Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

VII. TƲMORS, Ex Partium decidentia.

CHAP. XL. Of RƲPTƲRES.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ramex, Ruptura, Hernia; and in English, a Rupture, or Bursteness.

II. The Kinds. The general kinds are three: viz. 1. Proper. 2. Common. 3. Remote: as we have declared in Lib. 1. Cap. 8. aforegoing, of this Book.

III. The Proper are three∣fold: 1. Hernia Intestinalis: 2. Hernia Inguinalis: 3. Hernia Omentalis. The Common are sevenfold: 1. Hernia Humora∣lis: 2. Hernia Seminalis, or Hernia Vasis deferentis: 3. Her∣nia Carnosa: 4. Hernia Vari∣cosa: 5. Hernia Ventosa: 6. Her∣nia Aquosa. The Remote, are

threefold; 1. Hernia Ʋmbilica∣lis. 2. Hernia Ʋterina. 3. Her∣nia Gutturalis.

IV. Of the Proper, the Hernia Intestinalis is already treated of, both in Our Synopsis Medicinae, lib. 5. cap. 14. and in general terms, in this present Work, in lib. 1. cap. 8. of the common we have already handled; the Hernia Carnosa and Hernia Vari∣cosa, in our said Synopsis, lib. 5. cap. 17. a Hernia Ventosa, in lib. 5. cap. 15. of the said Book, and in cap. 29. afore∣going of this present Work; a Hernia Aquosa, in lib. 5. cap. 16. of the said Synopsis, and in cap. 30. of this Book also; of the Remote, we have also handled; a Hernia Ʋmbili∣calis, in Synopsis Medicinae, lib. 5. cap. 18. a Hernia Ʋterina, in lib. 5. cap. 72. of the same; and 1 Hernia Gutturalis, in cap. 26. foregoing, of this third Book of Our Chirurgery.

V. But in regard we have been very brief in our Discourses of the Hernia Intestinalis, and Umbili∣calis in the places afore cited; and something is wanting in our treating of a Hernia Carnosa, we shall in this present Chapter re∣sume the same again, supplying that here, which was defective there; and withal we shall now, treat of those other Hernia's of which in no other place, in any of our Works, we have said any thing at all; tho' they fall not so properly under the title of this Chapter.

VI. The thread then of the Discourse of this Chapter, will be concerning, 1. A Hernia Inte∣stinalis. 2. A Hernia Inguina∣lis. 3. A Hernia Omentalis. 4. A Hernia Humoralis. 5. A Hernia Seminalis, or Hernia Va∣sis deferentis. 6. A Hernia Car∣nosa. 7. And a Hernia Ʋmbi∣licalis: of all which in order.

I. Hernia Intestinalis.

VII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Enterocele, Oscheocele, Hernia Intestinalis, Hernia in Scroto, Hernia Peritonaei; in English, a Rupture of the Peri∣tonaeum, wherein the Guts fall into the Cods.

VIII. It is either perfect, when the Guts fall quite into the Scro∣tum; or imperfect, when they fall down but part of the way, and this latter is called only a Relaxation.

IX. The Peritonaeum is the Membrane that is either broken or relaxed, and lines all the inside of the Abdominal Muscles; then passing to the Back, does there involve, and give Coats to the Viscera: it is strong, and every where double; in the duplica∣tures of which, all the Viscera are hid, and thro' which all the Vessels do pass.

X. The lower part of it is the strongest, to enable the Belly the better to bear the weight of the Intestines: and being every where double, admits not of a perfora∣tion, for the transmission of the Seminal-vessels; but does so re∣ceive them between its Coats, as that passing between the first Coat, leaves it every where intire, even both at Navel and Groin: in which latter place, the Seminals do take the outer Coat of the

Peritonaeum along with them; which containing them in it self, does at length make that Tu∣nicle which involves the Testi∣cle, and is called Elytroïdes, or Tunica vaginalis.

XI. Here then, if the inward Lamina, or Coat is strong, it keeps the Guts and Humors with∣in the capacity of the Abdomen; so that tho' it is full of Water, yet it transmits none into the Scrotum: for the watery Tu∣mors of the Cods in Hydropical persons are generally Anasar∣cous; as coming outwardly into the Membranes of the Scrotum, and not passing from the cavity of the Abdomen thither.

