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.

THE FIFTH BOOK, PART. I. SECT. II. OF CHYRƲRGERY.

CHAP I. Of Chyrurgery in generall.

AFter we have spoken of the faculties of the medi∣cines, it remains that now we speake of Chyrurgery, and that we propound all the operations, which are made by the hand, and Chyrurgicall instruments, in mans body, for the recovering of healths sake, we will pro∣pound the operations which often are the matter of helpe. * 1.1

But although the word Chyrurgery, which signifies manuell operation, may be taken of all actions, which are done by the hand, yet according to Preheminency, tis taken for that part of Physick, in particular, which by the artificiall use of the hand, cures diseases of mans body, which are con∣trary to nature, and so Chyrurgery is imployed only in the externall parts of the body, and exercised in those internall parts also to which the hand, and Chyrurgicall instruments can reach.

Sith hence three things are required to performe an action, the Agent, the Subject patient, and those things by which

the action is made, in Chyrurgery also, these three are to be considered, * 1.2 the Agent, is the Chyurgeon, which Celsus in his seventh Book, and the beginning of that Book thus des∣cribes, a Chyrurgeon ought to be a young man, or a middle aged man, with a strong hand, stable and never shaking, and as ready with his left hand as with his right, sharpe, quick and cleere sighted, not daunted in courage, not pittifull, as he is willing to cure, whom he takes in hand, one that may not by the clamour hasten his motion more then the matter re∣quires, nor losse then is necessary, let him cut, but let him performe all things, as if no others paine could trouble him by their crying.

The subject is mans body, * 1.3 the knowledge exactly wher of, and the figure of every part, and their scituation, and con∣coction is required in a Chyrurgeon, which often defection of bodyes will bring forth.

Those things by which an action is performed, are instru∣ments; and some other things are necessary for perfor∣mance of operations, as the place, light, garments, Servants, standers by.

The Instruments are various, * 1.4 yet the cheife are, an in∣cission knife, a Pen-knife, a paire of Tongs, an instrument to pluck haire from the body by the Rootes, called vossella, a Probe, a broad Probe, a Seaton needle, a Needle, Threed, a Hooke, a little hollow Instrument of Chyrurgeons, boared, a Phillet, Swathing-bands, Clouts, and little rags, Lint, Sponge.

The place is to be chosen, * 1.5 which is most commodious for Chyrurgicall operations, and wherein the sick may not be hurt, by wind, cold, heate, or any externall accident.

The light whether it be that of the Sun, * 1.6 or some other, ought to be such, that the Chyrurgeon may accurately dis∣cerne that part, which he dresseth, least he should offend himselfe or the patient.

The Servants, * 1.7 and standers by ought not to be displeasing and troublesome to the sick, but ought to be attentive to the commands of the Chyrurgeon, silent, and which is their duty, faithfull to performe his dictates.

The garments of the Chyrurgeon ought to be so made, * 1.8 that they may no way hinder him in his operation.

The Chyrurgeon himselfe ought to endeavour as much as in him lyeth, to performe his operation presentsy, safely, and with delight, and as much as possible without paine.

All the Chyrurgicall operations are five, * 1.9 a putting toge∣ther or conjunction of seperated parts, a correcting and set∣ting right of those things which are out of joynt, or out of their place, a Solution of continuity, an Extirpation, or cut∣ting off of Superfluities, and a Restitution of deficiencies, of which now in their order.

CHAP II. Of putting together, and binding in generall.

POsition is that operation of Chyrurgery whereby the parts, are joyned together, * 1.10 which were seperated contra∣ry to nature.

Deligation or binding is necessary to this as also for the most part to other Chyrurgicall operations, to which belongs fascia∣tion, or Swathing-bands, and the putting in of Tents, fitting of Splints to bind about wounds, and the action it selfe or putting in of a round string to cleanse the wound, aright or true placing of the part bound.

Of Swadling.

A Swath is a long and broad band (or list:) * 1.11 fasciation is a convenient circumduction and convolution of the swa∣thing-band about the member to be cured, the most conve∣nient bands are linnen, which are cleane, light, soft, which have neither seames, nor knots.

The differences of Swathing-bands are various, * 1.12 which are taken from their figure, length, and breadth, they differ in respect of figure, because some are rolled up thick, long and equally broad, and rolled up into a round circle, others are rent, or broken, which consists only of one linnen cloath, but that cut or parted, either in the middle or outsides, others are sowed together, which are Swathing-bands and Ligatures ending in divers heads, and representing severall figures; Swadlings differ in longitude, because some are longer, others shorter, and so it is of latitude.

There are two kinds of deligation, the one simple, * 1.13 the other compound or manifold, the simple is either equall or une∣quall, the simple that is equall, is only round, which incom∣passeth

the affected member, in a round circle, alike every way, without declination, unto either part, but is simple e∣quall, binding is divided into Asciam, and Simam, which only differ in respect of more and lesse, because Asciadeclines a little from a round, but Sima, much of severall wayes of swathing are many differences, taken from the similitude of the parts which are bound, or from the similitude of cer∣taine Animalls or other things, of which Galen in his Book of swathing.

As for what belongs to the manner, * 1.14 sometimes the bind∣ing, is to be begun from the part affected, other times from a sound part, neerest to the part affected, sometimes from the opposite part, moreover sometimes swathing is to begin, at the end of the swathing-band, sometimes at the middle, thirdly swathing-bands should neither presse the part too hard, nor suffer it to be loose, for when tis too loose, it doth not sufficiently containe the part, and when it is too hard it causeth paine and inflamation.

