must then beginne from belovv the legge or Arme vpvvardes vvhich is the most farthest from the originall of the Vaynes and supernallye end the same to vvitt about the Harte the Liver vvhich are the originalls of all Vaynes Arteryes heerby to repell the humors vvhich are in that parte to praevent that there concurre noe more vnto that place As farre forth therfore as if that parte be rugged and vnsmoothe as is that Legge vvhich is farre more thicker in the Calfe therof then in the lovvermost partes therof vve must thē frō palme to Palmebreadthe a little more thē half throughe cutt the same and fovvlde both sydes cōtradictorilye the one to the other soe looslye sovve the same by vvhich meanes the sayed Ligament is made to be recurvated and croockedlye vvounde like a Bovve Having therfore stifflye rovvled op this foresayed ligature or rovvler An attractive Ligature vve may thervvith as smoothlye vvind involve a Legge vvithout makinge therin anye inaeqvalitye or furrovves causing that syde vvhich vvas cut of thē agayn sovved aeqvallye to agree vvith the thīnest parte the vvhol parte vvhich is the longest to agree vvith the greatest parte Above these tvvo foresayed Kindes differēces of Ligamentes vve may as yet adde thervnto a thirde Kinde The vvhich vve call an attractive Ligamēt vvhich vve may vse vvhen vve desire to retracte anye bloode nourishment or anye other vitall Spirites into that parte the vvhich the parte of it selfe can not dravve attracte vnto it because her attractive forces are debilitated very much feebled The secōde kinde of Ligament above rehearsed VVe vvill somvvhat alsoe speake of that ligament vvhich of it selfe is for noe vse profitable but accidentallye cureth throughe his continuāce of the remedyes vvhich are applyed vnto the dissease vvherfore vve may call it the retentive Ligament vvherin vve must consider thre especiall thinges First in vvhat disseases it is commodious Secondly on hovve manye fashones it may be composed made Thirdly Ligamēt for the dissease lastelye hovve vve ought to vse the same Touchinge the first vve ether vse the same consideringe the parte or the Dissease vvhich can tollerate noe other Consideringe the Dissease as anye vvounde or vlceratione accompanied associated vvith anye great payne or inflammatione or vvhen vve disire an Apostematione to be matured Consideringe the parte as vvhen a vvounde is in the Heade in the Necke in the Bellye or in the Testicles vvhich partes cā not indur to be stiffly tyed or bovvnd therfore neede noe ligatione but only to retayne the remedyes therone because that the other stiffe ligatures bringe vvith them great discommoditye Concerninge the seconde poyncte Ligamēt for the parte The retentive Ligamēt must have tvvo three or four endes accordinge to the forme situatione of the parte vvhich vve vvoulde dresse Touching the thirde poyncte that must be begunne in the dissease ended on the other syde of the same ⧠Of the Rules generall Instructions wheron we must consider in all Rowles Ligatures Chap. 3. THerfore convenientlye Tvvo thinges to be considered vvhen as decentlye vve desire to vvinde anye parte decentlye to vvinde or involve anye parte or mēbre vve must note cōsider on tvvo especiall thinges vvherof the first is the vvounded parte vvhich vve vvill vvinde the seconde is the aegritude or dissease Touching therfore the disseased parte vve take this for a generall Rule that shee must be tyed that in such a forme figure as vve vvil have her to cōtinue lye For if soe be vve vvind a foulded curvated parte vvhich therafter must be situated right and extented ther vvill as then conseqventlye insue such or the like Accidentes to vvitt that the Ligature vvill dissolve loosen that ther vvilbe caused great payn doloure in the parte because the Muscles Vaynes Arteryes Synnues the verye bones alsoe have an other situatione beinge erected extended then vvhen as they are recurved and croocked As in exāple If soe be a broken Legge Example being recurved soe on that manner be circumligated vvounde vvhich ought othervvyse to be tyed beinge stretched extended right forthe vvithout doubte all the Ligature vvill goe loose vvhen as vve desire to extende the same out of the vvhich vvill follovve great payn because the brockē Bones Vaynes Arteryes Synnues Muscles doe not as thē keepe the same place as they have done the parte beinge bovvnde tyed Contrarilye vve desiringe to dresse a fracture in an Arme he must then be shutt foulded together for if soe be vve dresse him beinge extended vvhē as therafter he shal be recurved bended then the Bones in therre lyinge vvith the other partes be turned into some other fashone vvherthroughe the Ligature vvil in one place be loosened in another spāned vvhich also suscitateth payne in that parte For it must necessarilye follovve that vvhen as a tyed parte be chaunged and then ether shutt bended or extended thē there are some of the Muscles extended crushed as in the rotunditye in the abbreviatione others vveackened vnited And vvhē they are exrected they must needes then be crushed throughe the Ligature out of the vvhich must necessarily follovve intollerable payne because of the Compresse vvhich in ferreth vvith it in that parte great fluxiones other accidentes mischaunces The dissease Novv for as much as cōcerneth the dissease vve must circumligate involve an Arme or a broken Legge vvith a vvounde on an other manner and fashon then a Fracture vvith out vvoūde on an other fashon a Legge vvhich hath but a simple Vlceratione then a Legge vvhich hath a concavouse or Fistulouse vlceratione And a Ioyncte vvhich is full of payne must one an other manner be tyed then that vvherin is noe payne Decētlye to vvind Therfore cōvenientlye decentlye to ligate or vvinde the Ligature must be right closely rovvled vp because vve may houlde him the faster stedyer in the hāde vvithout stirring or glidinge this vvay or that vvaye as he might chaunce to doe the same not being stiffly rovvled vp because that throughe his hardenes he may the better be handled conduced so that all ligationes farre cōvenienter more decēt to more contentment of the Patient and the circumstantes or standers by may be effected then other vvyse vvhē as the Ligature is layed dubble croocked curved vneven ⧠Howe we ought to tye the Ligament agayne make loose the same Chap. 4. Wherone vve ought to consider in the fasteninge of the ligature THe Chyrurgiane must cōsider note that ther be no seames knottes or anye vnevennes in the Ligament vvhich might chaūce to crushe the vvound and the Ligatione alsoe being finished consideringe that the end of the Ligature be not fastened one the vvounde nether one anye place vvher ther is any payne for vnles vvith
vvorriours amongst the Svvitsers Countryemen Englishemen farther amongst all sortes and Kindes of vvarriours it is soe commō that it seemeth this dissease as soon as they are gone out of their houses that there nothinge els follovveth them thē the shaddovv of their body vvherthrough in all leagers throughe this dessease at sometimes ther are more poeple deprived of their lives then throughe all the inqvietude through all povertye throughe the Plague yea more alsoe then of the enimye are Killede And touchinge my opinione heerein I take this sickenes to be a pestilentialle spirit and a certayne essence of the Plague Soe that necessarilye ther vnder must be occulted hidden a secreate ineffable venoume or poyson vvhich through defilinge and infectione spreadeth it selfe from the one bodye into the other Because the intestines or entralles of a sovvnde and vvelfaring man throughe some inclinatione or Sympathye are made partakers of such venoumouse vapours of him vvhose guttes are polluted vvith this dissease and by that meanes also are imparted vvith the bloodyeflixe As in the cōsumptione vve may see vvhich proceedeth out of some vlceratione of the Lunges and also in the Ophthalmye of the Eyes the same to be as infectiouse that the on body may obtayne the same of an other VVhich commeth to passe Reason of Aristotle as Aristotle sayeth because that the Lunges the Eyes are continuallye contayned in a perpetualle motion vvherthrough the venoumousnes is the easyer imparted to an other body Health beinge as it vveare a continuall rest and an assured estate And as the entralles have also their perpetualle motione the vvhich in Greeke vve call Peristaltica in like sorte alsoe may they imparte theire dissease vnto other entralles as the eyes vnto the eyes and the Lunges doe vnto the lunges Of the Causes Signes Accidentes prognosticationes and remedyes I vvill somvvhat discourse consideringe more the necessitye therof therby to instructe the yonge Chyrvrgian thē because of any pleasure vvhich I take therin or anye ostentatione The Dysenteria or bloodyeflixe Discription of the Bloodyeflixe is a sangvinolent excrement of the Bellye vvith greate doloure and as it vveare scissure vvhich the Latinistes call Tormina And this dissease may be taken properlye or improperlye The improper Dysenteria or Bloodyeflixe Dysenteria Improperlye taken is a fluxione of bloode vvith out any greate paynes or travayle vvherof ther are tvvo sortes or Kindes ether vvhen vve avoyde pure cleane blood vvhich vve call Sangvinolenta Cruenta or els vvhen vve avoyde vncleane bloode and impure The pure cleare bloode issveth forth of the Mesenterium vvheare a longe time it hath lyen occulted cōgregated as it oftentimes chaunced in those vvhich are grosse of Belly And sometimes alsoe it procedeth out of the Liver of the Milte of the Hemorrhodes and sometimes also out of some great vaynes and out of other partes yea and also out of the vvhole habitude of the bodye All vvhich differēces must throughe their ovvne signes be knovvne because the resanatione of the same may be the surer As for example it happeneth commonlye Those vvhich are deprived of anye Ioyncte are very subiecte vnto the Bloody-flixe throughe anye greate superfluitye of bleeding in those vvhich have lost an Arme or a legge that on certayne times they have the bloodyeflixe In vvhich kinde of Mysenteria vve neede not much to feare nether neede vve to vse those remedyes heervnder discribed But must restraygne such Patientes from great comestiones and superfluouse drinckinge of VVyne and cause him to be vvell phlebotomised vvherof vve in this place endevoure to advertice and instructe the yonge Chyrurgiane because that vvithout making any great delaye he might be adiuvable helpefull to the patient vvith these remedyes vvhich consequently follovve the vvhich in passinge by it seemed convenient vnto me to rehearse Because it is not my intent in this place onlye to speake of the improper Dysenteria curatione therof but of the true proper bloodyeflixe or Dysenteria vvhich in all Leagers is common familiare and infectiouse The impure Bloodyeflixe is the truest assuredst and is assimilated vnto vvater vvherin nue slaughtered fleshe hath binn vvashed the vvaterye Bloodyeflixe Fluxus Hepaticus is called Fluxus Hepaticus the Liver laske vvhich is caused throughe the imbicillitye of the retentive forces of the liver through the vvhich the vitall spirites the naturalle calliditye doe exhalate the personne is vvholye bereft of all his forces therthroughe also the stomacke is feebled that it can not any more compraehend any meate or drincke to feede one nether digest the same soe that by this meanes the vvhole bodye consumeth and vvithereth The black heavye thick bloodyeflixe proceedeth especially out of the Milte vvhich is as it vveare a Poole or receptacte of al melancholicke thicke and blackebloode Dysenteria properlye taken But that vvhich properly or vprightly is called Dysenteria or Bloodyeflixe that is a commō vlceration of the entralles out of vvhich first of all the viscositye of the same is driven expelled out then the Axvngiousenes therofe vvith a little redde blood intermingled Thirdly the internalle membrane of the intestines of the vvhich the pellicles and the little fibres are in the stooles seen thervnder to be mixed finallye the vlcerrtiō as yet proceeding more more grovving vvorse as thē consequently follovveth the carnositye the verye substance of the corroded corrupted guttes all vvhich kīdes are accōpanied associated vvith those cōmon accidentes to vvitt vvith bitinge or mordicante payn vvith continuall punctiōs vvith continualle concupiscence of goinge to stoole vvith intollerabilitye vvith a continuall cōmotiō VVhich foresayed Dysenteria or Bloodyeflixe ether happeneth to the small entralles or to the great intestines the vvhich vve first espye out of the situatione of the payne out of the diversitye and mixture of the matter VVhen as therfore the vpright Bloodyeflixe is in the smalle guttes Signes vvhē the small guttes ate hurte as then vve see blood certayne membranouse pellicles intermixed vvith the excrementes ther is also great payn above on the Navle the time betvvixte the payn the deiection is slovve and ther associateth it most commonlye a vomitinge and a greate oppressione of the harte and the Hick coughe in the entrance of the stomacke through community vvhich the forsayed entralles have thervvith For as Galen sayeth the Harmony coniunctione vvhich the partes of the bodye have the one vvith the other is vvonderfull to be admired because as soone as the actione of one parte is hindered or suffereth any thinge al the other partes of the body doe thervvithe cōspire and sympathise If soe be the sayed vlceratiō be in the greate guttes or entralles Signes of the great intestines ther as thē driveth one the deiectiones or excrementes certayne droppes of bloode and some little parcels of fleshe and the dolour of