XII. But if this inward La∣mina or Coat is thro' force, or any weakness broken or relaxt; then the Intrails are protruded to the Scrotum; and if broken in the top of the Process, the Bowels fall down into the lower parts of the Cod: but if the said top of the Process suffers only a relaxation, then the Mem∣brane being extended contains the Guts, and that membranous Partition that lies between the Guts and Scrotum, is visible.

XIII. The Causes. In Chil∣dren it may proceed from much crudity or moisture, vehement cry∣ing, strugling, and holding their Breath too strongly.

XIV. In elder persons it is caused from violent Exercise, jumping, leaping, vaulting, falling from a high place, blows, carrying great burthens, hard riding, vomiting, straining at stool, or exceeding great weight of the Bowels in fat People.

XV. The Signs. If the Peri∣tonaeum is broken, it is known by the sudden rise of the Tumor; whether made by blow, fall, overstraining, and the like; in which case, the Guts slide down into the Scrotum, or lye in a great Tumor in the Groin.

XVI. If it is caused by a blow or fall, Blood is sometimes extra∣vasated, and the Tumor is pain∣ful, whether in the Groin or Cods, and it soon falls from the Groin to the Cods; where, by laying your Hand upon the pro∣duction of the Peritonaeum, just at its going forth from the Abdomen; and withal causing the Patient to sneeze or cough; you may distinguish it from a Sarcoma, or Hernia carnosa, by perceiving the motion of the Gut, when it is there.

XVII. The Prognosticks. In young Children it is easily cured, if carefully managed; but in youths, with more difficulty: if under twenty, or while growing, they are curable, tho' the Guts are fallen down into the Cods.

XVIII. In people of full growth, the edges of the Peritonaeum sel∣dom or never unite, because they many times grow callous: and if the Gut is not speedily reduced, grievous pain succeeds, with Colick and Fever, because of the detention of Excrements; from whence many times comes inflammation, vomiting of Ex∣crements, yea sometimes Gan∣grene, and Death it self.

XIX. If the Rupture is very large, the Guts many times do their duty, as safely in the Scrotum, as if they were in their

true and natural places in the cavity of the Abdomen.

XX. If it is only a relaxa∣tion of the Peritonaeum, as it is least dangerous, so it is the easiest cured of them all.

XXI. If a Hernia Intestinalis be neglected in Women-kind, it will make a round Tumor near the Pudenda.

XXII. The Cure. In the first place, you must cause the Patient to lye upon his Back, and en∣deavour the reduction of the Gut; let his Head be declining, and his Hips raised high, causing his Heels to be drawn up to them.

XXIII. Then with your Hands, and warm Cloths, try to reduce it, by pressing moderately and gra∣dually upon it; but taking care withal, that you do not hurt or bruise the Testicle.

XXIV. If it will not yield to these, there being a repletion of hard Excrements, you must give Clysters of fat Broth, with much Salt; or Posset-drink lbi. with brown Sugar ℥iv. or the ordinary Turpentine-Clyster: or this; I•• Fat Broth lbi. brown Sugar ℥ii Aloes ʒi. mix and dissolve, and exhibit it warm; which repeat, till the Bowels are em∣ptied.

XXV. In the mean season, foment the Scrotum with a De∣coction of Camomil in Whitewine, applying hot Stuphs dipt in, and s•…•…eezed out of the Liquor; for some considerable time: and if the Excrements seem to be hardned therein, soften it, by applying after the Fomenta∣tion some emollient Cata∣plasm, made of Figs, Onions, Lilly roots, and Mithridate.

XXVI. The Guts being thus emptied, let them be reduced as before directed; and apply over the Part, Emplast. ad Herniam, or Our Empl. of an Ox-gall: Or this; ℞ Loadstone in fine pouder, Aloes, Dragons-blood, Bole Armo∣niack, Terra sigillata, Crocus Martis astringens, Mastich, Oli∣banum, Sarcocolla, Frankincense, A. ℥ss. Ox-galls evaporated to the consistence of an Extract, Tur∣pentine, Wax, A. q.s. make an Emplaster; which apply, and renew it, when you find it will stick no longer.