The use of swathing is twofold, one by its selfe, which is to draw together the disjoyned parts, to contract thedilated, to direct the distorted, to containe the member framed and the adjunct parts, to resist a humour flowing; or to represse a humour which is already flowne, or to force blood to extenua∣ted parts; but that which begins in a place affected re∣presseth from the part, that which begins from a sound or opposite, forces towards the part, the other is by accident, which is to keep on medicines applyed to any part.

Of Cerots or Bolsters.

SPlenia, * 1.15 are Plaisters so called, from the figure of the Spleen, the Ancients calls them, Plumaccoli, but now they are called Pulvilli, Plagulae, they are linnen rags folded up together, which are put to the part, some according to longi∣tude right, others oblique, others transverse, and some doub∣led, fome threefold, others fourefold, sometimes single, and sometimes more, according to the use which they are put for to strengthen, the binding members, unequall in thicknesse, or thin and hollow parts are to be equalled, and filled up; that the whole dilagation may be equall, the parts also

are to be defended from the paine of the swathings and bands, and the Sanies, and thin matter, is to be expressed and imbibed.

Of Splents.

SPlentors, or splents, * 1.16 which are wont to be fitted to broken bones, and such as are out of joynt, after they are set, which were prepared by the Ancients, of wooden-slips of a cane, but now they are prepared of the wood, of Firre, or splentors of some other wood, or of the Barks of Trees, or Paistboard, and hard Leather, which may answer to the parts greivously wounded, or broken, or put out of joynt, especially to the hands, sometimes to the chest of the body, so made up, of light wood, that they may answer to the figure of the member, or of white thin plates of Iron, or tough skin, or shell, Paper glued together, and fitted, so that they may containe, the parts drawn and joyned together, least that they shake or totter, and slip out againe, and slide out of their places.

Of Binders.

LAqueus, * 1.17 is a band or binder so knit together that being drawn in or prest by weight, is shut, or closed, the use there∣of is to extend broken limbs, or such as are out of joynt, to continue such as are put right in their places, to bind the parts and draw them in straight, also to bind the heads of vessells out of which blood flowes, the differences of them may be seene, in Oribasius de Laqueis.

Of fit placing of a member that is bound.

THe convenient placing of a part that is bound consists in this, that it may have that position, which may pre∣serve its naturall figure, and may be without paine, and may be convenient for the cure of a disease. A member shall be so

placed if all its parts, bones, muscles, nerves, veines, and arteries, may enjoy that position whereby they neither are distended, nor pressed; if the member be set or placed softly, and equally; if the orifice in a hallow ulcer, or wound, tend downeward as much as may be, that the quitture may be purged out; lastly if moderation be observed in ordering of the binding so that it be neither too straight nor too loose.

But collocation is made either by putting in, or by sus∣pending; a member is fitly restored, when tis underpropt with certaine stayes, with feathers, wooll, or soft rags, that it may be quiet and leaning or resting on somewhat, it should lye allwayes even, and soft, least it either should be shaken by motion, or extended by reason of flux, or least the sanies and thin matter should be retained in it: the member is suspended, either when the sick keepes his bed, or newly be∣gins to walke, and especially the hand, and the arme are to be kept in a Swath, which Celsus calls, Mitellam.

CHAP III. Of Coaptation of broken bones.

Synthesis, which joynes together seperated parts, is either of bones, * 1.18 or of fleshy and soft parts, setting together bones is either a fitting those that are broken, or a restoring those which were out of joynt.

The putting together of broken bones, is performed by two operations, * 1.19 whereof the one is called Catastasis, Antitasis, or extension; the other is called Diorthosis conformation, or tis called reposition of the bones, into their owne places; extension is either equall, or unequall, equall is that wherein the member is equally extended from either side of the broken bone, but that is said to be une∣quall, when the member is more extended on one side; that side ought to be more extended, wherein the broken bone is contained but no man can rightly performe those operations, * 1.20 unlesse he knoweth the nature, and differences of bones and fractures, for when a muscle is drawn back to its head, and so carries with it that part of the member which is joyned to it, first there is need of extending, which the Greekes call Antitasis, which ought to be done, as neere as may be, with little or no paine, and that is performed by one worke, or more, and that either with the hands only, or raynes as it

were swathings, or instruments, according as the bone is more or lesse broken.

Diorthosis, or conformation, * 1.21 is a restitution of a broken bone into its place, and a right fitting of the extremities of the broken bone, which is performed if after the member be so much extended, that in putting it back the bones cannot touch one another, the Chyrurgeon is to take hold of the member on both sides, with both his hands, and that which is slid into the right part he should thrust into the left, and the contrary, and what ever hangs out of the bones, he should put back into their owne cavities, untill the extremities of the bone are rightly united, and thrust back, into their places, and the member hath recovered its naturall figure. * 1.22

But if the extremities of the broken bones, breake through the skin, that they hang out, some convenient instrument of Iron, like a barr, is to be used, to force the broken bones into their place, but if any particle of a bone so hang out, that it cannot easily be put into its place, it is to be cut off with a sharp paire of cissars, or to be filed off with a file, that it may be shorter, neither let it any more hinder the reposition: in such a fracture which is joyned with a wound, if any thing stick betwixt the broken bones, which may impede their glutina∣tion, whither particles of a bone, or any thing whatsoever, it is to be taken away without violence; when the bones are rightly placed, the extension is to be remitted by degrees, and with convenient binding and placing of the member, and so to be performed, that the bones united and rightly framed may remaine so.

