving and feeling do ensue.

Forrest. lib. 6. Chir••ag. Obs. c. 6. de his ita promanc••at. If the Spina••is medulla be wounded about the beginning of it, death of a necessity must ensue, because a Convulsion of the whole Body

will follow; but if it be wounded in the lower parts, the Wound is not always deadly, unless the wound be a large one, or it be a puncture, although a Convulsi∣on doth alwaies ensue; so that it is not so dangerous as that which is received about the beginning; and Fallop. de Vulnerib. capit is cap. 2. hath these words: wounds of the Spinalis medulla are ac∣counted deadly by Hippocrates in Coac. Praenot. yet I have seen them sometimes cured; but if the wound happen to be in the upper part, death and a Convulsion of the lower parts must ensue.

Howsoever, seeing the wound∣ed must be dressed, thus you shall go to work: you are to pour in∣to the wound such things as as∣swage pain, stay Convulsions, and which procure Digestion without biting and sharpness: Such are un∣ctuous and fat Topicks, as this Medicament is: ℞ Ol. Hyper. & de luteis ovor. an. ℥ j. Terebin∣thin. ℥ss. Theriac. Andromachi. ʒ ij. Misceantur. Secondly, you must anoint the whole Back-bone with such a Medicament. ℞ Ol. Vulpin. Hirundinum & Lumbricor. an. ℥ j. Ol. Mastichini, & de Ca∣stor. an. ℥ ss. Misc. Thirdly, you must embrocate the whole Scalp with this or the like Medicament: ℞ Ol. Chamaemel. ℥ j. Ol. Lumbri∣corum ℥ ss. Misc. These means are to be applied warm.

CHAP. XXVIII.

Of Wounds of the Breast.

WOunds of the Breast are either not penetrating to the cavity of the Breast, or else they do penetrate. Those that penetrate, are either without of∣fence done to any part contained therein, or some part or parts are wounded.

You shall know the wound to penetrate by these signs: If the Patient shut his Mouth and Nose, the breath will break through with a noise, so that it will move and dissipate the light of a Can∣dle set near the wound; and the Patient will be troubled with dif∣ficulty of breathing. If the parts contained be wounded, you shall know which of them is wounded by the proper Symptoms, with which the Patient is troubled, as follows.

If the Heart be wounded, much Blood gushes out, a trembling possesses all the members of the Body, the Pulse will be small and weak, the colour of the Face will become very pale, a cold Sweat,

and frequent swooning will assault the wounded party; and when the Limbs grow cold, Death is at the Door.

If the Lungs be wounded, it will be discerned by these signs: the Blood which comes out of the Wound is yellowish and froathy, a Cough ensues, the Patient hath difficulty of breathing, and a pain in the wounded side, which before he had not; he lieth at greater case when he lieth on the wounded side; but being turned on the contrary side, these easements are ••bated.

When the Midriff is wounded, these Accidents follow: The party is troubled with a heaviness of that part; he is taken with a raving by reason of the branches of the Merves of the sixth conjugation of the Brain, which are spread through the body of it, difficulty of breath∣ing, a Cough, a sharp Pain, and Fever will trouble the party wounded; yea, the Stomach and Guts sometimes by the vehemency of breathing, will be drawn up into the capacity of the Chest through the Wound, as once hap∣pened to Ambrose Parey, as he con∣fesseth, lib. 10. c. 30.

That a Vessel is wounded, and Blood poured forth into the capa∣city of the Breast, you shall know by these Symptoms: there will be a difficulty of breathing; the Fe∣ver will increase; he will vomit Blood; after the Blood putrefying the Breath will stink; his Appe∣tite will be lost; he will have a de∣sire to vomit; he desireth not to sit up, and often fainteth, noisome Va∣pors assaulting the Heart, being taised up from the putrefied Blood.

As for the Prognosticks of Wounds of the Breast, receive these.

First, Wounds of the Breast which either pierce not to the ca∣vity, or if they be penetrant, hurt neither Vessel nor Entral, are not deadly, but may speedily and easi∣ly be cured, if a me thodical course be taken.

Secondly, if the great Vessels (whether they be Veins or Arte∣ries) be wounded, they cause death. See Celsus, lib. 5. c. 16. and Hip∣poc. prorrhet. lib. 2. because they spend a man by great effusion of Blood, which can hardly be staid for two Reasons: First, because they lie deep in the Body, so that neither can they be bound, nor Medicaments convenient be ap∣plied to them: Secondly, because the Coats of them are membra∣nous, and so cannot be healed by the first intention: yet if the Arte∣ries be divided, the Wound is more dangerous.

First, by reason of the Blood contained in it; for it is more spirituous than that in the Veins.

Secondly, by reason of the flow∣ing of the Blood; for seeing the Blood of the Arteries is more spi∣rituous, and hotter, it issues out leaping, so that it can hardly be staid.

Thirdly, because of the Coats of the Arteries; for they are harder than those of the Veins, and sometimes become Cartilagi∣nous.

Fourthly, by reason of the hard consolidation of the Coats of the Arteries; for they are still in the motion of dilatation and constri∣ction

but consolidation doth re∣quire rest, as Galen observes, lib. 5. Method. c. 8.

Fifthly, by reason of an Aneu∣risma, which most commonly re∣mains after that a Wound is cured, wherein an Artery hath been di∣vided.

As for Wounds of the Lungs, they are either superficiary and small; or deep, wherein the sub∣stance of the Lungs are wounded, and the great Vessels divided: those may be cured; these are deadly for eight Causes.

1. Because they are in continual motion.

2. Because the Lungs are very moist, and so subject to Inflam∣mation and Putrefaction.

3. Because the Medicament can hardly reach to the bottom of the Wound.

4. Because the discharging of the Quittour (which is requisite for Cure) is both hard and dange∣rous; hard, because it must be discharged by expectoration by the upper parts; dangerous, because this must be performed by cough∣ing, by which the Wound is more torn.

5. Because a fearful flux of Blood must ensue, the Vena Arte∣riosa, and the Arteria Venosa be∣ing wounded, and so many Vital Spirits must rush out together with this spirituous Blood.

6. Because great plenty of Blood must fall into the capacity of the Breast, which first by its heaviness must press down the Diaphragm, and cause difficulty of breathing; and afterward, being turned to Quittour, acquires a malign qua∣lity, and so may procure a Fever, Raving, and Convulsion; yea, in process of time Empyema, and last of all a Phthisis and Hectick Fe∣ver, the Acrimony of the Quit∣tour corroding the tender sub∣stance of the Lungs: That a Phthisis doth ensue after an Em∣pyema, Hippoc. lib. 5. aph. 15. witnesseth.

7. Because the entring of fresh Air into the Lungs, and the expul∣sion of fuliginous Vapors from the Heart are hindred.

8. Because the Heart must of necessity be affected by consent, for the Lungs are instead of a Pil∣low, and fan to the Heart, to wit, Vena Arteriosa from the right Ven∣tricle, and Arteria Venosa from the left.

Secondly, Forest. obs. 4. lib. 6. in Schol. hath these words.

It is to be noted (saith he) that if the Lungs be wounded in the fleshy part, wherein there is a remarkable branch of Arteria Venal••s, then a man must of ne∣cessity die, because he is choaked with Blood: You shall know this by the plenty of black frothy Blood.

Thirdly, that dangerous Wounds of the Lungs have been sometimes cured, read Plater. lib. 3. observ. pag. 690. Horstius lib. 3. observ. Medicar. de Morb. Pector. observ. 11. Valeriol. lib. 4. observ. Medic. obs. 10. Acraeas, lib. 2. c. 1. Guilhel. Fabricius observ. Chirurg. cent. 3. observ. 36. & cent. 1. Epistol. epist. 52. Matthias Glandorpius in specul. Chirurgico observ. 24. See sundry in Schenkius observ. Medic, lib. 2. de Morb. pulmon.

As for Wounds of the Heart, other the Pericardium only is ••ounded, or the substance of the Heart also.

If the Pericardium be wounded, the Wound of it self is not deadly, for it it but a ministerial and ig∣roble part, and hath both few and and small Vessels and Nerves, and it doth not cleave to the Heart, but leaves so much distance as gives way to the pulsation of the Heart, and is fit to contain the waterish Humor; yet by accident it may become deadly, if it be so great, that all the waterish Humor ••ows out: for this wanting, an Hectick Fever seizeth upon the wounded party; seeing it is ap∣pointed for the cooling and moist∣••ing of the Heart. See Example in Schenkius lib. 2. Observ. Medi∣car. & Cardan. comment. ad aph. 18. lib. 6. aphor. Hippoc.

Secondly, if the substance of the Heart be wounded, the Wound is so be accounted deadly. See Hippoc. lib. 5. aph. 18. & Galen. in comment. Cels. lib. 5. c. 26. & Aristot. lib. 3. de part. animal. c. 4. Vidus Vidius, tom. 2. oper. Medic. lib. 7. de curat. memb. c. 2.

First, because the Heart is the beginning of Life, and so it being spoiled, it can afford no help to the rest of the parts. See Arist. lx. citato. Secondly, because it is the laboratory of the Vital Spirit. Thirdly, because it is the shop of the vital Blood. Fourthly, be∣cause it is in continual motion, which hindereth consolidation. Fifthly, because it is a hot intral, and full of Blood, and so very subject to Inflammation. Sixthly, because it hath a substance com∣pact, hard and dry, which doth not easily admit consolidation. Se∣venthly, because coplous Blood doth issue out into the cavity of the Breast, by the which a man is suffocated.

Thirdly, superficiary Wounds of the Heart do not so soon kill as deep Wounds.

Fourthly, Wounds in the left Ventricle sooner dispatch a man, than those in the right.

As for the Wounds of the Dia∣phragma; the Wounds of the Mid∣riff, but chiefly in the Nervour Center, are deadly, according to Hippoc. lib. 6. aph. 18. & Galen in comment. & Cels. lib. 5. cap. 26.

First, because it is membranous and in continual motion.

Secondly, because the Wounds of this part are very painful, by reason of the remarkable branches of Nerves which it receives from the lower Vertebrae of the Neck, according to Gal. lib. 13. de us. part. c. 5.

Thirdly, because the Pericar∣dium is tied to it; and although the fleshy circumference wounded may seem to afford some hope of recovery; yet Wounds in it are not without danger: First, be∣cause the principal parts must suf∣fer also; the Brain by reason of the Nerves, which are inserted in it; the heart by reason of the vicinity, and the Arteriae Phrenicae; the Liver by reason of the contiguity, and Venae Phrenicae. Secondly, because the whole Midriff is in continual motion. Thirdly, be∣cause

breathing is hindred. Fourth∣ly, because Blood must issue out into the capacity of the Breast, which may cause suffocation. Fifth∣ly, because fearful symptoms en∣sue, as the pulling up of the Heart∣strings, pain of the Spina, which reacheth to the shoulder, difficulty of breathing, for it will be slow, great, and with sighing; a trou∣blesome Cough, a Fever, and Ra∣ving, by reason of the affinity which it hath with the Heart and Brain. See Cels. lib. 5. cap. 26. Fernel. lib. 7. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. c. 8. Fo∣rest. Observ. Chirurg. lib. 6. observ. 47.

Now to come to the cure of Wounds of the Breast, those which do not penetrate require no speci∣al consideration, but are subject to the Intentions which have been delivered for the cure of Wounds in general.

In curing of penetrating Wounds, thus you must proceed.

First, you must lay the Patient in his naked Bed, his Feet being stretched out at length, and the Orifice of the Wound down∣ward.

The Patient being thus placed, let him lie still untill the Chirur∣geon hath made ready such things as are to be applied to the Wound: in the mean time let the wounded party labour to further the dis∣charging of the Blood, without the Vessels fallen into the cavity of the Breast, by coughing, and hold∣ing in his breath.

When no more Blood issueth out, then put into the Wound 〈◊〉〈◊〉 Flammula, dipped in the white of an Egg, so that the greatest part hang without the Wound: for this neither causeth Pain, nor let∣teth in the Air, and is sufficient for the discharging of any hurtful moisture, Whereas a Tent may be swallowed up by the Wound, hindreth the flowing of the Mat∣ter, grieveth the Patient, and be∣ing continued causeth a Fistula: whereas the Flammula may be continued untill the fortieth day, the longest time required for ordi∣nary penetrating Wounds.

In stead of a Flammula you may use a Silver Pipe, such as is used when a Paracentesis is administ••ed; but it must have a stay on both the sides hollowed, to receive a Thread of a reasonable length, lest it be pulled into the capacity of the Breast, in the Diastole, Na∣ture labouring to shun Vacuity: But when the Wound doth afford but a small quantity of laudable Quittour, it is to be taken out, and the consolidation of the Wound to be procured. The Wound and the Pipe are to be anointed, either with Arcaeus his Liniment melted in a Spoon, or with some artificial Balsam warmed. Above, apply Diachylon simplex: While you dress the Wound, it is convenient, chiefly in the Winter time, to hold a Pan with hot Coals above the Wound, to hinder the expiration of the natural heat, and the inter∣mission of the cold Air.

One thing I would have you to observe, that both Blood and Quittour which is lodged in the capacity of the Breast, may be discharged both by Coughing and by Urine. If it be discharged by Coughing, first, the Matter is car∣ried

into the Pleura, then into the substance of the Lungs; after∣ward it is carried to the Wind∣pipe, and from thence mounting up to the Mouth it is spit out. If it be evacuated by Urine, then it passeth first into the substance of the Pleura, then into Vena sine pari, near to the Diaphragma, where a branch of it doth pass by a streight course to the Emulgents, and so to the Ridneys and Bladder. See an Example of this in Fabri∣cius ab aq. pendent. part. 2. lib. 2. c. 42.

One here may move a Question, why it is so dangerous a matter if Matter fall into the capacity of the Breast, and so light if it fall into the capacity of the Abd••men? Three Reasons may be alledged for this.

First, because the Matter which falleth into the cavity of the Breast, is easily inflamed; partly because it is still moved by the parts of the Breast; partly because it is lodged near to most hot parts.

Secondly, because the Breast doth require an ample and free ca∣pacity for inspiration and expirati∣on, to cool and preserve the natu∣ral heat of the Heart.

Thirdly, because it is a hard matter to draw by any passage the matter from thence, unless it be in the depending part, even if you use a large and wide Syringe called by Galen, Pyulcus.

These things being done, if In∣dications of bleeding move you thereto, first, open a Vein in the contrary side, and then in the same side, as the strength of the party, and the symptoms shall re∣quire.

Arcaeus, lib. 2. cap. 1. will have this vulnerary potion ministred af∣terward: ℞ Rhab. ʒss. Rub. Tinct. Mammiae, an. ℈ j. Terrae sigillat: ℈ss. aq. Scabios. Bugloss. & Succi Granat. an. ℥ j.

After this he adviseth to prepare a decoction to procure easie breath∣ing and ease, such is this: ℞ Hord. mundat. ℥ iv. Passul. major. exaci∣nat. ʒ iv. Rad. Bugloss. ℥ iij. L••∣quirit. contus. ℥ ij. Jujub. n. xx. Pruna n. xv. Rad. Petrosel. contus. man. 1. fiat. decoct. in lb xiv. aq. Pluvial. ad consumpt. 3. part. A∣romatizetur decoctum Cinnam. ʒ iij. ac coletur. In Colaturâ dissolve Penid. ℥ iij. syrup. Ros. simpl. & de duabus radicib. sine aceto an. ℥ ij. Sacchari Candi ℥ iv. Quartâ quâ∣que horâ capiat aeger hujus decocti ℥ vj. This doth nourish, where∣fore he is to take no other food for the space of three days, unless it be a Ptisan, having the Emulsion of the great cold seeds wherein the Roots of Fenil and Parsly have been boiled.

If any Matter offer it self to be purged by expectoration, then Galen adviseth to further it by the exhibition of Vinegar and Water warm; for it powerfully dissolves clotted Blood. If the Patient doth cough with difficulty, then mini∣ster unto him Syrup of Colts∣foot, and Liquirice, with Syrupus Acetosus.

Frambes. canon. & consultat. Medicinal. lib. 8. adviseth Morn∣ing and Evening to minister a vulnerary potion, made of the leaves and Roots of Comfrey; Plantain, Sanicle, Bugloss; 〈◊〉〈◊〉

in Spring Water and some Vi∣negar. In the decoction strained some Saccharum Rosatum is to be dissolved, and some good Bole mingled.

He willeth also that injections be made of Barly Water, Mel Re∣satum and Sugar; as thus: ℞ Pti∣san. ℥ iv. Sacchar. Rub. ℥ ij. Mel∣lis Rosat. ℥ j. Misc. In your in∣jections you must have a care of two things: First, that no bitter thing be put in them: for this would be unpleasant to the Taste, and overthrow the Appetite. Se∣condly, that all the injection come out, for if a part of it should be detained, it would putresie and annoy. It is not amiss for four or five days to lay upon the Pipe or Flammula, a Sponge wet in Aqua Vitae, and wrung, both to keep out the Air, and to extract the Quittour by its gentle heat.

Use not Pledgets of Lint, lest by breathing they be pulled into the cavity of the Breast; from whence would ensue putrefaction, and death at last. According to the small quantity of Quittour, or great which the Wound yieldeth, dress it once or twice a day. And when the Patient breatheth freely, sindeth little pain, and no weight toward the Midriff, but small store of Quittour, and that laudable, doth flow out of the Wound, it is time to shut it up.

CHAP. XXIX.

Of the cure of a Fistula of the Breast following a Wound thereof.

IF after you have diligently and carefully used the means set down by me, concerning the cure of Wounds of the Breast in the former Chapter, for the space of ten days, you see that the Wound tends not to Unition, you may imagine that a Fistula may ensue. That a Fi∣stula will ensue (if it be not pre∣vented) you shall conjecture by these signs.

First, if during the aforesaid time, you have used both inward and outward means, and yet the Wound sends out greater store of Quittour, than it did before, it is a great sign that the Wound is growing towards a Fistula, and that the Patient is entring into a Phthisis or consumption of the Lungs.

Secondly, if the Wound send forth a thin bloody Quittour, like to Water wherein Flesh hath been washed, the same is to be feared: for this is a sign that much coagu∣late Blood is lodged within the Breast, which must be turned to Quittour, and be discharged part∣ly by expectoration, partly at the

Wound; which will require a long time, during which, the Wound may become fistulate, if it be not well looked unto.

Thirdly, if the Quittour which issues out of the Sore, stinks vehe∣mently, as the breath also, a Fi∣stula may be expected: for this shews that there is a great putre∣faction in some parts, which are contained within the capacity of the Breast, which is not easily overcome; first, because no bit∣ter Medicaments which chiefly re∣sist putrefaction, as Aloe, Myrrhe, Wormwood, the lesser Centaury, Carduus benedictus, &c. are to be injected, as hath been said: Se∣condly, because we cannot conve∣niently apply Topicks to the parts affected: Thirdly, because they cannot be kept to the wounded parts, by reason of the motion of the Heart, Lungs, Midriff and Ribs, in Inspiration, and Expiration: Fourthly, because the Body is like to fall into a consumption, so that it is to be feared, lest a convenient supply cannot be afforded by Na∣ture to repair the Solution of Uni∣ty, which you have taken in hand to cure.

Fourthly, if a waterish substance, thô not bloody, do still come out at the Wound, (do what you can) you are to fear lest a Fistula en∣sue; for it is to be feared lest some Spermatick Parts, as Mem∣branes or Fibres are wounded, which admit not Unition accord∣ing to the first intention, or that there is some store of coagulate Blood in the capacity, which will require no short time for suppu∣ration and discharging. When you shall see these signs appear, then are you to summon your Wits, and go about the prevention of a Fistula. This case hath been ac∣counted very difficult, yea, despe∣rate in great Wounds of the Breast, by most Chirurgeons both Ancient and Modern. Nevertheless, Fran∣ciscus Arcaeus arose in the last Age, a Spanish Physician, who by his Wit and Practice found out a way of curing, not only Wounds tend∣ing to fistulation, but such also as are de facto fistulate, and charitably hath consigned it in his Treatise of Wounds, lib. 2. cap. 2.

To compass this, he uses three Intentions: The first is a conveni∣ent Diet: The second is internal Physick: The third is external Application.

As for the Diet, such a one he prescribes, if the party be strong, for eight days and more, according to the toleration of the party wound∣ed, he is to eat nothing but Bread and Raisins: for he affirms, th••t his pectoral decoctions do nou∣rish; from hence untill the thirt∣eth day, he is to eat Flesh to Din∣ner, and to rest contented with Bread and Raisins to Supper; from the thirtieth to the fortieth day, about which time Fistula's of the Breast are for the most part cured, he permits Flesh both at Dinner and Supper: If the party be very weak, he permits unto him, even from the beginning of the cure, to eat Flesh both at Dinner and Supper; but it must afford a good Juice, and be of easie concoction: such is the Flesh of Chickens, Mountain-Birds, Kids, Lambs and Rabbets. As for the internal Physick, it is of two sorts, Purging and Pectoral.

For purgation of the Body, he prescribes these Pills. ℞ Pil. Ag∣gregativar. & de Agarico an. ʒss. Diagrid. Gr. iij. fiat massula ex qua formentur pilul. v. He is to swallow them about Six a Clock, and about Ten a Clock to sup some Chicken-broth, and to Dine about Twelve a Clock. This is a Dose large enough for the strongest per∣son: you may detract from it as much as the constitution and strength of the party shall move you. As for the pectoral Medica∣ments, they are either meerly pe∣ctoral, or healing also. Out of the description of his Medicaments, one may conjecture that either he was not well verst in the composi∣tion of Medicaments, or that he was negligent in setting them down.

Wherefore I am to take some pains to set them down according to Art: his decoction meerly pe∣ctoral, thus you shall prepare: ℞ Polypod. Quercin. ℥ iv. Rad. Enul. ℥ iij. Hyssop. Capill. Vener. Recent. an. man. iv. Liquirit. ℥ ij. Epithymi man. j. Fol. sen. ℥ iij. Passul. Major. Exacinat. ℥ iv. De∣coq. ista in lib. xxiv. aq. Font. ad Consumptionem lb viij. ac coletur decoctum: quod c ar••ificetur addit. Saccari rubri in decoct. soluti, ac mell. despumat. an. lb ss. Let the Patient drink half a pint warmed in the Morning, and so much a∣bout Four a Clock in the After∣noon: At Dinner let him drink a pint, and so much at Supper. Let this decoction be used eight days, within which time laudable Quit∣tour is for the most part pro∣cured.

His healing Decoction thus you shall make: ℞ Scob. Gua jac lb. ss. Cort. ejusd. ℥ vj. semin. Cumin. ℥iss. Glycyrriz. ℥ ij. Passul. Major. exacinat. ℥ iij. Decoq. ista in lb. x. font. ac totidem, lib. vini albi ad consump. lib. viij. ac coletur de∣coctum. Sumat Aeger mane, lib. ss. ac dormiat: sumat tantundem horâ quartâ pomeridianâ. In pran∣dio bibat, lib. j. ac tantundem in coenâ. If the party be dry, and desire more drink, then pour up∣on the Simples which remain after the first Decoction, six pints of Wine, and so much Water, and boil away half of the Liquor: this will serve for quenching of the thirst: let the wounded party continue the taking of this De∣coction, untill the cure be finish∣ed. The Room wherein he lies, he will have still to be kept shut and warm, and he advises to lie in bed the first thirty days; if the Patient cannot endure to lie in bed so long, then let him sit up the warmest part of the day, and go to bed again betimes: by lying in bed the motion of the parts contained in the Breast is mode∣rated, and the Wound is kept warm, which must be observed in all penetrating Wounds of the Breast.

If the party troubled with any such Wound be in a Consumption, or Phthisick, then he prescribed to him this Decoction: ℞ Herd. Mundat. ℥ iv. Passul. exacinat. ℥ iv. Rad. Bugloss. ʒ iij. Glycyrrh. ℥ ij. Card. Benedict. man. j. semin. Cumin. ʒ ij. Jujubas numero xx. Pruna numero xv. Rad. Petrosel. man. j. coq. ista pari modo in lib. xx. aq. Pluvial. ad Consumpt. lib. viij. utatur hoc decoct. ut praecedente.

Verum, postquam decoctum est aro∣matizatum Cinnamon. ℥ss. addan∣tur Penidior. ℥ iij. Syrup. Ros. Rub. simplic. & de duabus radicibus sine aceto an. ℥ iij. Sacchar. lib. ss. Now and then, whether the Body be costive, or no, he adviseth to take a Dose of the Pills prescribed before.

As for the Topicks he will only have an Emplaster laid to the Sore, and to be wiped often every day by the Patient himself for the hastning of the Cure. This Em∣plaster he setteth down: ℞ Ceruss. Litharg. an. ℥ iv. Oliv. Antiq. Aceti Fortiss. an. lib. 1. coq. omnia igne lento ad emplastri consistenti∣am. These Methodical proceed∣ings of Arcaeus, are not only effe∣ctual in preventing a Fistula, but in curing of it also, if it be pre∣sent. He deserves thankful com∣memoration of Posterity for the supplying of this defect, which of∣ten for want of Art and Means, did fall out in the Cure of dan∣gerous penetrative Wounds of the Breast.

Sennert. part. 2. lib. 2. c. 18. holdeth these Fistulations to be of hard Cure, and that not without cause: For first, the parts of the Breast, as the Muscles, Ribs, Lungs and Heart, are in continual moti∣on. Secondly, because the Quit∣tour cannot be promptly dis∣charged. Thirdly, because much Quittour is gathered: And they are more hardly cured, if the Ori∣fice lie upward, and not in the depending part: Two means he appointeth for the cure of these; and because they are very rational, they are not to be passed over in silence.

The Injection is this: ℞ Flor. Ros. Rub. Summitat. Hyper. Equi∣seti, Cariophyllat. Rad. Ireos an. ℥ j. Veron. Valerian. Millefol. Pilosel. Eupat. Sigil. Salomon. an. man. j. He advises to add to these the les∣ser Centaury, the Root of Aristol. and Gentian, as also Myrrh and Frankincense; but seeing the Myrrh and Frankincense must be used in Powder, and it is not sit to use any Powders in the Injecti∣ons which are appointed for the Breast, because the internal parts are very tender, and because they, and the lesser Centaury are bitter, which by reason of their bitterness may offend the Taste, they are to be left out of the Injection. After a Nights infusion, then you shall boil the Simples set down by me, in a Gallon of fair Spring or Rain Water to the half, that is, until a Pottle remain. You shall first clarifie every lb of this Decocti∣on with two ounces of Hony, and so much Sugar, adding the white of an Egg beat to water. Last of all; having strained it, you shall reserve it in a Glass Vessel to your use.

As for his vulnerary Potion, he will have it made of these Simples: Plantain, Agrimony, Fluellin, Sca∣bions, Hypericum, Betony, Lung∣wort, Ground-Ivy, Harts-tongue, Sage, Avens; you may add the white Hoar-hound, Sanicle, ••nd our Ladies Mantle. Of these you may s••ame unto your selves such a Decoction: ℞ Eupat. Seabios. Cariophyllat. Sanicul. Plantag. Pul∣monar. Ling. Cervin. Alchimil. Tussilag. an. man. j. Rad. Consol. Major. & Borag. an. ʒ j. coq. ista in lib. x. aq. font. aut plu••ial. ad

medictat. consumptionis, ac cole∣tur decoctum. Postea addit. Sac∣char. ac Mel. an. ℥ iv. &c. Albu∣minib. ovorum clarificetur decoctum, atque iterum coletur. Capiat Aeger singulis diebus horâ quintâ matu∣tinâ lib. ss. Calid. ac dormiat: ca∣piat tantundem borâ quartâ Pome∣ridiquâ. If you well consider the faculties of the Simples, which en∣ter into the Injection, and the vulncrary Potion, you must con∣fess, that it must be a very obsti∣nate Grief which refuseth to be cured, if these means be methodi∣cally used, and the Sore be dressed according to Art.

All Authors almost, who have discoursed of Wounds of the Tho∣rax have made mention only of Wounds received in the fore part of it; but have made no mention of Wounds inflicted into the back, which pierce also into the cavity or hollowness of it: where∣as these are most dangerous by reason of the Spinalis Medulla, which is placed there; and the multitude of Nerves which pro∣ceed from thence. If such an e∣vent do fall out, first you are to dress the Wound in the Back, as I have set down in the six and twen∣tieth Chapter. As for the Wound of the Breast, it is to be cured by Injections, and vulnerary Potions, set down by in me the six and twentieth Chapter.

CHAP. XXX.

Of Wounds of the Abdomen, or lower Belly, which penetrate, and yet without any hurt of the parts contained.

THese Wounds either pierce to the cavity through the Mus∣cles and the Peritonaeum, or else they do not penetrate. If they pierce, then either some part starts out of the Wound, or else none doth. The parts which start out, are either the Caul or the Guts: if no part start out, then either some part contained is wounded, or none at all.

You shall conlecture a Wound to penetrate: First, if the Probe, or a Wax-candle go deep in streight-ways: in searching you must first see that the Wound be not inflicted obliquely: for in this case you may thrust the Probe a great way between the Muscles, the Wound notwithstanding not penetrating. 2. You must dili∣gently search, that the passage of the Wound be not stopped with any of the super-jacent Bodies, as

the Fat, the Membrana Carnosa, or the Muscles.

Secondly, if the Injection be made with Wine warmed, if the Wound penetrate, the Wine will be received within the cavity; but if it pierce not, it will re∣turn.

Thirdly, we may conjecture by the Figure of the Weapon, whe∣ther it penetrate or no: for if it grow broader from a rush point, and the Wound be broad in the outer part, it is likely that the Wound is penetrating.

Fourthly, if the Caul, or one of the Intestines start out of the Wound, then no doubt is to be made of the penetration of the Weapon.

As for the presages, receive these: First, a Wound of the Belly, not penetrating, is void of danger, unless it be extraordina∣rily large; for in such a Wound many parts must suffer Solution of Unity, the pain must be great, many Spirits must be dissipated, and the party must be more sub∣ject to fainting.

Secondly, a Wound received in the middle part of the Belly, is more dangerous than that which is re∣ceived in the sides: First, because in the middle it is more tendinous, and so the more sensible and subject to Inflammation and Pain. Second∣ly, because the Intestines roll to∣wards the middle part.

Thirdly, all penetrating Wounds are to be accounted dangerous: First, because they are most com∣monly large, but always deep. Se∣condly, because the Air hurts the Guts. Thirdly, because Quittour falls into the capacity.

Fourthly, when in a Wound of the Belly, any of the remarkable parts contained are wounded, it is to be accounted a deadly Wound most commonly. Of such Wounds Celsus thus pronounceth;

He cannot escape who is wounded in the basis of the Brain in the Stomach, in the Portae of the Li∣ver, and to whom the middle of the Lungs, the Jejunum, the small Gut, the Kidneys or the Bladder are wounded.

As for the cure of such Wounds, First, a Wound not penetrating is cured without any difficulty, as Wounds in other fleshy parts of the Body.

Secondly, if the Wound be pe∣netrating, and any part contained start out, four Intentions are re∣quired. The first is, that the part be situate in its own place. The second is, that the Wound be stitched. The third is, apply con∣venient Medicaments. Fourthly, that a course be taken for the re∣moving of ill Symptoms.

If the Gut start out, and you be presently called to it, then you are to thrust it in with Hands and Fingers. But if it hath long hung out, and by reason of the cold Air be filled with flatuosity, and swell∣ed, so that it cannot be reduced; first of all you are to use an incar∣native Fomentation to discuss the Flatuosity, and then to try the repo∣sition of it. The Fomentation must be made of Chamaemil, Melilot, Dill, Peny-royal, Germander, Tansey, Lavander, Wormwood, Mints, Bay-berries, Cumminseeds, Fennil-seeds and Aniseeds, boiled in red astringent Wine, or Milk, if such a chance fall out in the Coun∣try.

If after sufficient Fomen∣tation you cannot put in the Gut, then you are to dilate the In∣cision.

If the Caul come out, and by reason of the cold Air it be much cooled, which you shall discern by the unnatural hardness of it, or if it be black, or of a livid colour, then it is to be bound up near to the warm and sound part, and the corrupt part must be cut away. Let the Thread hang out at the Wound, until the corrupt part se∣parate from the whole. Then draw the Thread wholly out of the Wound. If the Caul be no∣thing altered, it will be sufficient to thrust it within the Peritonae∣um without binding. It is re∣quisite that we use deligation, when we cut away any portion of the Caul: otherwise much Blood would fall into the capacity of the Abdomen: for the Caul seemeth to be a texture of Veins and Arteries enterlaced with fat.

The second scope is to stitch the Wound. This kind of stitch is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Before you stitch, you must perform these three things. First, you must have a elear light, that you may have a perfect view of the Wound: Secondly, you must lay the Pati∣ent upon the side opposite to the Wound, that the Guts trouble you not, while you are stitching: Thirdly, that you have your Ser∣vant by you, to hold up the parts which you are to stitch.

These things being provided, go about your business: of this kind of stitch there be three usual sorts.

The first is thus performed: First, the Needle is thrust through the Skin and the Muscles, even to the Peritonaeum, not touching the Peritonaeum on that side: then from within outwards, the Needle is to be thrust through the Peri∣tonaeum and Muscles of the oppo∣site side. Then within the di∣stance of an inch, the Nee∣dle is to be thrust through the Muscles of the same side, leaving the Peritonaeum. Afterwards from within outwards the Needle is to be thrust through the Perltonaeum and the Muscles. So you are to proceed until sometimes piercing the Peri∣tonaeum, and sometimes sparing it, you have sufficiently united the parts disjoyned. Some, of four stitches make one Ligature, cut∣ting the Thread, and tying the ends of it firmly together, and use as many Ligatures as are sufficient.

The second is done by stitch∣ing the Muscles together, and the sides of the Peritonaeum together. In this sort of stitch, first, the Needle is to be passed through the Skin and the Muscles to the Peri∣tonaeum: then the opposite side of the Peritonaeum is to be joyned to the side lying under the Muscles pierced: this being done, the op∣posite Muscles are to be pierced, this course is to be followed until all the brims of the Wound be de∣cently united.

The third differeth not from the stitch which is used in other parts of the Body: For the Needle is to be thrust through two sides of the Muscles, and so many of the Peritonaeum still, until sufficient stitches be taken. The first is ac∣counted the best. After stitching you leave an Orifice in the de∣pending

part to admit a Tent, that the matter procured by sup∣paration may be discharged. This kind of stitch is used, because the Peritonaeum being a Membrane would not admit Consolidation without the entercourse of flesh. And if it were left unconsolidate, an uncurable Tumor would be left in the outer parts, the Guts insi∣nuating themselves into the Cavi∣ties of the Muscles.

One thing is to be observed, that you second and strengthen this kind of stitch, by a drie stitch, and that very firm: for within a few days the thread will cut asunder the brims stitched, and the stitches will become loose, because the intestines continually do butt upon the Abdomen; where∣fore the drie stitch is requisite, as it is in the cure of the double Hare-lip.

The Third Intention was said to be the application of convenient Topicks. Such are all choice vul∣nerary Balsames, whereof I have spoken sufficiently before, and ag∣glutinative Emplasters, such are Diapalma, and Emplastrum de mi∣nio newly made, and not too drie in the Summer-season. In the Winter Emplastrum sticticum is the best.

The description of it is thus set down by Crollius: ℞ Ol. lini & Oliv. an. lb j. Ol. Laurin. lib. ss. Litharg. auri & argent. an. lib. ss. Minii ℥ iiij coq. ista ad Emplastri consistentiam, tum adde Cerae, Co∣lophon. an. lib. 1. Istis Liquefact. injice Gum. sequentia in aceto scluta, atque ad justam consisten∣tram iterum reducta. Opopan. ℥ ij. Galban. Serap. Elemi, Anom. Bdel. an. ℥ iij. Istis incorporat. in∣jice sequentia in alc. redacta, Ca∣laminar. ℥ iiij. Arist. long. & ro∣tund. Carab. Magnet. Lap. Hae∣matit. Coral. Rub. & Albor. Vi∣triol. alb. terrae Jigil. Croci Mart. Ceruss. Antimon. an. ℥ j. Oliban. Myrrh. Aloes hepat. Mummiae, Sanguinis Dracon. an. ℥ ss. Istis probe commistis adde Terebinthinae ℥ ij. Vernicis ℥ j. Caph. ʒ iij. pa∣retur Emplastrum, ex quo formen∣tur magdaleones manibus Ol. Hype∣ricon. inunctis. I have altered the Doses of the Simples, I con∣fess, Art so requiring, and have set down the artificial Compositi∣on. The faculties of it you may read in himself; for they belong not to the subject which we have in hand. Fab. ab Aq. pendent. Chi∣rurg. part. 2. lib. 2. c. 45. adviseth to use astringent Powders as this: ℞ Sang. Dracon. Bol. Armen. Ma∣stiches, bac. Myrti an. siat ex om∣nibus pulvis. If Sarcocol, the root of Comfrey and Borax were added, the Medicament would be the more effectual. The last Inten∣tion of curing of these Wounds penetrating, wherein no contain∣ed part is wounded, was said to be the shunning and hindring of evil Symptoms. Now these Symptoms are two: The pain of the parts adjacent being continual, and the collection of Quittour or Blood in the hollowness of the Abdomen.

To avoid the first, Gal. 6. Meth. c. 4. adviseth us to embrocate all the parts from the Arm-pits to the Groins with Sallet-Oil warmed: But it were better to embrocate those parts with the Oil of Cha∣maemil, Roses, and white Lilie, if they be to be had: for so the In∣flammation

would be prevented, Pain would be eased, and the parts kept soft and pliable.

As for the second accident, Blood and Quittour may fall from the brims of the Wound into the hol∣lowness of the Belly, and may of∣fend, not the Guts only, but all other parts contained also: for sometimes a Tumor is caused, and sometimes the Dropsie is procured. You shall know that these things are contained in the hollowness, First, by the Weight which is felt there, the Pain, the Tension of the part: Secondly, if you crush the Belly, you shall perceive the Mat∣ter to shift from place to place under your hands. Seeing this Matter cannot be sensibly emptied, because the wounds of the Belly must not be kept open, for the reason set down before, when I spake of the stitching of these Wounds; we must labour insensi∣bly to dissipate it by Medicaments; which rarefie the parts, and dissi∣pate and draw out the Matter: wherefore you may embrocate the Groins with Oil of Rue, Dill, Eu∣phorbium, Wax, Castoreum, of Tiles, Then you may apply Diachylum magnum cum Gummi sostned with Oil of Scorpions, or Oxycroceum, and de Mucilaginibus mixed toge∣ther.

CHAP. XXXI.

Of penetrating Wounds of the Belly, wherein some of the parts contained are wounded, and First of the Wounds of the parts appointed for Chylification.

NOw the contained parts which are wounded, are either ap∣pointed for nutrition or procreati∣on. If for nutrition, then they either procure Chylification, or help Sanguification. Those which procure Chylification are the Sto∣mach and the Guts. The Sto∣mach hath two parts, the Orifice, which is called Oesophagus, and the bottom which is called Ventri∣culus.

If the Oesophagus be wounded, then the Wounds are either super∣ficiary and small, or else deep, and passing to the Cavity of it: And both these are either streight or transverse, and these either near to the Stomach, or somewhat remote from it.

Wounds small, streight, and which are somewhat remote from the bottom of the Stomach, are less dangerous; But those which

are great, transverse, and neer to the bottom, are deadly; and ad∣mit no consolidation. See Guido Tract. 3. Doct. 1. c. 1. for this these reasons may be given. First, because the passing of the Meat and Drink doth hinder consolida∣tion. Secondly, because it is con∣tinually bedewed with moisture descending still, either from the Head, or from the Almonds. Third∣ly, because its Office is absolutely necessary for the preservation of life, that is, the carrying of the Meat and Drink to the bottom of the Stomach. This carrying of the Aliment is performed by impulsi∣on and attraction. The external Membrane, which is fleshy, and hath transverse Fibres, doth thrust it down; but the internal Mem∣brane, which hath streight Fibres, doth attract the nourishment. Wherefore the Fibres of both the Membranes being cut asunder, the passing of the nourishment is stai∣ed, and so the party defrauded of Aliment. Fourthly, because the Meat and Drink must be discharg∣ed by vomiting, seeing it cannot pass to the bottom of the Stomach. Fisthly, when the upper nervous part of the Gula is wounded, which is nervous and of exquisite sense, which the Grecians call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, death doth most commonly sud∣denly ensue.

Celsus. lib. 5. c. 26. hath these signs of it wounded: Ʋbi stoma∣chus autem percussus est, &c. But when the Stomach is wounded, the Hicket and vomiting of Choler doth ensue. If Meat or Drink be taken, it comes up again speedily, the Pulse grows weak, thin Sweats break out, and so the extremities of the Body grow cold. Fernel. lib. 7. Pathol. cap. 8. addeth Fainting. Although I have set down the me∣thodical curing of such a Wound, Chap. 27. yet I thought good here to touch a few things necessary to be known.

Wounds in the Oesophagus are more dangerous than those of the Ventriculus for these reasons; First, because it is of a nervous and membranous substance, and so is not easily united. Secondly, Because the pain is exceeding sharp, and so depriveth one of rest and sleep. Thirdly, Because it hath a great consent with the Brain, by reason of the Nerves descending from the sixth Conjugation, which are be∣stowed upon it. Fourthly, Be∣cause Topicks cannot convenient∣ly be applied to such a Wound; yea, if you minister vulnerary po∣tions, either they return by vo∣miting, or slipping down make no stay, or else they issue out at the Wound. Fifthly, Appetite is lost, and so the desire of Meat and Drink, without which the life of Man can∣not long continue. Sixthly, be∣cause Convulsions may ensue, which are deadly, according to Hippoc. Aphor. Sect. 5.2. Seventhly, be∣cause vomiting of Choler doth en∣sue, according to Celsus, loco ci∣tato, which may enlarge and tear the Wound.

Now as concerning the Wounds of the bottom of the Stomach, they have the same differences which those of the Orifices have, which after the Prognosticks, and manner of curing these wounds, receive these presages.

First, small and superficial wounds are easily cured; but penetrating

Wounds are accounted deadly by Hippoc. Aphor. 18. Sect. 6. & Cel∣sus lib. 6. c. 26.

Now this word Deadly hath a threefold signification; for First, it signifies, that bringeth inevitable death; Secondly, it signifies, that which most commonly bringeth death; Thirdly, it signifies that which is dangerous, and may bring death. Now Wounds in the bot∣tom of the Stomach penetrating, are not always deadly in the first signification, although they be in the second and third significa∣tion.

Secondly, penetrating wounds in the bottom of the Stomach are hard to be united: First, because it is of a membranous substance. Secondly, because Meat and Drink keep asunder the brims of the Wound. Thirdly, because vulne∣rary potions slip out at the wounds. Fourthly, because a convenient Ligature to keep the brims of the wound together, cannot be appli∣ed. Fifthly, because the Stomach is very sensible, from whence en∣sue Pain, afflux of Humors, Watch∣ing and Inflammations. Sixthly, because the Body cannot be with∣out the benefit which it affordeth to it, for it is the pot wherein the nourishment of the whole Body is boiled.

The Second presage: Penetra∣ting wounds in the Ventriculus, are not so dangerous as those of this kind in the Oesophagus. First, because the bottom is more fleshy. Secondly, because vulnerary poti∣ons and other Medicaments may longer stay here. Thirdly, be∣cause the dignity of this is not so great; for the Orifice is the seat of the Appetite. Fourthly, because the bottom is not of such an ex∣quisite sense as the Orifice. That Wounds in the bottom of the Sto∣mach may be cured, read Crollius in praefat. Basil. Chymic. Schenkius, and others. It were too tedious to set down their narrations.

You shall know that the bottom of the Stomach is wounded, First, if the Wound be under the Dia∣phragma, or the Mucronata carti∣lago: Secondly, if the Chylus come out at the Wound either sincere, or mingled with the Meat unalter∣ed.

As for the cure of these Wounds, you must not suffer the Tent to en∣ter into the wound of the Sto∣mach: it must only keep open the parts lying above the Stomach. Let it be armed with a Digestive made of the Oil of Hypericum, Turpentine, and the yolk of an Egg; for this asswageth pain, pro∣cureth Quittour, and is glutina∣tive. The Stomach outwardly is to be embrocated with Oil of Mint, Myrtils, Quinces, Wormwood, and Oil of Roses; Let him drink the juice of Pomegranates and Quin∣ces, or Syrups of them in the de∣coctions of Horse-tail, Mouse∣ear, and Periwincle or Plantain∣water sugared. To poor peo∣ple you may prescribe Posset-drink, wherein these Herbs have been boil∣ed: Let the party Drink and Eat very sparingly; for the Wound will better unite when the Sto∣mach is somewhat empty and wrinkled together.

If the Guts be wounded, then they are either the small or great Guts. If the small be wounded, the Chylus comes out at the wound,

the Flanks swell and become hard, the Hicket troubles the Patient; be vomits Choler; he hath great gripings in his Belly; oftentimes a cold Sweat breaks out, and the ex∣tream parts cold.

If the great Guts be wounded, the Excrements come out at the Wound. Now the wounds of the Guts are either superficiary, or they pass to the Cavity. If they pass to the Cavity, then they are either streight or transverse, and these either great or small.

This being noted, you may thus correcture of the event: First, if the Wound be but superficiary; yet it is not altogether without danger; because all the external parts of the Abdomen are divided. Secondly, great Wounds of the Guts, but chiefly if they be trans∣terse, for the most part prove deadly.

First, because they are of a membranous substance, which hath but little Blood. Secondly, because the Chylus and excrements do con∣tinually pass by them. Thirdly, because local Medicaments cannot conveniently be applied to them, partly because they lie deep in the Body, partly because they conti∣••••ally change place. Fourthly, because the brims are kept asun∣der, they being distended by flatu∣osity, the Chylus and the Excre∣ments. Fifthly, because their Of∣fice is absolutely necessary for the preservation of the life of Man; for either they distribute the Chy∣lus, which is performed by the small Guts, or else they contain and discharge the Excrements, which the great do: But these are hindred, the Guts being wounded. Sixthly, because they are very son∣sible, and so Pain, Inflammations, Fevers, and Watching may en∣sue.

The third presage: Wounds of the small Guts are more dangerous than those of the great: First, be∣cause they are more nervous and membranous than the great. Se∣condly, because they are of a more exquisite Sense. Thirdly, because they are nearer to the Stomach. Fourthly, because they have more mesaraical Veins. Fifthly, by rea∣son of their excellent Office; for they distribute the Chylus, and more resine it, according to Galen 4. de us. part. c. 17.

The fourth presage: Amongst these are the Wounds of the Jeju∣num. First, because it hath more mesaraical Veins than the rest, which makes it look red. Second∣ly, because it may be soon infla∣med, by reason of the plenty of Blood. Thirdly, because it is next to the Liver, and so soonest inflamed. Fourthly, because it hath a tenderer substance than the rest. Fifthly, because it receiveth immediately and in full force, the sharp Choler from the Gall: where∣as the rest receive it but mediate∣ly, and the sharpness of it being much abated.

The fifth Presage: The great Guts are more apt to receive Con∣solidation than the small; partly because they are of a more fleshy substance: partly because they are not so sensible: And Thirdly, the Excrements contained in them are solider than the Chylus, and so not so apt to flow to the wounded part, and so to keep the brims a∣sunder.

As for the cure of these Wounds, they require four Intentions. The First is to stitch the brims of the Wound with the Glovers-stitch; if the Gut be not without the Wound, it must be drawn out gently: Let it be sown with good flaxen thread not waxed; for then it will swell and not so soon cut the brims of the Wound asun∣der.

Secondly, to reduce the Gut to its own place, but it must first be fomented with red astringent Wine warmed: Secondly, an agglutina∣tory Medicament is to be applied to the Wound, such is this: ℞ Ma∣stich. Sarcecoll. an. ʒ j. Borac. & Myrrh. an. ʒss. fiat. s. a. pul∣vis. qui aspergatur.

Thirdly, the external parts of the Belly are to be stitched, as I have taught in the former Chap∣ter. Better it is to stitch these parts than to leave them open. First, because you cannot any more ap∣ply local Medicaments to the Wound; for the Guts still shift. Secondly, because the Air will cause pain and griping. Thirdly, be∣cause the cold Air may breed fla∣tuosity, which distending the Guts, may break the stitches. Fourthly, because the natural heat being kept in, the Gut is sooner conso∣lidated.

The Fourth Intention is; you must have a care that the Excre∣ments hurt not the Wound, they becoming hard by staying. To this purpose you must feed the Patient with moistning Meats, and mini∣ster emollient Clysters, made of the decoctions of a Sheeps-Head and Feet. In curing of these Wounds, you must not admit the ministring of vulnerary poti∣ons.

CHAP. XXXIII.

Of Wounds of the parts that help Sanguification and Procreation.

WOunds of the Liver, which is a part assist∣ing Sanguification in the separati∣on of Bile, are either super∣fciary, lightly hurting the outer part, or they are deep and great, p••ercing even to the trunks of the Vena porta, and the Vena capa. Celsus lib. 5. cap. 26. sets down these signs.

These are the signs of the Liver wounded, a great flux of Blood in the right Side, the Sides all drawn towards the Spina: the Party de∣••ghts to lie upon the Belly; prick∣ings and pain even to the Neck, and to the side joyned to it: The Shoulder-blade stretched, some∣times vomiting of Choler doth al∣so happen.

Peccetius lib. 2. cap. 8. Oper. Chirurg. adds, after Meat they feel a heaviness in the Side, they are unquiet, they have a sharp Fe∣ver, sometimes they piss a bloody Urine: After some daies also they discharge by siege rotten Blood, the Face becomes discoloured and wan.

What will befall, the Liver be∣ing wounded, these Aphorisms fol∣lowing will shew you. First, super∣siciary wounds of the Liver may ad∣mit cure: but great and deep Wounds will not. Hip. Aph. 18. lib. 6. hath these words: If the Bladder, or the Brain, or the Heart, or the Midriff, or a small Gut, or the Stomach, or the Liver be wound∣ed, it is deadly.

Sundry reasons may be alledged for this. First, is the great Flux of Blood which follows. Secondly, the Inflammation which possesses it being wounded; for it is a Mem∣ber hot and full of Blood. The Third is the difficulty of Cure: for Vulnerary potions lose much of their strength before they come to the Liver.

Topicks cannot well be applied, it lying deep, and the Quittour cannot be well discharged, and so it may corrupt the substance of the Liver, and so Sanguification is disturbed, from whence ensue the Consumption of the Body, or the Dropsie.

If you object that good Authors have in their Monuments set down Examples of some who have been cured, who have received a deep Wound in the Liver.

I answer, that those Examples

are rare, and come near to Mira∣cles, God his providence concur∣ring with the extraordinary strong constitution of the Body: where∣fore let not these draw from you any bountiful promise of recovery.

The Second presage, If cold Sweats burst out of the Forehead and Neck, if the wounded party often faint, if the Extremities grow cold, and the party become very weak, then death attends.

Touching the Cure, let it be dressed with astringent Trochiscs dissolved in Plantain-water, ad∣ding thereto Syrups of dry Roses, Myrtils, and Poniegranates: for a doubtful hope is better than a re∣solved despair.

The Second part helping San∣guification, which may be wound∣ed, is the Spleen: for according to Arist. lib. 3. de part. animalium, it is a bastard Liver. The wounds of it as of the Liver are either superficiary or deep. Signs of the Spleen wounded deeply, are these according to Celsus lib. 5. c. 26. Black Blood doth issue out of the left Side, the Side it self and the Stomach become hard, great Thirst ensues, and the pain reaches to the Neck.

Concerning these Wounds re∣ceive these Prognosticks, First, deep Wounds of the Spleen are for the most part deadly. Celsus lib. 5. c. 26. affirms, that they who are so wounded hardly are ever cu∣red: for this Prognostick these reasons may be given: First, be∣cause a searful flux not only of the venal, but of the arterial Blood al∣so doth ensue. Secondly, it is a worthy and necessary part, it fur∣thering Sanguification, and being a second Liver, if it perform not its Duty.

Thirdly, because it being a part full of Blood and hot, it may be easily inflamed. Fourthly, because it hath a great consent with the Heart, by reason of the multitude of the Arteries communicate with it: for noisome vapours may be sent to the Heart, from the Quit∣tour and putrefied Blood.

The second presage; although deep wounds of the Spleen be dead∣ly, yet I am of the opinion that the Spleen may be cut out of a Man, or a Woman, and the party may live. The experiment of this exsection in a Dog, Mr. Gillam and I made in Dr. Bonham's House. First, in∣cilion was made in the left Side, hard under the short Ribs, four Inches in length through all the containing parts of the Abdomen: then the Spleen was drawn out: Thirdly, all the vessels by which it was bound to the adjacent and contiguous parts, we bound, to prevent the immoderate flux of Blood: Fourthly, we cut away the Spleen near to the substance of it. Fifthly, we stitched the parts of the Abdomen, and left the heal∣ing of the parts to Nature; all the wounded parts were in a short time healed. But about six weeks afterward the Cur became Mangie, the Spleen belike not drawing un∣to it self the saeculent Blood. Vidus Vidius de curat, memb. li. 10. c. 10. thinks this operation to be impos∣sible with keeping of life, by rea∣son of the immoderate flux of Blood which must ensue. But the binding of the vessels doth remove this scruple, which I wonder he did not consider.

The Third Presage: By reason of the Spleen wounded, the Sto∣••uch, Liver, and the whole Body may become ill-affected: so that the Dropsie, Scabbiness, Melancho∣ly, and such Diseases may ensue.

The wounds of the Spleen are cured as those of the Liver: It falls out in wounds of the Liver and Spleen, that much Blood falls into the Cavity of the Abdo∣men. But this Blood is either dis∣cussed by the natural heat, or else it causes an Aposteme in the Groin.

The Third part assisting Sungui∣fication is the Kidney; This may be wounded either superficially, or deeply; and so either where the Carunculae papillares only are; or to the Pelvis also, and this last either without any hurt done un∣to the Vein and Artery emulgent, to they being wounded also.

If the Kidnies be wounded to the Pelvis, clots of Blood will come with the Urine: there will be a great pain in the part affect∣ed, and will reach to the Groin and Testicle. See Celsus l. 5. c. 26. Fernel. li. 7. Patholog. c. 8.

If the Kidney be wounded through the Back, then it is not like that the party can escape: for the Wound must pierce the Pso••, and the Nerves springing there from the Spinalis medulla can hardly be free.

If the Wound be inflicted by the Side, and pierce but only to the Carunculae papillares, it may be cuted, and yet not without diffi∣culty, because the Muscles of the Belly must be wounded, and the Peritoneum also, between the Membranes of which it is lap∣••ed.

If the Wound pierce to the Pel∣vis, the Wound most commonly falls out to be deadly: First, be∣cause the draining of the Serosity from the Veins and Arteries is ab∣solutely necessary: otherwise if it be staied in the Body, it would hinder the unition of the Wound, and procure waterish Powks and the Dropsie. Secondly, because the substance of it hardly doth ad∣mit consolidation, partly by rea∣son of the compactness of its sub∣stance, partly because it hath within it self the Carunculae papil∣lares and the Pelvis, which are sper∣matick parts.

If the Vein and Artery emul∣gent be wounded, there is small hope of recovery, because a fear∣ful flux of Blood must ensue.

The Cure is performed by sana∣tive injections, vulnerary poti∣ons, and the ministring of Tro∣chisci de alkekengi cum opio; or if the pain be not great, sine opio in new Milk, having Saccharum rosa∣tum dissolved in it.

The fourth part appointed for Sanguification, which may be wounded, is the Bladder. It may be wounded first in the Neck, where the sphincter Muscle is, which i•• fleshy: Secondly, in the body of the Bladder. If the Wound be in the body of the Bladder, then it happeneth either in the sides about the Groins where the Ligaments of it are, or in the other membra∣nous parts.

The signs of the Bladder wound∣ed are these, according to Celsus lib. 5. cap. 26. and Fernel. lib. 7. Pathol. c. 8. The Urine comes bloody and sparingly: if the body of the Bladder be wounded, then

the Urine falling into the Cavity of the Abdomen, it will seem to be an Ascites, and the pain will be communicated to the Groins and Stones in Men.

As for the Prognosticks, receive these: 1. Wounds in the Neck of the Bladder, where it is fleshy, are curable. This needs no confirma∣tion, for we may see frequent ex∣periment of this in those who are cut for the Stone. 2. Wounds in the lateral parts about the Groin are curable also in those who are young, and of a good constitution of Body. 3. Wounds in other parts of the body of the Bladder, which are membranous, are uncu∣rable. See H••ppoc. A••h••r. 18. Sect. 6. and Galen in his Commen∣tary upon this place: He yields this reason, because the Bladder is ner∣vous, thin and has but little Blood. Of this same opinion is Aristotle lib. 3. Histor. Ammal. cap. 15. who saies, that the Bladder be∣ing cut, cannot unite, unless it be in the beginning of the Neck.

Celyus ••••b. 5. c. 26. subscribes to these, affirming, that they hardly 〈◊〉〈◊〉 be healed whose Bladder is wounded: For the confirmation of this Opinion, these reasons may be yielded: First, because it is membranous: Secondly, because the Wounds of it are very painful, whence affluxion of Humors, and an Inflammation do proceed: Thirdly, because it easily mor∣tifieth: Fourthly, because it be∣ing the Chamber-pot of the Bo∣dy, the Urine contained in it, will not suffer the Wound to consolidate, by reason of its Acri∣mony nipping, by reason of the Quantity distending, and by rea∣son of its Humidity relaxing. Fifth∣ly, because fearful Symptoms en∣sue after such Wounds, as Fevers, Watching, the Hicket, dejection of Appetite, Convulsions and Faint∣ings. Sixthly, if in Wounds of the Bladder, a Fever continue, if the Wound become black, or of a livid colour; if the party can∣not sleep, or continually slumber, and if a Convulsion do happen, and the party become weaker and weaker, you may prognosticate that the party will die.

When you go about to cure Wounds of the Bladder, minister vulnerary potions: This which fol∣lows is excellent: ℞ Cydon. Incis. num. iiij. Equiseti, Sumach. baccar. Myrt. an. ℥ iij. Ros. Rub. siccat. P••g. ij. Balaust. ℥ss. coq. ista in lib. 16. Aq. Font. aut Pl••vial. ad 3. partis Consumptionem, a•• coletur, decoclum. In colaturâ dis∣so v. Sy••up. è Ros. Rub. siccat. & Mell. Rosat. an. ℥ vj. Syrup. Myr∣tini ℥ iij Gummi Tragacanth. ℥ss. Nil capiat aeger praeter istud d••∣coclum ante ••iem decimum si con∣stent vires. Although the party be very dry, yet let him not drink any water, for that will bring inevitable death.

As for the Topicks, Anodyne and agglutinative Medicaments are best, as a Digestive made of Cyprian Turpentine, the yolk of an Egg, and some of the Oil of Eggs: you may use your artificial Balsames brought to a reasonable thick consistence, with the white Joyners Vernice, and Turpen∣tine.

Now only remains, of all the Wounds in the parts of the Ab∣domen, to speak of those which

happen to the parts destinate for procreation.

Those are the Matrix in Wo∣men, and the Genitals in Men. If the Matrix, then it is either wound∣ed in the Neck, or even into the capacity of it. If the Wound pierce to the capacity, then Blood will issue out at the privy part, and the pain will be about the Groins.

Celsus esteems these Wounds to be of difficult Cure: These Rea∣sons may be yielded: First, it is thin and membranous, unless the the Woman be great with Child. Secondly, because it is of an ex∣quisite seeling; and so Pain, a Fe∣ver and Inflammation may ensue. Thirdly, because it hath a nota∣ble consent with the principal parts of the Body. Fourthly, be∣cause it is a moist place. Fifthly, because it is, as it were for the sink of the Body to receive impuri∣ties, which is the cause that these Wounds may become cancerous Ulcers. Ordinary Wounds, even of the body of the Matrix, are not to be accounted deadly, be∣cause Infants have been by Inci∣sion taken out of the Matrix, the Mother remaining alive. This kind of delivery is called Partus Caesareus; And the whole Matrix hath been taken out from the bo∣dy, the party living long afterward. Peruse Shenkius of this matter, lib. 4. Observat. de uteri affectibus, where you may read of sundry examples. Dresse the Matrix as the Bladder.

Seeing the Genitals of Man may be wholly taken away, and yet the party live, and that the Wounds of these are not deadly, as appeareth in those who have been gelt, and have lost their Prick, I think it superfluous to discourse of them, and the rather, because the dressing of them doth not dif∣fer from that which is used to other parts of the same na∣ture.

CHAP. XXXIII.

Of Wounds of the Nervous Parts.

BY the Nervous Parts, here I understand three sorts of parts: to wit, Nerves, Tendons and Liga∣ments.

That a Nerve is wounded, you shall know first by the part: If great and many Nerves be in the place wounded, or pass by it; A∣natomy teacheth this. Secondly, you shall know this by the Symp∣toms, for there will ensue a Pulsa∣tion, Inflammation, Convulsion, Raving, if it be cut asunder, and at last sometimes Mortifica∣tion.

The Solutions of Unity which happen unto Nerves, are four; a Puncture, an Incision, a Contusi∣on, and a Distortion.

Of the Wounds of Nerves re∣ceive these Prognosticks: First, Wounds of the Nerves are dange∣rous. First, because they are of an exquisite sense or feeling, both because the Membrane, wherewith they are covered, proceeds from Meninges, and that they are im∣pregnate with plenty of Animal Spirits. Secondly, by reason of the consent which they have with the Brain, and the Spinalis Medulla: For according to Galen, lib. 12. de usu partium c. 11. the Brain is the Well-spring, the Spinalis Me∣dulla the River, and the Nerves the Creeks. Thirdly, by reason of the fearful signs, which follow after that a Nerve is wounded, which are extreme pain, afflux of Humors, a Gangrene, a sharp Fever, Raving, and a Convul∣sion.

As for a Puncture, it is either not conspicuous, not to be discern∣ed by the sight; or it is conspicu∣ous: The first is called Punctura Caeca; the second, Punctura A∣perta: of the two, the Caeca is the worst; for local Medicaments cannot so well be applied to the part wounded.

Before I come to the cure of this particular Solution of Unity in Nerves, I will acquaint you with the general indications required in the cure of Wounds of Nervous Parts in general: First, Blood is to be let. Secondly, the Body is to be purged: See Galen, c. 2. lib. 6. Method. Aeginet. lib. 4. c. 54. these prevent the afflux of Humors. Thirdly, the party must use a ve∣ry slender Diet. Fourthly, we must provide that the Air which the Patient doth enjoy, be warm; for if Air be cold, a Convulsion must ensue. Peruse Apher. 15. Sect. 5. Wherefore when you dress

such Wounds, you are to use warm Cloaths and Stupes, and the Medi∣caments warmed.

Now to come to the cure of a Puncture in particular: if it be Punctura Caeca, these local Medi∣caments are apt. These Medica∣ments must be hot, drying, of sub∣til parts, to digest, dry putrefacti∣on, and attract. See Galen, lib. 6. Method. c. 2. & l. 3. secundum genera: such are Ol. Rutaceum, Chamaemelinum, Anethinum, Costi∣num, Liliorum Alh••rum, Ʋulpi∣man, de Castoreo, de Euphorbio, Lianbricorum, Hyperici cum Gum∣mi, de Scorpionibus, Terebinthinae. Galen advises, to use Sallet Oyl warmed, and applied with Wooll; old Oyl is best. Paraeus lib. 9. c. 38. ••dvises to add to it Aqua Vitae; for the thin and virulent Humor, which issues from the Nerve, is spent and dried the more. Galen, lib. 6. method. c. 2. & lib. 3. secun∣dum genera, commends a Medica∣ment made of Buphorbium, which is this: ℞ Cer. part. 1. Terebinthin. pic. an. part. dimid. Euphorb. part. 12. According to the tenderness or the hardness of the Body, more or less of the Euphorbium is to be used. You shall know your Me∣dicament to be proportionate to the grief; First, if the party feel a pleasant heat, as is that of the Sun in temperate weather: Se∣condly, if the party do pleasantly itch. If the party feel no heat, then there can be no attraction; if it be immoderate, it will attract Humors, and cause Inflamma∣tion.

If by the Application of these Medicaments, the Pain and other Symptoms cease not, then cross incision of the Skin is to be made, that the Medicaments in their full force may be applied to the pun∣ctured Nerve. When the Pun∣cture is either thus laid bare by In∣cision, or at the first by the wound∣ing Instruments; it is not requi∣site to apply to it Medicaments so hot and drying, and when it is hid to shun Inflammation: Wherefore your ordinary artificial Balsam dropped in warm will serve; for by this Unctuosity they smooth the part, by their Heat they make attraction, and so mitigate Pain by discharging the place of the Sanies, and by their Moisture they open the Orifice, and keep it open.

The Incision of the Nerve is ei∣ther streight and direct, or trans∣verse. If it be transverse, it is either quite cut asunder, or but in part.

A Nerve quite divided is less dan∣gerous, than that which is but on∣ly cut in part, according to Guid. Magn. Chir. tract. 4. docl. 1. c. 4. See Galen. l. 6. methed. c 2. Av. •• cen. l. 3. c. 4. Fen. tract. 4. c. 1, 2, 3, 4, 5, 6 & 7. The reason of this is, because a Nerve being quite cut asunder, cannot send any harm to the Brain.

A Nerve quite cut asunder can∣not admit any consolidation, ac∣cording to the first intention. See Hip. Aphor. 19. sect. 6. where he saith, when the Bone is wounded, or the Cartilages, or a Nerve, or the thin part of the Cheek, or the Praeputium, it doth not grow a∣gain or unite. He hath the like Aphor. 28. lib. 7. Arist••t. lib. 3. Histor. Animal. subscribeth to him: for these Parts are spermatick.

As for the cure of such a Wound, the Topicks which are used ought to dry with little mordication or biting, according to Galen, lib. 6. method. c. 3. & lib. 3. secundum genera. c. 2. such are Ʋnguentum de ca••ce lotà, & Ʋnguentum Dia∣p••mpholygos. If the whole Nerve be cut asunder, no Convulsion can ensue, because both the ends give way. This kind of Wound is cured easily by sarcotical Medica∣ments, whereof I have spoken here∣tofore sufficiently. In this kind of Wound the motion of the part in∣to which the Nerve is implanted to move, is abolished. If the Nerve be cut asunder but in part, first it is to be dressed with the Medica∣ments before prescribed; but if the Symptoms, as Pain, &c. and a Convulsion he like to ensue, the best course is to cut the Nerve or Tendon quite asunder rather than by deferring of the Incision to ex∣pose the party wounded to the dan∣ger of death. This being done, use Anodyne and desiccative Medi∣caments. When you have thus dressed the Wound above your Pledgets, either in Diapalma or Diachylon simplex in the Summer malaxed with the Oyl of Roses, Quinces, or Myrtils; for the ten∣derness of the part will hardly ad∣mit the application of any firm Emplaster. Last of all, you are to roll up the part with Fascia Expulsiva, whereof I have spoken in its proper place, partly to ex∣press the Santes which doth gather in the place, partly to stay the af∣fluxion of new Humors.

Now it is time to come to the Contusion of a Nerve. This may be either a solitary, or with some Solution of Unity. If it be solita∣ry then you are to foment the part with Sallet-Oyl hot, and to apply it with Wooll. If the Skin be divided, then Medicaments drying and uniting the parts are to be used. Such is Emplastrum Fodi∣cationis malaxed with Oyl of Hy∣pericum.

Last of all, a distortion may happen to a Nerve by a fall, ex∣traordinary motion, or some other violent external cause, which may hinder the motion of the part. In this case apply Emplastrum de mucilaginibus, or Diapalma, having Gummi Ammoniacum added to it.

After Contusion and Distortion of Nerves, a hardness often re∣mains, which causes a numness of the part. This proceeds from the setling of gross Humors in the place. In this case you are to use Medicaments which soften and di∣gest, as the Oyl of white Lillies, Goose-grease with Bd••llium; but the Oyl of Sheeps and Neats-feet impregnate with the Mucilage of Marsh-mallow, Linseed and Fenu∣greek, exceeds all other Medica∣ments. Let the part be embrocated with this Medicament warmed; and let Emplastrum magnum cum Gummi malaxed with Storax li∣quida be applied. Now it remains that I speak somewhat of accidents which usually fall out when a Nerve is wounded.

The first of these is an Inflam∣mation: you must meet with this by applying Medicaments, which are cooling and drying; for these both abate the Inflammation, and correct Putrefaction, such are

Bean-meal, Barley-flowre, the Meal of Vetches, Cich-pease, or Millet boiled with sufficient store of Oxymel, until they be brought to the consistence of a Poultice. But before you apply this Medica∣ment to the Member, embrocate it with Oyl of Elders, having min∣gled with it a little Rose-vine∣gar.

The second Symptom is Pain: Here you must use liberal Phlebo∣tomy, purging, and a spare Diet. If the party cannot admit Bleed∣ing, then Ventoses with Scarifica∣tion, Leeches, Vesicatories in the opposite parts; for a local Me∣dicament, use a Cataplasm made of Bean-flowre, Mallows, Groun∣sel, Violet-leaves boiled in Milk, and having Ʋnguentum Populeum mingled with the Cataplasm, when it is taken from the fire.

The third Symptom which may trouble both you and the Patient is a Convulsion: Of this Accident Hippocrates Aphor. 2. Sect. 5. so pronounceth: If a Convulsion en∣sue upon a Wound, it is deadly. But this must happen after too great effusion of Blood, as he ex∣plaineth himself in the next A∣phorism; for if a Convulsion fall out by reason of repletion, it is cured by bringing the Body low, by using the general curative means in that measure as the cir∣cumstances shall shew. If a Con∣vulsion happen, then you must em∣brocate all the Spinalis Medulla from the Head to the Coccyx with Sallet-Oyl warmed, and afterwards applying Rolls of Wooll, or a Sheeps-skin, newly killed, to the part: Then the Member wound∣ed is also to be dressed; so if the Wound be in the hand, you must begin to foment in the Arm-pits, by which the Nerves march, and then to proceed to the Vertebrae of the Neck and Breast with Oyl and Wooll. But if the Foot be wounded, then you must begin the Fomentation at the Vertebrae of the Loyns, and Os Sacrum, and so proceed to the ends of the Toes. It is not amiss to hold the whole Member in warm Oyl, as in a Bath, if it may conveniently be done. So much then of Wounds of a Nerve.

If a Tendon be wounded, you shall perceive it by these two Signs: The first is, if the Wound be near to the Joints, for the Tendons are the endings of the Muscles, and the ends of Muscles ever end ei∣ther at the Joints, or near to them. The second is, if the Wound be re∣ceived in parts which are not fleshy: such are the Backs of the Hands and Feet. As for the cure of these Wounds, the indications set down in the Cure of the Wounds of a Nerve will serve.

If Ligaments be wounded, see∣ing they are not so sensible as those of the Nerves and Tendons, they procure not so fearful Accidents: only drying Medicaments, and not too hot, are here to be used to con∣sume the Sanies, lest the Ligament rot. Stronger Medicaments may here be used, because a Tendon is not so sensible; in this case use Oyl of Mastick, the natural Bal∣sam, artificial Balsam, and dry∣ing and consolidating Powders; above apply Emplastrum Fodicati∣onis. In curing of these Wounds which happen to the Nervous parts, take heed that you use not a Fo∣mentation:

for that moistens and increases Putrefaction.

This one thing let me insinuate unto you, that if one be offered to you, who hath the great Ten∣don, inserted into the Heel wound∣ed, that you suffer him not to walk before it be perfectly united and skinned, for otherwise it will break open again.

CHAP. XXXIV.

Of Wounds of the Joints.

A Joint is the setting together of Bones for the perform∣ing of free motion according to Galen, lib. de Ossibus in Prin∣cipio.

Now Wounds of the Joints are made either by a Puncture or In∣cifion; and these are either in the upper compassing parts, or else they pierce to the cavity of the Joint. The Solution of Unity in the Joints is apparent to the Eye: wherefore it is needless to set down signs.

As for the Prognosticks receive these: All Wounds of the Joints are dangerous: First, because they are of an exquisite sense; by rea∣son of the Nerves, Tendons, and Membranes: wherefore sharp pains do ensue, which procure affluxi∣on of Humors, from whence spring Inflammations, Fevers, watchings; loathing of Food, Thirst, Convul∣sions, Gangrenes, weakness, and sometimes Death. Secondly, as all Wounds of the Joints are grie∣vous, so great Wounds piercing to the cavity are most dangerous, yea most commonly, if they be inflicted into great Joints, and the Aqua Articularis, the Joint∣water issue out. Of this Water, see Cels. lib. 5. c. 26. Par. lib. 9. c. 39. Lang. lib. 1. ep. in praef. & lib. eod. ep. 4. Plat. tom. 2. prax. fol. 782. & 933. & 737. After that this natural Humor is let out, then succeedeth the issuing of an excrementitious Humor. Celsus affirms it either to be a thin whi∣tish Ichor, or to be a glutinous and whitish Humor, like to white Honey, which he calls Meliceria. This term by him, lib. cod. 5. cap. 28. is taken for a kind of Ulcer. Pareus saith that this Excrement is sometimes thick and white, and sometimes thin. Langius liken∣eth it to Whey. Platerus a∣verreth it to be a waterish Ichor. This diversity doth proceed from the diversity of the temperature of the Bodies of wounded persons. It is cold and moist, and is caused of the elementary Juice, which is sent to no•• rish the Joint: but it is corrupted by the weakness and di∣stemperature of the Joint wound∣ed.

A Question may here be moved, why a greater quantity of Quit∣tour doth flow out of a Joint wounded, than out of another part, if the quantities of the Wounds be equal.

Many reasons may be alleged for this: First, the Pain which follows after a Wound in the Joint, is so grievous, that it makes a greater attraction of Humors: Secondly, the Joints are of a substance with∣out Flesh and Blood, and of tem∣perature cold, so that they cannot concoct the superfluous Humors which do flow thither, nor turn them to a laudable Quittour: Thirdly, by reason of their weak∣ness they cannot so forcibly repel the Humors flowing, as other fleshy Members can, by reason of their heat: Fourthly, their situati∣on furthers the admission of super∣fluous Humors much, they being seated in a dependent part.

As for the Cure, if it be a Pun∣cture, it is to be dressed as the Puncture of a Nerve or Tendon: Shun cold, relaxing, moistning and unctuous Topicks, unless Pain en∣force you to use Anodyne means. Cold nips Wounds, hardens the Skin, hinders Suppuration, ex∣tinguishes the natural heat, causes blackness, brings Aguish Fits, and Convulsions. Peruse Hippoc. A∣phor. 20. Sect. 5. If the Wound be procured by Incision, then either the brims are reasonable near one to another, or else they gape much, being much separate. If they be far asunder, then you must use stitching fust of all to bring the brims together; you must on∣ly stitch the Skin in Persons of ripe Age, but in Children you may stitch the subjacent parts; for in such they will admit Unition.

Galen. 2. de fractur. Affirms, that all parts of the Body delight to be covered with the Skin, which Nature hath provided for an uni∣versal cover. If this may be af∣firmed of any, it may be most justly pronounced of the Joints, for they have but small store of na∣tural heat, which may be extin∣guished, if the cold Air be suffer∣ed to pierce unto them; which is hindered by bringing the brims of the Wound together by stitching. When the Wound is stitched, there must be left a small Orifice in the depending part to admit a Tent, that the Quittour may be dis∣charged.

This being done, if the Wound pierce not to the cavity of the Joint, dress the Wound with some good artificial Balsam, having mingled with it a drying and heal∣ing Powder; such is this; ℞ Thur. san. Dracon. Myrrh. Aloes Hepat. Mastich. an. ʒ ij. Rad. Symphyt. Centaur. Major. Borac. Sarcocoll. an. ʒj. fiat pulvis, capiat Balsami ℥j. & pulv. ℥iss. Above apply Emplastrum Fodicationis, or this Cataplasm: ℞ Furfur. macri, far. Hord. & Fabar. an. ℥ ij. flor. Cham. & Melilot. an. pug. ij. Lixi. vii communis, lib. 1. Acet. Sam∣bucin. ℥ iv. coq. ista ad. cataplas∣matis consistentiam, tum addatur Ʋng. popul. Ol. Ros. & Myrtil. an. ℥ j. This is excellent to prevent Pain, or to asswage it if it be pre∣sent. All the Applications must be actually hot: for actual heat doth concoct and discuss excre∣mentitious Humors in the Joints and strengthneth them. If the

Wound pierce to the cavity of the Joint, the Medicaments must be very drying: first, because the Boues and Ligaments whereof the Joints are framed, are of their own nature very dry, and so require dry Medicaments: Secondly, be∣cause they have not feeling, and so may suffer very strong Medica∣ments: Thirdly, because plenty of thin Quittour is gathered in Wounds of the Joints, a very drying Medicament is required.

Use then greater quantity of the former Powder with the Balsam, or mingle it with Arcaeus his Liniment, and above apply the former Medi∣caments.

Let me give you notice of one thing, that in curing of a Wound of the Joint you have a special care of the position of the Member, for a perverse posture increaseth Symp∣toms, and bringeth Distortion, Numness, and Contraction sundry times, after that the Wound is cured. Wherefore if the upper part of the shoulder be wounded, a large Boulster must be put in the Arm-pit, and the arm carried in a Scarf to bear up the lower part of the Arm, that the brims of the Wound may the more aptly conso∣lidate. If the lower part of the Arm be wounded, you must carry it in a posture, mean between ex∣tension and contraction. And when the lips of the Wound begin to unite, you must cause the Pa∣tient to use a moderate motion of the Arm, lest it prove less plyable to motion, after that the Wound is cured. If the Joint of the Elbow be wounded, it must be so placed that it be neither too much con∣tracted, nor too much extended.

The German Chirurgeons here are very scrupulous in Wounds of the Musculus biceps, which they call die Mauss, or the Mouse, for the likeness it hath with a Mouse, for it hath a small tendinous be∣ginning and ending, but a thick fleshy Belly. They esteem the Wounds of this Muscle, which with the Brachiaeus doth bend the El∣bow, to be deadly: Thus I would have you to distinguish. It may be wounded both in the begin∣ning or Head and Tail, and in the Belly also. Wounds in the be∣ginning and insertion of it are most dangerous, because these parts are tendinous, and so of an exquisite feeling; it is double in the begin∣ning. If a Wound be inflicted in the Belly of this Muscle, it is less dangerous, because it is fleshy, yet a great flux of Blood may ensue, because it hath remarkable Veins and Arteries, and great pain, be∣cause it hath not small Twigs of the Nerve. If the Wrests or Joints of the Fingers be wounded, they must be kept half shut, moving a Ball in the Palm of the Hand; for if they be kept still extended they may prove unable to gripe when they are healed.

If the Articulation of the Hip be wounded, the Thigh Bone must be kept in its cavity, which may be done by laying the Pati∣ent on his back, and applying fit Boulsters and Rollers. If the Knee be wounded, it must be kept ex∣tended, if the party will not have the Member contracted after the Wound healed. When the Joints of the Toes are wounded, they are to be in their natural posture, not bending of them inwardly or out∣wardly.

To conclude the Me∣thod of curing of Wounds in the Joints, if they pass to the Cavity, although they be cured, yet the Member will remain stiff.

Seeing Wounds are accounted great for four respects: First, by reason of the greatness of the Solu∣tion of Unity. Secondly, by rea∣son of the Excellency of the part. Thirdly, by reason of the ill Con∣stitution of the party wounded. Fourthly, by reason of the grievous Symptoms. In the first and two last respects Wounds of the Joints may prove great.

And seeing Wounds may four manner of ways cause Death. First, if the office of the part be necessa∣ry, as that of the Lungs. Second∣ly, if the part be excellent, as the Brain. Thirdly, if the flux of Blood cannot be staid, as are the Wounds of the Liver, and the great Vessels. Fourthly, if evil Symptoms do follow, as appeareth in Wounds of the Bladder. Wounds in the Joints, most commonly prove deadly for the fourth cause.

Before I put an end to this Treatise of Wounds, wherein I have persisted the longer, because it is an object whereabout Chirur∣geons are most frequently busied, I will speak somewhat of Vulnerary Potions, because I have often made mention of them, and have set down the description of some in the cure of some dangerous and great Wounds.

As for their qualities they are drying, familiar to the natural heat, and radical moisture, and by a secret faculty they correct malignity.

The operations of them are these, they do purifie the Blood, cleansing it from all impurities, and excrementitious Humors, they cleanse Wounds and Ulcers also, they agglutinate broken Bones, and unite Nerves, they hasten the scaling of Bones; they procure the expulsion of strange Bodies in Wounds; they dissolve clotted Blood; they dry up superfluous Humidity, and withstand Putre∣faction.

Let no man wonder, that they have such admirable effects. We know that there are Meats and Drinks, yea Medicaments which are hurtful in some Diseases, and at some times, as in a burning Fe∣ver to drink Wine, or to minister hot or obstructing Medicaments: Shall we not then think that Na∣ture hath provided means helpful and profitable in Griefs, unless we will take her to be rather a Step∣mother than a loving Mother?

But seeing GOD, by his Provi∣dence did fore-see, that Man would fall and become mortal, and that Diseases (the means to bring a Man to his end) would increase; of his own goodness, he, from the begin∣ning, created means to second Na∣ture against Diseases, and to defer Death by prolonging Life by use of such things as are familiar to Na∣ture, and contrary to the Grief: such are Vulnerary Potions in Wounds.

The chiefest of the Simples are these: Scabious, Sanicle, Bugle, Mouse-ear, Burnet, Madder, Tan∣sey, Comfrey, Vervein, Bistort, Tormentill, Periwincle, Centaury the greater, Borage, Here-hound, Adders-tongue, Betony, Valerian, Ladies Mantle, Avens, Carduus

Bertedictus, the Cordial Flowers, Sp••edwel; Agrimony; the capil∣lar Herbs, Prunella, Osmund, Cla∣rey, Gentian, Herniaria, Scordium, Cats-Mint, Cinquefoil, Mead-sweet, Colts-foot, St. Johns wort, Plantain, Knot-grass, She epherds-purse, Yar∣row, B••ds of Briars and the Oak, Pyrola, Lunaria, &c. Amongst these some are hot, and some tem∣perate.

Those which are hot are not to be used until the seventh day be past, when Symptoms most com∣monly cease, and Concoction ap∣peareth: For they would heat and attenuate the Blood, and cause de∣fluxions. These Simples you may use two manner of ways: First, in Decoctions: Secondly, in Infusions, using Wine, Ale or Beer, as shall be thought fittest.

Let this be a Pattern of a De∣coction: ℞ Sanicul. Bugul. Scab. Beton. Nepetae, an. man. ss. Rad. Centaur. Majoris, Symphyti, Bo∣rag. an. ℥ss. Passul. Major. ex∣acinat. ℥ ij. Liquirit. ʒ vj. semin. Hyper. & Card. Benedict. an. ʒ iij. flor. Cord. pug. ij. Coq. ista in aq. font. lb viij. ad Medias, ac cole∣tur decoctum: Aromatizetur. de∣coct. Cinamom. ʒ v. Illíque addan∣tur. Mel. Ros. & syrup. Myrtin. an. ℥iss. Vini albi lb. ss. Dos. ℥iv. mane, & tantundem horâ quartâ pomeridianâ. Some of the fore∣named Simples may be boiled in the Patients Broths. Thus you may frame to your selves Decocti∣ons fit for the constitution of the party, the time of the grief, the part wounded, and the time of the year.

AN APPENDIX Concerning Chirurgeons Reports Before a MAGISTRATE, Upon their View of a Wounded PERSON.

SCET. I.

Whence the Reason of Mortal Wounds is to be taken, what Wounds are safe, and what indifferent.

SEveral there are, who up∣on a slight, or however not a Mortal Wound, contrary to all expecta∣tion die, which Case, when it comes before a Judge and Jury, may not a little perplex them, in determining the true Cause of the Parties death. Now if in the Verdict and Sentence the Aggressors are pronouced guil∣ty of uncertain Murther, Justice and the Laws are violated: But again should the Guilty be acquit∣ted, it would also be unjust not to give a Murtherer his desert. And because in such Difficulties Physici∣ans and Chirurgeons are often con∣suited, that Courts of Judicature may be their assistence proceed

more clearly in such Trials; my design in this Appendix to Wounds is, to shew by what Means and Methods it may be deprehended, whether the Party upon whom an Inquest sits, died of a wound recei∣ved, or the intervention of some o∣ther evil. Now, that this enquiry may be full, I shall first say something of the Mortality and other diffe∣rences of Wounds. Afterwards, how it comes to pass, that some∣times Men die of very slight Wounds. And last of all; how the Partie's death may be laid not so much to the Wound, as to several other occasions of it.