XXVII. Then bind up the Part with a Bag-truss, made with Bol∣sters stuft with Cotton, and fitted with a steel Spring to keep the Bowels up, and all things close and firm. Or the Bolsters may be be fixed with steel Plates, having Worms and Screws therein; by which the Bolsters may be made to sit closer, or or more distant; and keep the Gut up, without pressing upon the Spermatick-vessels, or Os Pubis: and these may also be useful in an old Rupture, and where the hopes of Cure are vanished.

XXVIII. Where the Rupture is very large, thro' the often fal∣ling down of the Bowels, a Bag∣truss is to be proportioned, with a hole for the Penis to pass through; which is to be put on whilst the Patient is in Bed, and in a declining posture: by which means the falling down of the Bowels will be much hindred, and the Patient much eased in his going abroad; and if he

is young and growing, may be in the possibility of getting a Cure.

XXIX. Rest is of exceeding great advantage to the Sick; and therefore the Patient is required to keep his Bed 40 or 60 days: for by this means great Ruptures have been cured, to which all other means had been applied in vain, and the Patient ac∣counted as desperate.

XXX. And if the Patient has any need to sneeze, or cough; and upon going to stool, or any other violent motion, he ought to feel, and lay his Hand hard upon the place affected; that if there should be any danger of a Prolapse, or Relapse, it may thereby be prevented.

XXXI. As for Internals, and the remaining part of the Cure, we refer you to Lib. 1. Cap. 8. of this Book; and to the third Edition of Our Synopsis Medi∣cinae, lib. 5. cap. 14. afore∣mentioned, where you may have abundant satisfaction: tho' after all, it is my belief that rest, lying in bed, and a good Truss contribute more to the Cure, than all other things in the World, whether inwardly given, or outwardly applied.

XXXII. For things inwardly given can never come to the Part, but pass with the Ordure thro' the Bowels, without making any stay there: unless the virtue of the Specifick, by mixing it self with the Chylous Juice, and so joining with the Blood, does by circu∣lation approach thereto, when it is consign'd for the nourish∣ment of the Part. Which Con∣sideration, in my opinion, signi∣fies not much to the Cure; but only makes the Bloody and Nutritious Juices somewhat more consolidative and agglutinating.

XXXIII. Nor can things out∣wardly applied come directly to the Part hurt, any more than the other; there being the Scarf∣skin, Skin, Flesh, Membranes, &c. between, and interposing be∣tween the substance of the Agglutinatives and the Rupture it self.

XXXIV. If the Compress or Bolster sits uneasy, let a Quilt be made to lye under it, or brown Paper doubled, and soaked in Smiths Forge-water, wherein some Astringents have been boiled; by which the Truss will sit the easier, and the better retain the torn or relaxed parts to∣gether, for their more speedy agglutination.

XXXV. But if the Gut by reason of its long prolapsion, and the Excrements being hardned therein, cannot be reduced by the methods before prescribed; let the Patient be put into a half Bath, keeping on the Bag-truss the while: after which, coming out of the Bath let him be set on his Head, or carried with his Head downwards; by which means many times the pro∣lapsed Bowels are often re∣duced.

XXXVI. But if yet all endea∣vours should prove ineffectual, and the Patients Life is in apparent danger; which is manifest by manifold Vomitings, Sickness at Stomach, Inflation of the Belly, thro' the Patient's not going to

stool; it is better doubtless then to lay open the Production, whilst there is strength; than to let the miserable Patient perish under the force of his Disease: since the Operation may be done without any matter of difficulty or danger.

XXXVII. The way of doing it is thus. Lay the Patient flat on his Back, on a Table or Form, and bind him thereon; then make incision upon the upper part of the Scrotum, to the Production of the Peritonaeum; which must also be divided, without touching the Guts or Omentum: then pass in a Cannula, like the common Director, but as large as a Goose-quill, which put into the cavity under the Process of the Peri∣toneum upwards, avoiding the Guts: then make an incision of such a length as may be sufficient to put your Fingers into the Scrotum, and raise the Intestines and Omentum, which then reduce into their natural places within the cavity of the Abdomen.