Yet before swathing-bands are put about a broken mem∣ber some medicines used to be applyed, to hinder the Flux of humours and inflamation, and to farther the generation of brawny flesh, of which, read the Institutions.

The deligation is to be performed, * 1.23 neither too straight nor too loose, with two swathing-bands, whereof the first is to begin above the fracture, and to be bound about it, twice or thrice upwards; the other, being longer by halfe, is to be rolled about the contrary way, and is to be put on first upon the fracture, and beginning from thence to be rolled about something downeward and againe is to be carried above the fracture, and lastly towards

the superior sound part, but in fractures of great bones, that the deligation may be the more stable, and the bones firme∣ly put into their places, may remaine so, Bolsters or crosse folded cloathes, and splentors, and Plates, are also to be used, moreover the member is rightly to be placed, gently, equal∣ly, and inclining upwards, so that the part may obtaine its naturall position, to which purpose, both a hollow Pipe, and Cane, or Plate, or such like, are sometimes to be applyed, the deligation being well performed, is to be loosned the third day, the fracture to be cleansed, and bound up againe, and this is to be continued untill hard flesh be grown, and the fracture healed, but if a fracture be joyned with a wound, after the extension is abated, and there is convenient con∣formation of the broken bones, the lips of the wound are to be drawne together, and being drawn, to be kept together, yet so that the swath-bands be not too straight bound, which ought to be flacker, and to be extended on both sides, be∣yond the lips of the wound, least paine should be stirred up, but in the following deligations, a hole, or vent, may be cut above the wound, both through the Plaisters, and swa∣thing bands, that it may be perfectly cured.

CHAP IV. Of restoring of bones that are out of joynt.

Synthesis which puts bones slid out of their places into them again, calle this Arthrembla, this is performed three wayes, either with the hands of the Chyrurgeon which is convenient in tender bodyes, and when the hurt is newly done, or with certaine common instruments, as by the helpe of raynes, swa∣thing-bands, Laqueorum, scalarum, sedilium, forium bifidar∣um, and it is convenient for children, Women, and those whose muscles are grown stronger, and luxations have been longer, or by instruments, certaine Engines, peculiar for that purpose, is performed, and are used for strong bodyes, and old luxations, and altogether on those, which cannot be re∣stored by the two former wayes, of such Engines, you may see Hippocrates, of joynts and fractures, and Oribasius of Engines intititled, de machinis.

But after what manner soever, restitution of a boneout of joynt is performed, foure operations are necessary to doe, it

first Extension, Reposition, Deligation, and Confirmation, * 1.24 and Collocation, of the members so replaced.

Extension, is made, either by the hands of the Chyrurge∣on, or his Servants, or by raynes, bindings and swathings, or Instruments, and Engines, as is said.

Extension being made, the bone which is slid out of its place is to be put into it againe, which worke the Greekes call, Moclia, and Mocleuses, * 1.25 namely a compulsion of a bone that is out of joynt and extended into its owne place, which being slid from or out of the end, in the same way which the joynt slid, it ought to be put back to that place out of which it slid, whereof there are so many wayes as there are joynts.

The joynt being restored, the intention is to be remitted and the member afterwards, so to be strengthned that the joynt cannot againe goe out of its place, * 1.26 which for the most part is performed in the same manner as in fractures.

Lastly the member is to be placed gently, and equally, and to be kept unmoved till the fourth or seventh day. * 1.27

CHAP. V. Of the putting together of the soft and fleshy parts.

THe fleshy and soft parts, disjoyned, * 1.28 preternaturally are joyned together, either without any division of them, or by solution of their continuity, that putting together, which is performed without any division of parts is various, and of different parts, and first of all sometimes certaine parts being slid out of their places, come to be put into their naturall place againe, such are the guts, and paunch, which sometimes by the wounds of the paunch come out, sometimes the Rim of the belly being loosned, or broken, falls into the groine, and cods, or breake out at the navell, hitherto belongs the wombe, and gut Rectum, which sometimes also fall out of their places, and therefore all these are to be put into their places againe, but how the restoring of each singular part ought to be performed, is spoken in our Institutions, and 3 d. Book of praxis.

Moreover, * 1.29 for what belongs to the manner of joyning together, wounded parts, without division, the lips of the wounds, since they are disjoyned, are to be brought and joyned together, and when they are brought, being joyned are to be kept together, which may be done too wayes without solution of continuity, either

by swathing, or gluing, or a suture with the Glue, and in∣deed as for swathing that is convenient being made for Wounds according to the length of the member, * 1.30 and not very deep, and when we hope by fasciation only, the lips may be joyned. A future is not rashly to be appointed, and indeed if the wound be long, narrow, and straight, swathing is better, that is, deligation of three fingers breadth is enough. The manner of fasciation may be seen in the Institutions.

But when in transverse and long wounds, * 1.31 sasciation a∣lone is not sufficient to draw and continue the lips of the wound together, there is need of a suture; but when in wounds of the face prickings cause deformities, and in o∣ther long and great wounds before the glutination of the wound the sutures are broke; render bodies also cannot in∣dure a seam which is made with a needle, a certain lutina∣tion or suture is invented by glue, by which without any division of the wounded part, or stitching with a needle, the lips of the wound are drawn together. Provision to perform this may be seen in the Institutions.