exceedinge daungerous for there ensuethe out of hāde some greate inflammatione there vnto consequētlye thereafter a Gangraena or mortificatione he that happeneth to receave a vvounde in the foremoste parte of his arme is alsoe subiecte vnto the same daunger of inflammatione and mortificatione and causeth great payne trouble because that those vvoundes most commonlye are praesente deathe What vve ought to iudge out of the accidents of vvoūdes Novv as much as belongeth vnto the judgemente opinione vvhich is to be considered noted out of the accidentes of all vvoūdes Hippocrates teaceth vs in so much as in the greate badde vvoundes as are the vvoundes of the Sinues of the Tēdones of the Ioynctes of the bones little or noe svvellinge or inflammatione at all apperareth illustratethe it selfe it is a verye evell and badde signe for vvhye it signifyethe vnto vs that those humors vvhich consideringe the payne shoulde have assembled packed thēselves that vvaye have circumcinglede themselves rovvnde aboute the vvoūded parte have retracted thēselves into some principalle especiall parte of the bodye Accidētes of a de parted svvellinge Those vvoundes in the vvhich there appearethe anye svvellinge or tumefactione verye selden or never fall into any Phrensye or into cōvulsione of Sinnues because that the venomous humors vvhich might ascende dravve tovvarde the Braynes or into the sinuishe partes of the boddye have congregate and gatherede thēselves together aboute the vvounde but if that one the suddayne the svvellinge vvithout anye evidente reason as in example in the applyinge of anye remedyes throughe purgations or throughe phlebotomisinge or bloode lettinge came to departe vvith dravve it selfe into some other place and that in such as are vvounded behinde in there backe bone that persone is troubled vvith convulsione of synnues through the vvith dravvinge of the matter into the sinnuishe partes of the backebone and the vvounde beinge in the foremost partes of the bodye and the matter of the svvellinge ascēdinge vpvvardes throughe the greate vaynes tovvarde the Braynes the patient strayghtvvay fallethe into a madnesse Phrenesye or if soe be that the matter dravve tovvarde the breste then ther ensue greate intollerable stitches or Apostemations because that those badde humors can not by anye meanes possible be consumed or vvastede but descende sincke dovvne into the cōcavitye of the breste And if that the svvellinge novv departinge be of a verye highe redde colloured that thervvas store of bloode therin vvhich is descended suncke dovvne tovvarde the guttes then it necessarylye cōsequentlye fellovveth that the patiente falleth into the Blodye flyxe or Dysenterye As farre forthe therfore as there procedethe anye convulsione of synnues out of a vvounde The convulsione in vvoundes is verye daungerous especiallye from anye greate inflammatione that is a signe of deathe for therbye vve may playnlye note marke that the synnuishe partes of the bodye must needes be hurte and that the Braynes are in some or other passione If that into anye vvoūdes vvhich have fiercelye bledde anye Spasmus happen that is a bad signe All thrustes of the sinnues and Tendones Thrustes in the synnues are very daūgerous are verye daungerous and especiallye vvhen as the skinne and the fleshe chaunce to shutt together for therin engenderethe a sharpe corrodinge matter vvhich resuscitatethe and causethe greate intollerable payne because she can not by anye meannes get issue out of the vvhich procedethe follovvethe convulsione of synnues inflammatione and a Gangraene or mortificatione The Organicke partes vvhich are vvholye cut of can noe more be restored agayn In soo much as anye especiall and principalle or Organicke parte or anye instrumentalle parte totallye vvholye is hevved of and sequestred and separatede from the bodye it can not by anye meanes be restored and cured because that the blode and the vitalle Spirites are vvholye exhalated throughe the greate vaynes vvhich are cleane a sunder and that by the vvhich the cure must be done and the foregoinge health agayne restorede The temperature of the boddye the time of the yeare the age the handlinge and trafique and the manner of the patients livinge the knovvledge of the cōtrye are a greate helpe ayde for the prognosticatione of vvoundes a childe or a yongemā vvhich as yet is in-his grovvth vvil better and vvith more ease be healed or curede then an aged personne and a stronge mā a greate deale sooner then a feeble and debile person A leane and sclender persone vvilbe curedevvith more facilitye then a thicke and grosse lived man And a sounde bodye farre sooner then a sicke and corrupte bodye That man vvhich laboureth easier then a stillsittinge and idle persone A soberman farre sooner then a bancketter and one that haunte the hoores The most conveniente time of the yeare to cure heale a vvoūde is in the fore summere or Vernall time of the yeare or at the least in such a time in the vvhich it is nether to hotte nor to coulde because that extreame heate or extreame coulde are the enymyes of all vvoundes and especiallye the changinge of heate of coulde vvherfore alsoe the fore vvinter or Autūnus is verye vnprofitable for the same In some regions and countryes Other cōsideratiōs to be his in prognosticatinge the vvoundes are ether easyer or difficulter to becurede for at Rome the vvoundes of the heade are difficulter to be curede then the vvoundes of the Legges the vvhich notvvithstandinge at Avignon vve finde cleane contarye As farre as the vvounded person keepe and continue his perfecte Sence and memorye nether gettethe anye agues vve may then assure our selves that the vvounde vvil quicklye and easylye be curede VVe ought not thetfore to discourage the patiente althoughe he have an ague by the greate vvoūde as longe as the inflammatione is yet before hande and as longe as there engenderethe anye matter But an ague is verye daungerous Signes to the contrarye vvhē she issuethe from a small vvounde and especiallye vvhen she hath longe continuance after the inflammatione and supuratione or vvhen she incitateth the patient vnto Phrenesye VVhen the patient parbrakethe against his vvil greene galle or immediatlye vvhen he hath receaved the blovve or at the time vvhile the inflammatione is as yet duringe that is alsoe a badde signe especiallye in these vvhich are vvounded in a synnue or in annye sinnuishe place But the parbrakinge or vomitinge vvhich commeth by the frevvil of the patiente is nothinge suspicious especiallye in those vvhich are vsed to vomitinge if that a man praesentlye after meales or after that the inflammatione is come or the vvounde being in the heade Consideration for the vvonds of the heade doe not come to vomite The Chyrurgiane must vse greate foresight in givinge iudgemēt of the vvoundes of the Heade for the aunciente Chyrurgians have alvvayes esteemed thē doubtfulle suspect because of
last issueth out of the mouth of the vvounde greate quantitye of filthye matter The signes of a vvounded Liver are these The Liver beinge hurt naÌ„lye that out of there right syde they avoyde a greate quaÌ„titye of bloode Both sydes of the bodye are as it vveare plucked tovvarde the backe bone The patieÌ„t is verye pale in his face as if he vveare halfe deade His eyes are fallen invvardes and hath intollerable payne beinge ignorant throughe his impatientie vvhat he shal doe he ist best at ease vvhen he lye th one his bellye he hath a verye prickinge stinginge payne vvhich dravveth tovvarde his breste and also toevvarde the sydes of the same Heavinge and contractinge his shoulders togeather must he breathe and somtimes throughe parbrakinge he avoydethe choller Hath a verye violent fervent pulse he is easylye inceÌ„sed to ire sorrovve somtimes he hath an ashe coloured face his vrine alsoe soÌ„tymes verye bloodye his stoels like matter and dye most coÌ„monlye vvith the Hickcoughe VVheÌ„ the kidnyes are hurte then desceÌ„deth as it vveare by degrees coÌ„methe the payne into the flanckes Of the vvounds of the kidnies and soe forvvarde vnto the testicles the patient can verye difficultlye be released of his vrine he pisseth bloode or at the least his vvater is bloodye Somtimes his vrine is quite retaynede by the vvhich occasione the patieÌ„te beinge extreamlye svvollene dieth The milte beinge hurte If the Milte be hurte or vvounded then the bloode issueth out of the left syde of the pacieÌ„te is blak of coloure The same syde alsoe the stomacke beginne to be indurated harde the patieÌ„t vvaxeth thirstye the payne retracteth it selfe tovvardes the breste as in the vvoundes of the Liver The vvoÌ„be beinge hurte Novv the VVombe beinge hurte the vvomaÌ„ hathe greate payne in her flanckes in her Haunches in her hippes she avoydeth bloode partlye throughe the vvounde and partlye throughe her privityes after the vvhich somtimes follovveth a parbrakinge of Cholera Others caÌ„ not speake some lye out of memorye others vvhich doe not rage say that they are troubled vvith greate payne in there sinnues in ther Eyes vvhen they dravve tovvarde deathe they are troubled vvith the same accideÌ„tes vvhich vve have recited of the Harte The Middle reefe VVhen the middle reefe or Diaphragma is vvouÌ„ded theÌ„ are the sydes of the patieÌ„t dravvne shruncke vpvvardes they have exceedinge greate violent payne internallye in the backe bone they have verye retardate breathe and there issueth out of the vvounde frothye bloode The entrance of the stomacke The entrance of the stomacke beinge hurte the patiente beginnethe to have the hick vp avoydeth choller vvhen as he eateth or drincketh he casteth it strayghte vvay froÌ„ him agayne he hath a smalle feeble obscure pulse he getteth a little coulde svveate vvith a coolinge of all externalle partes The stomake the gutts The stomacke that gutte Ieiunum have hoth of them one manner of token because that there meate drincke issueth out of the mouth of the vvounde somtimes beinge halfe digested and altered in Chylum they feele a payne as if a man vvoulde rente teare there Harte out of there bodyes they gett hardnesse in ther sydes soÌ„times alsoe parbraketh the patient Cholera vpvvards throughe the mouth his spittle is bloodye betveen these tvvo is noe other difference then that the gutt IeiunuÌ„ hath his place situatione somvvhat lovver then the stomacke The bladder beiÌ„ge hurte vve feele payne Hurtes of the bladder in the flanckes that parte of his bellye a little aboue his privityes extendethe stretchete it selfe in steade of vrine the patieÌ„t pisseth bloode or else the vrine issueth forthe of the vvouÌ„de the entrance of the stomacke is perturbed out of ordre vvherfore the vvounded vomite Cholera or at the least are afflicted vvith the hick cough they beginne to vvax coulde in handes feete and consequentlye ensueth death ⧠Instructione how to give a certayne reporte of all woundes whatsoever before the magistrates Cap. 4. ALl such vvhich before anye magistrates Codsideratione to be had before the giuinge of reporte of anye vvouÌ„ded or sicke personne vvil are disposed to give reporte instructione shallby noe meanes intrude themselfves before that of the magistraete they shal be requested therto sent for seinge that most commonlye proferede vvitnesse is repraeheÌ„dable he that taketh such a thinge in hande ought first of all to visite and see the patient because he might ripelye and dilligeÌ„tlye consider of al thinges namelye especiallye one the greatnes of the dissease one the situatione place of the same not onlye as theÌ„ may give good instruâ—one but alsoe one all occasioÌ„s on the praedictione fore sayinge of the vvoundes vvithout havinge vnadvisedlye therin hasted him selfe for it is a harde and difficulte matter to give a perfecte coÌ„plet iudgement of the end of all vvouÌ„des or other sicke persoÌ„nes because of the accidentes vvhich might chaunce thervnto for those vvouÌ„des vvhich vve doe not esteeme of soÌ„times are occasione of death coÌ„trarylye those of the vvhich vve expected nothinge but death are yet notvvithstandinge cured VVe knovve that some ther are cured healed notvvithstandinge althoughe they vveare vvounded in the Membrane or pellicle of the Braynes yea some vvhich vveare hevvede in the substaÌ„ce of there Braynes as I alsoe remember some to have bin cured vvhich vveare hurte in the luges in the Middlereefe in the Liver in the smalle guttes or eÌ„tralles the Bladder the Kidnyes or in the Matrix or vvombe Althoughe vve accordinge to the iudgemeÌ„t reason of the aunciente professors esteeme such vvoundes to be deadlye incurable Contrarylye vve se some meÌ„ men dye of smalle and vndiepe vvoundes vve must therfore in such thinges make a distinction amonge the vvounded for some ther are vvhich are of soo goode a temperature and state of bodye that of a greate and large vvounde vvhich in anye other mans bodye vvear praesent dea the they are cured contralye there are others vvhich beinge vvounded in anye externalle partes vvhich are nothinge noceÌ„te or dauÌ„gerous to the lyfe of the patient vvithout anye penetratione of the vvhich notvvithstandinge they chaunce to dye ether of the badde coÌ„stellatione or constitutione of the time or by the refluxione of anye badd humors vnto the vvounded parte Some meÌ„ dye of a small vvound Althoughe therfore that some vvoundes are curable and alsoe of a good constitutioÌ„ dispositione vvithout anye badde or coÌ„trarye signe therin to be marked but for all that vve may not give anye absolute iudgement or reporte of the same but muste onlye say that the vvounde is curable soe farre forth as there be nothinge praetermittede vvhich consisteth and belongeth as vvell in the patient as vnto the Chyrurgiane vvhich hathe him inhandes it belongeth alsoe vnto the circuÌ„stantes and vnto other externall