XXXVIII. The Bowels being thus reduced, you must stitch up the Wound, as in a Wound of the Abdo∣men, taking up with your Needle so much of the Production as may shut up the Cavity, and hinder the falling down again of the Bowels. This done, you must Cure the Wound, as we shall hereafter shew in Lib. 4. fol∣lowing, where we treat of Wounds of the Belly; this being not so large or dangerous, as many of them are.

XXXIX. There are many other ways of doing this Operation, two of which are by Incision; the first of which divides the length of the Process, laying the Seminal Vessels bare: the other is Castra∣tion. There is another way, which is by Puncture, taught by Paraeus; and two other ways also, the one by the Actual Cautery, the other by the Potential: but as they are all of difficult performance, with much hazard, and great cruelty; so we never meet with a Patient which will submit to any of those ways of Cure; for which reason sake, we here totally omit them.

II. Hernia Inguinalis.

XL. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Bubono∣cele, and Hernia Inguinalis; in English, A Rupture in the Groin.

XLI. This is also either perfect, when the Peritonaeum or Rim as they call it, is absolutely broken: or imperfect, when it is only stretched or extended.

XLII. It is a Tumor in the Groin, either of the Guts, or of the Omentum: the latter of which we shall speak of under the next Head.

XLIII. The Causes. The Pro∣catartick or remote Causes, are violent Exercises, falls from high places, blows, stroaks, leaping, wrestling, riding hard, crying, vomiting, coughing, &c.

XLIV. The Antecedent Causes, are viscous and flatulent Humors, in great abundance, with a great repletion of the Belly.

XLV. The Cause in Women, is

many times a dilatation of the Membrane in Travel; or because of a transition of the Ligamenta Ʋteri teretia, which pass be∣tween the Laminae or duplica∣ture of the Peritonaeum, after the same manner as the Seminal Vessels do in Men.

XLVI. The Signs. If there is a Rupture of the Peritonaeum, the Tumor is the greater, more difficult to be reduced; and in the reduction, you may many times hear a little kind of noise.

XLVII. But if it is only re∣laxed or extended, it is known by the smalness of the Swelling, and its more easy reduction with the Fingers.

XLVIII. The Prognosticks. Where it is broken, it is of dif∣ficult cure; Children and growing people may be cured; Old people never.

XLIX. If the Rupture is large, and the Intestines come much forth, and has been long unreduced; being filled either with Wind, or hardned Excrements, or both, the reduction will be difficult and painful, and sometimes hazardous to the Life of the Patient.

L. The relaxed Membrane is much more easily cured; as we hinted in the same case, in a Rupture in Scroto.

LI. The Cure. First use Fo∣mentations, emollient and discu∣tient Cataplasms; and then strive to reduce it with your Fingers.

LII. After which, apply a Catagmatick, or an Astringent or Agglutinative Emplaster; which keep close to it, with either a Whale-bone, or Steel Truss, made with fit Bolsters for the compression of the Tumor; as is taught in the foregoing Discourse.

LIII. Inwardly give Vulnera∣ries, and strong Agglutinatives; and let the Patient rest, and be quiet, keeping his bed for 40 or 50 days; performing the rest of the Cure exactly as in an Oscheocele, before described.

III. Hernia Omentalis.

LIV. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Epi∣plocele, Hernia Zirbalis, and Hernia Omentalis; in English, A Rupture of the Peritonaeum, wherein the Omentum or Caul breaks forth.

LV. This is twofold; 1. Into the Groin. 2. Into the Cods: and these are both of them either a compleat Rupture of the Membrane, or a relaxation of the same.

LVI. The Causes are the same with the Hernia Intestinalis; whether it is Oscheocele or Bubo∣nocele.

LVII. The Signs. It is known by its softness, inequality, and slip∣periness of the Tumor: it is also of a continued bigness, whe∣ther the Patient is full or empty.

LVIII. The Prognosticks. It is not dangerous: yet by reason of its softness and slipperiness, it is, after reducing, difficultly retained within it, proper place; but in Children, it is of easy cure.

LIX. And it is more easily cured in such Bodies whose Habits are humid and sanguine, than in such as are dry and melancholick: but if the Tumor is small and recent, and only in the Groin, the Cure is not difficult, be the Habit of the Body what it will.