First therefore, in reference to my purpose, I make a triple dif∣ference of Wounds. Some are mortal: Some safe: And others are of a middle nature, which may be called dangerous. As for mor∣tal Wounds, though Hippocrates and Galen have plainly declared, what are so, and whence they are such: Yet because there are some, and those men of Note, who have introduced I know not what dif∣ferences of Wounds, whereby per∣haps some might be perverted in their judgment of things, I shall say the more concorning this matter. These men, as Franc. Valeriol. gener. med. cap. 8. write, that Mortal Wounds proceed not only from the nature of the wounded Part, but also from the Essence of the Wound, from its Magnitude, from a complication of Symptoms, and from the proper differences of Solution of Unity. But upon my consulting the great Masters of Medicine, and mature considerati∣on of things themselves, it appears that Wounds may not improperly be judged and called Mortal from the nature of the Parts alone. And indeed it is sufficiently evi∣dent, that the Essence of a Wound, which consists in the fresh Solution of Unity of some soft part, is the same every where: for a Wound is as much a Wound in the But∣tock as in the Heart, and bears the same Character and Nature. Wherefore, were it true that any Wound were in its Essence Mortal, all Wounds would always be Mor∣tal, and none Salubrious. Nor like∣wise is any Wound mortal from its magnitude; but only great or little; 〈◊〉〈◊〉 which differ much from Mortal: for oftentimes a great Wound may be safe, and a little one destructive. Yet, whereas they say, a Wound may be called Mortal from supervening Sym∣ptoms, this bears some semblance of Truth: for if grievous Symptoms supervene, every one knows, such a man is mortally affected. But in very deed no Wound has from the Symptoms any thing why it should be mortal: For suppose one were wounded in his Finger, and an Inflammation or Convulsi∣on arising upon it, he should die, must the Wound therefore be cal∣led mortal? So all Wounds might be said to be mortal: For, as Hip∣pocrates truly writes, 2. Praedict. Men die of all sorts of Wounds, though in ignoble places, and that they seem in nothing grievous. Therefore supervening Symptoms may bring Death; but they can never alter the nature of a Wound. For the same reason also, if after a man has received a mortal Wound in his Brain, he for all that recovers; yet a Wound can

never be constituted mortal for the presence of Symptoms, nor safe for their absence. And upon that score I conclude the nature of a mortal Wound from the Parts. Besides, Hippocrates, whose single judgment is to me worth a thou∣sand, in 2. Praedict. circa medium, 6. Aphor. and in Coac. Praenot. dis∣coursing much of Mortal Wounds, takes their differences from the nature of the wounded Part, and never from any thing else. And as to this thing, whatever I could hitherto get out of the nature of the things, the testimony of Au∣thors, and my own observations, the sum of all is this. All Parts that hold a Principality in the Bo∣dy, and are Fountains of the Fa∣culties, namely, the Heart, Brain and Liver, If at any time they be wounded, they make a Wound Mortal. I may also among these reckon the Stomach, for the great necessity of its Action, since the Ancients, as Q. Serenus Sammo∣nicus, calls it Rex Corporis. Nor would I exclude out of this rank the Spinal Marrow, as having much affinity with the Brain: For it is as another Brain to all the Parts below the Head. In the second rank I place all those Parts, which once divided never grow together again, and yet exercise some ne∣cessary action of Life; such as the Diaphragm, small Guts, and the Bladder. In the third I put such Parts as are endowed with an ex∣quisite sense, such as is especially the Mouth of the Stomach. And in the last place I put all such Parts, as may by their large effusion of Blood or Spirits destroy Life, such as the Veins and Arteries. But here you may stick a little in the Mire. For since invisible Wounds in these parts scarce ever bring Death, without the intervention of Symp∣toms, you might justly suppose that the differences of Mortal Wounds might be taken from the Symptoms. To this I say, that these Symptoms, through whose intervention wounded persons seem to die, do always follow the nature of the wounded Part. For if the Mouth of the Stomach be wound∣ed, Syncope, by necessary conse∣quence supervening, destroys the Party; so the wounded Brain kills by a Convulsion, Apoplexy, or some such Symptom; Arteries and Veins by effusion of Blood. Wherefore the whole reason of Mortal Wounds depends upon the very na∣ture of the Parts, and in their Wounds whatever Symptoms su∣pervene, they follow some cer∣tain property of the same parts. Besides, Hippocrates and Galen their distinction of Wounds into Mortal of necessity, and Mortal for the most part, if you consider it aright, seems to be taken from the very nature of the Parts. For those Wounds are Mortal of neces∣sity, which are inflicted on the more noble or very sensible Parts, or whose use is altogether expedi∣ent for the Animal: such are mortal for the most part, as are in∣flicted on less noble parts: And such are safe, as Galen says want danger, which tend, as much as in them lies, to recovery; but these have a great Latitude on the ac∣count of Majority or Minority. They that are in the middle place Galen calls dangerous; and he says, they are such as have an

equal tendency to Life or Death: Hither Wounds termed Cacoethe, or malignant, may be referred, to wit, such as are contumacious to cure: And such as the Learned have called indifferent, and of a middle nature. To this kind al∣so these Wounds may be reduced which we mentioned from Galen to be for the most part Mortal; but from which their slightness deducts much of the danger; such are they which slightly touch the extreme part of the Liver, or the Meninges. Thus much in gene∣ral, now I proceed to particulars, where all things shall be made more clear.

SECT. II.

In what Parts of the Body Wounds are Mortal.

THat Wounds of the Heart are mortal is one of those things, Galen says, that are taken for granted, and if the Wound reach to the Ventricle, presently the man must of necessity die of a great flux of Blood, especially if the left Ventricle be wounded. But if it reach not to the Ventri∣cle, and stop in the substance of the Heart, some continue that day, they were wounded, and the night following, and then die of the Inflammation.

Wounds of the Brain are mor∣tal upon two accounts; because it is a principal part, and Original of the Animal Faculty; and because it usually causes many and grievous Symptoms. For because it is a principal part, the Spirits are quick∣ly exhausted, and the harm is im∣parted to the whole Body: And grievous Symptoms proceed from inflammation, and from intercepti∣on of the Animal Faculty. By Wounds of the Brain I understand such as reach to its substance, and such as only reach to the Meninges. And the Nature of them is such, that if the Wound be not all the bigger, they do not of necessity, but for the most part carry a Man off. And lest I should be thought to speak without Book, I will give you some Authorities. I have seen, says Galen, a wounded Brain often cured; and once in Smyrna of Ionia a very considerable one: But this is very rare. He writes also, that this person received the Wound in the fore Ventricle of his Brain, but that he could not have recovered, had he been wounded in both. Many such things have happened since Galen's time, which seem to exceed all Credit. For Marcellus Donat•••• de med. hist. mirab. recounts ma∣ny instances of wounded persons,

in whom not only the coats of the Brain were cut and wounded, but the Wound had penetrated to the very substance of the Brain, and which is wonderful, to the Os basi∣lare. Nay, the very substance of it has sometimes been lost, to the quantity of a Hens Egg. I think, all things considered, wounds of the coats of the Brain are mortal (for the substance of the Brain must partake of their annoyance) yet not of necessity, but for the most part: For it has been observed, that several so wounded have esca∣ped, unless they fell into the hands of bad Chirurgeons. Wounds of the substance of the Brain are in like manner mortal; but more dangerous, and so fewer escape of them. And if the Wound be large and with loss of much substance, then either none escape, or if any one does, it is by a miracle of Na∣t••re. Amatus Cent. 3. cur. 83. has a remarkable History of a young Man, that received a wound in his Forehead, the point penetrating to the ventricles of the Brain, who yet recovered, without any Symp∣tome arising, because the Sword entred betwixt the very Ventricles of the Brain, its substance unhurt. For the Membranes that cover the Brain, under the right Suture of the Scull, descend double into the midst of the Brain, separating the right side from the left, by a ma∣nifest Interstice, so that if the Sword were thrust in just between these two Membranes, no wonder if the Wound were not mortal: for I suppose such Wounds to be of the same rank with those that only affect the Meninges, the Brain unhurt.

Some say, that not only a deep Wound of the Liver, but that part of it cut off has been cured. But such Wounds run much Blood, and therefore the party dies, who is so wounded, before the Wound can be agglutinated. For they that say shallow Wounds of the Liver, and the edges of it cut may be healed, seem in the right. Therefore Celsus saies, Wounds of the Liver are mortal only in the Portae, and that People seldom escape when the thick part of the Liver is wounded. And it is most certainly true, that a Wound is mortal only in the Convex or Concave part of the Liver: For as to the Limb, or edge of that Vis∣cus (for a Man's Liver has no Lobes) a Wound there is only dangerous; and unless inflicted on a Cacochymick Body, or on one that commits some error, it may easily be cured.

For the Stomach to be cut; Hip∣pocrates saies, it is mortal; thô Galen saies, some have made this Aphorism ambiguous: For some have been wounded in it, and rarely cured; yet if the Stomach be but slightly touched, it will ag∣glutinate. You may consult Mar∣cellus Donatus, who relates, how several wounded in their Stomachs, have recovered. But Cornelius Celsus writes that a wound in the Stomach is mortal. But I encline to Galen's opinion. And we must reckon accordingly in all these Wounds: For if only the outer coat be hurt, it easily heals; but if the Wound reach into the Ca∣vity, the cure will prove difficult. Also a wound in the bottom has lefs danger: But in the mouth of

the Stomach (which is very ner∣vous) any considerable Wound is desperate upon several scores, viz. of the excellence of the part, its singular Sympathy with the Heart and Brain, and its exsanguous na∣ture.

Wounds of the Lungs, if they be large, if they make a deep so∣lution of continuity, if they waste the flesh of the part, and if they offend the great vessels, and no∣table branches of the Vena arte∣riosa and Arteria venosd, must needs take life away, by the dissi∣pation of vital Spirits, and effusion of Blood, and by the clotting of the Blood which impedes circula∣tion. If the Wounds be small or mean, but not treated artificially, the case is the same. When the great vessels are not wounded, but only the Assera Arteria, or the Brenchia, such wounds do not kill suddenly, but certainly: For seve∣ral causes of death conspire, the sympathy of the Heart, dissipation of the vital Spirits, putrefaction of the Lungs, difficulty of cure, continual motion, and the Cough still enlarging the Wound. But if the less Blood-vessels be broke, or the flesh of the Lungs divided, the Wounds neither suddenly, nor of necessity kill a Man, unless the part be inflamed, thô more dan∣ger lies in a Wound of the sub∣stance, than of the vessels; be∣cause a firm Cicatrix cannot be made in it. But we must not for∣get what Galen 5. Meth. c. 2. saies, that wounds of the Lungs are in∣curable, not so much because the part is in continual motion (as those before him thought) as be∣cause, that Pus and Sanies are dif∣ficultly gotten out of the Lungs. Yet it has been observed, that when pieces of the Lungs have been brought up, the party has recovered. Celsus 5. l. c. 26. saies, the Wound is uncurable only when the middle of the Lungs is wounded.

Wounds of the Diaphragm, ac∣cording to the variety of its sub∣stance, have various Events: for if a Wound be received in the ner∣vous part, which is its centre, it proves mortal, its constant motion hindring consolidation. But if the Wound be in the fleshy part, which goes round the inside of the Breast, such an one has, as Galen saies, been observed to heal up, not∣withstanding its motion: Thô he alwaies thought the cure diffi∣cult, at whatever time an Inflam∣mation arose.

If any of the small Guts be wound∣ed, Hippocrates 6. Aph. 18. saies it is mortal. And if the Wound reach into their Cavity, Ga∣len saies, it is very seldom of the substance not only by reason of the substance of the Guts, but because we can∣not so well apply a Medicament to inward as to outward Wounds. But above all, we find the Jesu∣num most incurable, if it be wounded; because of the magni∣tude of the vessels, the thinness of the coat, its nervous nature, vicinity of the Liver, and suscepti∣on of Bile. Yet sometimes a Wound has been cured, when it has only touched the outside. But slight Wounds of the other Guts do heal up; because they are ve∣ry carnous: And they seldom kill, unless an Inflammation, or an Ileus supervene: But great Wounds and

transverse are mortal: because there is a great separation of parts, which are kept asunder by the continual passing of vitious Humi∣dities: and because there is no con∣venience for application of Medi∣cines.

Hippocrates 6. Aph. 18. sayes, A Wound in the Bladder is mortal. But here must be some grains of allowance. If indeed all its coat be divided, and cut through to the inside, with a notable Wound, the case is mortal; But a small Wound, experience has evinced; may heal up by the intervention of Flesh, and that exactly. If the Wound be incurable, it must be received in the nervous part: So we see daily that Wounds in the neck of the Bladder, where it is fleshy, made by cutting for the Stone, are cured. Yet it has been observed by some, that Wounds are seldom cured, if they be recei∣ved in that part, where the Blad∣der is tied to the Os sacrum.

A Wound in the Spinal Mar∣row is as mortal as in the Brain: for Galen saies, it is a kind of Brain to all the parts that are below the Head. It is such therefore because of the Nobility of the part, and of its nervous nature: Besides, many and grievous Symptoms pro∣ceed from thence: Its sympathy with the Brain, and neighbouring parts is great: It is difficult to cure: And the Wound proves the more mortal, by how much the higher it is in the Spine. For, as Galen saies very truly, if the Spinal Marrow be totally hurt in any of the Vertebrae, all the lower parts are resolved: But if only one side is hurt, and the other remain whole, the resolution seizes only on those lower parts, that are on the same side. This holds good as to the structure of the Parts. But if you consider the nature of the part, Wounds received in the lower part of the Spine are far worse than in the upper, since the Marrow be∣low is almost nervous; but above, it is far softer and perfect Marrow. As the excellent Anatomist Colum∣bus has observed. But such Wounds must be very great, to make them mortal: For one may be saved, when the weapon has not run deep in the Spinal Marrow. If the Mar∣row be cut quite asunder trans∣verse, it kills of necessity.

Wounds in the large Veins and Arteries, which are in the inside of the Body, prove mortal, such are the Vena cava, Magna arteria, the great Veins and Arteries about the Throat, in the Leg and Thigh, the great Veins in the Arm-pits, and Hams. Large Wounds in these must of necessity be mortal, by reason of immoderate effusion of Blood. And the party dies the sooner, by how much the less runs out of the Body; for then he is choaked. The nervous nature, and deep situation argue the diffi∣culty of Cure, when no Medicine can arrive there in its full virtue, Little Veins cannot so much ex∣haust the vital Spirits when they are wounded.

Slight wounds of the Aspera Arteria are sometimes cured; great ones are altogether mor∣tal. And people dye of such, not because the breath contained in the Breast, goes out at the Wound, but because being of a cartilagi∣nous nature, and in perpetual mo∣tion,

it can never be healed. It is observed, that they are the most grievous, if about the upper part of the Throat, where divers Nerves, Veins and Arteries encrease the danger. For if the Artery be cut any where else, it has a good event. And when people are taken with a dangerous Quinzey, some very grave Physicians do successfully prescribe cutting of it.

Wounds of the Kidnies, because many vessels are disseminated there∣about, and they receive a perpe∣tual afflux of Excrement, and have a necessary use for conservation of life, are generally mortal. Thô Ceisus thin••s them incurable. But some skilful Chirurgeons have observed, these Wounds, if deep, are very difficult to cure; yet if they reach only to the thick fleshy part, and are slight, the party sometime recovers.

Many have thought wounds of the Spleen to be mortal. But since it has been experienced, that the whole Spleen has been cut out of Animals, they still living and surviving; and since Aristotle has reported, that an Animal may be born without a Spleen: There∣fore unless some great vessels be cut, I do not think a wound in the Spleen mortal in its own na∣ture.

Sect. III.

By what tokens Parts, whose Wounds are mortal, may be deprehended to be wounded.

WE have, according to the best of our skill, de∣clared in what parts Wounds are mortal: Now we must produce some tokens, which set these Wounds before our Eyes. For in∣stance, suppose a Wound received in the Head or Breast, but no conspicuous signs to shew, whe∣ther the Brain or Breast is wound∣ed, then the cause of the parties death must be ascribed to some other thing than the Wound. Therefore we must not be igno∣rant of this in general, that marks of Parts disaffected are wont to be deduced from the Hurt of the acti∣on, Site of the Parts, from the Excreta, from the property of the Grief, and from proper Sym∣ptomes. So, if after a Wound Respiration be hurt, a prudent Physician will say, that either the Lungs or Breast, or the Vertebrae of it are hurt. But if Urine come out at the Wound, there is none but will acknowledge, either the Bladder or Ureters, or Kidneys

must be wounded. If Excrements, the large Guts. If Chyle, the small. As for the Site; if the Wound be received in the right Hypochondrium, the Liver may justly be suspected to be hurt; if in the Peclen, the Bladder: and so in other places the subject part may be suspected. The property also of the pain will ascertain you of the thing; for if the pain be dull, the flesh of the Liver, or Spleen, or Lungs is hurt: if rack∣ing and pungent, their vessels and coats: but if violent, you may say the Stomach, Guts, and nervous parts are wounded. Regard also must equally be had to the pro∣per Symptoms of each part: for a Phrensie, Epilepsie, and such accidents attend wounds of the Brain, Nauscousness, Vomit and Hickup, those of the Stomach: Respiration hurt, those of the Breast. But now to particulars.

When the Heart is wounded much Blood comes away: If it he the right Ventricle, the Blood runs black: If the Left, it runs more florid and light-coloured. The Arteries flag, the colour grows wan, Sweats cold and ill∣sented, and at length, when the parts grow cold, speedy death ensues.

If the Brain or its Membranes be wounded, Blood comes out at the Nose, and in some at the Ears; generally vomiting of Bile follows: Some have their Senses stupefied: The Eyes turn strangely in the Head: On the Third, or the Fifth day a Delirium follows; Many have a Convulsion of their Nerves: A peculiar violent Head-ach fol∣lows a hurt in the Membrane: which is enraged by shutting the Jaws, and holding ones Breath. The Eyes are hot, the Tongue salters; the Mind doats: but when the Brain is wounded, the Patient falls down; the Voice is lost, the Face is drawn, there is vomiting of Bile, and a white Humor runs out of the Ears, like Pap.

When the Liver is wounded, much Blood comes out of the right Side; the Bowels are drawn to the Spine, there is a delight to lie on ones Belly, a pricking pain runs up to the Throat; some∣times there is vomiting of Bile, the Patient turns pale, coughs, and is in a Fever; Stool and Urine comes bloody; and the Body at last consumes away.

If the Stomach be wounded, the Hickup and vomiting of Bile follows; the Meat and Drink is thrown up immediately; there are Swoonings; the Pulse fails; small Sweat runs off; the extream parts are cold; a most violent Pain; especially if it tend upwards.

If the Lungs be wounded, there is difficulty of breathing; frothy Blood comes up at the Mouth; there is a noise in breathing; the Party likes to lie on the Wound and then he speaks; if he lie on another part he is dumb. Paul says, if the Wound be wide, fro∣thy Blood comes out at it; if not wide, it comes up at the Mouth; the vessels of the Neck are raised; the Tongue is of a strange colour, they draw in much breath; they crave cold things; and if it conti∣nue long, a Fever and Consum∣ption kill the Man.

When the Midriff is wounded, the Praecordia are drawn upwards,

the Spine akes, they breath slow∣ly. Paul affirms, that the breath∣ing is large, with sighing, and pain all over the Shoulders.

When the Guts are wounded Meat and Drink come out at the Wound, the Praecordia swell; Sometimes Choler makes a way at the Mouth: If the lower Guts are wounded, the Excrements and Smell shew it.

When the Bladder is wounded, the Groins do ake, they swell above the Os Pubis; Blood comes away with the Urine, and Urine runs out at the Wound, the Stomach is disaffected; therefore they either vomit Bile, or have the Hickup; they are cold, and then dry.

If the Spinal Marrow be wound∣ed, the Nerves are paralytick, or convulse; Sense is lost; at times the lower parts void either Seed, or Urine, or Ordure.

If the Veins or Arteries, which are deep in the Body be wounded, the Veins pour out abundance of black Blood, the Parties wax pale, and their death is sudden? The Arteries pour out thin, yellow, and frothy Blood, the Pulse alters, and Death quickly ensues.

When the Aspera Arteria is wounded, it bleeds but little; there is great pain backwards; the Throat is by little and little filled with Blood; the Voice is hoarse, and the Tongue is dry.

When the Kidneys are wound∣ed, the Pain reaches to the Groin and Testicles; there is difficulty in making water, and it is bloody, or all Blood.

When the Spleen is wounded, black Blood proceeds from the left Side; the Praecordia and Sto∣mach grow hard on that side; Thirst is violent, and there is Pain in the Throat, as when the Liver is wounded.

And these are most of the Signs, whereby you may easily find, whe∣ther the parts of the Body, whose wounds we have declared mortal, be wounded. If none of these signs appear, you may conclude none of these Parts are touched; and you must seek for the cause of the Disease somewhere else.

Sect. IV.

What Wounds may be called safe, and what dangerous.

WE said that those Wounds were safe, which are in their own nature without dan∣ger, and in general they are such, as are received far from the afore∣said parts: Of which kind Celsus makes those to be that only wound the flesh; but in the same Au∣thor's Judgment these same are sometimes worse, sometimes bet∣ter. For whatever Wound is large, creates danger; and that is worst, which is beaten against a thing, or out of which something is cut; or when the flesh is part cut away, and part hanging on; a Wound is worst that is round; the safest, that is in a right line. Besides, a Child is sooner healed than a Youth or elder Person: a strong Man than an infirm; one of a middle habit, than one very gross or very spare; one of a sound habit, than corrupt; one of much exercise, than an idle person: a so∣ber and temperate Man, than one given to Wine and Women. The most seasonable time for cure is the Spring, or such as is neither hot nor cold; therefore Autumn is most pernicious. And these are the things that render Wounds, which are in themselves safe, dan∣gerous. Thô in reality they ne∣ver change their Nature. For if only a fleshy part be wounded, the Wound is in its own Nature safe; and if any danger arise, some∣thing else is in the blame. Wounds of a middle Nature, if we may be∣lieve Guido, are such as are recei∣ved in the heads of the Muscles, in the Scull, in the Breast and Bel∣ly. And Galen says, That all wounds of the Nerves and nervous parts are not indeed mortal, but only dangerous. In another place he says, they are dangerous, that have an equal tendency to death and life: and he calls them doubt∣ful. It has been observed by ma∣ny skilful Men, that Wounds under the Clavicle, and the inner process of the Scapula are formidable, and full of danger: for beside the Ba∣silick Vein and Axillar Artery, there is the fifth pair of Nerves, which run from the Vertebrae of the Neck to the Arms. Of this kind are many of those Wounds, which Celsus writes, difficult of cure, viz. in the Arm-pits and Hams; about the Anus and Testi∣cles; in the Thighs and among the Fingers: and any Wound that has hurt the head, or end of a

Muscle, a Nerve, Artery, Mem∣brane, Bone, or Cartilage, In this respect wounds in the Neck are dangerous; for often it so falls out, that some remarkable Nerve or Tendon is thereby hurt especi∣ally if the wound reach to the Spinal Marrow. It has been also observed, that wounds which are near the Navil (for thereabout lie the perforated Tendons of the oblique and transverse Muscles) are not without danger; thô they reach not deep. And such as are received in the back part of the Breast: for thô they reach not the Cavity; yet because thereabout no small Veins and Arteries, and many Nerves are dispersed, they are dangerous. Whenever Joints are wounded, they import danger, by reason of the Tendons and Li∣gaments that are found there, for wounds in these parts use to pro∣duce malignant Symptoms, espe∣cially if the inside of the Arm be wounded. Of this nature are the Arm-pits, the bending of the El∣bow, the inside of the Wrist; and the outside of the Leg: for in these parts there are great Veins, Arte∣uies, Nerves and Tendons, which usually occasion Bleeding, violent Pain, and several other mischiefs. But if nervous parts are wounded (because this requires a skilful con∣jecture, and no small diligence in a Chirurgeon) you may easily know it in this manner. When a Nerve is either prickt or cut, Mo∣tion, and sometimes Sense is lost, or at least hurt; and there is a nu••••ess in the parts under the wound; Pain is violent; the part 〈◊〉〈◊〉 inflamed; and by consent with the Brain a Delirium often arises: A Convulsion often follows; and that oftner when the part is prickt, or partly cut, than when it is quite cut asunder. The same signs, but more obscure, happen in wounds of the Tendons and Membranes, which invest the Scull and the rest of the Bones, especially when the Ligaments of the Joints are cut. We said also, that many of those wounds, that are for the mostpart mortal, may be reckon'd among these, i. e. when they are small. If therefore the Lungs in any part, the thick of the Liver, the Dura Mater, Spleen, or Womb be but slightly wounded, they are in this rank. And whereas I say, Wounds of the Nerves are not mortal; be∣cause some Men doubt of the mat∣ter, I shall maintain it by Reason. In the first place we must take notice of this from Galen, that under the name of Nerves, both the Nerves themselves arising from the Brain and spinal Marrow, and the Ligaments and Tendous are comprehended, of all which he calls the Wounds malignant and dan∣gerous, never mortal: And those that are so wounded, are so far from dying for the most part; that they oftner recover.

For (says he) not one died of a wound of the Nerves: wherefore he that joyns experimental Anatomy, and the use of Medicaments, he may al∣ways, as we do, cure wounds of the Nerves without any danger; so that no principal part may be drawn into consent; nor the wounded, or contused Nerve la∣bour of an Inflammation; or if they should come, much less shall either Putrefaction, or Lame∣ness, or Convulsion, or Death

ensue.

Besides it has been proved before, that mortal Wounds can be inflicted only on those parts, that are either principal, or af∣ford a necessary use to the Animal, or such as are endued with an ex∣quisite sense, or destroy strength by large bleeding. Now consider every particular, and you will find the Nerves none of them: For they are not of such an ex∣quisite sense, unless where there is a concourse of many sensitive Nerves. You see an Hand, an Arm, a Leg and their Nerves cut off without loss of Life; therefore without doubt Wounds of the Nerves should not be ranked a∣mongst mortal ones; but only among the dangerous. This also is to be observed, that the great∣ness and smalness of the Wound makes no small difference. For Nerves, which have their Original from the Brain immediately, or mediately from the interposition of the Spinal Marrow, are more apt to cause Convulsion, than Ten∣dons, which are made up of a Nerve and a Ligament: But a wounded Ligament, if it be one that proceeds from one Bone to another is not so dangerous; but if it insert it self into a Muscle, the more of Nerve there is in it, except it be very carefully lookt after, the more danger there is in it, than in other Ligaments. Thô, I confess some people may be met with, who have such exquisitely sensible Nerves, that upon a slight Wound, especially in the top of the Spine, they not only die, but that suddenly.

SECT. V.

Of what nature Wounds of the Head may be reckon∣ed to be.

A Question may arise con∣cerning Wounds of the Head, that are only in the cutane∣ous part, or make bare, or break the Bone, but do not hurt the Menynges, what such they are, whether they be altogether safe, and without danger, or dangerous and of a middle nature? For it is an Argument they are safe, be∣cause inflicted in a carnous part, or in the very Skin, no Principal, or Nervous, or any such Part being offended: But it is an Argument they are dangerous, because near the Brain, and they put a Man in more hazard, than any other parts, when wounded. For my own part, I am of opinion, that Wounds of the Head have I know

not what peculiar to them, and different from divers others, so that one must have a great care, how he gives his judgment in them. For they produce many and grie∣vous Symptoms, the like whereof seldom occurs in others; so that the great Hippocrates might very well leave us a whole Book of Wounds of the Head. And there are seve∣ral things, which admitting a pa∣rity in others, do shew, that these Wounds are worse and more dan∣gerous than others; namely, the nature of the Part, aptness to mi∣stake, and difficulty of Cure. For the Skin (to speak of that first) which is very thick, moist and rare, is exposed very much to the injuries of the external Air: For since the the ambient Air is in its own nature always moister and colder than the Skin of the Head and the Bone underneath; no wonder, while it is whiffling up and down the Wound, if it be able to convert the natural tempe∣rament of the part to immoderate moisture: Which is more readily done, if the wounded party live in moist and therefore unhealthy places; especially if the Skull be laid bare or opened, so as that the Menynx appears. Besides the Skin of the Head has a manifest con∣nexion with the Pericranium, and receives Nerves from the first and second Veriebrae of the Neck, and from the third Conjugation of the Brain, which are disseminated all through its substance: for which reason Paraeus thinks, that Wounds, Contusions and Apostems of this Skin should be treated with all di∣ligence. And the construction of the Head is such, that whatever Disease is contracted in the Skin, it may easily by a breach in the Skull, or by the next Sutures be communicated to the Menynges, and the Brain it self. Besides, its constitution is such, that, as Hip∣pocrates writes, the Bone may be clest in another part, than where it is struck, which they call Resonitus cranii, or Contrafissure. More∣over Avicenna professes, that the Skull is often broken, the Skin re∣maining whole: And Celsus says, that the Bone is perfectly whole, yet by the blow some Vein in the Membrane of the Brain is broke, which bleeds. In these Cases the most diligent Physician is at a stand what to do. And Chirurge∣ons oftentimes are more then a lit∣tle mistaken in curing such Wounds, unless they be both learn∣ed and well experienced. For it is usual with them, while they en∣deavour to alter the coldness of the Ambient Air, not only to stifle the room with woollen Curtains, but in the middle of Summer to kindle a fire in it, and omit no∣thing that may cause heat, which may easily occasion a Fever and Inflammation. Nor do they know that Hippocrates, when he had commended a hot Season for other Sores, yet for those in the Head he commends the time of Aequinox. Then they often rashly dilate the Wound with many Sections; cut the Veins, Arteries and Branches of the Nerves with Instruments and their Nails, and tear the Peri∣cranium; which is of great use. This is a certain Nervous Mem∣brane arising from certain Li∣gaments sprung from the very Menynx, and some thin Mem∣branes

which come out at the Su∣tures, and join the Dura Menynx with the Cranium. Mistakes also are often made about the Sutures; while they mistake the dents that are made by the Weapon for na∣tural Sutures, and open them not, which is a work absolutely ne∣cessary. Thô in this fault they have Hippocrates for their compa∣nion, in the case of Autonomus 5. Epidem. which makes the mi∣stake less dishonourable. They are much more to be blamed, who mistaking the Sutures for Dents left by a Weapon, rashly trepan; and so endanger the Patient. And there are other mistakes, common to other Wounds, which are of more danger in these. The diffi∣culty in curing makes these Wounds also more dangerous: For, as Galen says, you cannot adapt that Ligature to the Head, which reason has invented to pre∣vent Inflammation, especially in other parts: Therefore you can neither repress the affluent mat∣ter, nor express what is contained in the sick parts. Besides, since the Bone of the Skull is very dry, and adjoining parts moist, it is a difficult thing equally to preserve the natural temperature of them all. Which has caused a difficult controversie among Physicians, whether driers or midling Medica∣ments are proper in the cure of the Head? From all which things Hippocrates might very well deter∣mine, that no Wound of the Head should be slighted: for only a Con∣tusion of the Skin, unless it be carefully handled, may cause a Fe∣ver, and create the Physician much trouble, and the Patient much danger. I conclude therefore, that Wounds of the Head are no ways safe, but altogether dange∣rous; especially such as reach to the Bone, and lay open the Me∣nynx. For they have place among Nervous Wounds, which I have said are dangerous. Yet I advise you, in giving of your Judgment, dili∣gently to observe the natures of Climes and Places, and other pro∣perties. For in a City low situated, and where many use to die of such Wounds, you must pronounce them dangerous altogether: But in a City high situated, and in a wholesome Air, you may say they are dange∣rous, but not so very dangerous.

SECT. VI.

How it may be determined, whether a Man died of his Wound, or of some other cause?

THings being in this manner stated, it will be no great difficulty to deprehend, what I pro∣pounded in the beginning, i. e. Whether a man died of his Wound, or something else occa∣sioned his death? For if the Wound, under debate, be known to be mortal (whether of necessity, or for the most part it be such) without doubt the blame is to be laid on the Wound. If it be safe and without danger, the Man's death must be imputed to some∣thing else. But if Wounds be of the dangerous and middle sort; as they are of a doubtful nature, our judgment concerning them should be such: For if they be great, they themselves occasion death; if little, it must be im∣puted to something else. Thus therefore, if a great Wound be re∣ceived in the Joint, which has cut or torn the Tendons, Nerves and Vessels, althô of it self it be not mortal; yet because it is full of danger, and admits of no errors without harm, and requires a most exact cure, to be managed with all care and diligence, which Physicians are not every where, thô they do their duty, able to perform (for never to mistake is above Humane Capacity) nor can the Sick every where observe an exquisitely-regular Diet. There∣fore if the Party die, you will not do amiss, if you report the Wound to have been the cause of his death; unless some egregious error has been committed in the cure, whe∣ther the Chirurgeon, or Patient, or any thing else occasioned it. Then indeed the Aggressor is much excused: for tho without that error the wounded party might have died; yet because the case is dubious, and where any doubt is, the conjecture should al∣ways be in favour of the Criminal, whatever the error were, it must be said to have caused the parties death. Concerning Wounds of the Head, which have something peculiar in them, as we have shown before, you must make report in this manner. First, consider with your self, how the Air and Salu∣brity of the place stand affected toward Wounds of the Head; and if you find, that in all Seasons people die of these Wounds, all Wounds, where there is occasion

to open the Skull, must be reckon∣ed among the very dangerous; and such, unless some egregious and plain error have been committed, must be concluded to have occa∣sioned death. Other Wounds, thô they be dangerous, draw nearer to the nature of safe ones. But when the Salubrity of the Clime abates the danger of these Wounds, then all Wounds of the Head, so that the Membranes be not affected, even if the Bone be broke and perforated, must by no means be ranked among the very dangerous: Except much of the Skull be taken away: For then, because it is impossible for the Membrane not to be hurt, you must account such Wounds dan∣gerous. Hence therefore it may be determined, which I find to be the Opinion of grave Lawyers, (T. in. l. si ex plaga, ff. ad leg. Aquil.) if a Servant not mortally wound∣ed die (by mortally, I mean very dangerously, as in great Wounds of the Joints) the Case will be an action of Battery not Murther. Wherefore Guido, an ancient and learned Physician thinks their Opi∣nion vain, that say, a Man would never die, thô he offend in the course of his living, unless he had received a Wound: So that they seem to lay ones Death to the Wound, thô never so safe, and without danger. But I shall confute their error by and by.

SECT. VII.

How it comes to pass, that Men die of small Wounds, and such as are not mortal.

NOw I undertake to declare, how wounded Persons die, not so much of their Wounds, as of some other cause, which is a thing that falls most under Con∣troversie. I find six causes of this unhappy event. The first is, when the wounded Party is of a Cacochymick Body. The second, when the wounded Part is some way weak and infirm. The third, when Men offend in their way of Living. The fourth, a bad constitution of the Air. The fifth, the Chirurgeon's negligence. The sixth, some uncertain Acci∣dents, which cannot be reduced to Method. I shall demonstrate all particularly. As to the first; sup∣pose a Wound be inflicted on a Body full of bad Humors, such as are the Cachectick, People trou∣bled with a Leprosie, the Pox, Dropsie, Consumption, and such

like; and that not in a principal Part neither, but in a carnous, and one not liable to danger: No Man is ignorant, what sharp Pain, great Inflammations, Fevers, Convulsions, and other bad Symp∣toms do thence arise, the Humors flowing in every way into the wounded Part. Nor can any Man doubt of the second: For if a Man, for instance, get but a little Wound in a Joint, which had not long before been troubled with a Defluxion: or if a Part once wounded, be offended in the same manner again: or if there be some peculiar disposition and constituti∣on of Body, which naturally dis∣pose a Man to some certain sort of Disease; is not a small Cut able to put such a Man into great danger of his Life? And errors com∣mitted in Diet, what do they not pervert and deprave, if after a Wound received, a Man cram him∣self and drink Wine; if he addict himself unseasonably to Venery; if he perplex his Mind with Cares, and his Body with unseasonable Exercise? But how frequently is there a sickly constitution of the Season abroad, which may irritate and exasperate even a small Wound, whether manifest intem∣perature, or the aspect of some unhappy Star occasion it? For from thence, even upon a slight occasion, Inflammations, malig∣nant Fevers, and other formidable Symptoms are deduced. I re∣member this has happened even in my time; and several Ages be∣fore have seen it. Therefore Hip∣pocrates does well advise us, to consider in Diseases the strength of Epidemick Diseases; and to know the condition of the Season. Perhaps Paul reckoned this among the latent occasions; for when he had said, that an Inflammati∣on happens in Wounds from the strength of Liniments, from Cold, much Eating; or from drinking of Wine, he then subjoins, or from some other latent occasion; which I think may not be understood amiss of a certain constitution of the Heaven, which Hippocrates called Divine. I need not say much of the Chirurgeon's igno∣rance or negligence, I should ra∣ther condole the calamity of the Age, wherein a sort of unlearned Men, and ignorant Barbers are called to cure Wounds, who the less they know of Learning, the abler Practitioners they take them∣selves to be, impudently vaunting that Learning is a hinderance to their Business. The last Reason, that often exasperates a slight hurt, depends on fortuitous Accidents; as if the Weapon which gave the Wound were rusty; if the Lint, which was used to the Wound were infected with any bad quali∣ty; if any hurtful thing fell into the Wound; if bad Medicaments be applied; and several other things which I know very well put a Wound into a bad conditi∣on. And these are the Causes, why a small Cut may much en∣danger a Man. And Hippocrates does not obscurely intimate this, when he says, that Men die of all sorts of Wounds: for many Wounds are seen in ignoble, and no bad places, which yet cause death, and no wonder; for the Souls and Bo∣dies of Men do much differ, and are of great force. But because

these are Generals, I shall instance in some particulars of such as have died of slight blows. 5. Epidem. circa finem, Hippocrates says, that Philes son upon a small denudati∣on of the Os Frontis, a Fever arising the ninth day, died. Be∣sides, a fair Maiden, the Daughter of Nereus, being struck with a flat hand on the Forehead by a Woman, her familiar, as they were a play, died the ninth day. Also the Master of a great Ship, having broke a Finger with the Anchor, died of it. A Boy, the Son of Metrophantus, being struck by another Boy with an Earthen Pot on the Head, died, because he scratched the edges of the Sore. And some of the most learned In∣terpreters of Hippocrates do hold, that all these died, either through the mistake of the Chirurgeon, or because of a bad habit of Body, or by reason of an unwholesome Season.

SECT. VIII.

On what days the secret Malignity of Mortal Wounds uses to shew it self?

THat nothing may be wanting about this Affair, it will be∣hove you to observe some term of days within which some latent mis∣chief from a Wound, if it have lain lurking a few days, must shew it self. If Mortal Signs do long postpone; you cannot then of right blame the Wound; but something else. Guido, a man of great experience, in his general Speculation of Wounds sets three terms, wherein Mortal Signs show themselves; the Seventh, Ninth and Fortieth. Tagaultius in this, as in all things else, follows him; only instead of the ninth day he puts the fourteenth. Some of the most skilful among the Moderns for the first days of the Wound suspend their Judgments; nor do they give their opinion of the quality of the Wound before the ninth day is over: for they say, within that time gentle or horrid Symptoms usually shew them∣selves, according to the conditi∣on of the Wound, the party hurt, and the ambient Air. Nor with∣out reason: for the ninth day, as Plutarch testifies, is judicatory of Diseases; and he says, that Achilles knew, the Pestilence in the Army had no vulgar cause, because it exceeded the ninth day. But thô I deny not these things to be true; yet they create not Science. Therefore the best way is to pitch

upon some Method at the pre∣sent, whereby a Chirurgeon may make perpetually a pretty sure conjecture concerning Wounds. Hippocrates, lib. de vulner. Capi∣tis, affirms, if a man have broke his Skull, and commit an error, if it be neither raspt nor perfo∣rated, a Fever seizes him before the fourteenth day in Winter; but about the seventh in Summer; and if all things persevere bad, in Summer he will die before the seventh, and in Winter before the fourteenth day. From which passage, I think, I shall be able to gather the true way of judging: For he says, that bad Symptoms begin and death happens later in Winter and sooner in Summer. And as this is most certainly true, I am able to give no other reason for it, than that in Winter our heat is more vivacious and strong; and therefore resists nocent causes the more; for the Ventricles are by nature hottest in Winter. On the contrary, since our strength is easily spent by the ambient heat, it so happens, that then we are most liable to morbid injuries. For the same reason, if things hap∣pen otherwise than well, I say, that mortal Symptoms are longer in appearing in a strong Patient ••han in a weak one: for as strength retards the approach of death, so does it of grievous Symptoms. How∣ever therefore as by Age, Complexi∣on, Sex and Time of the year the Strength is firmer, the longer will the Symptoms and Death be in ap∣proaching. So if a young Man of a good constitution, and in perfect health receive a Wound in Winter, whose event may prove hazardous, I would wait for the be∣ginning of the Symptoms on the fourteenth day before I would give my judgment; which if they per∣severe, I would predict death, on the next critical day, or on some other, according as the malady proceeded flower or sharper. On the contrary, if an old Woman be wounded, who is of a cold and dry complexion, and of a bad habit of Body; I guess the Symptoms in reference to the Wound would arise about the seventh day. And thô Hippocrates says, that in some Diseases, young people die sooner than old, it holds true indeed in spontaneous and violent Diseases: for old people generally die more of the tediousness of a Disease, and of a relapse, than of the violence of it. But in Wounds it is as we said before. And that you may not be rash in your judgment, we have given you both the nature and times of Wounds.

SECT. IX.

How one may know, whether a Man died of a Blow, or Contusion, and some Opinions about it.

THat many die suddenly of beating and Contusions, is so evident by several such sad E∣vents, that I need say no more of that: But if the manner of ones death be unknown, it is not yet agreed by what way and means it may be found out. The vulgar Opinion is, that Wheals, and black and blew Spots (these marks are made, when the little Veins, that are disseminated under the Skin, being broken and cut, do pour out Blood, which afterwards be∣ing out of its natural Vessels, con∣tracts a livid colour) are the only evidence of blows received. But I think, they are much out: for every bruised part does not always appear black and blew, unless it be endued with Veins, and those not lying deep. If a bruise happen (as Avicenna says) in Nervous places; or in any other but Fleshy, you shall neither find redness, nor any Ecchymosis. Besides, you may of∣ten find blackness and blewness in the Body of such as died of Poison, and of internal and sponta∣neous Diseases. And Hippocrates himself, l. 1. de Acutor. Regimine, says, in Pleuriticks, who die of taking Ptisan unseasonably, their side looks livid, like a bruise. And 4. Epidem. he says, one that died of a Dropsie, had his Hypochondria look red, as if his Body had been beaten with stripes. And 5. Epid. Nicolas his Son, when he had been ill of a burning Fever, and died the seventh day, his Posteriors ap∣peared red, when he was dead. Now the cause of this Symptom (for I think it is worth the know∣ing) seems to me to be the effort of Nature; which she violently ex∣erts in Extremity. For she thrusts the Blood thither, which being destitute of vivid Spirits turns livid. Paraeus also has observed, that in some, after death, spots (called Peticulae) appear before the Hu∣mors are cold, which are signs of Putrefaction. Therefore spots are no certain evidences of blows re∣ceived. There are some also who think voiding of Blood is a perpe∣tual sign of such a death. But they are out: for I have seen some, that died of an internal cause, who spon∣taneously bled, as they were about to be buried. Therefore we must ascertain our selves from some∣thing else, if possible.

SECT. X.

What are the chief Signs of such, as being beaten died, but of no conspicuous Wound.

NOw therefore we declare our Opinion of the Matter. A∣vicenna says, a Fall and hitting a∣gainst a thing (hither you may re∣fer Blows and Bruises) hurt Mens Bodies two ways, and cause death, namely, either because they tear the Bowels, the Coats, Nerves and great Vessels, or because they occasion Pain; to which I add a third, which is proper to a blow on the Head, because it produces most grievous Symptoms in the Head, an Apoplexy, Catochus, and the like, occasioned by the con∣cussion and compression of the Brain, and interception of the Ani∣mal Spirits. Things therefore standing thus, my opinion is, when a violent blow upon a part, under which some great Ves∣sel lies; as the Epigastrium, in which great Veins and Arteries are contained, that Blood will be voided by Excretion out of the Breast, or by the urinary Passages. But if it so happen that the Mouth of the Stomach receives a blow, because a hurt in that part uses to kill Men with the pain; it is not necessary that Blood come a∣way; nor likewise must you ex∣pect such a Sign in every blow on the Head. For the Head may be so weak, that the slightest blow may endanger one. Such a con∣stitution of the Head had he, that died of a box on the Ear Apo∣plectick, and the Maid in Hippo∣crates, mentioned before, who died of a flat blow given her in jest by a Woman upon the Forehead, be∣ing taken with a Vertigo and want of breathing. But it is otherwise, when one receives a violent blow on the Head; I grant Blood may come out at the Ears and Nose. Wherefore I think it is evident from what has been said, that they who die of a blow, do generally void blood; but this is not always necessary; for a blow on the Sto∣mach or on the Forehead, which according to Hippocrates is the weakest part in the Head, and has most danger in it, and on the Temples, which are also weak, does not always bleed. Nor must we conclude there has been a blow, if blood do come; for I have of∣ten observed it in such as have died of internal Diseases, especially of malignant Fevers. Since there∣fore the true Signs of a Mans be∣ing beaten can neither be had

from spots nor bleeding, we can determine nothing for certain. Thô when these two Signs ap∣pear, and there was no other ma∣nifest occasion of death, then there is suspicion of a blow.

SECT. XI.

How many ways People may be suffocated by an ex∣ternal Cause?

IT has been observed that several, who have been secretly suffo∣cated by their Enemies, do not presently afford any sign of a vio∣lent Death. Wherefore he that is called to judge of such Persons, and is not well verst in such Mat∣ters, will either rashly flie to some internal fault, or he must need say much to little purpose. There∣fore I will say something of this thing. By suffocation for the present I mean that sort of Death, which is accomplished by some external violence, hindring the Office of Respiration. This is caused either by drowning; or by a violent stopping of the Mouth and Nose; or by a String; or by inspiration of a strong and hot Air. And you may know them all thus:

SECT. XII.

What are the Signs of external Seffocation?

YOu geneerally find drowned People thrown upon the Shore, or lying in Wellsand stand∣ing Waters. But if the subtilty of Man should endeavor to re∣move all suspicion of the Crime; yet an unusual swelling and flabbi∣ness of the whole Body cannot be hid; the Belly also will swell; some mucous Excrements will

come out at the Nose, and froa∣thy stuff out at the Mouth; the Fingers ends are worn: for they that are drowned, endeavour to get out, and scrabble in the Sand, and so wear their Fingers. Where∣as, I say, that drowned Bodies are swollen; it is not so much by sucking in the Water, or by any Water contained therein, as by a Vapor, into which the Humors are turned by a putrid heat, there∣fore this swelling shows not it self, till after some time. There is another Suffocation, in some places more frequent, which is acted by shutting the Nose and Mouth vio∣lently, or by a strait cord. And that you may have no trick put upon you in this, take it as a ge∣neral Maxim, that it is a Sym∣ptom common to all who have the use of Inspiration stopt, for them to froath at the Mouth: for the expiration of fuliginous Excre∣ments being intercepted by a Cord, or otherwise, they are all violent∣ly impelled; whence it comes to pass, that part of the proper hu∣midity is expelled together with them, as you observe in letting Blood. But if one be strangled with a Rope, the print of it will appear either black or red, especi∣cially where the Rope crosses. The Head of the Aspera Arteria is often bruised, and there is a luxa∣tion of the second Vertebra of the Cervix; the Arms, Legs and Face are livid; the Breast is swollen, and the Urine is volded. Of all which things this Reason may be given. The swelling of the Breast is caused by much Vapor raised by containing the Breath within; the passage of the Urine by an un∣equal straining of the Muscles, which conspiring for the common safety are contracted towards their Original; and therefore make way for its passage. Also the Face is not pale, but of a violet or pur∣ple colour. But if you have a mind to search more narrowly, you will find the diffected Lungs full of purulent froath, and all the other Viscera in good order. And Anatomists in opening such Bo∣dies do find the Head and Breast full of Blood. But if the Breath has been stopt any other way, you will find the same signs, except the print of the Rope. In these also you may observe spots arise in divers places. For the force of strangling is such, that the expul∣sive faculty of all the parts of the Body is irritated, and therefore it forces all the Blood and other Juices to the Skin; and especially to those places, that have larger and more capacious Vessels, as the Back, Face, and such parts.

SECT. XIII.

Of such as are suffocated by inspiration of a hot and strange Air.

AS for those that are killed by a hot and suffocating Inspiration, such as lye in a room newly plastred, because Fire is con∣tained in the Plaster; or where burning Charcoal has no vent; or such as come into Pits, and stink∣ing Caverns, or great Holes where Grain is kept: I will first shew you the nature of such a death, and then the signs, that you may not only produce the signs, but do it according to Art. Erasistratus, as Galen says, thought, that such as perished in Charonian pits, and in Houses new Plastred, by the steam of Charcoal, and the like; it was because their breath was so thin, it could not be contained in the body. But, says he, as there is a familiar quality of a liniment in Pulse, Pot-herbs, Bread, &c. and a foreign one in Cantharides, the Sea-Hare, &c. So Erasistratus might as well have said, that in some Air there is a quality fami∣liar to our nature; in another there is one forein, and corrup∣tive. Now here Galen seems of the opinion, that People dye by drawing in an Air of an inimicous and forein quality to us. But in another place where he treats more exactly of the thing; They says he, that tarry too long in the Bath, faint, and at last dye; be∣cause the natural heat cannot be maintained: Now it is maintained by Ventilation of its principle the innate heat, by a moderate refri∣geration, and departure of that which is fumous, for People in Baths dye, not because the Spi∣rits are evacuated out of the Bo∣dy, but because of the heat. And the reason why People dye in stink∣ing Caves, in Houses new plaster∣ed, and by the steam of Char∣coal, is, because the cold Air is not attracted, which is absolutely necessary for Respiration. But if you demand what kind of death such People dye. Some famous Physicians think that all of them dye Apoplectick, and that the Brain is affected in its Ventricles, they being filled with a foetid and gross vapour, vellicating them by a malignant quality: for they say, the Animal is deprived of Sense and Motion, and froaths at the Mouth. Yet to me Galen's Opi∣nion seems truer, who holds, that all who dye in stinking Caves, and Pits, and such like places, dye not of any fault in their Brain;

but for want of cool Air, whereby the innate heat is ventilated and cooled. For whereas some say, that in suffocations the Brain suf∣fers, because the animal Spirit can∣not then be fed by the vital; Ga∣len denies it, and shews, that to feed the animal Spirit, there is no great need of that Spirit which is sent from the Heart: but it is suf∣ficient that there be an evaporation from the Blood; or which is of more moment, that there be In∣spiration at the Nose. And since there are two things, which we attract by Respiration, namely, the substance and quality of the Air, and when hot Air is inspired, enough of the substance indeed is attracted; nevertheless the Animal is suffocated, as thô it inspired no∣thing at all; therefore it remains, that a cool quality in the Air is chiefly requisite to Respiration; for want of which, because the na∣tural heat cannot be cooled and ventilated, when it is beyond measure heated, it kills the Ani∣mal; And Galen says, that froth∣ing is a Symptom common to all them, that have the use of Inspi∣ration intercepted. But as for the signs, which is the thing we here enquire after, I can find none, which all suffocated People have, but that of frothing: only swel∣ling in the Breast, and profusion of Urine do not appear in this last sort: for they dye of a less vio∣lent death, than they that are strangled with a cord; or they whose Mouth and Nose are stopt, And thus much of suffocated Per∣sons.

SECT. XIV.

Divers effects of Thunder, whence signs of it may be taken.

Some company walked abroad out of the City: A Storm a∣rose, and the Thunder killed one of them. His Friends suspecting he was killed by his companions, indicted them of Murther; nor could they be quit, till by the re∣port of Physicians it did appear, he must be struck with Thunder, and with nothing else. There∣fore that you may not be left de∣stitute here, I will give you my assistance: That therefore you may know the various effects of Thun∣der, so as to gather the certain signs of dying by it, I shall take something out of Seneca, which makes for our purpose.

Won∣derful, says he, are the works of Thunder, and its wonderful pow∣er is also subtil: The Money is melted, the Purse remaining

whole and unhurt: The Sword is melted, the Scabbard remain∣ing whole: The Wood about Piles inviolate, all the Iron is run down: The Hogshead being broken, the Wine stands; but its rigor lasts not above three days. There are these sorts of Thunder, the terebrating, the discutient, and burning; The terebrating is subtil and flammeous; it pier∣ces thorough the most narrow place, because of the sincere and pure tenuity of the flame. The dissipating is conglobated, and has the violence of a compact and stormy Spirit mixt with it: Therefore this Thunder passes and repasses frequently at the hole where it enters; the force of this being dispersed abroad doth break, not perforate. The Third sort which burns is very terrene, and has more fire than flame, and so leaves great signs of fire where it strikes. No Thun∣der indeed comes without Fire; but we call that fiery which im∣prints manifest signs of burning. That which burns or scorches, burns three ways. It burns, scorches, or blasts. &c.

So Se∣neca, whose Opinion, thô it be not unknown to the more skilful; yet because there are some who do not so well understand his succinct way of writing, I shall periphra∣stically illustrate the Author's Sense, about the kinds and differences of Thunder. There are therefore three kinds of Thunder (for it is found to do hurt three manner of ways) The First is, that which terebrates, and makes as it were a hole in a body. The Second is that which discusses, i. e. dissipates and severs the Body into divers parts. And the Third, which on∣ly burns. As for the First, whose property we said it was to tere∣brate, it is subtil, and collected into it self, and not at all expanse. The Second, which dissipates, has compact and conglobated Spirits, it does its violence unequally, and like a storm tears and breaks all. The Third, whose property it is to burn, has a terrene substance, and is liker to fiery matter than to flame, and therefore leaves evi∣dent signs of burning. For thô other Thunders burn; yet we call this burning, because it shews more signs of Fire and burning than the rest. This is twofold, one chief∣ly burns, the other makes the Bo∣dy black. That which burns is threefold, some burns slightly, and only blasts, i. e. as if a breath touched a body, and does little harm. The Second burns and con∣sumes. The Third kindles, and sets on fire. It is common for all Thunder to burn, and to disco∣lour, either changing the natural colour a little, or wholly changing the colour, into blew, pale, black, or some other colour.

SECT. XV.

Divers marks of such as have been slain by Thunder.

NOw therefore that we are in∣structed by Seneca; and that it appears, Mens Bodies are many ways affected by Thunder; yet two things are common to all (which to know is much to our purpose) namely, to contract a brown colour, where the Thunder strikes, and to be somewhere burnt, Besides, it smells like Sulphur, for, as the Learned Pliny observes, the flash of Lightning is sulphureous. Also they that are struck, lye on the contrary side; and, as Seneca observes, their Head lies from the Thunder. He that is awake, keeps his Eies shut, and he that is asleep, keeps them open. Bodies also struck with Thunder, as some Ex∣perimentators have observed, are colder where they are struck, than any where else in their Body. Some have written, that Bodies struck with Thunder, grow drie; but never corrupt. Therefore that Poet might very well be blamed, who fang, How Thunder-struck Phaëthon putrefied in some Val∣ley. But I know not whether Se∣neca would grant this, who, l. de naturalib. affirms. That People struck with Thunder breed Mag∣gots in a few days. Therefore, if you well observe what has been said, it will be no difficulty to find out, when People are slain by Thunder. But whereas some think, that Thunder must always batter, and that they who fall so, are always found with their Limbs broken, they are much mistaken. For, says Aristotle, if you consi∣der the nature of Thunder, every sort of it is Spirit, which is either thin and clear, and therefore not burning; or thick and fumid, and such consumes by burning. And upon this place where Aristotle af∣firms, that all Thunder is Spirit, and of such, Alexander Aphrodisae∣us adds, and not a Stone, or Bolt, or any thing solid, as some are of opinion. And whereas Iron, and the most solid of things is often broken and dissipated by Thun∣der; that is not done by any so∣lid matter; but because the nature and violence of Thunder is such, that it only hurts things which re∣sist, and put a check to it; and like a magnanimous Warriour, either it slightly touches, or quite neglects things that give way. Therefore, because Man is all over covered with a fleshy softness, you shall rarely find him bruised; but always burnt or blasted. For this reason Seneca might well be per∣swaded,

that there was a pestilen∣tial power in Thunder: because People do not only fall by the blow, but likewise by blasting. It is also observed, that Bodies slain by Thunder, are for the most part light; because the moisture by that great burning from Heaven is dried up. And this shall suffice for the signs of People being killed with Thunder.

SECT. XVI.

How a Chirurgeon may be able to predict some hurts of the Functions in some wounded Parts? First, what is the Instrument of voluntary Motion?

IT sometimes so happens, that upon a Wound given, before the event be seen, our Judgment is demanded in Court, whether it will lame a Man, or make any part imperfect in its Functions? To which Questions it is not eve∣ry one that is able to give a satis∣factory Answer: He had need be a skilful Artist, who knows exact∣ly the structure of the parts of the Body, and their use, and who has carefully observed the various e∣vents of Wounds. This Treatise also may be of use, thô you be far from any Court: For when, ac∣cording to Art, you predict the events of great Wounds, you will leave no room for reprehension to those querulous people, that would lay the blame of the abolished Function upon the Physicians cure, not upon the Wound received. The knowledge of this thing is account∣ed very necessary to him that pra∣ctises with his Hands, whether he be to take out sharp things, and points of weapons, or to take away any thing, or to cure Sinus's and Abscesses aright. Besides, it is so ablolutely necessary for a Phy∣sician to know by what Muscles the Arm, Hand, Thigh, Leg and Foot are extended, and again, by what Muscles they are bended, that an Empirick dare not condemn this knowledge; but must con∣fess, it is very useful. But here I would have my Reader under∣stand, that I shall not treat of all Hurts; but only of those which principally have respect to the ani∣mal Function, nor of all them neither; but of some external ones, whereby some conspicuous voluntary motion is hurt. For the harm that is done to the vital and natural Instruments, we do not meddle with here; because upon recovery of the Patient, no

impediment is left in doing his ci∣vil Affairs. For if the Heart, Lungs, Liver, Stomach, or Veins receive a Wound, it either kills the party, or if he escape he can perform vo∣luntary Motion, and go about his Business. But I have discoursed of this among mortal Wounds. Now therefore that I may have some foundation to build my Dis∣course upon, I take it for granted, that a Muscle is the instrument of that Motion, which is at the command of our Will, which we therefore call voluntary or spon∣taneous. Nor is there any part any where in the Body (if it have a spontancous Motion) but has Muscles inserted in it. Now there are three parts of a Muscle, the two ends which are nervous, and the middle carnous. And the be∣ginning of a Muscle, which they call the Head and Rise, comes from the Bones; but the middle which they call the Belly, has many Fi∣bres dispersed in it, which are de∣rived from the Ligaments and Nerves. The end is called a Ten∣don, because its action is to ex∣tend, and the Muscle ends in it. It is made up of many mixt Fibres, and is inferted either into a Bone, or into another Muscle, i.e. into that part of it, which is to be mo∣ved. Nor is it any obstacle that Galen somewhere says, that a Ten∣don, not a Muscle is the instru∣ment of voluntary Motion; and that a Muscle is made for the sake of a Tendon: for a Tendon is in∣deed part of a Muscle, and that to which action is principally owing: and the Muscle is the entire instru∣ment, so that it makes little mat∣ter, whether the property of the Function be attributed to the one, or to the other. For the Eye by all Men is reputed the instrument of Seeing; yet all the action of Seeing is most truly ascribed to the Crystalline Humor, as to the chiefest part of the instrument.

SECT. XVII.

What Cuts of the Muscles do hurt what Motions in general?

SInce therefore it is plain, that a Muscle is the instrument of voluntary Motion; then the moti∣on of that part, familiar to that Muscle, must needs be hurt, when such a Muscle is hurt. When Muscles are cut asunder and trans∣verse, Motion must needs be lost in the subject parts: When they are incised, Motion is only hurt; and the measure of the hurt is pro∣portionable to the measure of the Section; more Motion being lost in greater Sections, and less in less. And I would have what I have said, understood also of the Tendons: for if you cut them quite asunder, you destroy the motion of that part; if you make Incision, you will so far hurt it, as you make Incision. And the same may be said of the heads of Muscles. For Galen holds, that when the head of a Muscle is cut, it performs its Function no more. Therefore if a Muscle have but one head, it is a very easie thing by cutting that, to deprive it of motion; but if it have more heads, you must cut them all. And whereas we said but now, that all the Muscle must be cut asunder transverse, to de∣prive it of motion, I would not have you take it carelesly, because it is not every cutting of a Muscle, that takes away the use of a part; but only that which is transverse, and which (according to Galen) is made at right Angles. This a Physician must know, who has a mind to foreknow the hurt of a part, thô it be difficult: for all Fibres, as Galen says, are not al∣ways alike according to the longi∣tude of the Muscle; but sometimes have a various composition: Thus some Muscles have a simple sort of Fibres, others have a double, so that they look like several Muscles, one lying upon another. Besides, sometimes the Fibres differ in length. And a Man ought exact∣ly to consider these things, who would compleat himself in the predictions about them. Never∣theless, this manifold variety of Fibres need not trouble us much. For Muscles have generally their Fibres tending length-ways; you shall but seldom find them trans∣verse or oblique, considering the multitude of those that run length∣ways. And Vesalius attributes ma∣nifold Fibres only to three sorts of Muscles; namely, to those that draw the Arm to the Breast; to the Second, that moves the Sca∣pula, which have twofold Fibres, and to those that move the Cheeks and Lips.

SECT. XVIII.

Some general Instructions very useful for Predi∣ctions.

BEfore I come particularly to speak of wounded parts, I would premise something in gene∣ral, which will be of use to what shall be said afterwards. This there∣fore, First of all I would advise you of, namely that all Wounds received in the outside, and fore∣part of the Body, do always hurt Extension; and what are received in the inside, Flexion. For Galen has abundantly demonstrated, that the internal Muscles serve for bend∣ing a part, and the external for stretching it out. A Muscle so long operates, as it is contracted towards its beginning, and draws the part moved toward that: whether it be done by drawing the whole Muscle to that they call the Head, or when it is drawn in a lump. Besides, this is to be taken special notice of, that whether it be the external or internal Muscles that are cut asunder, in both, the figure of the part remains immove∣able. For neither extension alone, nor flexion alone perishes in a part, but both thrive, and both perish together. Not that the operation really perishes, whose Muscles are entire; but because these motions succeed one another by turns. For if the internal Muscle, which bends the part, be whole, when the ex∣ternal which used to extend it, is cut; at first indeed it may bend the part; but it cannot bend it a∣gain, unless you extend it with something else; because Flexion is of a part extense. The case is the same, when the internal Muscle, which is the bender, is cut, if the external be not hurt; this will extend at first; but no more af∣terwards: Unless with your Hand you supply the lost operation of the wounded Muscle, by extend∣ing that which is bent, or by bending what is extended; for then the sound Muscle will perform its operation. This also I must not pass by in silence: since some parts of the Body are distinguished by many Joynts, that the function of that part where the Wound is made, is not always hurt; but of an adjoyning part, which is tied to the wounded part by Articulati∣on. For Muscles are derived from the superjacent Bones, wherein there are Cotyle, and are inserted after the beginnings of the subja∣cent, which are to be moved: and by these intense Muscles, when the Heads are drawn upwards, the

whole Member is drawn up with them. Wherefore if a Wound will hurt the Functions in the Cu∣bit, it must be inflicted in the Brachium; if it will hurt those of the Brachium, it must be Inflicted in the Scapula, or parts thereabout. And you must remember this also, that the use of a part does not al∣ways perish by the cutting of one Muscle: for if the use be peculiar to some one peculiar Muscle, and competent to no other, we must believe the part will be made use∣less, because deprived of the acti∣on of that one Muscle. But if se∣veral Muscles conspire to one acti∣on, the detriment of one of them is not sufficient to destroy the whole action of the part.

SECT. XIX.

What harm Wounds of the Forehead and upper Eye-lid do?

IF one receive a Wound in his Forehead, especially near the Eye-brows, where the Fibres are carnous, if it be made length. ways, and according to the recti∣tude of the Fibres, after it is brought to a Cicatrix there is usu∣ally no hurt of the Function left. But if it be transverse, and more than superficial, you may say, that the Eye-brows and all the conti∣guous Skin shall be drawn down∣ward; and thereby create no small trouble to the Eyes, which lye under these parts; because the Eyes cannot afterward open freely, nor perfectly do their Office. And this may be the bare and true re∣port, as to the demands of the Court. But that you may not seem only to have reported the truth, but to have done it with judgment: It were best sometimes to shew the rise and insertion of the Muscle, which is the instrument effective of action, and the duct of the Fibres; and several other things besides, which may seem proper upon the occasion. If therefore at any time you are called to make a report concerning a Wound in the Forehead, you may accom∣modate these things, to what has been already said; Namely, that Galen calls this substance, which lies upon the Forehead, and sticks most tenacionsly to it, not a Muscle, but a Musculous Skin: And that Vesa∣lius will have it to be not a Mus∣colous, but a Carnous Membrane, full of many carnous Fibres. But Fallopius is of another opinion, and says it is a perfect Muscle; because the Motion and Fibres attest as much. Realdus also holds there are two Muscles, and he some∣times

saw one side of the Forehead Convulte, and the sound side in∣tire in its Function: And in dis∣section he has found the same thing; and moreover he says, that these Muscles are terminated in that common Suture, which distinguish∣es the Bones of the Head from the Bones of the upper Jaw. And these Muscles have no Tendon; be∣cause it is not a Bone, but only a Skin that is to be moved. And Vesaiius says, that the Fibres which are principally to be considered, do run in a direct line from the top of the Nose to the middle of the Forehead. Cohonbus says, the Fibres are not streight, but oblique from the top of the Nose to the middle of the Forehead. The use of the part is, to draw up the Eye∣brows. And thus what we have discoursed concerning Wounds of the Forehead, you may accom∣modate to the present occasion, as it shall offer it self. Thô here I must not omit what Hippocra∣tes mentioned in Coac. Prenot. viz. That the Sight is darkned by Wounds which are inflicted on the Eye-brows, or a little higher; and the fresher the Wound is, the better they see; and when the Wound is, after a long time heal∣ed, the Sight grows duller. For, as Hollerius declares, the Eyes grow ill by reason of the vicini∣ty, and consent in the adjoyning Bone by common Membranes, and certain Veins, and they grow duller in the process of the disease, that is, when the Ulcer is difficult, and flow in cicatrizing. Also the upper Eye-lid (for the lower is im∣moveable) if it be wounded in the space between the corners of the Eye; it is no difficult matter from the nature and site of the Muscles, if the Wound be transverse, to pre∣dict the total loss of the Function in the Eye-lid, if the weapon reach deep: But if the cut be not deep, you may say, that all the hurt which shall befall the Fore∣head, will be, that it cannot shut close. Now there are two Muscles in the upper Eye-lid: an oblique one reaches from the greater cor∣ner at the Nose, reaching half way of the Tarsus, and this draws the Eye-lid: And another oblique one arising from the Eye-brow near the less corner of the Eye, reach∣ing along the rest of the Tarsus, whose Office it is to lift up the Eye-lid. And it behoved the rise of either Muscle to be such; be∣cause it is necessary that all Muscles tend towards their proper princi∣ple. And thô Fallopius does here observe, that the former Muscle arises not (as he says, Galen and Vesalius thought) For oftentimes that place uses to be hurt and cut, as in curing an Aegilops, and yet no hurt of the Eye-lid follows. Then he observes, that this Muscle has its original from the inner part, whence another also proceeds, which raises the Eye upwards. But Galen himself, 10 de usu partium, 10. First observed this; therefore Fallopius basely ascribes his Ma∣ster's diligence to himself.

SECT. XX.

The Functions of the Cheeks and Lips; also of the lower Jaw and Mastication, by the wounds of what parts they are hurt?

ANd now to come to the hurts of the Cheeks: There lies a certain broad Muscle under the Skin in the Neck, which Galen first of all observed: It is thin and Membranous; which, if you please, you may call a Musculous sub∣stance, or a Musculous dilatation. It is spread round under the whole Skin, which is about the Neck: In the forepart it is carried down∣wards towards the Clavicle, and behind along the ridges of the Scapulae to the beginning of the back. The use of these Muscles is to draw the Cheeks from one another to the sides, without moving the lower Jaw, or open∣in the Mouth, which Functions must of necessity be hurt by a Wound of this Muscle. This sort of action is most apparently seen in the Convulsion, they call Spas∣mus Cynicus: for in it this Muscle is extremely stretcht, and contracted toward its original. But that you may make no slip in your Report; you must know, the Fibres of this Muscle do not every where observe the same duct: for they are part∣ly carried upward to the Lips, as in that part of the Muscle, which ascends from the Os Pectoris, and the middle Region of the Clavicle: and they partly run obliquely from the same; as in the portion of it, which arises from the rest of the Clavicle, the top of the Shoulder, the Scapulae, and the Region of the Neck. So that now you may see, what way the wound must tend to cut the Fibres transverse, which sort of Wounds only, as I said before, hurt the Functions. So Galen; but Columbus a diligent Anatomist, disagrees with him: for he thinks, that the Muscles, which perform the motions of the Cheeks, are situate between the Jaws, and arise from the Gums, and end in the Gums; and that this broad Muscle only draws the Lips obliquely downwards, and serves to open the Mouth. The motions of the Lips are thus hart by a Wound. Whereas two Muscles descend obliquely from the Cheeks, and as many ascend from the end of the Jaw, where the Chin is; the former are constituent of and move the upper, and the latter the lower Lip. If therefore

the spaces contained within the aforesaid limits be wounded, with∣out doubt the said motions will be hurt. But here you must care∣fully consider, that the Fibres of these Muscles are interwoven and complicate one within another: So that let the Wound be given which way it will, it is always transverse, and breaks the Fibres. It is no difficulty to find by the hurt of what parts the Functions of the nether Jaw are hurt. For if you inflict a Wound in the Region that lies between the Ear, the Forehead, and the Os Jugale, making an imperfect Circle (it is called the Temples) you will then offend the attraction of the nether Jaw upwards, and the shutting of the Mouth. For ther•• lies the temporal Muscle, called Crota∣phites, which arising from the Os Verticis, Frontis, and Temporis, is fastned to the crooked point of the lower Jaw, and draws it up, and shuts the Mouth. And the Fibres of this Muscle run from the cir∣cumference to the centre, such as are in no other Muscle besides. Here I would have you be careful in your prediction: for a wound in this Muscle does not only spoil the action of the lower Jaw, but, if we may credit Hippocrates and Galen, causes Convulsions, Fevers, Sleepi∣ness, and Doting: because these Muscles are near the principle of the Nerves. And if you give a Wound from the Os Jugate and root of the Ear at the beginning of the nether Jaw, you will ma∣nifestly hinder Mastication: for there the mansory Muscle, called Masseter, lies: This is a Muscle, which you may easily feel with your Fingers, when your Mouth is open, and arising from that part of the Head, where the Processis Styloeides are; it comprehends all the nether Jaw, and draws it round. But Galen is of opinion, that both these, and those that are called temporal Muscles, might as well be called Masticatory: for both of them conspire in the acti∣on of Mastication.

SECT. XXI.

By the Wounds of what parts the motions of the Head are hindred?

BY what Muscles being hurt the motions of the Head re∣ceive damage, take thus. There are seven Pair of Muscles, that are destined to the motions of the Head: Only one pair of these draws the Head forward: All the rest draw backward. But all of them lye under some other external Muscles, the exteriour under that they call the Musculous dilatation, which we said moved the Cheeks, the Posterior under the Scapular Muscle: Wherefore it must not be a superficial Wound, that hin∣ders the motions of the Head. And we must not be ignorant of their Original and Progress. The two first, which incline the Head forwards arise from the top of the Breast, and the end of the Clavide; they are long, round and strong: They are apparent enough, before the Skin is taken off. They are inserted into the Mamillary pro∣cess: If they are both moved, the Head is bent forwards; but if only one act, it is drawn on one side. But in the hind part Ana∣tomists have observed six pair of Muscles: All of them tend from the Spines of the first five Verte∣brae, and reach almost half way up the hind part of the Head. If then a deep Wound be inflicted in the Neck behind, so as to reach the parts under, you will manifest∣ly hurt the motions of the Head, according as these or the other Muscles are wounded.

SECT. XXII.

What functions wounds of the Arms do incommode?

WOunds of the Arms are both frequent, and pre∣judice the Functions that are most useful to Man. Therefore that you may foresee the Event of each of them, it is best first of all to recount the proper Functions of the Muscles, which do diversly move the parts of the Arm: for so you may easily reckon with your self, what hurts will ensue, I will begin therefore with the extreme parts of the Arm. There are eleven Muscles in all, that move the Humerus or Shoulder (I call all that is between the Throat and the Elbow the Shoulder, and the Cubit all that is between the El∣bow and the Palm) three ascend∣ing from the Breast to the Arm: two from the Region of the Ilia: five proceeding from the Scapula: And the eleventh lies upon the Epomis. All these Muscles grow together, and are implanted, where the Humerary is one. But these are their motions. That which lies upon the Epomis, draws the Arm right upwards. The two, that come by the sides of this, from the Scapula on each side, do raise the Arm up; but not streight; but they draw it backwards or forwards, according as they are on this or that side. The Muscles that rise from the Breast, draw the Arm thither. The rest of the Muscles turn it backwards, and that especially, which pro∣ceeds from the lower end of the lowest Rib under the Scapula. Now you see, by the Wounds of what parts what motions are hin∣dred: for if the Muscles, that lift it up, be wounded, without doubt that Function will be hurt; and so in the rest. The Cubit is mo∣ved by four Muscles, which in∣compass round the Os Brachii; and the two former bend the Joint, not streight; but one enclines it inwards and the other outwards. It is extended by that Muscle which manifestly appears near the hu∣meral Vein, especially in such as use much exercise, and it has two Heads, one upon the edge of the Head of the Scapula, another upon the Process, and it cleaves to the Os Brachii, and then to the Radi∣us, and it has another under it, assistent in the same action. Therefore when that Muscle is wounded, the Arm cannot well be bended; but if a Wound be re∣ceived in the hind part of the Arm, which is opposite to the fore∣said Muscles, and touches their

ends, then the office of bending the Elbow is lost: for upon that place the Muscle lies, which ex∣tends the Arm; and whether you call it one Muscle or two, Vesalius thinks it is no great matter. Moreover, if a Wound be received on the upper and forepart of the Cubit, between that and the end of the Radius, in that long, but narrow place, it will hinder the Radius from being raised supinely: for the long Muscle lies there, which arises from the Os Humeri, and is implanted in the lower Ap∣pendix of the Radius, and reckon∣ed the second among them, that draw the Radius forward. But if you wound the lower part of the Ʋlna, along to the lower Bone of the Wrist, you will prejudice all the motions of the Wrist. For there all the four Muscles are ex∣tended, the Authors of all bra∣chial motion: Of which never∣theless the two external, which are most liable to the injuries of Wounds, arising from the exter∣nal swelling of the Humerus, are inserted in the first and second Os Carpi, and serve to extend it: Therefore when they are hurt, this Function especially must be hurt. But if a Wound be inflicted in the inside of the Cubit inclining a lit∣tle back, then the second Joints of the four Fingers cannot bend. For there runs one Muscle, the first among the internal, which moves the upper part of the Hand, and which arising from the lower swel∣ling of the Humerus, is hid under others, till it come to the Elbow: but there it starts out, and is seen under the Skin; except as much as the former Muscle (which makes the broad Tendon, where it is thin, and turns into a Nervous end) does pass over. This then having passed the Wrist, is divided into four Tendons, each of which being sixt to the second Bones of the Fingers, are their benders. But whatever of the internal Muscles you cut, which run down with the first to the Wrist, von will manifestly hurt the Function of Contraction. The Hand is ma∣nifestly extended by the external Muscles, i. e. by them that are placed in the back part of the Arm. The first of these having past the Elbow, starts up, and is conspicuous under the Skin; and if you remove another, which lies above it, and extends the Wrist, you would say it lay uppermost and foremost. This is most fie∣quently divided into four Tendons, which come to all the Joints of all the Fingers, except the Fore∣singer, and dilate them. And the second Muscle, by which the little Finger is drawn aside from the rest, and the Palm is formed, having the same original with the former, is to be seen under the Skin with the first: but it pro∣ceeds underneath to the Hand. Therefore in what place soever the seat of this Muscle is wounded; either the Function of the little Finger will be hurt, if the Wound be given in the lower Region, or the Function of the three next, if it be inflicted a little above. And so much for Wounds of the Arm.

SECT. XXIII.

What functions are hurt by wounds of the Hand?

BUt if a Wound be received in the Hand in the back part, where indeed not Muscles, but the very Tendons creep along, as they pass to their Joints; it will not be difficult to foresee, what harm will thence arise to the Fingers. For that Finger will be hurt above all the other, next to which the Muscle or Tendon is offended. Yet I have often taken notice, that when these exterior Tendons have been cut, the Fingers nevertheless were extended; thô indeed they were a little weaker in exercising their Function: For there are certain other Muscles arising in the Palm, which exercising the same Functi∣on of extension with the foresaid, make the loss of the foresaid less prejudicial to the Fingers. When the Palm of the hand is wounded, you will often find the motion of the Fingers hurt thereby. But thus you may foresee all. Under that Tendon, which they call the broad one, and which lies next the Skin, there are four Muscles, which are apt to be wounded from the middle of the Palm to the setting on of the Fingers. And Columbus observes, that these extend four Fingers, besides the Thumb, thô they be internal: Which makes Chirurgeons often admire, how it comes to pass, that when the outer Tendons are cut, nevertheless the Fingers are extended, not know∣ing that there are these besides, which partake of the same Fun∣ction. And they arise from the Tendons of that Muscle, which, as we said before, bends the third Joint of the four Fingers: And then running to the external part, and being implanted in the third Joint, they extend it. But if you wound a man about the little Fin∣ger, that Muscle will be prejudiced which arises from the fourth Bone of the Metacarpus, and draws it aside from the other Fingers. If you wound the fleshy part of the Palm, which is the Ball of the Thumb, you will hurt the Muscles (there are three of them) that bend the Thumb. For the Thumb (as Galen says) has this thing pe∣culiar to and remarkable in it self; that nothing comes to it from any upper part; wherefore the wound must be received either in the Thumb, or very near it, which must hinder its function.

SECT. XXIV.

What harm is done by the wounds of the Thighs and Legs.

BUt, to come to wounds of the Thigh, if a Man be wounded any where in the But∣tock, in that region which reach∣es over half the Os Ilium from the Os Sacrum and Coccyx; unless the cut be shallow, it will hinder the extension of the Thigh. For this Muscle has its rise from the foresaid parts, ends at length in the greater Trochanter, and makes the Buttock. Observe, nevertheless, that since this Function requires much strength, other Muscles are assistent to it; lest by the hurt of one Muscle all the Function of the part should be lost. There are other Muscles to perform the rest of the motions of the Thigh; which because they run along the inside of the Loins, a place not seen by the Eies, I shall pass them by. But Wounds of the Thigh do often hinder motions in the Leg. If therefore you wound the Thigh in the fore-part between the top and the knee-pan, you will much injure the extension of the Leg. For under that place there lies the seventh Muscle of them that move the Leg, and under that the eighth•• Muscle, conspicuous above the Knee: yet because it has other Muscles to help it in this common action, the perfect loss of exten∣sion in the part need not be fear∣ed from the detriment of one Muscle. And if you wound that part which descends obliquely al∣most from the Groin, like a bor∣der, along the inside of the Thigh, and ends in the Shin, the Leg will find a great impediment, when it is drawn toward the Groin on the other side, or to the Thigh. And if the hind part of the Thigh re∣ceive a Wound, between the end of the Buttock and the ham, it hinders contraction, especially if the cut reach to the Tendons, which are so manifest in the sides of the ham, that when the Leg is contracted, they may be plainly, felt by the Fingers. And here a History of Galen's concerning a Runner must not be forgot; which because it is worth the remarque, and that there are several opinions about it, I shall not think much to relate. It is concerning the fourth Muscle that moves the Leg, which is not indeed in the inside, but on the outside opposed to three others, and its carnous broad end

is fastned to the outside of the Leg; its Function is to twine the Leg obliquely. I saw, says he, this Muscle broke in a certain ex∣cellent Runner, and broke in the middle, as one was contending with him: There was a hollow place in the middle, which the ends of the parted Muscle left, one being drawn towards its head, and the other towards the Tibia. Yet this Runner, after the pain was ceased, and the Inflammation abated, was not at all injured in walking; nay, he durst run again. And when he found no inconve∣nience in it, he ran Races again, and won them: Which might ve∣ry well be; for in running there is no occasion to twine the Leg about; but only to stretch and bend the Leg. But Realdus has observed some wounded in this Muscle, who, thô they were cured, yet it troubled them to bend their Leg: wherefore contrary to Galen, he ascribes the Office of bending to it. But now to the damages of the Feet. If you wound the Muscles, which after their rise, coming up about the Knee, do by their ellies on each side of the Leg make up the Calf, and at last make the strongest Tendon in all the Body, which comes to the Heel; then the Foot cannot well stretch it self. But the hurt of this one Muscle is not sufficient to destroy the whole Function: for four other auxiliary ones lend their as∣sistence. But between the Calf and the Os tibiae, viz. the Shin, two Muscles are to be seen; one next the Calf, whose Office it is to extend four of the Toes; but the other, which has in that place a tendinous Nature, runs by the Os tibiae, its office is to extend the end of the Foot: If you wound either of them, without doubt you will hurt the Functions that are peculiar to them.

SECT. XXV.

What Wounds of such or such Nerves, and of such or such parts of the Spine, do hurt the motions of this or the other part?

NOw I think. I have mentioned almost all places, which be∣ing extrinsecally hurt, use to hinder the motion of certain parts: so that, I suppose, I shall have ac∣quitted my self of this particular, when I have added this one thing further; namely, that Motion of the parts is hindred, not only when the Muscles, but the Nerves like∣wise are wounded, which being distributed through the Muscles, are the chief Authors of that mo∣tion. For this (as Galen says) must be understood as a maxim in all Muscles, that whether you hurt their Nerves, or cut all their Fibres across, you will immediately de∣prive these Muscles of all motion. Therefore it will be very necessary for you to know the principles of the Nerves, that are distributed into them, and the site of their Fibres. It is then a thing suffici∣ently known, that strength and fa∣culty of moving is derived from the Brain, as the Fountain, by the Nerves as Rivulets. Which Nerves, because they are not sufficient of themselves for motion, Nature has contrived Muscles, as a kind of Levers, that we may the more rea∣dily raise weights. Therefore eve∣ry Muscle has a Nerve inserted in it, from whence it has its motion. If then you cut, press, bruise this, or any way intercept the pass of the Spirits, all motion and sense shall be taken away. But as much as remains after the cut, continuous to the Brain, so much will still conserve the virtue of the princi∣ple: and whatever is below, can neither assord Sense nor Motion to it: That therefore you may not be ignorant of the hurt Functions of the Muscles, which proceed from their Nerves, I will briefly declare what Nerves are derived into such and such parts, and from what Originals. But I shall not mention all, for that would be too tedious. This I will say in general, it is ob∣served, that Nerves seldom come along the outside of the Body in∣to the Muscles; but affecting ra∣ther a certain safeguard and pro∣tection, they run along the inside. Yet those that come to the Hand are observed to run along the in∣side

of the Arm: but they do not so in the Leg: for they all run along the back part of the Thigh. You shall not therefore find a Nerve, neither at the Elbow, because it has no flesh on it, nor at the Knee or Shin, but always deep among the Fortresses of the Bones, Cartilages, Ligaments, or Flesh. As therefore to the Origi∣nal of the Nerves; they that come to the Arm and Hand, creep from the fifth, sixth, and seventh Verte∣bra•• of the Neck along the Armpit; and also from the first and second of the Breast, which if you reckon from the beginning, you may call them the eighth and ninth. But these Nerves from the very begin∣ning do strangely cross and inter∣mix one with another. Now if you wound any of these Pairs of Nerves, as they come out of the Vertebrae, it will certainly much hinder the motion of the Arms and Hands, according to the big∣ness of the Wound: Yet you can∣not well tell, what pair of Nerves being in their original, will hurt such and such Muscles: for as their contexture is manifold, so it is un∣certain what Nerves of the Muscles depend on such or such a hole of the Vertebrae. Yet it is sufficient to know, that Wounds received in the foresaid Vertebrae do pro∣miscuously hurt the Hands and Arms. Nerves proceed from the Vertebrae of the Loins and Os Sa∣crum in the same complication and confusion, to the Thigh, Leg, and Foot, as we said they went to the Hands, and Arms. Wherefore whatever pair of Nerves proceed∣ing from the foresaid Vertebrae, you hurt; you will likewise in∣commode some of the Muscles un∣derneath. Furthermore (for this will not be useless to know) you may easily, according to Vesalius, find out in a living Man, the Nerves which come to the extreme parts of the Hand: For if you press hard with your Finger between the po∣sterior process of the Ʋlna, and the brawn of the Arm; then you will find that there lies the fourth Nerve, which moves the Thumb, the fore, and middle Finger, by a kind of numbness in the same Fin∣gers: And if you press the end of the brawn on the inside, you will for the same reason sind, that the fifth Nerve lies there, which moves the little, and middle Finger by branches divided to the Hand. If in like manner you press the forepart of the brawn of the Arm on the inside, you will find the third Nerve, which comes to the inside of the Thumb, the fore and middle Finger, if you consider, as we said before, the numbness in those Fingers. If therefore those Nerves receive a wound about the Elbow, you may easily foresee what Fingers will be hurt there∣by.

Now there remains something to be said of the cutting asunder of the Spinal Marrow, which Galen 8. de administrat. Anatom, has recorded very opportunely for our purpose. If (says he) you cut the Spinal Marrow quite through in the region of the third or fourth Vertebrae, the Animal will presently be deprived of breathing, not the Breast only, but the whole Body below the Section, becoming immoveable. And it is plain, if you cut below the second or first

Vertebrae, or in the very beginning of the Spinal Marrow, the Animal will suddenly fall down dead. But if you cut the Spinal Marrow quite through (for you must always un∣derstand this) all the Muscles of the Breast immediately loose mo∣tion: and the Animal then breaths only by the benefit of the Dia∣phragm. They allow that in cuts of the Spinal Marrow, lower than this Vertebra, many parts of the Breast may be moved: For the greatest conjugation of the Nerves of the upper Muscles of the Breast, has a twofold original of both Nerves. Therefore cuts about the seventh Vertebra hinder not the function of these Muscles: much less cuts under the eighth or ninth. And the lower you go, the more Muscles of the Breast will do their Office. Galen likewise says, if the Spinal Marrow be cut length∣ways in a right line from above downwards, none of the interco∣stal, lumbar, nor crural Nerves will lose their use: but if it be cut cross only half way, all the Nerves derived thence perish. But what need a Man trouble himself with the hurt of the parts from wounds of the Spine, since they generally prove mortal? Because a Wound here is as dangerous as in the Brain. For the Spinal Marrow is a kind of Brain to the parts below the Head: and both Hippocrates and Celsus do account wounds therein mor∣tal.

SECT. XXVI.

Of Maiming.

SInce we have an Act of Par∣liament, Ann. 22. & 23. Car. II. to prevent malicious maiming and wounding, wherein also disfiguring is comprehended, it will not be amiss to explain, what Maiming and Disfiguring are: for we have already shewn suffici∣ently what Wounding means, of which, the two other are effects. And First concerning Mai••ing.