Dura mater Vaynes vvhich burst vvithin the braynes as vvell of those vvhich passe throughe the sutures as througe anye of the other smalle holes internallye are situated vvith in the braynes might come to breake out of the vvhich ther vvill issue bloode vvhich therafter cōgealeth and vvith great payne changeth in to matter vvith manye other fearfull accidents In this dissease theris all vvayes payne about that vayne vvhich is burst and if soe be vve chaunce to open in this place the skinne the bone there vnder hath a pale and deade Coloure but it is a difficult matter to iudge and knovve it vvherfore consideringe often times of the impossibilitye to doe anye remedye or cure therine by vvant of knovvledge death suddaynlye ensueth theron The vvhich Hippocrates reciteth of the daughter of Nerius A historye must of the daughter of Nerius described through Hippocrates vvhich vvas but 20. yeares oulde vvho in playinge beinge smitten on the bone Bregma vvith an outstreched arme of one of her playfellovves strayghtvvayes vvithout anye respiringe is fallen into a Vertiginem vvho as soone as she vvas brought into the house is fallen into a violent ague vvith payne in the heade and rednes of face one the seaventh day she voyded a goblet fulle of reddishe matter filthylye stinckinge out of her right eare by the vvhich she seemed to be somevvhat lighted and easyed but vvhen the ague agayne returned vnto her she vvas then vvholye abashed and allmost lay vvithout anye reason or vnderstandinge vvith Spasmo in her right cheeke or syde of the face vvithout beinge able to speake vvherone the foresayed Spasmus hath possessed the vvhole bodye vvith shakinge qviveringe vvith the tonge tiede and vvith irremoveable eyes and dyed on the ninthe daye ⧠What Fractures of the heade we ought to trepane and wherfore we must trepane them Chap. 3. We ought not at all times to trepane ALthoughe that in all fractures and fissures of the sculle the yōghe Chyrurgians take ther light or refuge strayght vnto trepaninge it is notvvithstādinge better that in the firste vve trye vvith playsters and vvith manye other remedyes and inventions therto constituted and ordayned consideringe one the consequence and importāce of the foresayed Fracture vvhether it be needfull or necessarye to take avvay anye parcell or peece of bone consideringe the excellentie and vvorthines of the braynes vvhich are such vvorthye partes vvherfore vve must vviselye and dilligentlye consider and marke vvhether the vvounde give a goode digestione forth of her and purifieth her selfe and vvhether there beginne in the vvounde to grovve anye redde pomgronate Kernell vvise fleshe or vvhether the ague vvhich consideringe the suppuratione in the vvounde be abated or asvvaged or hath left him vvhich soe in tollerablye vexed and tormented him vvhether his apetite be agayne restorede and vvhether the patient reasonablye taketh rest or sleepe vvithout havinge anye troublesome accidente chaunce vnto him vvherbye vve might suspecte that the membrane called Dura mater or the braynes are molested affected or suffer any payne ether throughe a splinter or throughe anye bloode or throughe anye matter vvhich might be come and situated it selfe therone And the matter luckylye ominouslye procedinge The fissures recollecte then selves sōtimes vve may continue the fore sayed remedyes and the vse therofe because that sometimes by this meanes the fissures are replenished filled vp vvith some obdurate substance and callositye vvhich agreeth and may be likened vnto the callositye or cicatrice of other bones Sometimes onlye the first table of the sculle breaketh and renteth vvithout pearcinge or penetratīge the Diploe Diploe is the porositye betvveene the botables Some times allsoe is the fore sayed diploe crushed plettered and broken yet the seconde tablē safe and illaese or vnburte vvherfore as then it is not necessarye to detecte and make bare or to trepane the membrane Dura Mater yea and as then vve may perceave the manner as it vveare of a splinter of the sculle therin lyinge erected The fracture at sometimes alsoe is soe greate vvith such a huge quantitye of massacred and crushed bones vvhich lye halfe and halfe separated or els for the most parte cleane beaten theroute that vve may playnlye vvith our eyes behoulde the membrane Dura mater soe that the bloode vvhich driveth therone may verye easylye flovve out of the vvounde in like forte allsoe may the remedies therin easyly be applyed To the vvhich fractures the trepane is nothīge behoovinge or nedefull And if so be in anye sorte you perceave anye skilfers or splinters by the vvhich that membrane might be pricked or crushed you must take them verye easylye therout It happeneth alsoe some times not onlye in the little children but in aged poeple The bones of the yonge Childrene are bēt invvardlye alsoe in vvho me the bones are soe thinne and tender that vvith anye rude blovve they are invvardlye bente as vve see a tinne or a copper potte to be brused vvithout the externall skinne beinge anye vvhere externally hurte To the vvhich disease of the bones vve must onlye take our refuge flight vnto our extractive dravvinge plasters vvherbye that the depressede bone might by anye meanes be elevated and heaved agayne into his right place Hippocrates comprehendethe in verye Shorte vvordes in his blooke De Locis in homene The opinione of Hippocrates tou the vvhole cure of the fractures of the sculle demonstratinge those vnto vs vvhich vve ought to trepane The opinione of Hippocrates touchinge the curinge of fractures or not As farre forthe therfore sayeth he as if the bone be broken or massacred ther is as thē noe perrille or daunger at all vvith moysteninge medicamentes must it be cured and helped vvhich quiet and take a vvay the inflammatione soften and mollyfye the bone because that vvithout payne vve might take the brokē peeces of bone therout but insomuch as the bone onlye chaūcede to be burst it is then verye daungerous must of necessitye be trepaned because that the matter vvhich distilleth throughe the rente or fissure one the membrane doe not in anye sorte corrupte and rott the foresayed subiacent or subiectede membrane for as vvithout havīnge anye issue agayne shee come to sincke throughe this angustnes and narrovvnes as then she causeth an ague and somtimes allsoe distemperatenes of minde vvherfore vve must needes trepane and make a large apertione because that the sanious matter may not onlye have an entrance but an issue alsoe vvhen as vve doe not in anye sorte suspecte that the membrane Dura mater sufferethe any thinghe or is in any sorte crushed or pricked vvith anye peeces of the brokē bones that ther is noe matter runne therone by the vvhich she might be troubled it is not thē necessarye that vve trepane or open the sculle For vvhat occasione vve ought to trepane The Chyrurgiane is constrayned to vse the trepane for divers occasions and
daunger in hurtinge of the tendones that consideringe the synnuishe fibers vvhervvith the muscles of the bellye are connectede vvhich in time chaūge themselves into a tendone vvhich vve commonlye call the great synnue What we ought to consider in the suture and so winge of a wounde Chap. 2. Why vve may not in the resovvinge of a vvoūde dravve the lipps or edges close together WE must not at anye time sovve vp a vvounde least in the first shee be vvell purifyed cleansed as vvell externallye as internallye if at the least vvith out any great daunger or perrill it may be effected extractinge and takinge therout all that is contrarie vnto the sayed vvounde as is congealed bloode vvhich comminge to corruptione might cause greate inflāmatione oftē times alsoe a convulsione in that parte throughe vvhich the sovvinge breaketh teareth soe conseqventlye hinderethe the vnitinge healinge of the vvoūde vvherfore in the resovvinge of a vvoūde vve must deligentlye note that vve doe not contracte dravve together on all sydes the lippes or edges of the forsayed vvounde except it vveare in the haremouth in the cleaved or severed lippes of the mouth but must leave some distance betvveene the one the other lippe or in anye place some or other apertione because the matter which gathereth it selfe together in the bottome of the vvounde may issue therout and by that meanes the medicamentes may be therone applied In like sorte the Chirurgiane must in sovvinge consider vse medicoritye and not take to great a qvantitye ether in the length or in the depthe of the fleshe and of the skine throughe the vvhich there might ensue and follovve great payne vvhich vve ought not to esteeme for smalle therof allsoe vvoulde remayne an illfavored vnseemlye cicatrice or scarre As to the contrarye the not deepe sovvinge of the vvounde myght easylye breake and burst agayne then in vayne it vveare sovvede For if soe be that the needle be to neere thrust throughe the edges of the vvoūde thē the threde because of his tenuitye teareth throughe the skinne or fleshe vvhen as vve thruste the needle to deepe and farre from the lippes or edges of the vvounde then there resteth and remayneth a greate parte of the skinne Fleshe vvith Fleshe commeth farre sonner to vnite thē skinne vvith skinne vvhich vvill not be vnited vvherfore indifferentlye vve ought to pearce together as much of the skin as of the fleshe because the fleshe farre sooner and easyer commeth to heale and cure vvith the fleshe then the skinne vvith the skinne and that is consideringe the naturall temperatenes of the foresayed fleshe vvhich is vvarme and moyste And as touchinge the distance of the stitches and soovvinge vve ought not to laye them to close one by the other nether to farre separate sequestred one frō the other as thē they can not retayne the vvounde And vvhen all to nye the other they are layed cause payne through all the stitches and dravvinge together of the same through the vvhich payne is caused a concursione of Humors vnto that place vve must therfore vse a meane therine vvell consideringe the largenes and length of the vvounde but above all vve must marke that vve thrust not throughe or in anye synnues or tendones consideringe the payne the Spasmus and manye other fearfull accidentes vvhich therof might ensue as allreadye vve have sayed Sovving of a vvounde may not be effected vvith anye violence in those partes vvhich vve endevoure to vnite and bringe together but thē is sovvinge laudable vvhen as the skinne stretcheth it allmost together of it ovvne accorde vvheras in this sorte it vvill not be effected or brought to passe easylye that the lippes of the vvound vvith violence must be ioyned it is as then most convenient that vve relay the stitches some distāce one frō the other lettinge them be somvvhat looslye sovved for if it chaunced vve drevve them somvvhat stiflye together the skinne might then easylye rente or teare soe burst a sunder throughe the tumefactione vvhich therof ensueth If that therefore Sovvinge may not by anye violence be done in the lippes of the vvounde vve disire perfectlye to cure a vvounde vve ought as thē soe to dispose of the sovvinge because that in thus doinge the humors bloode matter and the externall ayre might be repelled from the lippes or edges of the vvoūde because such thinges may hinder or at the leaste deferre the curinge of the same and in soe much as the lippes of the vvounde are not vvell vnited the one vvith the other and kept in that stature vnitinge the vvound can verve badlye hardlye be cured And alsoe if the lippes of the vvounde We may in noe vvise sovve the lippes of an inflamed vvounde doe greatlye chaunce to svvell inflame theye shrinck in themselves or els if they be to much brused or plettered vve must not thē in anye sorte resovve it agayne for the suture vvould strayght vvaye breake and soe consequentlye the inflammatione increased but must delay it soe longe vntill the foresayed inflammatione be seaced the vvounde be come to goode suppuratione and matter and is prepared and readye to be vnited brought together What is necessarye vnto the sowinge of a wounde and howe we ought convenientlye to doe it Chap. 3. WHen as the Chyrurgiane desireth aptlye convenientlye to sovve a vvounde he must first of all have in his hande a needle therto a threde and a canulle Cōcerninge the needle shee must be of a reasonable length somtimes right sometimes croocked accordinge as the partes reqvire nether must shee be made of to harde a steele or mettle vvher of they easylye might chaunce to breake but of gentle steele because they might rather bende then breake althoughe shee ought to be stiffe smooth infrangible havīge a sharpe triangled poyncte because that in her entringe she might both cut pricke soe the easyer perce or goe ther through because that in her govvinge throughe she might make a longe little vvound or hole not rounde because those little rovvndes are more difficulte to be cured What forme the needle must have then the longe holes In the heade she must be one both sydes hollovve in form of a gutture because the threde might therinne be hidden buried not hinder the percinge or entrance of the needle in the dravvīge throughe therof because shee then toucheth the bodye in that sort more easyer and softer It vvill not alsoe hinder accordinge to the sayīge of Avicenna that vve somvvhat anoynt the needle vvith oyle vvherbye the payne of the pricke night be somvvhat easyed the foresayed needle enter the easyer What forme the threde must have The threede must be smooth soft rovvnde and vvithout anye knott all eqvivalent vvith the thicknes greatnes of the needle but not in any sorte to thinne least he