LX. The Cure. Whether it is in the Cod or in the Groin, the Method of Cure is exactly the same with the Hernia Intestinalis, and Hernia Inguinalis aforegoing: Rest, Lying-abed, and a good Truss being the chief: so that no more need be said here.

IV. Hernia Humoralis.

LXI. It is called Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Hernia humoralis; in English, An Humoral Tumor of the Cods.

LXII. Concerning this Tu∣mor, Sennertus, Med. Pract. lib. 3. par. 9. sect. 1. cap. 7. hath these words: Recentiores hîc adhuc unam Herniae speciem addunt, quam Humoralem vocant, eámque ab omnibus Humoribus, exceptâ Bile, provenire statuunt. Verùm si à Sanguine sit hic Tumor, & quidem cum Inflammatione, per∣tin••t ad Inflammationem Scroti & Testium, de qua supra dictum: viz. Modern Physicians (says he) do here to these add one other species of a Hernia, which they call a Humoral Hernia; and make the same to proceed from all Humors, Choler only excepted. Now if this Tumor proceeds from Blood, with In∣flammation, it is a Phlegmon of the Cods and Testicles; of which before.

LXIII. From this of Senner∣tus it appears, that a Hernia humoralis is nothing more nor less, but a Phlegmon of the Cods and Testicles; which may be either simple, or an Oedemato∣des, if Phlegm is mixed with it.

LXIV. The Causes. These are the same with other Phlegmons, of which we have treated at large in Chap. 5. aforegoing of this Book.

LXV. The Signs. It is known by the Tumor, Colour, Heat, Pain; and other Symptoms of an Inflammation.

LXVI. The Prognosticks. It is a Disease long in curing, the Part being cold and membranous; sometimes it discusses and re∣solves, sometimes it comes to Suppuration; if it continues long, it is of dangerous con∣sequence, for it corrupts the Testicle.

LXVII. Cure. First, the Cure is to be attempted by Discussives and Resolutives; and then gentle Purging, with Bleeding, ought to be administred: the Sick may also be purged by proper Clysters, which are often to be repeated: a Vomit with Turpe∣thum minerale, is good.

LXVIII. And in this Cure, as in the other Hernia's, Rest, with lying in Bed, are material Expe∣dients; together with a Bag-Truss to hold up the Testicles, and such other Medicaments as the nature and accidents of the Tumor require.

LXiX. But if you find it will not discuss nor resolve, you must change the Applications, and use 〈◊〉〈◊〉 things as will promote the

Suppuration; then make incision in the side of the Cod, after cleanse the Ulcer, and consoli∣date the Wound, exactly as we have taught in the Cure of a Phlegmon: so that nothing more need be said of that mat∣ter in this place.

LXX. If afterwards there remains a hardness, you must resolve it by Discussives and Emol∣lients; as Avicen advises: ℞ Crums of houshold-wheaten Bread, boil them in Oxymel, and add a sixth part of Gum Ammonia∣cum; which mix, and boil to the thickness of a Cataplasm: apply it warm, and remove it twice every day.

V. Hernia Seminalis.

LXXI. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Spermatocele, Hernia Vasis deferentis, Hernia Seminalis; and in English, A Tumor of the Cods, proceeding from an Afflux of the Seed.

LXXII. The Kinds. It is twofold: 1. Spermatocele, or Hernia Vasis deferentis; when the Vas deferens falls twisted into the Scrotum. 2. When there is a great afflux of the Seed to the Testicles, in persons abounding with that Humor.

LXXIII. The Causes. The Procatartick Cause, is high Feeding of things greatly nourishing, Idle∣ness, and Dalliance. The Ante∣cedent Cause, is Seed not being timely or sufficiently evacuated. And the Conjoined Cause, is Seed contained in, and dis∣tending the the Vas deferens, and other Seminal Vessels.

LXXIV. The Signs. It is known, by feeling where the Vas deferens is fallen into the Cod; in the latter case, it is more difficult to know: the person is at first extream∣ly lecherous, and desirous of Coition.

LXXV. But that failing, the Testicles begin to swell, and the Tumor gradually increases, with a dull kind of pain, and heaviness of the Cods: this still increasing, puts the Patient to a trouble in going.