Maimed, Mutilatum, curtum, decurtatum, descissum and trunca∣turn among the Latins; and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 with the Greeks, signify the same thing; but what the thing it self is, does not sufficient∣ly appear. Aristotle (to begin with the best of Philosophers first) in his discourse upon this subject says, that Maiming, or Mutilation comes not from the loss of every part (for if you take away Flesh or the Spleen, a creature is not thereby maimed) but of some ex∣treme part; and that not every one, but such an one as being quite taken away cannot be generated

again. So that you see Aristotle places the nature of Mutilation in the deficiency of the extreme parts, if they cannot be repaired again. But Galen says, that is maim∣ed, of whose Body any part is cut off: And he says, that Muti∣lations are of the Lips, Ears, Nose, and of any fleshy parts, either vi∣olently taken away, or putrefied and cut off. He says, there is a Mutilation of the Tongue, when half of it is taken away, and of the Omentum and Privities, of the Nose and Ears. Wherefore if you will follow Galen, you must say, that is maimed, that hath any part of the Body cut off; but especial∣ly these three parts about the Face. Cornelius Celsus says, they are maimed, who have the Ears, Lips, or Nose cut off. So the Latins call a Ram or a Goat, without Horns, Mutili, i. e. maimed. In the same sense some have said, that Faemina veluti mutilus mas à na∣tura est producta. These things I have gathered, out of several Authors; Now I will proceed to deliver my own Sentiments.

SECT. XXVII.

Three sorts of Maiming.

HAving well weighed and con∣sidered this subject, there seems to me to be three sorts of Maiming. The First truly so cal∣led and exquisite: The Second is true indeed, but not exquisite: The Third may be called impro∣per. The true and exquisite has these three qualities- 1. Some ex∣treme part of the Face must be cut off. 2. Disfiguring must arise from thence. 3. The action of the cut part must be hurt. As when the cartilaginous part of the Nose is cut off, the Lips or Ears, and (as some will have it) the Eye-brow. For in these, unless the loss of substance be very small, there is the first sort of maiming. For an extreme part is cut off; great disfiguring is caused it being in the Face; and the actions are a little hurt. If any one demand, why I call this especially exquisite Maiming, my reason is at hand: because in Maiming the savour must chiefly be hurt, as several Authors hold; without doubt a Maim in the Face must be the principal: for it disfigures the best favoured part. Of this Galen de Morb. dif∣fer. & in Meth. Cornelius Celsus, and Paulus Aegineta do treat. And this I observe, that when Authors treat closely and nicely of Maim∣ing, they make it to consist in

these three particulars. But thô three things are required to Maim∣ing; yet Disfiguring is the main thing requisite; and in the next place the hurt of action. If there∣fore a piece of the Ear or Nose be cut off, so that the least prejudice be done thereby to the Hearing, or Smell: yet because a manifest dis∣figuring does result from thence, it is an exquisite Maiming. And that is a true, thô not an exquisite Maiming, which is not indeed in the Face, but in the extremities of other parts of the Body; as in the Hand, Foot, Tongue, Secrets, and Breasts. It is called not ex∣quisite, because it reaches not any part of the Face, where because of the Favour exquisite Maiming consists: But there is this in it; it may some way or other offend the Actions, in respect whereof the Maiming may be slight or grie∣vous. The Third is called Impro∣per, because it cuts off none of the extreme parts, which is requisite to true Maiming: Nor does it dis∣figure: nay, sometimes it hurts no action; It is sufficient that any part is cut off. So Galen said, that the Omentum was Mutilum. Wherefore I cannot chuse but wonder at some famous Physicians, who in Maimed Persons require on∣ly a cessation and privation of use, without any loss of part. But how dissonant this is to the opini∣ons of Philosophers and Physicians, (who must be judges in this case) may easily be understood by what I have already said. And they that consider the Force, either of the Latin or Greek words, will say as much. Since therefore thing∣stand thus, you must know, that not every loss of substance makes a Man maimed: For if any one from his Nativity want a Hand, Ear, or any other part, we may say he is lame, but not maimed. And if no part be wanting, but a Limb be made useless for action, it is weak or disabled.

SECT. XXVIII.

The opinion of Physicians concerning the signification of a Member.

THE Court does often con∣sult us likewise about the appellation of a Member, in the case of Maiming, disabling, or any way hurting a part. There∣fore lest we should report what the Lawyers will not admit in the case, it is best to treat of this di∣stinctly. A Member, if you con∣sult Physicians, is often used for any part of the Body without ex∣ception. For Flesh it self, a Nerve, a Vein, and any of those we call Similar parts, are styled by them Members. But what a strange thing would it be, should a Judge ask us about the name of a Mem∣ber, if we should tell him a Man were maimed, who had only a piece of flesh cut out? For Lawyers, when they enquire about Members, mean only the com∣pound parts of the Body. In this they seem to follow Aristotle, who l. 1. de Histor. Animal. calls only the compound parts, and such as have under them another subdivi∣sion of parts, and Offices of their own, Members: as the Head, Foot, and Hand. And what Aristotle calls a Member, Galen calls a Part: for 1. de usu partium he says, what∣ever Bodies have on every side a circumscription of their own, nor are on every side joyned to others, these are called Parts. And about these Members or Parts, which might more properly be called In∣struments, you will not find all Phy∣sicians of the same opinion. For sometimes you will find that part called an Organ, or Instrument, which consists of similar parts; upon this account Galen called a Muscle, Vein, and a Finger In∣struments. Besides, that part is by him called an Instrument, which is the principal cause of any action. So Galen called the Cry∣stalline Humor the chief Instru∣ment of Seeing. But of these In∣struments in the appellation of a Member, you will find no account among Lawyers. Therefore, not to detain you with many words, you may, as far as relates to our present purpose, truly call that a part of a Creature (I mean the external) which is able to perform a perfect action. For so Galen l. 1. c. 6. Meth. describes it. And thus an Eye may properly be cal∣led a Member of an Animal, be∣cause it alone does entirely per∣form the action of Seeing: So the Tongue, because it is the instru∣ment of Speech: And the Legs, because they perform Walking: And the Hands, because their pro∣per office is to take hold of things.

SECT. XXIX.

A more exact account of the true signification of a Member.

BUT that the nature of a Member may be understood more exactly, and according to the Lawyers Sense; you must knows, that Action (which Galen calls Operation) is nothing else but the motion which the part exer∣cises, while it is doing, and about its work. So when the Hand is moved to take hold of a thing, that motion is its action: And the end of the action, in which the motion of the Hand rests, is cal∣led Use: Wherefore Use is the end of the actions of the Body. Therefore whatever part it is in Animals, that is able to perform this perfect action of it self, and not by another, it may truly be called a Member. The Eye, Tongue, Hand, Foot are chiefly such. But you must take special notice of this, that there are ma∣ny parts, which seem to be au∣thors of performing actions, and nevertheless are not Members. Ma∣ny parts, saies Galen l. 1. de usu part. are required to the performance of actions: For some are called great; as the Hands, Feet, Eyes and Tongue, which are made for the sake of the whole Animal: And others are less, which are subser∣vient to the foresaid parts: For whereas the Eye is it self a princi∣pal Member, it has some parts by which it sees; others without which it cannot see; some for better Sight's sake; others for its con∣servation. Now all these Parti∣cles which serve the principal Mem∣ber, are not truly Members, but only parts of a Member. And if you consider these things well with your self, it will not be dif∣ficult to find, what part in our body is truly a Member in the Lawyers sense, and what is not. For thô Galen said very truly, that the Tongue was a Member; be∣cause the instrument of Speech: yet he never called the Lips or Teeth so: because these only serve the Tongue to act the better, but are not able of themselves entirely to perform an action. For the Lips, says Aristotle 2. de part. Anim••••. 16, are made chiefly for the desence of the Teeth; and they a little also help the Speech. But the Teeth do chiefly help the concoction of the Stomach, while they mince and grind the Meat. Also the Legs, since of themselves

they exercise going, are truly cal∣led Members: But the Feet and Toes, because they only help the action, are Particles subservient to the Legs. Wherefore when a Fin∣ger is cut off, I cannot say that a Member is cut off: for the functi∣on of the Hand is not thereby ta∣ken away, its action is only dimi∣nished: For the same reason I can∣not call either the Ears or the Nose Members: For the Ears are not the instruments of Hearing; but only the end of the passage, where it is joyned to the dilated Nerve: for all things beside, that are with∣out it in the winding passage, on∣ly help the instrument of Hearing: Nor is the Nose the instrument of Smelling, nor therefore a Member: Because the sense of Smelling is contained in the anterior Ventri∣cles of the Brain. For the carti∣laginous part of the Nose, and the Bone it self, or the inner skin of the Mouth, only do this for the Ammal, that Smells may the bet∣ter be perceived. Therefore if the Teeth, Lips, Ears or Nose be cut off, you cannot say a Member is cut off: for thô these parts were taken away, yet the Animal will be deprived of no action thereby. It is plain that Womens Breasts, because they are the instruments of making Milk are Members; so are Mens Stones, because they make Seed: And the Yard, because of the necessity of it to Genera∣tion.

SECT. XXX.

Of Disfiguring.

HAving sufficiently discomsed of Maiming, now I shall procee to Disfiguring. By which is meant the spoiling of ones Com∣liness, Beauty or Favour: so that Disfiguring is a kind of Ugliness, or hard-savou••edness canted by wounding. Now since Beauty is the opposite to Ugliness or Disfi∣guring, I shall make a little digres∣sion in shewing wherein Beauty or Comliness, or well-favouredness consists.

SECT. XXXI.

The general notion and explication of Beauty.

PLato tells us, that Beauty is a Gleaming or Ray of the Su∣preme Good, immitted first into Heavenly things; and then into Ment Minds, the Figures of their Bodies and Voices, which moves and delights our Minds by Reason, Seeing and Hearing. Here you see, Beauty is nothing else but the splendor of the Divine Essence, conspicuous indeed in all things; but shining more illustriously in the more noble, and in such as God has placed nearer himself; in other things it is less illustrious. This is that Beauty, which every where we desire in the things we love. And therefore Lovers are ever ignorant of what it is they love: because it is GOD. Now this splendor, which is altogether incorporeal, our Soul does not in∣deed perceive by Touch, Taste, or Smell, because these faculties are very much immerst in Matter; but rather by Reason, Sight and Hear∣ing, which are more spiritual. And whereas this Beauty is discerned in three things, in the Mind, in the Body, and in the Voice; that of the Body (which we have a de∣sign only to treat of) is also a Gleam, or Ray of the Divine Es∣sence: but conspicuous only in a matter apt and prepared. This preparation consists in three things, Order, Measure, and Features. By Order is signified the distances of the parts. By Measure, their quan∣tity. By Features, the lineaments and colour. The foundation of these preparations, is a temperate Complexion of the four Elements. This then is the Beauty of the Bo∣dy, which we perceive by the Sight: for that of the Mind we must perceive by the Mind, and that of the Voice by the Ear. And this is the Divine Philosophers Opi∣nion concerning Beauty. But Ari∣stotle does not derive its nature from so high an Original; only those things which Plato calls Pre∣parations, them he calls Beauty. For 13 Metaphys. cap. 3. he says, the species of Beauty are Ordo, com∣mensuratio & definitum, where he takes Ordo for the right dispo∣sition of the parts, whereby each is put in its right place: Commen∣suratio, for the mutual proportion and just intervalls of them: Desi∣nitum, for the bound or limit of each part. So that with Aristotle that is a beautiful Body, which has its parts aright placed, at a due di∣stance one from another, and of a just Magnitude. Thô the Philo∣sopher

has said these things learn∣edly enough; yet the agreeable∣ness of colour, that Plato men∣tions, and which contributes much to Beauty, he mentions not at all. Wherefore I shall cite Ga∣len, who has copiously and learn∣edly discoursed of Beauty. Beau∣ty, says he, according to the opi∣nion of all Physicians and Philo∣sophers, consists in an apt con∣nexion of the parts, viz. of a Fin∣ger to a Finger, of all the Fingers to the Palm, and Wrist; of them to the Elbow; of the Elbow to the Shoulder; and of all to all. And thô in this place he have ex∣pressed the proportion of pa••ts elegantly enough; yet of the de∣terminate magnitude of the Bo∣dy, and of the Features, he hath made no mention. Nevertheless, what is omitted here, he has sup∣plied in another place. For l. d. def. Med. he says, that Beauty consists in a Symmetry and pro∣portion of parts, with a probity of colour. And, c. 10. ad Thra∣syb. he says, true Beauty consists in a fresh colour, moderate store of flesh, and in a congruous pro∣portion of parts. Thus far Galen, who when he had discoursed as to the rest concerning Beauty ve∣ry well; yet he makes no menti∣on of the limits, and just mag∣nitude of the Body; because per∣haps it was not his design there, to give an exact notion of Beau∣ty. If therefore you put Aristotle and Galen together, Beauty will be an order or, proportion of parts, with goodness of colour, and a decent magnitude. Nor were it much matter if you said, that Beau∣ty is neither the order nor pro∣portion of parts, but an affection of the whole, and a quality ari∣sing thence: for great Authors take an honest liberty in speak∣ing, and make no difference be∣tween the order of parts, and an affection arising thence. But if you should still urge, that the thing ought to be explained in more proper terms, you may thus define it out of Plotinus, Beauty is an external perfection of the dissimilar parts of Bedies, arising ••••om their agreeable order, mea∣sure and bounds, accommodate to the Beholders Eyes. And these things briefly collected out of the best Philosophers may suffice for the general definition of Beauty, which might deserve a larger Treatise.

SECT. XXXII.

The definition of Beauty more particularly explained.

NOw I have a mind, for your sakes who desire to judge more exactly of things, more par∣ticularly to discuss, what order and proportion is required to render a person beautiful; lest while we are only in the contemplation of Universals, the more evident know∣ledge of the thing, which is more apparent in particulars, should be left to us unknown. Order there∣fore, or (if you had rather so call it) Commensurateness, is elegantly described by Vitruvius in this man∣ner.

Nature, (says he) has so made the Body of Man, that the Scull to the top of the Fore∣head, and the lowest roots of the Hair is a tenth part, and the Hand from the Wrist to the end of the middle finger as much: from the Chin to the crown of the Head an Eighth part: as much to the bottom of the Neck: from the top of the Breast to the roots of the Hair, a sixth: to the top of the Crown a fourth. A third part of the heighth of the Face is from the bottom of the Chin to the lowest part of the Nose: the Nose to the mid∣dle of the Eyebrows as much: from thence to the roots of the Hair as much, which makes the Forehead. The Foot is the sixth of the heighth of the Body: the Cubit a fourth: the Breast also a fourth.

The rest of the Mem∣bers have their commensurate proportions, which ancient Lim∣ners, and noble Statuaries used. Besides, three Nose lengths make the length of the Face: the semi∣circles of both Ears joyned toge∣ther, make up the circle of the Mouth open: the conjunction of the Eyebrows also does the same: the length of the Nose is the length of the Mouth, and of the Ear like∣wise. The two orbs of the Eyes are equal to one opening of the Mouth. Eight lengths of the Head make the talness of the Body: And the extension of the Arms side∣ways, shews the same; and so do the Feet extended. By follow∣ing of which proportion Pytha∣goras found out the Stature of Her∣cules exactly; as you may see in Gellius. The goodness of colour in temperate Men, as Galen, Art. Med. c. 51. says, arises from a decent mixture of White and Red. For, because Blood is of all Hu∣mors most abundant in us, which is Red; and because Phlegm is next in quantity to it, which is White; it was meet that the co∣lour

of the whole Body should be made up of them two: for it is according to nature. And such a colour is required in the whole Body. Indeed in some certain parts there is a peculiar beauty of colour. For Aristotle commends Eyes co∣loured like Goats Eyes: because such Eyes are a sign of a good dis∣position, and are the best to see with. Galen also commends yel∣low Hair above all. But one can∣not well determine the just length of Mans Body: for as to several Nations several Statures are more familiar, so they may seem more beautiful. So Hippocrates l. de aere, loc. &c. says, the Asiaticks are of a large Body: the Aegypti∣ans and Scythians are well set. The Europeans are of a different stature. Moreover, Men are generally tal∣ler than Women. And as for ages, in young Men, as Hippocrates 2. Apli. 54. writes, tallness is comely and gentile: but in aged people useless, and worse than shortness of Stature. Wherefore the pecu∣liar nature of the place, Sex and Age must be considered, before you can well judge of the just sta∣ture. But if you desire to find some certain stature of Man, which may be most exact, and as it were a rule, or standard for the rest (for all things that are, have their pe∣culiar nature, and determinate magnitude) I shall in some mea∣sure gratify you, in acquainting you, that the measure of four Cu∣bits is most convenient for a Man's length: under which a Man must be called short; and above which, over tall. Therefore the Spaniards, because they are shorter, and the Germans, because they are taller, cannot well be called handsome: But the Italians and Greeks, be∣cause they are of a stature between both, are upon that score account∣ed handsome.

SECT. XXXIII.

The nature of Beauty yet further explained.

AS for these things, wherein we have before said, that Beauty did consist, I think it is no great matter, whether you call them Species or Parts. For if you exactly consider Beauty, Order, Feature, and a just Magnitude will be its constituent Parts; none of which can be wanting in making up an exact Beauty. For let one be endued with order of parts, and a good colour; yet if he have but a little Body, he cannot be called beautiful. According to Aristotle 4. Mar. c. 3. who says, that little People may be called pretty, but not beautiful. And Ga∣len, l. 1. ad Thra••••b. plainly af∣firms, that these are the integral parts of Beauty. But if your judg∣ment be not so exact and severe, and you think it sufficient, that what we call falt, have most or only some Ornaments, but not all; I shall readily grant you, that a good Colour, an exact proportion of Parts, and the rest have each of them severally their peculiar Beauty. And thus Men of a little Body may nevertheless be called Beautiful or Handsome. This al∣so is worth the marking, that be∣sides this Universal Idea of Beauty, different Ages, and different Sexes have their particular Beauties. For the same Favor is not requisite in Women, that is in Men. As ingenui∣ty of Countenance, and assurance be∣come Men; so a kind of Softness and Modesty becomes Women. Be∣sides, a Beard is an Ornament to a Man, but not to a Woman. And as for Ages, Aristorse says it is the Beauty of a young Man, if his Bo∣dy be so made, that it is able to endure labour, or to run, or to act violently: thô he must have a sweetness of Countenance, which may please the he••olders. That of a Man grown is, to have a Bo∣dy fit for Military Employments, and a sweetness of Countenance mixt with something of Terror. That of an old Man is, to have a Body sufficient for necessary Em∣ployments, to shew no sadness, and to want those Diseases, that usual∣ly deprave old Age.

SECT. XXXIV.

Of a Cicatrix or Scar.

BEcause Disfiguring, or the spoiling of one's Beauty, is oc∣casioned by a Cicatrix or Scar, it will be worth while, for avoiding obscurity, to declare what a Scar is. A Cicatrix or Scar, in the com∣mon acceptation is Flesh con∣densed and dry, and hard like a Callus, coming instead of Skin, which is not true Skin, but ve∣ry like it: for the Skin, because it is a spermatical part, cannot be generated anew; and therefore something like it grows in its room. But this account of a Scar makes little to our purpose: there∣fore we must give another account o•• it. A Scar therefore is a cer∣tain Sign or Mark left in the Face by a Wound, more or less spoiling the grace of it. It is either de∣form or apparent. I call that de∣form, which manifestly offends the natural comeliness of the Face; and that apparent, which does it but obscurely. The deform or ugly Scar requires two things. First, it must spread over a good part of the Face. Secondly, it must leave some unevenness in it, either bunching or hollow. If the Scar be broad in the Face, I think no Man will deny, that it is ugly, because so conspicuous; unless it is only in the Scarf-Skin: for in time that will grow out, and there∣fore cannot be termed ugly. And it is a manifest deformity, when some parts of the Scar stand out, and others fall in, and no equality is observed. The Scar apparent is so called, not that the deformed Scar is not apparent (for on that very account it is deformed) but be∣cause it does but just appear, with∣out much prejudice to ones Beau∣ty. It is the property of this Scar, that unless it be narrowly looked upon, it cannot be discerned: Whereas the deformed may be seen, if a man cast but his Eye up∣on it.

SECT. XXXV.

In what Parts, and for what Reasons, a Scar is more or less deformed?

VVHereas there are two no∣table differences of Scars; nevertheless the condition of each is not always the same: For the deformed is sometimes more, some∣times less deformed: and so the apparent is sometimes more, some∣times less apparent. Now the rea∣son of this difference is grounded (to omit nothing material in the point) upon the parts of the Face, and the greatness of the Scar. A Scar therefore in the Nose is in my mind the most deformed: next to that, in the Cheeks: then in the Lips: next them, in the Eyes: then in the Forehead: and lastly in the Ears. Because such Scars dissigure the Face extremely. I put the Nose in the first place; not be∣cause it performs very noble Acti∣ons; but because it is principally exposed to view, as being in the middle of the Face, and promi∣nent also. I know, some do main∣tain, that a Scar in the Eyes is most deformed: Indeed if the Use of them be considered, I shall not contradict them. But now, not the Use but the Beauty of a part is under consideration: for some∣times an Eye that has the Optick Nerve obstructed and sees nothing, may appear Beautiful to look on: so that Beauty depends not on use or action. As to the gracefulness of the Nose, Melet••••s the Philo∣sopher says well, ••••do natura ho∣minis, where treating of the Nose, he says,

This part above all others renders the Face ei∣ther handsome, or ugly. In∣deed the necessity of the Nose on ones Face for action and use is small; only beauty and grace∣fulness is most apparent in it: On the contrary the Eyes are of less ornament, but of more use.

And Virgil, who is extremely hap∣py in expressing things by apt names, describing the Wounds of Deiphobus, calls only that of the Nose inhonestum or disgraceful, af∣ter he had excell••ntly well de∣scribed the rest, 6. Aen.

At{que} hic Priamidem laniatum corpore toto Deiphobum, vidit, lacerum crud••∣liter ora: Ora, manus{que} ambas, populata{que} tempora raptis Auribus, & truncas inhonesto vu∣ner•• nares.

And (which more confirms me in my opinion) we find it recorded in the Laws of the Lombards, that they who were caught in one Thest, should have one Eye put out: and they, who were found guilty of two Thests, should have their Nose cut off. So that from hence it is apparent, it is a greater punishment, and more a mark of disgrace, to be without a Nose than without an Eye. It is also said, that a certain King of the Aethiopians (according to Alex∣and. ab Alexand. l. 3. c. 5.) pu∣nished some delinquents not with death, but by cutting off their Noses; so that others beholding the ugliness of their Faces, might be deterred, from their crimes. Thus it appears, some people account it more grievous to lose their Nose than their Life. As for a blemish in the Eye, it does not near so much disfigure a Man. The Ears are put in the last place, because they are set behind the Face, and not easily discerned. As to the Magnitude of Scars, whether they be deformed or apparent, there are three degrees, vir. ••arge, Small and Middling. A great one pos∣sesses a great part of the Face, is very hollow, or stands much up. A little one, takes up but a little part, and is almost smooth. A middling one is between the two former extremes. And so you may judge of Scars.

SECT. XXXVI.

Some Cautions in judging of Scars.

HAving discoursed sufficiently concerning the nature and difference of Scars, I must now caution you in giving your judg∣ment about them, that you do not easily nor rashly judge of a fresh Scar. At first it always appears bigger and more deformed. Wherefore it would be better to tarry a while, till the reliques of the Fluxion, and the proper Ex∣crements of the Part, which swell and discolour the Scar, are disperst, and the part returns to its natural state: for then the mark of the Wound will not lie; and so you may then make a true Report. But if time will not be allowed you, and you must give your opinion presently; You may say, that time will take off much of the deformi∣ty; especially when the Party is young, and of a good complexion. This also you must take notice of (as Celsus, l. 7. c. 4, has observed) thô a Cicatrix or Sear may be brought upon most places; yet it proves otherwise in the Fore∣head

just above the Eye-brows, if the Bone be much hurt: for then an Exulceration will go near to last as long as one lives, which must always be kept covered with Lint and Plaster. Paraeus gives the Reason, viz. Because there is a cavity under the Bone, which teaches to the Os Cribrosum of the Nose, full of Air, which hinders the coming of it with Flesh: Or because the Bone is there so thick, that enough of alible Juice can∣not have passage out thence for the regenerating of Flesh. Besides, there is a great conflux of Excre∣ments into the Ulcer, which used to run out at the Eyes and Nose. This also you must not forget, that sometimes a foul Scar is left after a small cut. The blame whereof lies sometimes on the Chirurgeon, who either closed not the Lips of the Wounds as he ought; or ap∣plied improper Medicaments: Sometimes on the Patient's in∣temperance, and other external errors: And sometimes on the foulness of the Patient's body. And if sometimes we lay a mans death, though he were wounded, to the bad Humors in his Body, or to a bad Diet, or to some exter∣nal error, why may we not do the same in Scars, when a small Wound leaves a foul Scar? One may say then, that he does ac∣knowledge indeed, the Scar is de∣formed; but it is not so from the nature of the Wound, it being but small; but either from the dis∣orderliness of the Patient, or from some other external error. More∣over, if the Scar be such as that it can be covered either by the Beard or the Hair; you may call it in∣deed deformed; but by accident it may be so far from being deformed, that it is not apparent. Since there is no deformity but what is seen. And so a Man may sufficiently be informed in his judgment concern∣ing Disfiguring.

THE PRACTICE OF CHIRURGERY. BOOK IV.

CHAP. I.

Of the Definition, Differences, Causes, and Signs of Fractures.

HAving, as we promised in the beginning, fi∣nished that share of the Synthetick part of Chirurgery, which falls to the soft parts of the Body (comprehended in the Doctrine of Tumors, Ulcers and Wounds) it remains, that we proceed to the remaining portion of the Synthe∣tick part, belonging to the hard∣er parts of the Body, the Bones, which either suffer in their conti∣nuity, as in a fracture; or in their Contiguity, as in a Luxati∣on. A Fracture in Greek is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; and by Paulus Aegineta c. 89. l. 6. is defined to be a solu∣tion of continuity in a Bone, pro∣ceeding from some violent extrinse∣cal cause.

The differences of Fractures, according to Galen, c. ult. l. 6. Meth. are taken from the figure, magnitude, or diversity of Bones. From the Figure, a Fracture is streight, which is made length∣ways; transverse, breadth-ways; Or oblique, which is compounded of both the former. From the

Magnitude, according as the Fra∣cture is great or small. From the Bones themselves, according as a Thigh, Arm or Rib is broke. Hippocrates says, a Fracture is made three ways. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or transverse; as when a stick is broken short off. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, when it is split like a Plank. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, when it is broken to pow∣der, as Meal, or into many little pieces.

The External Causes are usually Contusion or Flexure; and what∣ever things may cut, bruise, break, shatter, or bend a Bone. Falls may be reckon'd among such cau∣ses. It is very rare, that an ero∣ding instrument; as Fire; or a pungent one, does break a Bone.

A Fracture without a Wound i•• known, First by feeling the pie∣ces of Bones in handling the part. Secondly, if the broken Limb be handled, it makes a crackling and a noise in the broken part, by the rubbing of two hard bodies one against another. Thirdly, there i•• a violent pain, by reason of the d••••ulsion or straming of the Nerves, or the pricking of a nervous body by some part of the Bone that sticks out. The Fourth sign is an Impotency of using the fractu∣red part, or of leaning upon it. The last sign is, if causes of Fra∣ctures have preceeded, and the fore-mentioned signs are present. These are perpetual concomitants of Fractures. And sometimes there is a crookedness, and a short∣ness in the part; but it is not al∣ways so.

If a Wound accompany the Fra∣cture, besides the foresaid signs, the breach or roughness of the Bone may be felt. And so much for a transverse Fracture.

If the Bone be split length∣ways, the part is thicker than in its natural state; and then there is pain, and an unevenness in it.

As to the Prognostick, No Fra∣cture in the Bones is void of dan∣ger; because of necessity, the so∣lution of the continuity must be great. In a fleshy part indeed, if a Wound be received, only so much is wounded, as the wounding in∣strument cuts, and no more; but if a Bone be broke, it must, by rea∣son of its rigidity and continuity, be broke quite through. A Fra∣cture also is dangerous; because it lies deep, where the Chirurgeon cannot come at it with his hands. But some Fractures are more dan∣gerous than others: In a great Bone they are more difficult to cure, than in a small: Matilfold, than Simple: With a wound, than with∣out one: And near the Joints, than far from them.

CHAP. II.

How an Inflammation in Fractures may be pre∣vented.

THE Cure of Fractures re∣quires Union. And Union can never be made, unless Bleed∣ing and Inflammation be prevent∣ed, according to Celsus, c. 26. l. 2. In the Bones indeed Bleeding need not so much be feared, as in the fleshy parts, unless the Fracture be with a Wound: for no considera∣ble Veins or Arteries go to the Bones: because they are hard Bo∣dies, their heat is little, and little of their substance can be wasted. Yet here we are mightily afraid of an Inflammation, even more than in a fleshy part. The reason is, Pain causes attraction, then because of their weakness many Excre∣ments are both received and bred there, which cannot be discharg∣ed by the fractured part. And that which increases the danger, is, the Bones often lye deep buried in much flesh. Now an Inflamma∣tion is prevented here, by remo∣ving its causes, as in a simple Wound, which we have already treated of sufficiently, and there∣fore we will not action age∣re.

CHAP. III.

Of curing a transverse Fracture, without a Wound; and First, of joyning together the parts of the broken Bone.

COme we now to these things that only respect the cure of the Fracture it self. This sort of cure is in Greek called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in English Bone-setting. First of all we shall treat of a transverse Fracture without a Wound. In this Fracture the Indication is the union of the Bone, which cannot be done by the first Intention, ex∣cept in Children; but by the Se∣cond it may, i. e. by the interven∣tion of a Callus, growing over, and surrounding the fractured parts. The intentions of Cure here are, First, to put together the parts of the fractured Bone aright. Secondly, to keep the parts so put together. Thirdly, to take care of the cure of the parts. Fourth∣ly, to endeavour to breed a Cal∣lus. Fifthly, to correct ill Acci∣dents.

That the parts may be rightly joyned together, there is need of extension and coaptation. For in Fractures, especially the transverse, because the Bones are distorted, and the streightness of the part is lost, it so happens, that some parts stick out, and others are hol∣low. And because one part of the fractured Bone lies upon the other, the Limb of necessity must be shorter: for the Muscles ever draw the Limb towards their Original. Wherefore Extension is necessary, whereby the Chirurgeon may set the ends of the Bones directly one against another, which lye not di∣rect, and may put the risings up into their Cavities. And tho some∣times the Limb seem not to be too short, (as when there are two Bones, and but one broken, or when one end of the Bone rides not upon the other) nevertheless, if the Coaptation be made as it ought, Extension must of neces∣sity be made in all transverse Fra∣ctures; for the shivers of the fra∣ctured Bone would be in danger of breaking off, should we without Extension direct and turn round the distorted Bone, or rub the ends one against the other. And if the shivers break off, then they either fall between the ends of the Bone that should be joyned, and so hinder Coaptation; or they slip

besides the Bones, and then they cause pain by distending and prick∣ing the Nervous Parts. And all these inconveniences are prevented in Extension.

However Measure must be ob∣served in Extension: for if it be more violent than is requisite, it causes great Pain, whence Fevers, Convulsions and Palsies often en∣sue. Galen com. 1. l. 1. de fract. writes, that sometimes the Muscles have been pulled asunder. If the Extension be less than it should, the Shivers will rub one against another, and so break, or they will not be lodged in their proper Ca∣vities. Therefore big Bones and great Muscles, which draw a part strongly toward their Original, require violent Extension: Such Bones are first the Thigh, next the Shoulder and Leg, then the Arm, then in the top of the Hand and Foot; especially if both the Bones be broke. The Radius in the Arm, that is, the upper Bone, re∣quires but small Extension; be∣cause this Bone has not Muscles to draw upwards: for it moves any downwards and supinely. You must also observe a due figurati∣on, i. e. that the Limbs be extend∣ed in that Figure, which causes the least Pain: And this is done, if the Fibres of the Muscles be stretched directly, and the Muscle be kept whole in some part of the Limb. Children, and such as are of a soft habit of Body, endure more violent Extension: Grown People and hard, on the contrary. Then we must consider the time of Fracture: for if the Chirur∣geon come the first day, he may the more powerfully extend. But if he come after the first day, he must either not extend at all, or more gently; because of the influx of Humors, or for fear of Inflam∣mation, according to Celsus, c. 10. l. 8.

The Instruments of Extension are threefold. First, the Chirur∣geon's Hands, for a weak or small Extension. Secondly, Cords and Strings for a moderate Extension. Thirdly, Instruments and Engines for a strong one.

When therefore you have let go your extending Instruments, a good coaptation of the parts of the Bone must be made, which we may know by three Signs. First, if the fractured Limb be uniform in Figure with the sound. Second∣ly, if no hollowness, roughness, standing up, or inequality be ob∣served in the broken Bone. Third∣ly, if Pain abate.

CHAP. IV.

How the Parts of the broken Bone may be kept united.

THe second intention of Cure is, to keep the parts united. This is done by Bandage, which must be so made, as to keep the parts set together, and to keep them from Inflammation.

Hippocrates uses three Rollers of Linen, not too course, lest it press the part; nor too fine, lest it tear.

He rolls the first Roller thrice about the Fracture, a good way on the part, so as to make three or four or more turns. By this means the Fracture is fortified, while the Roller is turned thrice round it: Also the Humors are liept off from coming into it, espe∣cially from the upper parts: there∣fore the Roller is carried up∣wards.

The second Roller, which is twice as long as the first, he rolls the contrary way: for if the first were rolled to the right hand, this is rolled to the left, that if any Muscle were drawn too much to one side by the first Roller, it may be restored to the contrary by the other, which must be rolled once about the Fracture; then to press Humors out, it must be carried downwards a good way of the Limb, i. e. by making three, four or more rollings, if there be need; then it must return upwards again by the Fracture, making a Circum∣volution upon the very Fracture, till he comes to the end of the first Roller, where the second also must terminate. This Roller, as I said, is first rolled about the Fracture, that it may press the Humors from it; then it is carried downwards, to stop the Humors, which might flow from the lower parts, as to a weaker: And be∣cause there is fear of a descent of Humors from the upper part; therefore Hippocrates does not end the Holler downwards, but rolls it upwards, that it may end where the first ended. These two Hol∣lers do more prevent Inflammati∣on, than strengthen the Fracture: for more Circumvolutions are re∣quired to this.

Having done thus, Hippocrates puts over the Bandage Compresses of linen Cloth three or more times double, of the form of a Roller, but narrow, that five or six or more of them may be applied lengthways round the Fracture, of

the same length with it, as many of them, as are requisite about a Fingers breadth one from another. They are to be spread with a lit∣tle Cerote (for if there were a great deal, they would slip, and not hold.) They are called Plagulae and Sple∣nia, from their oblong form. They supply the place of a glutinative Medicine, and besides, they asswage pain, while they hinder the com∣pression of the Rollers.

The third Roller fastens the said Compresses. The first turn of this Roller is made upon the fra∣cture, then one head of the Rol∣ler is carried upwards, and the o∣ther downwards. This is to be observed, That the Rollers must be drawn straiter upon the fra∣ctured part, than any where else; that it may the better be kept from defluxions.

Celsus c. 10. l. 8: has another way of Bandage. For first, he applies about the Fracture linnen Cloth dipt in Oyl and Wine. Then he takes six Rollers, where∣of the first is shortest, this is rol∣led thrice about the Fracture, and thrice also above the upper part of the Limb. The other Roller twice as long is rolled from the Fracture downwards; and then turning upwards, it must end in the upper part above the first Rollers. These are the two first Rollers of Hippocrates. Over these a broad linen Cloth spread with Cerote must be brought to fasten them. And where the Bone sticks out (for the broken Limb has always a propensity that way, which it had a propensity to in breaking) evermore a linnen Cloth three or more times double; dipt in the same Oyl and Wine must be ap∣plied over against the part whi∣ther the Fracture inclines. Some∣times I use Cloth, sometimes Tow, which I dip in rough black Wine, when I have a mind to strengthen the part, and prevent Inflamma∣tion; or in the white of an Egg, if the Fracture is without pain, and I have a mind only to keep it fast. Celsus dipt in Wine and Oyl of Roses, when Pain was grievous. Over this he brings the four re∣maining Rollers. So that the fol∣lowing must always roll contrary to the former, and the third must end below all the rest above.

Celsus his Bandage differs there∣fore from that of Hippocrates: For Hippocrates uses three Rol∣lers; Celsus six: Hippocrates uses Compresses; Celsus broad linnen Clothes: Hippocrates uses Cerote; Celsus Oyl and Wine. If any con∣siderable pain afflict the part, Cel∣sus his Bandage is best: but if there be little or no Pain, Hip∣pocrates his Bandage is better, which is most approved of by Galen, cap. 5. l. 6. Meth. The Moderns presently take a Roller, and roll the Fracture to both ends, not at all regarding what either Hip∣pocrates or Celsus says. But it is our best way, to follow the best of Physicians.

The Patient's good tolerance must be the measure in binding. the bandage must press lightly, so as to keep the Fracture firm, and press out the Humors. But there are other signs, which appear the next day. For if the Patient, that day the bandage was made, found himself bound tight, and the next day a lax, soft and small Tumor

appear (in the Hand, if the Arm were broke; in the Foot, if the Leg) the bandage is good: But if either no swelling at all, or a great and hard one appear in the Hand or Foot the next day, the bandage is bad; because the first does not keep the Fracture fast; the latter occasions Inflammation.

On the third day after deligati∣on, Hippocrates unbinds the Rol∣lers: for about that time they grow slick, which is one reason why they are unbound. Another reason is, because most frequently in Fra∣ctures, an intolerable Itch disturbs a Man, because of Humors and Vapors detained by bandage, and grown sharp; which itching usu∣ally ends in a painful and inslam∣matory excoriation. Then the Rollers must be unbound, and the part troubled with the Itch, must have warm water often poured up∣on it, to make the Humors and Vapours evaporate. Then the Limb must be bound up again. Good bandage being made, and the Itch being no more trouble∣some, the Patient must be kept bound from the third till the se∣venth day: On the seventh it must be opened again, be bathed in warm water, and bound up a∣gain.

But at this time, instead of Sple∣nia or compresses, you must use Ferulae or Splints (so Hippocrates calls them.) In our time, because we have no store of Ferulae, Chi∣rurgeons use thin slices of Wood called Scabbard, which they wrap in Tow: Some use Pastboard: others use pieces of Wood an Inch thick. The use of these is to keep the Limb not only immove∣able, but streight: And this Fer••∣ke best do, which, as they are light, they do not press nor cause Inflammation; and as they are stiff, they keep the Limb streight, where Scabbard is easily bent, and Pastboard likewise, especially dipt in Oil or Wine; and thick pieces of Wood press and cause Inflam∣mation. Hippocrates used these after the seventh day: because be∣fore the seventh day, the intention to prevent Inflammation was more considerable than that, to confirm the part: but after the seventh day on the contrary.

CHAP. V.

How the substance of the Bone may be kept sound.

THE third scope of curing Fractures is, to conserve the substance of the Bone sound: for Nature, i. e. the temperature of the part, cannot unite the Bone, except the part be sound. Because the fractured part then is weak, so as that the Excrements of the Body do easily flow to it, by rea∣son of its weak action many Ex∣crements breed, and cannot be ex∣pelled; and besides, because in a broken Bone, thô never so well sett, yet certain holes remain, that are afterward filled with Sanies: Therefore to keep the part sound, we have need of Medicines, that dry up the influxed matter, and repell the influent, which in a word, are called Astringents.

The matter of this remedy is va∣rious: for Hippocrates uses Cerote; Celsus, Linen dipt in Oil and Wine. Among the Moderns, some use Linen wrung out of black rough Wine: some, combed Flax, wrung out of black rough Wine: others take Oil and Wine, and with them mix equal quantities of Bol. Arm. Sang. Drac. Myrtil. Balaust. Ro∣sar. Rub. Others, besides these Powders, mix the white of an Egg, and make a Medicine as thick as Honey, and apply it upon comb∣ed Flax, or upon a piece of Linen. Some take the white of an Egg, and black rough Wine, mixing the foresaid Powders without a Cloth or Stupe, and apply it round the fractured Limb: And these Medicines, because of the white of the Egg, grow presently dry, and stick fast to the part. Some wind Rollers, wrung out of black austere Wine round them, to make them stick the faster.

As to the use of these, the in∣tentions to be considered are, First, to prevent Inflammation; Se∣condly, to preserve the tone of the part; Thirdly, to asswage pain. Also the season of the year, the habit of the Body, the Age, and Magnitude of the Fracture must be considered. If pain there∣fore be urgent, the Cerote of Hip∣pocrates, spread upon a piece of Linen cloth is proper: But over this Cerote another Linen cloth, wrung out of black rough Wine, must be applied to prevent Inslam∣mation. If the Cerote be made of Wax and Oil of Roses, or Myrtils, it will asswage pain by rea∣son of the Oil; it will prevent In∣flammation, and strengthen the Fracture by reason of Astriction, Thô the pain be but small, it must

not be neglected: but our chief∣est aim must be to prevent Inflam∣mation, and strengthen the Fra∣cture: therefore we take Oleum Ros. Vinum, & Ovi albumen, his pulveres dictos, ad mellis crassitu∣dinem miscemus, & linteo aut stu∣pâ apponimus. If there be no pain in a manner, then we use all our endeavour to prevent Inflamma∣tion and strengthen the Fracture; and therefore we abstain from Oil. If the habit of the Body be hard, the Summer time, the Fracture great, suppose in the Thigh, with the white of an Egg we mix the foresaid astringent Powders, addi∣tis corticibus granatorum, gallis immaturis, succo hypocistidis, quae stupis imponuntur: over this we apply a broad piece of thin cloth, wrung out of Wine; or if we care not to wrap so many cloths about the part, we wring the first and se∣cond Roller out of black rough Wine, and so roll them. And by these Medicines the substance of the part is kept sound: all which must be applied before bandage is made.

Next to bandage, succeeds the position or collocation of the Limb. This according to Hip∣pocrates, must be soft, lest by pressing it cause pain; equal, lest it distort the part high; and, lest the Humors descend. Therefore Chi∣rurgeons place the fractured Limb in Bed upon soft Bed-cloaths: or they tye a Pillow stufft with soft Flocks or Feathers to the fractured part: Or they make a Pastboard hollow, and line the inside with Tow, for the Arm, and such Bones as do not oblige the Patient to keep his Bed. But if the Patient be confined to his Bed, there is no∣thing better than to make a Case of thin boards, and fill it suffici∣ently with Tow or Wooll.

Besides, in the position, as also in the extension and bandage of a part, you must consider the pro∣per figure or posture of the part, i. e. such as is void of pain, and keeps the Muscles entire on every hand: And this is a middle Figure, in which, when we have nothing to do, we keep our parts; as an angular figure in the Arm, a streight one in the Wrist, &c. that is, such an one, as is intermediate be∣tween the extreme motions of eve∣ry part. Unless this posture be observed, in a little time the Limb will ake.

CHAP. VI.

Of breeding a Callusin Fractures.

THE fourth Intention is to breed Callus. This must be done, when all danger of Inflam∣mation is over: usually about the seventh day, according to Galen c. 5. l. 6. Meth. thô it may some∣times be done sooner or later, ac∣cording to the greatness of the Fracture, season of the Year, Age, habit of Body. &c. just as we said in the cure of a simple wound of the flesh. For while we are in fear of a Defluxion, we cannot thînk of breeding a Callus; because the nature of the part being hurt, it cannot breed Callus.

Now Callus is bred of the nou∣rishment of the Bone, which owz∣ing out of the edges of the Fra∣cture, grows concrete about the fractured Bones: And though it be not Bone; yet it is so hard, that if that Limb chance to be bro∣ken again, it will rather break in any other part, than where the Callus is bred. Here are therefore two Indications, First, to supply congruous Matter, Secondly, to keep it from being washed, or any way got off the edges of the Fra∣cture.

As to the matter of Callus, the Food must be thick (because the aliment of Bone is thick) and al∣so viscid: wherefore we must use, Rice, Wheat boiled in Water, Bar∣ley, the Feet, Stomachs and Heads of Animals, especially of Calves and Weathers: The Skin also of a Kid or Weather may be given, and Neats-feet. Wine must then be given, and that black and thick. And the Diet from low must be altered to high.

Medicines also may be given in∣wardly, which are good to breed and harden the Callus. So Succus primulae veris may be drank for several days together, Pulvis ra∣dicum agrimoniae drunk in Wine, or Succus ejus drunk alone.

The applications must be Em∣plastick: wherefore for Children and Women we make a Plaster è Farinà volatili, & Ovi albu∣mine. To grown persons we ap∣ply this Plaster; ℞ Boli Armen. Thuris, M••rrhae, Aloe's, Acaciae, Tragacanthae, Ladani, Gallarum, rucum cupressi, and part. aeq. in pollinem redacta, miscentur ovi albumini, cum modico farinae vo∣latilis. We use for perfusions, è decocto Granorum & foliorum Myr∣••••, radicum uhni, & foliorum fraxi∣ni; also è succo foliorum vit is al∣bae. These Perfusions are used when the bandage is untied, before

the Plaster is applied, and the part bound up again. Among other things, Chirurgeons use Empla∣strum barbarum, and Oxycroceum in Winter, Spring and Autumn, because they are hot; and Dia∣palma in Summer time. Thus therefore we provide Matter apt for breeding of Callus, both by Di∣et and Medicines.

But lest this Matter, of which Cailus should be bred, might be thrust forth, we must alter our ban∣dage: for the part must not any more be so bound, as to press out the Humors, but so as that they may continue there, and grow together about the Callus. The Fracture therefore need not be bound so frequently as before; once in five days is sufficient. The Rollers al∣so must be drawn looser. Yet in the first bindings, you need not tarry so long, but you may see how the Callus in the Fracture pro∣ceeds: It is long enough therefore to tarry two days between the openings: And then you must con∣sider, whether as much, and such a Callus breeds, as is requisite. But how you may help a Callus, when it is less or greater than it should be, I shall shew you afterwards.

In a Fracture made length-ways, the same cure must be used as in a transverse: Only the bandage must be straiter, otherwise it would be apt to slip.

CHAP. VII.

Of Symptoms attending a Fracture; and of a Fra∣cture of the Knee-pan.

NOw we are come to the fifth Intention, namely the cor∣rection of Accidents, which usu∣ally attend Fractures, and retard their Cure. And they are Pain, Inflammation, Itching, Excori∣ation, Callus greater or less than it ought to be, debilitation and slenderness of the Limb, the de∣praved Figure, a Wound.

If Pain then afflict, it must be as∣swaged by Anodynes, as Lana succida, infusa in Ol••o & aceto si∣mul mistis, & coctis; Spongia ex Oleo Rosarum expresa, & imposita; anointing ex Oleo Chamaemeline, & Lumbricorum; then a Linen Cloth dipt in black austere Wine, and applied; All which must be used actually warm. Hippocrates uses a Cerote, which is best, if it be made with Oil of Roses. A Fo∣mentation also with a Sponge is proper, wrung out of Water, in qua Malva & Chamaemelum Bul∣lierint.

How an Inflammation not yet arisen may be prevented, we have

shewn already. But if one be a∣risen, we apply this Medicament; ℞ rad. Althaeae, florum Chamaemel. violarum an. M. ••. coctis in aqua & contusis adde Farinae Hordei ℥iv. sapae ℥ iij. Ol. Rosar. Violar. an. ℥ iij. Vini nigri, aut aquae Hor∣dei q. s. Misce pro Cataplasmate. If the Heat be very violent, and the Inflammation in its state; ℞ rad. Alth. ℥ iv. fol. Violarum balaustiorum, Plantaginis an. M. iss. florum Chamaemel. M. j. deco∣quantur in aqua, & cum Oleo Ro∣sar. ac Chamaemel. aequis porti••ni∣bus simul mistis, fiat Emplastrum. If the Inflammation be in the declension, we use a Fomentation è flor. Chamaemel. & Beton. decoctis in Vino albo; also a Fomentation è Rosis & Calamintha similiter de∣coctis.

If the Itch trouble one, because of detention of the Humors or Wind, the place must be bathed with warm water, that when the Pores are opened, they may be dispersed: Or the place may be so∣mented with a Sponge dipt in warm water, and wrung out. Ba∣thing in Sea water is very good; which, by reason of the Salt, is detersive, and opens the Pores.

When this itching is neglected, it usually terminates in a painful, and sometimes an inflammatory excoriation, which must be cured by driers and coolers. In Summer time therefore Ʋnguentum de Ce∣russa is good; in great heat, Ʋn∣guentum de Cerussa caphuratum. If it be Summer, and the Body be excessive hot, Ʋnguentum Popu∣leon is good; also that they call Linimentum simplex; if it be new made. At other times Ʋnguentum de Lithargyro, and Ʋnguen••••an de Minio are proper. All these are cooling and drying; some more, others less.

The Callus sometimes is less or greater than it should be. The signs of its being less than it should be, are, if the part be weak in mo∣tion, and if, when the broken part is tou••••ed, no Callus, or very lit∣tle is selt. Now this comes to pass, because the Patient used too thin a Diet, or Meats either not thick, or not viscid enough, but friable: or because the Rolle••s wer•• drawn over strait. It must therefore be increased by a fuller Diet, the ban∣dage must be slackened, the a∣stringent Medicines must be more gentle. The Humors must be at∣tracted by bathing with warm wa∣ter (not very hot, lest the attract∣ed Humors evaporate again) till the part looks red, and swells a little; for then we must desist.

If the Callus be too great, the signs are, when it is handled it may be felt, and by pressing the Muscles and nervous parts, it causes pain. And then it is unapt for motion, by reason of the pain and compres∣sion. In this case the quite con∣trary course must be taken, as to Diet, Rolling, &c. Then the Cal∣lus must be softened and digested; for which purpose, these are good; Emplastra è Radicibus Althaeae, fo∣liis Malvae, & Meliloti, decoctis in aqua, cum axungia anatis. But before the Plaster is appiled, Per∣fusion must be made with the same decoction. When there is an Emollition, Perfusions must be af∣terwards made of water, wherein Betonica, Scabiosa, Scordium & Pa∣rietaria have been boiled. These

things must be done, not only till the part grow red, and swell a lit∣tle, but till it fall away and cor∣rugate.

If a Gangrene arise, we must immediately bath the part in a Lixivium, wherein Scordium and Plantain have been boiled: Then a Plaster must be applied, made è farina Lupinorum, pulvere Scor∣dii, & Oxymelite, cum modico lixivio.

If the Limb grow too small, be∣cause of the over-straitness of the Rollers, too much bathing, too much motion, or scarcity of vis∣cous Aliment; the Patient must be nourished; then a Bath of fresh water must be administred, where∣in if a little piece of flesh be boil∣ed, it would be better. Besides, Pication must be made, viz. Pitch must be spread upon a Cloth, and applied to the part, and then snacht off hastily for several times, that the plucking of the Hair may cause pain, and so attract nourish∣ment to the part. Then warm water must be poured upon it.

But after Fractures are cured, oftentimes the part remains de∣pressed in its Figure, and distort∣ed; because there was not a good Co••••tation of the Bones, either through, the Chi••urgeons igno∣rance, the Patients disorderly mo∣tion, or bad bandage. If the Limb be not hurt in its motion, the Pa∣tient must rest contented. If the hurt of the Limb in its Operations be considerable, the Patient old and weak, the Callus old too, and the fractured Bone great; the Pa∣tient must likewise rest himself con∣tented. But if the Patient be young and strong, the Callus fresh, and the fractured Bone small, the only way will be to break the Fra∣cture again; yet for several days we must, as much as we are able, soften the Callus by baths of Al∣thaen, Malva, Lotura lanae, Oesypus, & Lutum thermale: much Fri∣ction must be used by the Fingers anointed with Oesypus, perfusions must be made of Water, wherein Hemlock was boiled. We may al∣so use Emplastrum è foliis cicutae cum axungia porcina. Then the Bone may be broke again by the strength of the Hands or Fingers if the Callus be very hard, I break it with an instrument drawing dif∣ferent ways; then I cure it; as I have already shewn. Thô some good Chirurgeons are timorous (as Albucasis) lest the Callus should not, when broke, re-unite.

The operations in all simple Fractures are so exactly alike, that to instance in particular cases, would be but to repeat what has been already said. Only the Fra∣cture of the Patella or Knee-pan differs from all other Fractures in cure, as that Bone differs from all others in site and connexion. Hil∣danus Obs. Chirurg. 88. Cent. 5. has this relation. A Man forty years old, strong, and of a good habit of Body, by a fall broke his Knee-pan transverse, with a great contusion of his Knee; but with∣out a Wound. Though the Pati∣ent was all along treated accord∣ing to Art; yet most acute pain, and other Symptoms followed. At length the pain and other Symp∣toms ceased; but he halted, and had an exceeding great weakness in that Leg, so that he had much a do to walk, and if he climbed

any place, he could scarce lift his Leg up. Several things were used to strengthen the Nerves; but all to no purpose. And here it pro∣ved, as Paraeus has observed, that halting generally attends a Fra∣cture of the Knee-pan. Some are of opinion, that the cause of the lameness is, because the Callus, which joyns the fractured Patella, fills the Cavity underneath, and so hinders the motion. But the ex∣tuberance of the Callus is rarely so great as to do this. And in this Patient the Callus could not be the cause of lameness, as by what follows will appear. It is there∣fore to be considered, that the Pa∣tella may be broke transverse, ob∣liquely, or lengthways in a right line drawn from the Thigh to the great Toe. Now a Fracture length∣ways will not cause lameness, if an expert Chirurgeon have the handling of it: for he may easily joyn the disjoyned Patella, and keep it in its place, by Bolsters, Pledgets, and Rollers, when joyn∣ed. He may do it easily, I say: for the ends of the seventh, eighth, and ninth Muscles, that move the Leg, do meet about the Patella, and terminate in a very strong Ten∣don, which Tendon does so in∣volve the Patella, that if it is broke lengthways, the Fracture is apt to close of it self; because it is the property of Muscles to draw towards their Original. So when the Fracture is made, according to the rectitude of the Bone, Mem∣branes, Muscles, and Tendons, it is consentaneous to Reason, that they must return to their place again; and when the edges of the fractured Patella are immediately joyned, and that exactly; there can be no extuberance of Callus, and therfore no lameness. Pro∣vided the Chirurgeon has done his duty in applying proper Topicks, and has obviated Pain, and other occurring Symptoms.

But when the Fracture is made transverse, the case is quite other∣wise: for then the seventh, eighth, and ninth Muscles, draw towards the Hip, and the Tendon inserted in the Patella, draws downwards; and then it is so disjoyned in the middle, that the edges of the Fra∣cture, by reason of the strong at∣traction of the Muscles and the Tendon can never be joyned. And that the Fracture was such in the foresaid Patient, both Ocular in∣spection, and Feeling with my Fingers convinc'd me. For it was so disjoyned in the middle, that one might lay more than ones little Finger in the Cavity. No won∣der then, if from this disjunction of the Patella, lameness followed, and the Patient could scarce draw his Leg after him; since the Mu∣scles that move the Leg, especial∣ly the seventh, eighth, and ninth, were deprived of their strength. Lameness likewise follows a trans∣verse Fracture. For the foresaid Muscles and the Tendon draw the edges of the fractured Knee-pan up or down, or transverse, and so disjoyn them. Hence it is evident, that a transverse or oblique fra∣cture of the Knee-pan, can never by Art or Industry be so cured, but the Patient will be lame. Yet Paulus Aegineta de re Medica. l. 6. c. 103. will have the Leg ex∣tended, and the Knee-pan joyned with the Fingers, and so kept till

the edges of the fractured Bone touch one the other, and are grown together. This may indeed be tried; but I can scarce believe, that the edges of the Patella can be so joyned; or, if they were joyn∣ed, that the Leg can be kept stretcht, and the edges of the Fra∣cture be kept together so long with the Rollers and Pledgets, by reason of the pain, as till a Callus be bred. But thanks be to GOD, as Avicenna says, this Fracture rarely happens. And thus we have done with simple Fractures.

CHAP. VIII.

Of curing a Fracture with a Wound, wherein neither the Bone is made bare, nor the coming away of any piece of Bone is expected.

IN a Fracture with a Wound, either the Bone is made bare, or not made bare: Besides, we either look for a piece of Bone to come away, or we do not. We will first treat of a Fracture, where∣in neither the Bone is made bare, nor we do expect any piece of Bone to come away. In this case we must mind the Intentions of the Wound, and of the Fracture one after the other.

First of all the Bones must be put together by extension, as we shewed before in the first indicati∣on of Fractures.

Then we must answer the Second and Third Intention of Wounds, i. e. the Lips of the Wound must be closed, and then they must be kept close.

Afterwards we mind the Third Intention of a Fracture, and the Fourth of a Wound, i. e. we pre∣serve the substance of the fractu∣red and the wounded part found, by applying Medicaments to the Wound closed, and the Fracture set, which may asswage Pain, if there be any, and prevent Inflam∣mation, i. e. which may repell the influent Matter, and may dry up what is gathered there already, and press out of the part; such as are astringents and glutinatives. Of which formerly. If there be Pain, and in Winter time, we must use Ceratum picatum: which ac∣cording to Hippocrates asswages pain; In Summer we must use Ce∣ratum; at other times, Ceratum simplex. If there be no pain, we must most endeavour the strength∣ening of the Fracture, and pre∣venting an Inflammation. There∣fore we must apply combed Flax,

wet in the Whites of Eggs, or a Linen Cloth wrung out of black Wine, and Oil of Roses. If the part be void of pain, we may use the foresaid astringent Powders, mixt with the white of an Egg.

Then we must satisfy another Intention of a Fracture, i. e. the Fracture must be rolled, as we shewed before. But here we must observe, that the Rollers must be softer and broader than in a Fra∣cture without a Wound, that they may reach over the edges of the Wounds on each side, and so may close, not press the edges of ••he Wound. The Rollers also are not to be drawn so hard, as if there were no. Wound, lest by squeezing the Wound, Pain and Inflammation should arise. Where∣fore Hippocrates and Ceis••s vse ma∣ny circumvolutions; since it is better to turn often about, than to bind hard. The band 〈◊〉〈◊〉 must be unbound every thi•••• 〈◊〉〈◊〉, and must be bound loose, as long as there is fear of Inflammation. Splints must either not be used, lest they should press the Wound; or if they be applied, they must not be laid upon the Wound. In this case Celsus his bandage, which is made with six Rollers, is most proper.

CHAP. IX.

Of a Fracture with a Wound, wherein the Bone is not made bare; but we look for a piece of Bone to come away.

WE say, there is a recess or abscess of a Bone, when a piece of Bone is separa∣ted from the main Bone, and is thrust forth by nature. This comes to pass, First, when after an old Wound, the Bones are dry and withered; for then the perished Bone is separated by the expul∣sive faculty of the part, and so there is an abscess, or desquam∣mation of the Bone: Which may likewise happen without a Fra∣cture, as in Fistula's and old Ulcers, by reason of much San••es, tarry∣ing too long upon the Bone, and corrupting it. Such a desquam∣mation may also happen in a Fra∣cture not Set, by reason of much Sanies gathering there. Secondly, Bones recede, when some piece by the violence of the Fracture, is ci∣ther quite separated from the rest; or so shattered, that it is in a manner separated.

The causes of this are either

external violence, or corruption of the Bone, either by Sanies tarry∣ing too long there; or by the al∣teration of the external Air, which corrupts the Bones, and destroys their natural temper.

The signs which shew that a Bone will recede, are various. 〈◊〉〈◊〉 18. l. 3. de Fracturis. The First is, too much Sanies comes away, not proportionable to the magni∣tude of the Wound, which shews the Bone is corrupt, and will come away. Secondly, the Wound looks as if it enclined to excretion, the the Lips of it do not close; but are rather inverted; and if the Pati∣ent narrowly mind it, he feels a tacit motion in the inside of his Limb. Thirdly, if the Bones have been deprived of Setting, then by reason of the continuance of the Sanies, which corrupts the Bone, a piece of the Bone will come away. The fourth sign is, if the Bone be made bare of Flesh, it must necessarily recede; because Aliment cannot be given, since neither Veins nor Arteries go to the naked part; and also because the Bone is exposed to the external Air, and is corrupted by it. The Fifth sign is laid down by Paulus Aegineta, c. cog. l. 6. If the Flesh, which grows about the lips of the Wound, be lax, dull and spongy: for Nature heals not the Wound, while it has something within it, which she cannot keep. A Bone therefore will come away, where∣about the Flesh is lax.

The signs of a very quick re∣cession are, when there is a quick suppuration in the Wound, and an early and fair excrescence of flesh; for the way the Bone does recede is, when Nature creates Flesh in the lips of the sound Bone, which keeps off and thrusts forth the fractured. A great solid Bone, in a full grown Person, in winter time, recedes slowly, in threescore days or thereabout. A midling lax Bone in tender years, and Sum∣mer time recedes sooner, usually within forty days.

As for the cure; If the Bone that will recede, be quite separa∣ted from the rest of the Bone, and is fallen within the Wound, and sticks there, it must be taken hold of with a pair of Pliers, and drawn out. And if a piece of Bone be quite cleft from the main Bone, but remains in its place; yet ne∣vertheless, because it will never glutinate with the rest of the Bone, it must be taken hold of and pul∣led out, if it can without violence. If it cannot be done without great violence, it must not be extract∣ed; because Pain, Inflammation, a Fever, and Convulsion would be caused, and there would be a fistulous Ulcer when such a Cavity was filled, after the extraction of the Bone, with Sanies, which by corroding, hinders the flesh from breeding. Then therefore this bu∣siness must be left to Nature her∣self, which by degrees breeds flesh in the lips of the sound Bone, and causes Bones to recede, as in the wounds of the Head.

It ought also to be considered, whether the piece of Bone, that is to come away, be great or little. This may be known by the intense∣ness or remissness of the fore-mea∣tioned signs. For if Suppuration proceed slowly, and great store of Sanies appear; also if much lax

and dull flesh breed, a great piece is to come away; if on the con∣trary, a little one.

If a small portion of Bone be to come away; First, we must take care, that the gathered Pus tarry not long in the Wound, and so corrupt the sound Bone: The Pus therefore must be evacuated, not by pressure of bandage drawn tight (as in a Fracture without a Wound) for so Pain and Inflammation would arise; but the Pus must be so evacuated, that it may flow out of the Wound. The Second scope is, to help the recession of the Bone, which business nevertheless in a little Bone, must be commit∣ted to Nature; but in a great one must be promoted by Medicines. For these reasons Hippocrates ap∣proves of loose bandage, and fre∣quent, that the Pus may not be stopt, but may pass freely: He does not apply Splints, lest by compres∣sion they might cause pain: The rest he leaves to Nature. This is to be observed, that thô you look for a recess of the Bone, neverthe∣less the Wound must be stitched: for Nature will not heal up the Wound, where the Bone is to come out. The Fracture may be con∣firmed by many Rollers, as has been formerly shewn.

If a great Bone be to recede, the Cure differs in two things from that foregoing: for Medicines are applied, and the manner of deli∣gation is peculiar. The Indicati∣ons are; that the Pus be not kept in, but run freely, that the Fra∣cture be confirmed, Inflammation prevented, Pain not raised, and that a speedy recess of the Bone be procured.

To do all these things; as to bandage, many Plagulae are to be taken of double linen Cloth, long∣er than to go once round the Limb (for shorter would not keep the Fracture stable) but shorter than to go twice round the Limb (for longer would not be commo∣dious, when the Limb is unbound, to renew the applications: for then the Limb must be lifted up and moved) that so both the Fracture may be kept firm, and without stirring the Limb, when both the Heads are loose, the Wound may appear in loosing. The breadth of the Plagulae must at least be half an hand; in some so great, as to take hold of both sides of the Wound. They are to be carried round, so as to cross one another. There must be as many Plagulae as are necessary, that no space may be left empty: I have often found, it is better to use too ma∣ny, than too few, for confirming the Fracture; yet so, as not to press too hard. They must be wet in black, austere, and thick Wine; for so they stick the better, they prevent Inflammation, and con∣serve the substance of the part sound: upon which accounts, but especially to prevent Inflammati∣on, Galen not only so wet the Pla∣gulae; but day and night kept the part wet with such Wine; or he applied Cloaths and Sponges dipt in such Wine; but that the run∣ning of the Wine might not wet all the Chamber and the Bed, he laid underneath, a Leather made like a Canal, to carry the Wine off.

But before we apply the Plagu∣lae, it is necessary to apply Medi∣cines, which in the beginning, i. e.

so long as the Inflammation lasts, may asswage Pain, and are good for Inflammation, such as Cera∣tum rosatum, Ceratum picatum is likewise commended, especially while Pus is breeding: for by help∣ing Coction, and causing Suppu∣ration, it prevents Inflammation, because when the Matter is Sup∣purate, no harm can ensue. Hip∣pocrates sometimes uses Linen wet in Oil and Wine mixt together, when there is pain, and danger of a Convulsion.

When the time of Inflammati∣on is over, we must use all our in∣dustry, that the receding Bone may with all speed be thrust forth; which though it may be done by Nature; yet it may be helped by Medicines. Things manifestly hot do this; ut Oleum vetus, Cera Citrina, sordities vasorum apum ad ignem liquata, cui admiscebitur pars una euphorb ii, duae tith mali, tres Aristolochiae: this Medicine must be used in Winter, in adult and hard Bodies, and it is com∣mended by Avicenna. In other Bodies and Seasons Ammoniacum & bdellium, dissolutum cum oleo li∣liaceo, is good. Cinis lumbricorum terrae, melli admistus & impesitus extracts a Bone, that is to come away, by a specifick property. And Ceratum Sacrum does extract Bones.

CHAP. X.

Of a Fracture with a Wound, in which the Bone is made bare.

THe Bone made bare must al∣together be defended from the alteration of the Air, lest it pu∣trefy and recede. Therefore if the Bone made bare stick not up above the Wound, it must be covered, not with abstersive Medicines, which irritate and cause pain, nor with oily and mollifying Medicines, which make the Wound foul, but with the natural covering, i. e. the Skin. The lips of the Wound therefore must be drawn together till they touch, by stitching; then the Cure must be proceeded upon, as in a Fracture with a Wound.

If the bare Bone stick out above the Wound, if it can with any ease be restored unto its proper Cavity, by the benefit of due extension, without violence, it must certain∣ly be done; then the Wound must be stitched, as we said but now. But if the bare Bone stick out to

high, that it cannot without vio∣lence be put into its place again; then of two evils the less is to be chosen, and the Bone must be cut off with a File, a Saw, or some other Instrument, and made a little shorter, and then it must be put together, by making a mode∣rate Extension: for this is better, than to leave such Bones not put together, or by violent Extension, to occasion a Convulsion and Death. If after the Bone is cut off it be difficult to put it together, and we fear violent Extension, where∣in because of the Wound, many Fi∣bres are extended, and great Pain is caused, so that a Convulsion may be expected: Hippocrates in this case replaces the Fracture as well as he can, and puts in a Chisel∣like instrument between the fra∣ctured Bones, and raises it like a Lever: and so the Bones are more extended than the Muscles, and may be replaced.

THE PRACTICE OF CHIRURGERY. BOOK V.

CHAP. I.

Of the definition, differences, causes and signs of Luxations in general.

LUxation, or putting out of joynt, is called Dislocation. It is the slipping of the Head of some Limb out of its proper Sinus, into another place. For Dearti∣culation, or a Joynt, which is de∣signed for motion, consists of the head of a Bone, and a Sinus; In the head it is observable, that all Bones which have a round head, have all motions, as in the Thigh and Shoulder: In the Sinus, that all which have a deep Sinus, as the Os coxendicis, are not so apt to be put out of Joynt; on the contrary, in such as have a shallow Cavity, as in the Scapula. But lest the Bones might easily slip out of their Cavities, there are also Li∣gaments: and some of them are orbicular, which in all Joynts en∣compass the head and Sinus round: others are round, and are only in such Joynts as are made for strong motions, as in the Thigh and Knee. These out of a deep Ca∣vity, are inserted into the head of the Bone. Now the Joynts that have both sorts of Ligaments, or that have only the orbicular, but

very close, are difficultly disloca∣ted. In the Joynts there is a sort of unctuous and viscid Humor, lest the Bones by their perpetual motion should grow hot and dry.

In general there are three sorts of Luxations. First, when Bones gape, which before were joyned. This happens in three places; when the broad Blade-bone parts from the Humerus; or the Radius from the Cubitus, or the Sura from the Tibia, as Celsus writes, c. 10. l. 8. Rhases 15. contin. calls it Disjun∣ction. A Second sort is, when Bones are lengthened, through the laxity and distention of the Ligaments; whence it comes to pass, that the head of the Bone starts a little out of the Sinus; yet it is not quite out, but it may ea∣sily be put in. I have often ob∣served this Luxation in Beggars, in the Wrist and Elbow. The third sort is properly called Luxa∣tion, when the head slips out of its proper Sinus, of which there are no differences; but according as it is more or less, Paul c. 11. l. 6.

If then the head do wholly and perfectly slip out of its Sinus, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, by Rhases Dislocation: If in part, and but imperfectly, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Rhases Distortura, or wrench∣ing. The Joynts of the Arm, Hand, Leg, Foot, Fingers and Toes suffer both sorts of Luxation; only the Thigh and Shoulder suf∣fer a perfect Luxation: the rea∣son whereof is the roundness of the heads, and thinness of the Ca∣vities; whence it comes to pass, that the heads do almost touch the edges in a point, and so either quite slip out of, or come in again to the Sinus. Yet Hippocrates says, the Shoulder and Thigh may be more or less luxated, which must be understood of perfect Luxation, while they are more less distant from their natural place. Moreover, this true Luxation may be made four ways, upwards or downwards, to the right hand or the left, Galen c. 4. l. de Con∣stit. Art. adds forwards or back∣wards.

The first sort of Luxation is oc∣casioned only by internal causes, i. e. by Humors, mollifying and relaxing the Ligaments. The other two sorts, namely; the wrenching and true Luxation, are occasioned both by an internal cause, to wit, the Humors, flow∣ing to the Joynts, which by de∣grees fill the Cavity, and thrust the head of the Bone out of its place: and by an external cause, which by violence moves the Bone out of its place, as leaping, a fall, and violent running. But we shall only treat of those Luxations that proceed from an external cause.

There are divers signs of Lux∣ation. First, when the motion of the Joynt is lost: for as long as motion is not lost, thô there be suspicion of a Luxation, yet there is no Luxation. But this sign is not enough, others must be ad∣ded. The Second therefore is an hollowness appearing in some un∣usual place, and on the contrary an eminence on the opposite side: for the Tumor is ever on that side unto which the Bone slipt; and the hollowness, from whence it is slipt: This sign is discovered by the sight and touch, in the Joynts,

which are either naturally without flesh, or emaciated. The third sign is, the Limb generally is short∣ned: for the Bone being slipt out of its place, since it finds no re∣sistance, is drawn upwards by the Muscles; this happens in a perfect Luxation. The fourth sign is; the Limb out of Joynt is unlike the found one in figure, site and longitude.

A perfect Luxation is distin∣guished from an imperfect one, by the intenseness of the aforesaid signs. For if all the motions of the Joynt be lost, if the Limb be short∣er, if there be a great Eminence, and a Cavity, if the Limb be un∣like the sound one, it is a perfect Luxation: On the contrary, when it is imperfect. The most cer∣tain sign of a disjunction, where the Bones gape, is the thickness of the Limb above its natural pitch; and where the heads of the Bones meet, the extuberance is greater. That sort of Luxation, wherein the Limbs are made long∣er, because of the softness of the Ligaments is known. First, be∣cause the Limb looks, as if it were hung on by thread, and it dangles disorderly this way and that, because the Ligaments are relaxed, and the Bones do not then touch one another. Secondly, when the head of the Bone is put up, the Limb returns to its natu∣ral length; and if it be let go, it returns to its accidental length. Lastly, there is a Cavity quite round the Joynt, into which one may sometimes put ones little Finger.

The signs of a Luxation being removed, i. e. of a Joynt well Self, are contrary, which shew the na∣tural state: If there be no more signs nor causes of Luxation. Be∣sides, Avicenna brings another sign, namely the crashing, or snap which both the Patient and the by-standers hear, when the Bone slips back again into its Cavity. But this is neither a good sign, nor much to be desired; because it has two bad causes. For either the noise is made while the head of the Bone rubs against the edges of the Sinus, whereby those thin and cartilaginous edges are broken, and so go into the Cavity before the Bone gets into it again: and therefore true reposition cannot be made; because the head can no more turn round in its Cavity, which makes Men lame. Or the noise is, because the head of the Bone beats against the Sinus; which may cause an Ulcer, and make the part putrefie, the Carti∣lages may grow hard, and be se∣parated from the Bone; and so the Bone remains rough, and dif∣ficulty in motion is occasioned.

CHAP. II.

The Cure of a Luxation in general.

THe Doctrine of Luxations is truly Chirurgical; because here all depends on the Chirurge∣on's Hand, and nothing on Nature. There are four scopes in a Luxa∣tion; Extension, Reposition, De∣ligation, Collocation. Extension is necessary; because the Muscles contract the slipt Bone, and make the Limb shorter; because then it finds no resistance. Deligation is necessary, lest, because of the Re∣laxation of the Ligaments, and the Extension of the Muscles, the Bone might slip out again.

And the four aforesaid things must be so administred, that the due figure of the Limb may be kept, and Inflammation may be prevented. The Limb must be put in such a Figure, as that it may be void of pain. In Extensi∣on the Muscles must on one side be kept as they are, lest the head of a Muscle should be in the inside, and the end on the outside. In Deli∣gation and placing of the Limb, we must observe such a figure or posture of the Limb, as is the mean between the two extreme motions of the Limb.

An Inflammation usually hap∣pens in Luxations by reason of the pain, that is caused, both when the Luxation is made, and after it is made; when the Bone, being out of its place, presses up∣on the nervous parts, and pain is caused in the Extension, when the Bone is replaced. And an Inflam∣mation must be prevented, in re∣spect of the part recipient, by pro∣per figuration or posture; in re∣spect of the part mittent. i. e. the whole Body, by Bleeding, Purging, and Diet.

First of all Extension must be made, as we have shewn in Fra∣ctures. Secondly, the Limb must be replaced gently, lest either Con∣tusion, or Attrition of the Head and the Sinus one against another should be made; also twining a∣bout of the head of the Bone must be avoided, lest the edge of the Sinus be broke. Thirdly the Limb must be bound, lest it slip out a∣gain. The binding must be so made, as to keep the natural po∣sture of the Limb, and prevent In∣flammation, by pressing out the Humors that are got in; and by hindring others from coming in. But before binding be made, Me∣dicines must be applied, which hin∣der Inflammation, namely Astrin∣gents, which besides this advan∣tage, do contract the relaxed Li∣gaments,

and strengthen the part, Such are Ceratum barbarum, Dia∣palma, de Minio, Oxycroceum, Ce∣ratum simplex, Ceratum rosaceum, Ʋnguentum rosaceum, Vinum, Pos∣ca, Vinum granatorum, Succus hypocystidos, decoctum corticum gra∣natorum; Balanstiorum, ovi Al∣bumen. A compound Medicine may also be made è bolo Armena, Sang. Drac. Myrtill. Cortic. Gra∣nat. pulverisatis, & mistis ovi Albumini ad mellis cunsistentiam, exceptum hoc stupis pexis circa ar∣ticulum imponitur. If there be pain, it indicates lenient and un∣ctuous Medicines, i. e. things con∣trary to an Inflammation: where∣fore we must proceed thus. If the pain be small, it must not be re∣garded, and astringents with un∣ctuous Medicines, as Flax with the white of an Egg, must be appli∣ed. But if pain divert the Cure to it self, the part must first be anointed with things that asswage pain, which yet must have an astringent Virtue in them, such as Oleum Rosatum, Oleum Myrtinum, Mastichinum; then the aforesaid Medicine must be applied, or a Linen cloth dipt in Ceratum Ro∣saceum, over which the aforesaid Stupes must be applied. Cerotes must not be used in the beginning; because by their hardness they press and cause Inflammation: for which reason Galen before bandage ap∣plies Linen clothes dipt in some juice, lest by pressure they should cause pain; When these things are done, the Limb must be laid in a middle figure, lest it should occasion pain, The Posture must be soft, smooth, and high.

The Limb thus bound, must (as much as may be) be kept im∣moveable for three or four days; But then the Rollers being slacken∣ed, and an itching arising from the detention of the Vapors, the bandage must be unbound, and the itching part must be bathed with warm water. Yet lest the warm water should loosen the Li∣gaments, which rather want astri∣ction, therefore, if there be no itching, we must not meddle with fomentation. At the Second De∣ligation, if there be no pain, we may apply some Ceratum, as in Winter. Ceratum barbarum: in Summer Ceratum de Minio, Dia∣palma. About the same time also, we may apply splints of Leather and thick Paper, to confirm the head of the Bone. And thus we must proceed, till the Limb seem strong enough: About this time it must be unbound, and fomented with a decoction of Wormwood, Roses, Chamaemel, white Oaken Moss, which do strengthen. Then having applied a Cerote, the Limb must be kept for some days with∣out binding, and the Patient must be ordered to use his wonted exer∣cises, but moderately. Thus much of the general cure of all fresh Lux∣ations.

Old Luxations have the same Indications. Yet these must be preceded by sostning and discus∣sing the matter, which is flowed into the Joynt, and about the Joynt. For which purpose, ℞ Rad. Althee ℥ vj. Rad. Cucum. asinini ℥ iij. fol. malvae M. ij. coctis in aqua & contusis adde farinae Faenugnec. & seminis lini ana ℥jss. Olei com∣munis ℥ vj. axungiae porcinae ℥ iiij. Decocti praedicti q. s. misce & siat

emplastrum. We likewise use Dia∣chylon simplex, & cum Gummi, when the Callus is great and hard: But first we must rub the part with our Fingers wet in moist Oesypus, and we apply thick Oesy∣pus. We often dip the Limb in the washing of Wooll warm, Morn∣ing and Evening for an hour or two. The Mud of hot Bathes is also good; Those are Emollients. After them we must use digesters, such as, in soft natures, Ceratum de betonica; in hard ones Empla∣strum sacrum. Before the applica∣tion of the Emplasters, Fomenta∣tion must be made è decocto Cha∣maemeli, Hyssopi, Betonicae, Stae∣chadis; also è vino albo generoso. When the Humors are much, and very hard, if they be first soften∣ed, we must use a Fumigation è lapide pyrite or molari: also a Fo∣mentation è decocto Rad. Cucum. asin. Altheae, ivae, colocynthidos; which both by their heat and dri∣ness discuss the matter, and by an innate property attract the Hu∣mors about the Joynt. The Limbs may be held in the water of hot Bathes, and in the steam of the same, which are very digerent: when these things are done, you may manage all the rest, as in a fresh Luxation.

CHAP. III.

Of particular Luxations: and First of Luxations of the Jaw-bone.

VVHen the Jaw-bone is out of joynt, Mastication and Speech are depraved. It is very seldom, that it is dislocated: be∣cause the head of the Jaw-bone, which is contained in the Cavity, is encompassed on every side with Bones. Then the Jaw-bone has many strong Muscles, which keep it in its proper place, and it has two heads, which are not so apt to slip out, as one is. Thirdly, it has two acute Processes. Fourthly, the Jaw-bone can only be dislocated one way, i. e. forwards, Fifthly, there are few causes of the Luxa∣tion of the Jaw-bone.

For the Jaw-bone can never be out, unless its acute Process slip under the Os jugale; and so can∣not get back again: But this Pro∣cess cannot slip downwards, unless the Mouth gape very wide, and it cannot get upwards except in a distortion of the Mouth. Yet I have often seen the Jaw-bone lux∣ated: the cause whereof may be a frequent and constant motion of

the Jaw-bone, both in Mastication and Speaking, whereby the Muscles are tired, debilitated, and so give frequent occasion to the luxation of the Jaw-bone.

Gulielmus de Saliceto, and some other Chirurgeons, not skilled in Anatomy, have written, that the Jaw-bone may be luxated to the left and right, but this is false; for behind, the Bone hinders, on the right, the left head of the Jaw∣bone hinders; on the left, the right head of the Jaw-bone hinders. It therefore follows, that the Jaw∣bone can be luxated only forwards.

And either both its heads are lux∣ated, or only one. If only one, 1. That part of the Jaw is promi∣nent only forwards. 2. The Chin enclines to the luxated part. 3. The Mouth is distorted towards the part, contrary to the luxated part, and the distorted Jaw-bone ap∣pears more eminent. 4. The Den∣tes canini stand underneath the fore-Teeth. 5. On the luxated side, the acute Process appears more eminent. 6. The Teeth cannot be shut. If the Jaw be out on both sides, these are the signs. 1. The whole Jaw is prominent forwards, and not distorted, but fore-right. 2. The Mouth keeps open. 3. The acute Process ap∣pears prominent on both sides. 4. The lower Teeth stand out far beyond the upper. 5. The tempo∣ral Muscles are very tight and hard.

Hippocrates writes, that unless it be replaced presently, there do arise continual Fevers, Sleepiness, Inflammation, Pain, Convulsion, voiding of Choler, and usually on the tenth day death. Thô I have had several such under cure, I never met with any that fared so: Yet I believe Hippocrates did; be∣cause it is rational enough, that such Symptoms may happen, by reason of the Muscles and Nerves being primarily affected, and the Brain by consent.

In the Reposition of the Jaw∣bone, motions must be made con∣trary to them, that the Jaw-bone made, when it slipt out of its Ca∣vity. First, the Jaw-bone slips forwards, it must therefore be thrust backwards. Secondly, in opening the Mouth it is drawn downwards; therefore it must be forced upwards. Thirdly, the Muscles draw the acute Process upwards; therefore the Jaw-bone must be drawn downwards.

If the Jaw be out only on one side; it must be forced to the con∣trary side. We must begin with the last motions first. Therefore if both sides of the Jaw be out; the first action of the Chirurgeon is Traction or Extension of it down∣wards; the Second backwards; the Third upwards. To do these things, he must put both his Thumbs in his Patient's Mouth, and with his Fingers he must take hold of the outside of his Chin: then the Jaw-bone must be forced downwards, backwards, and up∣wards. Thus it is easily and quick∣ly replaced. But the Patient's Head must be held fast, that it give not way, when the Jaw-bone is forced backwards.

When the Reposition is done, things must be applied to the heads of the Jaw-bone, i. e. to the Tem∣ples, which may prevent Inflam∣mation, such as Ceratum rosaceum:

In violent distention, where there is more need of astringence, we may apply Stupes wet in whites of Eggs, adding, if there be need, astringent Powders. We must al∣so anoint the parts of the Tem∣ples, i. e. the whole temporal Muscle, with Oleum Ros. lumbri∣catum.

Bandage is made in this manner; a Roller is applied to the Chin, where it must be slit a little, that it may take hold of the Chin on both sides; then on each side at the Ears, the Roller must be slit again, and the Ear must be drawn through; af∣terwards the Roller is to be faster∣ed at the Crown of the Head. And the Patient must be kept thus, till the Jaw-bone be strengthened, which it is in one, two, or at most three days time: All which time, if there be any danger, the Patient had best abstain from Meat; nor must he omit Bleeding, and those things we have mentioned in the general cure of Luxations. But to speak the truth, I ever used to apply Medicaments to the place affected, and when there was oc∣casion to eat, I ordered the Swathes to be loosened.

CHAP. IV.

Of a Luxation of the Shoulder.

THe Shoulder is a great Bone, with a round Head, which is inserted into the shallow Sinus of the Scapula. And this head is surrounded only with an orbicular Ligament, which is loose enough. This Sinus has some Buttresses; for on the outside of the Scapula it has a certain large Process, con∣sisting of the Spine of the Scapula: on the upper part it has partly the said Process, and partly the Clavicle: in the inside it has the Processus anchoroeides. Hence it is apparent, that the head of the Shoulder may easily slip out: for this Joynt is uniform and simple, not, as it is the Knee, double. Then the head of the Shoulder which is round, is deprived of a long neck, is inserted into a Sinus, that has no depth in it, and therefore is more easily put out of Joynt, then the Thigh, which has a long neck, and is inserted into a deep Cavity. 3. This Ligament is only simple, viz. orbicular, (not round as in the Thigh) and it is very lax. Fourthly, the Joynt of the Shoul∣der is without flesh, and there∣fore it is more apt to slip out of its place, than a fleshy Joynt. But the Shoulder can slip no way, ex∣cept into the Armpits downwards: because there are no Propugnacula there, as in other places, and the

Shoulder is apt by its own weight to slip downwards. Yet Galen says, that five times he saw the Shoulder slip forwards.

If the Shoulder be slipt under the Armpit, it is in figure very unlike the sound Shoulder. Secondly, on the top of the Shoulder there ap∣pears an unusual hollowness, and under the Armpit, the round hard head may be felt. Thirdly, if the Shoulder be in its natural place, the upper Process of the Scapula appears round; but when the Shoulder is out, it appears acute: because the head which made the roundness is slipt down. Fourth∣ly, the Arm sticks far from the Ribs, and cannot without much pain be brought to them. Fifthly, the Patient cannot carry his Arm to his Head, because the Humerus cannot move upwards: and seve∣ral other motions of the Shoulder are hindred. Sixthly, the disloca∣ted Arm is longer than the other, if the Shoulder only slip downwards; but it is shorter, if it be drawn up∣wards by the Muscles. Seventhly, the part is wrinkled at the end of the Axilla, in the luxated Shoul∣der, far lower, and both more forward and backward, than in the found Arm; which signifies that the head of the Shoulder is slipt downwards. If the Shoulder be luxated towards the fore-part, these are signs; in the fore-part there is an eminence, in the hind∣part an unusual hollowness: be∣sides the Cubitus enclines back∣wards, nor are there any signs of the Shoulder being out under the Arm.

Hippocrates says, that the Shoul∣der and Thigh can only be per∣fectly luxated: This is true, if the Luxation be occasioned by an ex∣ternal cause. But if there be in∣ternal causes, i.e. Humors gather∣ing and hardning by degrees, these, while they force the head to give way by little and little, may cause an imperfect Luxation.