The patieÌ„t beinge in this manner situated vve must note in vvhat place the inscisione might easyest vvith most convenieÌ„ce be do ne to vvitt thre fingers bredth vnder the navell dravvinge ether tovvardes the left syde or tovvarde the right but not lineallye right forth betvveene the navell the privityes be cause vve must eschevv and avoyde the vvhyt lyne vvhich in this place is situated the endes of the muscle Epigastri alsoe the synnuis he teÌ„donousnes of the right muscle Excellent consideration because these vvouÌ„ded or hurt might suscitate cause great payne vvith manye other dauÌ„gerous accideÌ„tes vvherfor they difficultlye vvilbe cured vvhen as fayne vve vvould heale vp the vvounde Havinge noted all this the Chirurgiane must vvith his left hande his servant vvhich assisteth him nype in the length the one on the one syde and the other one the other syde first of all the skinne the incarnate or fleshye paÌ„nickle of this syde to lift it vp cut it clean through overthvvarte vnto the muscles vvhich beinge effected they must lett the foresayed elevated skiÌ„ne pannickle fall agayne And to finnish the rest of our operatione convenientlye fitlye after this first in scisione because the fore sayed skinne may fall agayne one the inscisione vvhich inscisione must alsoe bedone in the muscles and in the Peritoneo to stoppe them to prevent the runninge forth of the vvater then vve shall lift vp the foresayed skinne vve must agayne lift vp vvith the hande the skinne the fleshye pannickle and then as high as is possible follovve the fibers of the muscles vve must easylye thruste in the crooked lancet cut throughe the muscles and Peritoneum as broade as vve are vvonte to make the apertione in bloode lettinge or phlebotomye dilligentlye notinge that vve nether touch anye vaynes noe guttes or any other parte vvhich is situated in the coÌ„cavitye of the bellye Novv therfore to effect this vve may vvith great coÌ„venieÌ„ce dexteritye in steade of the crooked lancet vse our punctuall instrumeÌ„t heere before discribed defigured the inscision novv beinge done vve must thrust cleane through the inscidede skinne the fleshye pannickle the muscles and throughe the throughe cut Peritoneum in to the concavitye of the bellye a goulden The vse of the pipe or silver pipe as thicke as a qville or shaft vvhich must have a broade end that nothinge chauÌ„ce to slippe betvveene into the concavitye of the bellye and therone a little string or threde tyed by the vvhich foresayed pipe the vvater must be tapped as it vveare dravvn out but not all at once but by degrees not to superfluos at one time but on divers dayes to vvitt so longe till nature beinge released lighted of her pack or buttheÌ„ vvhich mitigatinge this evacuatione governinge of the forces accordiÌ„ge to the fortitude of the patient vvhich vve may knovve by feelinge of the Puls Because there are some vvhich havinge made to great an evacuatione at one time have alsoe evacuated the vitall and livinge spirites vvhich vveare therin inclosed and finally have caused the patieÌ„t his death VVheÌ„ as therfore vve shall have dravven vvater enoughe of at one time vve must then stoppe the pipe vvith a tente of linneÌ„ or vvith a tent of sponge to retayne the rest of the vvater lay theron a great plaster of Diacalcitheos some there are vvhich dravve out the pipe and let the vvounde vvhich is in the muscles and in the Peritoneo the skinne and the lippe of the vvouÌ„de vvhich before the inscisione vvas niped and lifted vp because that the foresayed vvounde might thervvâ— be stopped and covered Novv certaynlye to retayne and keepe backe the vvater Mr. Floris Phillippes Practise of Mr. Floris Philippes a renoumned Chyrurgian at Orleans a verye renoumned Chyrurgiane at Orleans sticketh his needle qvite throughe both the lippes of the vvouÌ„de comprehendinge sufficient qvaÌ„titye of skinne vvherin he letteth his needle sticke as vve are vvonte to doe in the harâ— mouthes and vvindeth his threde rovvnde aboute the needle vvhervvith he contayneth houldeth the lippes close together soe that there may not one droppe of vvater passe forth and vvhen he desireth to dravve or tappe more vvater therout he then vnvvyndeth his needle openeth the lippes of the vvounde vvithout dravving the threded needle ther out VVhilest that these thinges are this doinge vve must strengthen the patient vvith good cibaries and foode vvhich easilye may be chaunged in to bloode lett him soe rest vntill the next day on vvhich day if soe be he be stronge enoughe vve must yet dravve of some more qvantitye of vvater ether through the dravvinge out of the tente vvhervvith the pipe is stopped vvhen as vve put the pipe therin or vvith the elevatione of the skinne vvhervvith the apertione is covered vvith out puttinge the pipe anye more therin if soe be there can issue anye vvater out allvvayes egallinge or proportioninge the qvantitye of vvater vvith the forces and strengthe of the patient and in this manner must vve proceede in the dravving or tappinge of the vvater Others there are vvhich in the opening of the belly lay ther one a carrosive Corrosive vvith inscisione in the Escara vvher by the skinne is bitten corroded through theÌ„ they make an inscisione throughe the Escara vnto the concavitye of the bellye makinge a verye smalle apertione throughe the vvhich the vvater shall droppingly distill forth havinge dravven therout sufficieÌ„t vvater enoughe theÌ„ they stoppe it vvith scraped linte vvhich vvhen they are desirous to dravve more vvater therout they theÌ„ remove take it of Yet ther are others vvhich after the inscisione of the foresayed Escara thrust therin a little pipe therebye to dravve the vvater out as vve have above sayed Others set there on divers and sundrye corrosives on the place of the liver Applications of divers corrosives and of the milt penetratinge nothinge deeper then the skin inâ—tatinge therin the doctrine of the auncieÌ„t professors vvhich vveare vvoÌ„t sometime to apply nine at once Others make small inscisions like vnto little scarifications one the sydes of the bellye or els they lift vp the skinne thrust there throughe a needle vvith a silke thred vvhich threde they suffer to continue therin The navell vvhich heaveth vp it selfe may be pricked thorough And consideringe that oftentimes in those vvhich are troublede vvith the dropsy there navell heaveth vp it selfe yea and somtimes as bigge as an egge vvhich standeth as cleere as if it vveare a blather vvith vvater there throughe I have seene to be dravvne a silke or vvotleÌ„ threde by the vvhich the patient perceaved great ease consideringe the great qvantitye of vvater vvhich through this apertione is droppinge vvyse runne out Allsoe beyonde all this are the legges the hippes and the Scrotum often times svvollen for the vvhich there is noe better remedye theÌ„ that vve scarifye them throughe
be cured by takinge avvay that vvhich in the pallate is oppugnant vnto nature ether throughe dissectione or throughe cauterizinge or els throughe bindinge of the same If soe be vve feare anye superfluous bleedinge it is then the surest shortest easiest vvaye to discide it because the patiēt ther throughe might be freede from manye more miseries calamityes mischaūces vvherine othervvyse he might in time chaunce to fall as is the cough through the cōtinuallirritatiō of the forefayed longe hangīge pallate omissione losse of sleepe somtimes alsoe the choackinge soe that vve notinge observinge all these thinges are of tē times compelled for the succoure of the patient to effect our extreame The first vvay to cure the sinckinge of the pallate and laste remedye to preserve and keepe him from greater daunger ensvinge And aptlye to bringe this to passe vve must cause the patient to sit in a verye lucent and lightsome place and alsoe to set apert vvide open his mouth and depresse his tunge vvith the Speculum oris then take houlde one the foresayed pallate vvith a litte instrument or tōges made onlye for that purpose leavinge as much hanginge of the pallate vnder the foresayed tonges or instrumente as is to longe nought as must be cutt of pluckinge of the same a little tovvardes him because that vvith the poynct of the scissors he may convenientlye cutt of that vvhich hangeth vnder the foresayed instrument or tonges but not that vvhich is above the foresayed instrument as easylye it may be done for vven as this pallate is tender spongious and covered vvith a mēbrane Accidētes vvhich may insue through cuttinge to highe of the pallate vve as thē easylye take houlde theron vvhen as vve vvoulde plucke him vvherfore some Chyrurgians have oftentimes binne deceaved supposinge him to be much longer vvherfore they have cutt him to shorte allmost cleane avvay vvhere throughe allsoe verye troublesome and difficulte accidentes have follovved because this beīge happened al the pectorall partes are haynouslye merveylouslye therthrough offended vvith greate difficultye of vvel speakinge yea sometimes allsoe vvith vvant of speech or dumnes vvherfore vve ought not onlye to leave the roote vvheron that this dugge or this pallate is fastened but somvvhat more and onlye cut of that vvhich above his naturall constitutione seemeth to be toe longe Others there are vvhich take houlde on this pallate An instrument or tonge called Staphilagres vvith an instrument called Staphilagres vvhervvith they vvringe it rovvnde about havinge vvrunge it rovvnde it vvaxeth crooked purple coloured and in the sectione therof issveth little bloode therout Beinge novv descided cutt of if soe be there follovved a greate effluxione of bloode vve must as thē cause the patient to gargrise his mouth vvith vvater and vineger and then vvith some constringent decoctione vvhich hath bī boyled vvith grosse redde vvyne or els touch the place Remedye agayst the bleeding of the descided pallate orvvype it vvith some stronge cauterisinge vvater vvhervvith the opened vaynes might be seared together The seconde manner of effectinge this same is done vvith an actuall The secōde māner to cure the sinekinge of the pallate throug cauterisatione or a potēciall cauterye as concerninge the actuall cauterye vve must therevnto have in a readines and praepared a sylver or copper pipe vvhich in the one end therof must have a little apertione in sorme of a little vvindovve to receave there in that parte of the pallate vvhich you resolve to cauterize then you shall put into the pipe your glovvinge actuall cauterye vvhich vvith his end vvill abolishe and take avvay that vvhich shall hāge there in as if it vveare vvith a little cheesell strokē of and one this manner vve must cauterize and cutt of the pallate evē and smothe Touchinge the potentiall cauterye or corrosive vve must first receave into the apertiō or vvindovve of the foresayed pipe that parte of the pallate vvhich vve desire to corrosive and then vvith a privett or searchīge irō thrust into the foresayed pipe a peece of corrosive aganst the foresayed peece of pallate of the mouth and continue the same therone a certayne time dilligentlye consideringe that not anye parte of the corrosive fall one the tunge or the throte vvhen as throughe the humiditye of the pallate it beginneth to liqvefye This corrosive is discribed before amonge the instrumentes And vvhē vve desire to take avvay the foresayed pipe vve must thē first of all lay the Speculum oris one the tunge because as thē noe parte of the foresayed corrosive chaunce to