Nine books of physick and chirurgery written by that great and learned physitian, Dr Sennertus. The first five being his Institutions of the whole body of physick: the other four of fevers and agues: with their differences, signs, and cures.

CHAP. VII. Of disjunction in generall, and of dissection of soft parts.

THe third operation of Chyrurgery is disjunction, * 1.1 which devides those parts of the body which are joyned and continued together, of the first of these there are two kindes, Section, and Ustion; Section, some is of soft some of hard parts; and of soft parts according as it is made by cutting or pricking, in particular it is called, Tome, or cutting, or Pa∣racentesis, pricking; of the bones and hard parts there is per∣foration or boaring with a wimble, shaving, filing, sawing; lastly Ustion is common both to hard and soft parts, all which operations are now to be explayned in their severall kindes.

In cutting soft parts, * 1.2 first comes the opening of a veine, which is appointed for emission of blood out of the body, in divers parts of the body, the provision and convenient prepa∣rations for that purpose may be seen in the institutions.

Moreover since that sometimes the matter in tumours should be changed into quitture, * 1.3 nor doth an imposthuma∣tion, allwayes breake of its owne accord, and it is to be doubted least the purulent matter retained should offend the neighbouring parts, and bring rottennesse to the bones, some∣times also there is venemous matter, and affects the way to the internall parts, or an imposthumation or Ulcer neere a principle part, or joynts, may stop the fundament, oftentimes an Ulcer or imposthume full of matteris to be opened with an Instrument, or by which opening ought to be so performed

as that the adjacent veines, arteries and nerves may not be offended; the Sanies either is included in a bladder, or else hath no bladder; if the quitture be not included in a blad∣der, let that part be wounded that the tumour may come to its height, and the skin is very thin, yet as neere as may be doe it in a declining part; the Instruments fit for cutting are, variety of Incision knifes, according to the variety of figures, and necessity of their use, the bignesse of the cut is to answer to the quantity and the quality of the matter to be emitted, an incision being made, and the matter in some part evacuated, least the wound before the whole matter be let out should close up againe, tents are to be put in, nay if neede be, the wound must be dilated, and the part so bound up and placed, that the quitture may conveniently flow forth, but if the purulent matter be inclosed in a bag, the tumour according to its longitude if it be lesse or cut athwart like, the letter X; if it be greater and the whole bagg with the matter in it, tis to be taken out and nothing of it to be left be∣hind.

Thirdly Fistulaes also are often to be cut, * 1.4 which is done with a fit Instrument, which therefore the Greeks call Syrin∣gotomon that is a Pipe cutter, the manner of cutting may be seen in the Institutions.

Fourthly parts also are sometimes to be separated which are joyned together from ones birth, after ones birth, * 1.5 where∣unto belongs the cutting of the tongue when it is tyed, of eares when they are shut, of the fundament when it is closed, the opening of the private part of a female, the free∣ing of the prepucium when tis straightned, a seperation of it from the glans, the opening of the top of the yard, or glans when tis closed, separation of fingers growing together, the opening of the eye lids when they grow together, all which may be performed by cutting by a skilfull Chyrurgeon, and how it shall be performed, shall be explained in the Institu∣tions.

Fifthly hitherto belongs scarrification, * 1.6 which is performed with an incision knife, or launce, and so that the skin may be opened only with gentle cuttings, or to wound it deeper, and that the more ready evacuation of blood may follow, cupping glasses for the most part with a burning flame are to be applyed, which may attract the humours more potently, yet sometimes scarrification is appointed without cupping glasses, such as that of Mallets which was in use amongst

the Ancients, and the scarrification, in use with the Aegyptians this day.

Sixtly, * 1.7 Angeiologia so called in particular, which is a cutting of the vessells in the forehead, in the Megrim, and an invete∣rate Opthalmy, and when there is a perpetuall weeping of the eyes, whereby a vessell, freed from the neighboring parts, is tyed with a threed on both sides, and afterwards in the middle betwixt the two threeds it is to be cut transverse according as the manner of operations is delivered in the In∣stitutions.