The ways by which the Shoul∣der slipt into the Arm-pit is repla∣ced, are according to Hippocrates ten in number, l. 2. de art. but they may be very well reduced to three. The First way is by Cir∣cumrotation, or Circumvolution, while either the Patient or the Phy∣sician, puts the Hand clench't un∣der the Arm-pit, so that the mid∣dle knuckles of the Fingers may force the head of the Shoulder in∣to its Cavity. This way is used only in Children, and such as have very lax and moist Ligaments: But as by this way the Shoulder is easily reduced, so it easily slips back again. This way Hippocrates says, is not according to nature, because not so very safe. For while we turn round the head of the Shoulder upon the Scapula, some membranous and nervous bo∣dies may easily be torn, and so may the edges of the Sinus, where∣upon by reason of a conflux of Humors the Chirurgeon is frustra∣ted in Reposition.

The Second method is by a way contrary to that, by which it slipt out. If the head of the Shoulder be dislocated; First, it goes out of the Sinus, and so moves for∣wards. Secondly, it slips down∣wards. Thirdly, it is drawn back∣wards by the Muscles. This way differs from the first, because in the first, motion is made by Cir∣cumrotation

in crooked lines; in the Second, motion is made in right lines. In reposition there∣fore these three motions must be made by a way contrary to the slipping of it out. 1. From be∣hind forwards. 2. From the fore∣part upwards. 3. Back again. First of all therefore the Chirur∣geon puts his head to the Patient's Shoulder. Secondly, he puts his Fingers under his Armpits. Third∣ly, he must press the Patient's Elbow with his Knee, the Pati∣ent sitting all the while. Let us see now, how these operations an∣swer the foresaid Indications. The first motion, that must be made in reduction of the Shoulder, is forwards, and it is done by putting the Fingers under the Arm-pits. The Knee strengthens this motion, and makes it more easie, by pres∣sing the Elbow towards the Ribs, which by the dislocation stuck too far from it: For as when the head of the Shoulder slips into the Arm∣pit, the Elbow sticks out from the Ribs; so again, when the El∣bow is forced towards the Ribs, the Shoulder moves forwards. By the benefit therefore of the Fin∣gers and the Knee, the Shoulder is moved from behind forwards. And the Chirurgeon lays his Head on the Patient's Shoulder, lest, while with his Fingers he draws the Shoulder forwards, the rest of the Patient's Body might follow: Or rather (as I have learned by ex∣perience) lest the Scapula, which is moveable, should follow: for when the Shoulder is dislocated, if the Luxation be not new, it is ve∣ry difficultly replaced, for this ve∣ry reason, because when extension of the Shoulder is made, the Shoulder does not stir out of its praeternatural place, but rather the Scapula does move. Hippocrates therefore makes the first motion, i.e. he moves the Shoulder for∣wards: but he makes no menti∣on of the two other motions, be∣cause they are effected by the Muscles: For while the Muscles are sound, and the Luxation new∣ly made, they draw the Shoulder upwards, and restore it to its pro∣per place, if that the head of the Shoulder be not hindred, as it is, while it lies behind under the Arm∣pit. This way may also be ad∣ministred in another manner: for because we cannot so well with our Knee force the Elbow towards the Ribs, instead of the Knee we substitute a Servant, who with his Hand must take hold of the Elbow and force it towards the Ribs. And this second way may be admini∣stred in a third manner; the El∣bow may be brought back towards the Spina dorsi: for so the Shoul∣der is brought forwards: Then with one hand we must take hold of the Elbow, that motion may be made upwards; and we must lay the other hand hard upon the top of the Shoulder, lest the Sca∣pula might give way, as we said before.

The Third general way adds to the Second, Extension, which is very necessary, if the head of the Shoulder be confirmed out of place; moreover the Muscles always draw upwards, whence arises an Indica∣tion of drawing downwards by Ex∣tension. This way is performed either with instruments or with∣out.

Without instruments in a two∣fold manner. The First is, if the Patient lye, and the Chirurgeon sit upon the same level, taking hold of the luxated Arm with both his Hands, and putting his Heel under the Patient's Arm-pit (the right Heel, if the right Shoulder be out of Joynt, and the left, if the left be out) but before he put his Heel in his Arm-pit, it is ne∣cessary to put a hard Ball, like a Tennis-Ball under the Arm-pit. When this is done, a Servant must take hold of the opposite Arm, and draw it downwards: And an∣other having a strong Roller or Girt (broad enough to take hold of the Ball) must take hold of both its heads, and draw them up∣wards towards the Patient's Head; and with his other Foot lean upon the top of the luxated Shoulder. Now let us consider, how the Shoulder may be replaced by these operations. The First, who draws the Arm downwards, and the other, who pulls the string upwards, make extension and motion down∣wards. Motion forwards is made both by the Ball and the Heel: wherefore the Heel must be put between the Ribs and the head of the Shoulder, or the Ball, that the head of the Shoulder may be prest forward: And the reason why the Ball is used is, that whi∣ther the heel cannot reach, be∣cause of the hollowness of the Arm-pit (which is made by the Muscles and Tendons placed on all sides) yet there, by the benefit of the Ball, the Heel may operate. Two motions are therefore made by the Chirurgeon, the first down∣wards, and then forwards. The Servant, who draws the string up∣wards, makes motion upwards, and pressing the top of the Shoul∣der with his Foot, he keeps the Scapula from giving way. The third person, who draws the sound Shoulder downwards, keeps the whole body from giving way to the Extension.

The other way without instru∣ments is thus; A Man of a high∣er stature, than the Patient, must lift the Patient from the ground, and place his Arm-pit upon his own Shoulder, that so he may make Extension: Then he must bring the dislocated Arm towards his own Breast, that the Shoulder may move forwards. Afterwards a Servant putting both his hands behind him upon the Patients Shoulder, must draw and press that part, lest the Scapula might give way. Then a Boy must hang behind on the other side, so as his Feet may not touch the ground, that he may hinder the whole Bo∣dy from giving way. Thus far of the ways of doing it without in∣struments.

Instruments proper for the re∣duction of the luxated Shoulder are, the Ladder, Coulstaff, Pulleys, Glossocomium, &c.

The way of Extension by a Lad∣der is, that the Patient climb up three or four steps of it, and put his lame Arm over one of the Staves, placing it between his Side, and the head of the Humerus; and that a strong fellow take hold of that Arm, and pull it forcibly down backwards, whilst the Patient hangs by it.

The way by a Coulstaff is safer. The Staff must have a Bunch in

the middle, somewhat wedge-like, and be covered with a soft Boulster, fit to place under the Patient's Arm-pit. In order to the Exten∣sion, the Patient must be seated near some Post or Pillar, in which the Pulley must be fastned to ex∣tend his Arm; and the bandage must be made a little above the Elbow; which being fastned, and the Coul∣staff placed, and supported by a couple of fellows, the Chirurge∣on must stand on the contrary side, with his hands on each side of the Scapula, to press it downward, and keep the Patient firm in his seat, and govern the operation, taking care the edge be placed right whilst the Extension is making, lest they break the Bone, or other∣wise mischief him.

The Glossocomium, commonly called the Commander, is of use in the most strong tough Bodies, and where the luxation hath been of long continuance, and will not yield to the other ways of Exten∣sion. There ought to be great care in the use of it, for many shrewd accidents have happened thereby.

The Humerus luxated by relax∣ation of the Ligaments and Ten∣dons is restored to its place, after some of the ways abovesaid: but doth require your industry to re∣tain it, after it is reduced,

If the Humerus be to be redu∣ced, when it is luxated forward, the motion must be made contra∣ry. And thô the Limb be not made shorter; yet because we ease the head of the Bone, and dis∣intangle it, some little Extension must be made.

In general we must know, if the Shoulder be newly luxated, it may easily be replaced by the Fin∣gers. But when the Luxation is old, it is very difficultly reduced: because the Shoulder has fixt it self fast there, so that it is grown something callous; and besides, the Cavity it self is filled with flesh, which when the Bone is re∣duced, does nevertheless cause it to slip out of its proper Sinus.

When the Shoulder is reduced, we must bind it up. But before binding, we must apply things, which prevent Inflammation, and knit together the lax and distort∣ed Ligaments; such as we men∣tioned before; Bolus Armena, Sang. Draconis, Myrtilli, balaustia pul∣verisata ovi albumine subacta, ad mellis consistentiam, applied with Stupes or Clothes, And under the Shoulder-Joynt a Ball must be put, made of Linen or Tow wrapt together, it must be wet in the foresaid Medicines, and put un∣der the Arm-pit, lest the Shoul∣der, by reason of its weight, and the laxity of the Ligaments, might slip down again. Then a broad linen Cloth, wrung out of black austere Wine, must be applied. Thirdly, a Roller must be brought about it, which must keep fast the Ball, and always draw the Arm upwards, or at least keep it so. First of all therefore the middle of the Roller must go over the Ball, and be carried once or twice round the Joynt, then both the heads must be carried round the Neck on the other side. When three or four days are over, the bandage may be loosed: and if all fear of Inflam∣mation be not over, or if the Li∣gaments continue lax, the like

Medicine must be renewed, till all fear of Inflammation is over, and the Ligaments are strengthened. And then you may leave off the Roller, and the foresaid Medi∣cine, and apply some Plaster: in Winter Barbarum, and in Sum∣mer Diapalma.

CHAP. V.

Of Luxation of the Clavicle or Collar-bone.

THe Clavicle is a crooked Bone made in the figure of an S. one end of which be∣ing thicker, and almost three square, is inserted into a Cavity purposely sitted for it in the first bone of the Sternum, and bound in by a strong ligamentous Membrane. The o∣ther end being broad and flat, is joyned to the Acromium, where it not only serveth to keep the Shoul∣der at due distance from the Ster∣num, but also assists these several Processes, which are provided by nature to preserve the Shoulder-Bone from slipping upwards from its Cavity.

This Bone is capable of a dou∣ble Luxation, one at the Sternum, and that only outwardly, where it rises from the Breast, and lies like a lump. The other at the broad end near the Acromium, which is also subject to a twofold Luxati∣on, viz. upward and forward; be∣ing defended from all other distor∣tions by its neighbouring Bones.

This Luxation is for the most part occasioned by a fall, and pitch∣ing upon the Shoulder. It is dis∣cerned by the Prominence it makes.

The Clavicle is not so subject to Luxation as other Bones; but be∣ing luxated, it is most difficultly retained after restitution, by rea∣son of its smoothness of its heads, and the little hold they have up∣on the Acromium and Sternum. And if it be not restored, the use of the Arm is impaired in some of its motions.

The reduction of the Clavicle, which end soever of it is luxated, must be made by drawing that Shoulder backwards, and by pres∣sing the luxated end even with the Acromium, or to the Cavity of the Bone of the Sternum, whence it departed. Neither of the places affords it much room, therefore it will require your greater care: for if you place it not exactly, it will scarce hold right till you make your applications. Therefore you must have ready Emplasticks, Compresses and Bandage. Splints are also of use, whether they be of Pastboard, Scabbard; or Tin. The bandage ought to be a Roller

with two heads to come over the Shoulders, and under the Arm-pit, making so many circumvolu∣tions as may retain the Dressings close. This being well made, his Arm must be kept up with a Nap∣kin or Towel, and his hand pla∣ced under his Breast. If all be well you ought not to loosen the band∣age till you judge it united, which may be guessed at by the ease and use of the Arm.

CHAP. 〈◊〉〈◊〉

Of the Luxation of the Elbow.

THe Elbow is very difficultly both luxated and reduced, according to Hippoc. l. 2. de Ar∣tic. Gal. l. 1. de Fract. First, be∣cause it is multiform and various, not round. Secondly, the Bones that make up the Joynt, do mutu∣ally receive, and are received one of another; wherefore this Joynt is called Ginglymoeides, because it is made like hinges. Thirdly, the Ligaments of this Joynt are very tight. Lastly, the Bones are not two, as in most Articulations; but three, the Cubitus, Radius, and Humerus, which are mutually knit one to another by membranous Ligaments.

Unless the luxated Elbow be quickly replaced, most violent pain ensues; because its great head presses the circumjacent Muscles and Nerves that run to the Hands, and the deep and sharp edges prick the said part. Besides, the Radi∣us increases the pain; for if it be out, there are more pressures; if it be not out, there are great di∣stensions of the nervous bodies. This pain is usually attended with a Fever, vomiting of Bile, Numb∣ness, &c.

The Cubit is luxated forward or backward, outward or inward: and the Radius either follows, or abides in its place.

If the Radius follow, the part∣ing of the Radius from the Cubit may be felt by the touch. If the Cubit be luxated forward, these are the signs; we cannot bend the extended Cubit, the Cubit is made shorter, an unusual Tumor appears in the fore-part, and an unwont∣ed Cavity behind. If the Luxati∣on be made backward, the signs are the same; but that the Tu∣mor appears behind, and the Ca∣vity before. If it be luxated out∣ward, the signs are the same, but the Tumor appears outward, and the hollowness inward. If it be luxated inward, on the contrary.

The luxated Elbow must spee∣dily be replaced, otherwise a great Inflammation arises, because of the

pain, upon which the luxated El∣bow is quickly grown callous, the thin Matter being dispersed; but especially because the Elbow is less nervous, and of a cold temperament. When the Elbow is grown hard, it cannot be re∣placed, unless it be mollified with Medicines.

If the Cubit be luxa••••d for∣ward, First, Extensio•• ••••••st be made in a proper Figu•••• ••t di∣rectly, but obliquely, 〈◊〉〈◊〉 the Ca∣put humeri should touch the Cor∣nix, i. e. the high edge of the Cubit, and by Circumrotation it might be broken. When this is done, the luxated Cubit may be replaced four ways. First, if the Luxation be imperfect, it is repla∣ced by a quick bending of the Arm. Secondly, in a perfect Luxation, Extension must be made; then some hard and round body, as of linen Clothes wrapt up hard, must be put in the bending of the Arm, then the Elbow must be bent. Extension must be made by two Servants, one of which must draw the Humerus up, the other the Cubit down, but oblique∣ly. And the round body put in the bowt of the Elbow, must be prest, that when Inflexion is made, Reposition may be made also. Thirdly, two Servants must like∣wise extend, and a Girt must be applied to the luxated Arm, and bound so long hanging down, that the Chirurgeon may put his Foot into it, as into a Stirrup; Exten∣sion therefore being made, and the Girt drawn down by the Chirur∣geon's Foot, the Chirurgeon must then put his Hands to the Cubit, and pressing it backward must bend it. Fourthly, this is usually done with the Hands alone, ta∣king the Cubit in one Hand, and the Humerus in the Other, the Cu∣bit must be bended, and put into its place again.

If the Luxation be backwards, having made Extension obliquely, a fresh Luxation is easily replaced by the Hands alone. But because in this case extension uses to prove difficult (for the exteriour extend∣ing Muscles of the Cubit, are very strong) the Chirurgeon must anoint his Hands with Oyl, that the Muscles may be the more pliable: And if the Strength of the Hands be not sufficient to reduce the Cubit, we must use Hippocrates his Instruments, the Ladder, &c. If the Cubit slip inward or outward, it must be forced the contra∣ry way. When reduction is done, Medicines must be applied to as∣swage pain; to contract and strengthen the lax and distorted Ligaments, and to prevent Inflam∣mation: the first whereof is done by oyly things; the rest by astrin∣gents; where we must consider what is most urgent. If there be pain, we must mix Oleum Myrti∣num or Rosaceum with astringe•• Powders, and the white of an Egg. Or we must use Ceratum Rosace∣um, spread on a broad piece of Linen, and then Stupes must be ap∣plied dipt in a Medicine è pulveri∣bus astringentibus ovi albumine subactis. Then proper Bandage must be made, like that which we mentioned before in Fractures, always observing a middle po∣sture.

The Radius usually slips out∣ward. The Signs are, an apparent

Tumor outward, the Cubitus and Radius gape one from another. When extension is made, it is easi∣ly forced in again.

CHAP. VII.

Of the Luxation of the Carpus, Metacarpus, and Fingers.

THe whole Carpus, or Wrist, considered in it self, and joyned to the Arm by Diathrosis, may slip inward, outward, forward or backward, but principally for∣ward; the signs are a Tumor in the forepart, and the Fingers cannot be bent. If luxation be made backward, the Fingers cannot be extended, because the Tendons and Nerves are pressed upon by the Bones. If the Luxation be made either inward or outward, a swel∣ling appears on one side, and an hollowness on the opposite.

If then Luxation be made either forward or backward, the Hand must be laid on a Table, the back downwards, if Luxation be made forward; and the back upwards, if the Luxation be made back∣wards: then extension must be made by two Servants, one pulling at the Arm, and the other at the Hand. While extension is making, the Chirurgeon must force the luxated part the contrary way, either with the Hand, or in ro∣buft Bodies, by pressing it with the Heel. Celsus laies some linen Cloth rolled up hard, upon the Luxation, where it is to be prest most, that so the intrusion may be stronger, and the pain less. If the Luxation be outward or inward, as extension is making, the Chirur∣geon must force it the contrary way.

A Luxation of the Bones of the Carpus or Metacarpus is easily re∣placed, in the first by making no extension; in the second, by a mo∣derate extension, the Hand being placed on a Table, and some hard Body put under, and so the Bones being thrust by the Hand or Heel into their places, either forward or backward.

The Fingers are luxated either forward, backward, or to one side. The signs are very apparent, be∣cause the Joynts have but little Flesh on them. As extension is made upon a Table by two Ser∣vants, the Bone is easily thrust the contrary way. When reposition is made, Medicines must be applied, the Limb must be bound, put in a fitting posture, &c.

CHAP. VIII.

Of the Luxation of the Thigh.

THe Thigh has a round Head, growing in a long Neck, which is inserted into a very deep Sinus. The Thigh is bound to the Os Coxendicis by two Liga∣ments, the one orbicular, and the other round. Hence it is apparent that only a perfect Luxation can happen in the Thigh, and not an imperfect one, as we said before of the Shoulder. The Thigh slips forward, backward, outward or in∣ward. But it is done with great difficulty. First, because of the very strong Muscles, and abundance of Flesh upon those Muscles, which keep the Thigh in its proper Si∣nus. Secondly, because of the depth of the Acetebulum. Thirdly, because of two tight and short Ligaments. The Thigh is seldom luxated for∣ward or backward, because in these sides the edges of the Aceta∣bulum are highest; sometimes out∣ward, because there they are not so high; oftnest inward, because there the edge is lowest. And be∣sides the lowness of the edge I may add the round Ligament, which is inserted next the inside, and there∣fore will more easily give way to Luxation of the Thigh inward.

If the Thigh be luxated inward; it appears longer than the other, because the Thigh desconds. Also the Knee, Leg and Foot stand out∣ward; For if one end of a thing encline one way, the other end will encline the contrary: where∣fore if the Head of the Thigh be displaced inward, the Knee, Leg and Foot encline outward. Be∣sides, the Thigh cannot be brought toward the Groin; because the inflexor Muscles are straitned and hindred, that they can neither lift nor bend the Thigh. Another sign is, that on the Region be∣tween the Anus and the Testicles, a manifest Tumor appears in the outer side of the Sinus. If the Thigh slip outwards, the signs are contrary: for that Leg is shorter than the other, because the Head is more elate than its Sinus. Be∣tween the Scretum and the Anus there is a hollowness; and towards the Buttocks there is a swelling. The Knee, Leg and Foot stand in∣ward. The Heel cannot touch the ground, because the Leg is short∣ned: but the Patient can draw his Thigh upward, because the in∣flexor Muscles are not hindred. If the Knee slip forward, the extended Thigh cannot be bent, because the inflexor Muscles are hindred and pressed by the head of the Thigh.

Urine is stopt in such Persons, because the head of the Thigh presses upon the Bladder. The Groins swell, be cause the head of the Thigh is slipt into these parts. The Buttocks appear wrinkled and without Flesh; because the whole Thigh, toge∣ther with the Processes, is slipt for∣ward. If the Thigh be slipt back∣ward, there are the contrary signs. The Leg cannot be extended, be∣cause the extending Muscles, which are behind, are prest; wherefore they cannot be drawn toward their proper Principles; the Thigh af∣fected is shorter than the other, because the Head is got above the Sinus; the Heel cannot touch the ground. The Groin appears lax, and the head of the Thigh sticks out at the Buttocks.

It is very difficult to replace a dislocated Thigh; because, by reason of the very strong Muscles, extension cannot be made: and the difficulty is encreased, if the Luxation be not new, but callous by reason of Humors running to the Os Foemoris, and of the re∣pletion of the Sinus. The Thigh being replaced, it is apt to slip out again, because the Muscles are so weakned, that they are not able to keep the heavy Thigh in its Seat; and because the round Ligaments is either la••ated, or broken.

The Thigh may be replaced, either without or with extension. Without extension two ways, but never unless the Luxation be new, and moderate, i.e. standing but a little way from its Sinus, and in a Child's Body. The first way is, to turn round the head of the Thigh about the Hium (as we did when the Arm was out of Joynt) and not to separate it, if it get in∣to the Sinus. But this way is not safe, for fear lest the head of the Bone should rub against the edges of the Sinus, and so either bruise or break them. The other way is, to bend the Thigh suddenly: for so sometimes it is replaced accord∣ing to Paulus, c. 98. l. 6.

But the Thigh is best reduced with extension. If therefore the Thigh be slipt inward, thô there seems to be no need of extension, since the Leg is longer than it should be (not shorter, as in other Luxations, wherein the Muscles moving the head of the Bone, have their Original far above it, and so draw the head upwards) never∣theless a little extension must be made, as much as is sufficient to stir and extricate the fixt head. This may be done with the Hands, if the Luxation be new, moderate, and in a Child's Body. It must be performed in this manner; one Servant must hold the Patient's Body by the Armpits very fast; another must take hold of the Thigh with both his Hands above his Knee, and extend it. In the mean time, while extension is making, the Chirurgeon must with his Hands force the Thigh slipt inward, outward. When the Head is thus extricated by means of this impulsion, the Muscles that draw upwards, will easily put it into its place again; or, if the Muscles be weak, the Chirur∣geon may easily do it. If it be in a robust Body, we want stronger extension, which must be with Girts and Ropes. A Girt then

must be put on the space between the Genitals and the Anus; but so, as that it do not take hold of the head of the Bone. Then another Girt must be tied above the Knee, or another above the Ankle: and these Girts must be drawn by the two heads, either with the hands alone, or with a Ladder, to one of the staves whereof the up∣per Girt must be tied, and the Pa∣tient must be laid on the Ladder, and the other Girt must be drawn downward. You may also use the Scamnum Hippocratis. But these violent Extensions are most proper in other Luxations of the Thigh, when it is put outward, forward or backward: for when Extension is made, and the head is forced the contrary way, the Chirurgeon may easily reduce it. After reduction, Medicines must be applied, to pre∣vent Inflammation, asswage Pain, and to contract and strengthen the lax Ligaments.

CHAP. IX.

Of the Luxation of the Knee.

THe Knee is not easily put out of joynt: because it has two Ligaments, and it has a double head, and a Sinus. It un∣dergoes an imperfect and a perfect Luxation, and it slips outward, in∣ward, or backward: only Celsus adds forward; but so it is very hard for the Knee to be luxated, because of the Knee-pan, which be∣ing tied by very strong Tendons, does wonderfully strengthen the Knee forward, so that it cannot slip that way; unless there be a violent cause.

All the forts of this Luxati∣on are manifested to the Eyes; be∣cause it is a fleshless part: for there appears an unusual Tumor on one side, and a Cavity on the opposite; the Figure is depraved, Motion is weakned and abolished.

If the Luxation be imperfect, little or no Extension is required, but only forcing it to the contrary side. If it be perfect, Extension is necessary; which may be made by the hand in a fresh Luxation, and in Childhood. One Servant must draw upwards, and another below the Knee towards the Foot; and the Chirurgeon must force the Bone to the contrary side. In a grown Man, and a great Luxation, there is need of Girts or Engines, especially to draw downward, and make sufficient Extension, &c.

CHAP. X.

Of the Luxation of the Ankle and Toes.

THe Ankle may slip out in∣ward, outward, forward or backward. If inward, the Sole of the Foot turns outward: if outward, on the contrary. If forward, then the broad and strong Tendon in the Heel, is hard and tight: besides, that Foot is less; because the Leg and Joynt is mo∣ved forward, and takes up a great part of the Foot; whereupon the Foot is less and shorter. If back∣ward, the Heel is almost hid, be∣cause the Joynt is slipt to the Heel: besides, the Sole seems greater, and the Foot longer. If these signs be manifest, the Luxation is perfect; if they are obscure, it is imperfect.

The Cure is not difficult, if due Extension be used; with the Hands, if the Luxation be fresh, and in a Child, one Servant must take hold of the Foot, another of the Leg above the Ankle; and the Chirurgeon must force it unto the opposite part. If good Extension cannot be made by the Hands, we use Girts, to the Foot, and to the Leg above the Ankle; about the small. If very violent Extension be required, we may use the Scam∣nam Hippucratis; or Paulus his way, l. 6. c. 121. which is, to drive a stake deep into the ground; then to lay the Patient on his Back, astride the stake, which must be driven in so deep and firm, as not to give way, when Extension is made.

When the Joynt is reduced, the Patient must be kept longer in Bed, than for other Luxations, viz. Forty days; because the Ankle supports the whole Body, and therefore unless it be compleatly restored, that is, unless the lax Ligaments and distended Muscles acquire their pristine strength, the Patients do either relapse into the same Luxation upon every slight occasion; or they find their Foot very weak for a long time. We must therefore use aftringent Pow∣ders, mixt with whites of Eggs, applied about the Joynt with Tow. If there be pain, then Lenients are required.

The Bones of the Pedium and Tarsus are so strongly knit toge∣ther, that they never suffer Luxa∣tion. The Toes are seldom lux∣ated, because they are held by ma∣ny strong Ligaments and Ten∣dons. They are reduced as the Fin∣gers.

Partis primae Finis.

THE PRACTICE OF CHIRURGERY. Part II.

BOOK VI.

Of separating things unnaturally united.

CHAP. I.

Of Cutting Tongue-ti'd Children.

HAving in the First Part of Chirurgery shewn, how to unite solution of Conti∣nuity; in this Se∣cond we must on the contrary teach how to separate Continu∣ity, when it is preternatural. This part of Chirurgery is called by some 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, by others 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Distinction or Separation.

The fiest preternatural Unition, that I shall treat of, is of the Tongue to the parts under it, when the Membranous Ligament or Frae∣num, which connects it, is either too short, or extended to the tip of the Tongue: Then Children are said to be Tongue-tied. But before I meddle with the separation of the Tongue from the parts un∣der it, by cutting the Praenum, I must make some just Animadver∣sion upon the temerity of some

Midwives, who always wear one of their Nails of a great length and being thus ready with an inci∣sion instrument in their hand, wherever they come to do their office, they cut the new born Child's Tongue, and unless they did this, they believe the Children could ne∣ver speak: As if Nature (O strange ignorance!) could not make a Man speak, which is to perform a proper action, designed by her to Man, without the helping hand of a silly Woman. Aquapendent says, he saw a new born Child, which was detained a pretty while, till they got the after-burthen away, and it neither cried, nor perhaps was sensible of any trouble all the while, till the Midwife cut the Fraenum with her Nail, and then indeed it cried, because of the pain. But if this were all, the matter were not great: The worst is, the Child, when this Chirurgery of the Nail has raised an Inflammation, can∣not take hold of the Nipple, nor get any Milk, and so it dies. And which is yet worse, they impute the whole cause of its Death, either to the Birth, or to its ••••ability to take hold of the Nipple, or to any thing, rather than to the true, viz. the Midwives claw. Let all Peo∣ple therefore, that value their Chil∣dren, have a care, that the Mid∣wife meddle not with cutting then Tongues. If the Ligament be such as requires cutting, it may be cut in time enough; but this rare∣ly happens. Because Nature had never designed Man to speak, had she not furnisht him with apt in∣struments. Of many thousands, that are born with this Ligament, searce one requires cutting.

But if it so happen, that the Tongue is too strait tied, the way to cut it is this; the Patient must put his Pongue out beyond his Teeth, then we must take hold of it with a Forceps (Celsus uses a Vosella.) But because we can∣not use these instruments in Chil∣dren, who either know not, or are not willing to put out their Tongue; we first make them cry, then with a thin cloth between the Thumb and fore-Finger of our left Hand we take hold of the Tongue and draw it out, then we hold it up, or turn it back, that the Fraenum may appear: and with our right hand we cut the Fraenum. We take an incision∣knife, a little turning back at the point, then we cut the Fraenum transverse twice or thrice, and the parts on each side, taking great care, that the vessels thereabout be not injured, which a Chirurge∣on that has any skill in Anatomy, will not do, because he knows the vessels under the Tongue. Then the place may be washt with a lit∣tle Claret and Diam••ron, and it will heal of it self. Several when they are well again, speak readily, if the impediment depend only on the Fraemon; but if some inward and abstanse cause concurr, the es∣sect does not follow.

Hildanus C••nt. 3. Obs. 28. says, that a Child of two years old, was brought to him to be cut under the Tongue. When he opened the Child's Mouth, and lifted up the Tongue, he found it very thick, but no nervous Ligament under it. Therefore he sent away the Child, and would not meddle with it. About a Month after, a

Mountebank came that way. The Child was carried to him. He per∣swaded the Parents, that the Tongue was tied with a strong, nervous Ligament, and he boldly maintained that, if they would but give him a sum of Money down, he would make the Child speak in a short time. He got the Money. Then the Impostor places the Child in a Womans Lap, and slashes the Tongue deep before, and on each side; as the by stand∣ers told Hildanus. But the Child, who before could go alone, in the very moment skrieked out and was contracted, so that his Knees were drawn to his Belly, and his Hands to his Breast. And because of the continued pain, and want of due administration of Medicines, the Child was extremely wasted and weakned. When Hildanus visited him, his Legs and Arms remain∣ed contracted, and if they were by force extended, they were im∣mediately drawn back again, and he could not go at all. He said he did recover a little; but does not give account what the final is∣sue of the case was. He gives an account also of his own Brother, who when he was four years old could not speak a word, and by cutting of the Fraenum was able to speak.

He says, the operation has no danger in it, if it be rightly ad∣ministred, and especial care must be had, that you cut not too deep; he lifts up the Tongue, and with the point of a pair of Sissers he snips the Ligament in two or three pla∣ces: for so it is not so apt to grow together again, as when it is cut only in one place. Then he cuts all that is nervous, so as not to touch any thing that is fleshy. If enough be not cut at first, or if it grow up again, the same opera∣tion may be performed again. when the Ligament is cut, the Nurse must dip her Finger in Ho∣ney of Roses, or common Honey, and raise the Tongue gently with it: for thereby agglutination is hindred. This operation there∣fore ought not to be committed to Midwives, who with their Nails do not only tear the Ligament, but the parts adjoyning, which occasi∣ons Pain and Inflammation; then Children cannot suck, but grow froward, pine away and dye: wherefore we ought to act pru∣dently, and this operation, thô it seem slight, ought not altogether to be neglected. And it ought espe∣cially to be consider'd, whether, when the Tongue is short, there be occasion for cutting or no: for oftentimes upon other occasions besides the Ligament under the Tongue, Children cannot form any articulate voice, even when the Tongue is not tied at all, which the preceding case con∣firms.

CHAP. II.

Of the growing together of Fingers or Toes.

THe Coalition, or growing together of the Fingers or Toes, but especially of the Fin∣gers, falls next under our conside∣ration. It is occasioned either by the error of forming Nature in the Mother's Womb, or by an Ul∣cer on the inside of two Fingers, negligently cured, or by burning.

The Cure may be performed by the Knife, or by an actual or potential Cautery. Dissection is the best way for Fingers that are joyned together by a narrow Inter∣stice, and by burning. On the con∣trary, the actual Cautery, or po∣tential Cautery, for such as are joyned by a broad skin. But espe∣cially the potential, for saint-heart∣ed Men, Women and Children, who had rather venture the worst, than undergo such terrible means.

When you use an actual Can∣tery, the part must be defended with some Cataplasm. Cimolia, or Argilla mollis is the best of all.

By the potential Cautery it is done thus. First, they boil an Hempen thread in a Lixivium of Lime and Ashes; then they take it out of the vessel, and lay it upon a Mar∣ble, wetting it with a little of the Lixivium for an hour. The thread thus prepared, must be laid both on the upper, and under-side; in the interflice of the Fingers or Toes that are to be divided. Or the thread may be fastned to a wooden ring about the Wrist, to make it keep tight to the part that should be cut, without incommo∣ding the sound parts. This is the way of cutting by a thread.

The way of separating by a knife is thus. First, one must feel with his Fingers, all along the co∣herence, especially in a natural one, whether there be any hardness, or suspicion of a Nerve or Vein, which must be avoided; afterwards, when the Section is marked with Iule length-ways, it must be made above half way towards the Fingers ends, and then the other half, viz. from the roots of the Fingers to the place where you begun before. The Knife must be long and small. The next thing is, with Liniments and Diapalma, to cicatrize the Fingers so separated.

CHAP. III.

Of Imperforation of the Hymen.

CElsus performs the cure of this by overthwart incision, in manner of the Letter X, taking great care, that the Urinary pas∣sage be not violated, which lies near above it. I shall give you Aquapendent's way, who saw and cured an imperforate Maid; and that I may be the more exact in it, I shall give it you in his own words.

In the space, says he, of so many years, i. e. of for∣ty, which I have been Professor of Physick here at Padua, I only once saw an imperforate Virgin. And no wonder the case should be so rare, since Nature is seldom wanting or mistaken in things necessary, because of the many inconveniences and hazards of life which usually thence ensue. However, this Maid, from the very day of her birth, had the Membrane called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hymen, imperforate, which closed up the the whole Orifice of the Womb. The Alae were so little, that scarce any appeared, because they were contracted by the con∣tinuity of the Membrane, and its Tension, caused by the inter∣nal repletion: But when the Vul∣va was perforated, immediately the Alae were formed, as by the Membrane loosed on either side. So that from hence we may con∣jecture, the use of these Alae is to take upon them the defence of the pudendum muliebre, which before was otherwise guarded by the Hymen. This noble Maid was very well till she was Thir∣teen; but from that age she be∣gan to be ill, which illness was occasioned by the keeping in of her Courses, which came down then about. She felt great pains about her Loins, and about the bottom of her Belly, which were communicated also to her Hips. Which made some of her Phy∣sicians treat her as in the Gout, and for the Sciatica. Afterward her Body began to pine away, and consume, she was continual∣ly feverish, and could not sleep, she had lost her Stomach, and was at last delirous; a hard and painful Tumor arose at the bot∣tom of her Belly, in the region of the Womb, and all these Sym∣ptoms grew worse and more vi∣olent, when the time of her Menses approached, At last, when she was just at death's door, I being called, and having be∣held

her case with my Eyes, I made a simple incision upon the Membrane, whereupon, imme∣diately a great quantity of thick, viscous, aeruginous and foetid Blood issuing out, she was forth∣with well, to a miracle. But I made a simple incision length∣way of the Vulva or Scissure; lest, if I had cut Celsus his way, transverse in the form of an X, I might have hindred the form∣ing of the Alae, which results from the Lips of the Hymen be∣ing cut, loosed on either side, and retracted to the place of the Alae. And this is the Chirurge∣ry which I used with the greatest safety and success in a Maid ima∣ginable, whose Hymen was not perforate.

Hildanus also Cent. 3. Obs. 61. gives this account, how he opened the closed Orifice of the neck of the Womb.

There was, says he, brought to me a Girl half a year old, who had the Orifice of the neck of the Won •• closed up with a very thick Membrane. This Mem∣brane stuck on all sides to the Nymphe, or Carunculae cu∣ticulares, and in the upper part had a little hole, by which she made water. The Parents therefore imploring my help, the next day I set the Child on a Ta∣ble upon a Cushion, and draw∣ing back and opening her Legs, I put in a Probe, made a little crooked, and hollow on one side, at the fore-mentioned hole, and brought it forwards towards the Perinaeum to the end of the Membrane, then with a little Penknife, resting in the hollow of the Probe, I cut the Membrane, without hurting the adjacent parts, which was prevented by running the point of the Knife along the hollow of the Probe. When I had made incision on the Membrane, thô no Haemorrhage followed, yet I put in a Tent of soft Town, dipt in the white of an Egg, mixt with a little Rose∣water, and applied over it a fold∣ed cloth, wet in the same Li∣quor, to asswage Pain, and re∣pel the afflux of humors. At last I put in a broad and thick leaden Tent, armed with Ʋn∣guentum diapompholygos. And thus the Child was cured in a few days.

CHAP. IV.

Of the growing together of the Labia of the Womb.

SOmetimes a Woman, by rea∣son of the glutination of the Orifice of the Womb, may be un∣sit for Marriage, whether she be born so, or it happen afterwards, by a foul Ulcer or Wound not well healed, as it happened to a certain Man's Wife, who when he came to lye with her, found no admittance, nor could not, till a Chirurgeon had made it for him by separating the Coalition of the Labia. And no wonder, if such a part, when ul∣cerated, grow up, since the Mo∣desty of civil Women is such, that they had rather dye, than expose themselves to a Cure; but

Stultorum incurata pudor malus ulcera celat.

In this Case the Chirurgery must be adminiured in this manner. The Woman must be laid on her Back, her Legs must be brought divari∣cated to her Hips; her Arms must be brought under her Hams, and tied with convenient bandage to her Neck (as Paulus Aeg neta ad∣vises) then with a Knite crooked at the point, very sharp on the edge, but blunt on the back, and a very long handle, Section must be made at once or twice; having first marked a streight line along the middle of the Labia, direct∣ing the instrument with the fore-Finger outwardly, and with a hol∣low Probe before-mentioned, or some such instrument, inwardly. And Midwives, Nurses, and all that are about Women in Childbed, ought to take great care, that if the Woman have received any such hurt in her Travel, it be im∣mediately taken into Cure: Be∣cause Neglects herein often prove fatal, as the following instance will prove.

Hildanus, Cent. 6. Obs. 67. re∣lates, how a Woman at her full time was brought to bed of a dead Child, with much pain and diffi∣culty; and those pains most ex∣quisitely tortured her, at least six weeks after. At last, when he was called to her, he found the Orifice of the Womb quite closed up, and the parts extremely swelled. under the neck of the Bladder there was a great hole, that reach∣ed into the Bladder, at which the Urine dropt out. The cause of this so grievous an evil had been the Inflammation of the genital parts, not regarded by the igno∣rant Midwife, which was turned to

a putrid Ulcer, which had healed up more by Nature's assistance, than the Midwife's skill; but the Orifice remained shut up. He or∣dered her Clysters, Fomentations, anodyne Ointments, internal and external Medicines, whereby the pains were asswaged, the swelling abated, and her strength increased: But the mouth of the Womb could by no Art or Industry Chirurgical be opened again, so that she was ever after incapacitated for her Husband. She lived a long time after, and when he wrote this Ob∣servation, she had not her Menses the usual way; but was sometimes taken with the Gripes and a loos∣ness, and voided Blood with her Excrements.

CHAP. V.

Of the Anus imperforate.

SOmetimes Children are born with the Anus not perforate, which happens in a twofold man∣ner. Either some mark of a hole appears, or none. When it appears, the way to do it is thus. Cut cross ways at right angles, taking heed not to hurt the Sphincter Muscle, as you cut along the appearance of the hole, then put in a pipe of Lead or Silver, armed with some cicatrizing Medicament, till the part is cicatrized. In this case, thô the place of the Anus is co∣vered with a Skin, yet there is some sign of an Orifice, which feels empty, if one touch it. Al∣bucasis l. 2. c. 79. following Pau∣lus l. 6. c. 81. says, it may be per∣forated with the Midwive's Finger; but it is better to do it with an in∣strument, as I have proposed, than to commit such a business to the virulent claw of an ignorant old Woman; unless the Pellicle be so thin, that the Chirurgeon may do it with his Finger without difficul∣ty. Paulus mentions the cure of the Anus not perforate, through an Ulcer ill cured; But I cannot believe that ever such a case hap∣pened; because the Anus must be opened too often for an Ulcer ever to close it up in healing; because agglutination cannot be made in so short a time. Besides, such a mass of Humors and Excrements is always flowing thither, that it must hinder glutination. When a Child has been born with the Anus not perforate in this man∣ner, it has been cured.

For Hildanus, Cent. 1. Obs. 73. has a case of this nature. He was called to a Child, which being born with the Anus not perforate, was till the sixth day grievously tor∣mented with the Gripes, and in

great hazard of its life. For its Belly wat puft up and hard, it faint∣ed, and had cold Sweats; the Anus was covered with a hard Mem∣brane, in which there was not any sign of an Anus, besides a little li∣vid speck. He made an Incision, with an incision-knife (that the Sphincter might not be hurt) wrapt in a linen Cloth: then he put in a Speculum ani, and dilated the rest. The Child presently discharges a great deal of Excrements; where∣upon the Belly immediately fell, and the rest of the Symptoms aba∣ted. He then for several days put in a pipe of Lead, armed with some Desiccatory, as Ʋnguentum de Cerussa, de Minio, Diapom∣phologos, &c. It cicatrized, andlie did well.

When no sign of an Anus ap∣pears, Aquapendent would not meddle with it. Who says, he once saw a Woman born with∣out an Anus, that voided her Ex∣crements at her Womb, there being a hole within near the Os Vulv••e. But he would not attempt a Cure, lest, not well-knowing where the Anus lay, he might have hurt the Sphincter-Muscle, and so have cau∣sed an involuntary excretion of Or∣dure.

CHAP. VI.

Of rectification, or setting streight parts that are distorted.

MAny parts of Man's Body are of a bad conformation: Some from their birth, others af∣terward, either from a Disease, or from some external violence; as from the Rickets and other Disea∣ses, and from a hurt by a fall, blow, &c.

The parts affected are the Mu∣scles, and in them the Nerves and Tendons especially; or the Bone.

The signs of a Distortion are so manifest to the Eye and Touch, that I need not mention any; however, it is good to observe rickety and morbid Distortions, when they first arise: for then they may with the greatest ease be rectified, especially when the Par∣ty is young, and consequently the parts more flexible to a healing Hand.

As for the cure of Distortions; such as come from wounds in the Muscles and their Nerves and Ten∣dons, depend upon the right heal∣ing of those Wounds; and such as come from Fractures, or Dislo∣cations, depend upon the proper reduction of those Fractures and

Luxations: wherefore for such you must have recourse to the Do∣ctrine of Wounds, Fractures, and Luxations. But when the Distor∣tion is connate, or proceeds from the Rickets, or any inward cause, or from an outward cause, and which might have been cured, had it not been neglected; then the method of Cure is this. If the parts by continuance of time be grown hard and stiff, they must be made soft and limber by Emol∣lients, as Fomentations and Bath∣ings, ex radicibus & foliis Althaeae, Malvae, Fler. Chamaem. Melilot. sem. lini. Faenigraec. addit. Be∣tomcâ, ivâ artheti••••, florib••s pri∣mulae veris, & hujusmodi, quae ner∣vos roborant. Emollient Oils, Salves, and Plasters are likewise proper. When the hardened parts are suf∣ficiently softned, we must have re∣course to such things as strength∣en the Nerves and Nervous parts Among things that strengthen the Nerves, Succus lumbricorum, and Oleum Hildani ex floribus are ex∣cellent, and so is the water of Be∣tony, Sage, and Juniper-berries drawn without Wine. For Hil∣danus says, he observed it in him∣self as well as others, that Wine, even outwardly applied, is an ene∣my to the Nerves. When there is an Atrophy in the part, Succus lum∣bricorum is best, of which take this account. Johannes Wierus in tract. de Scorbuto takes fat Earth∣worms out of a Churchyard, these he washes first in water, then in Wine very well, he shreds them small, and puts them in a Glass covered with Paste, he bakes them in an Oven with Bread, when the Glass is cold he sets it in wa∣ter, and when the Paste grows soft, and parts from the Glass, the Worms are found dissolved into Liquor. This Liquor strained must be preserved for use, but it must be renewed every other day: for it quickly corrupts, especially in Summer time. Nicolaus de Me∣tri prepares this Liquor the same way, only he adds a little Oil Olive to the Worms. Cosmas Slotanus took these Worms, cleansed as a∣foresaid, put them in a large Re∣ceiver, and poured to them a good quantity of Oyl of Sweet Almonds and Violets, then he dissolved them into Liquor upon Embers, which after strong expression he used. This last composition seems to me the best, because so the Virtue both of the Oyl and the Worms is kept entire. The juyce of the Worms by its proper and peculiar virtue penetrates immediately, and passes to the Nerves, and all that is nervous, and therefore to the Veins and Arteries, whose coats consist of a nervous substance; and this juice strengthens, nou∣rishes, and moderately heats these parts, by removing the obstructi∣ons that are there. Besides, in this composition there is a viscous quality from the Oyls, by means whereof, as soon as the juice has penetrated, the Oyls shut the Pores, and so the innate heat is kept in, and as it were pent up, in the part affected. But before these things are used, universals, as Purging, Bleeding, &c. to cleanse the Body, must first be used. Yet when all is done, the whole stress of the Cure lies upon the right contrivance, making, and appli∣cation of Instruments. For un∣less

Instruments be rightly adapt∣ed, all will be in vain, whether E∣mollients or Corroborators. Where∣fore first of all you must get your Instruments made, and then as soon as you use your Emollients, your Instruments must be applied. Thus by the fore-mentioned To∣picks, Bandage and Splenia, may a wry Neck be reduced.

CHAP. VII.

Of the reduction of the Fingers.

HAving in the fore-going Chapter given you the ge∣neral method in curing of Di∣stortions, I thought it in the next place necessary to apply this me∣thod to particular cases, which you will find exactly done in the following case by Hildanus, Cent. 1. Obs. 83.

There was brought to me, says this excellent Author, a Child fourteen Months old. He had, when he was about half a year old, fallen with his right Hand upon burning Coals: His four Fingers and the external part of the Metacarpus were so burnt, that the ends of his Fin∣gers were drawn back to their first articulation, or roots. The Father had committed the Cure to unskilful persons, so that the Fingers, with the skin of the Metacarpus, were shrunk up in∣to the form of a Globe, and grown together. About seven Months after the Cure was made, they brought him to me. I first purged him with Manna in broth, and then I proceeded to Chi∣rurgical Topicks. Then I used the following Emollient Deco∣ction, and Unguent for several days; ℞ radic. Althaeae cum to∣to, Rad. Bryon. lil. Alb. an. ℥ j. flor. Chamaem. Melilot. Hyperic. Chamaepit. Chamaedr. an. M. j. Sem. Faenigraec. lin. an. ℥j. co∣quantur in jusculo pedum & ca∣pitis vervecis aut vituli pro fotu. Then I anointed the whole Hand and Arm with the following Un∣guent; ℞ Ʋnguenti Dialthaeae ℥ j. axungiae humanae, gallina∣rum, anseris, ursi an. ℥ ij. succi lumbricorum ʒ ss. M. f. Ʋn∣guentum. Then I wrapt the Hand in Emplastrum de Muci∣laginibus. By these means the Sinews and the Callosity contract∣ed from the shrunk skin of the Metacarpus, and the Fingers grown together on the outside of the Hand, being sufficiently mol∣lified; I then with a Razor cut away the Callus between the Fin∣gers and the Metacarpus and

next I separated the Fingers. Then I strowed on my Powder to stop Blood, and applied whites of Eggs mixt with Rose and Plantain water, and Oyl of Ro∣ses. I applied also a Defensative to the Wrist, and anointed the whole Arm with Oleum Rosa∣coum, Myrtillorum, and Lumbri∣corum. The next day I laid up∣on the Incisions the following Digestive with soft Lint, and anointed the Arm, as before, with the abovesaid Oyls, ℞ Tere∣binth. lotae in aq. Rosacea & Plantaginis ℥j. Oloi Rosacei & de vitellis ovorum an. ℥ij. croc. ℈ss. vitellum unius ovi. Misce.

The Fifth day I applied an Instrument, and began by de∣grees to draw the Fingers to their natural site. It was made of a Splint three Inches broad, long enough to reach almost from the Elbow to the Wrist. At the end next the Wrist, it had a stick fastned across it with four round pegs standing up. The Splint was tied in two places round the Arm with a string. The Instrument there∣fore being tied on, and well guarded with Lint and Cotton, I put Finger-stalls of Leather upon the ends of the Fingers, with strings fastned to them. Then I drew the strings tight, and fastned them to the four pegs afore-mentioned: And every day I bent them more and more. And that I might the better do it; I anointed the Arm and Hand with the foresaid Unguent, as oft as I dressed the Wounds. But, that the Fingers might not grow together again, I put Plates of Lead between the Fin∣gers. Thus by little and little the Fingers were reduced to to their natural site. In the mean time I healed and cicatri∣zed the Wounds, not with very great Driers, but with Medica∣ments, that were also somewhat emollient. And by GOD's Blessing the Hand was perfectly restored.

CHAP. VIII.

Of shrunk Sinews, and crooked Arms and Legs.

WHen, upon the falling down of some Humors the Sinews shrink, and the Joynts are bent, so that one cannot ex∣tend them, it ought well to be considered, before the Cure be undertaken, whether the Joynt be joyned with a Calius, or no, (the two ends of the Bones having been eroded by some Humor, and by an intervening Callus grown into one, as in Fractures) for then, let the Chirurgeon do what he can, he can do no good, as to the redu∣ction of it; only if he perceive it in time, as it is in growing, he may keep the Limb in the most con∣venient posture; but it will ever after be stiff and useless. If it is not joyned by a Callus, the me∣thod of Cure is this. First, a good Diet must be observed. Then the Body must be gently purged. Thirdly, the Nerves and nervous parts must be mollified and moistned by all means possi∣ble. The following Fomentation will do good. ℞ rad. Althaeae, li∣liorum alborum, Bryoniae, ebuli an. ℥ss. foliorum & florum Beto∣nicae, ivae artheticae, rorismarini, Majoranae an. M. ss. florum Cha∣maem. Melil. Sambuc. an. M. s. Sem. lin. Faenigraec. an. ℥j. ams. aneth. an ℥ ij. Incidantur & con∣tundantur omnia grosso modo, co∣quantur{que} in jure capitis & pedum vituli aut vervecis. The disaf∣fected Limb must be held an hour or two twice or thrice a day in this Decoction, as the Patient pl••••∣ses. Or a Bag may be made of the foresaid Herbs, which may be boiled in the foresaid Broth, and applied hot, and left on all night. When the Bag is taken off, and the Limb wiped with warm Clothes, it may be anointed with the fol∣lowing Liniment hot. ℞ Olei de Ranis (cujus descriptio haec est, ℞ ranas viventes man. XII. lumbricorum in aqua lotorum M. iij. storum & foliorum Betonicae, ivae Artheticae an. M. ij. roris marini, Majoranae, Florum primulae veris, Lavandulae, Salviae, Chamaemel. Melilot. an. M. j. Omnia cuni ranis & lumbricis incid••ntur, & in mortario conquassentur, prose∣ctis postea in cucurbitam assunde aq. Juniperi sine vino distillatae lb vj. Olei Olivarum lb. vij. a••∣ung. human. felis, canis, muris Alpini an. ℥ij. Maneant in infu∣sione horas 24. postea cucurbita suo capitello tecta ponatur in arenam, & tamdin coquatur, donec tota fore aqua fit extillata. Oleum ad∣huc

tepidum per praelum exprima∣tur, & reservetur ad usi••n) Ol. ex floribus an. ℥ j. Ol. Lumbric. vulpin. am••gdal. dulc. pinguedi∣nis muris. Alpini an. ℥ss. Misce. Or, ℞ Ʋngu. de Althaeae ℥ j. pin∣guedinis humanae, anseris, caponis, an. ℥ ss. ol. lumbricorum ℥ j. Ol. granor••an Juniperi ℥ ij. M. After anointing, let some very emollient Plaster be applied, as Empl. de Me∣liloto, de Mucilag. cum Gum. Or Empl. Oesypi Philagrii. It must be dressed twice a day in this man∣ner, till the Tendons and Joynt are soft enough. Then an Instrument must be fixt to it, well guarded with Tow, Cotton, or Lint, which must be kept on night and day, and as you think good, or as the Patient can bear it, it must be extended. But every, or every other day the Instrument must be taken off, the Limb must be a∣nointed, and the Plaster also must be renewed. By means of this Instrument, the crooked Limb must be exterded; but gently, lest Pain and bad Symptoms arise. For all violence is dangerous. In the mean time, while the Instrument is fixt to the Knee, the Patient must walk gently upon it, if he be in any measure able. But if the Arm be crooked, then he must stie it sometimes forward, and sometimes backward. The de∣scription of the Instrument is thus. There must be a wooden case, or cradle made hollow, and fit to receive the Thigh about the mid∣dle, and the small of the Leg a little above the Ankle. Then there must be an Iron hoop fit to receive the Knee, with an hinge to open and shut, that it may let the Knee in, and with a Button, and several holes to strai∣ten or widen, as there shall be oc∣casion. Then a male Skrew must be put through a hole in the hoop, just in the Ham, and a hole in the wooden Cradle which is placed be∣hind, and fastned with strings to the mid Thigh, and the small of the Leg. This male Skrew must rest by a Shoulder in the Hoop, then the female Skrew must skrew on behind the wooden Cradle, by turning of which the Hoop is brought to the Cradle, and there∣by the Leg extended as much as the Chirurgeon shall desire. Hil∣danus says, that without the help of this Instrument he has reduced several crooked Elbows in the man∣ner following. He ordered, be∣sides the foresaid Emollients, that the Patient should every hour take some heavy things in his hand, as a Kettle full of stones, and walk about with it. Though this be an easie remedy, yet he would not have it neglected, because he has found the great success of it.

CHAP. IX.

The Cure of a distorted Foot.

HIldanus, Cent. 6. Obs. 90. has an observation of the Cure of a distorted Foot, which may serve as a pattern in the like case, viz. A Woman big with Child, as she was going in Pattens, stumbled, and was disturbed, and out of order at it. She was after∣wards brought to bed of a Boy, whose right Foot was so Distort∣ed, that his Toes, and all his Foot turned inwards towards the inside of his Ankle. So that when he walked, he trode more upon the out-part of his Ankle, than the sole of his Foot. Many means had been used by excellent Phy∣sicians and Chirurgeons, but all in vain. When he was above three years old, and all hope of resti∣tution was past, they wrote to me, and begged that I would use my utmost diligence and skill about the Child. When I had viewed and considered the case well (to speak the truth) I despaired of restoring the Foot, the Distortion being now old and confirmed. However, at the Parents entreaty, I attempted the Cure in this man∣ner.

First of all, because the Child was lusty and fat, I purged his Body with Manna, and Syrupus Rosarum solutivus by turns, lest by Bathings and Fomentations I might draw the superfluous Hu∣mours to the part affected. When the Body was purged, I every day twice or thrice used the following emollient Decoction, for ten or twelve days; ℞ rad. Althaeae, Malvae. an. ℥ss. herb. & flor. Betonicae, ivae artheticae. flor. Cha∣maem. Melilot. am. M. j. Sem. lin. Faenigraec. an. ℥ j. coquantur in decocto capitis & pedum verve∣cis, fiat{que} fomentum, cui bis in die ad semihoram us{que} pedem immer∣gat. After Fomentation I a∣nointed the Leg and Foot all over with the following Unguent; ℞ Ol. Lil. Alb. Amygd. dulc. an. ℥ss. Ol. Lumbric. ℥ j. Ol. Granor. Ju∣niperi ℥ ij. Misceantur. Then I ap∣plied the following Plaster. ℞ Em∣plastr de mucilaginibus ℥ijss. Gum∣mi Ammaniaci in Spiritu Juniperi∣no dissoluti & percolati, iterúm{que} ad spissitudinem cocti ℥ j. cerae novae ℥ ss. Ol. de Vitellis ovorum ℥ j. dis∣solvantur lentissimo igne; deinde admisce pulv. flor. Betonicae, ivae Artheticae, Rosarum Rubrarum, an. ℈ ij. croci, pulv. Lumbrico∣rum terrestrium, Masticis, Olibani an. ʒj. Misce, & fiat secundum artem Emplastrum, addendo pa∣rum

Olei Rosacei, si opus fuerit. This Plaster wonderfully mollifies and strengthens the nervous parts.

The Foot being in this manner sufficiently mollified, I left off E∣mollients, and applied Corrobo∣rants.

In the mean time while I used Emollients. I applied a Serpera∣strum or Boot, hereafter descri∣bed.

Moreover, althô the Foot was wonderfully distorted; yet after the use of Emollients, it was easily reduced into the natural form, and that without pain: but as soon as ever the hand was off it, it re∣turned to its former monstrous Fi∣gure.

And whenever I extended the Foot (which I took special notice of) and reduced it to its natural posture, I felt a great hollowness between the inner Ankle and the sole of the Foot. For the Pro∣cess of the lower Appendix of the Os tibiae, which makes the inner Ankle, because it had rested a long time upon the Os calcis, was de∣pressed, and stood at a distance from the Os calcis. And the Pro∣cess of the Fibula, which makes the outer Ankle, was preternatu∣rally prominent, and twined the whole Foot inward.

Therefore to reduce the Foot to its natural posture and form, it was necessary to depress the Pro∣minence of the Fibula, and a lit∣tle to prolong the defect of the Process of the Appendix of the Os tibiae. That was done by Art and Industry; this by the benefit of Nature. And that Nature is wonderfully sollicitous for the maintaining her Individuum; I can visibly demonstrate by an in∣stance in my Study. For there I have the Sceleton of a Capon, in which the wonderful providence of the Creator may be observed. This Creature had broke its left Thigh-bone short off, and the one end of the broken Bone grew over the other by a firm Calius, and there∣fore that Leg must have been short∣er than the other: but provident and wise Nature made the Os tibiae of that Leg so much longer than the Os tibiae of the right, as the left Thigh-bone was shorter than the right; and thus no inequality or deformity was left. And if it was thus in Brutes, why not so in Children, while they are growing; especially if they be of a good ha∣bit of Body, as this Patient was? But to return to him; the Foot being thus sufficiently mollified, I was to think of something else. I then therfore anointed the Foot and all the Leg with Succus Lum∣bricorum, aqua Betonicae, ivae Ar∣theticae, Sa••viae & Juniperi mixto, and applied the following Plaster, which strengthens admirably; ℞ Emplastri Slotani ℥ iij. Gummi El••mi purissimi, Cerae novae an. ℥j. pulv. Mastic. Olibani, pulv. lumbricorum aquâ communi lote∣rum & exsiccatorum an. ʒ ij. Ro∣sar. Rubr. Balaustior. nucum cu∣press. an. ʒ j. cum s. q. Olei Lum∣bricorum fiat Ceratum, quod supra alutam extendatur, applicetur, & renovetur, de sexto in sextum di∣em. Afterwards, having replaced the Foot in its natural posture, which, (as I said before) might be done without pain, I applied the following instrument so neatly to the Foot, that the Foot could

not get back into its former prae∣ternatural posture, unless the swathes and bandage happened to be loose. The Instrument was made thus of Iron; it was shaped like half a Boot, but parted about the mid Leg, and held together by two pins of Iron running into two Loops, and a Skrew between them, to let the lower part down, or to draw it up right, as there should be occasion. This lower part was so made, as to take hold of the Foot, and keep it from starting any way out of its proper place. This was for the outside of the Leg. It was fastened to a piece above the Knee by a pin to run on, for the motion of the Knee. The inside of the Leg was cover∣ed with Splints, lined with Tow or Cotton, and so the Instrument on the outside was fastned round the Leg by strings.

The Foot being tied streight and fast in this manner, the Prominence of the Fibula was depressed, or at least hindred from starting out. And the Process of the lower Ap∣pendix of the Os tibiae, since there was an empty place, might grow out, and so by degrees fill up the hollowness about the inner Ankle. Thus the deformity of the Foot was rectified, so that when he walked no deformity appeared.

But Cures of this nature require a long time and great care. For violence does no good, it is Na∣ture's work to correct such defor∣mities, with the assistance of the Chirurgeon's skill and industry. I found this true in the foresaid Pati∣ent. The case was inveterate and deplorable; wherefore he wore the foresaid Instrument a whole year. And I contrived another for him to wear afterwards. For Chil∣dren when they are growing, must have new ones fitted to them, as they out-grow the old ones.

The reason why the former Phy∣sicians, thô expert persons, could do no good, was not for want of proper Medicines, but for want of Serperastra. Wherefore in such cases a Physician must set all his Wits to work to invent apt Instru∣ments, without which, the best Medicines are used to no purpose.

CHAP. X.

The Cure of a crooked Back.

A Crooked Back most com∣monly proceeds from the Rickets, and may, if minded when the Party is young, be cured. But then it must be done by Chirurgi∣cal means. I shall therefore give you Hildanus his method of Cure in the following Process, viz.

A Girl of eighteen Months of age, had the Vertebrae of her Loins beginning to grow in a bunch out∣ward. When some Barhers had for several Months endeavoured in vain to cure her by Ointments, Baths, and thin plates of Lead, but still the Spine grew more and more into a bunch; at length Hildanus was called. He found the third and fourth Vertebrae of the Loins extuberant, as big as a Ducks Egg, which were followed a little by the second and fifth; so that the Spine was grown into a huge bunch, especially towards the left Side: which made the left Leg far weak∣er than the right. In the Cure he proceeded thus.

First of all he chafed the Back, and the whole Thigh and Leg with the water following, to strength∣en the Nerves. ℞ Aq. Granor. Ju∣niperi sine vino distillati, Aq. Sal∣viae, Betonicae, lavandulae, an. ℥ ij. Pulv. radic. tormentillae, Rosarum an. ʒ ij. Misce, fiat{que} infusio in ampulla magna per dies octo vel de∣cem. Dein per inclinationem à pulveribus praedictis separata aqua ad usum reservetur. After chasing, he applied the following Plaster, which he often uses in Fractures of the Bones. ℞ Empl. Slotani ℥ v. Cerae novae ℥ ij. lapidis sabu∣losi, sive osteocollae ℥ j. Pulv. ra∣dic. consolid. maj. Terrae sigillatae an. ʒ iij. pulv. balaustiorum, nu∣cum cupressi, Rosar. odoriferar. an. ʒ j. Misceantur lentissimo igne, fi∣at{que} Emplastrum addendo Olei Ro∣sacei aut Masticis, q. s. But all the skill in curing a Gibbus consists in repressing the Extuberance of the Vertebrae. To this purpose there∣fore he made an Iron plate a little bent, long and broad enough to cover the whole Gibbus, and quilt∣ed it into a Bodice between two Clothes. But he covered it first with a course Cloth, that it might hurt the Child the less. The Bodice was worn upon the naked Body, and so sitted, as to comprehend all her Belly to the Muliebria. It was tied on with a long strap over the middle of the Belly. About the Breast it was tied gent∣ly, lest it might have straitned the Ribs or Midriff. But below the

bastard Ribs to the bottom of the Belly, it was tied pretty tight, that the Iron plate might repress the extuberant Vertebrae. And lest the Bodice should have slipt upwards, two straps an Inch broad, were fastned on each side of the Groin, to go under the Perinaum, and to turn up again upon the Buttocks, and so were fastned by straps to the Bodice on each side. He re∣newed the Plaster and the Chasing every fourth or sixth day. But he ordered all from the Hip to the Foot, to be chafed with the afore∣said water every day. So by GOD's Blessing the Gibbus was cu∣red in six Months. But she wore the Bodice and the Plate, by rea∣son of the weakness and softness of the parts, two years, in which time she grew pretty well.

Partis Secundae Finis.

THE PRACTICE OF CHIRURGERY. Part III.

BOOK VII.

Of taking away things superftuous.

CHAP. I.

Of things superfluous in general; and concerning Women's Labours.

I Gave you in the beginning of the First Book, a desig∣nation of the whole Work; and therefore shall not here trouble you with a repetiti∣on of what I intend to treat upon in this Third Part. What I com∣prehend in this one, some divide into two, making one to be 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or an extraction of hurt∣ful things sticking in our Body; and the other 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or a re∣moving of what is superfluous. But I am of Dr. Read's Opinion, that these two may very well be com∣prehended in one, viz. in the re∣moval of things superfluous. Things superfluous are such either by event, as a dead Child, a morti∣fied Limb, &c. Or by their own

nature, as Wens, the Stone in the Bladder, &c. The First thing super∣fluous by event, that I treat of, shall be a dead Child, or a living one staying too long, to the preju∣dice of its own, and the Mother's, life. And here I shall shew how to deliver, or bring Women to Bed artificially and safely, treating of Labours natural and unnatural, with the way how to help Women in the first, and the right means of remedying the last. It will ••herefore be necessary to know what Labour is, and the differen∣ces of it, together with its different terms.

By a Delivery we understand ei∣ther an emission or extraction of the Infant, at the full time out of the Womb. This definition may comprehend as well the natu∣ral, which is accomplished by Emission, when the Infant coming in a commodious and usual Figure, the Womb sends it forth without extraordinary violence: as the De∣livery contrary to Nature, extra∣ction by manual operation.

As to the general differences of Labour, we must take notice, that the one is legitimate or natural, the other illegitimate or against nature. To come to the know∣ledge of each, we say, that four conditions must absolutely be found in a Delivery, that it may deserve to be called Legitimate, or Na∣tural. 1. That it be at the full time. 2. That it be speedy, with∣out any considerable accident. 3. That the Child be living. 4. That it comes right in a good po∣sture or situation. For if any of these four are wanting, the Deli∣very is against Nature; and the more, by how much the more of them are wanting.

As to the due time of Labour, most Authors assert, that Nature hath appointed to all other Ani∣mals a certain limited time of go∣ing with young, and bringing them forth; but that Women only, by a particular favour of the same Na∣ture, have none prefixt, neither for Conceiving, going with Child, nor bringing forth. And as to Conception, 'tis most certain that a Woman can conceive at any time, night or day, Winter or Summer, or any other season what∣soever; because she can copulate when she pleases, which few other Animals can, who couple but at certain seasons, when they become lustful. But as to the time they are accustomed to go with young, it is no more precisely determined to them, than to a Woman; for as she may be brought to Bed ei∣ther in the 7th, 8th, 9th, or 10th, Month (but for the most part in the 9th.) so likewise, for example, thô the ordinary time for a Bitch to puppy, is the 4th Month, or thereabouts, yet some puppy soon∣er, some later. And the usual time of Ews yeaning their Lambs is at five Months end: yet some ad∣vance or recede from that ordinary term, according to the ground where they feed, and other par∣ticular disposition; which happen to all others, as well as to Women. The first time that a Child may live when born, is the 7th Month compleat, and it may better from that time till the end of the 9th Month; but as soon as that is pas∣sed, the stay it makes afterwards in the Womb, is no way beneficial

to it, because it hath then acqui∣red all necessary perfection, and strength to resist all outward inju∣ries. The Child born before the 7th Month, cannot live long, be∣cause of its weakness. But he that is born in the 8th, may very well live, yea, and more likely than one born in the seventh month (which is contrary to the general opinion of the World) because it is more perfect, as I shall demon∣strate afterwards, where I will par∣ticularly shew the cause of this error.

The proper figure and situation of a Child is thus. It ought to come with the Head first, in a streight line, having the Face turn∣ed downwards, that is, towards the Mother's Back, the Arms couch∣ed along on its Sides, and the Thighs stretcht upwards; but any other part that may first present it self to the Labour, makes it un∣fortunate and against nature; in which case there is often great dan∣ger to the Mother or Child, and sometimes to both, if not sudden∣ly and duly helped.

CHAP. II.

The signs that precede and accompany as well a na∣tural, as an unnatural Delivery.

WHen Women with Child, chiefly of their first, perceive any extraordinary pains in their Belly, they immediately send for their Midwife, taking it for their Labour; who when she is come, ought to be well inform∣ed of the matter, and careful not to put her in Labour before there is a disposition to it. For many times both the Mother and Child lose their Lives, when (by break∣ing the Amnios and Chorion) it is excited before the due time. Those pains, which may be called false, are usually caused by a Colick, proceeding from Wind, which come and go griping the whole Belly, without any forcing down∣wards, or into the Womb, as those do which precede or accompany Labour: And this Colick is dissi∣pated by warm Clothes applied to the Belly, and a Clyster or two, by which, true Labour-pains are rather furthered than hindred. A Woman may feel other kind of pains coming from an Emotion, caused by the flux of the Belly, which are easily known by the frequent Stools that follow.

The signs preceding a natural Labour few days before are, that the Belly, which before lay high,

sinks down, and hinders a Woman at that time from walking as easie as she used; and there flows from the Womb slimy humors, appoint∣ed by Nature to moisten and smooth the passage, that its in∣ward orisice may the more easily be dilated, when it is necessary; which beginning to open a little at that time, suffers that slime to flow away, which proceeds from the humors that strain through the thin substance of the Infants Mem∣branes, and acquires a viscous con∣sistence by the heat of the place, or from the Prostatae.

The signs accompanying pre∣sent Labour, (that is, shewing, that the Woman is effectively in Labour) are great pains about the region of the Reins and Loins, which coming and reiterating by intervals, answer in the bottom of the Belly with congruous Throws. The Face is sometimes red and in∣flamed, because the Blood is much heated by the continual endea∣vours a Woman makes to bring forth her Child; as also, because that during these strong Throws her respiration is ever intercepted; for which reason much Blood hath recourse to her Face. Her privy parts are swelled, because the In∣fants Head (lying in the birth) often th••usts and causes the neighbour∣ing parts to distend outwards, which thence appear swelled in this manner. She is often subject to vomiting, which makes many be∣lieve, who know not the cause of it, that the Women to whom it happens, are in danger: But on the contrary, it is ordinarily a sign of speedy delivery, because the good pains are then excited and redoubled every moment until the business be finished. This vomi∣ting comes from a Sympathy be∣tween the Womb and Stomach, by reason of the ramifications of the Nerves of the sixth pair of the Brain, which are distributed both to the one and the other, and by which it communicates the pain it feels at that time, arising from the agitation, which the violent and frequent motions of the Child cause, and the strong compression the Muscles of the lower Belly make during the Throws, for to help the issuing forth of the Child. Besides, when the birth is near, Women are sometimes troubled with an universal trembling, and principally of the Legs and Thighs; not with cold, as at the beginning of an Ague-fit, but with the heat of the whole Body; and the Hu∣mors which then flow from the Womb, are often discoloured with Blood, which with the signs above∣mentioned, is an infallible mark of the nearness of the birth; 'tis that the Midwives usually call Shows: and if one then put up their Finger into the neck of the Womb, they will find the inner Orisice dilated, at the opening of which, the Mem∣branes of the Infant, containing the Waters, present themselves, and are strongly forced downwards with every pain the Woman hath; at which time one may perceive them to resist, and again press to∣wards the ••inger, being by so much the more or less hard and extended, by how much the pains are stronger or weaker. These Membranes with the water in them, when gathered (that is, when they are advanced before the

Head of the Child, which makes the Midwives call it the gathering of the waters) presenting them∣selves at this inward Orifice, do then resemble very well to the touch of the Finger, the abortive eggs which have yet no shell, but are only covered with a simple Membrane: after this, the pains redoubling continually, the Mem∣branes are broken by the strong impulsion of the waters, which in∣continently flow away, and then the Head of the Child is easily felt naked, and presented at the open∣ing of the inner Orisice of the Womb. Now all these, or the greatest part of them met toge∣ther, at what time soever of a Wo∣mans going with Child it be, whe∣ther full time or no, one may be assured she will soon be delivered; but great care must be taken not to hasten her Labour, before the ne∣cessity of it be known by these signs; for that would but tor∣ment the Woman and Child in vain, and put them both in danger of their lives.

Labour contrary to Nature is when the Child comes in an ill si∣gure and situation; as when it pre∣sents any otherwise than the Head first; as also when the waters flow away a long time before it is born, because it remains dry in the Womb, and they are absolutely necessary to moisten the passage, and render it more slippery. When the After-burthen comes first, it is an accident, which renders the Labour always dangerous, by rea∣son of the great flux of Blood usually following, of which the Mother may dye in few hours, and the Infant (because it receives no more nourishment) is quickly smo∣thered in the Womb, for want of respiration, which it then needs, if it stay never so little after. The Labour is also grievous, when ac∣companied with a Fever, or any other considerable distemper, which may destroy the Child in the Womb; as also when pains are small, and come slow, with long interval and little profit, by rea∣son of which a Woman is extreme∣ly tired: but the difficulty most frequent and ordinary comes from the Infants wrong posture.

CHAP. III.

Of the several natural situations of an Infant in the Mother's Womb, according to the different times of pregnancy.

WHen we shall have ex∣plained the several natu∣ral situations of an Infant, those contrary to nature, causing for the most part all ill Labours, will ea∣sily be conceived.

It may be considered, that gene∣rally the Infants, as well Male as Female, are usually situated in the midst of the Womb; for thô sometimes a Woman's great Belly is a little higher on the one side than the other, yet that is, be∣cause the globe of the Womb in∣clines more that way; and this si∣tuation on the side must be un∣derstood only in respect of the Mother's Belly, and not of her Womb, in the midst of which it is always placed; because there is but one only Cavity in a Woman's Womb, marked with a small line in its length, without having two or more separations, as is seen in those of other Animals.

There are some who would have these two imaginary Cavities to be the cause why Women bear Twins, yea, and sometimes more; and that the Males rather lye on the right, and the Females on the left side; which is Hippocrates his opinion in the 48th. Aphorism of his 5th. Book, where he says, Foe∣tus mares dextrâ uteri parte, fae∣minae sinistrâ magis gestantur, but without any certain reason for it; because some Women have the Males on the left side, others the Females on the right; and when there are Twins, sometimes both are of the same Sex, sometimes not, and indifferently situated on the right or the left. This is all can be said in general of the si∣tuation of the Child in the Womb.

But in particular, when we con∣sider the several figures it makes, it differs according to the different times of pregnancy. For when the Woman is young with Child, the lit∣tle Foetus, called Embryo, is always found of a round figure a little ob∣long, having the Spine moderately turned inwards, the Thighs folded, and a little raised, to which the Legs are so joyned, that the Heels touch the Buttocks, the Arms are bending, and the Hands placed upon the Knees, towards which the Head is inclining forwards, so that the Chin touches the Breast. It resembles,

in this posture, very well; one sit∣ting to void his Excrements, and stooping down his Head, to see what comes from him. The spine of its Back is at that time placed towards the Mothers, the Head up∣permost, the Face forwards, and the Feet downwards; and it ex∣tends by little and little its Mem∣bers, which were exactly folded in the first Months. It keeps usually this posture till the 7th or 8th Month, at which time the Head being grown very big, is carried downwards by its weight, towards the inward Orifice of the Womb, tumbling as it were over its Head, so that then the Feet are upper∣most, and the Face towards the great Gut; thô some Foetus never turn before the time of Labour, some believe that only Males are so turned downwards when they are born, and that the Females are with their Face upwards; but both the one and the other are always turned downwards, with their Face towards the Rectum of their Mo∣ther, as is abovesaid; and when it happens otherwise, it is unnatural, for the Child's Face coming up∣wards will be extremely bruised, and the Nose wholly flatted, be∣cause of the hardness of the Os pu∣bis in the passage.

It may be noted that when the Child hath thus changed its first situation, being not yet accustom∣ed to this last, it stirs and torments it self so much sometimes, that the Woman, by reason of the pain she feels, is apt to believe her La∣bour is at hand. And if this cir∣cumstance be well considered, we may find it to be the first pretend∣ed endeavour, which Authors ima∣gine the Child makes to be bor•• in the 7th Month, and not being able to accomplish it, remains for till the 9th, and that reiterating it in the 8th, if it be born, it lives not long, because it was not able to endure two such puissant endeavours so near together. But it is a meer abuse, for if the Child turns it self so with the Head down∣wards, or rather is turned, it is but by a natural disposition of the weight of the upper parts of the Body, or by a natural propensity; and if it stirs much at that time and soon after, it is not from a de∣sire to be born, but from the incon∣venience it receives from this new posture, to which it was not be∣fore accustomed, as already hath been mentioned. And it begins to turn thus sometimes from the 7th Month, rarely before but by accident, oftnest about the 8th Month, and sometimes in the 9th only; and at other times also it turns not at all, as we may easily perceive in those that come in their first situation, that is, with their Feet foremost. From whence it is easie to conjecture, and I hold it for a certain truth, that the Children are the more strong and robust, and consequently may the more likely live, by how much the nearer they approach to the more natural and perfect time, which is at the end of the 9th. Month.

The Infant then is turned on this manner with his Head down∣wards towards the later end of the reckoning, to the end only that he may be the better disposed for his easier passage into the World at the time of Labour, which is not then far off: For in this po∣sture

all its Joynts are easily ex∣tended in coming forth, and the Arms and Legs cannot hinder its birth; because they cannot be bended against the inward orifice of the Womb; and the rest of the Body which is very supple, passeth very easily, after the Head, which is hard and big, being once born.

When there are many Children, they ought, if the Labour be na∣tural, to come in the same figure, as when there is but one: but usu∣ally by their different motions they do so incommode one the other, that most commonly one of them presents wrong at the time of La∣bour, yea, and before; which is the cause that one comes often with the Head, the other with the Feet, or in any other worse posture, and sometimes both come wrong.

But however the Infant may be situated in the Mother's Belly, or whatsoever fashion it be that it pre∣sents at the birth, if it be not ac∣cording to the posture above de∣scribed, it is always against nature: and the natural situation is so ne∣cessary to a good and legitimate Delivery, that those which are against nature, do cause for the most part bad Labours.

CHAP. IV.

What is to be done when a Woman first falls in La∣bour.

A Woman's Travel is only many Pains with reiterated Throws, by which she endeavours to bring forth her Child. It is so called, because both Mother and Child suffer, and take much pains in this action.

As soon as it is known that the Woman is certainly in Labour, by the signs preceding, and accompa∣nying Labour, before recited; of which the principal are Pains and strong Throws in the Belly, for∣eing downwards towards the Womb; and dilatation of the in∣ward Orifice, perceived by touch∣ing it with the Finger; as also the gathering of the Waters, which come before the Head of the Child, and thrusting down the Membranes which contain them, through which between the pains one may in some manner with the Finger discover the part which presents, especially if it be the Head of the Child, by its roundness and hard∣ness: Then must all things necessa∣ry to comfort the Woman in her Labour be got ready; and the bet∣ter to help her, care must be ta∣ken, that she be not strait laced; a pretty strong Clyster may be given

her, or more than one, if there be occasion; which must be done at the beginning, and before the Child be too forwards, for afterwards it is very difficult for her to receive them, because the Gut is too much compressed: They serve to excite it to discharge it self of its excre∣ments, that so the Rectum being emptied, there may be more space for the dilatation of the passage; as also to stir up the pains to bear the better downwards, through the endeavours she makes when she is at Stool. And the while all necessary things for her Labour should be put in order, as well for the Woman as the Child, a Midwife's Stool, or rather a Pallet-Bed girted, placed close by the fire, if the season require it; which Pallet ought to be so disengaged, as to be turned round about, the better to help the Woman when there is occasion.

If the Woman be Plethorick, it may be convenient to bleed her a little; for by this means, her Breast being disengaged, and her Respiration free, she will have more strength to bear down her pains, which she may do without danger; because the Child being about that time ready to be born, hath no need of the Mother's Blood for its nourishment, which hath been often practised with good success: Besides, this evacuation often hin∣ders her having a Fever after De∣livery. In expectation of which hour she may, walk about her Chamber, if her strength permits; and to preserve her strength, it will be convenient to give some good Gelly Broths, new laid Eggs, or some spoonfuls of burnt or brewed Wine; from time to time, or a Toast dipt in Wine; avoiding at that time solid food. Above all, she must be perswaded to hold out her Pains, bearing them down as much as she can, at the instant when they take her. The Mid∣wife must from time to time touch the inward Orifice with her Finger, to know whether the waters are ready to break, and whether the birth will soon after follow: She must likewise anoint all the Bear∣ing-places with emolientoyls, Hog's grease, or fresh Butter, if she per∣ceive that they can hardly be dila∣ted; and all the while she must be near her Woman, to observe her gestures diligently, her complaints and pains; for by this they guess pretty well how the Labour ad∣vanceth.

The Patient may likewise by in∣tervals rest her self on her Bed, for to regain her strength; but not too long, especially little, or short thick Women, for they have al∣ways worse Labours if they lye much on their beds in their Travail (and yet much worse of their first Children) than when they are pre∣vailed with to walk about the Chamber, supporting them under their Arms, if necessary; for by this means the weight of the Child (the Woman being on her Legs) causeth the inward orifice of the Womb to dilate sooner than in Bed; and her pains to be stronger and frequenter, that her Labour be nothing near so long.

When the waters of the Child are gathered, which may be per∣ceived through the Membranes, to present themselves to the inward

Orifice, of the bigness of the whole dilatation, the Midwise ought to let them break of themselves, and not as some, that are impatient of the long Labour, break them, in∣tending to hasten their business, which on the contrary they retard by so doing, before the Infant be wholly in the passage; for by the too hasty breaking of these waters, which ought to serve him to slide forth with greater facility, he re∣mains dry, which hinders after∣wards the Pains and Throws from being so effectual to bring forth the Infant, as else they would have been. It is therefore better to let them break of themselves, and then the Midwife may easily feel the Child bare, by the part which first presents, and so judge certain∣ly whether it comes right, that is, with the Head, which she shall find hard, big, round and equal; but if it be any other part, she will perceive something inequal and rugged, and hard or soft, more or less, according to the part it is.

Immediately after (that being the right time when all Women ought to be delivered, if Nature perform its office) let her hasten to deliver her Woman, if she be not already, and assist the Birth, which ordinarily happens soon af∣ter, if natural, and may be done according to the directions in the next Chapter. But if the Child comes wrong, and she be not able to deliver the Woman, as she ought to be, by helping Nature, and so save both Mother and Child, who both are in danger of their Lives, let her send speedily for an expert and dextrous Chirurgeon in the practice, and not delay, as too ma∣ny of them often do, till it be re∣duced to extremity.

Assoon then as the waters are broke, and the Midwife finds the Child to come wrong, she must ad∣vise the Woman not to forward her pains, lest by bearing down she engage the Child too far in the passage, and so give the Chirur∣geon more pains to turn it.

CHAP. V.

Of a natural Labour, and the means of helping a Woman therein, when there is one or more Chil∣dren.

WE have already taught, that there are four things requisite to a truly legiti∣mate and natural Labour, viz. That it be at the full time. That it be speedy, without any ill acci∣dent. That the Child be alive. And that he comes right. All which being found to be so, and after the Waters be broke of themselves, as abovesaid, let the Woman be presently placed on a Pallet-Bed, provided for her to this purpose near the fire; or she may, if she likes it better, be delivered in her ordinary Bed. For all Women are not accustomed to be deliver∣ed in the same posture: Some will be on their Knees (which is a dan∣gerous way) as many in Country villages; others standing upright leaning with their Elbows on a pillow upon a Table, or the side of a Bed; and others lying on a Quilt in the midst of the Cham∣ber; but the best and sureft way, is to be delivered in their Bed, to shun the inconvenience and trouble of being carried ••hither afterwards.

The Bed must be so made, that the Woman being ready to be de∣livered, should lye on her Back upon it, having her Body in a convenient figure, that is, her Head and Breast a little raised, so that she be neither lying nor sitting; for in this manner she breaths best, and will have more strength to help her pains, than if she were otherwise, or sunk down in her Bed. Being in this posture, she must spread her Thighs abroad, folding her Legs a little towards her Buttocks, somewhat raised by a small pillow underneath, to the end that the Coccyx, or Rump, should have more liberty to retire back, and have her Feet staid a∣gainst some firm thing; besides this, let her hold some persons with her hands, that she may the better stay her self during her Pains. She being thus placed near the side of her Bed (with her Midwife by, the better to help upon occasion) must take courage, and help her Pains the best she can, bearing them down when they take her, which she may do by holding her breath, and forcing her self, as much as she can, just as when she goes

to stool; for by such endeavours, the Diaphragm being strongly thrust downwards doth force down the Womb and Child in it; in the mean time the Midwife must com∣fort her, and desire her to endure her Labour bravely, putting her in hopes of a speedy Delivery. Some would have another Wo∣man at that time to press the su∣perior parts of her Belly, and so thrust gently the Child downwards; but I am not of their opinion, be∣cause such compressions will ra∣ther hurt than profit, by endanger∣ing the bruising of the Womb, which is extreme sore at that time. But the Midwife may content her self only (having neither Ring nor Bracelet on, and her Hand anointed with Oil or fresh Butter) to dilate gently the inward orifice of the Womb, putting her sin∣gers ends into its entry, and stretch∣ing them one from the other, when the pains take her, thus endeavor∣ing to forward the Child, and thrusting by little and little the sides of the Orifice, towards the hinder part of the Child's Head, anointing these parts also with fresh Butter, if it be necessary.

When the Infant's Head begins to advance into this inward ori∣fice, 'tis commonly said it is crown∣ed, because it girds and surrounds it, just as a Crown; and when it is so far, that the extremity be∣gins to appear manifestly without the privy parts, it is then said, the Child is in the passage, and the Woman in Travail imagines (al∣thô untruly, and it may be is not so much as touched by her) that her Midwife hurts her with her Fingers, finding her self as it were scratched and pricked with pins in those parts, because of the vio∣lent distention, and sometimes la∣ceration, which the bigness of the Child's Head causeth there.

When things are in this posture, the Midwife must seat her self con∣veniently to receive the Child, which will soon come, and with her fingers ends, her Nails being close pared, endeavour to thrust (as abovesaid) this crowning of the Womb back over the Head of the Child, and as soon as it is ad∣vanced as far as the Ears, or there∣abouts, she may take hold of the two sides with her two hands, that when the pain comes, she may quickly draw forth the Child, ta∣king care that the Navel-string be not then entangled about the Neck, or any other part, lest thereby the After-burthen be pulled with vio∣lence, and possibly the Womb al∣so, to which it is fastned, and so cause Flooding; or else break the string, whereby the Woman may come to be more difficultly deli∣vered. It must also be observed, that the Head be not drawn forth streight, but shaking it a little from one side to the other, that the Shoulders may the sooner and easier take its place, immediately after it be past, which must be done without losing any time, lest the Head being past, the Child be stopt there by the bigness and largeness of the Shoulders, and be in danger of being strangled in the passage: But as soon as the Head is born, if there be need, she may slide in her singers under the Arm-pits, and the rest of the Bo∣dy will follow without any difficul∣ty.