light or fall one any of the subteriacēt partes nether touch any parte but the pallate onlye because therby they might be indammaged and hurte Thus havinge brought this to passe vve must annoynt the pallate vvith a little oyle of roses vvith a little cotten or linnen there in beinge madefied and made fatt then shall the patient vvashe his mouth vvith a little roosevvater A sorte ther are vvhich doe not vse the foresayed pipe but they dippe moysten a little cotten or linnen vvhich is tyed to the privet or searchinge iron in oyle of vitriol or Aqua-fortis vvith the vvhich they touche the pallate and cauterize it the tunge before beinge layed dovvne vvith the Speculo oris thē a little season follovvinge they vvashe it vvith Plātine-vvater Others take a little kinde of spoone Staplulocauston a certayne kinde of spoone soe called vvhich of our praedecessors vvas called Staphilocaustō full implete vvith poulder of corrosive full Aquafortis or oyle of Vitriolle vvherin they cause the end of the pallate to depēde allvvay before havinge layed dovvne the tunge vvithe the Speculo oris and by this meanes they cauterize consume the pallate vvhich before vvas to longe it is right true that some of this corrosive in the spoone might chaūce to fall one the tunge vvherfore I vvoulde rather councell to vse that corrosive vvhich is thicke and of some crassitude as that is vvhich may be pulverisated beaken to poulder because vvithout beinge pulverizated it can not shevve his forces one the pallate VVhen as therfore throughe the applicatione of anye of the fore sayed corrosives or cauteryes the place of the pallate beginneth to be blacke it is then a signe that it is sufficiētlye cauterised and if soe be the coloure therof be not as yet chaunged vve must then yet once agayne applye the corrosive thervnto then cause the patient to gargrise his mouth vvith Oxicrate or vvith vvarme redd vvyne A tryed remedye I have knovvne the suncken pallate to be lifted vp agayne vvith a little povvnded pepper saulte by a spoone beinge therone fastened others vse there to some astringēt poulders The thirde meanes to cure this dissease is effected by ligature because of the timorousnes vvhich the patient conceaveth of the cuttinge of or cauterizinge the same or effluxion of bloode The
in there place tye them vvith a gouldē vvyer as is before rehearsed or els vve may set other teeth in ther places vvhich are by art made of Ivory Looke afore in the figure or formes or of any other matters as here before vve have set dovvne the figures and discriptions therof The Frenche Chirurgerye THE SIXTE TREATISE OF THE OPERATIone of Chyrurgerye Contayninge nine Chapiters Of that vvherone vve must consider before vve make an apertion in avayne Chap. 1. Hovv vve ought to phlebotomive or open avayne Chap 2. VVherō vve ought to cōsider after vve have opened the vayne vvhē shee bleedeth Chap 3. Of the number of vaynes arteries vvhich are vsed most cōmonlye to be opened Chap. 4. Of the apertione of the Arteries Chap. 5. Of Anevrisma or broken arterye hovve vve ought to make an inscisione therin after vvhat manner vve ought to binde them Chap. 6. Of the Cirsotomia vvhich is hovv vve ought to make our inscision in the Varices or bursten vaynes Chap. 7. Of horseleeches and of ther vse and hovv vve ought to applye them Chap. 8. Of boxes and hovve vve must applye and vse them Chap. 9. ⧠Wheron we must consider when as we desire to open a vayne or phlebotomize Chap. 1. Intentione porpose of the aucthor MYe purpose and intent is not in this place to discrib vnto you vvhat sicknesses reqvire phlebotomye in vvhat age in vvhat time or season of the yeare in vvhat countrye in vvhat cōstitutiō of the body it must be done of vvhat occasione namelye especiallye vvhether it be for anye simple evacuation or for anye deprivatione or derivatione or for any revulsione In like sorte alsoe in vvhat vayn vve ought to make the apertione vvhat qvantitye of bloode vve ought to detracte out of the same in vvhat sorte and hovv much at one time hovve often after the other or in vvhat time of the sicknes vve must make the apertione in the vayne But my purpose and meaninge is onlye to shevve hovv vve ought to opē a vayne vvheron vve must thinck dilligentlye consider before vve make the apertione therin after vve have opened her vvherone vve ought to not vvhē the blood issveth out of the same This doinge shall the Chyrurgiane be noe lesse vvorthye of prayses because he cā verye excellentlye phlebotomize then the physitione is prayse vvorthye by his perfect knovvledge vvhether the patiēt have neede of phlebotomy or not Why phlebotomye is difficulte daūgerous For although that it seemeth to be a smalle sciēce to phlebotomize aright very vvel yet notvvithstandinge is it oftentimes a difficulte matter verye daūgerouse because the vaynes ar situated somtimes close to the Arteryes yea alsoe thervppen as alsoe are the synnues Accidentes vvhich are caused take ther originall of ther hurtinge of anye vayne synnue arterye or tendone the tēdones If soe be therfore vve chaunce vvith the lancet to hurte a Tendone therafter most commonlye issueth a Spasmus or a Gangrene and mortificatione vvherthroughe the patiēt pitifullye ruefullye and vvith great torment endeth his lyfe If ther be then any arterye touched opened shee verye difficultlye vvil be cured vvherby the patiēt bleedeth to death vvhē as vve descide a vayne qvite asunder both the endes therof are immediatlye retracted and dravvne invvardes the one end this vvay the other end that vvaye soe that vnder the fleshe both of the endes are lost noe bloode cā possibly issve therout if shee be then vvith to great timorousnes feare pricked the skinne onlye vvhervvith shee is covered is as thē inscided the vayn not opened or els if shee be onlye pricked vvith the poyncte of the lancet the bloode as thē issveth therout droppingevvyse and the subtilest bloode onlye cometh out vvher cōseqvently therafter she exvlcerateth Sometimes alsoe lyeth the vayne occulted soe deepe in the fleshe that vve can not vvith the lācet finde thē vvithout great paynes yea also although vve espye them yet throughe there perpusillitye rotūditye they avoyde eschevve the poyncte of the lācet hovv accute subtile soever the same be Soe that ther are oftētimes divers occasions vvherfore phlebotomye is difficulte vvhich to an other vvhich never hath done it seemeth to be very easye Before the Chyrurgian maketh his apertiō in the vayne if soe be the patiēt be restringed bovvnde in his belly hath in a lōge time not bīne at stool vve must thē first of all cause him to vse a Clistere because throughe the phlebotomye the vaynes beīge evacuated emptied doe not attracte dravve vnto thē out of the guttes or entralles any corrupted rottē humors vvherbye anye of the vvorthyest partes might be offende hindered Nether is phlebotomye expediēt Wheron vve ought to cōsider before phlebotomye vvhen as the stomacke is burthened ether vvith anye cruditye of vndigested meat or drincke or vvith anye other viscositye vvhatsoever as also it is vvholye dissvvaded to doe after anye greate evacuatione or anye other occasione vvherby the patient might be debilitated as is superfluous parbrakinge a great laske great abstinence continualle vigilatione and great conversation vvith vvoemen VVhē as therfore the Chyrurgiane in the absence of the Physition hath on all these foresayed thinges dilligentlye cōsidered he must as then deferre the phlebotomye And if it soe chaunced that anye persone to praevent any dissease desired to be phlebotomized he must then cause it to be done vvhē as he is best of courage as beinge freede from all care of sorrovve of ire and besyde all this vve must not phlebotomize anye persone vvhich is to timorouse fearfull of phlebotomye because the afrightednes the feare causeth the bloode to vvithdravve it selfe tovvardes the internall partes of the bodye Hovve vve shoulde convenientlye phlebotomize And the patiēt as yet beinge lustye strōg vve must then cause him to sit in a stoole but if soe he be feeble debile is subiected vnto fayntnes sovvndīge as those are vvhich are of a hott nature vve must in the first let him suppe in a soft dressed egge or a morsell of breade sopped in vvyne then cause him to lye one the bedde halfe sittinge vpright stuff him vnder vvith cushēs as if he sate And above all vve must dilligentlye note that the light of the ayre or shining of the candle doe rightlye shine one the vayne because that through the shaddovv therofe the knovvledg of the vayne of the place vvhere she must be pearced be not vanished out of your sight then must the Chyrurgiane vvith his right hande take the right hand of the patient or vvith his left hande the left hāde of the patiēt out of the vvhich he meaneth to dravve the blood out depressinge the arme sōvvat dovvn vvardes and then vvith his left hand or vvith a vvarmed table naptkinne rubbe the insyde of the arme vvher he
intendeth to make the apertione Dubble bande in Phlebotomye And then binde the arme dubble a little above the elbovve vvith a little narrovve liste of vvollen clothe not to stiffe nor to loose because to looselye bovvnde or to stifflye tyed doe both of them hinder the bleedinge thē must the patiēt shutt his hand close vvherby as vvell throughe the binding as throughe the closinge of the hāde the vaynes lye fast stedfastlye in the fleshe and not move this vvay or that vvay vvhē vve should pearce them vvherthroughe also they rayse themselves and svvell the more throughe the bloode that by this meanes is dravvē thether vvardes by the vvhich alsoe vve may the easyer see and feele them ⧠How we ought convenientlye to make an apertione in the vayne Chap. 2. HAvinge dilligētlye considered all these thinges if the Chyrurgiane Continvance of the manner rightlye to phlebotove determine to phlebotomise in the right arm he must then take houlde one the foresayed arme vvith his left hande by the bendinge of the arm or about that place vvherin vve purpose tO make the apertione lay his thumbe one the vayne a little belovve the place vvher vve vvil pricke because that soe he may hovvlde the vayn stedefaste vvithout glidinge this vvay or that vvay because sometimes the vayne beinge spanned like a little cord might chaunce to rovvle glide vnder the lancet And because the foresayed vayne is oftentimes implete vvith vvinde vētosityes shee therefore yeeldeth slideth avvay vnder the lancet vvherthroughe vve can not fullye pearce her by this meanes the apertione falleth to small all this beinge in this sorte noted vve must vvith the first finger of the right hand feele vvhere vvith most convenience vve might make the apertione setting an impression on the skinne above the vayne vvhere vve purpose to pricke vvith the nayle of your finger then immediatlye take the lancet in the right hande vvhich betvveene our lippes vve must have in a readines vvith the vvhich vve finelye must make our apertione in the vayne causinge the poyncte and acuitye of the same gentlye to enter into the concavitye of the vayne not abruptly and rudely vvith a hastye thrust And to make this apertione vvith more certayntye vvithout tremblinge of the handes the Chyrurgiane must take the lancet in the middle vvith his thumbe his first finger sufferinge his hande vvith three of his fingers to rest on the arme so lay his thumbe and his first finger vvhich hould the lācet one the thumbe vvhich houldeth fast the vayne on this sort to hould fast his hande vvith out anye tremefactione to vse the same Some there are vvhich annoynt the place vvherin they intende to phlebotomise vvith a little oyle or vvith freshe butter thervvith somvvhat to mollifye soften the skinne soe vvith more ease and vvith lesse payne to pearce ther throughe To mollifye the skinne Others annoynte the acuitye of ther lancet vvith oyle because shee might the easyer perforate the same cause lesse payne the perforatione or vvounde might better contayne it selfe apert the blood if soe be it vvear grosse might the subtiler vvith more ease have his passage If soe be then that the apertiō be made vvith one thruste it is thē good but if not vve must immediatly give an other pricke ether a little belovve the same or els a little above the sam if the vayne sufficiētly demōstrateth her selfe If therfore the apertiō be to small the blood issue out of the same to subtilelye soe that vve feare that vve shall not dravve sufficiēt blood enough therout then immediatlye vve must thrust into the same hole or apertione agayn a little dilate the same because that oftentimes throughe to small an apertion the grosse bloode congealeth before the apertione and ther conseqventlye exvlceratethe Why vve must give a staffe to them in ther hāde vvhich vve Phlebotomize Havinge convenientlye brought to passe this apertione vve must then give the patiēt in the hande of that arme vvherin he is phlebotomized a roūd staffe partlye therō to rest his arme as alsoe to turne rovvnde the foresayed staffe in his hande because by this meanes the bloode might the better shoote out the vvhich if it doe not rightlye issue out vve must thē marke if the ligature be not