But that conjunction of wounded parts which is made by solution of continuity is performed with a suture and pipes to the suture, * 1.32 three Instruments are to be used, the Nee∣dle must be triangular and thred strong, least it should be broken, not too hard, but softned with Wax, equall, or e∣ven, the Pipe ought to be Gold mixt with Copper, or Sil∣ver, with a hole in the end that the Needle may passe through the hole, and the Pipe holding it, and being put to i••, it may stay the lips of the wound, least whilst the needle is put to it it should be stirred, neither should it be lengthned to the protraction of the thred and needle: the manner of the suture is two-fold, the one is that which is performed in the same manner as Skinners or Furriers use to sow their skins, being fitted for wounded guts; the other is thus, in the middle of the wound, with a Needle drawing a double thred, the lips of the wound are tied, and a knot being made, the thred a little above the knot, is to be cut off: Moreover in the middle space on both sides another hole is to be pricked with a double thred, and a knot being made in the like manner, tis to be cut off, and that is to be con∣tinued till the lips of the wound be rightly sowne together, and brought to mutuall contract. * 1.33

There is mention also amongst the ancients of a Pipe,

but what it was for the most part is unknown at this day, since it is incredible that those iron hooks should be fixed to the skin, since that would have caused intollerable pain, the opinion of Gabriel Fallopius is more probable, who teach∣eth that pipe to be that suture newly described, which is cal∣led Intercisa, and at this day is most frequent, which is drawn with a needle drawing a double thred through both the lips of the wound, and above the wound, with three involutions, both the ends of the thred are tied together and knit into a knot. But the word Fibula signifies every Instrument that joyneth things together. And thus much of the Chyrurgicall operation which is of putting or joyn∣ing together.

CHAP. VI. Of correcting of Bones that are represt or set a∣wry.

THe other Chyrurgicall operation is Diorthosis, or the putting right, a correcting of bones put awry, or wri∣then; The Skull if it be deprest, which often happens in Children, is to be reduced into its naturall condition and place, either with Cupping-glasses, the haire being shaved with a great flame put to them, and the mouth and nostrils being shut, the Patient by expiration, together with a violent striving, by putting Cucurbita Cornea, out of which the mouth and nostrills of the sick being shut, a strong man may suck up aire, or with some Plaister sticking very fast to the skin, which is to be applied, and when it cleaves very fast then to twich it up, or with an elevating Augur, or trepan, or by performation and elevation of the Skull.

The bones of the nose being broken or bruised, * 1.34 are to be drawn back by the finger, or a Specillum put into the no∣strill, and without are to be directed and put into frame by the hand, and afterwards a tent is to be put into the hol∣low of the nose or nostrill.

A member being contracted first it is to be softned, * 1.35 after∣wards either gently to be bowed, or with an Instrument fit for that purpose it is tenderly and by degrees to be drawn in, or stretched out.

The Legs or Armes in Infants being awry, * 1.36 the best way of directing them is, that they may be reduced by handling and directing them gently with the hands and by degrees, and with swathings drawing them the contrary way to that which they are in, and by rolling the swath-band by little and little they may be reduced into their naturall and due figure, but if the swathing be not strong enough, and that the child desire to goe, little bootes like bagging shooes in that manner as Paraeus hath described them in his twentyeth book of Chyrurgery, Chap. the eleventh, are to be fitted to his Legs; and thus much of the second operation of Chyrurge∣ry.

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

THe third operation of Chyrurgery is disjunction, * 1.37 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, * 1.38 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, * 1.39 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, * 1.40 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, * 1.41 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, * 1.42 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, * 1.43 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, * 1.44 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, * 1.45 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, * 1.46 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. * 1.47 Book and 7. Chap.

As also the cutting of the wind-pipe, * 1.48 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, * 1.49 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, * 1.50 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, * 1.51 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.

CHAP VIII. Of Section of Bones.

BUt that cutting which is performed in hard parts or bones is fourefold, according to the various manner of seperation, and variety of instruments, namely shaving, filing perforation, and sawing.

First shaving is a plaining and a making smooth of the inequality of bones with an incision knife shaving them, * 1.52 or a detraction and taking away of the filth clinging fast to the bones, and it is performed with files, in magnitude and figure, according to the severall natures of diseases and of bones; either straight, such as are hammers which they use in driving, or bent in the end such as they use in drawing, sometimes they use both a file, and a Hammer wrapt in a clout.

Secondly filing, * 1.53 or wearing away of bones with a file, it usefull in the teeth when they hang out contrary to nature.

The third is perforation whereby we cut the part out of the middle of a bone, * 1.54 either with a Trepan or with a file, or together with a Trepan and a file; the perforation which is made by a Trepan, the Greekes call, Trupesis, a wimble they call Trupanon, * 1.55 and Trupane; but a Trepan is either straight and sharpe, and in a hollowed circle, which is called a wimble in particular, or it is hollow which is called, Modic∣lus; Trepan is like to common wimbles which Carpenters use, and tis twofold, the one is that which answers plainly to the wimbles of Carpenters; the other, which neere the point at such a distance as the thicknesse of the skull is of, hath a knot without, or a circle fitted, which whilst the Trepan is within the skull, hinders it that it cannot goe deeper then is fit, which kind of Trepan, because it cannot goe deeper, the Greekes call Trupanon, or Abaptiston; Modiolus the Greeks call, Cointhion, and Coinichis, and Prion Caractos, tis a hollow Instrument of Iron, round and long like a Pillar, at the bottome of the mouth like a saw, or full of teeth, and straight Trepans, which are called Periteria, are opposed to it, which are turned about with a handle, which if it have a naile (or pin) in the middle tis called male, and if it have not is called female, but the perforation or boaring is per∣formed principally when the skull is broke, or when some matter, or blood is contained within the skull, the manner of which operation may be seen in the Institutions, sometimes also in rotten bones when the rottennesse goes deep.