LXXVI. And as the Tumor increase, the pain increases. At the first, the Scrotum is lank, and one Testicle feels tumified and swell'd: and tho' possibly, both Testicles may be swell'd in this Disease, yet the Affect seldom seizes more than one Stone; which is for the most part the left, but sometimes the right only.

LXXVII. And if no stop be put to the Disease, the Cods grow to an incredible bigness. I once saw a Hernia Seminalis, which was bigger than any Ostriches Egg, as big as little Child's Head; which being opened by Incision, it discharged nearly a quart of Seed, or some other thin Hu∣mor, not much unlike whites of Eggs.

LXXVIII. The Prognosticks. It is of difficult cure, unless recent: but if inveterate, and the Tumor is very great, it is cured with much trouble and pains, and seldom without Section.

LXXIX. Where the Disease has been of long standing, tho' the

Patient meets with a Cure, yet it leaves the Part so weak, that it is apt to return again; unless great care is taken in pre∣venting it.

LXXX. The Cure. If it is from the Vas deferens falling down twisted into the Cod: let the Patient lye backwards, and with your Hands you will easily re∣duce it, without any farther inconvenience in it.

LXXXI. The Method of Curing hath nothing peculiar in it self; but you must contrive such Bands, as may keep reduced the faln down Parts, in their right places, without hurting the sound ones.

LXXXII. But in this, as in an Enterocele, Rest, keeping Bed for some time, and a strait Bag-truss, are of essential moment.

LXXXIII. If it is in the latter case, whilst it is recent, if the Man be unmarried, Mar∣riage ought to be proposed; because that effectually takes away the Conjoined Cause.

LXXXIV. Then due Purging, both upwards and downwards; and to be reiterated every day, or every other day many times, according to the strength of the Patient, 'till there is an apparent diminution of the Tumor.

LXXXV. You may Vomit with Vinum benedictum, or Tartar emetick; but nothing is equal in this case to Turpethum mine∣rale, which is to be often repeated: afterwards, or between whiles, let the Patient purge with Catharticks, which evacuate the Pituitous Humor.

LXXXVI. And outwardly, Dis∣cussives and Resolutives are to be applied: but this only while the Disease is recent, and the Tu∣mor small, together with rest and ease, and a strait Bag-truss.

LXXXVII. But if the Tumor is grown so great, as that none of the other things will have any effect, there will be then a necessity of doing the Work by Section; thereby to discharge the Part of the abounding Humor, as in the Case before mentioned we have declared: afterwards the afore∣going Methods must be pursued, and the Wound healed up, as before declared.

LXXXVIII. But it ought not to 〈◊〉〈◊〉 perfectly healed up, but a 〈◊〉〈◊〉 is to be left in the bottom of•• the Scrotum; which is to be k•…•…pt open either with a Can∣nula, or a Tent, for some consi∣derable time; 'till the ultimate of the Matter is drawn forth, and the Testicle, and whole Part, seem to be restored to their due form and strength: other∣wise a Relapse is to be feared, and then the work will be to be done over again.

VI. Hernia Carnosa.

LXXXIX. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Sarcocele, Ramex carnosus, Hernia car∣nosa; and in English, A Fleshy Rupture of the Cods.

XC. Definition. It is a Sar∣coma, or lump of Flesh growing to, or round about the Testicle; which in outward appearance is hard, and many times of a Scirrhous nature or disposition.

XCI. The Causes. It is caused from a Rupture of some of the Capillary Vessels of the Part, by which Blood flows more than ordi∣narily to the Testicles and Cods; which not being protruded in to the Capillary Mouths of the Veins, is by the Plastick-power converted into the substance of the Flesh.

XCII. The Signs. Tho' it is possible to affect both Testicles, yet it commonly seizes but one, and that, Authors will have to be the right; because Nature does more easily cast out the Blood to it, by the Seminal Vein, springing from the Vena Cava.

XCIII. It grows by little and little, the Testicle growing every where greater; and is known by a hard Swelling, which may be felt with the Fingers; sometimes with a little pain, but many times without any pain at all, espe∣cially if it is Scirrhous.