the cause therof as if it vveare to harde tyede vvhich as then vve must a little districte and make it loose vvithout vvholye looseninge of the same Broade narrovv lancets The Chyrurgiane must alsoe have divers lancets vvherof the one must be a little broader then the other The broade lancets are verye necessarye vvhen as the vaynes lye highe exalted vvhen vve desire to make an ample apertion The smalle narrovve lancets are verye necessary vvhē as the vaynes lye profoūdlye occulted in the fleshe and also vvhen as in the highe exalted vayne vve desyre to make a smalle apertion because sometimes the sicke personne reqvireth a great festivous phlebotomy to the vvhich end vve must make an ample apertione as vve must alsoe doe if vve coniecture the bloode to be grosse dēce vvhen the patient is lustye and stronge Contrarilye if soe be vve retract dravve back the bloode vvhich supernaturallye hath issued out of any parte of our bodye as in those vvhich spitt bloode or those vvhich bleede much out of the nose as then vve must make our apertion smalle because that great evacuation of blood is not necessarye for them because through there noses they have avoyded sufficient then onlye in such accidētes vvher in is onlye reqvired a regressione of bloode Besydes it is necessarye expediēt that in the foresayed evacuatione and sicknes vve suffer the bloode to issve longe enoughe out of the apertione of the vayne vvhich the patient shoulde not be able to suffer if the foresayed apertione vveare ample because ther vvould issue to much blood othervvise therout In the Phrenesy vve ought to make but a small apertione VVe are also in phlebotomye vrged to make a small inscisiō in those vvhich are troubled vvith Phrenesye in those vvhich are grovvne madde because that little vvounde might vvith all expedition be cured agayne because that such raginge franticke persons vvill all vvayes make loose the ligature or dressing before vvear therof avvare vvherof they might com in daunger of bleedinge to death but the apertione being smalle although they loosen the arme yet notvvithstandinge they can not violently bleede because in such a small apertione the bloode congealeth occludeth stoppeth the vvounde VVe ought to make in smalle vaynes a smalle apertione in greate vaynes an ample apertione for if so be vve make in a greate vavne a smalle apertion thē shoulde necessaryly follovve that the blood vvhich coagulateth in the small vaynes be a hinderāce vnto the issuinge or runninge out of the bloode Touchinge the forme
figure of the inscisione it is effected in three sundrye sortes and fashons vvherof the first is made overthvvarte the secōd accordinge vnto the length of the vayne vvherthroughe the vayne is cleft or splitted not pricked the thirde is the meane betvveene them both vvhich vve may vvell call the contradictorye apertione because cōtradictorilye shee is made Three formes of inscisions in phlebotomye VVe make the apertione overthvvarte vvhen as vve are not minded to reiterate the phlebotomy for vvhē vve bende the ellbovve thē both the endes of the vayne ioyne together agayne This figure or forme is necessarye vvhen as vve desire to make a large apertione VVe must make the apertione sydelonge or contradictorye vvhen vve purpose to iterate the phlebotomye and vve makinge the apertione in this manner verye seldome or never misse the vayne and vvhich is more it is better for the circumstantes and standers by vvhen the bloode in this manner issueth therout That inscisione vvhich is made accordinge to the lēgth of the vayne is verye expedient vvhen vve intende to renue the bloode lettinge that not onlye the same day but one the next day alsoe because that vvhen vve bende the elbovve both the labia or lippes of the vayn do separate devide themselves But in vvhat forme soever vve make the inscisione The vayne must be inscided in her middle yet notvvithstādinge the vayne must be pearced in the middle vvithout vvholye cuttinge a sunder of the same Because her lippes might chaunce to be inverted invvardes and the bloode could not resulte out of the apertione but runne dovvn a longe by the arme or both the endes of the vayne are dravvē invvardes vvithout deliverāce of anye blood from her or at the least in the first very little ⧠Wheron we ought to marke after the thruste apertione of the vayne and when the bloode issueth therout Chap. 3. Although the vayne be vvel opened yet shee droppeth throughe the afrightednes of the patiēt WE may knovve that the vayne most commōlye is vvell opened as easily vve may perceave by the bloode vvhen as in the firste it rousheth and as it vveare leapeth out in great haste but immediatly altereth vnto droppinge vvhich throughe the afrightinge of the patient is caused for vvhich reason the bloode is dravven invvardes VVhich vvhen it chaunceth vnto vs vve must vvith patiēce abyde and vnbinde it somvvhat and incourage the patient causinge him to move his fingers turne Grosse bloode doth nothinge but droppe and crush the same in his hande The apertione in the vayne is sometimes ample enoughe but because the bloode is grosse it can not issue out therat to the vvhich end vve must put a little oyle therine vvhich to that purpose is verye profitable If soe be therfore the Chyrurgyane in absence of the physitione findeth the patiēt verye feeble and yet notvvithstandinge follovvinge the rule ordinance of the physitione is verye necessarye to be vvell phlebotomized vve must them doe it providentlye that althoughe at the first vve have not dravvne soe much blood as the sicknes or dissease reqvireth vve must then some certayne hovvres therafter agayn renue the phlebotomye for the seconde time and if it be needfull yet once agayne for the thirde time vvithout over charginge of the patient vvith to great phlebotomye at one time It might alsoe chaūce that before vve could detracte such a qvantitye of the patiēt as vvas ordayned and reqvired the patient might chaunce to be debilitated and in daunger to fall in great fayntnes sovvndinge vvheron the Chyrurgiane must dilligentlye consider as he may easyly perceave it vvhen the patiēt vvaxeth pale and oppressed at his harte his puls diminishinge vvhen the bloode runneth dovvne by his arme What vve ought to doe vvhē vve perceave the fayntinge to approch the patient VVhich vvhen it chaunceth the Chyrurgian must then immediatlye sease the bleedinge layinge his thumbe one the apertione of the vayne lay the patiente on his backe vvith his heade one a cushen sprincklinge could vvater in his face and give him a little vvyne in his mouth and cause him to smell at some vineger and then have a little patience vntill that agayne he reviveth comme to himselfe for as soone as he shal be come to his former strength agayne vve may as thē finishe the phlebotomye The patiēt lying fiat on his backe cā verye vvel suffer phlebotomye Some ther are vvhich in anye sorte can not indure phlebotomye hovv lovve soever they sitt althoughe it vveare on the bed or althoughe vve cōtinually helde vineger before ther nose or gave them vvyne to drincke yet notvvithstandinge they lyinge prostrate on the bedd vvith ther heade reasonable highe they can as thē verye vvell suffer and abyde the foresayed phlebotomye althoughe vve dravve a goode qvantitye of blood from them As of late I my selfe have knovvne to happen in an honorable and coragious gentleman After that vve have detractede a reasonable qvantitye of blood out vve must then dissolve and make loose the ligature and crush out the bloode of the vayne least that the bloode chaunce to congeale therine and coagulate and soe exulcerate and if soe be ther appeerede anye little parcell of pingvedity or fat vve must thē gentlye thrust it in agayne vvith the heade of a pinne and not cutt it of and then vvipe of the blood vvhich cleaveth is dryed or exciccated to the arme lay a little cōpresse one the apertion vvhich is madefyed in coulde vvater and vvinde the ligature tvvice or thrice aboute the elbovve like a borgondian crosse vvithout tyinge both the endes fast before you have caused the patient to bende his arme to laye the ligature therafter The Ligatione of the elbovve after phlebotomye This ligatione may not be to stiflye bovvnde because the cicatrice by this meanes may qvicklye be sitvatede on the apertione of the vayne The arme beinge thus fouldede together if so be the patiente be able to vvalke he must vveare his arme before on his breste in a scarfe if so be he lye on his bedde he must gently lay the same besyde him vvith out much movinge of the foresayed arme nether must he lye therone for ther have binne some vvhich in ther sleepe have hadde ther armes violentlye to bleede vvith great daunger of ther lives Hovv vve may stopp restraygne blood The bloode issueth sometimes vvith such violence out of some partes of our bodye that vvith noe cōpresses or ligatures vve can restraygne the same vvhich happeninge vve are thē constrayned to lay above one the toppe of the apertione the one halfe of a greate beane and the compresse therone and in this sort bind it together Ther remayneth somtimes a nigreditye or blacknes Daunger that happeneth to phlebotomye viriditye or greenes about the apertione but therof ensueth noe evell vnles anye other accident chaunced thervnto VVhen as therfore vve
desire to renue the phlebotomy To renue the phlebotomye vve must then lay one the inscisione saulted oyle because that hindereth the curinge of the vvounde and the sault keepeth the blood from coagulation vvherthroughe the apertione of the vvounde is stopped And if soe be the vvounde vveare soe stopped that the bloode vvould difficultlye issue therout vve must not then rigerously stretch out the arme vvhich the patient hath carried on his brest dubbed nether depresse the vayn vvith to great violence to get the bloode therout Because such violēce might cause great payn and inflammatione To renue the phlebotomye but vve must rather vvith a small privett or searching iron remove that blood vvhich therin is exciccated dryed or rather once agayne make an inscisione after that vve have bovvnde the arm somvvhat higher then the elbovve as before vve have sayed Hovv vve ought to open the vaynes or arteryes of the tēples of the head VVhen as vve desire to make an apertione in the vaynes or arteryes of the temples of the head of the foreheade or vnder the tunge vve must then cause the patient gentlye to vvring about his neck a table naptkīne or a tovvell therby to cause the bloode to ascēde on high the vaynes to svvel vvhich vve intend to open Hovv vve ought to open the vaynes of the handes feete And vvhen as vve desire to open the vaynes of the handes or feete vve must bath them in vvarme vvater because throughe caliditye vvarmethe of the vvater the foresayed vaynes might erect themselves the bloode the vayne beinge opened might the better issue out therof ⧠Of the number of vaynes arteryes which commonlye vse to be opened in mans bodye Chap. 4. THe aunciēte professors of Chyrurgerye have observed certayne vaynes vvhich in mans bodye must be opened accordinge as everye divers dissease shall reqvir vvherof the Chyrurgiane must not onlye knovve ther situatione ther divisione or separatione but alsoe the names of the sam because that he doe not mistake the one from the other Vayne of the foreheade They vvhich most commonlye are opened are 41. vvherof ther are in the heade 17 een the first vvherof is called the vayne of the foreheade vvhich is situated in the middest of the foreheade and is opened vvhen as vve have anye inveterated payn in the occipitialle partes of the heade to trouble molest vs. The seconde is called Vena Pupis Vena Pupis vvhich is situated right in the middest of the occipitialle or hinder partes of the heade this vayne is opened agaynst the soporiferousnes payne of the heade vvhich is situated in the foreheade The temporall vayne The thirde is called the temporalle or vayne of the tēples vvherof in each syde ther is on vvhich in divers brāches ascēdeth in the temples of the heade vve open those vaynes agaynst the superfluous lachrimation of the eyes agaynst vehemēt payne in the eares agaynst the Hemicrania vvhich onlye commeth in on syde of the heade Eeare vayne The fourth is called the eare vayne one eache syde one have ther place situatione behinde the eares this vayne is opened agaynst surditye Eye vayn payne vlceration of the eares The fifth is the eye vayne the vvhich in the greate corner of the eye close by the nose vve may perfectlye see shee is opened agaynst all disseases of the eyes eyeliddes The sixt is Nosevayn the nosevayne vvhich hath her place in the middest of the end of the nose betvveene the tvvo grisles or cartilages shee is opened agaynst the heavines of the head agaynst all reumes of the eyes eyeliddes The seaventh Lippevayne is the lippe vayne vvherof one each syde are tvvo in the internall partes of the opermost and nethermost lippe vve opē them agaynst all tumors excrescenses of fleshe agaynst all vlceratiōs of the mouth agaynst the vehement rednes of the face The eight is called Ranularis vena Ranularis vvhich is situated vnder the tunge one each