Lastly by sawing, * 1.56 or cutting with a saw, bones are divided, when any dead part, the flesh being first cut away with a knife to the bone, and the bone is laid open, or when some broken bone hangs our, and cannot be put back into it place, or when any chinke is to be filled up, or when the table of the skull is to be taken away.

CHAP. IX. Of Burning.

THe last kind of seperation remaines, * 1.57 which is burning, which is to be used when diseases cannot be taken away by medicines, nor cutting; burning is performed two wayes, * 1.58 either by those things which actually have in them fire, and a fiery quality as Iron, or other fiery Instruments made of Gold, Silver, Brasse, which are called actuall Cauteries, or with burning medicines, which are called potentiall Caute∣ries.

There are some differences of actuall Cauteries, especially, * 1.59 in respect of matter and figure, and differing also some other wayes; as for matter, Metallick Instruments prepared of Iron, Brasse, Silver, Gold, are in use this day, Iron burnes potently, Brasse and Gold not so violently, the figures of Cauteries are various, which are described every where, sometimes they are fiered more, sometimes lesse, sometimes impressed deeper, sometimes superficially only, the manner of burning is to be seen in the Institutions,

Another manner of burning is that which is performed by potentiall Cauteries, * 1.60 what Caustick medicines are, and Es∣caroticks, is spoken above, part the 1. sect the 1. Chap the 10 th. and in what manner Cauteries are to be prepared shall be shewne in the end of this Book.

Fontanells, * 1.61 and Issues are made by actuall and potentiall Cauteries, namely little Ulcers, prepared to evacuate, draw back, and drive humours through them, but in what parts, and how these Fontanells are to be made shall be shewn in the Institutions.

To this third operation may be referred that, * 1.62 whereby something is drawn in the body, or out of the body, by cup∣ping glasses, but a cupping glass is a vessell with a belly which is fastned to the body to draw, all whose strength of acting comes by reason of vacuity, but what the differences of them are, the manner of applying of them, and their use, shall be shewn in the Institutions: and thus much of the third Chy∣rurgicall operation.

CHAP. X. Of drawing of things out of the body which were sent into the body from without

THe fourth Chyrurgicall operation is, * 1.63 Exairesis, or extract∣ion of hurtfull and unprofitable things out of the body; but things which are to be taken away, are either sent from without into the body, or begotten in the body.

First for what belongs to the extraction of things sent from without into the body, they are twofold; first all those things which are sent to wound the body, as darts of all sorts, and Bullets shot out of Guns; Moreover certaine ex∣ternall things which come into the Chops and Throate, Eares, Nostrills, and Eyes, and stick in them,

But Darts are taken out two wayes, either by extraction, or impulsion, that is, either that way which they came in, or that way which it aimed to goe out at; tis drawne out by the part which it came in at, either without any launcing, or with launcing; for if the dart pierced not deep, if it hath not passed through great vessells, or nervous parts, and and meetes with a bone, veines, arteries, or nerves, out of the region whither it tended, and if there be no feare of any great tearing, it may be drawn back that way, which it enter∣ed into the body, and that without cutting; but if there be danger, and that it be to be feared least that the body should be lacerated, if the dart should be drawn out the same way that it went in at, the wound is to be dilated either by cutting, or without launcing, namely with that Instrument, which Ce••sus in his 7. Booke and 15. Chap. calls Hypsiloei∣des, or Swans, or ••torkes beake, or other dilating Instruments whereby the Dart may the casier be drawn back. Tis drawn out by the hand, if it may be, when it is apparent, and is fastned only in flesh, or with a Volcella, when it sticks so deep that it cannot be taken hold of by the hands, or other Instruments which the Greekes, Boloulca, that is certaine Instruments to pull out Darts, of which kind are long Tongs, Tongs with teeth, straight, a little bent inward, but the out∣most part broad and round, to which the latter Chyrurgeons have given severall names from their figure, and call them Crowes, Storkes, Ducks, Geese bill, the figures whereof are extant, in Amb. Parey in the 10 th. Booke 18 th. Chap. but

if the point of the Dart, hath pierced into the member more then halfe through, and the place by which the dart is to be drawn through, be more, then it hath hitherto passed, and neither bone, Nerve, Veines, nor Arteries hinder it, tis more convenient, to drive the Dart thither whither it tended; dissection being made in that part, and to draw it out by making of a new wound; but yet if the Dart be too broad tis not expedient to draw it out through another part; least that we add to that great wound, another greate one.

The reason of drawing out Musket bullets in many things is agreeable to the extraction of Darts, * 1.64 for three things are required to extraction, the first that the way may be dilated with an Instrument; secondly that the bullet be taken hold of; the Instrument takes the bullet, either as a paire of Tongs, or the point of the Instrument enters into the bullet, incom∣passeth it with its cavity, or it takes hold with the end that is toothed like a faw; thirdly a bullet being taken hold of with an Instrument, is drawne out by the hand of a Chy∣rurgeon with the Instrument, of which more in the Institu∣tions.