As soon as the Midwife has in this manner drawn forth the Child, she must put it on one side, left the Blood and Waters, which fol∣low immediately after, should in∣commode it, or, it may be, choak it, by running into its Mouth or Nose, as it would do, if it were laid on the Back. After which there remains nothing but to free her from the After-burthen, which I will shew how in the next Chap∣ter. But before that, let her be very careful to examine, whether there be no more Children in the Womb; for it happens very often that there are two, and sometimes more, which she may easily know, by the continuance of the pains af∣ter the Child is born, and the big∣ness of the Mother's Belly; besides this, she may be very sure of it, if she puts her hand up the entry of the Womb, and finds there ano∣ther water gathering, and a Child in it presenting to the passage: If it be so, she must have a care not to go about to fetch the After∣birth, till the Woman be delivered of all her Children, if she have ne∣ver so many: For if Twins be fast∣ned to the same Burthen, to which there are fastned as many strings and distinct Membranes, as there are Children; and if one should go to draw it forth as soon as the first is born, the rest would be in danger of their lives, because that part is very necessary to them, while they are in the Womb; and besides, it endangers Flooding. Wherefore the first string must be cut, being first tied with a thread three or four double, as we shall shew more exactly hereafter, and fasten the other end with a string to the Womans Thigh, not so much for fear that the string should enter again into the Womb, as to prevent the inconvenience it may cause to the Woman by hang∣ing between her Thighs; after∣wards this Child being removed, they must take care to deliver her of the rest, observing all the same circumstances as was to the first; which being done, it will be then convenient to fetch the After∣birth, as we shall shew in the fol∣lowing Chapter.

CHAP. VI.

How to fetch the After-burthen.

MOst Animals when they have brought forth their young, cast forth nothing else but some waters, and the Membranes which contained them; but Women have an After-birth, of which after La∣bour they must be delivered, as of a thing useless and inconvenient: Wherefore as soon as the Child is born, before they do so much as tie or cut the Navel-string, lest the Womb close, they must with∣out losing time, free the Woman from this fleshy mass, which was destined to furnish the Infant with Blood for its nourishment, whilst it was in the Womb, and which at that time is called with much rea∣son the After-birth, because it follows the Child, and is to the Woman like another Birth; for being brought forth, she is perfect∣ly delivered.

To perform this, the Midwife having taken the string, must wind it once or twice about one or two of her Fingers of her left Hand joyned together, the better to hold it, with which the may then draw it moderately, and with the right Hand she may only take a single ••old of it above the left, near the Privities, drawing likewise with that very gently, resting the while the Fore-Finger of the same hand extended and stretched forth along the string towards the en∣trance of the Vagina; always ob∣serving for the more facility, to draw it from the side where the Burthen cleaves least, for in so do∣ing the rest will separate the bet∣ter; just as we see a Card, which is glewed to any thing, is better separated from the place where it begins to part, than where it is close joyned.

Above all things, care must be taken, that it be not drawn forth with too much violence, lest by breaking the string near the Bur∣then, as sometimes happens, you be obliged to put up the whole Hand into the Womb, to deliver the Woman; or that the Womb, to which this Burthen is sometimes very strongly fastned, be not drawn forth with it: As also in drawing it forth with too much violence, there may happen a very great Flooding, which would be of a dan∣gerous consequence: Wherefore for these reasons, it must be care∣fully shaken, and gently drawn forth by little and little, after the manner we have just now descri∣bed; and to facilitate the better its expulsion, the Woman may

blow strongly the whilst into her Hands shut, just as one would in∣to the mouth of a bottle to know whether it be broke; or she may put her Finger into her Throat, as if she would excite vomiting; or else strive as if she were going to stool, bearing always down, and holding her breath, as she did to bring forth her Child: All these motions and different agitations produce the same effect, and loo∣sen and expell the After-birth out of the Womb.

When all these circumstances have been observed, if notwith∣standing you meet with difficulty, you may, if need be, after that you know on which side the Af∣ter-birth is situated, command an experienced Nurse-keeper to press the Belly lightly with the flat of her Hand, directing it gently down∣wards by way of friction, above all, being careful not to do it too boisterously. But if all this be in vain, then must the Hand be di∣rected into the Womb, to loosen and separate it in the manner here∣after-mentioned, where we shew the way how to draw it forth when the string is broke.

As soon as the Woman is deli∣vered of both Child and Burthen, it must then be considered, whe∣ther there be all, and care be had that not the least part of it re∣main behind, not so much as the skirts or any clods of Blood, which ought all to be brought away with the first; for otherwise being re∣tained, they cause gréat pains: All which being done, things fit for Mother and Child in this condi∣tion must be provided.

When a Woman has two Chil∣dren, she must be delivered in the same manner as if she had but one; observing only for the reasons gi∣ven in the precedent Chapter, not to fetch the Burthen, till the Chil∣dren be born; and then it may be done without danger, shaking and drawing it always gently, sometimes by one string, some∣times the other, and sometimes by both together, and so by turns till it come, proceeding in it accord∣ing to the directions already gi∣ven.

When the Infant comes right and naturally, the Woman is brought to Bed, and delivered with little help, observing what hath been taught in the two last Chapters, of which the meanest Midwives are capable, and often∣times for want of them, a simple Nurse-keeper may supply that place: But when it is a wrong Labour, there is a greater mystery belongs to it; for then the skill and prudence of a Chirurgeon is for the most part requisite, which we intend now to treat of.

CHAP. VII.

Of laborious and difficult Labours, and those against Nature, their causes and differences, together with the means to remedy them.

FOr the easier and better ex∣plaining these things, we say, that there are three sorts of bad Labours; to wit, the painful or la∣borious; the difficult; and that which is altogether contrary to Na∣ture.

The laborious is a bad Labour, in which the Mother and Child (though it comes right) suffer ve∣ry much, and are harassed more than ordinary.

The difficulty is not much un∣like the first; but besides, it is ac∣companied with some accident which retards it, and causeth the difficulty: But the wrong Labour, or that against Nature, is caused by the bad situation of the Child, and can never be helped but by manual operation, or the Chirur∣geon's Hand. In the laborious and difficult Labours Nature always does the work, being a little assist∣ed: but in that contrary to Nature, all its endeavours are vain and use∣less, and then there is no help but in an expert Chirurgeon, without whom she must certainly perish.

The difficulties of Labour pro∣ceed either from Mother, Child, or both.

From the Mother, by reason of the indisposition of her Body; or it may be from some particular part only, and chiefly the Womb: or also from some strong passion of the Mind, with which she was before possest.

In respect of her Body, either because she may be too young, ha∣ving the passages too strait, or too old of her first Child; because her parts are too dry, and hard, and cannot be so easily dilated, as hap∣pens also to them which are too lean. They who are either small, short, or mishapen, as crooked Women, have not a Breast strong enough to help their pains, and to bear them down; nor those that are weak, whether naturally, or by accident; and crooked persons have sometimes the bones of the passage not well shaped. They that are teuden and too apprehen∣sive of pain, have more trouble than others, because it hinders them from doing their endeavour: And they likewise who have small Pains and slow, or have none at all. Great Colicks hinder Labour also, by preventing the true Pains. All great and acute Diseases make

it very troublesome, and of a bad consequence, according to Hippo∣crates, 3 Aph. Sect. 5. Mulierem gravidam morbo quopiam acuto cor∣ripi, lethale. As when she is ta∣ken with a violent Fever, great Flooding, frequent Convulsions, Dysentery, or any other great di∣stemper. Excrements retained cause much difficulty, as a Stone in the Bladder, or when it is full of Urine, without being able to void it; or when the great Gut is repleted with hard Ordure, or the Woman troubled with great and painful Piles, and their ill situati∣on sometimes retard it extremely.

As touching the difficulty pro∣ceeding from the Womb only, it must be either be from its bad si∣tuation or conformation, having its Neck too strait, hard or callous, whether naturally, or by any acci∣dent, as having had there a Tu∣mor, Aposteme, Ulcer or superflu∣ous flesh whether on the Neck or inward Orifice; or because of any cicatrice caused by a preceding bad Travail.

Bes••les, those things which are or may be contained in the Womb with the Child, do also cause diffi∣cult Travail; as when the Mem∣branes are so strong, that they cannot be broken, which some∣times hinders them from advancing into the passage; or so tender, that the waters break too soon, for then the Womb remains dry. When there is a Mole, or the Af∣ter-burthen comes first, which al∣ways causes Flooding, and certain∣ly the death of the Infant, if the Woman be not presently delivered of them by Nature or Art; yea, and when the Navel-string comes first, the Child is suffocated, if not speedily born; strong passions of the Mind do likewise contribute much to it, as fear, sorrow, and others of the like nature. The Woman that miscarries has more pain than a Woman at her full time; as also than one that is hurt, althô she be very near her time.

As to the hindrances caused by the Infant, they are, when either its Head or whole Body are too large, when the Belly is Hydropi∣cal; when it is monstrous, having two Heads, or being joyned to another Child, Mole, or any other strange thing; when it is dead, or so weak, that it contributes no∣thing to its Birth; when it comes wrong, or when there are two or more: besides all these different difficulties of Labour, there is yet one caused by the Midwife's ig∣norance, who for want of under∣standing her business, instead of helping, hinders Nature in her work.

Let us now treat of the means, by which all these may be prevent∣ed, and the Woman succored in her bad and difficult Labour, as may easily be done, if we perfect∣ly know all these causes and diffi∣culties; as when it happens by the Mother's being too young and too strait, she must be gently treated, and the passages anointed with Oil, Grease, and fresh Butter, using these things a long time before the hour of Labour, to relax and di∣late them the easier, lest there should happen a rupture in any part, when the Child is born; for sometimes there happens a dilace∣ration to the Fundament, by which both are rent into one outwardly.

If a Woman be in years of her first Child, let her lower parts be likewise anointed, to mollifie the inward Orifice, and the Vagina or neck of the Womb, which being more hard and callous, do not ea∣sily yield to the necessary distensi∣on of Labour; which is the cause why such Women are longer in Labour than others, and why their Children (being forced against the inward Orifice of their Womb, which is, as we said, a little cal∣lous, and also for remaining long in the passage) are born with great bumps and bruises on their Heads. Small and mis-shapen Women should not be put to Bed, till at least their Waters be broke; but rather kept upright, and walking about the Chamber, if they have strength, being supported under their Arms; for in that manner they will breath more freely, and mend their pains better than on the Bed, where they lye all on a heap. Let those that are very lean, also moisten these parts with Oyls and Ointment, to make them more smooth and slippery, that the Head of the Infant and the Womb be not so compressed and bruised by the hardness of the Mo∣ther's Bones, which form the pas∣sage.

The weak Woman should be strengthened, the better to sup∣port her Pains, giving her good Gelly Broths, with a little Wine and a Tost in it; or other good things, as the case requires.

If she fears the Pains, let her be comforted, assuring her, that she will not endure many more, but be speedily delivered: On the contrary, if her Pains be slow and small, or none at all, they must be provoked by frequent and somewhat strong Clysters, that so they may be excited by strain∣ings at stool; and afterwards let her walk about her Chamber, that the weight of the Child may also help a little. If the Woman Floods, or hath Convulsions (which is by many too long neglected) she must be helped by a speedy deli∣very. If she be costive, let her use Clysters, which likewise may dissipate a Colick, at those times very troublesome, causing great and useless pains, very hurtful, because they fleet to and again through the Belly, without bear∣ing down, as they should do. If she cannot make water, because the Womb bears too much on the Bladder, let her try, by lifting up her Belly a little, or else by in∣troducing a Catheter into her Bladder to draw forth her Urine.

If the difficulty or flowness of the Labour comes from the ill po∣sture of the Woman, let her be placed in a better, more conveni∣ent to her habit and stature. If she be taken with any distemper, she must be treated for it accord∣ing to its nature, with more cau∣tion than at another time, ha∣ving always regard to her present condition. If it proceed only from the indispositions of the Womb, or from its oblique situa∣tion, it must be remedied as well as can be, by the placing of her Body accordingly. If it be by its vitious conformation, having the Neck too hard, and too callous, and too strait, it must be anointed with Oils and Ointments, as above directed.

If it come from a strong Cica∣trice, which cannot be mollified, of a preceding Ulcer, or a rupture of a former bad Labour so agglu∣tinated, it must be separated with a fit instrument, lest another La∣ceration happen in a new place, and leave the Woman in a worse condition than before; it must be made in that place, where the case most requires it; taking care that it be not upwards, because of the Bladder. If the Membranes be so strong, as that the waters do not break in due time, they may be broken with the Fingers, provi∣ded the Child be come very for∣ward into the passage, and ready to follow presently after; for otherwise there is danger, that by breaking these waters too soon, the Child will remain dry a long time; and to supply that defect, you must moisten the parts with Fomenta∣tions, Decoctions, and emollient Oils; which can never be so well, as when Nature does its own work with the waters and ordinary slime, which always happen well, when they come in time and place.

Sometimes these Membranes with the waters, press three or four Fingers breadth out of the Body before the Child, resembling a Bladder full of water; there is then no great danger to break them, if they be not already; for when it so happens, the Child is always rea∣dy to follow, being in the passage; but above all, be careful not to pull it out with your Hand, lest thereby you loosen, before its time, the After-burthen, to which it ad∣heres very strongly. If the Navel∣string comes first, it must be pre∣sently put up again, and kept up, if possible; or else the Woman must be immediately delivered. But if the After-burthen comes first, it must never be put up again; for being come forth, it is altoge∣ther useless to the Infant, and would be but an obstacle and hin∣drance in the way; if it were put up in this case, it must be cut off, having tied the Navel-string; and afterwards draw forth the Child as soon as may be, lest it be suffoca∣ted.

If the Woman has had a fall, or is hurt, let her immediately keep her Bed and take her rest. If it be any passion that retards the La∣bour, and cannot totally be over∣come, let them endeavour to mo∣derate it. If it be shamefacedness or modesty, the persons who are the cause of it must quit the cham∣ber. If it be timidity and fear of pain, she must be advised, that it is the will of GOD it should be so, and that her Labour will not be so bad as she imagines, per∣swading her to submit to the neces∣sity, pressing on her the consola∣tion of the unfortunate, whose pain always seem more suppor∣table by the consideration that it is common; so she must be inform∣ed, that others endure the same pain, and greater than hers. If she be melancholick, let her be diverted by some good news, pro∣mising her such a Child as she de∣sires. And in a word (thô she suf∣fer much) she must consider it but as a bad journey, which one quarter of an hours good weather makes one forget all past, as she will, when she is brought to Bed; assuring her chiefly, that she is in no danger, especially when it is

not very apparent, for then one ought to acquaint her with it, that she may settle both her tem∣poral and spiritual Affairs.

When the difficulty is only cau∣sed by a dead Child, the method mentioned in the natural Labour must be observed; and besides, the Woman must do all she can to further her Delivery, because the Child can do nothing, nor can it when it is very weak. She must take in the-interim some Confortatives to prevent Fainting, because of the putrid Vapors, ascending from the dead Child. But when it has so great a Dropsie, either in the Head or Belly, as that it cannot be born, because of the great distention and bigness of these parts, then we are obliged to open these parts to let out the water. And if it be of an enormous bigness, either Head or Body, or if it hath two Heads, or is joyned to another Child, or to a big Mole, there is a necessity, for to save the Mother, either to dilate the passage proportionable to the bigness of the monstrous Child, if it be possible, or else, which is better, to draw forth the Child by pieces, to prevent the Mothers perishing with the Child, which else would certainly happen, if this course be not taken. And if there be two Children, the Rules given before in that case must be observed. But if the Midwife can∣not remedy all these accidents, she must then readily send for an ex∣pert Chirurgeon, for his advice, or to do what he thinks fit. Let us now pass to Labours contrary to Nature, which can never be done without manual operation, and shew what is then to be done.

CHAP. VIII.

Of unnatural Labours, where manual Operation is absolutely necessary, and what Observations the Chirurgeon must make, before he goes about it.

THose Labours which abso∣lutely require manual Ope∣ration are, when the Child comes wrong. A Child may come wrong four several ways, which are; First, any of the fore-parts of the Body. Secondly, any of the hinder parts. Thirdly, either side. And Fourthly, the Feet. All the particular, and different wrong postures that a Child may present, can be reduced to the above-named four general ways, according as they approach more to one than to any other of them. And as the number of se∣veral wrong Births is very great,

we shall be contented only to treat of each of the principal of them.

Now the Chirurgeon (to behave himself as he ought) must make some observations, before he under∣takes his work. First, whether the Woman has strength enough to en∣dure the operation, which he may guess by the Pulse; if strong or weak, unequal or intermittent. Whether her Face, and chiefly her Eye be dejected, her Speech faint, the extreme parts of her Body cold. Whether she often faints away with cold Sweats, has Convulsions with loss of Sense. In short, if every circumstance perswades, that the operation would be in vain, 'tis better to let it alone, than she should dye under his hand, and he be blamed for it, and incurr the name of Butcher, as is most cer∣tain, when such a misfortune hap∣pens. However, if there be any hope, thô never so little, either for Mother or Child, we are obli∣ged in Conscience to do what Art commands, and not as some Phy∣sicians, who will rather suffer a poor Woman to dye without as∣sistance, than undertake a doubt∣ful operation. Wherefore, 'tis bet∣ter to attempt an operation of an incertain consequence, than to a∣bandon the sick to certain de∣spair; for sometimes Nature reco∣vers beyond Hope; but before the Chirurgeon undertakes it, let him give his Prognostick, of the great danger of death both Woman and Child is in. When the Woman has strength enough, the Chirur∣geon must not delay his help, for fear it abate, or be totally dissipa∣ted. To which purpose, being well assured of her strength, he must enquire of the Woman, her Mid∣wise and Friends, whether she be at her full time, or has received any hurt, which he may also per∣ceive by the signs, observing in what posture the Child presents, and what circumstances, whether alive or dead, and but one or more? All which being examined, he must try to perswade the Woman of the impossibility of her being delive∣red without his help; and to re∣solve to put her self into his Hands, which he may do by fair words without frighting of her, per∣swading her that the operation is nothing so painful as she may ima∣gine; and in fine, that for GOD's sake, her own, and her Child's, she is obliged to suffer it; for else she and her Child may both perish.

The Woman being thus resol∣ved, he must place her cross the Bed, that he may operate the ea∣sier, she must lye on her Back, with her Hips raised a little higher than her Head, or at least, the Bo∣dy equally placed, when it is ne∣cessary to put back or turn the Infant, to give it a better posture; but if he resolves to draw it forth, he must place the Woman so as we have directed in the natural Labour, which is, with her Head and Breast a little elevated above the rest of her Body, that she may fetch her breath with more facili∣ty, and help to the exclusion of the Infant by bearing down, when the Chirurgeon bids her. Being thus situated, she must fold her Legs so as her Heels be towards her Buttocks, and her Thighs spread, and held so by a couple of strong persons. There must be likewise others to support her un∣der

her Arms, that her Body may not slide down when the Child is drawn forth, for which sometimes a great strength is required. The Sheet and Blankets must cover her Thighs for decency sake, in re∣spect of the assistants, and also to prevent her catching cold, the Chirurgeon herein governing him∣self as well with respect to his own convenience, the facility and sure∣ty of the operation, as to other things.

Some would have the Woman bound in this posture, that (as they say) she being more firm and stable, the work may be done with greater certainty: but Ligatures are so far from that, that on the contrary they are very prejudicial; for the Woman being so fixt, and constrained as on a Rock, she can∣not raise her self, nor slide down, or be lifted up, when the Chirur∣geon finds occasion for it, to ren∣der his operation less difficult, which usually he does by partly putting back, partly drawing forth, sometimes directly, sometimes obliquely, for which reason her Body ought to be at liberty, on∣ly held in a posture to these seve∣ral Intentions by her Friends, ac∣cording to his direction. But if she must needs be bound, let it be with good reasons to perswade her patiently to endure her La∣bour, and to contribute her whole strength to the operation, promi∣sing her the speediest Delivery pos∣sible.

Let the Chirurgeon then anoint the entrance of the Womb with Oil or fresh Butter, if it be ne∣cessary, that so he may with more ease introduce his Hand, which must likewise be anointed, having the conditions above-specified. After which he must manage his operations, after the manner I shall direct in each of the fol∣lowing Chapters; having first re∣cited the marks by which it may be known, whether the Child be alive or dead.

CHAP. IX.

The signs to know whether the Child be alive or dead.

IF there be any case, wherein a Chirurgeon ought to make the greatest reflection, and use most precaution in his Art, it is this, to know whether the Infant in the Womb be allve or dead; for there have been many deplorable examples of Children being drawn forth alive, after they have been thought to have been dead, with both Arms, or some other Limb lopt off, and others miserably kil∣led by the use of Crochets, which might have been born alive, if they had not been mistaken. Where∣fore, before he resolve on the man∣ner of laying the Woman, to avoid the like misfortune, and the dis∣grace of being Author of such a pitiful spectacle, let him use his utmost endeavour not to be so de∣ceived, and to be fully satisfied whether the Child be alive or dead; always remembring that in this case, timidity is more pardonable than temerity, that is, it is better to be deceived in treating a dead Infant, as if it were alive; than a living one as if it were dead.

The Child may be known to be alive, if it be at the full reckon∣ing; if the Woman has received no hurt; if she has had her health well all her going with Child; if she be at present in good health, and very sure she feels it stir, which may be known by the Mother's re∣lation: and the Chirurgeon may be better assured of it, if he feels it stir himself, laying his Hand on the Mother's Belly; to whose re∣lation he must not always trust. If the Chirurgeon cannot be assured by the Infant's motion that it is alive, he may assoon as the waters are broke, gently put up his Hand into the Womb, to feel the pul∣sation of the Navel-string, which he will find stronger, the nearer he feels it to the Infant's Belly; or if he meets with a Hand he may feel the Pulse, but there pulsation is not so strong as in the Navel∣string, by which it is best to be known. If then he finds thus the beating of the Pulse, he may be confident the Child is alive; as al∣so if by putting his Finger into its Mouth, he perceives it to stir its Tongue, as if it would suck.

But on the contrary, the Child is dead, if it has not a long time stirred; if there flows from the Womb stinking and cadave∣rous Humors; if the Woman feels great pains, and a great weight in her Belly; if it be not supported, but tumbles always on that side as

she lays her self; if she faints, or has Convulsions; if the Navel∣string or Secundine has been a good while in the World; or if by put∣ting his Hand into the Womb, he finds the Child cold, and the Na∣vel-string without Pulse, and its Tongue immoveable; and feeling the Head, he finds it very soft, chiefly towards the Crown, where likewise the Bones are open, and riding the one upon the other at the Sutures, because the Brain shrinks, and is without Pulse when the Child is dead; which cor∣rupts more in two days in the Womb, than it does in two days af∣ter it is born; which the heat and moistness of the place do cause, the two principles of corruption.

But we may only conjecture it, if the Woman has been hurt, or floods much, and be not at her full time; if her water broke four or five days before; if her Breasts flag; if her Complexion be of a Lead colour, her Countenance lan∣guishing and dejected; and if her breath stinks. We say that these things may only make us conje∣cture it, but not, as the rest, cer∣tainly conclude it; many of which hapning together in one person, as∣sure us that the Child is dead, for want of which it cannot be very certain. Wherefore (as I have said) 'tis good to be very careful before they undertake it, that so they may avoid the abovesaid scan∣dals.

CHAP. X.

How to fetch the After-burthen when the string is broke.

WE have placed the pre∣sent way of extracting the After-birth amongst unnatural Deliveries, because 'tis not suffici∣ent to esteem it a good Labour, that the Child be well born, un∣less also the After-birth be well come away. In respect of the Child it may be called Natural; because after his Birth he has no more need of his Burthen; but in respect of the Woman it is ve∣ry unnatural. I would therefore first treat of this bad Labour; be∣cause it participates of a natural Labour, in respect of the Child, who is in no danger, being born. After that I will come to those in which both Mother and Child are in very great danger, if not spec∣dily and skilfully helped.

I have already shewed, how a Woman must be delivered in a na∣tural Labour, where you may find

the means; but sometimes the Midwife by endeavouring it, breaks the string with pulling too strong∣ly; or because it is very weak; or else so putrefied, when the Child is dead, that the least pull breaks it off close to the Burthen, which by that means is left behind in the Womb; or because it cleaves too strongly; or the Woman is weak and cannot expell it, being much tired by a long Labour; or because it was not speedily after Labour drawn forth, the Womb closes so as leaves it no passage, nor can it without much difficulty be again dilated to have it setch'd, because it remains dry, after the natural slime and humidities, which usually flow in Labours, are sometimes past.

Since it is a verity indubitable, that the After-birth remaining be∣hind after the Child is born, be∣comes an useless mass, capable of destroying the Woman, we must take care that it be never lest, if possible. Wherefore having endea∣voured to bring it away, and the Navel-string happening to break near the Burthen, you must imme∣diately before the Womb closes, introduce your Hand into it, being well anointed with Oil or fresh Butter, your Nails close pared, to separate it from the Womb gently, and draw it forth together with the clods of Blood that are there. When the Navel-string is not broken, it will easily conduct the Hand, by following of it to the place where the Burthen is situated; but when it is broken, we have no longer this guide; wherefore you must be then very careful, that you be not deceived in taking one part for another.

As soon then as you have intro∣duced your Hand into the Womb towards its bottom, you will find the Burthen; which you may know by a great number of little inequa∣lities, which are always made there by the roots of the umbilical vessels, on the side where they terminate, which make it to be easily distin∣guished from the Womb; if it yet cleave to it, notwithstanding that it is then a little wrinkled and un∣even; because its Membranes, which were very much enlarged, contract themselves immediately after the Child and its waters, which kept them extended, are excluded: But they that are expert in this Art, can easily judge of it. If you find the Burthen wholly loosened from the Womb, it will not be dif∣ficult to draw it forth, when you have got it in your Hand: But if it cleaves, find out the side where it sticks fast, and begin there to se∣parate it gently, by putting some of your Fingers between it and the Womb, continuing by little and little to do so, till it be quite loose; and afterwards draw it out very carefully; observing always (if it cannot be otherwise) rather to leave some part of it behind, than to scrape or scratch the least part of the Womb, for fear of a Flood∣ing, Inflammation, or Gangrene, which cause death; being also care∣ful not to draw it forth, till it be wholly or the most part of it sepa∣rated, for fear of drawing forth the Womb with it; And preserve it as whole as the circumstances will permit, because of shewing it to the company, that they may know the operation is well done.

When the Chir••geon finds not

the Womb open enough for to re∣ceive his Hand immediately into it, let him presently anoint all the Womans Privities with Hogs∣grease, that they may be dilated with more ease; afterwards let him by little and listle put up his Hand, but without much violence. The Woman may likewise contribute to this dilatation, as also to the exclusion of the Burthen, if she bears strongly down, holding her breath, and exciting her self to vomit, or snceze, and do those other things before directed: But if notwithstanding all this she can∣not void the After-birth, and if the Womb cannot be dilated e∣nough to fetch••t, or that it cleaves so fast, as it cannot be separated, we must leave it to Nature, assist∣ing her with remedies which sup∣purate; Wherefore injections in∣to the Womb are proper, made of Mallows, Marshmallows, Parie∣tary, and Linseed, in which is mix∣ed a good quantity of Oil of Li∣lies, or fresh Butter. This Inje∣ction softens and tempers, and by moistning and mollifying, makes the O••••sice to be the easier dila∣ted; and helps by suppuration the loosening of the Burthen. And to hasten the expulsion of it, give her a strong Clyster, that so by the motions to go to stool, it may cause the voiding of it; as it has succeeded with many, who have rendred it in the Bed-pan, and some∣times when they have least expect∣ed it.

CHAP. XI.

To deliver a Woman when the Child comes footling.

MOst Authors advise, when the Foot, or Feet come first, to change the figure, and place the Head so, as it may pre∣sent first to the birth; but if they would shew how it should be done, we might follow their Counsel; which is very difficult, if not im∣possible to be performed, if we desire to avoid the dangers that by such violent endeavors the Mo∣ther and Child must necessarily be put in: Wherefore 'tis better to draw it forth by the Feet, when it comes footling, than to venture a worse accident by turning it.

As soon then as the waters are broke, and 'tis known the Child comes thus, and the Womb is open enough to admit the Chi∣rurgeon's Hand into it, or else by anointing the passages with Oil or Hogs-grease, to endeavor to di∣late it by little and little, using to this purpose his Fingers, spread∣ing them one from the other after

they are together entred, and con∣tinuing so to do, till it be suffici∣ently dilated; then, having his nails well pared, and no Rings on his Fingers, his Hands well anointed with Oyl or fresh Butter, as also the Woman placed as we have al∣ready directed, let him introduce his Hand, into the entry of the Womb, where finding the Child's Feet, let him draw it forth in that posture as we shall now direct: But if it presents but one Foot, he should consider, whether the right or lest, and in what fashion it comes; for these reflexions will easily in∣form him, on what side the other may be, which as soon as he knows let him seek it, and gently draw it forth together with the first: But let him be very careful, that this Second be not the Foot of another Child; for if so, he may sooner split both Mother and Children, than draw them forth; which may ea∣sily be prevented, if having slided his Hand up the first Leg and Thigh to the twist, he finds both Thighs joyned together, and de∣pending from one and the same Bo∣dy: which is likewise the best means to find the other Foot, when it comes but with one.

All Authors, for fear of losing hold of the first Foot, advise to fasten a Ribband to it with a run∣ning knot, that so it may not be sought a second time, when the other is found: but that is not ab∣solutely necessary, because usually when one has hold of one, the other is not far off. They that will may use this precaution; but such as are expert, use it but seldom.

As soon then as the Chirurgeon has found both the Child's Feet, he may draw them forth, holding them together, he may bring them by little and little in this manner, taking afterwards hold of the Legs and Thighs, as soon as he can come at them, and drawing them so till the Hips be come forth: the whilst let him observe to wrap the parts in a single Napkin, to the end, that his Hands being al∣ready greasie, slide not on the In∣fant's Body, which is very slippery, because of the viscous Humors, which are all over it, and hinder that one cannot take good hold of it; which being done, he may take hold under the Hips so to draw it forth, to the beginning of the Breast, and then let him on both sides with his Hand bring down the Arms along the Child's Body, which he may then easily find, and be careful that the Belly and Face be downwards, lest being upwards, the Head be stopt by the Chin over the Share-bone; wherefore if it be not so, he must turn it to that posture; which is easily done, if taking hold on the Body, when the Breast and Arms are forth, in the manner we have said, he draws it, with turning it in proportion, on that side which it most inclines to, till it be as it should be, that is, with the Face downwards; and having brought it to the Shoul∣ders, let him lose no time (desi∣ring the Woman at the same time to bear down) that so in drawing, the Head at that instant may take its place, and not be stopt in the passage. Some Authors, to pre∣vent this inconvenience, advise that one Arm only should be drawn forth, and the other left to prevent the closing of the Womb

on the neck of the Child: this reason is plausible, yet if the Chi∣rurgeon knows how to watch his opportunity, he will not need this shift to prevent this accident, which may sooner happen when one Arm is left above; for besides that by its bigness it would take up so much place, which is already too little, causing the Head to lean more on one side than the other, it will stop it certainly on that side where there is no Arm.

There are indeed some Children that have their Head so big, that when the whole Body is born, yet that stops in the passage, notwith∣standing all the care to prevent it: In this case he must not en∣deavor only to draw forth the Child by the Shoulders, lest he sometimes separates the Body from the Head, but he must disengage it by little and little, from the bones in the passage, with the Fingers of each Hand, sliding them on each side opposite the one to the other, sometimes above and sometimes under, until the work be ended, endeavouring to dispateh it as soon as possible, lest the Child be suf∣focated; as it will certainly be, if it should remain long in that po∣sture; which being well and du∣ly effected, he may soon after fetch the After-birth, as above di∣rected.

CHAP. XII.

How to fetch the Head, when separated from the Bo∣dy, and it remains behind in the Womb.

NOtwithstanding all the care possible had in the fetching a Child by the Feet; yet sometimes one meets them so putrefied and corrupted, that with the least pull the Body separates from the Head, which remains alone in the Womb, and cannot be extracted, but with difficulty, forasmuch as it is ex∣tremely slippery, by reason of the place where it is, and of a round figure, on which no hold can be taken.

When then the Infant's Head, separated from, its body, remains alone behind, whether because of putrefaction or otherwise, let the Chirurgeon immediately without delay, whilst the Womb is yet open, direct up his right Hand to find the Mouth of this Head (for then there is no other hold) and having found it, let him put one or two of his Fingers into it, and his Thumb under the Chin, and then by little and little let him draw it, holding it so by the jaw; but if that fails, as it often will when putrefied, then let him pull forth his right Hand, and slide up

his Lest, with which he must sup∣port the Head, and with the right let him take a narrow crotchet, but strong, and with a single branch, which he must guide a∣long the inside of his other Hand, keeping the point of it towards it, for fear of hurting the Womb, and having thus introduced it, let him turn it towards the Head, for to strike it into either an Eye-hole, or the hole of an Ear, or behind the Head, or else between the Sutures, as he finds it most easie and con∣venient, and then draw forth the Head so fastned with the crotchet, still helping to conduct it with his left Hand; but when he hath brought it near the passage, being strongly fastned to the crotchet, let him remember to draw forth his Hand, that the passage being not filled with it, may be the larg∣er and easier, keeping still a Fin∣ger or two on the side of the Head, the better to disengage it.

You may try for the same pur∣pose an expedient (which came lately into my Mind) by which, without doubt, one may effect this painful and laborious operation, without tormenting the Woman so much as she is, when either the crotchet or crooked knife are used; which is a soft fillet, or linen slip, of the breadth of four Fingers, and the length of three quarters of an Ell, or thereabouts; then taking the two ends with the left Hand, and the middle with the right, let him so put it up with the right, as that it may be beyond the Head to embrace it, as a sling doth a stone, and afterwards drawing the Fillet by the two ends together, it will easily be drawn forth, the fil∣let not hindring in the least the passage, because it takes up little or no place.

But if the Chirurgeon cannot by either of these different means draw forth the Head, because 'tis too blg, he will be necessitated (if he will finish his work) to les∣sen it with a crooked knife. For to do this, let him slide up his left Hand into the Womb, and with his right guide up the knife, al∣ways observing that the point be turned towards the inside of the left Hand, for fear of hurting the Womb; and afterwards let him turn it to the Suture of the Head, and chiefly the Crown, where he must make the incision with this instrument, that having separated some pieces, he may the easier draw forth the Head, or at least having emptied some part of the Brain, by the orifice so made, the bigness of the Head will be much diminished by it, and consequently the extraction of it less painful.

The left Hand, being thus in the Womb, will be very useful to help, striking the knife into the Head, for to divide and separate its parts, as the Chirurgeon judges necessa∣ry; as also to hinder (by inadver∣tency) the Womb's receiving hurt; and the right without, for to hold the handle of this instrument, which therefore must be long e∣nough, and will serve him to move and guide it on which side he pleases, in turning, thrusting, draw∣ing, or slanting it, as the case re∣quires. Ambrose Parey, and Gu••l∣temeau, would have this knise to be so short, as to be hid in the right Hand, for to do the operation, af∣ter it is so introduced into the

Womb; but it is certain, that when it is filled with a monstrous Child, or a Hend as abovesaid, the Chi∣rurgeon's Hand will be so pressed in the Womb, that it will be very difficult for him to use it skilfully with one Hand alone, and do no violence to the Womb; which is the reason why this instrument ought to have a long handle, that being introduced into the Womb, it may be conducted to do the operation with the left Hand with∣in, as we have mentioned, and go∣verned by the right Hand which holds the handle of it without, which ought to be as long as the handle of an ordinary crotchet.

Now when the Head is thus fetcht out of the Womb, care must be taken, that not the least part of it be left behind, as also to cleanse the Woman well of her After-birth, if yet remaining. But a question of great conse∣quence, and much to the pur∣pose, may be here started, Whe∣ther the Child's Head yet remain∣ing so in the Womb, and the Bur∣then also, the Head ought to be ex∣tracted before the Burthen? To which may be answered with distin∣ction, That if the burthen be whol∣ly separated from the sides of the Womb, it ought to be first brought away, because it may hinder the taking hold of the Head; but if it be still adhering, it must not be medled with, till the Head be brought away: For if one should then go about to separate it from the Womb, it would cause a Flood∣ing, which would be augmented by the violence of the operation; for the vessels to which it is joyn∣ed, remain for the most part open, as long as the Womb is distended, which the Head causes whilst it is retained in it, and cannot close till this strange Body be voided. Be∣sides, the After-birth remaining thus cleaving to the Womb, du∣ring the operation, prevents it from receiving easily either bruise or hurt.

CHAP. XIII.

How to help a Woman in her Labour, when the Child's Head thrusts the neck of the Womb forth before it.

IF we only respect the figure the Child comes in in this Labour, we may say it is natural: but when we consider the disposi∣tion of the Womb, which is in dauger of coming quite forth of the passage; or the extraction of the Infant, we shall find it not so altogether: for its Head thrusting it forcibly before it, may easily cause a falling out of the Womb, if the Woman be not skilfully succored in time. Here may be seen the Vagina, or neck of the Womb bear forth in great wrinkles, according as the Child advances.

Women troubled with a bearing down of the Womb before they conceive, and whose Womb is ve∣ry moist, are much subject to this accident, because of a relaxation of the Ligamonts. The same method we have taught in the na∣tural Travail must not now be ob∣served; for in this case the Wo∣man must neither walk, nor stand upright; but keep her Bed, with her Body at least equally situated, and not raised a little, as is requi∣site in a natural Labour. She must by no means use strong or sharp Clysters, lest they excite to great Throws; neither so much humect the Womb, which is already too much relaxed: but to aid her at the moment each pain takes her, when the Child begins to advance its Head, and consequently tho neck of the Womb, let the Mid∣wife keep her Hands on each side of the Head, to thrust back by re∣sisting the Womans pains, the Womb only giving way in the mean time for the Child to ad∣vance, doing the like at every Throw, continuing it till the Wo∣man of her self has forced the Child quite into the World: for one must by no means draw it by the Head, as is meationed in the natural Labour, for fear of causing the Womb to fall out at the same time, to which it is then very apt.

If notwithstanding the Infant having the Head born, it yet stops there so long as to endanger its suffocation; then the Midwife must call a second person to her assist∣ance, to draw it gently forth by the Head, whilst she keeps back the Womb with both her Hands, to prevent its following the Infant's

Body so drawn forth. After the Woman is thus delivered, her Af∣ter-birth must be fetch'd as is a∣bove directed, being still careful for the same reason, not to shake or draw it forth too rudely, and then let it be placed up in its natural situation, if it bears down.

CHAP. XIV.

How to fetch a Child, when coming right it cannot pass, either because it is too big, or the passages cannot be sufficiently dilated.

THere are some Women, whose Children (notwithstanding they come right) remain some∣times four, five, and six whole days in the passage, and would continue there longer, if they were left alone, without being able to be born, unless assisted by Art; to which we are obliged, if we de∣sire to have the Mother's life. This happens oftnest to little Women of their first Children, and chiefly, if a little too much in years; be∣cause their Womb being very dry, cannot be so easily dilated, as others, who already have had Chil∣dren, or are not so old. When this happens, after that the Chi∣rurgeon hath done his endeavour to relaxe and dilate the parts, to facilitate the Child's birth, and that he finds all in vain, because the Head is much bigger than it should be, and that besides it is certainly dead (as it for the most part is, when it hath continued four or five days in this condition, after the waters are broke) which he may be more exactly assured of by the signs already described: He need then make no scruple to fa∣sten a Crotchet to some part of the Child's Head, and rather about the hinder part than any other, to draw it forth by this means direct∣ly, if possible; if not, let him make an incision with a streight or little crooked knife, which is best, about the Sutures, to empty thence some of the Brain, and so lessen the blgness of the Head, and im∣mediately after fix his crotchet fast to the Skull in the same place, whereby he will easily extract the Infant.

It is very certain when the Child is dead, one ought to do according to my direction, to save the Mo∣ther's life: But it is a very great que∣stion, Whether a live Child ought to be so dealt with to save the Mo∣ther's life, after there is no more hope that it can be born any other ways, because of the narrowness

of the passage, which cannot pos∣sibly be sufficiently dilated for its birth; or, Whether one ought to defer the operation, until there is a perfect assurance that 'tis dead? In this case I am apt to believe, that, since the Infant cannot avoid death, neither one way nor the other (for staying in the passage, without being able to be born, it must dye, and being drawn forth by crotchets, it is killed) one must and ought to fetch it out alive or dead, as soon as there is opportu∣nity to do it; and when all hope is lost that it cannot come any other ways, thereby to prevent the Mother's death, which could by no other means be avoided. Tertullian (as Riolanus very well notes in his 38th Chapter of the 12th Book of his Anatomical Ma∣nual) says upon this subject,

That it is a necessary cruelty, to kill the Child in this case, rather than to save it from the danger it is in of dying, and so certainly cause the Mother's death.

Not∣withstanding, this must not always be put in practice by the Chirur∣geon, but in such an extremity; and then he may do the work as dextrously as he can.

CHAP. XV.

How to deliver a Woman when the Child presents the side of the Head to the Birth, or the Face.

WHen the Child presents the side of the Head, thô it seems a natural Labour, be∣cause the Head comes first, yet 'tis very dangerous both to Child and Mother, for he shall sooner break his Neck, than e're be born in that fashion; and by how much the Mother's Pains continue to bear him (which is impossible, unless the Head be first right pla∣ced) the more the passages are stopt up. Therefore as soon as it is known, the Woman must be laid with all speed, lest the Child advancing further in this vitious posture, it prove more difficult to thrust him back, which must be done when we would place the Head right in the passage, as it truly and naturally should be.

For to effect this, place the Woman that her Hips be a little higher than her Head and Shoul∣ders, causing her to lean a little upon the opposite side to the Child's ill posture, then let the Chirurgeon slide up his Hand, well anointed with Oil, by the side of the Child's Head, to bring it right,

gently with his Fingers between the Head and the Womb: but if the Head be so engaged, that it cannot be easily done that way, he must then put his Hand up to its Shoulder, that so by thrusting them back a little in the Womb, sometimes on the one side, and sometimes the other, as he sees oc∣casion, he may give it a natural and convenient position.

It were to be wished that the Chirurgeon could put back the In∣fant by the Shoulders with both his Hands in this manner; but the Head does then take up so much room, that he has much ado to introduce but one, with which he must do his operation, with the help of his Fingers ends of the other Hand put up as far as neces∣sary. Afterwards let him excite and procure the Child's birth, as directed in the natural Labour.

At other times a Child comes with the Face first, having its Head turned back, in which posture it is very difficult it should be born: And if it remain so long, the Face will be so black and blue, and swelled, that at first sight it will appear monstrous; which comes as well by the compression of it in that place, as by the Midwife's Fingers handling of it too rudely, when she would place it in a bet∣ter posture.

Now to deliver this Birth, the same manner, as when a Child comes with the side of the Head, must be observed, being careful to work gently, to avoid as much as may be the bruising of the Child.

CHAP. XVI.

How to deliver a Woman when the Head of the Child is born, and the Womb closes about the Neck.

THe Child comes naturally with the Head first, because that by the hardness and bigness of it, the passage might be the bet∣ter made and opened for the other parts of the Body, which usually pass afterwards without pain: but notwithstanding sometimes the Head is so small, and the Shoulders so large, that without a very great difficulty they cannot pass; which makes the Child often remain in the passage after the Head is born. This accident may likewisehappen sometimes, having not been careful, but losing time in drawing forth the Child by the Head, as directed in the discourse of natural Labours, to the end the Shoulders might at the same in∣stant

succeed in the place the Head possest.

When the Chirurgeon meets with this case, he must speedily deliver the Child out of this prison, or rather this collar, in which he is caught; for a small delay may there strangle the Child: to avoid which, let him endeavour to cause the Shoulders to follow, by gent∣ly drawing its Head sometimes by the sides of it, sometimes with the Hand under the Chin, the other be∣hind the Head, and so doing by turns on the one side and the other, to facilitate the operation the bet∣ter, being very careful the Navel∣string be not entangled about the Neck; as also not to draw it forth with too much violence, for fear lest the Head be pulled from the Shoulders. If the Shoulders pass not with gentle pulling, slide up your Fingers on both sides under the Arm-pits, with which turning them inwards, you may by little and little draw forth the Shoul∣ders; but when they are in the palsage, and totally disengaged, if he cannot then draw the rest forth, still keeping his Fingers un∣der the Arm-pits, he may be con∣fident there is some other hin∣drance, and that it is certainly monstrous in some part of its Bo∣dy; or (as it for the most part happens in this case) that it is hy∣dropical in the Belly, for which cause it is impossible it should be born, before the Belly be pierced to evacuate the waters, and then 'twill easily be accomplished.

CHAP. XVII.

How to Deliver a Woman, when the Child comes with one or both Hands together with the Head.

FOr the most part when an In∣fant presents any part of his Body together with the Head, it is usually one or both the Hands, ra∣ther than any other, which hin∣ders its birth; because the Hands take up part of the passage, and for the most part they cause the Head to lean on one side. When the Child comes thus, it is quite contrary to Nature.

To remedy this, so soon as it is perceived that one Hand presents together with the Head, it must be prevented from coming down more, or engaging further in the passage. Wherefore the Chirur∣geon having placed the Woman on the Bed, with her Head a little lower than her Hips, must put and guide back the Infant's Hand with his Hand as much as may be;

or both of them, if they both come down, to give way to the Child's Head; which having done, if the Child's Head be on one side, it must be brought into its natural posture in the middle of the pas∣sage, that it may come in a streight line, proceeding farther, as I have directed before, in that Chapter which treats of the Child's Head coming on one side.

CHAP. XVIII.

How to deliver a Woman when a Child presents one or both Hands foremost, without any other part.

WHen an Infant presents only one or both Hands to the Birth, or an Arm sometimes out to the Elbow, and many times to the Shoulder, it is one of the worst and most dangerous postures a Child can come in, as well for him∣self as for his Mother; because of the violent force the Chirurge∣on is oftentimes obliged to use both to the one and the other, in searching for the Feet, which are very far off, by which he must always in these cases, turn and draw him forth; which will often make him sweat in the midst of Win∣ter, because of the difficulty in this Labour more than in all the rest, thô some others of them indeed are more dangerous for the Infant; as when it presents the Belly, and the Navel-string comes forth; but not so painful for the Chirurgeon, because the Feet of the Infant be∣ing near the passage, and not so hard to be found, as when he comes with a Hand; for then they are high, at the very bottom some∣times of the Womb, where he must seek them, to turn it and draw it forth, as I am going to direct.

When therefore it presents with one Hand only, or a whole Arm first; it must by no means be pul∣led forth by that part; for the Member will sooner be separated and rent from the Body, than the Child so brought forth, by reason the Child is pluckt obliquely and cross. And when both Arms pre∣sent, if pluckt together, there would not be place for the Head to pass, which would by that means be turned quite back. Wherefore having placed the Woman as is te∣quisite, one must put back the In∣fant's Hand or Arm, which comes forth into into the Womb again. Some Midwives dip it in cold wa∣ter, or touch it with a wet cloth, saying that the Infant will presently

draw it in, if he be living; but he is usually so prest and engaged in the passage by this bad posture, that he has not liberty enough to draw back his Hands so easily, be∣ing once come forth; wherefore the Chirurgeon must guide them back with his own, which he must afterwards slide into the Womb under the Child's Breast and Belly, so far till he finds the Feet, which he must gently pull towards him, to turn and draw it forth by them, as hath been already directed; ob∣serving to do it with as little vio∣lence as may be, which is much more easy, sure and safe, than to busie ones self in putting it into a natural situation.

As foon as he shall have so turn∣ed the Child by the Feet, if he has but one of them, he must search for the other, that so he may bring it to the first; when holding them both, he must govern himself af∣terwards in bringing the Child, as I have shewed formerly, speaking of those Labours where the Feet come first: But if the Arm be so far advanced (almost to the Shoul∣der) and big and swelled (as it hap∣pens when it hath been a long time forth) that it cannot at all, or without great difficulty be redu∣ced, Ambrose Parey in this case directs (provided the Child be cer∣tainly dead) to cut off that Arm as high as may be, first making an incision round the flesh, and then cutting off the Bone a little higher, with a pair of sharp pin∣cers, that so the flesh may be left longer to cover the sharpness and end of the Bone, to prevent hurt∣ing the Womb, when the Child is turned, to draw it afterwards forth by the Feet as it should be.

Notwithstanding if the Chirur∣geon, not being able to put it back, is absolutely constrained to cut it off (which must not be done but in such extremity) he may effect it without much ceremony, by twist∣ing it twice or thrice about; for by reason of its tenderness he will easily separate it from the Body, in the joynt of the Shoulder, with the Shoulder-blade, by which means he will neither need Pincers nor other instruments to cut the Bone and Flesh, as the said Parey teaches, neither will there remain any sharpness, by reason the sepa∣ration will be just in the joynt.

But above all, when the dismem∣bring of an Infant is thus intended, or to draw it forth with a Crotchet, let the Chirurgeon take great care that he be not deceived; for what a horrible spectacle would it be, to bring a poor Child yet living, after the Arm has been cut off, or any other part of the Body? Where∣fore let him make a double reflexi∣on on his work, before he goes a∣bout it.

CHAP. XIX.

How to deliver a Woman when Hands and Feet come together.

IF the Infant presents both Hands and Feet together at the Birth, it is altogether impossible it should be born so. The Chirurgeon there∣fore guiding his Hand towards the orifice of the Womb, will perceive nothing but a many singers close together; and if it be not suffici∣ently dilated, he will be a good while before he can exactly di∣stinguish between the Hands and the Feet, by reason they are some∣times so shut and prest together, that they seem to be all of one and the same shape: But when the Womb is open enough to intro∣duce the Hand into it, he will ea∣sily know which are the Hands and which the Feet; and having well taken notice of it, let him slide his Hand, and presontly direct it towards the Infant's Breast, which he will find very near, and by that let him gently thrust back the Bo∣dy towards the bottom of the Womb, leaving the Feet in the same place where he found them; ha∣ving therefore placed the Woman in a convenient posture, that is, her Hips a little raised above her Breast and Head, which situation ought always to be observed, when the Child is to be put back into the Womb: Let him afterwards take hold of him by the Feet, and draw him forth, according to the way directed in its proper Chapter.

This Labour truly is a little troublesome, but nothing near so much as that we have mentioned in the preceding Chapter, where the Child presents only his Hands: for in that the ••eet must be search∣ed a great way off, and it must be quite ••••••ned about, before it can he drawn forth; but in this they are ready presenting themselves, and there is not so much to do, but to lift and thrust back a little the upper part of the Body, which is almost done of it self, by drawing it alone by the Feet.

Some Authors who have written of Labours, and never practised them, do order all by the same pre∣cept often reiterated, that is, to reduce all wrong Births to a natural Figure; which is, to turn it, that it may come with the Head first: But if they themselves had ever had the least experience, they would know that it is very often impossible, at least, if it were to be done by the excess of violence,

that must necessarily be used to ef∣fect it, it would go near to destroy both Mother and Child in the ope∣ration. A Fiat in this case is soon said and ordered; but it is not so easily executed as pronounced. For my part, I am of an opinion clear contrary to theirs; and such as are skilful in the Art will surely a∣gree with me in it, that is, That (whensoever the Infant comes wrong in what posture soever from the Shoulders to the Feet) it is the best way and soonest done, to draw it forth by the Feet, search∣ing for them, if they do not pre∣sent themselves, rather than to try to put it in a natural posture, and place the Head foremost: for the great endeavors often necessa∣ry to be used in turning the Infant in the Womb, do so weaken both Mother and Child, that there re∣mains not afterwards strength enough for to commit the operati∣on to the work of Nature; and usually the Woman has no more Throws nor Halns fit for Labour after she has been so wrought up∣on; for which cause it would be very tedious and difficult; as also the Infant, which is already very weak, would certainly perish in the passage, without being able to be born. Wherefore it is much better in these cases, immediately to setch it by the Feet, searching for them, as I have already direct∣ed, when they do not present them∣selves, by which a tedious Labour will be prevented to the Mother, and the Child will be often brought alive, who without it will scarce escape death, before he can he brought forth by the strength of Nature.

CHAP. XX.

How to deliver a Woman, when the Child comes with the Knees.

WHen an Infant (not be∣ing turned towards the latter Months, as he ought, to come with his Head foremost) pre∣sents the Knees to the Birth, ha∣ving the Legs folded towards the Buttocks, one may easily be decei∣ved, touching but one of them, be∣cause of their hardness and round∣ness, and take it for the Head, espe∣cially when being seated a little high, it can be reached but with the end of a Finger only; but if it be touched and handled a little better, the Infant being fallen a little lower, it will easily be di∣stinguished.

As soon then as it is perceived,

it must not be suffered to advance further in this posture; having placed the Woman, the Knees must gently be put back, to have the more liberty to unfold the Legs one after the other, which the Chirurgeon may do, by put∣ting one or two of his Fingers un∣der the Ham, directing them by little and little all along behind the Leg, until he meets the Foot; and drawing always a little ob∣liquely, to come the easier to the end of it, that so having disenga∣ged one, he may do the same to the other, proceeding in the same manner as with the first; after which, having brought them to∣gether, he may finish the work, as when a Child comes footling; always observing to bring the Face of it downward, and such circum∣stances as are noted where we treat of that Labour.

CHAP. XXI.

Of a Delivery when the Child comes with Shoulders, Back or Breast.

THe most difficult of these three sort of Figures and Situations, in which Infants some∣times come, is that of the Shoul∣ders; because it is furthest from the Feet of the Infant, and the Chirurgeon must find them to draw it forth. The next the Back. And the Breech for the same rea∣son, causes least trouble, not only because the Feet are nearer, but also because by this Figure, the Head and Neck of the Infant are not so constrained and lockt, as in the other situations.

For to remedy this birth of the Shoulder, some advise that it should be put back, to make way for the Head of the Infant, that so it may be reduced to a natural birth: but it is much better for the reasons above alledged, to try to bring it by the Feet: to effect which, the Chirurgeon must thrust the Shoulder a little back with his Hand, that so he may have more liberty to introduce it into the Womb, and sliding it then a∣long the Child's Body, either by the Belly or Side, as he finds it ea∣siest, he shall fetch the Feet, and turning it bring them to the pas∣sage, and so deliver the Woman, as is already directed.

If it be the Back which pre∣sents to the birth, it is also impos∣sible to be born in that posture, what pains soever the Mother en∣dures; and besides, the Child ha∣ving the Body folded inwards, and

almost double, his Breast and Belly are so prest together, that he usu∣ally wants little of being suffoca∣ted: to avoid which, the Chirur∣geon must quickly slide up his Hand along the Back towards the inferior parts, until he meets the Feet, to bring it forth the same way as if it came footling.

But when the Child comes with the Breech, if it be small and the Mother big, having the passage very large, he may sometimes with a little help be born so; for thô he comes double, yet the Thighs being folded towards the Belly, which is soft and gives way, it pas∣ses without much trouble. As soon as the Chirurgeon finds the Child to come with the Buttocks fore∣most, he must not permit it to en∣gage lower in the passage; for it will not come, unless it be very small, and the passage very large, as we have already said. This be∣ing then in good time perceived, he must, if he can, thrust back the Breech, and sliding up his Hand along the Thighs to the Legs and Feet of the Child, he must bring them gently one after the other forth of the Womb, by folding, stretching, wagging, and drawing them gently towards the Side, be∣ing careful not to wind them too much, or cause a dislocation; and then let him draw forth the rest of the Body, as if it came with the Feet foremost.

I have said that the Chirurgeon, perceiving the Child to come with the Breech foremost, ought to put it back if he can; for sometimes he will be advanced so forward in the passage, that you may sooner destroy both Mother and Child, than reduce it back, when once strongly engaged. When this hap∣pens, he cannot hinder it from co∣ming in this posture, in which his Belly is so prest, that he often voids the Meconium by his Funda∣ment. However, he may much help this birth, by sliding up one or two Fingers of each Hand on each side of the Buttocks, to in∣troduce them into the Groins, and having crooked them inward, he must draw the Breech just out to the Thighs, and then by drawing and wagging it from side to side, he will disengage them from the passage; as also the Feet and Legs one after the other, being careful of dislocating any part; and then he may extract the rest as before, when coming with the Feet.

CHAP. XXII.

Of those Births, wherein the Infant presents Belly, Breast or Side.

THe Back-bone may easily be bent and turned forwards a little, but by no means backwards, without excessive violence. Where∣sore, the worst and most dange∣rous Figure that a Child can offer in the Womb to the bi••th, is the ••elly or the Breast; for then its Body is constrained to bend back∣wards, and whatever Throws or endeavours the Woman makes to bring it forth, it will never be ac∣complisked, for she will sooner pe∣rish with her Child, than ever ad∣vance it in this posture into the pas∣sage: wherefore it is in great dan∣ger, if not timely succored: And in case it should escape, which would be very strange, it would be a long while after its birth weak in the Back. But that which ang∣ments the danger much more, is, that for the most part the Navel∣string comes forth when the Child comes with the Belly. Therefore as soon as it is discovered to be so, the Chirurgeon must apply the sole remedy of drawing it forth by the Feet as speedily as may be in the following manner.

Having placed the Woman, let him gently slide up his flat Hand (being well anointed for the easier entrance) towards the middle of the Child's Breast, which he must thrust back to turn it; this situa∣tion being already half altered, the Feet being as near to the pas∣sage as the Head, when it pesents the middle of the Belly; then he must slip up his Hand under the Belly, till he sinds the Feet, which he must bring to the passage, to draw it forth in the same manner as if it had come footling, being careful to keep the Breast and Face downwards, which must always be observed before the Head can be drawn forth, for the reasons often already given, which must never be forgotten.

When a Child comes with Breast or Belly, the Chirurgeon must al∣ways proceed after the same man∣ner in both, inasmuch as they require the same circumstances. An Infant may likewise come with the Side, which way it is as impos∣sible to pass as the two former: but it is not so much tormented, nor is the situation so cruel; for it may re∣main in it a longer time without dy∣ing, than in the two former, wherein it is much more racked than in this, in which the Body may be bended forward, and not back∣ward,

as in the other; neither does the Navel-string come forth so easy as when it comes with the Belly first. In this, as in the other two Births, the Chirurgeon must draw the Child forth by the Feet in this fashion: having pla∣ced the Woman as she ought to be, he may push back a little with his Hand the Infant's Body, the better to introduce it, which he may slide along the Thighs, till he finds the Legs and Feet, by which he must turn it, and after∣wards draw it forth, just in the same manner as before, with the same Observations. Nor ought he to amuse himself in any of these three births, to place the Head right, that it might come natu∣rally; because it is in great danger of dying in these unnatural po∣sitions, if not drawn forth with speed; which can never be effect∣ed, unless it be by finding the Feet, as I have directed.

CHAP. XXIII.

Of Labours, wherein several Children present toge∣ther in the different postures above-named.

IF all the unnatural Figures and Situations, which we have hi∣therto described, that a single Child may come in, do cause those many difficulties and dangers men∣tioned; surely the Labour, where∣in several together come in these bad situations, must be much more painful, not only to the Mother and Children, but to the Chirurgeon also; for they are then so con∣strained and pressed, that for the most part they trouble each other, and hinder both their births: be∣sides, the Womb is then so filled with them, that the Chirurgeon can scarce introduce his Hand with∣out much violence, which he must do, if they are to be turned or thrust back, to give them a better position than wherein they pre∣sent themselves.

When a Woman has two Chil∣dren, they do not ordinarily both present to the birth together; but the one is often more forward than the other, which is the cause why but one is felt, and that sometimes it is not discovered that the Wo∣man will have twins, till going to fetch the After-birth, the se∣cond is then perceived.

We have already shewed, speak∣ing of natural Labours, how a Woman should be delivered of Twins, coming both right: It now remains to direct what ought to be done, when they come ei∣ther both wrong, or one of them only, as it is for the most part:

the first coming right, the second footling, or any other worse po∣sture: and then must the birth of the first be hastned as much as may be, that so there may be pre∣sently way for the second (which has suffered much by this unnatu∣ral position) to fetch it by the Feet, without trying to place it right, althô it were somewhat in∣clined to it; because it has been already so tired and weakened; as also the Woman by the birth of the first, that there would be more danger; that it would sooner dye, than come of it self.

Sometimes when the first is born naturally, the second offers the Head likewise to the birth: In this case 'tis good committing a work so well begun, to Nature to finish, provided she be not too slow; for a Child may dye, althò right, by lying too long in the birth; and the Woman who has been much tormented with bearing the first, is usually so tired and discouraged, when she thinks that but half her work is over, that she has no more Pains, or very few and slow, nor any considerable Throws to bear the second, as she had done the first. Wherefore if the birth of the second proves tedions, and the Woman grows weaker, let the Chi∣rurgeon defer it no longer, but di∣rect his Hand gently into the Ma∣tr••x, to find the Feet, and so draw out the second Child; which will easily be effected, because there is way made sufficient by the birth of the first: and if the second Wa∣ters be not broke, as it often hap∣pens; yet intending to fetch it footling, he need not scruple to break the Membranes with his Fingers, althô elsewhere we have forbidden it; but that must be understood with distinction: for when a Labour is left to Nature's work, they must break of them∣selves; but when a Child shall be extracted by Art, there is no dan∣ger in breaking them, nay con∣trarily they must be broke, that the Child may be the easier turned, which else would be almost im∣possible.

Above all, the Chirurgeon must be careful not to be deceived, when both Children together of∣fer to the Birth either their Hands or Feet; and must well consider in the operation, whether they be not joyned together, or any other ways monstrous; as also which part belongs to one Child, and which to the other, that so they may be fetcht one after the other, and not both together, as would be if it were not duly considered, taking the right Foot of the one, and the left of the other, and so drawing them together, as if they belonged both to one Body, because there is a right and a left, by which means it would be im∣possible ever to deliver them: but it may easily be prevented, if ha∣ving found two or three Feet of se∣veral Children presenting in the passage, and taking aside two of the forwardest, a right and a left, and sliding his Hand along the Legs and Thighs up to the Twist, if forwards; or to the Buttocks if backwards, he finds they belong both to one body; being certain of it he may then begin to draw ••orth the nearest, without regard which is strongest or weakest, bigger or less, living or dead, having

first put a little aside that part of the other Child which offers (to have the more way, and so dis∣patch the first whatever it is, as soon as may be) observing the same Rules, as if there were but one, that is, keeping the Breast and Face downwards, with every circum∣stance directed, where the Child comes Footling; and not fetch the Burthen, till the second Child be born; which if it were loosned from the sides of the Womb, would cause a Flooding, for the reasons already alledged, that the Orifices of the Vessels to which it was joyned, would continue open by this separation, as long as the Womb was distended by the other Child, yet within it, and never close (as it often happens) till be∣ing quite emptied of all, it begins to contract it self, and retire, (as a Man may say) within it self.

When therefore the Chirurgeon has drawn forth one Child, he must separate it from the Burthen, ha∣ving tied and cut the Navel-string, and then fetch the other by the Feet in the same manner; and afterwards bring the Burthen with the two strings, as hath been shew∣ed in the proper place. If the Children offer any other part than the Feet, the same course must be taken as is directed in the fore∣going Chapters, where the several unnatural Figures are discoursed of; always observing for the rea∣sons above-mentioned, to begin the operation with the Child that is lowest in the passage, and in the most commodious Figure for ex∣traction.

CHAP. XXIV.

Of a Labour, when the Navel-string comes first.

AN Infant does not always pre∣sent with the Belly, when the Navel-string comes first: for thô he presents naturally as to the figure of his Body, that is, with the Head first; yet sometimes the Navel-string falls down, and comes before it: for which cause the Child is in much danger of death at least, if the Labour be not very quick, because the Blood (that ought to pass and ••epass through those vessels which compose it, to nourish and enliven the Child, whilst he continues in the Womby being coagnlated, hinders the Cir∣culation which ought to be there ••ade; which happens as well by the Contusion, as the Cold those vessels receive, being much pressed in the passage, when it comes to∣gether with the Head, or any other part; as also because the Blood does there coagulate (as is

said) by reason of the Cold which it take; by the coming forth of the Navel-string.

But thô this accident may cause the Infant's sudden death, 'tis not so much for want of nourishment, without which he might pass a day or more, there being Blood e∣nough in his Body for that pur∣pose; but because the Blood can be no longer vivified and renewed by circulation, as it has continual need; which being obstructed, al∣ways causes the Creature's sudden death, sooner or later, according as it is more or less obstructed. Where∣fore in this case the Woman must without any delay be delivered; which if Nature do not speedily perform, the Child must be drawn forth by the Feet.

Women that have great Waters, and a long string to the Burthen, are very subject to this mischief; for the Waters coming forth in great abundance at the breaking of the Membranes, do often at that instant draw the string, which swims in the midst forth, along with them; and much the easier, if the Infant's Head be not advanced very forward into the passage, to hinder the coming forth of it in this manner.

As soon as 'tis perceived, you must immediately endeavour to put it back, to prevent the cooling it, behind the Child's Head, lest it be bruised, as we have already no∣ted, whereby the Blood may co∣agulate there; keeping it in that place where it was thrust back, un∣til the Head being fully come down into the passage, may hin∣der the coming down of it again: which may be effected by holding it up with the Fingers of one Hand on that side it comes down, until the Head be advanced as a∣bovesaid; or in case the Hand be taken away, to put a piece of fine soft rag between that side of the Head and the Womb, to stop up the way it came down by, always leaving an end of the rag without the Body, for to draw it forth by at pleasure.

But sometimes, notwithstand∣ing all these cautions, and the put∣ting back of it, it will yet come forth every Pain; then without farther delay, the Chirurgeon must bring the Child forth by the Feet, which he must search for, thô the Infant comes with the Head: for there is but this means to save the Child's life, which it would cer∣tainly lose by the least delay in this case. Wherefore having placed the Woman conveniently, let him gently put the Head which offers, back (provided it be not engaged too low among the bones of the passage, and that it may be done without too great violence to the Woman; for in that case it will be better to let the Child run the hazard of dying, than to destroy the Mother) and then slide up his Hand well anointed, under the Breast and Belly to search for the Feet, by which he must draw it forth according to former directi∣ons. This being dispatched, let him immediately take great care of the Infant, which is ever in this case very feeble.

CHAP. XXV.

Of a Labour wherein the Burthen first offers, or first comes quite forth.

THe coming forth of the Na∣vel-string before the Infant, of which we have treated in the foregoing Chapter, is often the cause of his death, for the reasons there given: but the coming first of the Burthen, is yet much more dangerous; for besides that the Children are ordinarily Still-born (if they be not affisted in the very Instant) the Mother likewise is of∣ten in very great peril of her life; because of her great Floodings, which usually happen, when it is loosened from the Womb before its due time, because it leaves all the Orifices of the vessels open, to which it did cleave, whence flows incessantly Blood, until the Child is born: For the Womb, whilst any thing continues there, does every moment strongly endeavor to expel it, by which means it con∣tinually voids and expresses the Blood of the Vessels, which are always open, when the Burthen is so separated, as long as the Womb remains extended and cannot be closed, until it has voided all that it did contain, and comes by the contraction of its Membranous substance to stop them by pressing them together. Wherefore if we ought to be vigilant to succor an Infant, when the string comes first, we ought much more to be so when the Burthen comes forth first, and the least delay is ever cause of the Infant's sudden death, if the Woman be not speedily de∣livered, because the Infant cannot stay then long in the Womb with∣out suffocation, standing then in need of breathing by the Mouth, the Blood being no longer vivified by the preparation made in the Burthen, the use and function of which then ceases, from the in∣stant it is separated from the ves∣sels of the Womb, to which it was joyned; for which reason there im∣mediately follows a great Flood∣ing, which is so dangerous for the Mother, that without speedy help, she soon loses her life by this un∣lucky accident.

When the Burthen is not wholly come forth, but lies in the passage, some advise to put it back before the Child be fetcht; but I am not of that opinion, for when it comes into the passage before the Infant, it is then totally divided from the Womb, at the bottom of which

it ought ordinarily to be situated and fastned, until the Child be Born: but because (as soon as it is wholly loosned, as it always is when it comes first) it becomes a Body altogether unnatural; it must never be thrust back, but on the contrary, be fetcht away, and at the very moment after, bring the Child by the Feet, althô it come naturally with the Head first. For what reason can there be to put it back, since it is of no use to the Infant, from the moment it is separated from the Womb? And such a proceeding is so far from being useful, that this Bur∣then would much hinder the Chi∣rurgeon from being able to turn the Child as he ought, to bring it by the Feet.

Wherefore when it presents in the passage, which may be soon perceived, if they find every where a soft substance, without the least resistance to the touch of any solid part; finding likewise the string fastned to the middle of it, and the Woman Flooding extremely, as is ordinary at such times. Then, instead of thrusting it back, the Burthen must be brought away, that so there may be the more li∣berty and room to extract the Child, according to former dire∣ction.

The Burthen being quite loosen∣ed from the Womb, and coming first in the passage, must not be thrust back into it again; much less must it be put back when it is quite come forth of the Body. Care must be only taken, that the string be not cut till the Child is born; not out of hopes of any benefit from it to the Infant during the Delivery, but that so much time may not be lost before the Infant be fetcht, which is then ever in great danger; as also the Flood∣ing may be the sooner stopt, which happens for the most part, as soon as the Woman is delivered; for which reasons it must be with all possible speed dispatched.

Sometimes, notwithstanding this dangerous accident, the Child may be Born alive, if timely suc∣cored: but it is then so weak, that it is hard to discover, whether it be living or dead.

When it so happens, the Mid∣wives do ordinarily before they separate the Burthen, put it into a Skellet of hot Wine, and imagine, with no small superstition, that in case it comes to it self, the vapors of the warm Wine was the cause of it, being conveyed by means of the string, into the Infant's Belly, and so giving it vigor. But it is more credible, that being al∣most suffocated for want of Respi∣ration, as soon as it needed it, it begins now by means of it to reco∣ver from that fainting. But ne∣vertheless, there is no hurt in keep∣ing the custome, thô superstitious, since it can do no prejudice, and may satisfy preingaged Spirits, pro∣vided necessaries be not neglected, in being blindly carried away with this conceit.

CHAP. XXVI.

How to deliver a Woman, when the Child is Hydro∣pical, or Monstrous.

A Child may in the Womb have either the Dropsie of the Head, called Hydrocephale, or of the Breast, or of the Belly. And when these parts are so filled with water, that they are much too big for the passage through which the Child must issue; then notwith∣standing any Throws or endea∣vors, by which the Woman may attempt to bring it forth, 'tis im∣possible she should effect it with∣out the help of Art; as likewise when the Child is Monstrous, ei∣ther by being only too big in the whole Body, or in any particular part, or by being joyned to ano∣ther Child.

If the Child be living that has the Dropsie, when the Woman is in Labour, it must be destroyed to save the Mother, by making a hole in either the Head, Breast, or Belly of it, where the Waters are contained, that being emptied by the apertion so made, the Child may the easier be drawn forth, or else he must necessarily dye in the Womb, not being able to be Born; and remaining there will also kill the Mother. Wherefore to save her life, the Infant must be by an indispensable necessity brought forth by Art, since 'tis impossi∣ble it should come of it self; which may be done with a crooked knife sharp at the very point, the Chi∣rurgeon proceeding in the follow∣ing manner.

After that the Woman is placed conveniently for the operation, he must slide up his left Hand on the right side of the inferior part of the Infant's Head, if the waters be contained therein; which he will perceive by the extraordinary big∣ness and extent of it; the Sutures much separated, and the Bones of it far distant one from the other, by reason of the distention made by the inclosed waters, of which being very certain, let him slide with his right Hand along the in∣side of his left his crooked knife, taking care that the point of it, ••n introducing it, be always to∣wards his left Hand, for fear of wounding the Womb; and having conducted it close up to the Head, against one of the Sutures, let him turn the knife towards it, and make an Apertion large enough to let out the water: And then it will be very easie to bring forth the

Child; forasmuch as the other parts are then usually small, and much consumed.

If these Waters were contained in the Breast or Belly, then the Child's Head being no bigger than ordinary, may be born; but the Body being exceedingly swelled with the Waters, will stay be∣hind.

The case being thus, let the Chirurgeon slide up his lest Hand, as aforesaid, and the instrument with the right, just to the Breast or Belly, to make incision, and to let out the Waters: after which, he may with much ease finish the operation.

You must know, that 'tis much more difficult to deliver a mon∣strous Birth, or two joyned toge∣ther, than one that has the Drop∣sie: because the bigness of the Hy∣dropick parts may be easily lessened by a single incision, which is suf∣ficient to let out the Waters which distend; and then 'tis easy to dis∣patch the rest.

But when a monstrous Child, or a double one, is to be extract∣ed, a single apertion is not enough, but sometimes 'tis necessary to take off whole Members from these Bodies, which makes the operati∣on much more painful and labo∣rious, and requires more time and skill to effect it; in which case the left Hand must be introduced into the Womb, and the sharp knife with the right just to the parts that are to be divided and separated, and there with all the care that may be, the member of the monstrous Child must, if pos∣sible, be taken off just at the Joynt. And when there are two Children joyned together, the separation must be made just in the place where they joyn; and afterwards they may be delivered one after the other; always taking them by the Feet, and if it hath but one, the same thing may be accomplished, after having lessened the bigness of it, by cutting off some one of the Members.

The instrument ought to be as long as an ordinary Crochet, for the more surety and facility; be∣cause that holding the handle of it with the right Hand, it may be thrust, drawn, sloped and turned, without pain, to any side at plea∣sure; and with the lest, which is within the Womb, it may be gui∣ded to cut and dismember more skilfully and easily those parts which must be separated. Wherefore it ought to have a handle so long, that the Chirurgeon's right Hand without the Womb may hold and govern it as abovesaid, and conduct it the better in the operation; which would not be so safely and conveniently done, if this instrument were so very short, as all other Authors recommend: because in this occasion the Chirur∣geon's Hand is so constrained and pressed in the Womb, that he can hardly there have the liberty to move his fingers ends, which is the cause why he cannot without much difficulty govern such an instru∣ment with one Hand only, unless he would very much force and offer violence to the Womb, and there∣by exceedingly endanger the poor Woman's life. Let us now come to the extraction of a dead Child, and shew the several ways of doing it.

CHAP. XXVII.

Of delivering a dead Child.

WHen the Infant is dead in the Mother's Belly, the Labour is ever long and dan∣gerous, because for the most part it comes wrong; or, thô it comes right with the Head, the Woman's Pains are so weak and slow in these cases, that she cannot bring it forth, and sometimes she has none at all; forasmuch as Nature, half overthrown by the death of the Child, which cannot help it self, labours so little, that many times it cannot finish the business it has begun, but most yield without the help of Art, of which at that time it has great need. However, before you come to manual operation, endeavour to stir up the Woman's Pains with sharp and strong Cly∣sters, to bring on Throws to bear down and bring forth the Child: But if all this prevails not, she must be delivered by Art.

We have already declared the signs to know a dead Child in the Womb, of which the chief are; if the Woman perceives it not to stir, nor has a long time before; if she be very cold, much pain and heaviness in the bottom of her Bel∣ly; if the Child be not support∣ed, but always falls like a mass of Lead to that side on which the Woman lies, if the Burthen or Na∣vel-string has been a long time in the World; and if no pulsation be there felt; and that dark and stink∣ing putrid matter comes away from the Womb. All these signs toge∣ther, or most of them, shew the Child is assuredly dead; which when the Chirurgeon is certain of, he must do his endeavor to fetch it as soon as possible he can, and having placed the Woman accord∣ing to former directions; if the Child offers the Head first, he must gently put it back, until he has li∣berty to introduce his Hand quite into the Womb, and sliding it all along under the Belly to find the Feet, let him draw it forth by them, as is formerly taught; being very careful to keep the Head from being lockt in the passage, and that it be not separated from the Body, which may easily be done, when the Child being very rotten and putrefied, the Chirurgeon does not observe the circumstances of∣ten repeated by us, that is, (in drawing it forth) to keep the Breast and Face downwards. And if, notwithstanding all these pre∣cautions, the Head, because of the

great putrefaction, should be sepa∣rated and remain behind in the Womb, it must be drawn forth ac∣cording to the directions given in the proper Chapter.

But when the Head coming first, is so far advanced and engaged among the Bones of the passage, that it cannot be put back, then being very sure by all the signs to∣gether, or most of the chief of them, that the Child is certainly dead, 'tis better to draw it forth, than to torment the Woman too much by putting it back, to turn it and bring it by the Feet. But because it being a part round and slippery, by reason of the moisture, the Chirurgeon cannot take hold of it with his Fingers, nor put them upon the side of it, because the passage is filled with its big∣ness, he must take a crotchet, and put up as far as he can without vi∣olence, between the Womb and the Child's Head, where he must fa∣sten it, endeavoring to give it good hold upon one of the bones of the Skull, that it may not slide, for∣cing in the point of it, which must be strong, that it may not turn; and after the Crotchet is well fix∣ed in the Head, he may therewith draw it forth, keeping the ends of the Fingers of his left Hand flat upon the opposite side, the better to help to disengage it, and by wagging it by little and little, to conduct it directly out of the pas∣sage.

It were to be wished that it were possible to introduce the Crotchet so far, that one might fix it (for the better hold) in one of the Eye-holes, or cavities of the Ears; but very often there is not room at first to carry them beyond the middle of the Head, and then they must be fastned according to our directions; and rather, if possi∣ble on the hinder part than any other, that so it may be drawn forth in a streight line; and when by the first fastning of the Crotchet the Head is drawn lower, and be∣gins to be disengaged, you may loosen it out of the first place to fasten it farther up, that stronger hold may be taken, and so succes∣sively removing and fastning of it, until the Head be quite born, and then taking hold of it immediate∣ly with the Hands only, the Shoul∣ders may be drawn into the pas∣sage; and so sliding the Fingers of both Hands under the Arm-pits, the Child may be quite delivered, and then the Burthen fetcht to fi∣nish the operation, according to knowledge; being careful not to pull the Navel-string too hard, lest it break, as it often happens when it is corrupted.

If the dead Child (of which above all, there must be good assurance) comes with the Arm up to the Shoulders so extremely swelled, that the Woman must suffer too much violence to have it put back, 'tis best then to take it off at the Shoulder-joint, by twisting it three or four times about, as we have al∣ready taught in another place, by which means there is no need of either Knives, Sawes, or sharp Pincers, as some Authors will have it; it being very easily performed without all that provision, because of the softness and tenderness of the Body. After that the Arm is so separated, and no longer pos∣sessing the passage, the Chirurgeon

will have more room to put up his Hand into the Womb to fetch the Child by the Feet, and bring it away as has been directed.

Althô the Chirurgeon be sure that the Child is dead in the Womb, and that it is necessary to fetch it by Art, he must not therefore pre∣sently use his Crotchets, because they are never to be used but when Hands are not sufficient, and that there is no other remedy to pre∣vent the Woman's danger, or to bring the Child any other way; because, very often, thô he has done all that Art directs, persons present, that understand not these things, will believe that the Child was killed with the Crotchets, al∣thô it had been dead three days be∣fore, and without other reasonings or better understanding of the mat∣ter, for recompence of his saving the Mother's life, requite him with an accusation, of which he is al∣together innocent; and in case the Mother by misfortune should after∣wards dye, lay her death also to his charge, and instead of praise and thanks, treat him like a Butcher or a Hangman; to which divers Midwives are usually very ready to contribute, and are the first that make the poor Women, that have need of the Men, afraid of them. So much they are in fear of being blamed by them, for having them∣selves been the cause (as some of them often are) of the death of Infants, and many ill accidents, which after befall the poor Women, not causing them to be helped in due time, and from the moment they perceive the difficulty of the Labour to pass their understand∣ings.

To avoid therefore these calum∣nies, let the Chirurgeon never use these Crotchets but very rarely, and when there is no other way, as also to endeavour his utmost (as much as the case will permit) to bring the Child whole, although dead, and not by bits and pieces, that thereby the wicked and igno∣rant may have no pretence of blame. I say, as much as the case will permit, that is, with respect to the Woman under his hands: For to save her, he had better sometime bring the dead Child with instru∣ments, than kill her, by torment∣ing her with excessive violence to bring it whole. But, in a word, we must in conscience do what Art commands, without heed what may be spoken afterwards: And every Chirurgeon, that has a well ordered Conscience, will ever have a greater regard to his Duty than reputation; in performing of which let him expect his reward from GOD.

CHAP. XXVIII.

Of extracting a Mola, and false Conception.

A Mole is nothing but a fleshy substance, without Bones, Joynts, or distinction of Mem∣bers; without form and figure re∣gulated and determined; engen∣dred against Nature in the Womb, after copulation, out of the cor∣rupted Seed of both Man and Wo∣man. Notwithstanding, there are sometimes that have some rudi∣ments of a rough form. It has no Burthen, nor Navel-string fastned to it, as a Child always has; for∣asmuch as the Mole it self adheres to the Womb, by which means it receives nourishment from its vos∣sels. When Women miscarry of them before the second Month, they are called false Conceptions: when they keep them longer, and this strange body begins to grow bigger, they are called Moles.

Now since these things contain∣ed in the Womb, are totally Pre∣ternatural, their expulsion must be procured as soon as possible, which is very difficult, when these strange Bodies cleave to it, and especially the Mola, which not be∣ing drawn forth, will often conti∣nue two or three whole years, nay, sometimes the whole remaining part of the Woman's life, as Parey tells us in the story of a Pewterer's Wife that had one seventeen years, whom he opened after her death.

To avoid the like accident, and abundance of inconveniences, which a Mola brings, it must be endea∣voured to be expelled as soon as may be, trying before you come to manual operation, to cause the Woman to expel it of her self: To which purpose give her strong and sharp Clysters, to stir up Throws to open the Womb to give way to it, relaxing and moistning it with emollient Ointments, Oils and Grease, not omitting bleeding in the Foot, and half Baths, if there be occasion.

The Mola will certainly be ex∣cluded by these means, provided it be but of an indifferent bigness, or that it adheres little, or not at all to the Womb; but if it cleaves ve∣ry strongly to the bottom of the Womb, or that it be very big, the Woman will hardly be rid of it without the help of a Chirurge∣on's Hand; in which case, after that he has placed the Woman con∣veniently, as if he were to fetch a dead Child, let him slide his Hand

into the Womb, and with it draw forth the Mola, using (if it be so big as that it cannot be brought whole, which is very rare, because it is a soft tender Body, much more pliable than a Child) a crotchet or knife to draw it forth, or divide it into two or more parts, as the case shall require. If the Chirur∣geon finds it joyned and fastned to the Womb, he must gently sepa∣rate it with his fingers ends, his Nails being well pared, putting them by little and little between the Mola and the Womb, begin∣ning on that side, where it does not stick so fast, and pursuing it so, till it be quite loosened; being very careful, if it grows too fast, not to rend or hurt the proper sub∣stance of the Womb, proceeding according to the directions we have given for the extraction of a Burthen staying behind in the Womb, when the string is bro∣ken off.

As to a false Conception, thô it be much less than a Mola, yet it often puts a Woman in hazard of her life, because of great Flood∣ings, which very often happen, when the Womb would discharge it self of it, and endeavours to ex∣pell it, the Floodings seldom ceas∣ing until it be come away, because the Womb still endeavours to ex∣clude it, by which the Blood is excited to flow away, and in a manner squeezed out of the open vessels.

The best and safest remedy for a Woman in this case, is to fetch away the false Conception as soon as may be, because the Womb can very seldom, without great diffi∣culty void it without help: For it being very small, the Woman's impulse in bouring downwards can∣not be so effectual, when the Womb is but little distended by so small a body, as when it con∣tains a considerable bulk in it; for then it is more strongly com∣pressed with the Throws. Ma∣ny times 'tis exceeding difficult to fetch these false Conceptions, be∣cause the Womb does not open and dilate it self ordinarily beyond the proportion of what it contains, and that being very little, so is its open∣ing. Which is the reason why the Chirurgeon sometimes is so far from introducing his whole Hand, that he can scarce put in a few Fingers, with which he is forced to finish the operation, as well as he can, proceeding in the following man∣ner, when he has introduced them.

Having well anointed his Hand, he must slide it up the Vagina un∣to the inward Orifice, which he will find sometimes but very little dilated, and then very gently put in one of his Fingers, which he must presently turn and bend on every side, until he has made way for a second, and afterwards a third, or more, if it may be done with∣out violence; but many times one has enough to do to get in but two, between which he must take hold (as Crabs do with their Claws when they take any thing) of the false Conception, which he must gently draw forth; and also the clotted Blood which he there finds. Afterwards the flooding will un∣doubtedly cease, if no part of this conception be left behind: But if the inward Orifice cannot be more dilated than to admit but one Fin∣ger,

and that the Flooding is so violent as to endanger the Wo∣man's life; the Chirurgeon then having introduced his Fore-finger of his left Hand, must take with his right, an instrument called a Crane's-Bill, or rather a Forceps, and guide the end of it along his Finger, and fetch with this instru∣ment the strange Body out of the Womb, taking heed that he pinch not the Womb; and that the in∣strument be always conducted by the Finger first introduced, which will judge and distinguish by the touch between this Conception and the substance of the Womb: In doing which, there being no other way, he will certainly ac∣complish his business.

CHAP. XXIX.

Of the Caesarean Section.

WHen a big-bellied Wo∣man is effectively in Labour, 'tis very rare but that an expert Chirurgeon can deliver the Child dead or alive, whole or in pieces; in a word, that he may do the work compleatly, if he behaves himself as the case requires, and according to the directions given in each particular Chapter forego∣ing, treating of the several unna∣tural Labours, without being ne∣cessitated in a very inhumane, cru∣el and barbarous manner, to have recourse to the Caesarian operati∣on, during the Mother's life, as some Authors have too inconside∣rately ordered; but never practi∣sed with success.

However, after the Mother's death, if there be any hopes to find the Child alive (especially in those Countries, where the Laws forbid the burying a Woman with Child, before it is taken out of her Belly) this operation may be undertaken. To accomplish which as it ought to be, when he per∣ceives the Woman in the agony, he must quickly make ready all things necessary for his work, to lose no time, because delay will certainly be the death of the Infant, which else a few moments before might have been brought alive. There are some, that when the Woman is just a dying, would have some∣what put between her Teeth to keep her Mouth open, and like∣wise in the outer part of the Womb: to the end the Infant re∣ceiving by this means some little air and refreshment, may not be so soon suffocated: But all this my∣stery will avail but little; because the Child lives only by the Mo∣ther's Blood, whilst it is in the Womb; but if he will needs do

so, it is rather to content the com∣pany, than out of any belief of the good it will do.