syde on vve make therin an apertion agaynst the Sqvinantie agaynst the incensione of the Almondes of the pallate more other disseases of the throte The ninth is very publique lyinge in the necke and is called the Iugularis Iugularis vayne of the Arabians Gvides on each syde of the necke one Shee may very conveniētlye be opened agaynst tht Sqvinantye agaynst all rheumes of the throte vvhich bringe vs into greate angustnes and trouble In the armes are sixe in every arme three vvhich in the fouldinge of the armes are phlebotomized The first is the head vayn Headvayne Cephalica vvhich is situated highest most outvvardlye in the arme vvhich vve opē agaynst the payn of the heade eyes eares payne svvellinge of the throte The second is the nethermost in the insyde of the arme is called Basilica Basilica being the foundatione of both the other vaynes and is also called Hepatica or liver vayne Hepatica or Liver vayne VVe open this vayn agaynst the stoppinge of the Liver agaynst all inflāmations of the vvhole bodye all disseases vvhich are situated vnder the heade The thirde is the Mediane The Mediane or Mediana as vvell concerninge her situatione as originall because shee taketh her beginninge out of the Heade Liver vaynes as also considering her conditions because vve open her as vvell for all disseases vvhich are situated in the vpper as vndermost partes of our vvhole body and ther trouble and molest vs. In the handes vve have sixe in each hande three Eye vayn in the hande The first descendeth a longest the Metacarpion of the hande and passethe betvvixt the thumbe the first finger vve call her allsoe the heade vayne or the eye vayne VVherfore shee is onelye opened agaynste payne in the heade eyes The seconde is called Salvatella Salvatella or Liver vayn betvvixt the little thirde finger shee is phlebotomized agaynst the yellovve gaundise in all disseases of the liver on the right hande and one the left agaynst all disseases of the milte vvherfore of som in the left hande shee is called the miltvayne Blacke vayne The thirde is alsoe called the Mediane Blacke and Common vayne descendeth by the finger called Medicus Blacke vayne or thirde finger vvhich vayne vve may open vvhen vve can finde nether of the other tvvo In the belly are tvvo in each syde of the bellye one Vena Illiaca vvhich vve call Venam Illiacam or Titillarem demonstratethe her selfe betvveen the hippes the flanckes She vvhich is opened in the right syde agaynst the Dropsye and other disseases of the Liver shee vvhich lyeth in the left syde agaynst the disseases of the Milt In the fundament or privityes of a mā are one each syde tvvo the one vvherof vve calle the Hemorrhoidalle vayne Hemorrhoidall vayne is onlye opened in
great hast have rushed therout vvithout anye remedy hovve to restraygne them Novv perfectlye to knovve such a svvellinge and to discerne it from other tumefactiōs Signes of this tumefactiō vve must observe that in this tumefactione ther is a continuall reverberatiō the foresayed tumor beinge of one coloure vvith the skinne hovve great or smalle the inflatione be it is alsoe tēder and soft in the touchinge of the same glidinge avvay vnder the finger vvhen as vve depresse it yea and almost throughe the foresayed depressione vvholye vanisheth out of our sight considering the bloode of the vitall spirites vvhich through the foresayed depressiō are crushed in the arterye vvherfore they alsoe as passinge throughe a little apertiō vvhich violence do make a noyse or sovvnde vvhich havinge taken avvay and removed the finger immediatlye shoote agayne in ther foresayed concavitye as alsoe agayne in ther forth comminge of the foresayed angust apertione vve may heare a certayne sovvnde vvhich cōmonlye chaunceth vvhen as this Aneurisma is caused throughe an Anastomosis and not of anye vvounde because the Orificium beinge apert the vitall spirites as being most subtile are before the bloode driven out soe that the vvhole tumefaction is almost replete vvith vitall spirites But if soe be the Arterye be burste there as then issueth much bloode therout vvhich bringeth in the tumefaction more blood thē vitall spirites vvherfore alsoe it is more obdurate and harder and the sayed bloode coagulateth and therin rotteth and corrupteth As much as concerneth the curatione of this tumefactione it consisteth onlye Curation of Aneurisma in the bindinge of the foresayed arterye and especiallye the same beīge somvvhat thicke for they vvhich are greate and especiallye the arteryes of the necke the arme pittes or of the flanckes may or can in noe sorte be tyed because it is impossible to finde them make them bare and if vve allsoe make an inscisione therin ther then follovveth such a quantitye of bloode and of the vitall spirites that most commōlye the patient dieth vnder the handes of the Chyrurgiane That arterie vvhich is situated in the bendinge of the arme may easilye be cured Of an arterye vvhich of the Author vvas tyed above the Aneurisma as out af this subsequent historye vve may note My lorde of Maintenon desired me to visite the sonne of my lorde of Belleville vvhich throughe phlebotomy in the bendinge of his arme had gotten a little Aneurisma vvhich through continuance of time is grovven as greate as a fiste vvherin in the ende the bloode vvhich therin vvas included coagulated so that in the foresayed tumefaction Aneurisma ther came a corrupting and rottennes vvhich he one the out syde of the foresayed skinne of the svvellinge he espyede vvhich from the vitall and livinge coloure vvas chaunged into a blacke and purple coloure vvherebye alsoe ther vvas an apertione caused in the skinne To the remedyinge and curinge of the vvhich especiallye the superfluous effluxione of bloede vvhich might therof ensue the losse alsoe of the vitall spirites if soe be the apertiō as yet vveare dilated I as then councelled the Physitions and Chyrurgians to praevent farther evells that vve ought to tye binde the Arterye vvhich vvas situated and his place in the bending of the arme somvvhat higher then the Aneurisma to the vvhich opinion propositione in the end they all consented agreed The vvhich alsoe vvith happye successione of all causes vvas brought to passe in the praesence of the vvorpshipfull master Drovet Doctour of Physicke at Beauvais and of the Chyrurgiane dvvellinge at Avet vvhich vveare come thether to cure him On vvhat sorte the Aucthor tyed this Arterye First of all I cōsidered on the arterye in the vppermost and inner parte of the fore arme as shee from above descēdeth vnder the armpittes vnto the bēdinge of the arme three fingers bredth therabove on the vvhich place vvhen I had seene and fixede myne eyes therone I made an inscisione in the skinne according to the length therofe vvhich lay opened right above the Arterye vvhere by tacture vve might feele her vvhich vvhen I had found and discovered her I thrust a crooked needle thervnder vvherin vvas a strōg threde vvhere vvith I tyed the foresaeyde Arterye vvith a dubble knott this beinge done I took avvay and purifyed all the congealed or coagulated bloode all other impuritye out of the vvounde or svvellinge and have vvashed the same vvith Aqvavitae Remedye agaynst the putrefactione in the vvhich I mixed a little Aegyptiacum by this means to cleanse it the better from all putrefactions and the patient is vvithin a moneth therafter ensuinge vvholye cured and grovvne sovvnde vvith out retayninge any lamnes in his arm vvherin I my selfe have vvondered If soe be that in anye other externall parte there chaunced to come any Aneurisma into the Chyrurgians handes he must then knovv that allvvayes for certayntye he shall finde the arterye in her vppermost parte or discover and bare her soe bynde and tye her vvith out anye more ceremonies ⧠Of the Cirsotomia that is of the manner howe we ought to cutt of the varices Chap. 7. Discriptione of a Varice VArices or burstene vaynes are troublesome because of ther greatnes their extracting thicknes and their gibbositye above ther nature property VVherfor ether because they cause payne and hinder the actione of that parte or els because they soacke in some certayne vlceratione vvith some humiditye vvherby she can not be cured vve are vrged to open them and cut themof Curation of a Varice or els vvith some actuall cauterye to cauterize them soe consume and bringe them to nought To vvhich purpose the auncient professors Councell of the auncient professors for the curinge of the Varices have ordayned that vve should cut out and cleane take avvay those vvhich lye croockedlye and dubbelye foulded in divers rovvnde revolutions or els lye intangled the one vvith the other But before vve proceede to such an operatione it is necessarye that first of all vve bath that part vvith hott vvater to cause the grosse bloode somvvhat to separate and vvexe or grovve subtile and the vaynes to svvel and exalt themselves But the most gentlelest remedye is that vvhich daylye vve vse vvhich is the simple apertione and inscisione of the foresayed Varices at one tvvo or thre places as if vve intended to phlebotomize makinge the apertion somvvhat greater and larger therin because of the grosse melancholicke bloode vvhich vve desire to let therout Throughe vvhich foresayed apertione vve extracte as much bloode as vve suppose to be goode and sufficient or els as much as the patient cā abide one vvhich foresayed apertione vve must lay compresses vvhich therone vve must binde as vve are commonlye vsed to doe one the vaynes vvhē as vve have phlebotomised prohibitinge the patient not to stirre or goe vvhich sayed Varices if so be they chaunced to svvell agayn
appease this forsayed mortificatione to save the ioyncte because that such an operatione Extirpatione of any ioyncte is effected vvith great daunger can not be done then throughe extreame daunger as oftentimes the patientes themselves doe dye vnder our haÌ„des because of the great effluxione of bloode or els some greate fayntnes Others immediatly after the extirpatione fall into a Phrensye in extreame intollerable payne in Spasmo in a coulde svveat vvheron praesentlye follovveth death VVherfore first of all vve ought to admonishe the frendes kinsfolke of the patient certifye vnto them that this operatioÌ„ is full of dauÌ„ger and is as vvell lamentable for the Chyrurgiane as for to patient and that vve ought not therof the make anye greate matter of vvorth or estimation seinge ther is no other hope nor anye other successe to be expected that it seemeth more convenient and necessarye to extirpate the mortifyed ioyncte and soe to avoyde flye death vvhich is more terrible and fearfull then the losse onlye of one ioyncte And before vve beginne this operatione that vve must extirpate the foresayed ioyncte it is necessary that first of al vve knovv the place vvher it must be done Reason hovv to make choyse of the place vvher vve shoulde extirpate the ioyncte because of divers opinions vvhich are hadde therof for some are of opinione that in the ioyncte vve ought to doe it because in this place it vvoulde fall easyer for the Chyrurgiane to execute the same is alsoe more tollerable and easyer for the patient be-because ther it may be done vvith more festinatione vvith a simple inscision of a vvell rescindent and cuttinge knife if onlye the Chyrurgiane be agile and experte in findinge of the ioyncte Novv as touchinge those vvhich suppose all vvouÌ„des of the ioynctes to be more subiected Reason for those vvhich extirpate any meÌ„bre in the ioyncte vnto deadly and dolorouse accidentes theÌ„ those vvhich happeÌ„ to be thre fingers above or vnder the same yet for all that they are noe lesse davngerouse because of the Tendones and al other sunnuish partes vvhich as then are alsoe cutt of vvhich are rounde more thicker there then in the ioynctes themselves VVherfor vve neede not to feare that ther vvill follovve more payne or convulsione althoughe the extirpatione vvhich is done three or foure fingers belovve or above the same because the TeÌ„dones and the synnues are as vvell in the on place as in the other aequallye cutt of And vvhich is more if vve extirpate a membre in the ioyncte the marrovve of the pipe as theÌ„ is not denudated because of the Epiphysis vvhervvith it is covered and contayned But contrarilye if vve savve throughe the focille or pipe the marrovve as theÌ„ is denudated for the praeservatione of vvhich Nature vvith greate difficultye must have a longe time to engeÌ„dre a Callum thervnto and to cover it because nature must separate that end of the savved bone And besydes all this ther follovveth noe superfluous effluxion of bloode as Hippocrates in his boocke of Hemorrhoidibus vvitnesseth vnto vs. Althoughe that all these foresayed reasons Reason for those vvhich extirpate the membre above or belovv the ioyncte are sufficient enoughe to persvvade the yonge Chyrurgian to extirpate the members in their ioynctes and Hippocrates allsoe commaundeth councelleth the same yet al PractisionerS of Chyrurgerye doe heere in agree vnite their opinions together that vve ought to extirpate the membre Reason for those vvhich extirpate the membre above or belovv the