To the cutting of vessells belong the cutting of the varices, * 1.8 which was done by the Ancients, almost in the same man∣ner as the cutting of the other vessells lastly propounded, as you may see out of Celsus the 18. Book Chap. the 13. Paulus Aegineta the 6. Book the 82. Chap. Hier. Fabricius hath another manner of Chyrurgicall operation, Tit. of Chyrurge∣ry of the vessells called varices, namely such a one, the In∣strument Volcella (which is to pluck up haire by the Roote) bowed or lifted up first with a hooke, he prick; the varices in many places, afterwards he puts to it a binding medicine re∣presenting the figure of a candle, according to length of it, and upon this he puts the barke of a hollow reed or Cane,

To Angeiologie also may be referred that cutting of an Aneurisme, * 1.9 out of Paulus Aegineta, 6. Book, 37. Chap. and 64. Chap. which may there be seen, which neverthelesse is scarce to be attempted unlesse the Aneurisme be very small, and in an ignoble part, not having any great vessells, since without great danger it cannot be performed.

Seaventhly, * 1.10 to Seperation or Section, belongs Paracentesis by which word every pricking in generall was denoted by the Ancients, and tis performed in divers parts, and that either with a needle or with the point of a knife, this opera∣tion is famous and Ancient, in the paunch, to evacuate wa∣ter of those that have dropsies, which retaines the name of the generall name, the manner and reason of performing whereof in the Institutions and in the 3. Booke of Practise part the 6 th. sec. the 2 d. Chap. 3. is delivered; in water of the head the same pricking is sometimes used in the skin of the head, and in the cods filled with water.

Hereunto belongs the cure of a Cataract by pricking which is so to be performed as Celsus also describes in his 7. * 1.11 Book and 7. Chap.

As also the cutting of the wind-pipe, * 1.12 which is called Laryn∣gotome, which when it is necessary is to be performed with a launce, (the other parts being removed, under the Larynx betwixt the third and fourth ring of the Wind-pipe, the manner of operation is propounded in the Institutions.

As also the cutting of the brest, in an Empyema, * 1.13 or an Ulcer or imposthume, in the cavity of the brest, which is performed on one side of the brest, betwixt the fift, and sixt rib, and how it also is to be performed is explained in the Institutions.

Moreover a Seton, * 1.14 or using of a Seton Needle by which operation the neck is prickt, and the wound kept open, that peccant humours may be evacuated by it, of which operation you may also read in the Institutions.

To prickings, we have annexed leaches, * 1.15 or the applica∣tion of leaches, which being chosen, prepared, and cleansed, are applyed with a rag, or a reed; by their biting they open the veines and draw out blood, and indeed from the sub∣cutaneous parts only, and capillary veines, if they are apply∣ed only to the skin, but if they are applyed to any great ves∣sell, they draw blood from the innermost parts of the whole body, and therefore they are applyed according as there is need of this or that evacuation, and are applyed to children when we dare not use the launce to open veines. To the veines of their armes when they are affected with any grei∣vous disease that requires evacuacion of blood.

Notes

• * 1.1

  The kindes of division.
• * 1.2

  Opening of a veine.
• * 1.3

  Opening of impost∣humes.
• * 1.4

  The cutting of a fistula.
• * 1.5

  Seperation of parts that are joyned to∣gether pre∣ternatural∣ly.
• * 1.6

  Scarifica∣tion.
• * 1.7

  Cutting of vessells.
• * 1.8

  Cutting of the vari∣ces.
• * 1.9

  Cutting of an Ancu∣risme.
• * 1.10

  Paracen∣tesis.
• * 1.11

  Couching of a Cata∣ract.
• * 1.12

  Laryngo∣tome.
• * 1.13

  An incisi∣on of the brest.
• * 1.14

  Applying of a Seton.
• * 1.15

  Leaches.