As soon then as the Woman has breathed her last, and that she is dead (to which all the company must agree) he shall begin his ope∣ration, which the Greeks call Em∣bryulcy. Most Authors would have it made on the left side of the Bel∣ly, because it is more free from the Liver, which is on the right; but if my Opinion may be authentick, it will be better and more skilful∣ly made just in the middle of the Belly; between the two right Mu∣scles; because in this place there is only the coverings and the white line to cut; when on the Side it cannot be done without cutting the two oblique and cross Muscles, which being couched one under the other, make a considerable thickness, besides that it bleeds more than towards the middle of the Belly; not that the loss of Blood is of any moment (which will flow when the Woman is but just dead) but because it hinders by its flowing, the seeing distinct∣ly how to make the operation as it should be.

To dispatch then with more ease and speed, the Chirurgeon having placed the dead Body, that the Belly may be a little raised, let him take a good sharp incision knife, very sharp on one side, with which he must quickly make, at one stroak, or at two or three at the most (if he will for the great∣er surety) an incision just in the middle of the Belly, between the two right Muscles unto the Peri∣tonaeum, of the length and extent of the Womb or thereabouts; af∣ter that he must only pierce the Peritonaeum with the point of his instrument, to make an orifice for one or two of the Fingers of his left Hand, into which he must im∣mediately thrust them to cut it (lifting it up with them, and con∣ducting the instrument for fear of pricking the Guts) in proportion to the first incision of the cover∣ings, which having done, the Womb will soon appear, in which he must make an incision in the same man∣ner as he did in the Peritonaeum; being careful not to thrust his In∣strument at once too far in, think∣ing to find the Womb a Finger or two thick (as all Authors affirm contrary to truth) in which he would be deceived, as these are that never well considered it. For it is very certain, that at the time of Labour, whilst it contains the Child and Waters in it, it is not above the thickness of a half Crown, although they have all sung to us, that by Divine Providence and a Miracle, the more it's extended with the Child, the thicker it grows, which is absolutely false; it being 〈◊〉〈◊〉 true, that it is at that time a little thicker at the place where the Burthen cleaves, where its sub∣stance is then as it were spongy; but every where else it is very thin, and becomes the more so, by how much it is more extended, until being emptied by the birth of the Child, it begins to grow thicker in contracting, and gathering to it self all its substance, which was be∣fore very much extended. It be∣ing just like the Bladder, which being full, is very thin, and being empty, it appears to us half a Fingers thickness, which filling

again, waxes thinner in proportion to the Urine that flows to it. Ha∣ving then so opened the Womb, he must likewise make an incision in the Infant's Membranes, taking care not to wound it with the in∣strument, and then he will soon see it, and must immediately take it out with the Burthen, which he must nimbly separate from the bottom of the Womb: And finding it to be yet living, let him praise GOD for having so blessed and prospered his operation.

But the Children so delivered in these cases are usually so weak (if not quite dead, as it often happens), that 'tis hard to know whether they be alive or dead. Yet one may be confident the Child is li∣ving, if by touching the Navel∣string, the umbilical Arteries are perceived to move; as also the Heart, by laying the Hand on the Breast; and if it prove so, means must be used to fetch it to it self, spouting some Wine in the Nose and Mouth, warming it until it be∣gins to come to stir of it self, Mid∣wives usually lay the Burthen very hot on the Belly of such weak Chil∣dren; if that helps, 'tis rather be∣cause of the temperate heat of it, than for any other cause: for 'tis impossible the Infant should re∣ceive any Spirits from it, after it is once separated from the Womb, and yet less when the Woman is dead. The best and speediest reme∣dy is immediately to separate it, and open the Child's Mouth, clean∣ing and unstopping all the Nose, if there be any filth, to help it so to breath freely, keeping it all the while near the fire, until it has a little recovered its weakness, spout∣ing some Wine into the Nose and Mouth of it, that he may a lit∣tle taste and scent it, which can∣not hurt it in this juncture, if one observes some moderation in the thing.

CHAP. XXX.

Of Ruptures in general, their differences, signs, and causes.

THe next thing which in our proposed method we shall treat of, shall be a Rupture; in Latine called Ruptura, hernia, ra∣mex; in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Now thô properly there be only two sorts of Ruptures, caused by the falling down of the parts, viz. Intestina∣lis vel Omentalis, of the Guts, or of the Caul; yet in regard of af∣finity, and of the place affected, other differences of Ruptures may be referred hither; which have got Names according to the varie∣ty of the illapsed matter.

These are the principal sorts of Ruptures. 1. Hern•••• incompleta, inguinalis, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, when the Gut or Caulcomes down no lower than the Groin. 2; Hernia com∣pleta, when either of them falls down into the Cod, the Tunica vaginalis, or Peritonaeum being broke: And if the Gut come down, it is called Ramex intestinalis and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 3. If it be the Caul, Ramex zirbalis, or Omentalis, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 4. If it be a Tumor from a slimy watry Humor, it is called Ramex aquosus, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, 5. If from Wind, Ramex flatu∣lentus, or Ventosus, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 6. If flesh grow about the Testicle, or in its substance, it is called Ra∣mex carnosus, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 7. If the veins being beyond measure full in the Cod and Testicles, be distended in manner of Varices, it is called Ramex varicosus, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 8. Avicen adds 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, that is, the starting of the Navel, or a Rupture there. From these there arise several mixt or com∣pound sorts, as 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, a falling down both of the Guts and Caul; 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, of the Gut and Water; 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, of Wind and Water; 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, of Water with Flesh, &c.

The common sign of all com∣plete Ruptures is a swelling in the God.

Bubonocele, or an imperfect Rupture is known by a swelling in the Groin.

The signs of a Hernia intestina∣lis, according to Celsus, c. 14. l. 7. are 1. When the swelling some∣times increases, and sometimes de∣creases: It increases because either a greater portion of the Gut comes down; or it is over full, either of Wind or Ordure. If the swelling increase because Excrements are

got into the Gut, then the Gut cannot be put back, there is a pain in the Cod, Groin and Belly, by reason of solution of continuity; the Stomach is disordered, and casts forth brown choler, then black, and last of all the excre∣ments; There is also an Inflam∣mation of the Stories. 2. The second sign of a Hernia intestina∣lis is, That the swelling is not pain∣ful. 3. The swelling sometimes is almost quite gone. 4. Being com∣pressed, it easily gives back with∣in the Abdomen, and then slips out again with a great noise. 5. The swelling is smooth, slippery and round.

The signs of a Hernia omenta∣lis are 1. The swelling is always the same, 2. To the fooling it is uneven, soft and slippery, because of its Fat.

The signs of Hernia aquosa are 1. The swelling abates after fast∣ing, 2. The veins in the Ser••••um are swelled: And if it be squeezed, the Humor flows into the vessels, which before were not full. 3. It shmes, and is pellucid, and if you hold a Candle on the opposite side, it appears as if you lookt through Glass or Horn. 4. There is no pain. 5. It comes not on a sud∣den, but by degrees.

The sign of a Hernia ventosa are, 1. The Veins are swelled. 2. It looks clearer than a Hernia aquosa. 3. It comes on a sudden.

The signs of a Hernia carnosa are, 1. A schirrhous hardness. 2. It changes not the colour of the Stones. 3. It abides always at the same bigness. 4. The lower parts of the Testicle may be stirred.

The signs of a Hernia varicosa are, 1. The Veins are turgid on a cluster, and wreathen, like Vine∣claspers. 2. The Testicle hangs lower down, because of the weight of the Humors.

The conjunct cause is the Gut or Cawl slipt down. The ante∣cedent is either the distention or breach of the Peritonaeum. And it is distended or broke by causes, ei∣ther internal, as the Humors that are contained in the Body; or external, as by a blow, loud crying, leaping, keeping ones breath, pressure of a weight, too much violence in em∣braces, especially when the Belly is charged with Excrements or Wind.

As to the Prognosticks, All Ruptures are difficult of Cure: Because a thin and nervous Mem∣brane is very difficultly united; nor is it cured by Medicines, unless the Rupture be small, lately made, and in Children; but either with Sear∣ing-Irons, or by Section.

CHAP. XXXI.

The eure of a Hernia intestinalis, when the Perito∣naeum is either distended or relaxed.

THE Gut comes down, be∣cause either the coat called Peritonaeum is distended, or broke. The signs of its being distended are, 1. The coming down of the Gut, not suddenly, but sticking in the orifice. 2. It comes not so low as the bottom of the Cod. 3. The swelling is equal. The signs of the coat's being broke are, 1. The sudden descent of the Gut. 2. An unequal swelling. 3. The falling of the Gut down to the bottom of the Cod.

In respect of the distention, two things are indicated, according to Avicen. First, the reduction of the Gut up again within the Abdomen. Secondly, the hindring it from slip∣ing down again. The first design is easily accomplisht (if much of the Gut be not fallen, nor that fil∣led with wind or excrements) for it may be put up, and prest back with the Fingers. But if it be full of excrements or wind, a bath of warm water must be got ready, then Lenients must be applied, and afterwards a Fomentation with a cloth warm. Some Oil may be added to a Bath of fresh water, or it may be made of Oil alone. Then some such lenient Cataplasin may be applied. ℞ Radicum al∣there coctarum ex aqua & contu∣sarum lb ss. farinae sem, lini, bu∣tyri an. ℥iij. Olei communis ℥iiij. mulsae q. s. ad cut aplasma. If these means will do no good, the Pati∣ent must be taken by his Hands and Feet, and shaken that the Gut may fall back, he hanging with his Belly upwards, and his Head down∣wards.

We answer the second Intention i.e. we hinder the Gut from flip∣ing down again, if we bind what is dilated, and remove all causes both internal and external. The principal of the internal is an hu∣midity relaxing and mollifying the Tunica vaginalis; which must be dried, strengthened and bound. Care therefore must be taken of the whole Body. Moist and windy meats must be avoided, and exercise also. Bread must be used, that is well baked, adding some Anise or Cummin-seed. Dry flesh must be eaten. The Drink must be astrin∣gent. The Diet being ordered in this manner, the influent Hu∣mors must be evacuated both with Phlegmagogues, Agaricum,

manna, mel rosarum solutivum, &c. and with Purges of serous Hu∣mors, Syrupus de Calamintha, de Hyssopo, de Betonica, cum decoctis faeniculi, Petrose ini, &c. And af∣terwards we must proceed to astrin∣gents, Glutinants and driers; such as are, Herniaria seu Polygonum minus, Betonica, symphytum, Rosae Rubrae, balaustia, plantago, nuces cupressi, cortex quercûs, radix si∣gilli Salomonis, Mastiche, bolus Ar∣mena, mumia, Sanguis Draconis, mala cydonia, cyminum, out of which, posions, powders, and ele∣ctuaries both dry and soft may be made. And for greater exsiccati∣on's sake Decoctum Sarsae parillae, cum modico ligni indici, ex aqua chalybeata is good; it must be taken for many days.

Local Medicines must be dry∣ing and astringent. Avicen makes a Medicine è nucibus cupressi, è fo∣liis ejusdem, & sabina. Paulus cap. 35. l. 3. has this, ℞ cort. granat. ʒ x. gallar. immatur. ʒ v. vini astringentis ℥ v. decoquantur, & imponantur, priùs ablutoloco aquà frigidà: & quarto quolibet die re∣novetur. Avicen commends this; ℞ nucum cupressi, aeaciae, balaust. gallarum immatur. an. ʒj. myrrhae, thuris, sarcccollae, tragacanthae, gum∣mi Arabici an. ʒiij. mumiae, san∣guinis Draconis an. ʒij. terantur cum aceto. Another excellent one ℞ malicorii, boli Armenae, sang. drac. an. ʒj. tegulae pulverisatae ʒij. pulveris bislinguae ʒijss. cum ovi albo, modico aceto & colopho∣nia fiat emplastrum. After this is applied Avicen and Celsus apply a Truss, to keep up the Gut. And thus a slight Rupture is cured in a young and tender body.

But if the malady will not give way to these things, the Patient must lye in Bed full forty days, ap∣plying an astringent Medicine and a Truss. Let him forbear much Laughter, Venery, and Bathing. Morning and Evening let him take this Electuary; ℞ rhabarbari asse, consolide majoris, nucis moschatae, nucum cupressi, cymini, trag acau∣thi, gummi Arab. mastiches, boli Arm. sanguinis Drac. mumiae, pi∣cis Graecae, an partes aequales: Pul∣verisentur omnia subtilissimè, & cum melle despumato fiat electuari∣um, cujus dosis ℥ss. Quidam pul∣verem leporis combusti addunt. Let him drink upon it some austere black Wine, water Chalybeat, or common, wherein Cypress or Myr∣tle Leaves have been boiled. After forty days are over, let him rise; but in the mean time let him wear the Plaster and Truss, till it shall be thought safe to leave them off.

CHAP. XXXII.

The Cure of a Hernia intestinalis when the Peri∣tonaeum is burst.

THe intentions of Cure are the same here as in the for∣mer Chapter. The Gut must be put up, and care must be taken, that it slip not down again; which is done by uniting and glewing up the Rupture. It is united by astringents. And here these must not be purely driers, but they must have also in them a glutinous visci∣dity; such as this; ℞ Terebinth. ℥iss. cerae, thuris, myrrhae, ichthyc∣collae, carnis cochlearum, an. ℥j. Gluten. triduo in aceto maceretur, inde in mortario plumbeo laevigetur ac conteratur, post, igne liqueseat ac misceatur caeteris. Another, ℞ Resinae aridae, Ammoniaci, thu∣vis, bituminis, sulphuris vivi an. part. aeq. terantur terenda, lique∣fiant liquenda, deinde sulphur ad∣jiciatur: Applicetur vel linte••, vel corio, & sinatur donec sponte decidat. Aëtius highly extols char∣ta, tribus diebus in aqua mace∣rata: But it is doubtful what this Charta is, whether Parchment or Paper, which being wet stretches, and dry contracts, and by contract∣ing may also deduce the parts to mutual contact, and unite them. The course of forty days is also proper.

If these means will not do, ac∣cording to Avicen, the place must be seared with a hot iron. The searing must be strong, because so the skin is contracted, that the Gut cannot any more come down. But you must have a care that the Intestine feel not the strength of the fire, nor be burnt; for there would be danger of death. The Patient therefore must be laid on his back, with his Head low, &c. When the Gut is reduced, a Ser∣vant must lay his Hand on the bot∣tom of his Belly, and press it hard. The Patient must be tied upon the Table with many Ligatures, on the Breast, Arms, Hips, Knees and Feet; the swathes of the Breast must be broad. It is a hard mat∣ter to desend the spermatick vessels, by hurting of which the generati∣on of Seed is lost; but it is no pre∣judice to life. The searing-Irons must be of two forms, semicircu∣lar and pointed, that they may have a sharp point, and the figure of a Cone. We begin to fear at the upper part, descending along the whole region of the Rupture.

The Cure is also performed by incision, which is twofold, Chi∣turgical, or Empirical. True Chi∣rurgeons

cure it without extracting a Stone: Empiricks cut off a Stone. Without extracting a Stone, it is performed in this manner. First of all the Patient standing must hold his breath, that we may know how large the Rupture is. Then the tumefied part must be marked round with ink, according to the bigness of the place affected. Af∣terward the Patient must be tied upon a Table, and a servant must press the bottom of his Belly. The Chirurgeon must with his left hand lift up the marked skin, as much as he can, and with a Penknife cut the circle diametrically, through the Skin and Membranes, to the Tunica vaginalis, either burst or dilated, which must be sowed up afterwards, together with the Skin and Membranes. The seminal ves∣sels must be kept unhurt. After the Patient must be put to Bed, ha∣ving first applied pledgets cum ovi albumine, and then glutinants, as pulvis boli, &c. and things also that breed flesh, as Terebinthina, &c. applying over all Emplastrum barbarum. When a cicatrice is bred, the Patient may rise, and wear an astringent Plaster for several days, and a Truss likewise.

The usual and dangerous way, with extraction of a Stone, is de∣scribed by Paulus, cap. 65. lib. 6. The Patient being laid on his Back, the Gut reduced, he tied, and a Servant pressing the part, they make an oblique mark in the Groin. Then they make a deep incision, so that the Stone and the spermatick vessels may be taken out. They hold these with their left hand, putting their singers in∣to the hole, they separate all the Membranes, and extract the Testi∣cle at the hole. Then they take hold of the parts with hooks made for that purpose, and sow all up. Then they cut off all above the Su∣ture, and afterwards fear it with a hot iron, to prevent a Haemorrhage, and to glutinate the parts the soon∣er. Which done, they leave along thread, putting in some concoct∣ing Medicine. Afterwards, they make a hole in the same part of the Scrotum, and put in some conco∣cting Medicine, they use Butter (which nevertheless putrefies) they mix thus, aut ovi vitellum, & mo∣dicum resinae terebinthinae. Then they endeavour to breed flesh, with Ʋnguentum de Betonica, aut Isidis, and bring a cicatrice with dry lint.

CHAP. XXXIII.

Of the Cure of a Hernia omentalis.

THis Rupture is not made by the breach of the Perito∣naeum; because no great portion of the Omentum comes down, it being fastned to the bottom of the Stomach, the Gut Colon, and to the Spine. Therefore it is made by distention of the coat; espe∣cially because the Omentium is fat, which may very well therefore make lax and dilate, but never break.

The intentions of cure are two. First, the Omentum must be redu∣ced within the Abdomen, which is done with the Hands: Then, it must be kept from coming down again, which is done by Astrin∣gents. And because dilatation is made by moisture, or by a relax∣ing fat: therefore Ramex omenta∣lis requires greater driers than In∣testinalis. This is commended; ℞ Aloes, malicorii in vino nigro elixats, succi hypocystidos, thuris, glutinis fabrorum, an. part. aeq. gluten passo incequatur ad integram dissolutionem, post teratur in mor∣tario, & caetera addantur. As to the rest, this cure differs not from the cure of a Hernia intestinalis, and therefore here a Truss, the forty days course, Causticks and Incision will be proper. It is to be noted, according to Celsus c. 25. l. 7. That if a small portion of the Omentum come down, it must be forced up again: If a great one it must be seared, that it may dye and fall off: The readiest way is to bind, cut off and burn it. Yet we must not rashly and too soon proceed to Section; because of∣tentimes a Rupture is cured beyond expectation.

CHAP. XXXIV.

Of the Cure of a Hernia aquosa.

THe causes of a Hernia aquosa are either occult or mani∣fest, according to Aetius cap. 22. l. 14. The manifest are percussion, collision, and breach of the vessels in the Stones: for the Blood that flows to the vessels is then turned into a watry substance, because of the weakness of the part. The oc∣cult cause is from the vessels being filled with a watry Humidity. Guido adds, some fault in the Liver, or Spleen, by reason whereof a Li∣quor gathers in the Hypocondria, which easily falls down.

Percussion, Collision, &c. are apparent of themselves. If the colour and habit of the Body be bad, the Rupture proceeds from a fault in some of the Viscera. If none of these, from Repletion: and Repletion proceeds from Drinking too much. Aetius distinguishes the Causes by the Humor: which if it be yellowish and pale, the Rupture comes from repletion of the Veins; if dull, from Percussi∣on; if white, from some fault of the Liver or Spleen. We must know, that sometimes water is al∣so gathered in the coat, which immediately involves the Stones; oftentimes between it and the Elytroeides; sometimes between the Elytroeides and the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

As to the Cures the causes must be removed, the faults of the Li∣ver and Spleen amended. If it comes from too much drinking, we must abstain from it. The abundance of watry humor must be evacuated, both what is in the Hypochondria and the Abdomen, and what is redundant in the whole Body. For which purpose Sarsa∣parilla in decoctions is very effica∣cious. Besides, Diureticks and Pur∣gatives are good; but Diureticks are best. Diureticks are known, which must be taken frequently; as also such Medicines as purge thin and serous Humors by stool, such as Syrupus è rosis laxativus pilulae cochiae, & mastichinae, vel aloephanginae, quarum scrupulus ex∣hibere potest cum elaterri gr. ij.

As for local Medicines, the in∣tent of them is to evacuate water contained in the Stones: which is done, if it either give back to re∣pellents, or be brought out by Digestives through some patent place, or by Scarification. Dige∣stives are hot and drying, which must be used before Scarification. Aetius commends this; ℞ Argenti spumae ʒvj. salis fossilis, atramenti sutorri, an. ʒx. cerusse ʒiiij. o'ci

lbj. terebinthinae ʒxj. Spuma argen∣ti, cerussa, sal, mista cum oleo cequi debent: addatur atramentum suto∣rium, cum aceto tritum, postea te∣rebinthina adjiciatur. A Cataplasm may also be made è baccis lauri, fa∣rinâ fabarum, faenigraeci, sulphure, cumino, Ammoniaco, terebinthinâ, sapâ & oxymelite cum ol. laur. no simul mistis. This is excellent; ℞ stercoris bubuli lbj. pulv. cymin. ℥j. baccarum lauri, fimi columbi∣ni, castorei an. part. aeq. coquan∣tur cum ol. ros. & pauca cera. Yet first of all the place must be fo∣mented with a sponge dipt in de∣cocto pulegii, calaminthae, origani, foenigraeci, anisi, dauci, cymini, ru∣tae, ameos, salviae. And after fo∣mentation, the place may be a∣nointed with ol. de ruta, aut costo, aut cuphorbio, aut castor. aut etiam de baccis lauri. Also aqua calcis vivae digests very much. If there be water in the Hypochondria, we must the longer insist upon driers and strengtheners of the Stones. Avicen uses fearing Irons, in the region of the Groin, to corrugate the part, that the water may not fall down. Moreover, in opening there is a twofold intention, to let the water out, and to hinder it from gathering again. Apertion is made by incision or a caustick. If by a caustick, it must be appll∣ed to the place where the water is. Afterwards we hinder the water from gathering again by some ve∣ry drying Medicine, such as this of Aetius; ℞ cerae ℥iss. picis ʒvj. Ammoniaci, thymiamatis ℥ ij. alu∣minis liquidi ʒiss. M. Galen c. 13. l. 14. met. keeps the part open a long time, by putting in a pipe of Silver or Lead. Guido makes a Seton, and keeps it long. Celsus shews the place for incision, where he says;

If it be a Boy that is ill, he must be opened in the Groin, and the water must be forced up∣wards: If an adult person, in the bottom of the Scrotum, and the water must be got out, and the place must be washt with salt water, or nitrous.

But we must observe, that the water be not lost too long in the Scrotum, lest by carrying there, the Stone should be corrupted, or with the water there should grow a Hernia carnosa, and flesh.

CHAP. XXXV.

Of the cure of a Hernia ventosa.

THis is cured by Digestives alone, not with searing Irons, no•• Incision. Paulus describes this; ℞ piperis grana centum, lauri baccas num. Lxxx. nitri ʒxx. cerae ℥v. olei ℥ iiijst. M. All things else may be administred here, as in a Hernia aquosa.

CHAP. XXXVI.

Of the cure of a Sarcocele, and a Hydrosarcocele.

A Sarcocele, or Flesh-rupture comes from a defluxion of thick Humors, which are gather∣ed between the coats of the Te∣sticles. The thick Humors are two, Phlegm and Melancholy, of which, Scirrhi, and fleshy hard∣nesses are bred in other parts as well as in the Testicles.

This swelling is hard, resisting the touch, indolent, and if it be an exquisite Scirrhus, it is with∣out sense. If it come from Melan∣choly, the colour is sublivid: If from Phlegm, it changes not the colour of the skin: If from adust Melancholy, there is a pricking pain, and the swelling is not all alike, but here soft, and there hard.

This requires the same cure with a Scirrhus; of which we have treated sufficiently in the Doctrine of Tumors. Only here it is worth the observation, that Pulvis radi∣cis anonidis taken for several Months, wasts a Sarcocele: which Matthiolus makes good by the Hi∣story of a Patient, who by the con∣stant use of the said root reco∣vered his health, when before his Physicians had given over all hope in Medicines, and placed all they had in cutting and burning.

However, if the Disease do not give way to Medicines; you must proceed to cutting, which is not without hazard, whether the Stone be left, or it be taken out. And it must be observed in this opera∣tion, whether flesh grows about the coats, or about the very Stones; and whether it stick firmly or loosely, to the substance of the part. This being observed, you must cut quite through the Scro∣tum, till you come at the concrete flesh; which, if it be not strongly fastned, must by little and little be loosened with the Fingers ends, or the handle of the knife from the Stone, or coats, and taken away: But if it be grown firmly together with the part, it cannot be cured without cutting the vessels and the Testicle. In this case therefore the vessels and the Testicle must be drawn out, tied, cut, and sear∣ed. Some fear them with a red not Razor; and so out and sear at once. The rest of the cure is per∣formed as in a Hernia intestinae∣lis.

The method is particular, when a watry Rupture is joyn'd with a fleshy. For then first of all, you must cut and make a hole in some part of the Sorotum about the mid∣dle, not in the bottom, not must it be very large. Having got out the water, put in a very long Tent arm'd with some suppur••∣tive Medicine, as Resina, terebin∣thina, cum thure, ovs vitello & hu∣tyro. Apply an emollient and suppurative Plaster; as Diachylon cum gummi, & axungia porei. And when Pus is bred, it must not be evacuated at the hole, but kept within on purpose, that by its con∣tact it may by degrees putrefy the flesh. Nor must the Medicaments be changed, unless all the flesh be turned into Pus, which requires a long time. Nevertheless this is the safest way: And it succeeds well, even in the greatest Rup∣tures.

CHAP. XXXVII.

Of the cure of a Hernia varicosa.

THe Rupture called Ramex varicosus, is, when the veins of the Testicles are dilated and wreathen like Vine-claspers, by some melancholick Humor.

The cure, as to the whole Body, is the same as in a Scirrhus. The part affected is holpen by Medica∣ments and manual operation. The Indications are three; To repel the influent Humor; To evacu∣ate and dry it up, when slown

in; and to astringe the dilated ves∣sels.

Astringents answer all these in∣tentions; for as they are cold and binding, they repell the influent Humor: As they are drying, they dry it up, when come thither: And by their binding quality, they astringe the dilated veins. These are approved Medicines; Succus hypocistidis, balaustia, gluten pisci∣um, malicorium, bolus Armena, sanguis draconis cum ovi albo, &c.

If the disease will not give way to Medicines, we must have re∣course to the knife and fire. Here we must observe in what place the Varices lye; whether in the veins of the Scrctum, or in the next coat, or in the Tunica vaginalis, or in the body of the very Testicle. If they lye in the Scrotum, the veins must be seared with thin and sharp irons, which must be fixt in the di∣lated veins, where they are conglo∣merated: Afterward things must be applied to take off the Eschar: Then Lonticula cum melle: And at last Sarcoticks. If the veins be tumid in the coat, which Pau∣lus and Rufus Ephesius call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, incision must be made in the groin, and at it the Memb••ane together with the Stone must be extracted. Afterwards the dilated veins must be separated from the coat, either with the Fingers, or the handle of the Pen-knife: Then the vessels must be tied in two places, and cut off above the Ligature. If the Rupture be in the Elytroeides or V••ginalis t••mica, and only a vein or two dilated, you must proceed in the same manner as when it is in the Dartos, viz. Having open∣ed the Groin, and the veins being tied, and cut, the Testicle must be put up again: But if all the veins he swollen, they must be tied and cut out with the Testicle. If the Rupture be between the inner∣most coat and the Testicle, inci∣sion must be made in the Groin, the vessels extracted, the Testicle cut off, and the place seared. Pau∣lus here uses a distinction accord∣ing to the judgment of Leonides: If only some of the vessels that nourish the Testicle, are become varicous, they only must be cut off and separated, and the Testicle must be put up; but if all of them are so, then the Testicle, as well as the vessels, must be taken away; lest it, being destitute of nutrient vessels, should waste and ••ot away.

CHAP. XXXVIII.

Of Amputation of a Member.

THE next thing, which in my proposed Method I am to treat of, is the Extirpation of a Part, when by a Gangrene, Wound, Fracture, or some other accident, it is become not only useless, but dangerous to the whole, Ne pars sincera trahatur. In this Case it becomes the Chirurgeon to ac∣quaint the Friends with this kind of Remedy, and withall to make his Prognostick accordingly. But before we proceed in this Opera∣tion, we shall take notice of what some knowing Authors have writ hereof. For in those places where Amputation cannot be made, as in the Buttock, Shoulder, Back, &c. Fab. Hildanus proposes the use of potential Cauteries applied to the mortified Part, and often renewed, till the last Eschar reaches to the live Flesh. Yet he condemns Ar∣senick, as being venomous, and producing many dangerous sym∣ptoms. This method in Sarcomata has been used with good success: but in a Mortification there ap∣pear to me many greater inconve∣niences that attend it. First, from the Caustick it self, as he proposes it, of Salts: It will melt in the working, and is more disposed to spread in the Skin, than penetrate deep into the Flesh. This every young Chirurgeon knows in his making of Fontanels, that he can∣not apply a bit of Caustick so lit∣tle, thô he use all his Art in de∣fending it, but that it will have spread much farther than he de∣signed it. Then, the separation of such Eschars is too slow to ef∣fect the design: and in an ill habit of Body, such Medicaments are apt of themselves to procure a Mortifi∣cation rather than Cure. Whereas on the contrary, an actual Caute∣ry answers all Intentions: It not only consumes the Mortification, but dries up the venomous humor, thereby preventing its further pro∣gress; and also communicates warmth to the languishing parts, by vertue of which the separation is much farthered. But where An••∣putation it self is feasible, nay al∣together necessary, as in the Limbs, there arises a new Question, whe∣ther it ought to be done in the sound part, or in the dead. Fab. ab Aquapend. advises, the dead within a fingers breadth of the live (as also do many others) then with a Cautery they burn up all the remaining Mortification. Others

perform the Operation with a hot Knife. Aquapendent speaks so con∣fidently of his success in the pra∣ctice of this way, that utterly to deny the thing, were to give him the Lye. I shall only make this Objection, That the Sphacolus does seldom affect the Member so equally round, as that an Opera∣tion in the dead part is feasible: nay, which is worse, when once the Mortification seizes in the great vessels, it runs up so fast under the skin, that before any considerable part of the Member is outwardly gangrened on the one side beyond the Knee or Elbow, the other side will have reached to the Inguen or Axilla. This, I confess, frustrates all manner of Amputating, whether in sound or mortified parts. Yet generally speaking, the Gangrene grows not so fast, but that if you make Amputation two fingers breadth, more or less, within the live Flesh, you may prevent it; and that for better than it is pos∣sible to be done by the other way of operating. For if you work there by actual Cautery with a hot Knife, your Knife will stick fast in the Flesh till the moisture be whol∣ly driod up, and then you must re∣peat many Knives and Canteries, in every one of which you will meet with the same inconvenience: yea, before you can cut through with your hot Knife, it is very probable that you will near the Bone meet with some parts that are alive and sensible, especially when you come to the Periosteum, (for the Mem∣branes do not usually corrupt at the same rate of swiftness with the Flesh) and then all your pains and trouble will be as great or greater, than if you did it in the sound part. Hildanus mentions several other in∣conveniences, who has taken pains to confute this opinion.

Both these ways of Amputation seem to me much more difficult and painful than our common way; which makes me presume they proposed them, to prevent the effu∣sion of blood.

But modern Chirurgeons have answered this Objection, by good bandages and deligation of the ves∣sels, and when we cut above the knee by clapping Cauteries to the vessels only; which sufficiently an∣swers that intention. Now I shall briefly deliver the whole Doctrine of Amputation.

In heat of Fight, whether it be at Sea or Land, the Chirurgeon ought to consider at the first dres∣sing, what possibility there is of preserving the wounded Member; and accordingly, if there be no hopes of saving it, to make his Am∣putation at that instant, while the Patient is free of a Fever, &c. Therefore that you may the bet∣ter make your judgment of the Wounds, I shall give you some few Remarques of such as require Amputation, viz. If a Leg or Arm he shattered by splinter or great shot, the loss of substance will di∣rect you. If the principal Muscles be torn off, and the Bone fractured in pieces, or if the wound be with Musquet-shot in the inside of the joint of the elbow, or in the knee or ancle, with a fracture of the bones of the said joint, nay, sup∣posing it has not fractured them, yet if the Bullet be so lodged that you cannot extract it, you shall then presently make extirpation of

the part. If it be the Arm, cut it off in the place where it is so shat∣tered, and saw off the end of the Bone smooth, your assistant the while pulling up the musculous Skin and flesh. If the Ankle be thus maimed, you shall then cut off the Leg within three or four Fingers breadth under the Knee, in regard so long a stump would be troublesome. But if the Leg be shattered off by the calf, do not put your Patient to the pain of new Amputation, for the short∣ning it a hands breadth, or a little more. Save what you can of a shattered Hand. And if the Toes with part of the Foot were shot off, cut off the lacerated parts smooth, but with care to save as much of the Foot with the Heel as you can; it being much better than a wooden Leg. But if the Arm or Leg be not so shattered, though the wound be large on one side, and hang gaping down with great fracture of the bones, yet be not discouraged; the large∣ness of the wound will make for your better pulling out those ex∣traneous bodies, shivers, splinters, rags or ought else, and for the ea∣sier discharge of matter. Dress it as a wound by a splinter.

If the great joynt be so shot by Musket-bullet, that you think it not reasonable to cut off the Mem∣ber, be sure you make extraction of the Bullet, and free it of all ex∣traneous Bodies, leaving not the least shiver to prick the Nerves or Tendons: and make such way pre∣sently, that you may be able to dress the wounded Nerves, Ten∣dons, &c. without making new in∣cision, when the part is inflamed and unfit for it.

If after some days the wound do not digest, but inflame and Gangrene, and the Gangrene do not yield to your applications; then, as in a Sphacelus, you are to proceed with the extirpation of the rotten member, while the Pa∣tient is free from Delirium, and has strength to bear the opera∣tion.

Seat him so as it may be for your conveniency. At Sea they sit or lye, no great matter which; nor has the Chirurgeon any body to hold them; but with the help of his Mates, and some one or two that belongs to the Hold, he goes on with his work. Yet where we have convenience to proceed more formally, we always place the Pa∣tient to our most advantage, where he may be held firm, and in a clear light, and so that our assistants may come better about us. The Member is to be supported by some one, whilst another stands behind the Patient, and draws up the skin and musculous flesh. Then make your Ligature two fingers breadth, or thereabout in the sound part; so that if you ampu∣tate in case of mortification, you may be sure to quit your self of it.

This Ligature is omitted by many of our Chirurgeons here in the City, they only making a turn with a Tape, pinning it on as a mark to circumcide by: and in∣stead of the Ligature I propose, they make a gripe, which gripe is commonly made by some assist∣ent, who has strength to do it. In∣deed this is good, where a shatter∣ed Membrane is to be cut off, to smooth the stump; in which case

there is no great fear of bleeding. But in Amputations it seems to me to be very inconvenient: for I ne∣ver yet saw any man so gripe, but that still the Artery bled with a greater force than was allowable. It being so, in what a huddle is the stump then drest? But sup∣pose the uneasie posture, and the long griping tires the griper; or that his hand be crampt the while, what condition is the Patient then in? Whereas by this ancient way of Ligature, the vessels are secu∣red from bleeding, the member be∣nunimed, and the flesh held stea∣dy, ready to receive the impressi∣on of their crooked knife (or, razor, which many have amputa∣ted with.)

This Ligature made, the assi∣slent strengthens it, whilst he draws up the musculous flesh. In the mean time the Operator, with a sharp crooked knife, by a turn with his hand, cuts the flesh off round to the bone; then with the back of it he scrapes the Pericste∣um from the bone; if there be two bones, then with a dividing knife he scparates the fleshy Mem∣brane from them. The bones freed of the Periosteum, Guido proposes a linen cloth, and Hildanus a kind of Purse, to be brought over the upper divided flesh, to pull it up∣ward, and make more way for the Saw. But I think that needless. The flesh divided, the parts sepa∣rate enough of themselves; besides, the assistents pulling up the mus∣culous flesh and skin is sufficient. That done, you are at liberty, whether you will cauterize the vessels by a Button-cautery, or by Ligature stop the bleeding, or by agglutination. The use of Chal∣canthum I do not approve. To apply escharoticks to the ends of the Nerves and Tendons newly in∣cised, causes great pain, weakens the part, and makes way for Gan∣grene; it not being likely you can so apply them to the Artery, but that you must burn the parts about, which are, as I said, the Nerves, &c.

The way Hildanus proposes, by drawing the vessels out by a Forceps, is not a work to be done in heat of sight, nor without a clear day-light. If you attempt it on Land, his Arm would be bowed, and his Leg stretcht out, that the vessels may be the longer after extirpation, that you may the better take hold of them. Am∣brose Parey proposes a more easie and sure way of deligation, by pas∣sing a Needle with a strong twist∣ed thread through the skin near the great vessels, by piercing through the raw flesh and skin: then make your Ligature upon a fold of rag.

Thus you bind the Artery and Vein. These several ways have been practised by eminent Chirur∣geons for the stopping the Blood in the Arteries in Amputation, but the late discovery of the Royal styptick has rendred them of less use. But in heat of fight it will be necessary to have your actu∣al Cautery always ready, for that will secure the bleeding Ar∣teries in a moment, and fortify the part against future putrefacti∣on: they requiring after cauteri∣zation no such strict bandage, as that thereby you need to fear in∣terception of the Spirits. When

we cauterize the Artery, we do then touch the end of the bone, it hastning exsoliation.

The next thing is the loosning the Ligature, and bringing the Lips close over the stump. Then whe∣ther you should with a cross stitch hold them so, or content your self by bandage, as well as you can, is by some controverted. They that object against the former, say, it causes pain and inflammation. So does bandage also, if it be made too strait. Therefore they should object against that also. The most that are done without the cross stitch, are the next dressing broad stumps, some of them with Lips turned outward by the bandage; in the least of them the whole stump is bare: whereas in those in which the cross stitch is made, the Lips are found close to the bone at the next dressing, cover∣ing the great vessels, and a third part, or half of the stump is well digested; and oftentimes by the second dressing near agglutinated, so far as it lies under the skin, and without inflammation happily cu∣red. Whereas the broad stump is a certain sign of a long cure, and commonly the death of the Pati∣ent. If the musculous flesh and skin are well pulled up in time of Amputation, and brought over by a moderate extension as far as they will easily admit, you will find it not painful. You ought to pierce the skin with a needle and strong brown thread, ceared about half an inch from the edges of the Lips.

Having made them cross from side to side equally, tie them with a moderate astriction, then apply a pledgit on the cauterized vessels with pulv. rad. irid. succ. cepar. cum melle. But if no cautery was used, then buttons of Tow spread with your restrictive, and dipt in pulv. Galeni, must be applied to the mouths of the vessels.

Afterwaads sprinkle the stump thick with this powder; ℞ b••l. Armen, farin. volatil. picis naval. an. ℥iiij. aloës, thuris, mastich. sang. dracon. an. ℥j. gypsi ℥jss. pil. lepor. corii raspats, an. ʒiij. Misce s. a. You may mix some of the same cum album. over. and ap∣ply it upon a thick round stupe, which has first been wet in oxycrate and dried; and over that another stupe spread with the same, so broad as to come over the first, and up a pretty height above the stump. This latter must be snipt deep in the edges, that it may lie smooth about the Member.

An Ox-bladder ready cut and wet is to be turned over••••t, and a cross cloth next the Bladder, to hold the dressings ••eady.

Then with a Roller with two heads begin upon the stump, and rowl up to the next Joynt, and so again about the Member, to re∣tain your dressings firm. Then fasten it so as that it may not be capable of falling off.

But before you make this ban∣dage, you ought to apply your defensative over the parts above the stump. Some apply it before they begin the Amputation: but then it is apt to wrinkle, and to sit un∣easy. In the dressing of the stump you ought so to apply your Medi∣caments, that you may without much bundle rowl up the Mem∣ber. Then place it to the ease of the

Patient, one holding his hand some while upon the stump. Your De∣fensative may be such as is used in Gun-shot wounds, or, ℞ far. hord. bol. Armen. an. ℥iij. sang. dracon. ℥iss. Flor. ros. rubr. balaust. nuc. cupress. pulv. an. ʒij. acet. ʒx. al∣bum. ovor. num. viij. ol. ros. & myrtill. an. ℥j. cerae q. s. Boil these powders in acetum, then add the rest to it, to make it of the consi∣stence of a Cerote.

The third day take off the dres∣sings; and then you may cut the cross stit••h, and sprinkle the wound with pulv. Galeni, and dress it with this digestive; ℞ terebinth. lot an decoct. hord. ℥iij. ol. lumbr. ℥ j ss. gum. elemi dissolut. in praedict. ol. ℥ss. farin. hord. eribrat. ʒ ij. vi∣tell. unius ovi, croci pulv. ℈j. Misc. Apply to the bone a pledgit of dry Lint, or prest out of spir. vini.

After the wound is digested, you may deterge with mundif. Para∣cels. or apii, or this: ℞ Terebinth. Venet. lot. in spir. vin. ℥ iij. pulv. rad. irid. aristoloch. rot. sarcocoll. thuris, mel. ros. an. ʒj. Then in∣carn and cicatrize, as has been pre∣scribed in compound wounds.

CHAP. XXXIX.

Of the extirpation of a cancerous Breast.

IF notwithstanding all your en∣endeavors to cure a Cancer, the Tumor increase, and be like to ul∣cerate, you may do well to fore∣warn the Patient of the danger: and if it be loose, and in a place where it may be safely extirpated, propose it to them, lest afterwards they desire it when it is too late.

That you may be the more suc∣cessful in the operation, I shall of∣fer to your consideration these few qualifications. First, that the Pati∣ent be of a strong constitution, and of a tolerable good habit of Body, and not in a declining age, when the Menstrua are ceased. Second∣ly, that the Cancer be loose, and the axilla free from painful glands. It were also to be wisht, that the Cancer took its original from some accident, as a bruise, &c. Third∣ly, that the operation be perform∣ed in the Spring, or Autumn of the year: lest through the great heat of the Summer the spirits be resolved; or by reason of the ex∣treme cold in the winter, the na∣tive heat should be choaked.

In order to the operation you ought to have good rollers, com∣presses, restrictive powders, and defensatives, as in other amputati∣ons. The use of Chalcanthum or

other escharoticks I do not ap∣prove: for you cannot apply them so to the mouths of the Arteries, but they will corrode the adjacent parts, and cause pain, which ought not to be, especially in a Cancer. Besides, they require a strict ban∣dage, which is very troublesome on the Breasts. To avoid which in∣conveniences, I propose the stop∣ing of the Blood by a small but∣ton-cautery; which I acknow∣ledge is not done without some pain, but that is momentary, and serves to correct the indisposition of the part: whereas the other lies gnawing so long as it is upon the part, and renders it crude and indisposed. There ought to be actu∣al cauteries of different sorts ready heated in some corner of the cham∣ber, lest in the extirpation there happen to be lest some reliques of a cancerous gland behind. All things being ready, the Patient must be placed in a chair to the light, and held steady. It is then at the operators choice, whether he will make a Ligature about the basis of the cancerous Tumor, or pull it to him with one hand, while he cuts it off with the other. For the cutting into the Breast, and pulling out the cancerated knot, rarely succeeds well: nor indeed is every Breast so capable of being freed of the Cancer, when it is cut off by making a Ligature. If the Cancer be cut off clear, your business is then to stop the blood as you please: but if any scirrho∣sity remain, you shall do well to consume it by actual cautery. The Ancients used in these operations to permit them to bleed freely; nay, provoked them to it by crush∣ing out the blood; after which, the actual cautery was applied all over, then they dressed the wound as a burn: but according to my me∣thod pulv. Galeni is most proper. Then palce the Patient in bed, and give her an auodyne draught that night, to quiet the ferment. The second or third day after you may dress her with some digestive, as that ex terebinth. cum vitello ovi; or, ℞ terebinth. lotae ℥iij. syr. de ros. siccis, ℥iss. succ. plantag. so∣lani, an. ℥ij. succ. apii ℥j. co∣quantur ad dimid. succor. consum∣ptionem; dein adde far. hord. & ciceris an. ℥ss. croci ℈ij. vitell. unius ovi. Misc. But if there be no pain, dress it with Empl. è bolo. After digestion proceed with deter∣gents, and incarn and cicatrize as in wounds; remembring to keep the body soluble the while by Cly∣sters, or purge and bleed as you see occasion. And if they had no Fontanels before, make them some now: for thô the Cure may seem successful, yet if there be any evil quality in the Humors remaining, the Ulcer will scarce cicatrize.

If in cicatrizing it the Lips do grow callous, attempt the eradi∣cating timely by actual cautery, whilst it is within a narrow com∣pass, and lies in the superficies: for if you defer it till it has siezed the Musculous flesh, it will be too late, it being then scarce capable of pal∣liation. Yet some Authors have left us prescriptions, whereby they give us hopes to cure them or extirpate them. Those they have offered to us for the cure are much the same with what I have already set down, viz. ℞ ol ros. corae alb. an. ℥ij ss. succi granat

& solani. an. ℥ ij. cerussae lotae ℥ ij. plumbi usti loti & tutiae praep. an. ℥ss. thuris, mastich. an. ʒ ij. fiat imguentum s. a. Or, ℞ unguenti tutiae Vigonis ℥iiij. theriac. Venetae ℥j. sacchar. Saturni ʒ j. succ. ge∣ranii q. s. ducantur in mortario plumbeo, &c. Others commend the juice of Mullein boiled with Honey. Riverius tells you in one of his observations, that he cured one by often dressing it with aq. ros. plantag. & rhoead. with a mix∣ture of mel. rosat. Aetius proposes extract. Sumach: but that is more proper in Cancers of the Ʋterus.

Empiricks amongst us brag much of their skill in curing of them; and, by the giving of Mat∣thews's Pills, or Opium mixt with some purgative, they do now and then alleviate pain, and thereby encourage diseased people to com∣mit themselves into their hands, whom if they can perswade to an Amputation, they get some Mo∣ney in hand: but their frequent miscarriages in that work, have taught the more prudent people to avoid them.

Some eminent Chirurgeons, I suppose, after a fruitless endeavor to cure them, have attempted the extirpating of them by Escharo∣ticks. Guido has commended to us Arsnick powdered and sprinkled daily upon them, the Eschar be∣ing first pulled off. Riverius in his observations tells of a Cancer that was extirpated by this appli∣cation. ℞ aq. fort. ℥ j. sublimati crudi ℥ viij. salis Ammoniaci ℥ ij. arsenici ʒ j. These are to be di∣stilled ad siccitatem, then the ca∣put mortuum powdered, and the like weight of Vinegar to be put thereto, and distilled again to the consistence of a soft paste for use. Ol. arsenici, aq. regia, ol. vitrioli, lap. caustic, &c. have been propo∣sed. When such are applied, there will be need of good defensatives. By the Authority of some of these Authors, young Chirurgeons have been sometimes ingaged to their prejudice: and some years since an eminent Chirurgeon, since decea∣sed, undertook the eradicating of an ulcerated Cancer in the Breast of a Woman that had strength and courage to endure it. He applied the strongest of the fore-mentioned Escharoticks: they penetrated deep and made great sloughs, which he pulled off, and by repeating the Escharoticks raised new; but the use of them was not long continu∣ed: for the gleet partaking of the corrosives, ulcerated the adjacent parts; and the Cancer was so en∣raged by the Escharoticks, as shew∣ed there was no good to be done by them. Indeed if they had con∣trived Medicaments, that could have penetrated deep with little pain, there might have been some hopes of success. So cancerous ex∣crescences and Ulcers in the Mouth are increased by touching them with Oil of Vitriol, Sulphur, &c. Upon which consideration there remain but two ways, either the actual Cautery, or palliative Me∣dicines. If the Cancer be in such a place as you may hope to eradi∣cate it, the actual Cautery is then a sure help: but not by applying it lightly upon the upper parts; but by thrusting at the root with a scoop, or chisel-like Cautery, car∣rying it away before you. If there remain any rags of it, with a pro∣portionable

button-Cautery, burn it down to a crust: but if this can∣not be effected, then endeavor pal∣liation by such Medicaments as a∣bove have been proposed. And in case the Menstrua or Haemor∣rhoids be stopt, bleed by venaese∣ction or by Leeches, and make Fon∣tanels: for by such means many people live tolerably well, who have Cancers ulcerated; when others, who ailed less, by their impatience are dead.

CHAP. XL.

Of taking away Blood by Venaesection, Scarification, and Leeches.

THô one would think that but little skill were required in opening a vein; yet it often so happens, that this very thing cre∣ates trouble to the Artist, and no small pain to the Patient, either when the Artist cannot undertake the work, or, if he does undertake it, when he cannot attain his in∣tended end.

When he does not undertake it, it is either because the Vein that should be opened, does not appear, or the Chirurgeon cannot find it. In which two cases, as the first saves the Chirurgeon blameless, so the latter argues either want of skill, or dulenss of sense. In the int••rim however, thô not to un∣dertake a thing upon occasion of∣fered, discovers the slenderness of the Chirurgeon's skill; yet such an one is to be born withal, yea, in some measure to be commend∣ed: Since it is better to do nothing at all, than to attempt any thing timerously or rashly at another's peril.

But when he undertakes the thing, and attains not his desired end, this happens either because the vein was not touched, or if it was, not as it ought. It was not touched, either because it lay not there, or the Lancet reached it not, or divided it not right. Which soever of these things happens, it is absurd, and alien to Art; un∣less it happen through the Patient's fault in snatching the Limb away before the Chirurgeon has done his work. If the unskilfulness of the Artist be in fault, it is either because the bandage was too loose, or some way incongruously appli∣ed, by reason whereof the vein cannot be kept tight, but slips away from the hand: or because it is not full enough, but falls down flat, and resists not the in∣strument:

or because the instru∣ment is blunt, or wrong thrust in.

A vein is ill divided when the incision is too narrow or too wide, or not correspondent to the incisi∣on of the skin. When the orifice is too wide, bleeding in ones sleep may be feared. When it is too narrow, besides, that it bleeds not as one would have it, a Tumor arises about the wound, which the Greeks call Thrombosis. And the same thing happens, when the incision of the vein and skin is not the one correspondent to the other; which happens several ways. Either because the skin is drawn out of its place by the sillet; or by the Thumb which stays the vein: or because the Lancet is put in too obliquely.

But there are worse mistakes than any yet mentioned, to wit, when the Nerves are hurt, or an Artery is touched. And the mis∣chief is, it afflicts the Patient the more, for that he finds his calami∣ty and destruction to proceed from what he expected health or help by. Whoever therefore would be accounted a skilful Artist in this thing, he must endeavour all he can to avoid those mischiefs: Which he may easily do, if he will but right∣ly consider, what out of good in∣tent, and confirmed by frequent experience, I here set down.

First of all, the Artist's hands must be warm, and the Patient must sit upon a Bed or in a Chair (but it is better in Bed, because of swooning) then either the Limb must be so brought to the light, or the light to the Limb, that the place of the vein may be so con∣spicuous, as that his hand, when he goes about his work may not be in his light. Some may think this caution about the light superflu∣ous, but I have often observed Chi∣rurgeons in a fault herein, and by consequence mistake. Then band∣age must be made, so as that the vein may fill, and be extended.

But in tying the fillet two things must be observed, which are chil∣dishly neglected by many. The first is, that the hand (if the vein be to be opened in the Arm) be kept open till the fillet be tied as it should: for so it afterwards ex∣presses the Blood out the better, when it is tied. Another thing is, that when it is sitted, the skin over the vein be neither drawn up (as most do) nor on one side, nor any other way out of its place. For this, when it returns to its pro∣per place, stops up the wound of the vein; and it returns again presently, when the string is but a little loosened. In Bodies where the veins are full of Blood, little skill serves the turn and every Boy is reckoned an Artist sufficient: But in scarcity of Blood, or strait∣ness of veins, or when they lie deep, or are inconstant, more skill is required, both to find out and know the vein, and to keep it, and also (which is the main thing) to open it right.

When the fillet is thus fitly tied, if the vein be eminent, or conspi∣cuous to sight, or manifest to the touch, it must be opened as soon as there begins to be any reni∣tency in it; for by tarrying it grows more obscure, whereby the work is also rendred more dif∣ficult.

The fittest place of Section is that which is safest, and most pa∣tent. I call that safest, which is farthest from the Nerves and Ar∣teries; and that most patent, which is highest, and most manifest.

But when the fillet is tied, and the Limb a little rubbed, if the vein still lie hid, recourse must be had to hot cloaths, and somenta∣tions of warm water: and if it be not found out by these, it will scarce appear by any other means. Wherefore the Lancet perhaps must not be thrust in there; but some other adjoyning vein, if it be turgid, must be opened.

The narrowness of the orifice is holpen by inlarging the wound; and so the stoppage of it is holpen by removing of what stops it. But greater care is required in mending the narrowness, than if the vein had not been touched before: be∣cause the Blood is continually dif∣fused between the skin and the vein, which by forcing up the skin disjoyns it from the vein. There∣fore as soon as the skin at the wound rises into a swelling, it must presently be softly pressed with the Thumb, that the violence of the blood may be forced back, and the rising swelling deprost: Then the Thumb must by degrees be taken off a while, till the wound appears and gives room to the operating hand or instrument to operate. Then the Lancet must be gently and carefully put into the first Section, and the incision en∣larged as much, as the first Secti∣on was deficient. But great care must be taken in this operation, that only the skin be not (as it often is) dilated without the vein; because then the labour would be to no purpose. The instrument therefore must be put again mo∣derately into the cavity of the ves∣sel, and the wound must be suffi∣ciently enlarged according to Art. But if the return of the skin hin∣der the efflux of Blood, it must be gently reduced into the same place, where it was when the vein was cut, that the division of it and the vein may meet together, and it must be kept there, till as much blood is run, as you would have.

But it happens also, that the skin, or rather all that is over the vein, covers the wound of the vein, which nevertheless is not drawn out of its place; And this happens when the vein lies deep, and the Chirurgeon puts in his Lan∣cet too much slanting, and does not raise the point, but pulls it out the same way he put it in. When this happens, if you would make the Blood run (supposing the vein sufficiently divided) you must with a very small Probe or a pin's head, either raise the skin, or depress it a little, till the Blood runs as you would have it: for by this means, either the vein is a little separated from the skin, or the skin from the vein, and way is made for the Blood.

When a sufficient quantity of Blood is taken, and the fillet is loosed, and the vein on each hand softly expressed, or exgurgitated (if I may use a Chirurgeon's word) that the lips of the wound may not gape, and may joyn the better, laying the Thumb of the mini∣string hand on one end of the Se∣ction (it is the best on the lower) the skin must be drawn according

to the rectitude of the wound, and a small pledgit of Lint or Cotton must be laid upon it, and neatly tied, that it may not bleed again afresh, nor the Limb be pained by too strait binding. But if it be difficult to stop the blood, either because of its thinness (as when the blood is very serous) or be∣cause of the large orifice, then with the Thumb, the fore and middle Finger of the left Hand, the skin must be drawn to each extremity of the Section in a right line with the Section, and so the blood is stopt: or, if you list, the edges may be closed up by applying your Thumb and fore-Finger, not to the ends of the wound, but to the sides: but the first way, if it can be done, is the best, and fittest for the business.

When the blood is thus stopt, and the edges of the wound fitly joyned together, a bolster of Cob∣webs, or (which is safer) half a Bean, or (which is best of all) a piece of bole Armenick, made in∣to the form of half a Bean or half a hazle-Nut, may be laid upon the wound instead of a bolster; which being covered with soft Lint or Cotton, must be so artificially bound on, that the too great astri∣ction hurt not, nor the too great laxity occasion its bleeding again unawares. When these things are done, all bodily labour and motion of the Limb must be forborn. This our advice may be contemned by several; but certianly by such as little regard their Patient's Life: for sometimes it has been known, that People have died through neg∣ligence in this very thing. Where∣fore since a Bean, or a bit of Bole is not of any such weight of bulk, as to encumber a Chirurgeon much, no one should be without them, who frequently lets blood.

And if an Artery chance to be cut, and it cannot be stopt the foresaid way, nothing is more pro∣per and safe for the Patient's safe∣ty, than to bring close together, and exactly to joyn the edges of the Section, then to cover it with the foresaid Bole, and carefully bind it, and then with the Hand gently and constantly to retain and press it till it grows together, and this cure must be used for se∣veral days.

We have already told you how to stop Blood, and how to recti∣fy Venaefection, when it is perform∣ed amiss, how many ways one may mistake, and how mistakes may be avoided. Now it remains to shew (a thing worth the while not to be ignorant of) how an unexpected cutting of an Artery or Nerve, and the pricking of a Tendon may be avoided: how many ways of open∣ing a vein, how the Lancet should be managed: and several other things.

We must therefore know that the veins, which Physicians order to be bled, have no where Arte∣ries, or Nerves, or Tendons lying above them, nor lying at an equal height with them; but under∣neath them in several places, yet not in all, which (besides the assu∣rance an Artist has from dissecting dead bodies) is easily seen in the Hands, Feet, Hams, Arms, and other parts of living People. From whence it is evident, that he who pricks a Nerve or Tendon together with a Vein, must have run his

Lancet in deeper, than was neces∣sary to let blood; since to perform the business required, it had been sufficient to have cut the upper part of the vein, next the Skin or one side of it, and not to have stab'd it through on both sides.

A Nerve indeed, when in this case it is wounded, can hardly be discerned, before it is hurt, and there is not another in the whole body, that I know of, which is usually hurt; besides that, in the middle of the bent of the Arm, that lies under the common vein (or rather the Tendon of the mus∣culus biceps.) But Tendons, be∣cause of their frequency and mag∣nitude, are oftner touched, but with less danger than when a Nerve is hurt. They are hurt sometimes by chance, when the Lancet is run in too deep, and sometimes when the Chirurgeon mistakes, and pricks a Tendon for a Vein. And as there are some who mistake a Tendon for a Vein, so on the con∣trary there are others, who some∣times, when the Vein appears not to sight, but only to touch, dare not open it, believing it to be a Tendon and not a Vein.

When therefore a Limb is tied, and the Vein is not apparent in the place, where it is usually found, and some round thing is perceived deep under the skin, of which you doubt, whether it be a Vein or no, presently loose the fillet: for when it is loose, the Vein will fall, and cannot be perceived again, till the fillet is tied. Therefore if what you felt, appear the same, both when the fillet is tied, and when it is loose, you must with∣hold your Lancet, since this must needs be no Vein, but a Tendon, or the head of a Muscle, or some∣thing beside a Vein. Wherever Arteries are, they beat; by which both their place and depth are de∣clared to any Artist, who has but competent experience.

Swooning frequently happens in Blood-letting, which uses to cre∣ate to the by-standers, yea, and to unexperienced Physicians more fear, than hurt to the Patients. Yet it happens through no fault of the Artist, but the faint-hearted∣ness of the Patient, which disturbs the spirits in the Body, and checks them, which makes the Soul seem to depart. But this is immediate∣ly prevented; namely, if the Pa∣tient lye along, and hold some liquor, as water or wine in his Mouth till the blood runs. And if notwithstanding it seize one, stop the blood with your Thumb laid to the orifice, and presently throw some cold water in his Face: If it continue longer, you may also pinch the Nose; and when the fit is over, take off your Thumb, and take away what Blood in prudence you shall think sit, but stop it not, as some over-timerous persons are apt to do. If it take one sitting, he must be helped the same way the other was to be preserved from it: he must presently lie on a Bed, or be gently laid on his back up∣on the ground, and have cold wa∣ter thrown in his Face, as was said before: For an Artist may easily perceive it coming, if he look in the Patient's Face, or if he observe his Pulse; for that is pale, and this alters its stroke. But as it may ea∣sily be perceived, and is raised on so slight occasion; so neither is it

hard to get off, nor when a Pati∣ent is seized by it, is it difficult for him to be restored to his Senses, Thô at its coming it cause some terrible motions of the whole Bo∣dy, quivering of the Eye-lids and Lips, and other things of that na∣ture; yet they are presently over. Which is not so in Swoonings, which proceed from over emptiness.

Now we must speak of the form of Section, and its manner of per∣formance. By the form I mean the manner of its position, and its magnitude. By this we call the Section either large, small, or mid∣ling: By the other, transverse, or oblique, or length-way of the ves∣sel. Long Section is better than transverse. Oblique is the best, and easiest to be performed. As to the manner of doing of it this way or that way, tho it may more easily be apprehended by once seeing the work well done, and the observation of it, than by ten times reading it with the clear∣est voice; yet because every Scho∣lar cannot have an expert Master, and reading (well understood) is of some efficacy to direct the Hand, it will not be amiss to sub∣joyn somewhat of these things.

The Limb being the way before∣said tied with a Fillet, and the Vein appearing tense, either to the sight or touch, it must presently be opened with a well-pointed Lancet; not perpendicularly, run∣ning the Lance: in suddenly (as many do, who make more haste than good speed) but obliquely, and thrusting it in gently. When the Vein is perforated, the Lancet must not be drawn back the same way it went in: but suddenly the point must be raised, and the heel of the Lancet depressed, which Chirurgeons properly enough call elevation. And that you may do this the more commodiously, you must hold your Lancet at a good distance from the point, about the length of a long Bean; not that all of it should be run in, but to perform the thing the better, which when it is taken too short, cannot well be done. Besides, it makes well for this thing, that the opera∣ting hand, whilst it operates, be not pensil, but supported by the rest of the Fingers which hold not the Lancet, leaning on the Pati∣ent's Limb.

A sudden stroke is to be con∣demned upon this account, be∣cause, besides that it often fails the Artist, it is in danger of hurting a Nerve or an Artery, because there can be no aim or measure in a sudden thrust.

Now if an oblique pertusion do not please you, the Vein may be opened length-way or transverse. But as an oblique Section is prefe∣rable to all the rest, so a trans∣verse is worse than any. The Se∣ction may be called broad, when it is broader than is necessary for a free efflux of Blood. Strait, when it is straiter than it should, and in this some Tumor presently ari∣ses. And that is midling, by which, without either Tumor, or superflu∣ous Wound, the Blood passes freely.

That all these things should be done as they ought, the Artist must be Ambidextrous, because the Patient's right Arm and right Foot, and the left Temple require the left Hand, and the opposite

parts the right. Yet all Veins may be opened, either with the right hand or with the left, if the Artist be but handy in either of them; thô not so commodiously. Where∣fore it will become a good Chi∣rurgeon, to have both hands rea∣dy and well exercised, not only in opening of a Vein, but in any other business proper for a Chirur∣geon, which can scarce well be done, when one Hand is useless.

There are divers places in Man's Body, and many Veins, wherein Physicians advise Bleeding. In the Forehead, one at each Temple, which has often two branches, one in the middle of the Forehead, which has sometimes two, some∣times three branches. Behind the Ears, and at the Nose by the great corner of the Eye. Sometimes bleeding at the tip of the Nose by putting a Lancet about the depth of a Pumpion-seed between the cartilages, does good. Two under the Tongue. Two Jugulars, which sometimes also have branches. Three in the bent of the Arm, of which the Basilick or Hepatick Vein branches into several twiggs. In the left Arm this is called the Splenitick. The Cephalick has seldom any branches in the bend∣ing. The common arises from the Cephalick and Basilick, it is called the Median, Purple and Black Vein. From this comes that they call Fu∣nis brachii, from which comes the Salvatella to the Ring-Finger, and another to the Thumb. One in the Yard, and sometimes two. One at each Ham and each Ankle, where if they cannot be found, they must be sought at their ends, namely towards the Toes on the upper∣part of the Foot. Of all these if that cannot be had, which is sought for, the next must be taken, and of those that are divided into seve∣ral branches, the largest is to be chosen, except in the Jugulars.

The form and use of the fillet is the same, to demonstrate and keep tight the Vein, in all parts be∣low the Neck. Nor is the other obscure, which is put about the Neck, for the Veins above the Breast. For the manifestation of which, a Towel is put about the Neck, and the ends of it brought forward, which are given into the Patient's Hand, and twisted like a Cord, till the Veins appear: Hold∣ing ones breath is also good for this.

Now we must treat of scarifying and Leeches. Scarification has one general cause, namely the dis∣charging of the part, where it is made. Therefore according to the magnitude of the Part, the vehe∣mence of the Burthen, the depth of that which should be got out and its faultiness, the wounds must be more frequent, deeper, larger, or straiter, shallower and thinner: for thin, small, and cutaneous sca∣rifications are proper for Diseases, that lye not deep nor are grievous; but for stronger Diseases, as for a Gangrene, other Scarifications are more suitable.

There is no part of the body but may be scarified, if either it be Gangrened, or troubled with an old Inflammation. Scarificati∣ons are sometimes used, where there is neither Gangrene nor In∣flammation, but where they are feared, as in venomous bitings and stings, suppose of the Aspe, Scor∣pion,

or other venomous beasts; for which nothing is better, than to make speedy scarification upon the very sting or bite, and near about it, making two, three, or at the most four wounds. In the stinging of a Scorpion, if there be but one pricle, one scarification made upon the prick is enough. In the bi∣ting of Asps, because they bite with several Teeth, or in other bites or stings, in which more than one print of a sting or tooth is left, one may make a wound upon eve∣ry prick or bite. When there is neither Gangrene nor Inflammati∣on, nor suspicion of either, scari∣fications are used for derivation, with Cupping-glasses or Horns.

All scarifications are better made with a Rasor than with any other sort of instrument: But with Cupping-glasses, the German Lan∣cet is the best.

The application of Leeches is not effectual enough for Gangrenes of the greater Limbs; thô it serves the turn well enough, when a Gan∣grene invades the less parts of the Body, as the Ears, Nose, Fingers, Yard, and the Piles either inward or outward; but scarifying is quicker and safer than Leeches: However, for soft and effeminate persons (who are affrighted at the very name of an instrument) they are often used instead of the knife.

They will not stick unless the skin be clean, and free from filth and ill scent. Wherefore if they be to be applied to any part, where there has been an Ointment or Pla∣ster, it must be clean wiped, so that it may resemble nothing but pure flesh. Sometimes a slight scratch is made, like that where Cupping-glasses are applied, that the sense of the Blood there may make them stick. They will hard∣ly fasten in winter time, unless they be kept in a warm place.

They are kept in a glass, or earthen vessel full of water, and well covered, that they get not out; but so as to admit the Air. They may be used at any time, namely, either the very day they are taken out of the River or Lake (unless they have been new∣ly fed; for then they would not readily stick) or when they have been kept several days. They will hold good for half a year, but el∣der they are ineffectual, either through hunger or sluggishness, or for some other reasons. Where∣fore, when you can renew them, it is better to do it every second or third Month.

When a Leech is fastned, it must be let stick, till it fall of it self, or if it must be taken off sooner, strew a little Salt or Ashes on it, and it immediately leaves the skin. If you would take away more Blood, than it can contain, snip the Tail with a pair of Scissers, and it will nevertheless suck Blood still, which runs out at the wound: Yet it will fall off of it self, or by lay∣ing Salt or Ashes on its Back.

CHAP. XLI.

Of the couching of a Catarrhact.

A Catarrhact is called in La∣tin Suffusio, in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, the Arabians call it water, it is commonly called a Catarrhact, the denomination, as I suppose being taken from Catarrhacta a Portcullis, which being let down stops all passage. For a Catar∣rhact falling down from the Head into the Eyes, stops all passage of the light and vision, whereupon the Patient afterwards grows blind.

This impediment is caused by a pituitous humor growing within the Eye like a tunicle, or a speck, or drop, or film, or water, which appears like a white coat to them that look on it, and this is so, when it is confirmed; for in the beginning when it is growing, it looks not like a coat, but like smoke, or vapor, or a mist; whence it comes to pass, that ac∣cording to the various density of the humor, the Sight is hindred, as when one sees through a thick Air and Smoak, or through a Mist. The various position of the humor likewise makes a great difference; for thô it be always op∣posite to the Pupilla or sight of the Eye, yet it is sometimes ex∣actly against the middle, and the space round about is free; then in the middle nothing is seen; but round, all things appear. In short, according as the humor possesses this or that part of the Pupil, so the sight must needs vary.

This humor grows in the Eye chiefly by reason of the weakness of the Eye, occasioned by a fall or blow, or some other cause, that weakens the Eye, which since of its own nature it is cold, by weak∣ness it is made colder; wherefore no wonder if signs of coldness af∣terwards appear in it, to wit, the breeding of a cold humor, its con∣cretion, density and obduration, I say, of a pituitous matter, which at length grows hard in the weak∣er part of the Eye, such as is the aqueous humor, which Galen makes to be the excrement of the Eye, so that from what has been now said, It appears why Phlegm becomes concrete in the Eye, and why in the aqueous humor, though there be various opinions in what part of the Eye exactly it does con∣geal. Celsus l. 7. c. 7. will have it grow between the two coats, the Cornea and the Ʋvea, where he holds there is an empty space, which I think not altogether so consenta∣neous to truth. Paulus l. 6. c. 21. holds it to be in the Membrana cornea, as appears from his own words, A Suffusion, says he, is the

concretion of a superfluous humor in the Membrana cornea near the Sight of the Eye, which I take to be false, thô Paulus says otherwise, l. 3. c. proprio, namely, that a Ca∣tarrhact is an effusion of humors, which congeal between the Tunica ceratoides and the crystalloides. Ga∣len de usu partum c. 1 & 4. writes that it grows between the Cornea and the Crystalline: which saying of Galen's is so general, that by it we are no wiser than we were. But it has been frequently obser∣ved both by operators themselves, and by such as have looked on, when the needle has been put in backwards behind the Ʋvea tunica, that it has appeared before the Suffusion; which perswades me, that the Humor congeals at the hole of the Tunica uvea, or about its circumference, or a little behind it in the aqueous humor. But since the hole of the Ʋvea is dilated, one would think, the concrete humor should lye just behind the hole of the Ʋvea, because if it grew in its circumference, it could not be di∣lated. However, this objection is answered by Paulus, who will have the suffused Eye prest with the Finger, and if after the com∣pression and motion the pupil be dilated, it is a sign of no confirm∣ed Catarrhact; if it be not di∣lated, it is a sign it is confirmed, which it is convenient to know in order to a cure.

The best way of cure is by Me∣dicines, when it can be done; and it may well enough be done by them, when it is fresh, and not per∣fectly congealed. In this way of cure innumerable Medicines are found in Authors, called Eye-salves or Collyria; but all to no purpose, because whether they be Powders, Liquors, or Ointments, the Eye has such an aversion to them, that it will not suffer them to be appli∣ed, or if it be forced to receive them, yet in the twinkling of it they are turned off; for the moti∣on of the Eye cannot be hindred. All which things considered, lea∣den rings have been invented, to keep the Eye steady; but to no purpose: for the Eye would have its motion, and then the Medicines slipt off. At length it was found possible to keep Medicines on the Eye, thô it should move. This is performed by a Glass vessel, or Cupping-glass, whose mouth is just as big as the ball of the Eye: In this Liquors and Waters, and with them Powders may be put; and the Cupping-glass may be appli∣ed first with the Eyes shut, and then by degrees opening the lids; by this way it is experienced, that Medicines will tarry long on the Eyes, and do good. This is a ge∣neral course, whereby most diseases of the Eyes may be cured, whe∣ther external or internal. First of all, Cupping-glasses were used, which would let some of the Li∣quors run out; but afterwards oblong Glasses were more exactly sitted to the Eye, with Ears, through which strings are put and fastned behind the Head, And be∣cause Water, which is applied to the Eyes, ought to be lukewarm, to the end the cold may not offend the Eye, but may raresy it, and cause the Medicine to penetrate, and since warm water evaporates, and the vapour not finding a pas∣sage out, may draw the Eye, and

bring humors thither; therefore the glasses were made with a pipe at the top, to let out the expiring vapor. And thus a most apt and convenient vessel is invented, viz. to keep a thin and watry medicine to the Eye, whose contact the Eye will easily endure: It is also useful to put in more Liquors at, as by a Funnel. Among those infinite Me∣dicines, which are proposed by Au∣thors for the cure of Suffusions, this is one of the best, used in man∣ner aforesaid. It is this, Aqua eu∣fragiae, chelidoniae, & rosarum cum medico Aquae vitae primae distilla∣tionis. In this there is a dissolving, attenuating, and penetrating facul∣ty, which are the main intentions in the proposed case. So far the Medicinal part, now we proceed to the Manual operation.

When the Suffusion is perfect, then all are for having it cured by Chirurgery, because Medicines do but irritate the Eye, but do no good, because of the concretion and hardness of the Suffusion; whereas the Needle will do the work by couching it. But first, I say, the Cure must be tried by Medicines, while the Patient has some glimmering of Sight, as through Smoak, or a Vail, or Mist: For if there be any further loss of sight, the Suffusion is consummate, wherein because of the concretion of the Humors, and the thickness of the Membranes, the Sight is quite hindred, which can only be helped by Chirurgery. And this operation is one of the nicest in the whole Art. In Latine it is called Catarrhactae depositio, in English Couching of a Catarrhact. For, as I said, it so happens, that a Membrane or very thin pellicle, such as comes upon Wine or Beer, does some∣times stick to the inner part of the Tunica Ʋvea, where the hole is, that we call Pupilla, or the Sight of the Eye, and it covers the Cry∣stalline humor, and hinders the in∣let and the out-let of the rayes. This, when it has acquired a due consistence, and is neither too flu∣id, no: old and tough, may be ta∣ken away and couched by the be∣nefit of the Needle. The Body therefore being purged, in the de∣crease of the Moon, on a clear and serene day, the Patient must be set on a seat in a clear place, against the light; over against him the Operator must sit, but a little high∣er: A Servant must stand behind the Patient, and hold his Head immoveable. The sound Eye must be bound up with a Ribband. And the Chirurgeon, after having chew∣ed a little Fennel in his Mouth, must breath upon the Eye affect∣ed, and rub it a little with his fin∣gers, and bid the Patient turn his Eye towards his Nose. Then the Needle being often prickt into a flannel or woollen cloth, to make it warm, must be forced (with the right Hand, if the left Eye; and with the left, if the right be ill) at one thrust through the Con∣junctiva, about the thickness of a Crown piece, just by the Iris, and by degrees, as it were by dril∣ling and turning it round, must be got through the Cornea. When it is come to the empty space, any who has but moderate skill, can∣not be mistaken, because when he presses he feels no resistence. Then the Needle must be inclined to∣wards the suffusion, and with its

point must by little and little be separated from the edge of the Ʋvea, and then by turning it gently must be wrapped about it, and must be couched, and violent∣ly forced beneath the region of the Pupilla, to the outer corner of the Eye, till it stick there. When this work is done, the Needle must be drawn out gently, and the white of an Egg beaten up and mixt with Honey, to hinder Inflamma∣tion, must be applied between two fine silks, and so the Eye must be bound up. After this, Rest, Ab∣stinence; and a moist and cooling Diet will be proper.

CHAP. XLII.

Of Lithotomy, or Cutting for the Stone.

THE next thing in our pro∣posed method, which we are to treat of, is the Stone. And because the extracting it, or inci∣sion for it, called Lithotomy, is an operation so difficult, that Hip∣pocrates by his Oath, obliged him∣self not to meddle with Lithoto∣my; but to leave it to Men skilled in that operation: I think we can∣not do better, than in our discourse concerning it, to venture on no∣thing upon our own Authority or Credit, but to relye wholly on them who have made it their main business to cut for the Stone. And thô several have writ on this subject; yet I shall only make use of what one of my Collegues, Dr. Groenevelt (of whose Lithotomical administra∣tions I have been an Eye-witness, and of whose success therein, not only I, but multitudes are wit∣nesses) has made publick on this subject.

As to the Etymology, accord∣ing to the Philosopher, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, We must first enquire the names of things. Now the Stone, called Calculus, is derived from Calx, for it is a con∣crete body hardned like Chalk in∣to a Stone. The Greeks call it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the pain proceeding from it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; only the Stone in the Kidneys they call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, because the Greeks call the Kidneys 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. And thô any disease in the Kidneys might properly enough be called Nephritis; yet since the vi∣olence of the Stone causes the most exquisite pain, it is 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 peculiarly so called.

From what has been said it is apparent, that by the word Stone we mean a hard Body, grown into the form of a Stone, especially in the Kidneys and Bladder.

Here to be solicitously inquisi∣tive,

whether the Stone be a Di∣sease,, or the cause of a Disease, or a Symptome, would be fruitless: For these are but mere curiosities about the name, and in a diffe∣rent respect may be differently re∣solved, I think, (thô Galen thinks otherwise) it can scarce be called a Disease, since it is no bad dispo∣sition of any part. It must be owned to be a cause, since it is apt to occasion obstruction, ex∣ulceration, racking pains, and the like: And when it is voided, it may be reckoned among sym∣ptomes.

What the subject of the Stone is, I suppose all Men know well enough, namely the Kidneys and Bladder, which, as if they were wombs designed for that very pur∣pose, are found pregnant with Stones, and are often delivered of them with most violent Throws. Here a question may arise, whe∣ther the Stone be bred in the Ca∣vity, from whence the Ureters pro∣ceed, and in the Tubuli, or in the very Parenchyma of the Kidneys? I know not how to deny either, because not only my own experi∣ence, but several great Men's ex∣periments, such as Eustachius, Fo∣restus, and others evidence the same. But it is to be obser∣ved, that the Stone which is bred in the very substance of the Kid∣neys, if it be of any bigness, can∣not fall into the Pelvis, without dilaceration, since the Caruncles, which Anatomists call the Mamil∣lary Processes, and through which alone the passage lies, are so small, that they will scarce admit a hair of ones Head. And what has been said of the Stone in the Kidney, the same in a manner may be un∣derstood of the Stone in the Blad∣der, to wit, that it has two pla∣ces; one in the cavity of the Blad∣der, in the midst of the Urine, another in the ends of the Ure∣ters, between the double coat of the Bladder, where falling small from the Kidneys, it sticks and sometimes grows: For the Ureters are implanted in the Bladder not far from its Neck, and before they come into the cavity of the Bladder, do pass the double Mem∣brane of it a fingers breadth, in the ends whereof within the very duplicature of the Membrane a Stone sometimes grows, not float∣ing in the Cavity, but sometimes firmly knit to the coats of the Bladder.

Yet here we will not deny, but that Stones may grow in other parts of the Body, since the Au∣thority of Hippocrates 5. Epid••m. Hist. 25. makes it good, and so many experiments of famous Men, and my own experience evince the same. Joh. Van Horne of blessed Memory, formerly Professor of Ana∣tomy and Chirurgery at Leyden in Holland, in my Memory and Pre∣sence also, took several Stones out of the Brain of Adam Stuart, who while he was alive was Professor of Philosophy. The famous Ferne∣lius observed Stones of different hardness in the Lungs. Twice at an Anatomical Dissection here in London, I found divers Stones in the Gall-bladder. I saw a Stone as big as a Walnut voided by a Wo∣man in her Stool, who before that had been continually troubled with the Heart-burn.

Mr. Tolet a Chirurgeon of Pa∣ris

says, he saw a Man who twen∣ty years before that, had voided a Stone at his Navel. Capiv••ccius. Parieus, Senn••rtes, S••••••••ger, and other famous Men, will furnish the curious Readers with several such Observations.

The opinions of Physicians in assigning the Cause of the Stone, we found repugnant and contrary one to another; for some, who have raised their contemplations to things Divine, endeavour to fetch the cause of the Stone from the beginning of the Creation, infli∣cted as a punishment of our Apo∣sta••••e by the Almighty Power on Mankind, thinking it nothing strange, that what had its original from Earth should turn into Earth

Ʋndeg••nto d••r••on sum••s, —

As O••••d sang Met••m. 1. Fab. VII. Whence we are said to be of a terrene Constitution, and carry Bones about us equal in hardness and solidity to Stones, such as is the Os petr••s••m in the Organ of Hearing, and the Teeth, to which the most wise Creator has assigned a middle nature between Stones and Bones. But the most com∣mon and received opinion, both among the Ancients and Modern, is, That the cause of the Stone in the Kidneys must be ascribed sole∣ly and only to the burning heat of the Kidneys. For they will have it, that thick, viscous, pituitous, and tartarous excrements, as they call them, which they hold to be the material cause of its genera∣tion (for they assign a twofold cause, the material and formal,) are by little and little dried, and when the thin and moist parts are wasted, that they are converted into the form of a Stone; just as we see Chymists and Chirurgeons bake their medicamentous and cor∣rosive Stones out of several juices of Herbs and Minerals, by exhala∣tion in a gentle heat. But in how great difficulties this opinion in∣volves Men, is apparent enough to all, but such as veneration for An∣tiquity has quite blinded: for does not daily experience shew, that Stones are bred in old Men, in phlegmatick Women, and in others of a cold Constitution? See Hippo∣crates Sect. 3. Aph. 31. They far∣ther urge; If a viscous and tough Matter may by the heat of a Fur∣nace be hardned into so hard and stony a matter, why may not a vis∣cous matter he hardned into a Stone, by the preternatural heat of the Body? I Answer, First, is any mortal able to endure such a heat in his Body, as the heat of an Oven is, which is required to 〈◊〉〈◊〉 the viscous Matter to so great a hardness? Secondly, is the case the same with the Stone, which is drowned in Urine, and with Bricks which are dried in a red hot Kiln? If Stones were bred only by a mo∣derate heat, (as some are of opini∣on) they would dissolve again in water; as we see Clay, dried in a mo∣derate heat, dissolves, if it be wet again. If they came from heat, Fevers Continual, Symptomatical, Habitual, and I may say Maras∣moides, would ensue. And this Quirk gives but little satisfaction, An intense heat is perceived here, since the heat does not precede the Stone, but does occasionally arise from it, as we find heat, when a Thorn is got into the Finger, but the Thorn is not caused there by the heat.

To think here to recount the various opinions of dissenting Au∣thors, would be superfluous; while some think the Stone grows from excess of cold, (thô in a Body, and in parts, hot enough) and con∣geles like Ice. Others fly to the refuge of occult qualities. And some, who like not such words, maintain that a certain saline l••∣pidisick Spirit, and the natural vo∣latil earth of Urine, as they call it, are coagulated, and so a kind or new Entity, by Helmont called DUELECH, is produced in the Kidneys or Bladder; just as Wood, Plants, and Animals thrown into some waters, are said to be turned into Stone; and, as they say, whole Troops of Horse and Foot (if we may credit History) have in some places been turned in∣to Stone by a certain Spirit expi∣ring out of the earth; but in the mean while they consider not, that this lapidisick and penetrating Spi∣rit (granting such an one to be in the Urine) does not so much pro∣duce the Stone in it, as it rather imbues the Kidneys and the rest of the Body with a lapideous Nature, and must, as in the example al∣ledged, change it into Stone. Le•• it suffice us now to add something, and (with deference to better judg∣ments) briefly to lay before you the most simple and most intelli∣gible Cause.

From the Analysis of Urine it is evident, that it consists of vari∣ous parts, for besides the great quantity of water found here, which makes up the basis of the Urine, and a small portion of bile, gi∣ving it a golden, or rather a ci∣••on colour, and also a pituitous matter, swimming on the surface, and sticking to the pot, which makes that part, they call the Corona; there is moreover a saline and certain earthy portion, which from the necessary Aliment is mixt with the Urine, and by the t••ste and contents is found to be in it, and resides naturally in all Urine. Now this gross, earthy, and less agita∣ted part (which we make to be the material cause of the Stone) with which, perhaps to make it thicker, a little Salt is mixt, whe∣ther it be over-luxuriant in the bo∣dy through some taint in the Vi∣scera of Chylification or C••••mifi∣cation, or that it is not sufficient∣ly mixt with the ••••st of the parts of the Body, or that through the excessive quantity of it, in what it is taken in (where with many Ali∣ments must needs abound) it can∣not be mastered and separated in the Stomach, and that it passes thence with the Chyle through the Guts into the Veins, and be∣ing carried with the Blood through the ventricles of the Heart into the Aorta, it at length gets into the Emulgent as they call it; there this stops, either in the very little extreme branches of the Artery, or in the flesh next them, or if it be able to get out of the Ca∣runcles, that are extuberant like little paps, it stops in the T••buli and the Pelvis, and is apt to stick there, it becomes contiguous, and at length continuous, and there it becomes first a small Particle, which (with Fernelius) we may call the Nucleus, and do believe, as he does, that it is the rudiment of a larger Stone, which afterwards a like matter and new food gather∣ing

there more and more, it daily grows one shell over another, till at last, no gluten intervening, be∣sides the immediate contact of the least Particles, it becomes a Stone, made up as it were of many plates, as we see in peelings of Onions, and in the Bez••ar Stone, which is made up also of many coats, and so it increases gradually, as is evi∣dent to the curious searchers of Nature.

That arenous and calculous con∣stitution of the Kidneys, which Fernelius and most of his Adhe∣rents insist upon, if you will give it a favourable interpretation, may be allowed, understanding by it not a certain occult quality, and lapidifick virtue (which some would make fiction of) differ∣ing from the manifest causes; but rather an over-straitness of the Pores, and it may be of the little vessels which are in the Kidneys, and through which the Urine ought naturally to be transcolated, whe∣ther one hath it so from the day of his birth, thither also we refer an hereditary disposition to the Stone; or that as he grows in years, he gets it by the res non naturales, as they are commonly called; for we may easily imagine, that this less moveable and agitated matter, since it is gross and of an earthy nature, whenever it finds the ways strait, through which it ought to have an open passage, is apt to stop, (Of this we have a familiar instance in the churning of Butter, where on∣ly by agitation the Butter is sepa∣rated from the serous part of the Milk, because the particles of the Butter are less apt for motion than those of the Serum. The most in∣genious Des Cartes Princip. Phi∣losoph. part. 4. p. m. 14. does ve∣ry learnedly shew, that such a se∣paration is also made in Must) and at length, in process of time, after the manner aforesaid by further and further accretion it is formed into a perfect Stone.