XCIV. It is distinguished from a Rupture of the Peritonaeum, or Guts; because in this, there is no swelling in the Groin, as there is always in that.

XCV. The Prognosticks. It is of difficult cure, tho' it be recent; but uncurable, if inveterate; unless it be done by Section.

XCVI. If it has been indeed of long continuance, and grown very great; it is apt to degenerate into a Scirrhus, or Cancer; ac∣cording to the habit of the Body, and disposition of the Humor abounding.

XCVII. The Differences. It is twofold: 1. One, in which the Sarcoma, or fleshy substance sticks close to the Testicle, and cannot be separated, without taking away Testicle and all. 2. Another, in which the Sarcoma compleatly involves the Testicles; but is round about loose from it, so that it may be separated and cut off, without any hurt to the Stone it self.

XCVIII. The Cure. While it is recent and very young, the Patient is to Purge often, and also Vomit; which is more espe∣cially performed by Turpethum minerale, which is indeed ac∣counted as a Specifick in this case: afterwards, pouder of Restharrow-roots, and Opiates are to be given every night.

XCIX. And outwardly, things repercussive and drying are to be applied; or Empl. de Ranis, with a fourfold quantity of Mer∣cury, or our Empl. Mercuriale.

C. Anointing with Mercurial Ointments also is good, over which you may apply Ceratum de Galbano, Ceratum nigrum, Ceratum de Spermate Ceti, or Ceratum ad Tophos, which ex∣ceeds them all.

CI. And besides these, the Emplastrum Mercuriale before mentioned, Our Empl. ad Stru∣mam, and Empl. Arthriticum, we commend upon our own experience; also Our Diachylon with Gums, where it is but just begun.

CII. Add to all these things, a Bag-truss, which may tye up the Testicle very straight; rest also, and lying in bed for 6 or 7 Weeks, without which, nothing at all will be done.

CIII. But when it is manifest,

that no Physical means, whether internal or external will do, you must then positively attempt the Cure by Manual Operation: and in doing this, you must consider whether the Sarcoma is fixed to the Testicle, or hangs loose from it.

CIV. If the fleshy substance is fixed fast to the Testicle, so as it cannot be separated, 'tis certain, that if you design a Cure, you must come forthwith to Castration; (those other courses with Esca∣roticks, being both painful, troublesom, and dangerous) the Method of which we have plainly taught in the third Edition of Our Synopsis Medi∣cinae, lib. 5. cap. 17. sect. 18, 19, 20.

CV. But if the Sarcoma be free from the Testicle, and the Testicle hangs loose in it, (as for the most part it does) then having opened the Testicle longways, you must gently draw forth the Sar∣coma, with the Stone it self: and with a very sharp Knife you must carefully make inci∣sion through the fleshy sub∣stance; but with this caution, that you do not in the least touch the Testicle it self.

CVI. This done, with your Fingers turn out the Testicle; and cut the Sarcoma, slitting it upwards, (on the same side you made the Incision) as high as you can: then holding the Testicle upwards, (which is to be done by an Assistant) let the Artist take all the Sarcoma into his left Hand underneath, and draw it forth as far as he can conve∣niently; and he will find the whole substance to hang upon a kind of Membrane, from which he may separate the Sarcoma, by an Incision-knife in his right Hand, at one single cut: then replacing the Testicle, he may heal it up as an ordinary Wound.

CVII. A Cure of this kind was done upon a Patient of mine, about three or four years since: it was a Frenchman who did the Ope∣ration; and tho' the Patient de∣spaired of his Life, the French Chirurgeon did it with such an assurance, that in about three minutes of time the Section was compleated, and not with the loss of two ounces of Blood, nor did the Man himself at all cry out: after which, the Wound was healed in about a weeks time, and the Patient restored to his perfect health. Where note, the Sarcoma here cut out, weighed four pounds and a half, good weight.

VII. Hernia Ʋmbilicalis.

CVIII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Om∣phalocele, & Hernia Umbilica∣lis; in English, A Rupture of the Navel.

CIX. It is a breach of the Peritonaeum by the Navel, by which the Intestines or Omentum, are thrust forth.

CX. The Cause. The Proca∣tartick Cause is external violence, falls, blows, coughing, crying, great straining at stool, vomiting, or otherwise, &c. The Antece∣dent Cause, is a weakness of that part of the Membrane.