Moreover sometimes thing shappen externally to the Chops, * 1.65 Throate, Eares, and happen into the Nostrills, and Eyes, and use to stick in them, each of which require severall wayes of drawing forth; if a little fish bone, or the back bone of a fish stick in the Throate, and that it be in sight when the mouth is opened, tis to be taken out with a Volcella, and that either straight, or a little bowed towards the end, and convenient to take out the bones from the Threate, but if it should descend deeper into the Throate, or having used a Speculum of the mouth to open it wide, if it doth not ap∣peare, a vomit is to be stirred up with oyle of sweet Al∣monds, or of Olives, or with a quill, or putting downe ones finger.

A Worme sticking in the Eares, * 1.66 first of all it is to be drawn out a live, and that it may be the better performed, and the worme may the easier be taken, it is to be enticed outward, by injecting sweete things into the Eares, and applying of them outwardly, but if it cannot be enticed, or drawn out a∣live, it is to be killed with those things that are bitter, and by a peculiar propriety and force, are destructive to wormes, but being killed, tis drawn out by powring in water or wine and Oyle luke warme, and putting in of tents made of Cot∣ton, wet with Hony, Turpentine, or some glutinous gum,

wherewith twisting it up and down in the Eare, the worme is drawn forth, the sick leaning on that side the Eare is af∣fected

Other things which may be put, or slid into the eare are either hard, or liquid; if the things are hard, warme Oyle is to be powred in that they may be dissolved, if it be possible, or certainly the passages of the Eare may become slippery; but if the thing which falls in be of that nature, that it will swell with moistning, as Pease, Beanes, &c. all moist things are to be avoided, afterwards sneezing is to be provoaked, the Nostrills, and the mouth being shut, that the spirits may be forced to goe out through the Eares, and so that together to be thrust out which was slid into the Eares, but if the thing cannot be extruded in this manner, tis to be drawn out with a convenient Instrument, yet very warily, least either that which is to be taken forth should be thrust deeper, or the membrane called the drumme of the Eare should be broken.

If that which is to be taken out be liquid, the affected should hop upon his foote on the contrary side, bending his head downeward on the afflicted side, that the moisture may come forth, which if it doth not come to passe, sneezing is to be occasioned, or a little dry sponge is to be put into the Eare, so that the extremity of the Channell which goes into the Eare be first stopt and fortifyed with Cotton, that whilst the spirit is drawn, there be no roome granted for the letting in of Aire in any wayes.

If any thing come into the Nostrills sticks in them, there is another way of drawing of it out, then that of drawing out those things that stick in the Eares.

If sand or dust stick in the Eyes, the stone found in the maw of a Swallow, Crabs Eyes, Pearles, if they are cast into the Eyes, cleanse them, but if any greater thing be fixed in the Eye, tis to be drawn out with a fine linnen cloath, wet in pure fountaine water, or with a sponge tyed to a soft quill, but if it be greater, tis to be taken out with a little Volcel∣la, or unlesse extraction in this manner doth succeed, Ano∣dunes, or medicines taking away paine, being applyed and other convenient medicines, the businesse is to be commit∣ted to nature.

CHAP. XI. Of drawing out of things generated in the body ac∣cording to nature, but retained in the body beyond the limits of nature.

AFter these, amongst those things which are to be drawn out of the body, somethings are found which in∣deed are generated in the body according to nature, yet are detayned there contrary to nature, and hitherto belongs first of all, extraction, or excision of a living or dead child out of the body, moreover the drawing out of Urine de∣tained preternaturally.

First of all, * 1.67 if the young can neither be brought out by the helpe of the mother, nor by any other, there is no other helpe remaines then cutting, whereby the living child is taken out, and those which are brought forth on this manner, are called Caesares, the young is cut out when the mother is living or dead, * 1.68 but of this Cesarean bringing forth, you may see a peculiar Book of Francis Rousset, but as for the extraction of a dead child by what meanes that may be rightly performed Celsus teacheth in his 7. Booke. 29. Chap. 23. Aetius Tetrach Book 4. Ser. 4. Chap. and Hieron Fabricius ab Aqua P. of Chyrurgicall operations, Amb. Parey describes fit Instruments for this operation in his 23 d. Book Chap. 26. Job. Andr. a Cruce.

Next to these is the drawing out of a Mole and the same reason for the most part is in drawing out them as in the extraction of a dead child. * 1.69

Lastly hitherto belongs the drawing out of Urine by Chyrurgicall operation, * 1.70 but that operation is performed by Silver, or brazen Pipes, which they call Catheters, which that they may be fitted for every body greater or lesse, three of them are to be prepared for men, and too for wo∣men in a readinesse, the manner of operation is in the In∣stitutions.

CHAP. XII. Of taking away the corrupt parts of the body.

SOmetimes the parts of the body are so corrupted that there is no hope of curing of them, * 1.71 which as being un∣profitable and hurtfull, and such as may infect the parts next to them, and pollute them, are to be taken away; whatever therefore is corrupted, is to be cut off, but the manner of cutting offis various according to the variety of the parts that are hurt, and the place where they are, and nature of the disease it selfe, and therefore the rightest manner of taking away such from the body is known by particular operations, yet oftentimes in fistula's and other malignant Ulcers, cutting alone is not sufficient as being that which cannot take away the smallest fibrillaes and particles, but after cutting there is need of an actuall or potentiall Caute∣rie that the remainders may be taken away, nay some∣times without cutting, by Cauteries only things so corrup∣ted are taken away.