As to the Stone in the Bladder, whose generation differs not from the formation of the former, we have no difficulty to struggle with; only we may observe, that it has not always its rise in the Bladder; but sometimes owes its rudiment to the Kidneys. About three years since we took two Stones from a cer¦tain boy, and when we had search∣ed whether there were any more Stones in the Bladder, we found none: Two days after a third came out at the wound, the Boy was tormented with continual pain, and want of sleep, so that being trou∣bled with a vomiting, a continual Fever, Looseness, and such like symptomes, he at length expired. We dissected him, and found the Pelvis of the right Kidney full of divers Stones, and the Ureter as wide as a small Gut. But to our business, a Stone grown in the Tu∣buli or the Pelvis, and sometimes a little one in the very Parenchyma of the Kidneys passing the canal of the Ureter, when at the end thereof it comes to the straits between the duplicature of the Bladder, it may sometimes stick, and there stop∣ping that Cavity, thô it can scarce hinder the passage of the thinner and more slippery Particles, yet it retains the grosser, and being thus increased, does often stick ve∣ry fast to the coats of the Bladder,

and breeds a secondary Stone (if I may so call it) therein: The same we suppose may be done in the cavity of the Bladder. For if a small Stone of the Kidneys find passage through that narrow pas∣sage, we mentioned; and if it be detained in the Cavity, when it is not voided by the Ʋrethra, it ac∣quires an increase through the con∣tinual apposition of new matter in manner aforesaid. As to the pri∣mary Stone of the Bladder, as they call it, I have no occasion to add much, since we must acknowledge the efficient and material causes to be the same with those of the Stone in the Kidneys; nor do they differ in any thing except in the subject. Yet some cannot chuse but admire, what way a Stone can be formed in the midst of that flood of Urine, by means where∣of one should think a dissolution of the Stone must rather be pro∣moted, (whereby perhaps Fernelius was enclined to derive all the ru∣diments of the Stone from the Kidneys) but the wonder will ea∣sily cease, if one have ever seen the tophous concretions, and some∣times the perfect Stones, which grow upon the Sea-shoar and Ri∣vers Banks, not unlike the Stones that are formed in humane Bo∣dies.

The remote and mediate causes, by means whereof a calculous mat∣ter is communicated to the mass of Blood and the Kidneys, are intem∣perance, and a disorderly way of living; for excess in eating alone, as in Children, is sufficient to afford matter for the Stone. Because it often so happens, that through this excess, abundance of Humors flowing through so many vessels, the Glands being filled beyond measure, and the passages of the Chyle being either obstructed or compressed, the publick coction is much endammaged; or there be∣ing a gathering of corrupt and pu∣tresied Juyces, the Mesentery be∣comes the seat of slow Fevers and stubborn diseases. And this cor∣rupt mass does not only occasion an intemperature of the whole Bo∣dy, but it also causes an ill constitu∣tion of the Organs, breeds matter for the Stone, weakens the Sto∣mach, extinguishes its spirituous serment, and gives rise to soure belchings, fluctuations and rum∣bling in the Guts. Such a food I account Bread, not well fermented nor well baked, to be; and Cheese, which is hard of concoction, breeds sowre belchings and wind, it can scarce enter the passages of the chyle out of the Guts through the lacteal veins, it breeds obstructi∣ons, it makes the Blood tough, and out of its terrene salt breeds the the Stone. Hereby I do not pre∣scribe to strong, found, and lusty Men, whose Affairs will not admit of a Medical way of living. To such (because according to Hippo∣erates, Sect. 2. Aph. 50. Things to which one has been accustomed, thô worse, use to giveless disturbance, than things to which one has not been accustomed, or because custome is a second Nature) I would re∣commend the best sort of Cheese in moderation. Beef, Pork, Goats∣flesh, pickled, and smoak-dried Meats, are hard of concoction, and afford an earthy juice. Ducks, Geese, and other Water-Fowl breed superfluities and excrements. To

these you may add all Pulse, raw Herbs, boiled Wheat, and Rice, unless they be mixt with inciders and detergents. Hard Eggs, stony Pears, Crabs, Cornelian Cherries, Medlars, and such like Fruits, of a gross and austere nature, straiten the passages very much, and afford an exceeding thick juice. Sharp Spices, as Pepper, Ginger, Cubebs and Mustard are bad. Among Drinks apt to breed the Stone these are of the number, new Beer, and too much hopped; for Alder boil∣ed in large Coppers with Hops, and covered with Sand in a Cellar for three years turns to a hard Stone, of which we make the best Whet∣stones to sharpen Anatomica•• in∣struments upon. Also sweet Ale, foggy and not fermented, thick and fenny water, or of melted Ice, and any that has a remarkable taste, which argues the nature of the place whence it comes, and brings along with it the virtues of Alume, Sulphur, Iron and the like, and therefore ought not to be account∣ed merely Drink, but medicated al∣so. Drinking cold water is bad for such as sweat after labour. Wine that is red, troubled, sweet, the Moravian, Hungarian, Cretian, Ita∣lian, Malmsey and Spanish, in which a saline tartar never fails, gets into all the vessels of Man's Body, sticks to the Kidneys and Joynts, and breeds knots and stones. For in Wine there is a thick substance, which in tract of time sticks to the sides of the vessels, and is cal∣led Tartar, which is found in a great quantity in Rhenish Wine, and cau∣ses much hurt. But it is not the gross Tartar alone that breeds the Stone; for besides the Water and Tartar in Wine there is a Spirit, from whence all Wine has its strength, as the Austrian Wines have less Tartar than Rhenish, yet they do more mischief; and no wonder, because Spirit of Wine is nothing but Tartar resolved in∣to its Principles; for this Spirit consists of a little Oil, much acid, and a volatil Spirit, which is the reason why tartarisate Spirit of Wine is far stronger than simple Spirit. And hence also a reason may be given, why Spirit of Wine, and several generous Liquors fur∣ther the breeding of the Stone.

And besides Meat and Drink, the rest of the res non naturales breed the Stone. Neither satiety nor fasting, nor any thing else that ex∣ceeds measure, is good, accord∣ing to Hippoc. Sect. 11. Aph. 4. Hither may be referred excessive study and care. And the use of Venus is exceeding hurtful. If you would know the reason, there is in us (according to Hippocrates) something that is salt, sharp, &c. which by the immoderate use of Venus is made sharper, so that there∣by it is increased more in quality than in quantity: for the sweetest or fat part of the Blood is partly wasted with the Spirits, partly with the Seed, and what remains is made sharper and sharper, and so being separated and by it self, it is more violent, and does the more mischief. Hither you may add im∣moderate motion after eating, dan∣cing, riding, fencing, &c. whereby rumbling in the Stomach is caused, concoction is hindred; crude Chyle is carried out of the Stomach, and the heat is forced outwards. Idleness does as much as excessive

motion, the powers of the body are thereby as it were suffocated, the matter being retained within; whence it is, that we find slothful and fat Persons, and such as live a sedentary life, frequently subject to the Stone.

Travelling in Winter through stony and mountainous places; for it is well known that Travellers, especially upon an empty Stomach, and in winter-time, fall into a Bo••∣limus, which makes them subject afterwards to divers obstructions. Retention of the Excrements and Urine gather abundance of crudi∣ties in the Body, chill the natural heat, produce noxious vapors, and so cause the Stone. The Spaniards confirm the same, who void a great deal of Gravel with their Urine; and therefore are not sub∣ject to the Stone, as Riverius up∣on this subject writes, Violent passi∣ons of the Mind are bad, especially Grief, Anger, and Fear; Grief does insensibly, and by little and little, waste Men's strength, cool and dry the Body, hinder Digestion, and beed sower and bad humors. Anger breeds Fevers, moves Choler, and disturbs the Spirits. Fear breeds an Acid, wastes strength, and di∣minishes the vital effervescence. Boëtius gives good advice;

Gaudia pelle, Pelle timorem, Spem{que} fugato, Nec dolor adsit: Nubila mens est, Vincla{que} fraenis, Haec ubi regnant.

And an hereditary disposition de∣rived from the Seed and Blood (as it were by right of Succession) contributes to the breeding of the Stone. This consists chiefly in a weakness of the expulsive faculty, and in an innate fault of the Blood. Astrologers add to these causes the conjunction of Saturn with Mercu∣ry in the eighth House, which, they say, disposes the Child so born to the Stone. But whether the in∣flux of the Stars be able to effect so much in our Bodies, I submit to better judgments.

If we consider the differences of Stones, they are various and di∣versly distinguished. In regard of quantity, a Stone is said to be el∣ther large or small. In respect of colour, red, yellow, ash-coloured or black. This diversity of co∣lours depends on the external fi∣gure of the concurring Particles, or on some extraneous Matter pu∣trefied, as Pus, Blood, or Slime. In respect of the Figure it is round, oblong, (such an one as I lately took from a Noble Countess's Son in this Land, in the presence of seve∣ral Doctors of Physick) Angular, Triangular, Quadrangular, or slat. But the various figure of the Su∣perficies is owing either to chance, or motion, or to the site of the adjoyning parts: hence the Blad∣der breeds round ones, the Ure∣ters oblong ones, and some seem to resemble exactly the cavity of the Pelvis of the Ridneys. Yet the principal differences are taken, ei∣ther from the Subject, hence it is called either the Stone in the Kid∣neys or Bladder; or from the Matter, which is either thinner or thicker, whereof there be four de∣grees, Sand, Gravel, Tophus, and the Stone. 1. Sand differs from the Stone only in Magnitude, and it receives its minute shapes in the pores of the Kidnies, which (as

Fernelius says) gathering together and cementing makes up the Stone. 2. Gravel, which has its rise from coagulated Sand with a Mucus. 3. A Tophus, thô it has the form of a Stone, and is larger than Gravel; yet it is softer and more friable or b••ttle. 4. The Stone properly so called is solid, hard, and firm as a Rock, And the more plenty there is of a saline and earthy Matter, and the more exactly this is petrified, the hard∣er the Stone is; and the softer, when otherwise.

Thô properly there be no Pa∣thognomonick signs of the Stone in the Kidnies; they being aequi∣vocal, and common to other di∣seases; yet these following may be observed in Practice, as discover∣ing it most. 1. A fixt and stand∣ing pain in the region of the Loins; and this is dull, and causes a sense of weight, when the Stone is lodg∣ed in the very Parenchima of the Kidnies, it being endued with a dull sense; but when it is got in∣to the head of the Ureter, the pain is sharp, cutting, and exceed∣ing cruel. Not many years agon a Patient, who was ill of a stop∣page of Urine, for he voided none but what he vomited, and that had an Urinous smell, was extreme∣ly weakened by it. He consu••ted several great Physicians, and took several Medicines, but to no pur∣pose, for he died of it; and when his Body was opened, the Pelvis of his right Kidney was filled with a Stone, whose lower end was pro∣tuberant like a nipple, and quite stopt up the Vreter; a sharp Stone was so exactly fixt in the head of the left Ʋreter, that nei∣ther Kidney could do its office, and so he died. 2. There is a difficul∣ty in stooping, the Nerves or Mu∣scles of the Spine being thereby compressed and distended. 3. A very troublesome pain in the Back. 4. A numness of the Thighs and Leg on the same side, because of the compression (by the weight of a great Stone) of the Muscle called Psoa, or of the Nerve that is branched out into all the Mu∣scles of the Thigh. 5. A retra∣ction of the Testicle on the same side with the Kidney affected, be∣cause of the drawing up of the ves∣sels, which proceed from the Kid∣nies to the Testicles. 6. Reaching and Vomiting, because of the con∣sent of the Kidneys with the Sto∣mach, not so much by means of the Peritonaeum, (as some would have it) of whole Membrane each participates, as because of that com∣mon Nerve, from the Stomachich branch of the sixth pair, implant∣ed into the proper and inner coat of the Kidneys. 7. Urine often∣times bloody, the little Veins; dis∣persed through the substance of the Kidneys, being torn and open∣ed by the attrition of the sharp Stone: And sometimes about the beginning, the Urine, comes thin, watry, and in a small quantity, be∣cause of the obstruction of the Kidney by the Stone: but when it passes through the Ʋreters into the Bladder, then a thick, trou∣bled and watry Urine is voided. 8. I would have this accounted a main sign of the Stone, when Stones or Gravel are voided by Urine, (which do not stick to the sides of the pot, but presently sink to the bottom) whereupon the

Patient finds sensible ease. And because the Stone and Colick are so much alike, that not only an Emperick, but even a rational Physician may be mistaken; I would have these marks of distin∣ction well observed. If the pain be above the Kidneys, it belongs not to the Kidneys, but to the Bowels. The pain of the Stone tends outwards, nor does it ever depart from that one place, unless the Stone be displaced and slip in∣to the Ʋreter. The Colick wan∣ders, changes place, runs through all the Guts, and comes down to the Twist. Those that have the Stone are better after Eating, and those that have the Colick are worse.

Hippocrates lib. 4. de Morb. does thus recount the signs of the Stone in the Bladder. When he would plss, he is afflicted with pain, and his Urine dribbles from him as in the Strangury, it is bloody, when the Bladder is exulcerated by the Stone, or inflamed. But this sign is not very manifest; however, the end of the Prepuce shews it. Some∣times he pisses Gravel. Boys trou∣bled with the Stone rub and pull their Privities. But since these signs are a little obscure, I will produce other circumstances, that in so difficult a case the truth may better appear. 1. In the begin∣ning when the Stone is but little, the Party troubled with the Stone, after making water, feels a dull pain in his Glans, which pain passes from the Glans along the Ʋreter, to the Bladder, just as if he had the Strangury. For thô the Stone be but little, yet by its asperity it pricks the neck of the Bladder, and so cau∣ses a pain in the Glans, which pain returns from the Glans to the Blad∣der. He that is troubled with the Stone does always in a manner, but especially when he is about to make water, rub the end of his yard with his fingers, squeeze and draw it; hence it is, that Children troubled with the Stone have al∣ways their hands on their Privi∣ties, and by plucking their yard, make it as long again as usual. 3. If the Stone be heavy, the Par∣ty finds a heavy pain, just as if there were a weight hanging at the bottom of his Belly between the Intestinum rectum, and the Os pubis, which pressed them down; besides, he then finds a pain about his Navil, because the bottom of the Bladder is joyned to the Navil by the Ʋrachus. 4. If the Stone does not quite obstruct the passage of the Urine, Nature is often ir∣ritated to discharge the Urine, but in vain; sometimes a little comes away; sometimes, whether he will or no, away it comes, but with pain all the time. 5. Turning the Heels upwards and the Feet to the ground, it often happens, that the Stone slips back to the bottom of the Bladder, and the Urine finds a free passage. 6. Out of the Fit, we often see him that is afflicted with the Stone sitting cross-legged; for by that means the Stone is in some measure raised from the neck of the Bladder, so that the Urine has a free passage. 7. The Urine being kept, and grown sharp and hot, by the excess of pain which it causes, draws spirits to the yard, and so the virite member both in

Children and adult Persons is erect, not out of any Venereal ap∣petite or Lust, as otherwise one would be apt to think. 8. From the consent of the Anus and Blad∣der, because of the communion and connexion of Nerves, which they receive from the same branch, the calculous Person has both a motion to go to stool, and to make water at the same time. But these irritations are in vain; and if any thing be voided, it is but little, and with great pain. In Infants there is often a violent fal∣ling down of the Arse-Gut. 9. Most calculous Persons are continually athirst, and often desire much drink: for thô they void but a little Urine at once, yet because they make water often, they dis∣charge a great deal, and so the Scrum of the Blood is wasted, which Nature endeavors to supply, so as she may keep the inwards in that due temperament and symme∣try. By reason also of their conti∣nual pains, watching and inquic∣tudes arise, the salt part in the hu∣mors is made sharper, and the mass of Blood grows hotter every day than other, which requires much and frequent cooling: Some∣times the Jaundice, Dropsie, or some such disease does ensue upon it. 10. Calculous persons are bet∣ter after Opiates, and worse after powerful Diureticks. 11. Hippocra∣tes Aph. 79. Sect. 4. judges them to have the Stone 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, &c. and Johannes Ze∣chius in consult. med. lib. cons. 58. by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 understands thick Gravel, or a dirty Excrement (like snot) sticking to the bottom of the pot, which is a Pathognomonick sign of a large Stone in the Blad∣der, and that it has been growing there a long time. 12. It is good to be sure, when a Man puts his Finger into the Anus of Children, or a Catheter along the Ʋrethra into the Bladder of grown persons, and to search well, if there be a Stone, whether it be large or small, and whether there be not more than one. For it behoves a Man to know these things exactly. Here also the antecedent causes fall un∣der consideration, namely, of what complexion the Patient is, what his Diet has been, and what Sym∣ptomes he has had; for without doubt he must have had cruel pain, if the Stone be great, hard, and uneven. Moreover, thô it be necessary to know, whether Stones be enclosed in a bag, and by it stick to the Membrane of the Bladder, yet it is very difficult, unless by searching with a Catheter or the Finger. And thus having briefly examined the Diagnosticks, we now proceed to the Prognosticks.

Children, as Hippocrates says 6. Epidem. are most subject to the Stone in the Bladder, and old Men to the Stone in the Kidneys. And Aph. 6. Sect. 61 Diseases of the Kidneys and Bladder are difficult∣ly cured in old Men. A disposi∣tion to the Stone from Parents to Children, through some primige∣nial taint in the Seed does clude all Medicine, be it never so generous, whether intended for the preventi∣on or cure; which made Aretaeus think it a thing much more diffi∣cult by the help of Art, to hinder the Kidneys and Bladder from breed∣ing the Stone, when they have a

disposition to it, than to prevent a fruitful womb from conception. The Stone in the Bladder in respect of Medicines is more difficult to cure than that in the Kidneys; but in regard of Chirurgery, it is much easier; however sometimes, the pain tending outwards to the Mu∣scles of the Spine, and an abscess arising, it has been known that Stones have been discharged that way, and the Ulcer has been heal∣ed. The Stone is a violent and dangerous evil, causing Inslamma∣tions, Exulcerations, cruel Pains, Watchings, Fevers, stoppage of Urine, and other most violent Symptomes. If the Stone be not great but small, not in a Body ca∣chectick, nor abounding with hu∣mors apt to breed the Stone, and if the disposition to it be not he∣reditary, we may draw a good Prognostick thence; if on the con∣trary, a bad one. If the Stone be considerably large and hard, the Patient must of necessity, if he will be eased of it, submit him∣self to Chirurgical operation, thô it be hazardous. But if the Stone be of an unusual bigness and weight, such an one as at the opening of one who died of it near St. Tho∣mas's Hospital, I took out, which weighed nineteen ounces and three drachms, such are to be esteemed desperate, and must not be med∣led with, while they live. They that have the Stone inclosed in a coat, or without one, and sticking to the Membrane of the Bladder, are in the same predicament, as also are old Men, and young Children also, if they be infirm. On the contrary, if the Patient have strength, if he have good Viscera, if the Stone be not too big, though he have several, yet through GOD's assistance, the operation may be courageously undertaken, and good success may be expected. Stones in Women are voided and extracted with better success and security, than in Men, because they have a short and wide passage for their Urine.

Thus much in reference to the Theory being premised, we pro∣ceed now to such things as may be produced from Practice, the foun∣tain of Cure, in order to prevent the invasion of the enemy, and to beat him out again, when en∣tred.

To perform this methodically, we have a threefold care upon us. First, that the causes which are any way able to breed the Stone may be removed, and that so its gene∣ration and encrease may be hin∣dred. Secondly, that when the Stone is bred, it may be got out. Thirdly, that the Symptomes, the cruel pain may be asswaged, and the difficulty of Urine which usu∣ally attends it, may be kept off. These things may be accomplish∣ed by means taken from Diet, Pharmacy and Chirurgery.

In the prevention we must first of all take care, that the bad Diet before-mentioned among the cau∣ses of the Stone be avoided; and on the contrary, that a conveni∣ent one be made use of. Meats therefore must be used which are easy of digestion, afford little ex∣crement, and have an attenuating and inciding virtue. To this end Mutton or Capon-broth, boiled

with Chervil, Sorrel, Barley, and the like, especially in Spring time, are very proper. And if Sobriety and Moderation be requisite in any disease, it is in this,

Illud quod medium est, atque inter utrumque, probatur.

Moreover, the passions of the Mind must be so moderated, that their excess do no prejudice to the Body.

Now we proceed to the proxi∣mate matter, that is, the load of crude and gross humors impru∣dently gathered by a disorderly Di∣et, or from some other cause, which that it may not get to the Kidnies, must be revelled and eva∣cuated; to which end it will be proper to give Purges, such as Manna, Cassia, Diaprunum, &c. Repeated vomiting also is good, (especially for such as are made for vomiting, and who perceive great crudities in the first con∣coction) which if it come of it self, must by no means be checkt; if not, Medicines must be given to provoke it; for by means of it a noxious humor gathered in the Body is often successfully carried off, and Revulsion is forthwith made, so that it falls not on the Kidneys. But if any such like Matter be gotten into the Kid∣neys, it must presently be discharg∣ed by means of Diureticks. For this Intention, Turpentine, and Medicines prepared out of it, are proper. Amatus Lusitanus re∣ports, how a certain Monk by the use of it was cured of the Stone and Gout. The famous Bevaro∣vicins in his Treatise of the Stone mentions an excellent preparation out of I evinus Lemnius; strong French White-wine, having red hot Flints often quenched in it, expels the tartarctis Matter out of the Kidnies, before it grows to a Stone. Also Mineral waters, Timbridge in England, and the Spa•• beyond Seas are excellent, because they have an inciding, attenuating, opening, dissolving and abstersive virtue, Bathing also the Body in River water up till above the Loins, pro∣motes evacuation of Gravel, before it grows into a Stone, especially if some proper Purge be given the day before, and the same day, if some specisique Diuretick be ta∣ken.

The next scope in curing is, to discharge the Stone, when bred. Yet here we must consider, that if there be a large Stone in the Kid∣neys, it ought not to be removed, but if there be a small one, especi∣ally in the Cavity, it must be got out quickly: For when a large Stone is got into the Ʋreters, by the violence of pain that attends it, it often causes Convulsions, and Swoonings, so that if the pain be not quickly asswaged, as well by internal Remedies, as external Fo∣mentations, the Patient sometimes perishes. But before a little Stone be removed, Clysters must be gi∣ven, which may mollify and smooth the ways, by which it is to pass, To which end Henry IV. King of France did often take a Bolus of fresh Butter and Sugar-candy, drinking after it a glass of small Wine. Some commend Oil of Sweet Almonds, or Oil-Olive, Cas∣sia

fistula, and fat Broths, drunk in large quantities. Physicians do with great success prescribe molli∣fying Clysters, made of emollient Herbs and Roots, adding some∣times Diureticks, or only Oil of Chamaemel, Lilies, Sweet Almonds, &c. Avicen believes, that the re∣peated injection of Clysters eases Nephritick pains. Externally they apply Cataplasms made of Emolli∣ents and Fomentations of the same, to which they add coolers, lest pains might be exasperated. They also use Oil of Sweet Almonds, and of Scorpions, with ointment of Marsh∣mallows, for a liniment. It is evi∣dent also, that bathing in fresh wa∣ter with emollient Herbs, adding things also that are good to break the Stone, is a most effectual reme∣dy to make lax the passages. These things being done, Medicines are further prescribed to help the mo∣tion of the Stone, such as are, all that provoke Urine, and are pro∣perly called Diureticks, of which you may find a copious Cata∣logue in Authors, and therefore I shall forbear naming them. But we use to add to these, Anodynes, and lest any inconcocted Matter should be carried to the Kidneys, we a little before give some gentle Purge. And if this method does not dislodge the Stone, when bred, as in other cases, so in this, the ut∣most remedies must be tried, name∣ly a Vomit must be prescribed: For by this means all the lower parts are exceedingly prest, and things are expelled, which could not by any former means be re∣moved. But we must remember to add specisique Diureticks to our Vomits.

When the Stone is big, where∣as we have already said, that we may not remove it, now it re∣mains, that we say what we may do. Whether in nature any re∣medies are to be found, which perfectly dissolve the Stone, ma∣ny doe dispute, and are at daggers drawing about it. If the Stone be brittle, of a loose and soft sub∣stance, and coagulated of Mucus and Sand, it is evident by mani∣fold experience, that such an one may be broke and wasted. Mat∣thiolus and Dodonaeus do for this purpose greatly commend Golden∣rod, and the Chymists their Salts of Rest-harrow, Millet, Bean-shells, Salt of Egg-shells, Salt of Urine, of the Stone taken out of a Man, of Juniper, Ash, volatil Salt of Amber, &c. The Medicine made of Millepedes seems to excell all the rest, for which consult Hart∣man. I am certainly convinced by experience, that Spirit of Nitre does easily dissolve the Stone, when it is taken out of Human Bodies, to the admitation of the beholders. If there has been a calculous dis∣position lodged in the very Seed and menstruous Blood, no cure by Me∣dicine must be used, but only by Diet. For the whole foundation of Health is laid as it were in the Conception, and the good or bad Principles of the future state of Health are thence derived to the off-spring.

The next Indication is answered, if the violent pain (the true rack and torment of Man,) be mitiga∣ted, which is commonly done with one trouble by the Medicines be∣fore prescribed to lubricate the ways; and if these prote ineffectual,

in excessive violent pain we may have recourse to Narcoticks, such as Philonium Romanum, re••••••es Ni∣colai, Landanum optatum, &c. I happened to be called to a Woman above 40 years old, who at first had a great pain in the region of her Loins towards the Puves and Groin; shortly after bloody and purulent Urine followed, also heat and dribling away of her Urine, she had a violent pain when she made water, she had a motion to Stool and Urine both at once, yea sometimes her exerement came in∣voluntarily from her, she was rest∣less and awake night and day, she answered impertinently to what she was asked, she had a fierce wild staring look, which moved the by∣standers to compassion the disease growing worse and worse (several Medicines, yea and Narcoticks, as in an extreme case, being often, but cautiously, given) she at last died. When we had opened her, we found her Bladder full of stinking slimy Pus, and very red, and ero∣ded with an Ulcer besides. We found the U••eters more fleshy than usual, full of Pus and Stones, the right had four white, large, soft Stones, joyned with a saltish, viscid, and filthy Matter; and the left had little black Stones, but harder in it. But in her left hidney we found bloody Pus; and several small Stones, in figure like those in the Ʋreter of the same side. But now to our business; Difficulty in ma∣king water oftentimes occasions great trouble in this case, to avoid which both Diureticks inwardly (but with great caution) and lini∣ments outwardly of Ointment of Marsh-mallows, Oil of Sweet Al∣inonds and the like; as also Fo∣mentations and Cataplasms, accom∣modated to this end, may be used. But if it so happen that the Stone get into the neck of the Bladder, and so hinder the passing of the Urine, it must by lying on ones Back, with the Legs high, and by shaking the Body, be removed thence; and at length, if this will do not good, it must be forced back into the Bladder with a Ca∣theter.

The Dimetick and Pharmaceu∣tick remedies being thus briefly dis∣patched, it remains now that we discourse of the last remedy, name∣ly the Chirurgick. We judge that letting of Blood, if there be a Ple∣thera, or an excessive Fermenta∣tion of the Blood, may be of use. I have often by experience found that Cupping-glasses set to the Loins, have in a Nephritick Fit brought down one or more Stones into the Bladder. If the Stone in the Blad∣der be too big to be expelled, nor for want of a requisite Medicine can be dissolved; if the violence of the disease will yield to no Medi∣cines, then a desperate disease must have a desperate cure. Here I cannot chuse but laugh at Mounte∣banks and Empericks, who brag, how they can break the Stone in the Bladder by giving Medicines inwardly; of whose fruitless at∣tempts I could give you plentiful instances. But at length we are come to the last remedies, and if we will use them, we must pro∣ceed to Cotting (of which Pa∣raeus, Schultetus, Hildanus, Corne∣lius Celsus and others have writ∣ten) But for some days before, the Body must be prepared by Diet,

he must eat but little, and that wholsome food and not glutinous; among other things let him use exercise, to the end the Stone may come further down to the neck of the Bladder, as Celsus advises. When we are certain of the thing, the body must for a day or two before be kept with a low Di∣et, and then the Cure must be ad∣ministred in a warm place, which may be performed divers ways. The first is called the Apparatus minor. All things therefore being in readiness, the fore and mid∣dle Finger of the left hand must be put into the Anus, and with the right the lower Belly must be pressed towards the Bladder, (avoid∣ing violent compression in the case, which might occasion cruel pain, Inflammation, yea, and a Gan∣grene,) whence it comes to pass, that the Bladder being squeezed in∣to a narrow room, the Stone may the better be taken hold of, which being taken hold of, incision must be made in the Perinaeum, upon the Stone, and if the Stone be small, it may be thrust out with the Fin∣gers; but if large, it must be ex∣tracted with an hook. Here we must make no more haste than good speed, for when the Blad∣der is hurt, it causes distention of the Nerves, with danger of death. The second way is Hildanus's, which is performed in this man∣ner; all things being in readiness, the Operator puts in his Catheter (I mean not such an one as we use for suppression of Urine; but one that has a furrow or hollow∣ness in it, such an one as is de∣scribed in Paraeus l. 17. c. 44.) upon the Stone, then with a Razor half wrapt up he makes incision to the Catheter; afterwards upon the Catheter he puts into the wound a Director; that the Yard may be free, he takes out the Ca∣theter; with the Director, if there be occasion, he di••ates the wound, and then by the side of the Direct∣or he puts in his scoops, and draw∣ing out his Director, and putting his Finger into the Anus, he takes hold of and extracts the Stone with a hook, either whole, or piece∣meal, if it be either large or brit∣tle. The third way is, when the wound is made in manner afore∣said, and he puts a Forceps upon the Director; he takes out the Di∣rector, takes hold of the Stone, and so extracts it, this way is of use, when it cannot be gotten out with an hook. The fourth way of operation is called the Franconine Lithotomy, from its. Author Peter Franc, which is performed in this manner; Incisi∣on being made in manner afore∣said, the Lithotomist meddles not at all with the extraction of the Stone unless it appear in the wound, but binds up the wound after the usual manner. After a few days (except the Stone come away out at the wound, of its own accord, which Peter Franc the Author of this invention says, in his practice has often befell him,) he endeavors to extract the Stone, which opera∣tion ought to have place, when the Patient is very weak, as Hil∣danus judges. The fifth way is, when the Stone is so big that it cannot pass by a wound made in the neck of the Bladder, unless ei∣ther the membranous substance of the Bladder, or its Sphincter be

hurt. This, the Author Peter Frane does not propose for any Man to imitate; He only did it in a desperate case at the request of the Child's Parents, upon which he performed the Operation. The Patient was a Child of two years of age, who had a Stone in his little Body, as big as a Hen's egg, (the Author would have it obser∣ved, that this operation has no place in adult persons,) he made Section in the Groin, and the up∣per part of the Os pubis, as is usu∣ally made in a Caesarean Birth, and so cut the bottom of the Bladder, and extracted the Stone. The Child, thô he was much weakened, recovered, and the wound was cu∣red. Hildanus also, in his Obser∣vations, mentions such another example. The sixth and last way is performed by an instrument, which Hildanus invented; Incisi∣on being made in manner afore∣said, he puts his instrument through the wound upon the Stone; this, when it is put in, may be dila∣ted, (like the instrument which we call Speculum matricis) after dilatation, the Operator endeavors to take hold of the Stone, and to extract it, when taken hold of. The famous Lithotomist of Paris, called Collet, cut several very suc∣cessfully this way; from a curious inspection of whom, and of others likewise, the Author of this Trea∣tise has made such proficiency, that among the rest he has adventured on this way of operation, and dai∣ly continues to practise it. In the Female Sex, whether the Party be a Maid or Married, one may with far less trouble, and without Section or much effusion of Blood undertake and perform this ope∣ration. Because the orifice of the Bladder occurs presently to sight in the Pudendum; it is sufficient to put in a Catheter, and below its furrow to put in a Dilator, and then to extract the Stone with a Forceps. Sometimes nevertheless, because of the over-bigness of the Stone, a small incision must be made in the orifice of the Bladder, from which and a too violent dila∣tation, there is danger lest the Sphincter should be hurt, and an involuntary emission of Urine should follow.

Now it remains, the Stone be∣ing extracted, that we discourse, in what manner the Patient must be treated. He must not presently be put to bed. If his Body be strong, the Blood may be suffered to run a while, that the Inflamma∣tion may be less. Then he must sit in a Semicupe, so that he be up in it from his Ruees to his Navel, (all else must be covered with Cloths,) to the end his bleeding may be stopt. In a weak Body the Haemorrhage must immediately be stopt, sometimes a Cupping-Glass must be set to the Groin and Hips, and to the Pubes, if the bleed∣ing cannot be stopt; which when it is stopt, the Patient must be laid on his back in bed. In the mean time the lower Belly from the Na∣vel to the Loins, and the Privities also, must be well anointed with proper Oyls, made a little warm. A Linen Rag two or three times double, wet in some astringent Me∣dicine, may be applied to the Wound. Sometimes a Pipe is put into the Wound, whereby Grave•• and extravasated Blood may more

commodiously be discharged after∣wards: By it also a Syringe may be put in, wherewith, upon ••••gent occasion, the Bladder may be sy∣ringed, and so whatever preterna∣tural is contained in the Bladder may be presently discharged. If a Lipothymy supervene, it may be removed by Cordials, and the Pa∣tient may be laid quietly to rest, which unless it come of itself, must be promoted by moderate Ano∣dynes. And thus, if strength will permit, (Celsus expresly says it,) within four and twenty hours, he must be set again in the bath, and as he is able he must tarry in it; and if he sweat, he must be wiped with a Spunge. In the mean while, if sleep be kindly, breathing free, if the Tongue be moist and thirst little, if he goes well to stool, and but moderate pain with a small Fe∣ver, you may be certain the cure will succeed well. Finally, as much as is possible, we must endeavour, both in regard of Meat and Medi∣cine, that Nature, which supplies the most wholsom Balsam, may be strengthned, and so the Wound may be healed.

And now, all things belonging to the Stone in the Kidneys and the Bladder being briefly described, one thing remains, namely, the way of taking a Stone out of the Ʋrethra, which we shall briefly describe. It happens sometimes, that it is void∣ed out of the Bladder; but when it is gotten into the Ʋrethra, it sticks there, and stops the passage of the Urine. In this case, all means must be tried and applied, which are proper to bring away a Stone, without Incision. Among these, first of all occur Diureticks, Emol∣lients, Fomentations, and Baths of a relaxing quality, by means where∣of Stones of no small bigness have been brought from the Ʋrethra. The second way is, Extension of the Ʋrethra by Wind, tying that part of the Yard, which is next the Pubes, in the same manner as it was frequently used by the Aegyp∣tians; for when the Ʋrethra is di∣lated, the passage is more free for the Stone. The third way is by sucking, when by drawing the breath with great violence, the Stone is drawn with it. The fourth way is to break the Stone by the help of a Forceps and Probe, which is often used with success, and there∣fore much to be commended. But if all these ways be fruitless, we must proceed to Incision. Among Authors there is a great Contest about the place, wherein Incision should be made. Some chuse the Side, for fear, if the lower part should be cut, there should be a Fistula. Others are for the lower part, lest the Nervous Bodies should be hurt. We have used both these ways, and found the cure easie, nor could we perceive any detriment accrue to the Patient, when we made Incision in the Nervous la∣teral part. After incision is made, the Stone may be extracted with a fine little Hook. When these things are done, the Wounds after Ex∣traction of the Stone whether of the Bladder or of the Ʋrethra,) must be cured. But since we have al∣ready in the beginning of this Work treated sufficiently of Wounds of all sorts, we shall here sc••bear re∣petition.

Partis tertiae Finis.

THE PRACTICE OF CHIRURGERY. Part IV.

BOOK VIII.

Of supplying Defects in the Body.

CHAP. I.

Of supplying the Nose, Ears or Lips, when deficient.

HAving in our propo∣sed Method finished the three first Parts of Chirurgery, we now proceed to the fourth and last, which is the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Additrix, or supplying Part. And we will begin with the addition of the Nose, Ears or Lips, when wanting. Upon this subject several both of the Ancients have written, as Galen, Paulus Aegine∣ta, and Celsius; and of the Modern, as Alexander Benedictus, Vesalius, Ambrosius Paraeus, Stepha••••is Gour∣melius, and Johannes Schenkius. But Gasper Taliacotius, Professor of Anatomy in Bononia, was the first that ever I perused, who de∣scribed this Operation in a plain

and practicable way. The fore∣mentioned Authors indeed in ge∣neral terms describe a method; but so ambiguously, that he, who upon their credit should undertake the reparation of any of these lost parts, would lose his own; and perhaps the Patient his life. There∣fore without troubling you with what others say on this subject, I shall in short give you what Ta∣liacotius says more at large there∣on.

As that Man's Endeavours are to be admired, unto whom no∣thing seems hard or difficult, which upon Grounds of Reason, and by Industry is attainable: So he is to be pitied, who in attempting no∣thing betrays his Sloth, and not only is of the Opinion, that all things, especially in Physick, are so fully found out already by the Antients, that there can be no room for further Invention; but (which is more hateful,) does by Calumny and Detraction discou∣rage, as much as in him lies, all laudable attempts. But not re∣garding ill-natured Persons, some Men of Ingenuity and Resolution, have ventured upon this difficult Operation; taking the hint from Horticulture, that, as Grafts or Buds are ingrafted or inoculated into Stocks, so in Animals one part might be ingrafted upon another, to supply a defect, where any should happen. And thô this A∣nimal-ingrafting agree in many things with the Vegetable; yet they differ in several, and the Ani∣mal must be aided by the Artift's Industry. As in Vegetable-Graft∣ing or Inoculation the Stock must be cloven, or the Bark perforated, so must the part in an Animal be wounded, upon which the tradu∣ctive part is to be grafted. And the part, out of which restitution of what is deficient must be made, may be likened to a Tree or Sci∣on from whence the Graft is ta∣ken. But in a traductive part of an Animal there must be more∣over Conformation according to the part which it supplies. Now that we may the better compre∣hend our Business, we will consider what matter is proper to supply parts deficient; from what place this matter should be taken; the quantity of it; and the manner of agglutinating one part to ano∣ther.

The matter, out of which the foresaid defects must be supplied, is the Skin, (which palpably de∣tects the mistake of such as thought, a Nose must be supply∣ed out of solid Flesh.) If you ask, Why the Skin? I answer, All Physicians hold, when we would supply a lost part, that we must put in the room of it, somthing like in substance to it; or, if we cannot do that, somthing as near it as may be; as when we breed a Callus for a broken Bone, which supplies the room of a true Bone. Wherefore since the Lips, Nose and Ears do much resemble the substance of the Skin; and since, when part of them is cut off, it is impossible they should of them∣selves shoot or bud out again, so as to remove the deformity; there∣fore the first Authors of this Art, took the Skin of another part, and accommodated it to their use. This they thought, in imitation of graft∣ing in Trees, was possible to be

done: And they thought no part could with less inconvenience to Life be separated from one place, and translated to another, than the Skin. But since there be four sorts of Skin, it will be requisite to know, which of those sorts are for the purpose in hand. One sort of Skin is bare of Hair, of exquisite sense, difficultly separated from the Bodies underneath it, and will not fold as the rest will, such is the Skin of the Palms of the Hand, and of the Soles of the Feet. Ano∣ther sort has a Muscle, and that but a thin one, immediately un∣derneath it, such is the Skin of the Forehead. A third, by reason of the various and manifold Implica∣tion of carnous Fibres, you may either call it a Cutaneous Muscle, or a Musculous Skin, no matter which, such are the Lips and Cheeks. The last sort is the common cover∣ing of the whole Body, some∣where hairy, other-where without Hair, every where void of moti∣on, and may without difficulty be separated from the subject parts. Of these four sorts the last is only proper for our use. For the first cannot well be removed, without hazard of Life; nor (were it pos∣sible) could it be shaped into the fashion of the lost Member. In like manner the two middlemost sorts are rejected, as alien, for they are to be met with but in few parts, nor can they commodi∣ously be joyned to the defective part. But the last sort may, and therefore is the fittest for our pur∣pose.

The place from whence the Skin is taken, must be covered with a Skin like the lost part, and big enough to supply the defect. And since it must have time to unite with the defective part, the Skin must be taken from such a part as may be brought to the other, and, with as little incon∣venience to the Patient as may be, may continue there. The only part to supply the Nose and Lips, is the Arm above the Elbow; and to supply the Ears, the Skin be∣hind the Ears. For neither disfi∣gures a Man, since the Arm is co∣vered with Clothes, and the new Ear does indifferently well cover the place behind it, whence it was taken.

What quantity of ingrafted Skin one should take, is hard to define. For it is observed, that the Skin after the second cutting from the Arm, somtimes shrinks an eighth, a sixth, or a fourth part both in length and breadth, by reason the Nutriment is not so plentifully brought to it, as when it was close united to the Arm, or because the Nutriment does not assimilate a∣right. But thô it be thus difficult to be exact in our quantity; yet we should take the best measure we can, proportionable to the part we are to supply, and rather en∣cline to excess than defect.

The way to unite the parts, is by stitching, and by that sort which is called by some interscissa, and by us sutura non continuata, which we treated of in our discourse up∣on Wounds.

There remains one difficulty to be resolved, which is, Whether the ingrafted Skin should be ta∣ken from ones own Body, or from another Person's. There are good Reasons, why it may be taken

from another Person's. Plants thô of different Natures may be in∣grafted one into another; what then should hinder a piece of one Man's Body from being ingrafted into another's, seeing both are of the same kind, and nothing near so different as one kind of Tree is from another? But this supply∣ing of a part from another's Body, having never been practised, nor likely to be practicable, we will conclude, that it is best to supply the defect from ones own Body. For a long time is required to unite the supplemental par••••o the defective, and all this while the two Bodies must be fast bound one to the other. But I know not any contrivance possible, to keep two Person's Bodies so bound toge∣ther, but that they would rend one from the other, long before Coalition were made, and so our Intentions would be quite fru∣strated.

These things being premised to general, we will now proceed more practically to the Subject here un∣der Consideration.

CHAP. II.

Intentions of Cure in supplying Defects, and how the Body ought in general to be prepared.

THe main Intentions of Cure are, First, to prepare the Cutaneous Graft. Secondly, to insert it into the defective part. Thirdly, when it is ingrafted, to keep both parts bound together, till the time of Coalition. Fourth∣ly, to cut the ingrafted part from its ancient seat. Fifthly, to shape the new parts. Lastly, to defend the parts from Injuries, and when the work is brought to perfecti∣on, to make it durable.

Before we meddle with the tra∣ductive Skin, we ought to consi∣der the complexion of the Pati∣ent, and his habit of Body; and then we must cleanse him well. If the Body be healthful, and re∣plenished with good Juices, we must abate their Turgescence by bleeding, lest the part might be inflamed. A low Diet will be pro∣per; but not purging.

If the Body be Cholerick, the best way is to clear the first ways with a gentle Medicine, as Pulpa cass. ℥jss. vel Flectuarium Leniti∣vum, or Syr. Ros. Solut. or Vio∣lar. Solut. dilured with Decoctum Cordiale, or some cooling Waters. Tamarin••s and Prunes are good in Potions, and both more plea∣sant and safe for such Persons. This done, the Bile must be cor∣rected with Syrup. Endiv. Oxalid. Cichor. Oxysacch. Simpl. &c. in Decoctis Herbarum ac Seminum; vel aquis ad ea destinatis, ut sunt Aq. Oxalid. Endvo, Capil. Ven. Rol.

Cichor. Sonchi, &c. Whise we are preparing the Bill, we may ••eed. About five or six days af∣ter ••leeding we may purge the whole Body with some thing stron∣ger than the first; such as Elect. Cathol. Diaprum. Solut. ad••••ixto vel Elect. ex Succ: Rosar vel Ro∣sar. Mesues. Or, if you like a Potion better, use Manna cum Rhabarb. Or Decoc••••m ex Pu••p•• Tamarind. Myrobal. Citrin, cum Rhabarburo per noctem insushm. The cour••e of Life must be such as hinders the encrease of Bile, and cools the Liver. All the Res non Naturales must tend to cool∣ing and moistning. The Drink must be small. Barley Cream, E∣mulsions of Pumpion Seeds, boiled Rice and Gourds are good. Veal, Kid and Chicken boiled, and not roasted. Saxatil Fish. Sallets of Borage, Endive, Cichory and Sor∣rel. And in their season, Figs, Grapes, Damsens, and Pumpions. Pears and Apples are good, provi∣ded they be baked. Let the Pa∣tient avoid watching, care, and trouble of Mind; but Venus espe∣cially, as a thing that weakens the Body ••••reamly. If the Body be costive, eat Raisms, and use Le∣nient Clysters.

In a Phlegmatick Constitution give first some Hiera or Elect. Hier. cum polline Trochiscorum Agarici. Potions may be given of Mel. Rosar. Solut. & Cathol. ex decocto cymarum Absinth••i. But in this case avoid Cassia. Then the Phlegm must be cut, and Obstructions opened by Preparatives, such as Oxymel, Syr. de Beton. Mel. Rosar. Syr. Byzant. ex quinque Radic. &c. About three spoonfuls may be gi∣ven at at me in decocto Beton. Ab∣finth. Ment. Grigan. S••aechad. vel sure Passulm. ••el eori••dem aquis. Then stronger Purges may be gi∣ven, as Mel. Rosar. cum modico Dinphoenic. vel ••ect. Cathol. cum Didacarthami ℥ ss ver infusio aga∣rici irochis••ati ex Oxymelite. I would not here exclude the use of Rh••barb. Some Pills may be taken once in eight or ten days, such as ex ••••era cam agarico, de tribus cum Rhabarb. Cochiae, and it there be pain, ex Hermodac••••••••. We must streng then the Stomach by outward Applications. We must abstain from Phlebotomy, unless there be great occasion. The cold∣ness of the inwards must be tem∣pered with Diagalanga, Rotulae ex Aromatis Galeni, Theriaca, seu Mi∣thridatium, alternis diebus. We must have a care of Diet. A cold and moist Air must be avoided. Meat must be roasted rather than boiled, and seasoned with Spices. Most Fish is bad. So are Beef, Pork, Lamb, Mutton, the Feet and Extremities of Animals, Cheese, Milk, horary Fruits, and the like. We allow a little generous Wine. The Patient must never eat his fill; it is good somtimes to go supperless to Bed. Venus is more pernicious than any thing. Motion and Exercise is good, if not pre∣sently after Meals, (for then it is bad,) but in the Morning, till one sweats.

In a Melancholick Constitution we proceed in the like course, be∣ginning with Electuarium Diasen. Syr. de Polypod. sero ex infus. fol. sen. & passul. decoct. The next day we may give Syrup. de Borag. de Lupul. Fumar. in aquis cò de∣stinatis,

aut decoctis, ex Borag. Me∣lissophyl. Callitrich. Glycyrrhiz. Asplen. &c: Purges may be gi∣ven ex confect. Hamech, decocto Myrobal. Indor. ex infusione fol. Sennae, Syr. de Epithymo, aut Po∣lypodio. It will be good somtimes to give Pilulae de Lapide Cyaneo, or de Fumaria. Bleeding with Leeches at the Haemorrhoids is good. If the Patient (as such Peo∣ple usually are,) be lean, he must use a Milk Diet. The Diet must be moistning, of Veal, Mutton, Pullets, small Birds, and the like, rather boiled than roasted. Bo∣rage and Capers in Sawce are pro∣per. Apples and Pears coddled and strewed over with Sugar, are good. His Drink must not be thick and feculent. Sleep is good. Venus is naught. Thus the Caco∣chymy is to be removed from Bo∣dies by peculiar remedies, accord∣ding to the nature of the peccant Humour. When the Body has got a Venereal taint, the Patient must for about four Months be treated as such, that his Body may be rid of all impurities, and so be made fit for this difficult Operation.

CHAP. III.

An Enumeration of what things are necessary for the delineation of the traductive Skin, and the provision of all Implements.

BEfore we talk of the admini∣stration of this Work, we must first of all enumerate di∣stinctly, what things are necessa∣ry for the performance of the Work, that Chirurgeons may be fully informed, with what Imple∣ments they must be furnished, before they undertake the deline∣ation of the traductive Skin. For these things considered, and right∣ly ordered, they will perform their work with credit, and avoiding all confusion, they will prevent all occasion of mistake, which might otherwise arise. Some of these things respect the Artist; others the Patient's Wound. What re∣spect the Artist, they are the Ser∣vants, and his fellow-helpers. For one Artist alone is not sufficient to perform this operation; because many things must be done at one and the same time, which require the assistance of several Persons. The Chirurgeon therefore must have at least two Servants; who must be, not only nimble in their Body and Hands; but of a vigi∣lant Eye to observe their Master's Commands, and to perform them. These must of necessity be either well skilled in this sort of Chi∣rurgery; or they must be very prudent and diligent. For the Chirurgeon does not only stand in need of their help in the pre∣paration of Medicines; but in making Dissection, in deligation of the delineated graft, and then in inserting of the same into the curt parts, which one work is more difficult than all the rest, that are necessary to this sort of Chirur∣gery. Let the Artist therefore, if he cannot get such as are Learn∣ed and Experienced, at least pro∣cure such as are apprehensive in their Mind, quick in their Senses, and nimble of Body: And if they be raw in the business, before the operation let him inform them now and then, of all things that are to be done in the operation. For so he would have them more ready in his Service, more at his Beck, and exceeding Obedient. It is of moment besides, to chuse an opportune place, wherein to perform the operation, and to take care of a Bed for the Patient to lye on, with all things belong∣ing to it. For it is of no slight concernment, what sort of Light there is, what its Position is, and what Pillows there are. First, therefore the Chamber, wherein the Bed is set, must be very light, because the Work requires a clear light: But the delineation of the

traductive Skin, does especially require it; for thô other things might be done by Candle-light; yet the delineation of the tradu∣ctive Skin must be done by day∣light, and all People but the Ope∣rators must be put out of the room. The Patient most be pla∣ced on the Bed, with his Face against a large Casement, and the Bed must stand from the Wall on all hands, that the Operators may go round any way, as there shall be occasion. There must be three Pillows in readiness, whose use we shall shew afterwards: They must be stuft with Flocks, and not with Feathers; because Feathers are apt to grow too hot, and by reason of their softness, to give way. The Bed is better than any Chair or Seat.

And having reckoned up all things in respect of the Chirur∣geem, we will now proceed to what things are necessary in re∣spect of the Patient; and the de∣lineation of the propaginous Skin. Some things are to be performed, before the work is undertaken; others in the doing of it, and others after it is finished. Among the preceding requisites, the prin∣cipal is; to contrive by all means how to stop the Blood when we cut the Skin: Because in cutting the Skin, thô we wound no part else; Yet even this Wound may be feared, if an Inflammation, or an ••r••sipelas, should arise. For Anatomy shews us, that several Vessels of all sorts run along the Arm, and lye under the Skin, which if we have not a great care, may be wounded. Beskles, there is danger in the largeness of the Wound, which the supplemental part must be of. For thô you make the wound at one cut, yet as soon as the Forceps is let go, a large Hiatus appears, and all un∣der the propaginous Skin lies bare. Then the Air comes in, and the part lies bare to various defluxions. Wherefore, to avoid these dangers, no small care should be taken, and we must make provision afore∣hand against the worst. There are several things proper in this cafe, such as, Lacluca, Trifolium, Poly∣gonum, Auricula muris, Lenticu∣la palustris, Psyllium, Ʋmbilicus Veneris, sempervivum, portulaca, Ovi liquor; Omphacium, Solanum, Rubus, Capreoli vitium, Plantago, Sorbi, Corni, Mespili, Cydonia, Myrti folia co••um{que} fructus, Ro∣sarum capita, Balaustia, Sumach, acaciq, Bolus Armena, Nuces cu∣pressi, Galla immatura, &c. To these you may add the Posca Grae∣corum, which is nothing but Vi∣negar and Water, so mixt and proportioned, as that it may be grateful to the Taste; So Galen defines the Symmetry of it. As for the place where these things are to be applied, the nature of the thing shews, they must be ap∣plied near the Part, especially above it, (for so we hinder any con∣flux to the Parts below.) They must be applied round the Hu∣merus; And because the Armpits have a vast in let of Blood into the Arm, (whence a vast inunda∣tion of Blood, upon these parts might be feared,) we must take the more care of this place; which is best done by cutting away the Hair, and plying it continually with Medicines for the purpose:

It is best to do it half an hour be∣fore the operation, while other things are getting ready. We must take care to renew them be∣fore they grow warm. These may serve for Repellents; ℞ Ol. Ros. Omphac. ℥jss. Myrtin. ℥ v. Sang. drac. terr. sigill. an. ℥j, Bol. Arm. ℥ v. Camphor. ʒ j. Ce∣rae albae ʒ vj. Contundantur quae contundenda simt subtilissimè, & cera cum oleo eliquetur ad lentum ignem, addantur pulveres, ubi pa∣rum refrixerit, & reficiantur s. a. We may make these things more cooling and astringent, if we wash them in Vinegar of Roses. Spread this on a Linen cloth, and apply it all over the Humerus. Or if you like a Liniment. ℞ Ol. Ros. ℥jss. Myrt. ℥ j. aceti nigri ••cerrimi ℥ v. pulv. Bol. Armen. ℥ j. agi∣tentur omnia in mortario plumbeo, quous{que} consistant, & oblinatur un∣diquaque humeri articulus. Or this, ℞ Succ. Plantag. Semper∣vivi, Solani, an. ℥ ij. aceti nigri acerrimi aq. Ros. vel peduncu∣lorum Ros. plantag. an. ℥jss. In∣fundantur lintea in liquorem hunc, at{que} illis actu frigentibus universus articulus circùm latè foveatur. Or, if you like a Decoction, ℞ Su∣mach, Summitat. Rub. Myrtill. Gall. immatur. Balaust. Ros. an. M. j. f. decoctio in vini nigro au∣stero, quous{que} tertia pars superfue∣rit, infundantur lintea, & dicto jam modo applicentur. And this may serve for things necessary be∣fore the operation.

As for things requisite in the performing the operation, they are these, viz. A Forceps, and Knives. The Chirurgeon must take care that they be sharp, and whether they be convenient this way or another, he must lay them in a dish for the purpose all in order; lest there might be any confusion in the operation, the blame where∣of will be laid on the Operator, and not on his Servants.

When the work is done, these things must be in readiness, viz. Linen to put into the Wound; Stupes to defend it and the adja∣cent parts, store of Medicines to take up in the Stupes; a broad Linen cloth to lay over the Stupes and the Wound; and a Roller to roll over the Stupes, and to bind the Wound. I shall now briefly shew you the use of these things. First, there must be a piece of Linen cloth, to put between the raised Skin and the parts under∣neath, to keep them asunder, lest they should grow together again. And there is one benefit more in the Linen cloth; that one may lay Medicines upon it to stop and re∣pell Blood. It ought to be ex∣actly of the same dimensions with the Wound. You should have pieces of several dimensions in readiness, that you may take one which suits best. You must also have flaxen Stupes, to guard the Wound; some broad and long; others narrow and short, all of an orbicular shape, with their sides a little compressed. Of the lar∣ger there must be four at least, about three Inches broad, and six or seven long. They must not be over thick, for then they are cumbersome, as they swell with the liquid Medicine, and the Blood which they soak up, and when they once grow up, they inflame the Parts. The less must be two

Inches broad and three long. It is convenient to lay all these on, and to guard the Wound well. But it may not be improper to make more than we have menti∣oned: For it is better to have too many than too few. Then it is proper to have a Linen-Cloth to go round all and stay the Wound. It must go round the Arm and the Wound, and it must be larger than the Wound: All these must be wet in Whites of Eggs, which must be well beaten, adding Rose∣water, a little Dragon's-blood, and Terra Sigillata, mixing and beating them well together. Then you must have a Roller ready, thin, and all of an evenness, about three Inches broad and four Cu∣bits long. Either to bind the Wound too tight, or too slack, is inconvenient: Wherefore we must so order the matter, that what it wants in tightness, may be suppli∣ad by often rolling, and that there may be nothing, but the Rol∣ler takes hold of it, let the Rol∣ler be neither broader nor narrow∣er than we have mentioned; if it be broader, we cannot straiten the Parts with it; if narrower, it will twine and twist like a Cord, and so hurt the Parts. It must not be rolled dry, but wet in Pos∣ca; for when it is wet, it will be more pliable, and will be instead of a Medicine, to stop blood. We have been the more copious and particular in these things; because it is an odious thing to have ought to seek, when we go about such an Operation as this.

CHAP IV.

In what manner the cutaneous Graft must be de∣lineated.

WE have already discour∣sed of all things that should be in readiness for the Ope∣ration; now we will proceed to the Operation it self. The deline∣ation of the Skin, is the Basis of all the rest. Therefore here we must be exact, and do all things by Polycletus his Rule. However it is hard to define the quantity of the Skin exactly, since it depends on conjecture. But diligence and prudent circumspection, will go far towards ascertaining it's dimen∣sion. And after mature conside∣ration, let the Artist go couragi∣ously about his Work. First, let him place the Patient on his Bed, and let him remove all Impedi∣ments, either to the Patient, or to himself. Next, let him appoint those that are to help him, their Stations and Places, every one in their order. Let the Patient lye on his Back upon the outer edge of the Bed. He may change this place, either for the convenience of the Chamber, or of cutting the Arm, if so be the light fall well. Thus he must be placed ready for the Chirurgeon and his Assistents, when they are about to begin the Operation. The Arm, whence the Skin is to be taken, must be made bare. The Assistents must be in their places. One must sit on the upper end of the Bed behind the Patient's Head, at the Artist's right Hand. He must with his right Hand support the Patient's Arm, and with his left, when there is occasion, hold the light, or do any thing else, as occasion requires. Another Person's Office is to lift up the Skin, to fasten the Forceps, to help the Chirurgeon, to hold up the Forceps, while the Artist cuts, and when the Work is performed, to take it away. And he must be at the Chirurgeon's left Hand, or on the contrary side, if the opposite Arm must be cut. For thus each of them by the op∣portunity of their Places, will be enabled more readily to do their Duties, and observe the Chirurge∣on's beck; for several things, while the Operation is performing, must be intimated by a Nod, and not by Words. Because for the Patient's sake, Words must be forborn. In the Interim, the Chirurgeon having his Hands free from all Entangle∣ments, must come near his Patient, always standing; that on any oc∣casion he may turn which way he list, and buckle himself to his Work. And first of all, let him gently handle the Skin on the fore∣part of the Humerus, whence he

means to borrow his Graft, let him lift it up and let it fall again, and in the same manner raise it, and let it go again, that by this gentle Contrectation, it may be prepared for Separation with more case, when we should cut it, and lift it quite up with the Forceps. But ever use moderation, lest too rough handling before Section, should make the Humors flow with greater impetuosity after it shall be performed: For great Veins and Arteries lye near this place. And since the main business is the Symmetry of the Graft, you would do well, (especially where the Operator is a Novice in the Practice of Addition,) to mark the Skin with Ink, and when he has taken up as much Skin as the case requires, he shall give it to his Assistent on his left Hand to hold, then he shall take the For∣ceps in both his Hands, and with∣in the Assistent's Hands he shall fix it on the traductive Skin. Yet in the mean time, if he have de∣parted from the prescribed quanti∣ty, he must raise it and take it up again, and having looked well on both sides, whether all things are right, he must straiten his Forceps, and fasten it there with an Iron Ring. He shall give this again to the Assistent on his left Hand, and then he may proceed to Section. Presently therefore let him take the Knife in his right Hand, and thrust the point in gently through the Skin, about the middle of the slit in the Forceps, and so cut on each side to the very corner of the slit, if need require. When Section is thus made, which is the first step in the Art, and as it were, the Rudiment of the whole Work, and when the Knife is laid down, or given to one of the Assistents, he must with the end of the Probe thrust a piece of Linen Cloth through the gaping skin. The As∣sistent on his left hand must get this ready. He may take measure by the slit of the forceps, and out of the great variety lying by him, may chuse the fittest. When it is put through, if it be wrinkled any where, it must be made smooth, and distended along the whole space, so as that the ends may hang at equal distances from the for∣ceps. Then the Artist may loosen his forceps, by taking off the ring which held the two handles toge∣ther, and give it to the Assistent on his left Hand to hold up gently, and presently let him put his right Hand under the Humerus, in the inside, and let him raise the Arm a little, that the place may lye bet∣ter for the cure, which must be used to it by and by. In like man∣ner, between the Plates of the For∣ceps, when it is opened, let him lay his Hand on the Wound, and with his Fingers expanded let him hold down the Cloth on both sides, which is still in the slits of the For∣ceps. For so he hinders the Cloth from being pulled out with the Forceps, when the Assistent takes it away, which he must do assoon as the Artist lays his left Hand on the Wound. When these things are done, the Artist must compose his Graft and six it in an even Si∣tuation. I call the Graft, all that Skin which is separated from the Muscles underneath, and which is circumscribed by it's internal and external Superficies, and on each

Hand by the sides of the Section, This, for causes which we shall mention afterward, the Lips turn∣ing inwards, does somtimes swell strangely. It will therefore be convenient either with a Probe, or with the inside of the Hand to smooth down all unevennesses, and lay them right, that the Grast may be equally extended, according to all its parts, and presently to go about its proper Cure. For here any delay is dangerous: Where∣fore the Artist must put the shorter stupes, which he has in readiness, to the Wound innermost, and others outwardly, and over these he must lay the large ones, one at each side, and one at each end. And when he has in this manner guarded the whole Wound, then he must lay a Linen Cloath double for a common guard to all, and that the Wound may be the better bound. But this must be done by Rollers. Therefore taking the Roller in his Right Hand, and open∣ing the end of it, let him apply it to the upper part of the Grast, lay∣ing his Left Thumb on the end of it, and roll downward toward the inside of the Arm. When this is done, let him straiten the Arm a little, and ••oll again, rolling gra∣dually downwards, till the whole Graft, and the broad Linen Cloath, which is brought over it, be by rolling from one end to the other all covered. And the Artist must take care, that in binding, he nei∣ther straiten nor slacken the part too much. If it be over slack, the Blood will run to it, and the Me∣dicaments off it. If it be over-tight, it will weaken the part, and de∣stroy the i••••ate heat of the Skin: Whereupon the Graft dies, because all manner of passage for the Ali∣ment is stopt. And moreover, be∣cause strait binding causes pain, this will cause an afflux of Humors, and (which is the utter ruine of the Graft,) will occasion Inflammati∣ons, Erysipelas's, and other Swel∣lings. Wherefore moderation must be used. Let him turn in the end of the last Roller about an Inch, then tie the end over with Thread; so there will be no fear of its undo∣ing; and thus is the administration of the delineated Graft performed. But still there is a care incumbent on the Artist, to keep both the Arm and the Patient himself quiet and undisturbed. And for this, a middle posture is most proper; so the Arm must be bent. This I would have observed, that as the Humerus hangs down a little, so the Ʋlna may be gently raised, and in the same moderation the Hand must be above the Ʋlna. For this reason, as we said, care must be had of Pillows, Bolsters, and such Furniture. Therefore while the Artist lays the Pillows, both his Assistents must stay the Patient's Arm. He that is uppermost, and sits at the Artists Right Hand, must put his Left Hand under the Pati∣ent's Armpit, and lay his Right up∣on his Elbow; the other must with his Right Hand stay the Patients Cubitus, and with his Lest Arm go round his Body. By thus doing, they will on both sides keep the Arm steady and quiet, which is the principal thing we desire, because of the violent terdency of the Blood to any disturbed part. All things being in this posture, the Artist must bend the Arm, the

Assistents helping, into a safe and opportune posture, and, according is the season is either hot or cold, cover it with Linen or Woollen. It will also be requisite for the Pa∣tient not to stir in the least, lest the quiet of the Arm be disturbed, and put the Humors in motion, which of themselves are too apt to be mo∣ved. Therefore a profound rest both of the Arm and the whole Body is absolutely necessary. But this is not all, we must likewise give check to the violent motion of the Humours. Therefore we must endevour to defend the part by pou∣ring on refrigerants and repellents all over the Region of the Woun∣ded Humerus, especially toward the Armpits for an hour or two. Of which sort of Medicines Posca is best, provided it be in quantity sufficient: For I have found by good success that it stops the most impetuous Fluxes of Blood.

CHAP. V.

The Cure of the delineated Grast.

NOW it remains, that we lay down the cure of the deli∣neated Skin, as soon as the whites of Eggs are taken off, and what course of Diet the Patient ought exactly to observe, till all fear of Inflammation be over. And the Cure of the Wounded part does chiefly consist in suppuration, not neglecting the use of Repellents in the mean time. For since Hu∣mours are perpetually running thither, and abundance of them, through the weakness of the part, do gather there, the Chirurgeon's chief aim should be to disenss by Suppuraters whatever is gathered there, and to hinder by Repellents whatever comes from any where else. This Hippocrates does intimate, where he says, that an Ʋlcer the s••••nest suppurated is the safest from Inflamation, and the soonest De∣terse and siled with Flesh. Now since there are several sorts of sup∣puratives, there may be as many several sorts of Medicaments, which according to the Heat and Cold, and the several Seasons of the year, may as occasion requires be made choice of. In the later end of Spring, and all Summer, Sallet Oyl drawn from ripe Olives, pure Wax and Turpentine in equal quantities will be proper. For these mightily promote Pus, and I frequently use it. For the wealthy and delicate you may use this following. ℞. Terebinth. let. ex Rosac. ℥ v. ol. res. comp. ℥ j. Addatur cerae albis∣simae, quod par fuerit his omnibus excrpiendis, & ex arte conficiatur unguentum. But in a cold Season, when the heat retires inwards, we must use much stronger means. Therefore in the later end of Au∣tumn and all Winter, you may use such a Medicine, ℞. cl. commun.

℥ viij. cerae pune ℥ ij. colophon. picis naval. sagapen. a. ℥ j. mastich. thur. galb. terebinth. à. ℥ v. ubi oleum cum cera ad ignem probè liquata fuerint, injiciatur colophonia pri∣mum, deinde pix navalis, saga∣penum, terebinthina, mox & reli∣qua, & refrigerata recondantur. This also is good, ℞. cer. alb. resin. pin. sevi vaccin. pic. naval. terebinth. th••••. myrrh. à ℥ v. M. & in pulverem, quae convenit, re∣dactis, cum ol. q. s. f. Ʋngu. ex arte. Next follows the use of Re∣pellents, which (because they are applied only to the outside of the Wound, and the suppuratives to the inside,) may best be applied to the upper part of the Humerus. But before we proceed to them, we will discourse of the admini∣stration of suppuratives. Within a day or two, or after all fear of a Haemorrhage is over, in the Morn∣ing the whites of Eggs may be re∣moved, and that very gently, lest any little branch of a Vein might upon a slight touch bleed afresh. Wherefore it were good to have some singed cotton to apply to the Wound. If the Cloaths be hard and dry, and do stick fast, they must be softned by moistning. Posea is good for this use, and then Oyl of unripe Roses. These may somtimes be mist and applied either cold or a little warm, ha∣ving always regard to the Season, and other Medical Circumstances. For Medicines when they are mo∣derately warm do better insinuate themselves, and by the modera∣tion of their quality perform what we desire. But the Artist must have a care they be not too hot, lest the Blood being stimulated thereby, burst out again. Let therefore the Assistents stand on each Hand, one of which must hold a Bason to receive what comes from the Wound, and the other must have liquor, fit to moisten the Cloaths. In the mean while the Roller must be taken off, with all the gentleness imaginable, so as not to disturb the Arm or the Pa∣tient. Wherefore it were best to clip it with Scissars, not all the Rounds at once, but one by one, and rather on the outside than the inside of the Arm. For in so doing we shall neither disturb those parts by its motion, nor shall we come near those great Vessels of the Arm, which it is the best not to touch at all. When the Rounds of the Rollers are stiff with Blood, it is the Assistents part to irrigate them by dropping liquor from on high. Then he may take them off with a Probe, or, when joyned, he may gently sever them with his Fingers, and throw them into the Bason, and when the Wound is laid bare, he may cover it with a white Linnen Cloth made warm, while the Artist is making ready for the rest of his Work; who must take that Cloth off, and apply another to the Wound, spread with sup∣puratives. Where note, that the first Cloth must not be taken off, till the other is ready to clap on, which must be done as near the same instant as may be: Which is a rule ever to be observed. Then the Artist must take up the end of the Linen. Cloth, which is run under, in the outside of the Arm, and sew another of the same big∣ness to it, running the Needle along, and no where sewing double, lest

by its bulk it might exasperate the Wound. Then with his Right Hand taking hold of the inner end let him raise it, and draw it through till all the old is come through, and the new is drawn into the Wound. Then one of the Assi∣stents must clip off the Old, and throw it into the bason with the rest. But if the Lips turn inwards, then let the Artist with his Probe spread it again gently, and drop in a little Turpentine either alone, or mixt with Oyl of Roses, then let him apply Lint dipt in Suppura∣tives, and upon that Linen Cloths, wet in Repellents, warm; then in the same moderation that was for∣merly prescribed, let him bind all up again, and place the Arm in a middle posture. These Repellents differ nothing or but very little from the other. If they do, it is best to apply gentle ones to the Graft, and stronger to the Shoul∣der and Armpits. These are pro∣per for the Grast; ℞. olei Ros. omphac. olei Ros. comp. à ℥ j. M. Or, ℞. olei ros. comp. myrt. à. ℥ j. M. These you may use sing∣ly, and, with a Cloth dipt in them a little warm, you may irrigate the Graft all over. For the Shoulder this is good; ℞. ol. omph. myrt. à p. ae. And this Liniment; ℞. Sant. rubr. gran. myrt. ros. rub. à. ℥ v. ungu. ros. Mes. ℥jss. redi∣gantur in tenuissimum pollinem santali, mnti & rosae, paretur∣que ex arte linimentum.

As for Diet, it must be very spare in the beginning, and so continued for about four days, till the Humours are setled. The Drink must be small. Wine must not be touched. After the fourth day is over, you may advance a lit∣tle. After the seventh is over you may indulge your self yet more liberally. And this may suffice for the cure of the Skin, when first delineated.

CHAP. VI.

The Cure of some Symptoms, which somtimes be∣fall the delineated Skin.

THree sorts of Symptoms do somtimes befal the delinea∣ted Skin. A Mortification of some of the edge of the cutaneous Graft, an Inflammation of it, and of the parts adjacent, and profusion of Blood. There are several causes of Mortification in this case, a Disea∣sed and Veneral habit of Body; a lax and thin Skin, where the in∣nate heat is weak; too violent pinching with the Forceps, and too strait binding. Unless therefore the Patient be of a good habit of Body, especial care must be had, in taking up the Skin with the For∣ceps, to use such moderation as but just to keep it up, and not let it slip and hinder the operation. It is a good way to take enough of the Skin, that if a little Mortifica∣tion should happen, there may be still enough to serve the turn. Great care also, as we have said before, must be had in binding, that it be neither too strait nor over slack. But when you have a suspition of this mischief, (as you very well may in the forementioned Bodies,) the Wound must be open∣ed, and not let alone till the third or fourth day, you must look very narrowly to the edges, that time∣ly care may prevent the worst. You may know it is beginning, when upon trial by a Probe, sense is either small or quite lost, and if the part look very pale or livid. It must therefore be resisted by things that dry strongly, and de∣stroy Putrefaction. Such is Ʋn∣guentum Aegyptiacum, whereof there are several sorts; but this is the best; ℞. Alumin. virid. aeris, mellis, aceti acerrimi à. p. ae. M. Praecipitate is good either alone or in Oynment of Roses, and other Oyntments. Somtimes pulvis aloes strowed on the Skin has quite de∣stroyed the Malady. It is best to use a decoction of Lupiues, where∣in Aloes has been boiled. This is also a very safe Oyntment; ℞. te∣rebinth. letae ex succo absinth. ℥ j. farin. bord. cretae ℥ j. pollinis aloes purissim. ℥ ij. mell, albi sincerissim. q. s. agitetur mel, excipianturque singula, & ex arte paretur exter∣gens medicamentum. You may use it in Oyntments and apply them to the parts that are tending to Pu∣trefaction. Great care must be had of the Patient's Diet, especially were the Body is Cacochymick or Venercal. All things therefore must be drying and consumers of excrementitious moisture.

The next Symptom, which somtimes ends in the former, is an Inflammation. For because the Blood runs plentifully to that part, all there about is swollen, red, and

painful, and if not prevented, threat∣ens certain ruine to these parts, especially to the Graft. This is most apt to arise in the Spring time, and when People have fared plentifully before; wherefore it is altogether proper to prepare Folks Bodies before the operation. When an Inflammation doth arise, the best way is to bleed in the contrary Arm. The Patient's strength must define the quantity. Diet must be prescribed. The Patient must abstain from all hot things; and things of a penetrating sub∣stance. Coolers and Astringents are best. No Drink at all must be used; Spoon-Meat is sufficient. Rubbing the lower parts with course Cloaths, Cupping either without, or with very small Sca∣rification, when too little Blood has been taken away. Lotions of the extream parts are good, a little warm, with cooling Herbs boiled therein. Bleeding the Haemor∣rhoides with Leeches is proper.

The next Symptom is, profusi∣on of Blood, which may be stopt by letting Blood in the opposite Arm, if the Patient's strength will bear it; by Cupping, Scarifying Ligatures and Frictions. It is good to roll several Rollers pretty hard, not dry, but wet in Posca, hereby I have known Bleeding several times stopt. In this case it is best not to open the Wound till the fourth day. Next of all, the whole Region of the Shoulder must be fomented with Posca, and Cloths wet therein, frequently renewed, before they grow warm. When the Wound is opened, it is good to have things in readiness that stop Bleeding, if it should happen, such as singed Cotton applied either to the Wound or close by it. Castane•• cortex exiccatus, & in pollinem subtilissimum redactus, and gluten Galeni, quod aloos, thuris, masti∣ches aequas portiones continet, & ovi albumine excipiuntur, and Bol. Arm. sang. drac. & pil. lepor. in pollinem redacta. Abstinence both from Meat and Drink is here good. What is eaten should be Cooling and Incrassating. When the Pa∣tient rises he must keep his Arm steady in a sling made of a broad Roller. After the Seventh day is over, he may feed a little more plentifully till the Fourteenth, and then it will be time to take up the Graft.

CHAP. VII.

Why the taking up of the Graft is deferred, and not done at one Section, what time is proper for the Administration, and what Provision must be made for it?

THE reason why all is not done at one Section, but part of the Operation deferred, is, because the cutaneous Graft, if it were cut quite off at the same time that it is delineated, would shrivil up all on a heap, which might occasion a Mortification, for that Medicaments could not then so well be applied, as when it is ex∣plicated: Besides, the great Mus∣cles would be laid quite bare, which would produce the like in∣convenience, if they were exposed to the open Air. Wherefore it seems most proper to perform the Operation gradually.

As to the time, when the cuta∣neous Graft should be taken up, it cannot be desined by days or hours; it's requisite corpulence and the intermission of Symptoms will best determine that. For upon affluence of Blood, and it's being by heat compacted into carnous Fibres, the Skin grows thicker, so that when it is cut off it does not ••••••ivle up together; which (as I said before,) was the reason why the Skin was not both delineated and cut off at one and the same time. We must therefore tarry till the Skin grow thick and com∣pact enough, which (if we may set any certainty to things uncer∣tain,) it usually is within Fourteen days. In which time the subject Parts have the benefit to be clothed with a new Skin, whereby they are fenced from the Injuries of the ex∣ternal Air. And another main rea∣son for deferring it, is, the abate∣ment of the violent Symptoms, which must needs fall out in that time, and which would otherwise spoil the whole business. A brea∣thing time therefore is requisite for a second Operation, and Sat c••to, si sat bene.

And because it is good for an Artist to have his Tools about him, we will consider what Pro∣vision there must be made for the Operation. Now since the Skin must be cut at one end, and that somtimes Veins inter••ur, the same things therefore must be in readiness here, which were prepared for the Delineation of the Skin: Ovi aibu∣men rosacea dilutum in great plen∣ty; it will be good to put some Sanguis draconis and Bole Armeni••k

into it. Two broad pledgets of Lint; their quantity must be mea∣sured from the amplitude of the Section; they must be large enough to cover the whole Secti∣on, both of the Graft, and of the Arm, whence it was taken. Be∣sides, there must be Medicaments and Liniments in readiness for the cure of the Wound underneath; the compass whereof, because it is the ground whence the Graft was taken, we call the Bed. That therefore we may heal it, there must be in readiness Cloths spread with Suppuratives, and a Cloth exactly of the dimensions of the Bed; there must also be other Cloths, for the inside of the Graft, and they for this time must be single, and spread with suppura∣tive Medicines. There must like∣wise be two Rollers of the same bigness as before: One to keep fast the Medicines upon the Bed; the other for the Graft. This must be rolled over all the Arm, there∣fore it must be longer than the other. There must also be a smooth and sharp knife or two. There must be a Needle and Thread to sew the end of the Rollers; and so much may serve for the Apparatus.

CHAP. VIII.

The manner of taking up the Cutanous Graft.

IN the Graft there is a twofold Superficies, the natural, which is smooth, and well-coloured; and the ascititious, which is uneven and red. Therefore the Graft must be so applied to the curt parts, that the natural Superficies may be out∣ermost. Besides, it is to be con∣sidered, at which end it must be cut, so as to be best fitted to the Part; If the Nose or upper Lip must be supplied, then the upper end toward the Armpit must be cut; If the neather Lip, then the lower end next the Elbow must be cut. But as to the administra∣tion of the Section, it is twofold; either it is right from the inner angle of the Graft, to the outer Superficies; or it is sloping from the inner Angle of the Graft, to∣wards the Shoulder, somtimes so, as to take in an Inch and an half more of Skin. For when we find that the delineation of the Graft falls short, and that it shrinks, then is the time to eak what it wants by an oblique or slant Secti∣on. Because Nature endeavours Unition, as much as she can, at both ends of the Graft, which shorten it much. And when the Skin is loose and thin, this Section is proper, as we may gather by its shrinking in breadth. But when there is no ground for Fear, then a right Section, without any slo∣ping is best.

The Patient must be set on his Bed, in the same place and po∣sture,

as we advised for the deline∣ation of the Skin, against the Light, at a distance from the Wall, and on the side of the Bed, for the more convenience of the operati∣on. The assistents must observe their stations; one at the Artists right hand, the other at his left. the one must hold the Patients Arm leaning on Pillows, with the Hand upright, from the Elbow: The other must handle the Hume∣rus, according as the Artist shall direct, and as the Graft must be cut right or sloping. If the Ar∣tist make a right Section, he must order the Assistent at his right hand to compress the Skin next the Graft. For often the Skin gives way, and hinders the right Section. Now the Assistent will hold the Skin right, if he put one hand under the Armpit, and the other as near as he can to the Cutaneous Graft. Then the Ar∣tist must with a Probe lift up the Cutaneous Graft, putting his left Forefinger underneath, and car∣rying his left Thumb over against it, let him hold the Graft gently up. Then let him take the knife in his right hand, and cut even, and at a right Angle upwards. When the Graft is taken up, let him turn it back toward the El∣bow, and guard it well with Lint, where it is wounded. For som∣times, when a Vein is cut, it will bleed much. And this is the man∣ner of right Section. But in the oblique or sloping Section, the Assistent lays no hand on the Pa∣tient's Arm, only the Artist puts his knife between the Graft and the Muscle, underneath, and cuts slanting upwards. Assoon as he has considered how much he will add to the Graft, let him take it up between his right Thumb and Fore-finger, and give it to the Assistent at his right hand to hold. He must then put his Probe un∣der the Graft, putting gently un∣der it his left fore-finger, laying his Thumb over against it, and then he must raise the Skin gent∣ly, so as the knife may have room to go in. Which he must take in his right hand, and with some strength cut slanting, as far as he shall think good. When the Graft is taken up, he must turn it back to the Elbow, and where it was cut off, he must cover it with Lint, and fence it well. But he may immediately commit this to be done by his assistent. And the Artist himself may look to the other Part, may lay on Lint, and take care by all means to stop the bleeding. Then my advice is, to cover the whole Bed with divers Liniments, and then to lay on the broad linen Cloth. He may give the Graft to the Assistent on his left hand, who may conveniently hold it in his right, and, with warm linen Cloaths, keep it constantly from the injuries of the Air. In the mean time, the Artist must be covering the whole Bed, by rol∣ling it with one Roller, whose end must be fastned with a needle and thread on the outside of the Arm. When this is done, let him lay some Ointment over the Roller, as far as the cutaneous Graft will reach, and then let him lay back the Graft upon it. Great care must be taken to spread it well both in length and breadth. When the Graft is turned back, laid

smooth, and placed as it ought, the Artist must order an Assistent to lay his middle and fore Finger on the top of it, and bid him take care that it shrink not. Then let him take another Roller, and apply it where the Graft grows to the Stock, and there begin to roll, till he has covered the whole Graft, and bound it to the Arm. Here is the difficulty of the business: For if the Graft be bound too tight, it dies; if too slack, it shrinks. Therefore great care must be taken herein. And be∣cause it is difficult to hit right at first, the Artist, that he may be sure, must, whenever he opens the the Part, diligently take notice of the whole Substance of the Skin, whether it be as it ought, or whe∣ther it dies, or shrinks. This the Eye will shew; the other is known by paleness and senselesness. Be∣cause an Error herein is very hard to amend, therefore I would by all means advice the Artist to be care∣ful in it. When all is done, he must place the Arm in a middle posture, as before. And so the Administration of this Operation is performed.

Here it will not be amiss to mark out the parts of the Graft, and assign to them, and to some other things, names, that when we have occasion to mention them, we may not use Circum∣locutions. Horticulture directs us best in giving Names. For from it the best hints of any such ope∣ration were taken, and by it we have been hitherto directed. All therefore that is the subject of our operation, we call the Graft, the Cutaneous Graft, the Propagmous Skin, or the Brachial Skin. Its length and breadth are conside∣rable; but so is not its depth. The length exceeds the breadth usual∣ly one Third. The length we may divide into three parts, the upper, middle and lower, and we may give every one its name. By the upper part we mean that, which was last cut from the Arm, which we call the top of the Graft. We might more properly call it the insititious end or top, because it is ingrafted into the cut parts. The lower part, which grows to the Arm, we may call the root of the Graft; for from hence Ali∣ment is carried into the rest of the Graft, as from the Root into the Tree. What is between the Top and the Root, we may very well call the body of the Graft. As to the Superficies, we call it either Internal or External, the Inside or Outside, or the later we may call the Cutanous Side. The edges of the Graft we call either Interror or Exterior, or the In∣ternal or External linear Con∣fines, We may properly enough call them Lips; because both in roundness and thickness, they much resemble the Lips of the Mouth.

This we thought fit to mention concerning Names, that all con∣fusion might be avoided, and ob∣scurities cleared, which might otherwise arise about Names.

CHAP. IX.

Of the Cure of the New and Old Wound, both in the Graft, and in the Bed, and also of rearing the Graft.

WHen we took up the Graft, our care was first to stop bleeding. The next day it will be proper to open the Wound, and to look well about, what should be avoided, and what should be done further.