And the Conjoined Cause, is the Rupture or Breach it self.

CXI. The Kinds. It is two∣fold: 1. That in which the Intestines themselves strut forth. 2. That in which the Omentum or Caul is protruded.

CXII. The Signs. It is known by the diversity of the Matter therein: if the Intestine come forth, the Tumor is soft, une∣qual, and is put back into the capacity of the Abdomen, with some noise or rumbling.

CXIII. But if it is the Omen∣tum faln into it, the Tumor is soft, and of the same colour with the rest of the Skin.

CXIV. The Prognosticks. If it is recent, and in growing People, it is more easily cured: but if it is in elder people, and inve∣terate, it is either incurable, or with much difficulty.

CXV. If it is only distended, not broken, the Cure is the more easy: but if it is broken, and the Rupture large, it will be the more hard to heal.

CXVI. The Cure. Let the Patient abstain from all violent Exercises; rest, and for some time lye in bed; as also forbear all flatulent Meats and Drinks, or Fruits which engender Wind.

CXVII. Then the Sick being laid upon their Back, make a reduction of the Protrusion; and apply over it Emplast. ad Her∣niam, Catagmaticum, or some other glutinative or astringent Medicine, with a good Truss, Bolsters, and Bandage.

CXVIII. If these things do 〈◊〉〈◊〉, but the Sick seems to be uncurable, unless it be done by Manual Operation; we will here shew you the Method of doing it, according to Celsus; by Chirurgery, or Manual Ope∣ration.

CXIX. Lay the Patient upon his Back, that the Intestine, or Omentum protruded, may be put back again: then take hold of the Navel with a pair of Pincers, and draw it forwards; then pass quite through it at the Basis a Needle with two single Silk-Threds uncoloured; after which cut off the Thred by the Needles-eye, and tying the ends together, bind the root of the Navel lifted up, or pulled forwards, very strongly; that the part of it above the Ligature may dye, and fall away.

CXX. But Fabricius ab Aqua∣pendente, likes not so well of the former unpleasing Opera∣tion; and proposes therefore to do it rather with a Truss, which he hath often proved; applying a Glutinative Emplaster, or binding Cerate spread upon Leather. This Truss was made of double Di∣mity, or Linnen-cloth: on the part of which that covers the Navel, was a caveous Plate made like to a round Cake; in the center of which was a little round knob of Lint, which goes into the breach or dilatation of the Navel; to hinder the protruding Matter from coming forth again; upon which knob of Lint was placed the aforementioned Cerate: the Truss was then applied, and the Abdomen bound strait e∣nough: from the Truss, went

Bands to pass over the Shoul∣ders, to hinder it from falling down; and Straps on the lower part of it, to go underneath the Cods, to keep it from rising up.

CXXI. An Observation. One thirty years old, and of a fat gross Body, had a Hernia Um∣bilicalis, the bigness or breadth of the palm of a Hand: he had worn the common Navel-trusses, which sat not steady, but pinched him there, nor kept up the Rupture; his Belly being very great, and likely to suffer a greater Rupture, if the weight of it was not timely born up. He had a Bracer made, to lace in his whole Belly; under which a Bolster might be placed on the Navel; it reached from the Pubes to the Cartilago ensiformis, and laced behind: under this Empl. ad Herniam was put, with a quilted Bolster, wrought upon Sole-leather, which was tackt to the Bracer. Wiseman.

CXXII. One of a full Body who had a Hernia Umbilicalis, thro' a defect in Bandage had it much increased, with excoriation of the Skin; the Rupture in the Perito∣naeum was great, and the Omen∣tum and Guts had made their way to the external Skin of the Abdo∣men, which was worn very thin. The Excoriation was drest with Ʋng. Tutiae, &c. and a soft Compress applied between the Quilt and Emplaster; and a Belly-piece was made, to bear the weight, and retain the com∣pression. Afterwards a Bracer was made with a Bolster, to sit under the Belly-piece, which retained the Rupture; and the Paient went daily abroad. Wise∣man. See more of this matter, in Lib. 1. cap. 8. sect. 35, ad 39. aforegoing, of this Work.