Hereunto belongs the Amputation of parts corrupted with a Cancer, * 1.72 also a cutting off of the Uvula, corrupted either by inflamation or by Morbus Gallicus, the cutting off also of the putred, or corrupted yard, as also of the cor∣rupted wombe.

Corrupted bones are taken away by filing, shaving with an incision knife, or with a wimble, of which it is spoken before, as also with divers kinds of Tongs, whereby the corrupted bones of the fingers, and broken bones hanging out may be taken away.

Hitherto belongs the plucking out of teeth, * 1.73 which is performed, the Teeth being first loosned from the gums, and is done with severall Instruments, whose names are taken from the figure, and similitude for the most part, which they have with the beakes of living Creatures, which Hie∣ron Fabricius, reckons up, the figures of them are extant in Amb. Parey. the 16 th. Book Chap. the 17 th. and Joh. Andr. a Cruce.

Lastly it sometimes happens that in mans body certaine parts are corrupted with mortification & they so dy that ther is no hope of recovery of life, * 1.74 when there is one indication

that which is corrupted is to be cut off, least the sound also should be affected, which operation the Greekes call Acro∣teriasmos, or a tearing off the dead ••lesh, but in what place and when that Amputation is to be made cannot be deliver∣ed in a compendium, see the Institutions.

CHAP. XIII. Of freeing and taking away things generated in the body contrary to nature.

THe last kind remains of taking away things out of the body, * 1.75 namely those which are generated in the body con∣trary to nature, but there is no little difference amongst those things, for some of them are borne together with the parts of our body and are adhere tenaciously, as Warts, Warts great above and small below, swellings and inflammations in the fundament, the top of the yard, the way to the wombe, cal∣lous flesh, Cornes, Knots, the Kings Evill, excrescencies of flesh in the Nostrills, and Polypus, swelling in the Chops, small tumours in the Urinary passage, Excrescencies on the eye lids, fleshy ruptures, or else they are contained in some part of the body, as water in an aqueous rupture in the paunch, stones or gravell in the reines, bladder or yard.

The cutting of warts is performed either by binding, * 1.76 cuttings, or burning; Warts hanging downe are taken away either with a silken threed, or Horse haire, or they are to be tyed with some other strong threed every day harder and harder untill they come off; cutting is performed with an in∣cision knife, like a Mirtle leave, or with a launce; burning is performed with an hot Iron, or with green wood that is burnt; but how severally the tumour called Thymus in the fundament, glans or prepuce, are to be taken away is shewn in the Institutions, and in the 3 d. Book of practice.

Sometimes a little tumour ariseth in the Urinary passage from an Ulcer, * 1.77 and is so increased sometimes that it stops the urine, this is to be taken away by the helpe of a Chyrur∣geon, and fit medicines, but least that other parts should be eroded, medicines are to be ejected through a silver Pipe, to the tumour, or else it is to be incorporated and mixt with the top and head of a wax Candle, and thrust into the place af∣fected, or a little Cane with Lint and white wax put into it, and bedaubed with a fit medicine, being hollow that the

urine may passe through it. This is to be put into the urina∣ry passages.

Polypus if it admits of cure, * 1.78 it is to be cut off with a sharpe Iron Instrument made after the manner of a Spatula, being put into the Nostrills, of which operation see the Institu∣tions, and the first Book of Practice.

Fleshy excrescencies in the Chops called, * 1.79 Epuli, as also Encanthis, or excrescencies in the greater corner of the Eye, and the naile of the Eye, unlesse they can be taken away with medicines, are to be cut off, as also peices of flesh here and there growing in the skin of the body, * 1.80 and excrescencies which represent a kind of soft flesh, which are like the rootes of Mushroms, and grow like them, and therefore are called Musheroms, knots also, Kings evill, Kernells, swellings in the Throate, and swellings in the flesh, or fleshy ruptures if they cannot be eradicated by Medicines, must be taken away by cutting.

A watry rupture, * 1.81 or water collected into the cods cannot alwayes be taken away by discussing medicines, the cods are to be opened, and the water to be let out through the wound.

Lastly the stone of the bladder, * 1.82 since it is seldome di∣minished by medicines, the bladder being cut, tis to be taken out, and sometimes a stone sticking in the urinary passage is to be drawn out, but in what manner those cut∣tings, and operations all of them ought to be persormed, is spoken in the Institutions, and may there be seen, nor can the wayes of those operations be reduced into a compendium, but all things which are there spoken in the operations are diligently to be observed, and thus much of the fourth Chyrurgicall operation.

CHAP XIIII. Of the restitution of parts that are lost, or of the Chyrurgery of imperfect parts.