Now there are two Wounds in each part, viz. in the Bed, and in the Graft, altogether diverse, each whereof requires its proper Cure. That which was made at the first delineation, both in the Bed and Graft, is old: The other is new, both at the top of the Graft, and at the upper end of the Bed. Any one may see, these require different Remedies. The Part newly wounded requires Suppuration. But the old Wound, after the abundance of Humors gathered by Affluxion and Con∣gestion is spent, dies by reason of the weakness of the Part caused by wounding, instead of Suppu∣raters were Driers, and these no ordinary ones, that all that is soft may turn into Skin or Callus. In the mean time care must be taken, that both the top of the Graft, and the upper edge of the Bed, be brought to perfect Suppuration, which is usually done in nine days, or at most in eleven, some∣times in seven. For here we do not allow so long a time for mo∣ving of Pus, as before, because we have another design now; and there were several sufficient reasons then to protract the Suppuration of the Wound. As the grievous∣ness of the Symptoms, whose rage ought first to be appeased. And the thickning of the Skin, or at least, the hindrance of its decrease. For no small strength accrews to it from the growth of carnous Fi∣bres, which put a stop to the de∣crease of the Graft. Wherefore you may sooner leave off Suppu∣raters, and use Driers, when the Parts begin to have a Callus or Skin. It is a sign, Wounds are sufficiently suppurated, when the Artist sees, what Celsus learnedly observes, An equal Redness all over, moderation in Driness and Moi∣sture, and little or no pain. For then it is time to leave off Suppu∣raters, and to endeavor all you can to cicatrize the Wound, which is done both in the Bed and Graft by the same Remedies. Only the Bed, as Experience has taught us, requires stronger Medicines; be∣cause the Wound in the Arm is

moister and fouler, by reason it is upon the Muscles, to which the adjacent Vessels give a liberal sup∣ply of Vapors and Humors, and so hinder the drying of the Sore, in which it's Cure chiefly consists: But where (a, in the cutaneous Graft,) there is but little moi∣sture, it grows callous sooner; and therefore the Graft requires much gentler Medicaments, than the Bed. It is best therefore, when it is at the Artist's choice, (however his scope may be the same,) to protract the Cure of this a little, since each Part has now and then it's proper Symp∣toms. But let us pass the Cure of the Graft, and proceed to that of the Bed. There are several cicatrizing Medicaments; but this we have had Experience of, Ʋn∣guentum ex pompholyge. Here is the description of it, ℞ Cerae Al∣bae, Ol. Ros. an. lb V. succi fru∣ctûs solani sat. ℥ iiij. Plumbi usti & loti, pompholyg. an. ℥ j. Thu∣ris puri ℥ v. Coquatur oleum cum solani succo ad hujus consumptio∣nem, tune adjiciatur cera, quâ liquatâ, addantur caeterarum re∣rum pulveres, ••i{que} tenuissimi, subi∣gantur in mortario omnia, & ad unguenti formam reducantur. This Unguent is spread upon Cloth, and applyed to the Wound. There is another, which I have experienced to be no less success∣ful. ℞ Lap. Calamin. terrae Lemn. an. ℥ iiij. Litharg. aur. Ceruss. an. ℥ iij. Succi Semperviv. ℥ ij. cerae ℥ v. Ol. Ros. Omphac. lb j. M. & S. A. F. Ʋnguentum. Several other things are proper, as, Ʋn∣guentum ex minio, ex lithargr•••• ex cerussa, ex calce lota, and others of the like nature, which because they dry much, do therefore harden the Flesh into Callus. When proud Flesh arises either in the middle or edges of the Bed, it will be the part of a prudent Artist to have recourse to other means, whereby he may destroy this proud Flesh. This mischief is fomented by a too moist diet, and other Er∣rors therein. Therefore a drying diet must be ordered; and such Medicaments as these may be used. ℞ Terebinth. cerae Alb. Resin. Ammon. an. ʒ xiiij. Flor. Aer. Opo∣pan. an. ℥ ij. Aristoloch. long. Thur. mascul. Bdell. an. xvj. Myrch. Galb. an. ʒ iiij. Litharg. ʒ jx. olei si aestas fuerit lb ij. si byems lb iij. Bdellium, Ammon. & Opo∣••anac. in Acet. q. s. per unam no∣ctem macerato, calefactis terebin∣thinam permisceto; in oleo, adjectâ cerâ, caeteris{que} in pulverem reda∣ctis, coquito & s. a. f. Ʋnguentum. Spread it on a Cloth and apply it to the Wound. For it wonder∣fully dries up moisture and wastes proud Flesh. Here is another as good and much experienced; ℞ Resin. Pin. lb j. cerae lb v. olei comm. ℥ iiij. aeruginis ℥j. ss. resi∣nam & ceram in oleo liquato, aeruginem studiose terito, oleo ad∣dito, f. Ʋnguentum. This also is Excellent; ℞ Ʋngu. Ros. Mes. ℥ j. Praecipitat. Opt. Pulv. ℥ j. ss. M. It insensibly consumes the proud Flesh, and cleanses the Ul∣cer without pain. But it som∣times happens, That as the Bed is skinning over, Pustules do arise suddenly, which somtimes are painful and somtimes do itch. This happens in Cholerick Persons and in hot Seasons; and somtimes in

Phlegmatick Persons, who have a sharp Serum. It often hinders the Cure; therefore we must en∣deavor to prevent it by a good Di∣et and Medicaments. This follow∣ing I have had great Experience of: ℞ Ol. Ros. Comp. lb v. Ol. Ros. Omphac. ℥ iiij. Succor. Fol. Plantag. Solan. Hortens. Centaur. min. Lapat. an. ℥ j. ss. Olea bul∣liant cum succis ad eorum consum∣ptionem. Adde Cer. Alb. q. s. f. Ʋngu. molle. Asperge domum Li∣tharg. Pulv. ℥j. ss. Pompholyg. Praeparat. ʒ ij. Recrem. Pliambi. Pulv. ʒ iij. Pulv. hordei cremats ʒ j. ss. Bol. Arm. Pulv. Camphor. an. ʒ ss. Ʋngu. infrig. Galeni. Po∣pul. an. ℥ j. M. F. Ʋnguentum. s. a. Here is another good one: ℞ Litharg. ℥ j. ceruss. ℥ v. cerae Alb. ℥ iiij. Ol. Ros. lb j. Album. ovorum recent. No. iiij. Liquefiat. cera cum oleo in olla vitreata, ad∣datur Lithargyrum & cerussa, con∣tinuó{que} misceantur: Ʋbi autem refrixerint, ovorum albumina, ea∣{que} probe agitata, injiciantur, & f. Ʋnguentum. It cools the heat of the Humors, and by gently dry∣ing cicatrizes Ulcers. There is another very bad Symptom; viz. When upon a conflux of ill Hu∣mors to the Bed, it is eaten into several Ulcers. This is holpen by good diet, and purging the Body, and by good Medicaments out∣wardly applied. Among divers I shall mention but two: ℞ Resin. Pin. Terebinth. cerae citrinae, Olei commun. an. ℥ j. ss. Dissolve ce∣ram & resinam in oleo, tand••m{que} terebinthinam, omnia colentur, & in cacabo ad lentum ign••m bulli∣ant, a••ri{que} exposita demum refri∣gescant. The other is this: ℞ Terebinth. Mell. Ros. col. an. ℥ j. Thur. Alocs. Sarcocoll. Farinae Hord. cribrat. sub. an. ʒ v. Dis∣solutâ terebinthinâ cum melle, ad∣dantur pulveres, & agitentur in defesso, us{que} quo exacte commisce∣antur. These are the principal Symptoms, and they proceed from impurity of Humors, which must be corrected by good diet and purging. Wherefore it is best to prepare the Body well before the Operation be undertaken. If any Purgatives be given afterwards, they must be very gentle. But a well-ordered diet is the main thing, being both easiest and safest.

Now we will proceed to the Cure and rearing of the Graft. The chief of the Cure consists in bree∣ding a Callus by good Medica∣ments. The rearing of the Graft consists in nourishing it by plenty of kindly Aliment. When the Cicatrice is bred, it is fit for in∣grafting. But we must first sup∣purate the new Wound in the Graft, and then cicatrize it. The Medicaments are the same as be∣fore. So dry Linen Cloths, and those medicated, or Lint, are good, prepared in this manner. Take fine thin Linen Cloths, wet them in the Liquor, which we shall now describe, dry them in the shade, and so wet them and dry them three or four times. This is the Liquor: ℞ Gallar. immatur. Su∣mach, Myrtill. Balaust. Cortic. Granat. an. Mj. Acac. Hypocyst. an. ℥j. Alumin. ℥ij. bulliant omni•• in vino nigro austere, quous{que} ter∣tia saltem pars supersit, macerentur in co linteamina, & in umbra ex∣i••centur. And because all things relating to the Cure are done in

order of time, we shall distinguish the time of the cutaneous Graft in∣to four Ages. For as the time of all Animals living is circumscribed by certain Intervals, wherein their Bodies receive notable Changes; so the time of the Graft may very usefully be distinguished into it's Ages, wherein it undergoes con∣siderable Alterations. The Infan∣cy of the Graft is the time from it's taking up till the Wound is dry∣ed; so long as there is no driness in the Carnous Fibres, but they are all soft, flaccid and moist. For whereas before it was nourished at both the ends, now it receives nou∣rishment but at one, and so must needs languish and be subject to divers Symptoms, Ulcers, In∣flammations, and Corruption of part of it; all which are obviated, as we have taught formerly. The youth of the Graft is, when signs of Driness shew themselves; for then the Skin neither receives the Excrements of other Parts, nor breeds any in itself. This is a great sign of Strength: The Eggs grow callous first, and then the rest; and the top before the root. The Manhood of the Grafting is, when the Cicatrice is come to the root, and all it's inner Superficies is turn'd callous. The old Age is, when the Graft is all over cal∣lous.

Now it remains, that we treat of the ill Accidents that befal the Graft; And first of all we will treat of that which comes through the Artist's fault, viz. The decay of the Graft through the uneven laying and binding of it up. For when it is turned either to the right or left, and the Skin lies on rucks, Ulcers do arise and so the Graft is fretted. You may know it by the bandage being on rucks, or the Skin it self, for there Ulcers are most apt to arise. Whereup∣on the Graft is starved, the pas∣sage of it's Aliment being inter∣cepted. Wherefore great care must be had in binding, about the Position of the Graft, that it lie even; and then Ulcers are pre∣vented. But if any one should prove so supinely imprudent, as to commit such a mistake, he must help it thus. Suppose the Graft be turn'd to the left; this turning must be put even; it may be reduced by a Linen Cloth about an hand's breadth folded, till it be but an Inch in breadth; lay this on the Graft when you have laid it right, at the roof, then bind it up with Rollers, as before, thus with Bolsters you may reduce it; and when there shall be no further occasion, you may leave them off. The Ulcers, if there be any, may be cured as those in the Bed.

When the Graft fades, and grows more languid than it ought, this happens somtimes through too strait binding, somtimes from a Callus, obstructing the Passage of Aliment. When the fault is in the binding, the Artist may ea∣sily help it. But when the cause lies in some fault of the Graft it self, or of some other Parts, ha∣ving well considered where it lies, we must endeavor to remove it. When it lies in other Parts, the remedy lies in carrying off Impu∣rities by purgings. When it lies in the Intemperature, suppose in the Frigidity of the Graft it self; then it is best to use gentle Fricti∣ons

to the Part: For that brings Nutriment into it from the root, by opening it's Passages. You may rub till the Part grows red, and swells a little, which are signs you have done it good. What∣ever you do more, you do thereby but discuss and waste it's Nutri∣ment. You must rub from the root towards the Graft. You may excite the languishing heat by irrigating the outer Skin with hot Oyls made actually warm. The Artist may do it thus, he may take some Cotton dipt in the said Oyls, and anoint the Graft over all the outside, then with his Hand he may rub from the root to the top several times, then wipe it, and bind it up. A Fo∣mentation also of generous Wine may be prepared, especially in Winter Cold, and in Phlegmatick Persons. No moist thing, especi∣ally no Oyl, may be used to the inside of the Graft, because it hinders Callus.

We may soften the hardness of the Callus by Plaisters, such as Diachylon, Diapyritid. Diapahna, cum mucilag. rad. Althaeae, & rad. Cucum. agrest. Diadictamn. &c.

CHAP. X.

The time of Ingrafting, that is, of what Age a cutaneous Graft must be chosen, to ingraft with∣all.

VVE told you before, there were several Ages of the Graft, in one of which Incision must of necessity be made. No Man, I think, will grant, it may be made in all. For upon what account we deferred the ta∣king up of the Graft after it's De∣lineation, upon the very same here we protract Incision. Because the Graft has not strength enough to undergo the violence of Incision, and to preserve it self likewise from sudden withering away, for the Flesh is not firm enough. And other Symptoms were to be obvi∣ated, Inflammation and Bleeding, whose violence were enough to di∣stract the Operation. Wherefore it could by no means be, that as soon as ever it was cut off, and in it's Infancy, it could be implanted into the curt Nose. Nor is the time of it's youth proper, since the violence of the Symptoms is not quite asswaged, nor is it strong enough to endure the violence of Incision, nor, were it implanted, would it well unite. For it not being yet dry enough, but moist and continually moistened with Excrements from the Brain, no wonder, if it should putrefy, or at least heal with much difficulty. But it is not worth while to tarry for it's old Age. For we require a Graft firm and robust, not flac∣cid and feeble. For what, I pray, should we do with it? The Nose is perfectly to be repaired, which we can never do with a soft, wrin∣kled, pale, juiceless, and diseased Part, (for old Age is a disease to every thing,) nor can we imagine it. We must therefore take the Graft, and ingraft it into the curt Parts, when it is grown hard, and begins to decline, but is so strong as to endure the violence of the Operation well enough.

CHAP. XI.

Of things necessary for Ingrafting.

AMong things requisite for Ingrafting, some are for convenience, others for necessity; and these are necessary, either in the very operation, or after it is per∣formed. We will begin with those that are for convenience. And first of all, the Head must be shaven, made clean from Dandriff, and kept from Lice. The Beard must be shaven. All this should be done the Evening before the intended operation. Things necessary for Ingrafting, are Knives, Scissars, Needles, Thread, Head-rollers, a Chair, Cloth, and Lint. The use of the Knives is, to excoriate the curt Nose, and the cutaneous Graft. They must be very sharp, and several of them; and those of several shapes, streight and croo∣ked, according as the operation shall require. The Scissars must be sharp; their use is, to clip off the remains of Flesh or Skin, which cannot be cut off with a Knife. There must be a Roller, an Ell and an half long, and eight Fin∣gers broad. This must be dou∣bled, it must go round the Fore∣head and tye behind. Its use is, when the Graft and Nose are stitcht, to stick the Needles in order, lest they might otherwise be confounded and intangled. The Needles must be very sharp and triquetrous, such as Glovers use: They must be strong, and there must be three, or more, above the number you have oc∣casion for, that, if any break, you may not want. The Thread must be midling and even; but it must never have been boiled. The Thread for each of the Needles should be about five Ells long. The Chair may be an ordinary one, without Arms to it, upright in the back, to the lowest Verte∣brae of the Neck; but then it must be a little reclining, for the Head to lean upon: For it is better to perform this operation in a Chair, than on a Bed. There must be a Cloth to wrap about the Patients Neck and Breast, to receive the Blood, and to keep him clean. There must be Rags and Lint, to wipe the Blood off the excoria∣ted Parts. These things are ne∣cessary in the operation.

Things necessary when the ope∣ration is performed, are either for the Cure, or for the Conservation of the Parts, when they are sew∣ed. The first is performed by Medicaments. There are two Parts, which we must take care of, the Bed, and the Suture of the Ingrafted parts. There needs no alteration be made in the Cure of the Bed; but the same things may be used as before. And whatever is good for a green Wound, and

for a Suture, the same is good to cure the ingrafted parts. We must therefore repress an afflux of Hu∣mors, and an Inflammation. This may be done with the white of an Egg and Rose-water in the same proportion as before. There must be two Pledgets of Low, about an Inch broad, and as long as the Nose, to guard the Suture. The other must be as long, but broa∣der, to guard the adiacent parts from Inflammation. And because the Suture penetrates to the inside of the Nose, there may be two Tents made, big enough for the Nostrils, and long enough to help the Cure, but not so long as to cause Sneezing. Both the Pledg∣ets and the Tents must be dipt in the whites of Eggs, when there is occasion to use them. Thus much for the Cure.

Now we proceed to the Rollers, and such things as are for the con∣servation of the Work, when per∣formed. But before we say any thing of the Rollers, we will shew the posture of the Arm, which these Rollers are to keep it in. And it is thus; We must raise the Humerus as much as we may, and apply that part of the Arm, where the Musculus triqueter ends, to the Face, or near the Nose. Then the Cubitus must be bent in a little, it must also be brought upwards, and at the Wrist it must lye just on the top of the Forehead. The Hand must be clapt on the Head, along the S••tura Sagittalis, so that the Brachiale may be almost upon the Sutura coronaria, the Meta∣carpium upon the crown of the Head, and the middle Finger may almost reach the angle of the Lambdoeides. And because the Arm must be continued in this posture till the parts are united, and that without motion, (for otherwise the coalition of the Parts would be hindred,) it must be so contrived, that, be the Pa∣tient never so willing, he cannot move his Arm. But besides, the motion of the Head must be con∣sidered; for if the Head be not kept steady, the case will be the same. Now the Head may be kept steady by a Hood fixt to the Doublet behind, coming a little over the Forehead, down along the sides of the Cheeks, with holes for the Ears, and fixt tight to the Doublet again before. The Dou∣blet must be well fastned to the Breeches, because there is the stay of all. There must be several Rollers, to bind the several parts of the Arm, of which that is the chief, which comprehends all the back part of the Arm; and from which, as branches from a Tree, all the other proceed. This may be called the Royal Roller. Its rise is from the Shoulder-joynt and Armpit, and it goes from thence along the Humerus to the Elbow; from thence to the Cubi∣tus, and so to the Wrists and Fin∣ger's ends. Its office is, by the help of other Rollers fastned to the edges, to keep the Arm fast to the Head, and to give rise to the other Rollers, of which there are four in number. The First begins behind the Humerus, comes un∣der the Armpit, and so goes along to the other Armpit: This may therefore be called the Axillary Roller. It must be three Fin∣gers broad. Its office is to guard

the Shoulder-joynt. The Second is the Elbow-Roller; it must be as broad as the former. It comes from the edges of the Royal Rol∣ler, and both on the right and left fastens the Arm to the Head going behind, and it is fastned to the Hood about the Lambdoeidal lines. And it is of such moment to keep the Arm fast, that there is another Roller, which comes from the infide of the Cubitus, a little above the Elbow-roller, and so goes across the Breast, and is fast∣ned to the Doublet about the Hy∣pochondria. This may be called the Pectoral Roller. Last of all, there is a Roller which fastens the Arm to the Head at the Wrist: It may be called the Brace-Roller. And these are the things we would have in readiness before Incision.

CHAP. XII.

The Administration of Insition.

VVHen the Artist has a mind to perform Insi∣tion, let him chuse the Forenoon for the time, because then Crudi∣ties are concocted. Therefore the Patient would do well to eat but a light Supper before. A Tailor should be at hand, to fit the Insititious garment to the Patient. Let the Patient there∣fore first put on his Breeches, then his Doublet and Hood, let him tye his Doublet to his Breeches with points; then let him button his Doublet. Then put on the Hood, put the Ears out at the holes, and fit it right to the Head. Then let the Artist raise the Pa∣tients Arm, (letting the Graft alone as it is,) and let him put it in the posture, we mentioned before. The Assistents must keep it thus, while the Artist fits the Rollers. Let him first open the Royal Roller, bring it behind the Arm, obliquely along the Face, and fasten it to the Hood upon the sides of the Lambdoeidal Suture. There must be two strings, and three or four Fingers breadth be∣tween each. These eyelet-holes must be overcast by a Tailor, lest they should tear, and give way. He must do the same on the other side. Then take the Second Rol∣ler, which we call the Brace-Roller, and tye it on each side to the Hood. Then take the Third, i. e. the Axillar Roller, carry it forward toward the Pap on the contrary side, and tye it with strings. Then carry the Pecto∣ral Roller from the Cubitus to the opposite Hypochondrium, and tye it to the Doublet with strings. 〈◊〉〈◊〉 let the Artist ex∣amine

all things well, that no∣thing be loose or gaping, and see that all things be ready for Insi∣tion. When he finds all things sit, let him then loose and untie the Rollers, and put off the Hood, and throw it back on the Shoul∣ders. The Assistents must set the Chair ready and the Cloth. The Artist must rid himself of all in∣cumbrance. The Patient must sit right against the light of the window. The Assistent must tye the Cloth about the Patient's neck, to save the Blood from run∣ning down his Breast. The Ar∣tist must stand before the Patient, and appoint his Assistents their posts. One of them must stand behind the Patient, and hold back his Head, so that it cannot move any way: The other must stand at his right Hand, and reach the Artist his Knives on occasion. For they must be often changed, be∣cause this operation blunts them much. The Assistent should keep them, as much as he can, out of the Patient's sight. He must al∣so reach Rags and Lint to wipe the Wound. Before the Artist sets upon Excoriation, he ought to consider the breadth, depth, and ••renness of the Wound. And here take notice, that the ampli∣tude of the Wound affords the greatest hope of Insition. The Wound must be deep enough to bleed well, since Blood is the on∣ly Glew and Cement to unite the Parts. It must be even on the edges, without notches or angles, in an even line, but oblique. Som∣times the Artist must put his Fore-finger into the Nostril, to keep it steady for cutting. The outside must be first cut in an even line, then he must go deep∣er on the inside; and if at the end of the Wound any thing stick which cannot be taken off with a knife, he may clip it with a pair of Scissars, and so bring it to an evenness on the inside. Then he must proceed to the cutting of the Graft, which he must not do at a venture, but in proportion to the curt Nose, He must there∣fore wipe the Wound, and clap a paper on the end of the Nose, which may serve, when fortifi∣ed, for a pattern to cut the Graft by. Great exactness is required here. When he has for∣tified the Paper, let him give it to his Assistent. Let the Patient hold a linen Cloth to the Wound, to stop the Blood and keep out the Air. Then the Artist must open the Graft, and commit the Arm to one of his Assistents. Who must put his right Hand under the Elbow, and with his left keep the Ʋlna and the Wrist upright. The Artist must ap∣ply the Paper to the Graft, and well consider how the Section must be made. Let him cut off what is superfluous, let him take off the Callus within, and make it of an exact measure with the foregoing Section of the Nose. Here the greatest dili∣gence and exactness imaginable is required: For there is no room to amend a mistake here. Then let him bring the Graft to the Nose, and try whether they ex∣actly sit, so that there may be neither eminency nor vacuity in the edges of the Wounds. And when they are exactly made fit,

by taking away all unevenness, he must proceed to stitching. Where observe, that the stitches must be all at an exact distance in the Nose, but both at less, and not at even distances in the Graft. When he goes to stitching the Nose and the Graft, let him set the Patient on a Chair in a clear light, let him put on the Hood, and then the Roller, as we men∣tioned before, over the Forehead, and fasten it behind in the Neck. This serves to stick the Needles on in order, to avoid confusion after stitching when the threads are tied, lest one might be taken for another. When this is done, let him pass his Needle through the Parts; First through the Graft, and then through the Nose. But before he passes his Needle, he must mark out the stitches. Let him begin with one in the mid∣dle of the Graft, and then take the rest equally on each hand of it. He must take care to observe just distances in his stitches, that all may exactly sit; for the cer∣tainty and speed of Coalition, and the beauty of the Cicatrice, de∣pend all upon exactness in stitch∣ing. The Artist may begin his stitching, either on the right or left side of the Nose, first passing the Needle through the Graft, then through the Nose; let him bring it out directly towards the Forehead, and stick it in order on the Roller. When this is done, then comes the tying. But the Patient must first be laid in his Bed, lest moving afterwards should break or stretch the stitches. First, the middle stitch must be tied, and then the rest on either hand. The manner of it is thus. The Artist must turn the Arm into the posture, we mentioned be∣fore, when he cut the Graft equal to the Nose, he must bid the As∣sistent that holds the Patient's Head, to hold his Hand on the crown of his Head by the Wrist, the other must keep the Cubitus, and the Elbow steady, while a third takes up the Graft, and applies it to the curt Nose. The Artist must with his left Hand take the end of the Thread that hangs out of the Graft, and with his right, the Needle that belongs to it. Then let him draw the Thread gently, and see whether it be that which he designs to tye or no, let him tye it once tight, and tye another single knot, to keep it from slipping, and then cut off the thread almost at the knot. And thus let him do with the rest in order. When this is done, he must dip the Tents in the Whites of Eggs, and put them into the Nostrils, and then dip the Pledgets, and lay them on the Sutures outwardly. Then the Patient must be bound up with Rollers fastned to his Cloaths, so that he cannot stir any way. First of all, the Roller which fastens the Wrist to the crown of the Head, must be tied on each side with its strings, then the Elbow, then the Axillar, and then the Pecto∣ral Roller. I would advise the Artist himself to do this, and not to commit it to Servants, be they never so skilful. This done, let him advise his Patient to lie as still as he can, not to stretch out, or pull his Arm, nor stir it any way, lest it should cause an

Inflammation, which after so much slashing, stitching and tying, is apt enough to come of itself. Wherefore to avoid this, it would do well, for an hour and an half to clap some linen Cloaths dipt in Whites of Eggs and Rose-wa∣ter in equal quantities to the place of Insition, changing them as they grow hot: For nothing is better to prevent an Inflammation. And so is Ingrafting performed.

CHAP. XIII.

The Cure of the Insition, and what Course of Life must be observed.

MEdicaments, proper for the Cure of the Ingrafted parts, are of a middle nature between such as cicatrize, and such as incarnate: For they must be dry∣ing, and moderately astringent, such as Ebulus, sambucus, side∣ritis, palmae, pini, tedae cortices, draconii folia recentia, quae fra∣ga gignit herba, anagall is, sa∣lix, androsaemum, astragalus, phi∣lomunculus, telephium, symphy∣tum petraeum, arancae tela, sed ea praecipuè, cui è pistrino pollen insederit, (haec enim valentiùs exiccat) equisetum, chamaepytis, arnoglossum (quod in jungendis vulneribus nulli remediorum ce∣dit) isatis, centaureum minus, folia pentaphylli, mumia, folia bederae recentia, gummi ceu hu∣mor glutinosus folliculis ulmi in∣clusus, ceratum ex cerussa & em∣plastrum barbarum. Those are good for the Cure of the out∣ward Wound; but that on the Inside requires another course; for you must for three days at least tent this with Suppura∣ters a little drier than ordinary, such as Ʋnguentum ex Pom∣pholyge. It is good to strew Myrrh, Frankincense, and Dra∣gon's Blood powdered upon the stitches, to keep them from ouz∣ing. When the Pledgets are ta∣ken off, it must be done with all gentleness; therefore they must be suppled with some Li∣quor, but sparingly, lest any moisture should insinuate into the Insition. Afterwards Linen Cloths spread with Medicines must be applyed outwardly, and Tents dipt in some inwardly, till the fourth day; and then we must proceed with Driers, as we said before. This must be care∣fully observed, that in dressing, they loose the Elbow Roller ve∣ry carefully, especially at the first, lest the Insition should be separated. Therefore an Assi∣stent must with all diligence keep the Patient's Arm in its for∣mer posture. As to the stitches,

the time when they are to be loosed, is, when manifest tokens of Coalition do shew themselves, which they do in Summer, and a dry Season, on the third or fourth day; But in Winter and Au∣tumn, not till the fifth. It would be absurd to loose all the stitches at once. For thô the Princi∣ples of Union shew themselves in all parts; yet it is best to keep some stitches fast, till all be more firmly united. You must begin to loose them first, where the Union is not confirmed. This will be manifest, where the Part is driest. The fleshy and upper Parts usually unite the first. The lower, because they are excar∣nous and dependent, and so re∣ceive the moisture that falls from above, are flower in uniting. Thô sometimes it falls out other∣wise. The stitches must be clipt with a pair of keen little Scissars, near the hole, and the thread must be drawn out by the knot. It would be improper to let the stitches alone till the Nose were cicatrized; for so the lips of the holes would grow callous, and would never cicatrize, but the Marks would remain: All which is prevented by taking out the stitches in time. But where the stitches are taken out, we must apply Sarcoticks and Aggluti∣nants. The first stitches are taken out about the fourth day, and all the rest before the seventh; for within that time the Parts do ci∣catrize. When the stitches are thus taken out, apply dry Lint with Ceratum ex Pompholyge, till the fourteenth day, in which time the Parts unite and clcatrize, as their driness does most certainly testifie. The course of living is either low or midling: For the first week use a low, and for the second, a midling Diet. All must be Spoon-meats, to avoid chew∣ing, which would disturb the Nose. Keep quiet. Be chearful. And be moderate in Sleep and Watching.

CHAP. XIV.

How the Symptoms, attending Ingrafting, are to be corrected.

THE Symptoms attending this Operation, are either proper to the Ingrafting, or common to other parts. Symptoms proper to Ingrafting are Proud Flesh and Excrescence on the inside, and gaping of the Suture. The First is Nature's fault, the Second is the Artist's. Proud Flesh arises in ill∣habited Bodies, and in cold and moist constitutions. We must not cicatrize, till this Proud Flesh is taken away; and it may be taken away by Tents dipt in Ʋnguentum Isidis, Apostolorum, or Damasce∣wan, and put up the Nose. If there be any gaping of the Suture, it was the Artist's carelesness in taking his stitches, that occasioned it. The only Remedy is, to do it quite over again, as we directed in Insition: For be it little or more that is amiss, the case is the same, the Operation must be performed anew.

The next are the common Sym∣ptoms, namely pain occasioned by binding the Arm in the aforesaid posture, for which the only Reme∣dy is Patience, since it may not be loosed, nor can Medicaments be applied. Unless changing sides to lie on may give a little ease. The pain in the Wrist arises from its be∣ing tied down to the Scull, upon a rough hood. The Remedy is to put Cotton under the Wrist be∣tween it and the Head. Thirst, want of Sleep, and other general Symptoms may be cured in this, as in other cases.

CHAP. XV.

Of Cutting the Graft quite from the Arm, and how it must be Cured.

AS soon as the curt parts are united with the Graft, it is time immediately to take it from the Arm, and to commit it to the new Stock. We must consider therefore, when we may reckon them united, and so at what time the Graft must be cut off, then how it ought to be done, and how cured, and lastly how Symptoms may be helped. The time of full unition is about the Twentieth day. Therefore we should cut it off with∣in Twenty days at the furthest. Somtimes in dry Weather, and a good Constitution, it may be done within a Fortnight or thereabout.

Before the Artist sets upon the Operation, he must have in readi∣ness Whites of Eggs, and Rosewater with a little Powder of Dragon's Blood, to stop Bleeding; round Pledgets and Rollers both for the Arm and Nose. Those for the Arm must be of the same breadth and length as before. For besides the new Ulcer, which arises upon cutting of the Graft, the whole Bed must be oovered, which it may with a plate of Lead and dry∣ing Medicaments. The Roller de∣signed for the Nose must have its ends long enough to tie behind the Head. It must be about four Fin∣gers broad. As soon as it reaches further than the Nose, it must be divided into two, and so must have a double end on each Hand. Two of them must be tied above the Ears, upon the tip of the Lamb∣doeides: And the other two must pass under the Roots of the Ears, and be tied behind on the begin∣ning of the Neck. But the ends on each Hand must cross one ano∣ther, the lower being tied above, and the upper below. This also must be observed, that where the Roller is whole, and lies upon the Graft, it must, about a Fingers breadth from the bottom, be cut transverse, and another must be put under Perpendicular to it; so that it may reach no farther than the top of the other Roller. For when the Graft passes through this way, it does not turn up, but being prest on each side makes way forward, so that gradually it receives the shape of a Nose. There must be several square pieces of Linnen in readiness at the Fire upon occasion of the Graft, as we shall shew by and by. Then there must be a ve∣ry sharp Knife or Rasor, where∣with to cut off the Graft. When all things are thus ready, let the Artist proceed to his Administra∣tion. He must order two Assi∣stents, one on his Right Hand by

the Patient's Face and at the upper part of the Bed; the other on his Left, on the outside of the Bed. First, all the Rollers must be unti∣ed, and the Hood must be thrown off the Head upon the Shoulders; and while the Artist is about Cut∣ting, the Assistents must keep the Arm in the same posture, it was in before. He must take the Knife in his Right Hand, and apply his Left to the Graft. He must hold the Root of it between his Thumb on the outside, and his Forefinger on the inside, and with the Knife cut it off by the Root close to the Arm. When this is done, three things remain: The first whereof, which is the Artist's part, is to dress the Graft: The other two, name∣ly, to bring back the Arm, and to dress the new Wound, belong to the Assistents. These actions must not be divided. For each of them requires its Cure immediately; nor can the Artist apply himself to so many Operations all at once. Therefore these charges must be committed to several Persons at one and the same time. And that every one may know what his du∣ty is, we shall first proceed to the Cure of the Graft, which is the principal thing. But here two things give us a great deal of trou∣ble, one is the fresh Wound, the other is the refrigeration of the Graft, after its being cut off. This later is apt to affright People that are unexperienced in the affair, be∣cause in the very Moment that the Graft is cut off, they see it turn pale and white, and stiff and cold, as if all its heat were expired. But these fears presently vanish, if we apply but warm Linen Cloths to the Graft, changing them for hot as they grow cold. How long this is to be done, is hard to determine, because of the several Complexions of Mens Bodies; it ought to be continued till the Graft is revived, which we may know by its growing a little redder and more fresh co∣loured. Then clap on warm Cloths, and underneath some dipt in the Whites of Eggs, then bring the Roller over the Pledgets, and lye it behind the Head, as aforesaid. As for the Assistents parts, he on the Lest Hand must apply a Com∣press dipt in Whites of Eggs to the fresh Wound; and if there is any Wound remaining in the Bed, he must apply its Medicaments, and roll it all over with a Roller, and sew the end at last: For the Roller must not be tied on a knot. Af∣ter dressing, it is adviseable to draw the Arm from the Head, and bring it to a middle posture: This must be done by degrees, and not at once. He that dressed it may most conveniently do it, by taking hold of the Patient's Elbow with his Right Hand, and of his Wrist with his Left, and so bring it into its posture. The other may put Pil∣lows underneath, and support and gradually compose the Arm into a middle posture. We will now say somthing further in reference to Cutting. We advised to cut off the Graft close by the Arm, if it were but for the better cure of the Arm. If you think, that there will be more than needs of the Graft to supply the Nose, you may either the very same day, or the next, cut off what you think will prove su∣perfluous; but have a care that you take not too much away: For

then the Nose would still be defi∣cient. We must have a care like∣wise, that we tye not the Graft too hard: For that might repress the Blood and so cause it to perish. The Patient must live on a whol∣some Diet, but eat little. He must have a care of cold and uncertain Weather, which often causes the Nose to perish.

CHAP. XVI.

Of Shaping the Graft, so as it may represent the Nose.

THE shaping of the Graft consists principally in three things, viz. In forming the No∣strils and the Bridge, in its Insition, and last of all in conforming the whole Graft according to Na∣ture's Model. Nothing of this kind must be attempted, till four∣teen days are over from the Graft's Cutting off, and then it will be time to begin this Operation. In the mean time the Graft must be carefully guarded by Medicaments and binding. Tents, as we said before, must be dipt in unguentum ex succis or ex pompholyge, either alone or mixt together, and put into the Nostrils. But the end of the Graft, that is, the fresh Wound, requires Suppuration for the first Week; and the later Week unguentum ex succis or de pompholyge may be applied. The Artist must also take care, that the external parts cicatrize neat∣ly. He may accomplish this by several means, of which I shall mention the most experienced and successful. They are either Plai∣sters applied outwardly, or Fomen∣tations used before the Plaisters are applied. In Summer time ceratum diaphaenicinum and ex cerussa are proper. It will be better, both for the comeliness of the Cicatrice, and the strength of the part, if a little oleum de Beta be mixt with it. And this is no ordinary Plai∣ster; ℞ Styrac. liqu. ℥ iiij. cerae flavae ℥ij. thuris, myrrhae, oliba∣ni, ligni aloes à ℥ v. redigantur singula in tenuissimum pollineni, & oleo amygd. dulc. recenti, & cera cum resinae, q. s. ex arte pa∣retur ceratum. But before we ap∣ply the Plaister, we have often with good success fomented the part with generous Wine warm, in half a Pint whereof five Grains of Musk were steept. The Graft may be fomented either with a Sponge or with Rags dipt in this Wine, which, when their warmth begins to fail, must be changed for new. For so the Pores are opened, and the Blood is drawn into the Graft. This done, the Artist must cover the whole Skin, and the Nose also, a Fingers breadth, with his Plai∣ster. In the Winter and Autumn

we Foment with this; ℞ Vini Cretic. lb ij. oliban. styrac. li∣quid. an. ʒ j. adipis asini ʒ ij. In∣fundantur omnia per noctem in vi∣no Cretico supra dicto, deinde his ebulliant, mox colentur & colata serventur. Ceratum Barbarum is good. And this; ℞ Galbani, opopanac. thur. aristoloch. long. ma∣stic. myrrh. an ℥ j. Ammoniac. ℥jss. litharg. aur. ol. commun. an. ℥xviiij. bdel. ʒ ij. lap. calamin. haematit. an ℥j. olei absmth. ℥ iiij. terebinth. lb v. ol. rosac. ℥ j. redigantur in tenuissimum pollinem quae religenda sunt, & gummi aceto dissolutis cum cera, s. a. f. ceratum. This also is excellent good, ℞ Aristoloch. rotund. been alb. & rubr. an. ℥ v. rad. lil. ℥ v. cicer. rubr. lupinor. combustor. an. p. s. nucis moschat. cinnam. an. ʒ ss. amygd. amar. con∣tusar. ℥ ij. ol. tartar. ℥ iij. aqu. pluvial. lb. ii. contrita distillentur, mox ℞ liquoris ℥ ij. ol. caryophyll. de spic. an. ℥ j. Styrac. liquid. ℥ v. ambr. ℈j. mastich. ʒ ij. terebinth. ℥ v. bulliant olea cum liquore, de∣inde additis reliquis cum cerae q. s. f. ceratum. s. a. Another thing re∣quisite to the guard of the Graft, is the Binding, which must not be inartificial. For because the Graft must come as near the shape of the Nose as may be, it is requisite to make it gradually pliant, to bend it a little, and to form the Tip and the Bridge. In Nature's Model of the Nose there are these things con∣siderable, the Length, the Tip, the Bridge, ••he Alae or sides of the Nostrils, and the Holes or Nostrils themselves. The length of the Nose is reckoned to be the third part of the Face's length, namely the spac•• between the Tip-end of the Nose to the middle of the interci∣lium is equal to that of the Fore∣head from thence, and to the space between the bottom of the Bridge, and the end of the Chin. The Tip is the round end of the Nose. From hence the Bridge is inserted transverse to the upper Lip; and its length is the space between that insertion and the edge of the up∣per Lip. The proportion of the Alae or sides is such, as that they pass on either side down to the upper Lip in the shape of an (S), only the bought is far larger where it descends to the upper Lip. The Holes or Nostrils are of an Oval Figure, more acute towards the Tip, and more obtuse towards the lower end. After this Mo∣del of Nature therefore must we always form the Cutaneous Graft, when ever the Bridge and the Alae are cut off. And if any part of them remains, the Graft must be formed proportionable. When therefore the Artist would shape the Nose, having first con∣sidered its length, let him mark that part with Ink, which he designs for the Tip. Then let him mark the Confines of the Alae, from the Basis to the Tip; and then mark the Bridge from the same Tip to the Basis. When he has done this, let him consider well, whether all things be exact, and then let him take his Knife, which must be very sharp, and cut, as he had design∣ed, the Graft. But he must ob∣serve this caution in the Section, to the Bridge he must cut in a right line, but towards the Alae in a bow, deep and oblique. He must put small Tents dipt in Whites of Eggs into the Nostrils,

and he must bring the Bridge be∣tween them. Then he must put an orbicular Compress below the Nose. This is done to keep the Bridge from starting, and the Tents from slipping out. He must not take away these Tents till the next day. And take this for a rule in forming the Bridge, always take it long enough and broad enough; for one may take away from it, but can never add to it. There∣fore of the two extreams the ex∣cess is less dangerous than the de∣fect. The reason why the Bridge is cut in a streight line, and the Alae in an oblique or sloping in∣wards, is because this is best both for the Nostrils and the Bridge. For whatever is taken from the thickness of the Alae, as much is added to the Amplitude of the Nostrils. And we may do it the more boldly, because proud Flesh is apt to grow there. Besides, when the Ulcer is healed, the Skin turns inwards, and so the circumference of the Alae being Skin and not a Cicatrice looks the handsomer. The reason why we Cut the Bridge streight down, is, because so it is the stronger, which would otherwise fade away. But the Cutaneous Graft must be well hollowed out towards the Alae, otherwise you can ne∣ver make a decent Nose. Where∣fore whether there be proud Flesh or any thing superfluous of its substance, it must be taken away thus. The Patient must sit against the light, and lean his Head back upon one of the Assistents. Then the Artist having turned up his Nostrils, and diligently viewed whether there be any thing super∣fluous; if there be, he must take it away by little and little and very moderately with keen little Knives. He must repeat this of∣ten, for upon Cutting, proud Flesh is apt always to arise, the growth whereof must be checkt with Tents dipt either in unguentum isidis or de pompholyge, and clapt into the Nostrils, as soon as the proud Flesh is taken away. Every day the Tents must be twice taken out and new ones dipt afresh put in their room, having first wiped the Nostrils with Cotton or soft Wool. Let the Artist have an Eye to the largeness of the Ca∣vity, and if it be not big enough, let him not fear to cut out enough to enlarge it, till the Graft be proportionable to Nature. To this action I can assign no cer∣tain term, I commit it to the Artist's prudence. Only let him take care, while he turns his Knife inward, that he no way hurt the Bridge. For its tender sub∣stance could not bear it. There∣fore the safest way is never to turn the edge of the Knife that way; but to begin the Section at the Tip, and when he is gone half way, to take the Knife out, and put it in at the Lip, and so make the Sections meet. For if he should carry the Knife round and it should slip, it might endanger the Bridge. You need not fear that this tormenting work will spoil the Graft; on the contrary the oftner it is Cut, the harder and stiffer it grows, when once it is Cicatrized. The time of Cicatri∣zation is uncertain, somtimes three weeks (which is soonest,) som∣times, Forty, Fifty or Threescore

days and above; according as the season or the Patient's Constituti∣on is hotter or colder, drier or moi∣ster. But this time needs not seem long, since the Patient may all this while go abroad, and live at his Liberty, provided he abuse it not by excess. The warm Air cannot injure him, but a cold one may; wherefore in Winter and Autumn he must be the more careful.

CHAP. XVII.

The Insition of the Bridge.

AFter the Bridge and the Ca∣vity of the Nostrils are formed, and a Callus is bred, it will be time to ingraft the Bridge. The reasons why we defer the do∣ing it so long, are various. When the Bridge is ingrafted, we cannot turn up the Nose, nor look into it, nor put a Knife deep, or with any safety into it, all which may very well be done, while the Graft is not inserted into the upper Lip. Nor could it be done, till the Wounds on the sides are healed. Besides, should the Bridge be in∣grafted before it were confirmed by a Callus, it would shrink, and draw down the Tip, and so make the Nose imperfect. Therefore it is convenient, to defer it's Insition till the thirty eighth day in Sum∣mer, and till the sixtieth in Win∣ter. Though sometimes in each season one may do it sooner. Be∣fore we set upon Ingrafting the Bridge, several things must be got ready, as a crooked Needle and a Forceps, which are peculiar to this Operation: Other things also, common to the Insition of the Graft, are here requisite, as sharp Knives, Thread, Whites of Eggs mixt with Rose-water, round Com∣presses, and Tents dipt in Whites of Eggs and Rose-water. We ne∣ver use the Forceps, but when the Basis of the Bridge is quite gone. For then we must excoriate the Part which is to receive the Bridge; and this could never be done with∣out this Instrument: For the Cal∣lus would hinder one from doing it without the help of a Forceps to take up the Part. This For∣ceps has two long handles, one with Notches, the other with a Ring fixt at the end, and another Ring running loose in that, to slip over the Notches, and so to hold the Forceps tight. From the joint a circle arises, large enough to en∣compass the Parts about the mouth. From this divided in the middle, arise thin Plates with a blunt streight edge sharp-pointed, that they may the better be put into the Nose. With this we must take up the Skin, and then cut it. The Needles must be bent Semi∣circular. It is good to have two or three of them in readiness, tho' there be but occasion for one, if

that holds without breaking. There must be also a pair of Scis∣sars, to clip a little off the Bridge, when part of it remains; for it will not bear cutting with a Knife, because of it's acute sense. When the Operation is undertaken, the Patient must sit in a clear light against the Window, and the Ar∣tist standing right before him, must open his Forceps, and put it gent∣ly up the Nose to the Circle. Then he must try to take up the Skin, which is the Basis of the Bridge, between the Edges of the Forceps, so as that the pressed Skin may start out above the sides of the Forceps. When he has ta∣ken it up, let him squeez the For∣ceps, and put the Ring upon the Handle to keep it fast. Then let him cut off the Callus and the Skin, that stands up above the Forceps, with a small sharp Knife. He may leave off, when the Blood comes freely all over. Then he must take off the Ring, loose the Forceps, and give it to the Assi∣stent. But first let him take care to see, that the Wound of the Basis corresponds to the bigness of the Bridge, before he loose his Forceps. For it is far better, that the Wound should be larger, rather than less, than the Bridge; because the largeness of the Wound is the ground of Unition, and if it be larger than needs, it is no great matter, since the Cicatrice is co∣vered by the Nose. But when the Bridge is not quite gone, but part remains, he must then take a pair of Scissars and clip it off at once, as much as needs, which, if it were cut, would put the Patient to intolerable pain. Af∣ter excoriation, or clipping, the end of the Bridge (or if it be too long, a little more) must be cut off. Effusion of Blood terminates this operation, as before. The reason, why we excoriate the Basis first, and then the Bridge, is, lest if we should cut the Bridge first, the Blood falling down might hinder the other operation. When things are thus administred, the Artist must take the Needle in his right hand at the middle, and pass it in at the top of the Philtrum (or the dent in the upper Lip,) or, if the bottom of the Bridge be standing, underneath that, till it comes out at the upper part of the Wound on the other side; when he sees the Needle appear, let him thrust it further; but with his left hand let him hold the Nose aside, that he hurt it not; and then taking hold of the Needle with his Fin∣gers, let him draw it quite out, with a little piece of the thread. When he has done this, let him wipe the Needle, that it slip not out of his Fingers, and let him take the Bridge by the end, and pass his Needle through that, ta∣king good hold, lest the holes should break. Then he must tye the thread, and cut off the ends. When he has done stitching, let him put in the Tents, and put un∣derneath the Compresses. He must apply the usual Plaister to the out∣side of the Nose, and then bind all carefully up. Let the Patient keep himself quiet for one day, ei∣ther in Bed, or at least in the House. It would not be amiss to cut short his Diet till the fourth day; about which time, especially in warm weather, signs of Unition appear.

Wherefore then abouts it will be proper to take out the stitches. But in cold weather, and in moist Bodies, not till the sixth day. As to the rest of the Cure, you have it before in the Cure of the Graft. Every day it must be drest with Tents dipt in Ʋnguentum ex pom∣pholyge, or with such things as were applied to the Graft, dry Lint, &c. which, after the striches are taken out, must be continued till the Parts are strongly united.

CHAP. XVIII.

The further Conformation of the cutaneous Graft.

VVHen the Bridge is firmly united, which in Summer is about the four∣teenth day, and in Winter about the twentieth, the care of Confor∣mation ensues, which is a constant molding of the whole Substance of the Graft into the shape of the Nose. For though by the forego∣ing Configuration, the cutaneous Graft has in a good measure ac∣quired the shape of a Nose; yet it falls far short, both in solidity and shape; because as yet it is but soft and flaccid, and has little in it of the grace of a Nose. For hitherto it has had enough to do to live; but now that the Trou∣bles are over, it begins to provide for it's own strength, and to be clear of another nature. Now the Tip begins to have life in it, and the Nostrils being strengthened in∣wardly with a Cicatrice, the whole Nose grows more compact and so∣lid. But this will not be complete till a long time, according to the diversities of Bodies, and of the ambient Air. This last Work de∣pends upon two sorts of Means, viz. upon Tubes inwardly and a Cover outwardly, made in the shape of a Nose, wherewith the cutaneous Graft being guarded in it's tender Age, may insensibly grow into the shape of a Nose. As for the Tubes, their Figure is cir∣cular, oblong, and unequal. It is circular, but not exactly, for where it comes to the Bridge it is flattish. It is broader below to∣wards the Alae, and narrower above towards the root of the Nose, growing narrower by de∣grees. Below, they turn back a little, and take hold of the Alae, and towards the Tip they run out like a Myrtle-leaf. They also in a streight line enclose the Bridge, meeting like two Boards exactly plained. Their length is unequal, for on the upper side, towards the ridge of the Nose, they run out farther in length, (to compress those Parts as they swell with proud Flesh,) than on the oppo∣site side, where there is no heed of them. Wherefore that end comes sloping downwards. But on both sides they must be equal

in Bulk, Length, and Figure, not too big or long, so as to squeeze the Bridge and kill it; nor too little or short, so as not to be able to repress proud Flesh, and help the Callus. At first they must be made of Lead very thin; after∣wards, as the Callus comes on, a little thicker, which it usually does in three months from the time of Coalition. But when the Nose is a little hardned, they must be made of a stiffer substance, ei∣ther of Silver or Gold. The Co∣ver must be of the same substance with the Tubes, either of Lead, Silver or Gold, according to the time. As soon as ever we use the Tubes, this must be applyed to the Nose. It must be of the exact shape of a Nose. It must cover the tip and the Alae, and then run down the Bridge to the upper Lip. But holes must be left in it for the Tubuli to stick out, and for re∣spiration. The Cover must come up above the Insition, and rest up∣on the bony Part, to keep all the firmer, and to defend the Cicatrice from external Injuries. It must be lined with Silk or thin Cloth, and the Lining must be changed every, or every other, day. Though this Lining is not needful in hot and dry weather. The Cover is kept on with five Strings, where∣of four are in pairs and one single; the single one runs up just between the Eyebrows, along the Forehead, and the Sagittal future behind the Crown of the Head, underneath which it is fastned behind to the other Strings. The upper of the lateral Strings comes from the mid∣dle of the Cover, passes the Cheeks and the Os jugale, and so above the Ear, and is fastned with it's opposite upon the Occiput at the tip of the Lambdoeides, and to this is the single string fastned; so the lower lateral strings come like∣wise from the middle of the Cover, and are carried cross the Cheeks under the Ears, and are tied be∣hind in the nape of the Neck. The strings should be of Silk, about a Finger broad. Rings must be fast∣ned to the Cover, whereto the strings must be fastned. Now we will shew, how the Cover is to be tied on. We must consider, that in the tip of the Nose there is a dent; wherefore it must be bound tight to the Graft there, that it may represent a Nose. For this purpose, lest the string should slip any way, we have fastned a Ring to the top of the Nose, through which this string must pass. We have added two more in the sides, through which strings must pass thence along under the Ears, and tie behind in the Neck, to keep the Co∣ver close down to the Nose. This Cover makes the Cicatrice even, and repels the Humors from it. By these two things, the Tubes and Cover, is the fashioning of the Nose completed. They should be used for two years; and if towards the later end they grow irksome, the Cover may be left off in the day time (but not the Tubes,) and put on again at night. And because strings may fret the Flesh, the Cover may be tied on with a Roller, especially in the night time. It must be long enough to the behind, and broader than the Cover, so as it may comprehend the Cover, the Tip, and the Alae. That part which 〈◊〉〈◊〉 upon the Nose

must be whole; but about a Fin∣gers breadth from the Nose on ei∣ther side it must be slit, and the lower part must be carried above the Ears, and the other below, along the Cheeks, and both must be tied behind. And thus is the whole Art of Engrafting a new Nose fully described. Only it remains, that we inform you, how the Colour and Cicatrice of the Nose may be amended. There is nothing better than, in the heat of Summer, for an hour or an hour and a half, to sir with your Nose against the hot Sun. Do this every day for a good while together. And the heat and dry∣ness will strangely confirm the Callus, and add to the beauty of the Nose. The things following are good for a Cicatrice; Fel bubu∣lum, vitulinum, caprinum, vel testu∣dinis. Illud ladano oportet exci∣pere & coralli pollinem admiscere. This is an excellent Water; ℞ Aq. vitae quartò dest illatae lb v. sem. lu∣pin. eruc. au ʒij. rad. rut. ʒj. Medul∣lam panis albissimi, all. ov. No. iiij. Macerentur per drem & noctem simul, & extrahatur liquor, quem usui servare oportet, & leviter al∣ternis saltem diebus cicatricem illi∣nere. Saevum asini makes a beau∣tiful Cicatrice. Huic prisci fel vi∣tuls cum myrrha, melle & croco ad∣debant, & pyxide aereâ recondebant. Alii storem aeris addebant. We prepare an effectual Liquor thus, ℞ Sevi asini, mell. alb. aqu. ar∣dent. lupin. an. ℥j. aq. flor. fabar. ℥ iij. macerato biduum, & mox liquorem per alembicum extrahito. If to this Water we add some ce∣ratum ex cerussa, and a few drops of the Oyl of Ben, it will be very efficacious. Aqua ex vitibus destil∣lans is good, and so is that, quae ex geniculis arundinum effluit. With this and asini sevum and Oyl of Ben, we make a Liquor, which, if added to the Plaister, makes it most effectual. In the day time you may anoint, and in the night apply the Plaister. Astringents must be applied just in due time: For when they are applied too soon, they make a hollow Cicatrice; and when too late, a tumid and uneven one. And thus much of Engrafting the Nose.

CHAP. XIX.

Of Curing the Hare-Lip, and supplying a Lip defi∣cient.

LIps are curt, or deficient, ei∣ther from the Birth, and then they are called Hare-Lips, or by accident without loss of substance, and then they are called curt Ci∣catricose; or lastly, they are truly curt, where substance is deficient. And only these last need engraft∣ing. But first we will begin with the Hare-Lip, because this is the most simple evil, and easiest to cure. If both Lips be such, the

same method of cure must be used for both. And what that should be, the nature of the Disease shews, namely, the separation of those parts which should be joyned. Somthing indeed seems to be lost, and so there seems somthing to be needful to supply the place of what is lost. But we may very well ob∣tain our end, and perform a cure, without the superaddition of any thing. Now that the disjoyned parts, which ought to be entire, should be united, the seat of the Disease indicates. And this work of unition is owing first to Nature and then to Art, which removes what hinders Nature, and assists her in her Operations. It is Art's task, to excoriate the parts, and keep them close together, that they may unite in their Blood, to sew them when united, to keep them sewed, and to reduce them to a right temper and health. Let the Artist therefore take up that part of the Lip, which must be excori∣ated, in his Left Hand, and then take off the Skin equally with a very sharp Knife, till the Blood comes, to the very Angle of the Hiatus, and then he must smooth the Wound. This Operation may al∣so be performed very quickly and safely with a pair of Scissars. The same must be done on the other side. Then he must draw the parts together with his Hand, and stitch them. We must observe this, not to take our stiches superficially, but thorow all. The Artist must therefore pass his Needle streight through the Lip from the outside inwards, and on the other side he must pass the Needle from the in∣side outwards. He must tie the threads and fasten the ends, and then cut them off. He must take his stitches not too near the edges of the Wound, but at a good di∣stance, lest the hold should break. The number of the stitches is best defined by the amplitude of the Wound. After stitching is done, some compresses, dipt in Whites of Eggs and Rosewater, must be ap∣plied both to the inside and outside of the Wound. Then a thin, soft, and even Roller of about three Fin∣gers breadth, dipt in Posca, must be brought along obliquely above the Ears, and must be tied tightly behind the Head. A piece of Linen Cloth also, dipt in mild Posca, must be applied to the inside of the Lip, to defend it likewise from Fluxion. Within a day or two the compresses must be removed, and congluti∣nants must be applied. The out∣side may have such things applied to it, as are mentioned before in the cure of a curt Nose, as with Lint and unguentum ex cerussa, and a Plaister of ceratum ex cerussa ap∣plied over it. But the Medicaments for the inside are Srrupus ex rosis siccis, syrup. myrtin. and where there is much foulness, julep. vio∣larum or mel rosaceum. These used either alone or mixt hasten Coalition. It will do well to add a little pollen myrrhae to them. ℞ Syr. ros. sicc. ℥ j. Mell. ros. ℥ v. pollinis thuris ℈ j. M. We must spread a rag with it, and apply it often to the inside of the Lip. About the beginning of the fourth day we must loose some of the stitches, where the parts seem best united. But then it is best to keep the parts together with a glew, which may stick, till there is a perfect Coali∣tion.

And as soon as the Glew sticks, the stitches may be loosed. Flos calcis with the white of an Egg is a good Glew. You may use this. ℞ Gum. tragac. mastic. Arab. thur. an. ʒ v. albumina ovo∣rum No ij. agitentur albumina di∣ligentissimè usque dum spumam eji∣ciant, hanc blandè detrahere con∣venit, & quod subter est limpidum, & aequale, retinere, mox reliquo∣rum pollinem inspergere, atque to∣tum ad quandam inter extrema mollia & âura studiosè permiscendo consistentiam perducere. The way of applying it is thus. Two Linen Cloths must be got, double, and about three Fingers long, and as broad as the Lip, with threads fastened at small, but equal, distances in both, as many on the one side as on the other. They must be spread with the Glew, and the ends, where there are no Threads, must be applied wet to the Lip. With this proviso, that the Threads meet at four Fingers distance from the outmost edge of the Linen Cloths, and that the ends of the Linen Cloths be an Inch at least from the edge of the Wound. About six hours after the Glew is applied, (in which time it fastens to the Lips,) we must tye the Threads gently. You may know they are close enough tied, when the Lips of the Wound meet, and when there is no pain. Then we must dress the Wound with drying Liniments, such as we used to the Bed. While he does this, the Artist must loose the Threads, wipe the Wound and apply Medicaments, then he must tie the Threads again, apply a thin Cloth, and then a Roller. This 〈◊〉〈◊〉 be done twice a day, for four∣teen days, in which time the edges of the Wounds will be strongly united. But I would advise the Patient, that, when he goes to Bed, he would apply ceratum ex cerussa, and bind it with a Roller. He may likewise use the same things here as in the Cicatrice of an en∣grafted Nose.

When a Lip is curt Cicatricose, the Callus must be quite cut away, which you may know to be done by the bleeding every where. That day it must be drest with Medica∣ments, that stop Blood, and after that with suppuraters. The Lip must be brought into its proper place. Which that you may do, you must fold a Linen Cloth se∣veral times in manner of a com∣press, you may lay Medicaments on it, and keep the Lip higher or lower, as is fit, and then fasten all with a Roller. After Seven days, Sarcoticks and Epuloticks must be used. A thick leaden plate of the shape of a Lip, with Medicines up∣on it, may be applied. And when it is cicatrized, the business is done. It will be best not to leave off the leaden Plate too soon; but to wear the same in the Night and tie it on fast. For so in time it will be per∣fectly well, without any fear of breaking open again.

When a great part of the Lip is wanting, it cannot be supplied without a Graft. Therefore I would advise him, that intends this Operation, diligently to peruse what has before been said in engrafting the Nose. For the delineation of the Graft is exactly the same, and the taking of it up partly the same, (namely, when the upper Lip is to be supplied,) and partly different,

when the under Lip is to be sup∣plyed: For then the Graft must be cut off at the end next the El∣bow. Moreover, the method of Cure is the same from the taking up of the Graft till it's Insition. Only you must take care, that the Callus be well grown on the in∣side of the Graft. For the moi∣sture, that comes from the Gums, hinders the healing of that Part very much. Insition must be made with crooked Needles; and the Stitches both in the Graft and Lip must be at equal distances. Nor must the Graft be cut from it's Stock, till it is well united with the curt Parts, which it is in Summer within Four and twenty days after Insition; but much a longer time is required in Winter and cold weather. The method for Conformation must be such as the substance of the Lip requires. This will be much holpen by bind∣ing, which must be with a Roller carried above the Ears for the up∣per Lip, and underneath for the lower Lip: Or, with a double-headed Roller, when both the Lips are to be bound. A plate of Lead will be also as necessary for the Lip, as it was to cover the Nose. And this may suffice for the Cure of curt Lips.

CHAP. XX.

Of Supplying curt Ears.

THE business of supplying a curt Ear consists in taking up the Graft, in Engrafting, Cu∣ring and Forming of it. Here the Graft is not taken from the Arm, as it was for the Nose and Lips, but from the Region adjacent, be∣hind the Ear. It is at one and the same time delineated, taken up, and engrafted. There must be in readiness Knives, Needles, Thread, Whites of Eggs mixt with Bole Armenick and Terra si∣gillata, and Compresses. Two things are peculiar to this Operati∣on, viz. Gossypium ustulatum, to stop Blood upon cutting the Ar∣tery; and a Roller to go along by the Ears under the Chin, which must tye on the Crown of the Head: The Basis of it, that is, the Part below the Ears, which goes under the Chin, is whole; but from the Roots of the Ears, or lower, it is parted into two, the Part toward the Face, is called the Fore-part, and the Part be∣hind, the Hind-part. That be∣hind keeps on the Dressings, and the Fore-part is assistent to it in keeping all fast. The place whence the Graft must be taken, is the place behind the Ear without hair. The dimension of the Ear will shew the quantity of the Graft. It is best here also to take it large enough. The curt Parts must be carefully scarified all over, and the Graft must be stitcht to the Part, beginning at the Concha in∣terna where the Skin rises from the Head, and not at the Helix

externa. The Passage of the Ear must be stopped with Cotton. But first of all the bleeding of the Artery, when the Graft is raised, must be stopt with Gossypium ustu∣latum, and Compresses wet in Whites of Eggs, and Rose-water must be applyed to the Bed, and great care must be taken to pre∣vent an Inflammation, by apply∣ing Clothes about the Neck wet in Posca, and changing them as they grow warm. The Patient must live very temperate, and use Spoon∣meat to avoid chewing. Some∣time on the third day the Wound may be opened, and the Com∣presses may be removed; but this may not be done till a Caruncle is grown at the end of the Arte∣ry, to plug it up. When these are taken away, the Bed must be treated with Suppuraters for four∣teen days as formerly, And the Graft must be exiccated carefully, both in the Coalition, and on the back-side where the Wound is, which must turn to perfect Cal∣lus. The very same Medicaments are proper here as in the former Ca∣ses. One thing must be taken care of, that the holes of the stit∣ches he filled with strewing on some Powder: And they must be loosed in order, as formerly has been directed. Bolsters must be put between the Head and the Graft, which may both keep it in the shape and posture of an Ear. The Artist must have a care of the proud Flesh that rises in the Bed, especially about the Root of the Graft, which Part is long in heal∣ing. As for the Medicaments, what they are, and when they should be changed, what the Symptoms are, and how they should be cured, you may find all in the foregoing Discourse Of Sup∣plying a curt. Nose.

CHAP. XXI.

The History of a Nose artificially Engrafted.

ANN. 1590. When the Duke of S••v••y made War upon G••neva, a Virgin fell into the hands of the Soldiers, whose Cha∣stity when they had attempted in vain, they being e••••aged cut her Nose off. About two years after she went to Lausanna; where Mr. John Gr••ffonius, a most inge∣nious and successful Chirurgion, then ••ved. He undertook to cure her, and restored her Nose so arti∣ficially, that, to the Admiration of all, it appeared rather Natural than Artificial. I my self have seen her several times, and she continues unmarried at Lausanna this present year 1613. It's true, in the cold of Winter the Tip of her Nose looks livid; but it is nourished as other Parts of the Bo∣dy, and endued with sense. Grif∣fonius had some hints of the me∣thod from an Italian, as he tra∣velled through Lausanna, who had conversed with the famous Taliacautius; though he had nei∣ther seen the Operation performed, nor Taliacautius his Works, before he cured this Maid. But he per∣formed the Cure in the same man∣ner as Taliacautius describes it. Hild. obs. chir. 31. Cent. 3.

AN APPENDIX OF THE Venereal Disease.

THat, we call the Venereal Disease, with whose Name one Nation now upbraids another, was first brought from the West-Indies into Europe Ann. Dom. 1493. and till then was not so much as known by name to our Parts of the World. At it's first arrival it was attended with tremendous Symptoms; but within an hun∣dred years last past, they have been in some measure changed, and much altered. Within the said time, and at the present, it gene∣rally shews it self first by a virulent Gonorrhoea, only now and then a Shanker gives the first Notice of the Disease. But when it does not discharge it self by a Gonorrhoea, it quickly infects the mass of Blood.

This Venereal Disease is propa∣gated either by descent from Pa∣rents to their Children; or by contact of some soft Part, where∣by a Virulence and Inflammation are insinuated into the Body upon the Occasions following. First, in sucking, viz. either the Child infects the Nurse by the open Pores of the Nipples; or the Nurse the Child by it's tender Mouth Secondly, Children may get it by lying naked in the same Bed with infected Persons: For though adult Persons can scarce contract it without impure Coition, albeit they lye in Bed together; yet Childrens flesh, being of a more lax and rare texture, is easily sus∣ceptive of the venom from infe∣cted Persons. Thirdly, the most usual way of contracting it is by impure Coition. The most usual signs of the Taint, are a Gonor∣rhoea, Shankers, Inflammation, and heat of Urine. So long as it goes no further than a Gonor∣rhoea, it falls far short in Malig∣nity of a confirmed Pox, when the whole mass of Blood, and se∣veral Parts of the Body are infe∣cted. Therefore the Cure of a Clap and of the Pox is diffe∣rent.

In a Gonorrhoea, therefore (or, as the Town calls it, a Clap,) the stress of the Cure lies upon purg∣ing, and especially with such Medi∣cines as carry off bile and serous Humors. A Cooling Diet also must be prescribed all along. This is a

good Purge, ℞ Mass. pil. coch. m••j. ʒ iij. Extract. Rud. ʒ j. Jaap. Diagrid. an. ʒ ss. cum s. q. Opebalsami f. Pil. è singulis drachmis vj. The Dose of these Pills is four, to be taken every Morning about four or five a Clock, (so that the Patient may sleep upon them,) for Twelve or Fourteen days or longer, if there shall be oc∣casion, that is, till the heat of Urine, and the yellowness of the Running are gone; which when it has succeeded according to expe∣ctation, the Patient may take the Pills every other day for a Fort∣night longer; then he may take them twice a Week, till the Run∣ning is quite ceased: For there is danger in the least Gleet, if one cease purging, before that is gone. If Pills will not do, you may try a Potion and Clysters. It is good to give Twenty five drops of Balm of Gi••ead in Sugar, or the quantity of a Wallnut of Turpentine every Night at Bed-time. In the mean while the Patient must abstain from all Salt Meats. He may eat Mut∣ton, Veal, Chicken, Rabbet, or any food easie of Digestion. He must drink no Wine nor strong Drink, nor any sowre Liquor. His Drink may be Water boiled three parts, and Milk one in four; only at Meals he may drink a draught of small Beer. Emulsions of the cold Seeds are good to allay Heat of Urine and Inflammation in the intervals of Purging. After a Month is over, and not sooner, it will be proper to bleed a Sanguine Constitution. Injections are not very safe; only toward the later end an Injection of Rose-Water may be used. This course gene∣rally succeeds: For the Cure de∣pends upon good Purging; if so be the Patient drink not the Wa∣ters; for they are injurious. If the Prepuce swell, use Emollient Fomentations, Oyntments and Plaisters. If the Scrotum swell, use a Cataplasm of Oxycrate and Bean-Flower. And this method may do well enough for a Clap.

But when the Disease has got footing, so that it may deserve the name of a confirm'd Pox, the on∣ly way (as Dr. Sydenham says,) is, to salivate; which may be done thus: ℞ Axungiae porcinae ℥ ij. Mercurii crudi ℥ j. M. With this let the Patient himself chase his Arms, Thighs and Legs, with his own Hands for three Nights one af∣ter another. Let him have a care, the Unguent come neither at his Armpits, Groin, nor Belly. He may tie a Flannel therefore about his Belly and Back, to secure it. On the morrow after the last anointing, give of Turbith. miner. gr. viij. in conserva rosar. rubr. After the third anointing, or at least after giving of the Turbith, the Gums begin to swell, and the party Spits. In the mean time, it is the Physician's part to carry on the Salivation with Judgment and an even hand, lest, by raising it too high, he endanger Life. When the Salivation is come to the height, (at which time two quarts of Spit∣tle are discharged in four and twen∣ty hours,) or when the Symp∣toms, thô the Patient spit little, are vanisht, (which usually happens about four days after the Salivation is at the height,) his Shirt and Sheets, in which he lay before, must be changed: Because they,

being dawbed with the Unguent, may carry on the Salivation too far. But if the Salivation fail, before the Symptoms disappear, it must be quickened now and then with a Scruple of Mercurius dulcis in a Dose. If upon the Mercury's get∣ting into the Blood, the Gripes ensue, you must hold your Hand, and use no more Mercury either inwardly or outwardly, till they are stopt; which is done by giving now and then a Drachm and an half of Diascordium, and by setting the Patient on an empty close Stool over a Fume of Cephalick Herbs, boyl'd in Canary Wine. When the Patient begins to recover, you must not stop the Salivation either by Purgers or diet Drinks: For such stopping of it often occasions a Relapse. Only when the Sali∣vation rises too high, it may be de∣pressed by a Purge. When the Mouth is much exulcerated in Sa∣livation, it may be often washt Night and Day with aqua rosarum Da∣mascenarum, or with Lac aquae permistum, or with decoctum hor∣dei, radie alth. & sem. Cydon. The same Diet is good in Saliva∣tion, or was ordered before in the purgative ••urse. And last of all, 〈◊〉〈◊〉 Dr. Syderham be much against the diet Drinks, so much and so generally celebrated by most Pra∣〈8 letters〉〈8 letters〉, yet I think a course of them is very safe, yea requisite, after ••alivation is over.

AN APPENDIX CONCERNING EMBALMING.

EMbalming goes among the Learned under several Names. It is called Balsamatio à Balsamo; because the medicinal Ingredients, which preserve Bodies from Cor∣ruption, are endued with a balsa∣mick Virtue. It is also called Conditura à condiendo: And Mu∣misatio à mumia, for it's Ana∣logy. Some call it Ʋnctura fera∣lis or Medicatio cadaverum aro∣matica. The Ancients called it Pollinctura, and those that practi∣sed it, Pollinctores from pollingere or pollincire, quod est, poliendo ungere, vel pellem ungere. It may be defined to be An artificial Ope∣ration, whereby a human Body is so prepared by a skilful Artist, ei∣ther with or without Embowelling and Dissection, by the balsamick Quality of medicinal things, that

i•• will endure whole many years, and may be kept free from rotten∣ness and corruption.

That the Hebrews had the Art of Embalming, is apparent from Scripture: For Gen. 50.2. Jo∣seph commanded his Servants the Phy••icians to embalm his Father: And the Physicians embalmed Is∣rael. It is very probable, they learned the Art from the Aegypti∣ans, and that in process of time they lost it. For if we consider the maner of Embalming among the Jews, as it is described by Maimonides, and as it was used about the death of Christ, it looks more like a respectful Ceremony paid to the dead, than any Pre∣servative from Corruption. Mai∣monides words are these: The manner in Israel about the dead and their burial, is this, when any one is dead, they close his Eyes, and and if his Mouth be open, they keep it shut with a Mus••ler, tied about his Jaws. The place also by which the Excrements are voided, is stopt up, but it is done after the Body is washt. Then he is anointed with Ointments made of several sorts of Spices, and, after the Head is shaved, the Body is wrapt in white Linen Shrouds made for this purpose, which are of no great va∣lue, that a mean may be kept between the rich and the poor. After this manner, in all probabi∣lity, was Lazarus embalured be∣fore his burial, he being none of the meanest Jews; and yet Mar∣tha feared he would stink in four days time.

But the accuracy of Embalm∣ing is owing undoubtedly to the Aegyptians. The best account whereof, now extant, we find in Herodotus. lib. 2. Histor. Euterp. His words are these;

Then they carried the dead Party to be Em∣balmed. There are certain Per∣sons appointed on purpose to perform this Artifice; who, when the Corps is brought to them, shew to those that bring it, wooden Moulds in the shape of the dead. They say one sort of them is most curiously wrought. A Second is meaner and cheaper. And a Third is of a very small value. When they have shewn these Moulds, they ask, in which Mould they will have their Dead put. When they are agreed of a price, they depart. And they, with whom the Dead is left, do Embalm the Body very careful∣ly, in this manner. First of all, with a crooked Iron they draw out all the Brain through the Nose, and so fill up the place with Medicaments: Then with an Aethiopick stone they cut about the Ilia, and that way they take out all the Paunch; which, when they have cleansed and filled with Phoenician Wine, they stuff again with beaten Spices; then filling the Cawl with pure Myrrh and Cassia, and other Spices (except Frankin∣cense,) they few it up again. When they have done this, they salt it up close seventy days, for they may not salt it longer. After seventy days are over, when they have wash'd the Corps, they wrap it in fine Linen cut into slips, laying on a Gum, which the Aegyptians commonly use in∣stead of Glew. When the Bo∣dy is restored to the Relations.

they make a wooden Coffin in the shape of a Man, into which they put the dead, and entomb him. But they that would save charges, prepare the Body thus; They give a Clyster of Oil of Cedar. Then after this they nei∣ther cut nor draw the Belly of the Dead; but fill it by the Vent, and salt it the aforesaid number of days; on the last of which days they draw out the Oil of Cedar, which they had put in, which is of such Virtue, that it brings the Guts wasted along with it. And Nitre con∣sumes the flesh, and leaves only the Skin and Bones. When they have done this, they restore the Dead, and do nothing further. The third way of Embalming is for the poorer sort; They cleanse the Guts by Purging, and dry the Body with Salt for seventy days; and then they restore it. And if an Aegyptian or a Stran∣ger be either kill'd by a Croco∣dile, or drown'd in the River, the City, where he is cast up, must embalm him, and bury him Honourably in the Sacred Monu∣ments, whom no one, no not a Relation or Friend, but only the Priests of Nile, may touch; because they bury one who is somthing more than a dead Man.

Now, thô, in this account of He∣rodotus, one cannot easily imagine, how the Brain could be got ou•• at the Nose; nor how Salting could contribute so much to the preser¦ving of Bodies; he being a Hi∣storian more than a Philosopher, may be excused, as reporting things by hear-say more than from experience. However, from the account he gives, and from what other Historians say; and withal, from a curious inspection into the Mumies brought from Aegypt, it may be concluded, that the Aegy∣ptians and their followers had two sorts of Embalming, the one cu∣rious, and costly for great and rich Men; the other cheap, for the common and poorer sort. In the costly way, they used as well out∣wardly for anointing and dipping the linen Shrowds in, as for stuffing the three Ventricles, divers aro∣matick Spices, which, by their innate Balsamick Virtue, by their bitterness also, and oleous Sulphur, or the penetrability of their vola∣til Salt, resist putrefaction; and by their sweet Smell prevent stench and offensiveness; such as Opobal∣samum, Oil of Cedar, Aloes, Myrrh, Saffron, Cinamon, Cassia, &c. This was for the Rich. For the poorer sort, they used either Asphaltus, which is the Bitumen Judaicum, that comes off the dead Sea; or Pissasphaltum, which is a mix∣ture of Pitch and Bitumen.

The Babylonians buried their Dead in Honey and Wax. And the Persians interr'd their Dead, but ence••ed them first. This was also the custom among the Gre∣cians; for in X••nophon we read, that Ag••lilaus of Lacedaemon, who died of a Fever, was embalmed in Honey. And so was the Bo∣dy of Alexander the Great, as we may gather from Statius in Sy••vis.

Due & ad Aemathi••s manes, ubi belliger urbis Conditor, Hyblaeo perfusus nectare durat.

Thus far of the Embalming used by the Ancients; Now we will proceed to the modern ways of Embalming; and First of Em∣bowelling, concerning which, I will give you Paraeus his Senti∣ments in short; First of all, the Body to be embalmed, must be embowell'd. The Heart may be embalmed apart, according to the Relations pleasure. The Skull must be sawn asunder, and the Brain must be taken out. Then deep gashes must be made along the Arms, Legs, Thighs, Back, Loins and Buttocks, especially where the larger veins and arteries run along; First, that the Blood may be got out, which otherwise might occa∣sion corruption; Secondly, that there may be place to put in the Spices. Then the Body must be wash'd with a Sponge dipt in Aqua vitae and strong Vinegar, where∣in Wormwood, Aloes, Coloquin∣tida, common Salt, and Alume have been boiled. Afterwards, these gashes, all the passages, and openings, and the three Ven∣tricles must be filled with the fol∣lowing Spices grosly powdered. ℞ pulv. rosar. chamaen. melilot. balsam. menth. salv. lavandul. rorismarin. majoran. thym. absinth. cyper. calam. aromat. gentian. ireos Florent. assae odoratae, cary∣ophyll. nucis mosch. cinnam. styrac. calam. benzo. myrrh. alo. santal. omnium q. s. f. pulvis. The gash∣es and open places must be sewed up, that the Powders shake not out. Then the whole Body must be anointed with Turpentine melt∣ed with Oil of Chamemel and Ro∣ses; adding, if you please, some Chymical aromatick Oils; and bestrew it again with the foresaid Powder. Then wrap it in Linen, and after that in Cere-cloth. And put it into a leaden Coffin well sodered, and filled with aroma∣tick Herbs. But if none of the said Spices can be got, as it hap∣pens, when Towns are besieged; you must be content with powder of slak'd Lime, and common ash∣es, suppose Oak. For thus, if the Body be wash'd in strong Vinegar, or Lixivium, it will keep a long time, provided the season be not very hot, nor that it be laid in a hot and moist place. To embalm the better, it is a good way to prick the Body, when embowel∣led, with sharp Bodkins, that the Liquor preserving it from cor∣ruption, may penetrate the deep∣er. When it is prickt, it must be laid in a wooden Tray, fill'd with a decoction of Vinegar, and aro∣matick, and bitter things, as Aloes, Rue, Wormwood, and Coloquin∣tida, and it must be kept there Twenty days, pouring upon it six quarts of Aquavitae. Then set it upright in a close and drie place.

Balthasar Timaeus à Guldenkle••, a Man famous for Embalming, writes thus to his Son, Lib. 6. Epist. Medicinal. Ep. 10.

The method of Embalming dead Bo∣dies, which you desire to know of me, is various, and is ordered according to the Parents or Kin∣dred's pleasure. Somtimes the whole Body, and all its Cavities and Limbs are artificially em∣balmed, oftentimes the middle and lowest Venter, and somtimes

only the lowest i•• taken out, and preserved by convenient Reme∣dies from rottenness and corru∣ption; which are also various, and of divers kinds. Some use Aloes and Myrrh, some Spirit of Wine, some Vinegar and Salt, some a Lixivium and quick Lime, and others use compound Powders, distilled Oils, Ointments and Bal∣sames. I have embalmed seve∣ral persons in the following me∣thod, upon which I now also insist. First of all, I take care to provide necessary Implements, Knives, Razors, Scissars, Twee∣zers, Bodkins, Needles, Thread, Hooks, Cords, Swathing-bands, a Saw, Sponges, Tow, Linen, Vinegar, Aquavitae, Salt wa∣ter, Cerecloth, Oils, Balsams, a magistral Powder, described hereafter, &c. These things be∣ing all ready in order, when the Corps has been well wash'd and cleansed with warm Wine from the external filth; I order it to be laid on a convenient place, then I cut the lower Belly cross∣ways, and take out the Guts and Mesentery, the Stomach, Kid∣neys, Spleen, Bladder, and Womb, and order a Servant to empty them. By and by I open the middle Venter or Breast, I take out the Lungs, Heart, Veins, Arteries, Diaphragm, and the Oesophagus to the Epiglottis, and carefully empty all the Vessels. Then I wash all the Cavity of the Belly and Breast, first with cold water, and wipe it well with Sponges; and then with strong Vinegar, and lastly with Aqua-vitae, or Sp••ritus Solomo∣nis, which is very effectual in preventing of rottenness and cor∣ruption. These things being done, I strew the Powder here∣after described upon all the parts, and rub it in well, then I apply every where Pled∣gets of Tow or Cotton dipt in Aquavitae, and, strewing on more Powder, I fill the whole Cavity of the Belly and Breast, and then I sew up the Skin, which was cut. The Head I embalm thus; I separate the Skull circularly with a very sharp Saw, or I open it only from the Crown towards the Occiput; then I take out the Brain, and wash the Cavity in the same man∣ner, as I did the Belly; First, with cold water, then with Vi∣negar, and last of all very well with Aquavitae, or Spiritus Solo∣monis; then I wipe it with Spon∣ges, and fill it with the Powder and Tow. When I have cleans∣ed the Jaws well with a Syringe, I fill them with powder of Cloves and Cinnamon; I plentifully and iteratedly anoint the Face with Balsame of Peru, or Spiritus So∣lomonis. Then I divide the mus∣culous and carnous parts with deep incisions, especially about the Buttocks, and, having care∣fully squeezed out the Blood, I bestrew them with the Powder hereafter described. Last of all, I wrap the Body up in hot Cere∣cloth, and anoint it all over with Pix navalis, Resina pini, and St••rax liquida melted at the fire. If the Body is to be kept a long time, the fleshy parts must be taken away and buried with the Entralls. If it be the Friends pleasure either to put the Heart

in its place again, or to keep it apart in a box, let it first of all be washt with Aqua nostra Bal∣samica ex aloe & myrrha, af∣terwards with Spiritus Solomonis, and then let it be anointed with Balsamus Peruvianus, But these things must be observed; 1. The Embalming must be hastned af∣ter the Parties death, and not be deferred above Four and twenty hours, especially when the wea∣ther is hot. 2. The Body must be kept in a cold place, and must not be exposed to the Rays of the Sun. 3. It must not be put in a Coffin of Wood, but in one of Lead, with Tinn or Silver over it. For Wood rots, and in moist or subterraneous places swells, and so bursts the Tin or Silver Coffins. 4. Great care must be taken in the Embalm∣ing, lest any putrid exhalation should come out, and offend those about the Funeral; as I remember it once happened, to the disgrace of a certain eminent Physician. 5. Those that are employed about this operation, must have a care that they take no harm from the Essl••via, and Vapors that arise from the cor∣rupt Viscera, especially when the Bodies of such are to be em∣balmed, as have died of some con∣tagious Disease, or of a Con∣sumption, or Empyema. In Summer time this operation is performed in a Room, with the Windows open to the North. In VVinter it may be performed in a Room with a Fire of Ash, Oak, or Juniper in it; but not in a Stove. He that goes about this work, must take some Alexi∣pharmacks, whereby he may de∣fend his Heart and Brain against hurtful Exhalations. Let him anoint his Nostrils with some Balsam, or hold to them a Sponge impregnate with Bezoardick Vinegar. Let him hold in his Mouth some trochisci de zedoaria, de corticibus citri, or some other preservative. Or, if he have none of these things, let him take some Meat, or a Mouthful of Bread dipt in Wine. I think, it is better to begin with opening the Lower Belly, than the middle; and that it is best to abstain from quick-lime, and other corrosive things: Because Bodies are not kept but consumed by such things. The Powder to fill the the Cavities of the Head, Breast and Belly; ℞ Myrthae electae lb iiij. Croci sylvestr. lb ij. Sty∣rac. calamit. lb ij. cinnam. acu∣tissim. lb j. caryophyll. lb ij. Alo. caball. lb v. rorismarin. siccat. lb ij. Thuris lb j. fol. laur. arid. rosar. rubr. an. lb ss incidenda incidantur, fiatque pulvis gros∣sus. A Cerecloth to wrap the Body in, and to line the Coffin withall; ℞ Cerae flavae lb xxv. Terebinth. Venet. Colophon. re∣sin. an. lb iii. pic. noval. lb ijss. vi••id. aeris lb j. thur. styrac. li∣quid. an. lb ij. ol. spic. lb ss. Laquefactis & mixtis adde sevi lb ij. mixturae huic immergantur telae lineae. The Powder to be strewed on the Cerecloth: ℞ Absinth. vulgar. abrotan. lavan∣dul. rorismarin. fol. laur. an. M. vj. salviae, majoran. ocymi, ori∣gan. thym. saturej. hyssop. flor. chamaem. an. M. iij. rad. Ir. Flor. lb. iiij. calam. aromat.

angel. cyper. cortic. aurant. citr. an. lb j. lign. Rhod. lb iij. Ju∣nip. Sassaph. an. lbjss. santal. citrin. lign. alo. an. lb ss. cin∣nam. caryophyll. an. lb j. flor. ros. rubr. lb ij. alo. myrrh. thur. styrac. benz. opt. an. lb ij. sa∣lis lb iiij. M. f. Pulvis, qui ir∣roretur olei spicae lbss. ℞ Ol. rorismar. lign. rhod. an. ℥ iij. caryoph. ℥ jss. absynth. origan. an. ℥ j. Misce exactissimè pro balsa∣mo. ℞ Styr. liquid. ℥ vj. Bal∣sam. Peruvian. ℥ ij. ol. mac. ℥ss. lign. rhod. ℥ jss. M. f. Balsamus.

But the greatest Master in Em∣balming in our Age, was Bilsius, who held strange opinions about the Lymphatick, Lacteal, and Tho∣racick Vessels, and about his Du∣ctus Roriferus; wherein he con∣tradicted the most famous Anato∣mists of his time, Bartholine, Sylvius, and Van Horne. He had found out a method of Anatomi∣zing Bodies without effusion of Blood, after a new and unheard of manner, with an accurate separa∣tion, and manifest demonstration, of all the parts and little Vessels, thô they were less than Hairs. But he was chiefly skilled in a new and curious way of Embalming Dead Bodies, after they were opened or dissected, replacing the embalmed Bowels in their Natural places, viz. The Brain in the Skull, and the Guts in the Abdomen, and more than that, not any embalming Spices stuck to the parts of the Bo∣dy. These new secrets of his drew the King of Spain into such admi∣ration of him, that, by his Gover∣nour in the Low Countries, he or∣dered Twenty Thousand Crowns to be paid him, upon condition that he should declare ingenuously up∣on Oath to the three Estates of Bra∣bant his admired Art; and he, as an Honorary Prosessor in the Uni∣versity of Lovain, should teach Anatomy publickly according to his Manual Operation, for which he was to have a Pension of Two Thousand Crowns per Annum; and he was also obliged to commu∣nicate his said peculiar method to some skilful Anatomist, that after his Death it might be perpetuated for the good of the publick and of Physicians. And thô Bilsius had got so vast a Sum of Money, and went to Lovain, to perform his agreement; yet the University of Lovain made bold to refuse him a reception into the Society of the Professors, upon this pretence, that Bilsius being of the Reformed Re∣ligion, it might in so doing lay it self obnoxious to an Excommuni∣cation from the See of R••me, ac∣cording to the Statutes. There was great bickering about the mat∣ter, till at last Bi sius, loden with his Money, bid Lovain farewel, and returned to his United Pro∣vinces, where (as far as I can learn,) his famous Secrets were buried with him.

Next to Bilsius comes Clander, who, after various Experiments, gives us this process for Embalm∣ing; after the Body designed for Embalming has been dead Eigh∣teen, or at the most Twenty four Hours, let it be laid in a long Tray of Oak, or of some hard Wood. Then get ready some Spiritus salis Ammoniaci balsamans, which may be prepared ex tempore in the manner following. Take of Pot∣ashes one Pound, pour on them of

common Water Six Pounds, let them stand an Hour, and shake them somtimes for the better dis∣solution. Into this solution put half a pound or somthing more of Sal Ammoniack powdered. Shake them together somtimes, for the better dissolution of the Powder, and in a stopt Vessel, lest the Vo∣latil parts should fly out. Then filtre it through a brown Paper. Upon the Body thus placed in the Vessel, let as much of this Spirit made in the foresaid proportion be poured, as will stand a quarter of an Ell above the Body. Now be∣cause this Spirit, as it is sated with an Alcalick Salt, does immediately r••ise the Body, and will not let it sink for some days or weeks, by reason of Crudities, which puff up the Belly like a Tympany, and be∣cause Corruption may be feared in the upper part, which the Liquor does not cover; therefore either the Vessel must be every day sha∣ken moderately, that the Balsa∣mick Liquor may come at all the parts. Or, which is better, the Corps may be pent down under the Liquor, with a piece or two of a wooden lathe. Then the Vessel must be most exactly covered, and the chinks must be stopt close with a Paper and Paste; partly that the Volatil Spirits may not fly away; and partly that the exter∣nal Air may not get in and corrupt it. The Body being placed in the manner aforesaid, if it be a large one, must be left three Months. Six Weeks is sufficient for little Creatures. Yea a Month is time long enough for some. Then you must look whether the Flesh of the Body be hard or soft. They must be kept, if possible in cool places, rather than in hot and moist. This must be observed especially in Sum∣mer. After two or three Months, the Vessel may be opened, and the Liquor gently poured off, or taken out. The Body must be tenderly handled. When it is taken out of the Vessel, it may rest for eighteen or four and twenty hours. Then, to dry up the superfluous moisture, you may lay it in a stove mode∣rately hot, or somtimes upon an Oven; somtimes also you may lay hot Bricks upon the Belly; or you may wrap it up, and put it in hot Sand, or you may strew hot Sand upon it, especially on the Lower Belly. In Summer time it may be exposed to the vehement Rays of the Sun. You must take notice, that every day you must turn the Body on a new side; that the moi∣sture in every place may the better be dried up by the external Heat. And last of all, it may be washt with a Sponge, to clear it of filth, if there be any.

FINIS.