THere remains the last Chyrurgicall operation, * 1.83 which is required in the cure of such as are imperfect and maim∣ed, namely when the extremities of the Nose or Eares or Lips are shortned, and these parts maimed, but although parts that are lost are counterfeited by Instruments fained made and painted, out of severall matter representing the

similitude of the part lost, yet this is only a counterfeite and palliating cure, but when it cannot be restored by a new generation of the deficient part, tis to be restored by the flesh of another member being brought and united to it, yet that operation is not to be tryed on every body, but first it is to be observed what kind of body it is which is to be cured, for in old men or in a body which hath an ill habit, wherein wounds are difficult to be cured, this way of cure is not to be easily attempted. Casper Taliacotius in his Book of maim∣ed Chyrurgery, by inserting, accuratly and largely describes the manner of this operation, the sum of this operation is this; he makes his transferring, or bringing into the Nose, and Lips, from the Shoulder; but to cure unperfect Eares he takes away from the Region behind the Eares, namely he appoints a convenient cutting in those parts, and the maimed parts being first cleansed, he commits and joynes the skin of that part which is cut off with the maimed part, and that they may be kept joyned together untill they grow together, he binds them with swathing bands. And indeed he puts that part of the Nose or Lips which is maimed, into the wound made in the Shoulder, with the head tyed to the Arme, as it were to a prop, that it is, immoveable, and fixt so that it can be moved no way. And in this manner when it hath stuck so long, untill the flesh of both parts be united and growes together, he cutteth off againe from the Nose or Lip, the traduct, or that which was brought from another place and is here g••own, then he makes conveniently, and frames that flesh so cut off from the Arme into a forme of a Nose or Lip.

Notes

• * 1.1

  Chyrurge∣rys what.
• * 1.2

  Discription of a Chy∣rurgeon.
• * 1.3

  The sub∣ject.
• * 1.4

  Instru∣ments.
• * 1.5

  Place.
• * 1.6

  Light.
• * 1.7

  Servants and stan∣ders by.
• * 1.8

  Garments.
• * 1.9

  Chyrurgi∣call opera∣tions how many.
• * 1.10

  Setting or putting to¦gether. Finding.
• * 1.11

  Swathing.
• * 1.12

  Differences of it.
• * 1.13

  Differences of deliga∣tion.
• * 1.14

  The man∣ner.
• * 1.15

  Splents made up with Lin∣nen.
• * 1.16

  Splents.
• * 1.17

  Swathing∣bands.
• * 1.18

  Setting how many∣fold.
• * 1.19

  Of broken bones.
• * 1.20

  Extension.
• * 1.21

  Strength∣ning.
• * 1.22

  The cure of a fracture with a wound.
• * 1.23

  Manner of swathing or deliga¦tion.
• * 1.24

  What things are required for the set∣ting of bones.
• * 1.25

  Reposition.
• * 1.26

  Deligation.
• * 1.27

  Colloca∣tion.
• * 1.28

  Setting of soft parts.
• * 1.29

  Wounds, how set.
• * 1.30

  Swathing.
• * 1.31

  A suture by glue.
• * 1.32

  A suture by a needle.
• * 1.33

  Fibulae.
• * 1.34

  Of the nose
• * 1.35

  Directing of contra∣cted mem∣bers.
• * 1.36

  Direction of crooked Legs or Armes.
• * 1.37

  The kindes of division.
• * 1.38

  Opening of a veine.
• * 1.39

  Opening of impost∣humes.
• * 1.40

  The cutting of a fistula.
• * 1.41

  Seperation of parts that are joyned to∣gether pre∣ternatural∣ly.
• * 1.42

  Scarifica∣tion.
• * 1.43

  Cutting of vessells.
• * 1.44

  Cutting of the vari∣ces.
• * 1.45

  Cutting of an Ancu∣risme.
• * 1.46

  Paracen∣tesis.
• * 1.47

  Couching of a Cata∣ract.
• * 1.48

  Laryngo∣tome.
• * 1.49

  An incisi∣on of the brest.
• * 1.50

  Applying of a Seton.
• * 1.51

  Leaches.
• * 1.52

  Shaving.
• * 1.53

  Filing.
• * 1.54

  Perfora∣ting.
• * 1.55

  Kinds of Trepans or Wim∣bles.
• * 1.56

  Sawing,
• * 1.57

  Burning.
• * 1.58

  Burning twofold.
• * 1.59

  An actuall Cautery.
• * 1.60

  Potentiall.
• * 1.61

  Issues.
• * 1.62

  Cupping glasses.
• * 1.63

  How ma∣ny wayes things may be drawn out of the body. Drawing out of things thrust into the body. A Dart how many wayes it may be drawne out.
• * 1.64

  The way of taking out of Musket bullets.
• * 1.65

  Things that stick in the Chops.
• * 1.66

  A worme in the eares how to be taken out.
• * 1.67

  Of taking out a lived child.
• * 1.68

  Of a dead.
• * 1.69

  Extraction of a Mola
• * 1.70

  Drawing out urine with a Cathera.
• * 1.71

  Cutting of dead flesh.
• * 1.72

  Amputa∣tion of a cancer. Of a Vvula, yard, wombe. Of bones.
• * 1.73

  Teeth.
• * 1.74

  Amputa∣tion of Limbs.
• * 1.75

  Things preternatu∣rall begot∣ten in the body how many-fold.
• * 1.76

  Warts.
• * 1.77

  Caruncles extirpated out the Ʋrinary passages.
• * 1.78

  Taking a∣way a Po∣lypus.
• * 1.79

  Epuli a naile in the eye.
• * 1.80

  Excrescen∣cies of flesh. Fungi. Nodi &c.
• * 1.81

  A watry rupture.
• * 1.82

  Stone of the bladder.
• * 1.83

  Chyrurgery of such as are maim∣ed.