ioyncte three or four fingers vnder or above the ioyncte accordinge to the dispositioÌ„e reqviringe of the moâ—tified ioynct For first of all the opratione is done vvith such festination so certayn because of the facility therof for vve may righte vvell knovve that the vvhole infectede spoylede parte most commonlye svvelleth the finitimate partes also thervnto lyinge that vvithout greate daunger difficultye vve can not knovve the ioyncte or the place therof in the vvhich vve ought very vvarily to enscide Farther allso the ioynctes are most coÌ„monlye verye difficulte cleane to cutt them of or extirpate them because of the bones vvhich are placed the one in the orher Touchinge therfore the certayntye therof experience teacheth vs that an inconvenience may as vvell come of the one as of the other And such vvoundes are noe lesse mortalle then the vvoundes of the ioynctcs Secondlye ther much sooner follovveth a cicatrice because of the greate qvantitye of fleshe vvhervvith the bone on all sydes is circumcinglede covered vvhich in that place is not of such a crassitude spongiousnes as in the ioyncte And althoughe the Cicatrice can not so soone be effectede the patient neverthelesse needes not abstayne from going that vvithout payne allso layinge his knee in a stilte vvhervvith he shall as then abyde the time of his complet sanatione The vvhich he in that sorte shoulde not be able to doe before that the cicatrice vve are vvholye curede obduratede if so be his legge hadde binne extirpatede in the ioyncte because the vvhole body resting theron throughe the confricatione or rubbinge together of the same might chaunce to breacke open agayne ExperieÌ„ce of the Author As touching my selfe I have allvvayes fouÌ„de that the cicatrice hath ever binne very difficulte yea allmost impossible to be curede effectede in the ioynct but iÌ„mediatlye therafter is openede agayn hovv little soever the bodye restede therone Conclusione VVherfore I also am of the same minde opinione vvith all other common Chyrurgianes that as vvell consideringe the festinatione facilitye of the operatione as allso the brevitye of the generatione of the cicatrice that vve ought to doe our extirpation or savvinge of of anye membre three or foure fingers breadth above or vnder the ioynct to vvitt of the Legge if it be vnder the knee For allthoughe the Gangraena or mortificatione of the Legge vveare onlye belovv in the foresayed Legge the middle of the Legge as yet illaef vnhurt sound vvherfor it is all vvayes better to make the stumpe short then longe because vvithe his length it is associated vvith a certayne deformitye might cause greate impediment vnto the patiente vvith thrustinge of the same heer agaynste this thinge ther agaynste somvvhat els VVhich in the Arme is contrary because ther it is better that vve suffer him â—o keepe as longe a parte therof as is possible to be by any meanes done It is right true if so be the Gangraena ExceptioÌ„ or mortificatione of the Legge doe end in the ioynct or close thervnto noe higher then to the beginninge of the hippe vve must then allvvayes rather doe the extirpatione in the ioyncte then above the same especiallye in the hippe Because the accidentes might allvvayes be vvorse consideringe the greate Vaynes Arteryes Synnues vvhich by hovv much the more vve
foresayed vaynes have bīne retayned in the supersituated partes although it semeth not that the foresayed parte is in any sorte corrupted or putrifyed then onlye soacked throughe vvith some certayne venoumousenes vvhertroughe sometimes that parte hath binne prepared as it vveare to some mortificatione or Gangraenatione that vve supposing to take houlde one the vaynes vvith the Crovvesbill and soe to bind them doe most commonlye chaunce to breake betvveene the Crovvesbill or els hovv gentlelye soever vve knit the threde together one that sorte to tye them are throughe the tyinge of the threde notvvithastndinge cutt a sunder vvherthroughe vve are in the end constrayned to vse the actuall Cauterye Galenus And not vvithout occasione Galenus testifyeth vnto vs to be a thinge verye expediente necessarye to stench and restraygne the bloode throughe actualle Cauteryes vvhich throughe anye corruptione hath corroded throughe the vaynes because they nether are able to suffer the Crovvesbill therby to be dravvne out nether the tyinge bindinge It is also the most surest vvay to cauterize all that vvhich throughe the Gangraena is corrupted or els that vve applye theron any Causticke medicamentes as vve are vsed to doe one the originalle of al corruptions VVherfore if so soe be the Chyrurgian have anye suspicione of anye venoumousenes vvhich after the extirpation might be dravven invvardes tovvardes the finitimate partes theraboute it is as then the surest remedye that to the restraygninge and stenchinge of the blood he have in praeparatione and readines three or fovr fervent glovvinge cauteryes vyhich he must applye on the Orificia of the descided vaynes Hovv throughe cauterisatione vve should restraygne stēche bloode vvithout houlding or depressing the same to harde theron because thus doinge ther may be left behinde a goode Escara And if it chaunced that the bloode throughe the applicatione of one cautery vveare stenched it is then sufficiently cauterized nether must vve anye more cauterize the same Vayne prosecutinge of the same on the other vaynes Instructiō hovv to restraygne bloode throughe ligature Contrarilye vve beinge constrayned to extirpate anye membre beinge verye much plettered and broken vvhich throughe noe Gangraena or corruptione is putrified it is as then most conveniēt to restraygne the blood throughe takinge hould of the Vaynes or Arteryes vvith the Crovvesbill compraehendinge allsoe some parte of fleshe thervvith vvhich vvith a good stronge threede vve must binde together as allsoe the fleshe vvhich vvith the threde is tyed is an occasione that the ligature must be the more certayner and surer And as Galen findeth it goode to stench the bloode throughe actuall cauteryes vvherby is anye corruptione or putrefactione in like sorte alsoe he commendeth the ligature in the effluxione of bloode vvherby is noe corruptione Accorde to agree the right vvorshipfull Mr. Gourmelen Mr. Pare or anye venoumousnes VVhich right vvel may be an agreemēt betvvixt to great personages of our time vvher of the on is a Physicione and the other a Chyrurgiane because of a certayne dispute vvhich they had concerninge this matter of the meanes vvhich vve ought to vse in the restraygninge of bloode as they have agitated most inmicisiously this disputatione the one agaynst the other vvithout the one vnderstandinge the other The bloode therfore throughe the foresayed meanes beinge stenched restraygned vve must as then strovve some restringēt poulder one that parte and applye therone divers drye plumaciolles or flatt tentes and therone an ordinarye restringent or defensive plaster layinge rovvnde about the stumpe a plaster of Refrigerans Galeni because that the foresayed defensive shoulde not chaunce to cleave too fast therone and soe binde the parte as it requireth and then curinge the same as a simple vvounde allvvayes dilligentlye consideringe that vve doe not take avvay the Escara vvhich throughe the foresayed Cauteryes is made nether the threedes allsoe vvher vvith the Vaynes have binne tyed if soe be at least ther be anye It happeneth allsoe sometimes Of the dressinge after the bloode is stopped that the Vaynes after that they have binne cutt of doe dravve themselves invvardes soe that vvith the Crovvesbill in noe sorte vve can take houlde therone It might allsoe chaunce that the tyed Vayne might chaunce to vntye vvherthrough the patiente is charged vvith a nevve effluxion of bloode If soe be anye of these accidentes chaunced and come vnto your handes and it seemed best vnto you to Cauterize the Vayne then to binde her or els rather to binde then to Cauterize her and such a mischaunce or accident happened into your handes vnexpected and not beinge therone provided vvithout havinge anye Cauteryes in are adines the right vvorshipfull Mr. Pare councelleth vs very fitlye to stench the bloode The vvhich if in tvvo or thre or four Vaynes it chaunced or Arteryes at one time then must the servant of one of the circumstantes lay the endes of his fingers one each vayne one gentlelye crushinge the same one the Orificia of the Vaynes because as Galen sayeth the Chyrurgiane may have time to restraygne the bloode And then take a needle of a fingers length or longer and of a reasonable crassitude vvhich is very sharpe and rescindent as heere before is defigured vnto vs beinge threded vvith a stronge threde vvhervvith the vayne after this sort follovvinge must be tyed Havinge first of al considered vvhere the bleeding Vayne is situated Hovv vve should doe this ligature to stenche the blood you must thē thrust your needle therthroughe beginninge on the skinne a good fingers bredth higher then the vvounde one the syde of the Vayne makinge the same to come contradictorilye out of the vvoūde to vvitt one the syde alsoe somvvhat lovver then the Orificium of the Vayne because the threde may be thervnder ther to circumcingle the same sufferinge the end of the threde to hange one the skinne vvithout extractinge or vvholye dravvinge out of the same Then you must agayne thrust the same needle inter nallye in the vvounde one the other syde of the vayne because in soe doinge the threde vvhich vvith both his endes is come forth externallye on the skinne may take houlde on the foresayed vayne vvith some certayne portione of fleshe soe through both the stitches of the needle passages of the threde may stifflye be bovvnde together throughe both the endes of the foresayede threde layinge betvveen the thredes a little compresse of lether tvvice or thrice dubbled as thick as a little finger becaus ther through the payne might be praeventede vvhich through the foresayed stiffe bindinge might be caused because the knott through the continuance of time should not cut throughe the skinne A certayne ligature VVhen as this ligature is convenietlye done shee as then is verye certayne vvhich allso may be done in all partes of the bodye vvher ther is anye fluxione of bloode as in greate vvoundes of the Armes of the Hippes or of the Throte Heere before
a pinne vve fasten it or els vvith a Needle sovve it it allvvayes inferreth payne vvith it vvherfore vve must fastē the sayed Ligature ether higher or lovver or one the syde of the same one the end of the rovvler one such a place of the Ligature vvherone the Patient doth not lye as behinde one the Heade in the Temples of the Heade one the Backe on the Buttockes nether one the Flanckes or Armepittes And concerninge the dissolutione or vntyinge therine vve must cōsider tvvo thinges Tvvo thinges vvherone vve must consider in the dressinge of a vvounde Namelye one the time vvhen the Patient must be dressed one the cōvenience of doinge the same and heerin disagreethe the practise of the aunciente Chyrurgianes from vs For touching the dressinge of vvoundes Celsus vvilleth that vve ought not to dresse the vvoūde but in thre dayes once suffering it tvvo dayes Celsus to continue vvithout dressing And then vvilleth he vs that vve dresse it but once in five dayes And as touchinge the simple fractures Hippocrates Hippocrates councelleth vs that in thre dayes once vve dresse thē But novve adayes vve doe not observe this mānes for vve dresse the Patiēt after the first dressinge 24 hovvres vnles vve feared anye greate fluxione of bloode vvherfore vve suffered the Patient to lye lōger vvith out dressing to vvitt tvvo three foure or five dayes longe It is right true that vve sometimes make loose the ligamēt in tvvo or three dayes once vvithout touchinge of the playster onlye to give ayre to the parte to note vvhether there be nether Inflāmatione nor any other Accident come ther vnto But vvhen as the vvounde is come to verye great suppuratiō that ther is much matter payne or Inflammatione at hande vve as then dresse the vvounde tvvo or three times in the space of 24 houres to vvitt all eight hovveres once if it be possible And touching the simple Fractures For simple fractures vve keep thē sometimes sixe or seaven dayes vndressed vnles that ther vveare anye Accidentes at hād but allvvayes vve tarrye as longe as is possible for hovv little soever vve touch a brokē legge the endes of the bones of the fracture are neverthelesse stirred dislocated the on rubbed agaynst the other vvherthroughe is caused payne and the combinatione or together healinge is hindered because that all conglutinatione can not be vvith out cōtinuall coniunctione of the one parte vvith the other The redressinge or dressinge Hovv vve may gētlelye take of the Ligament must be done one this manner to vvitt that vve easilye make loose the bande or rovvler novv vvith the one hande and then vvith the other looseninge of the same alvvayes houldinge the vvhole Ligament in the hande But because most commōlye the first dressinge of the vvounde cleaveth soe fast as if vvith glevve it vveare theron fastened because of the bloode matter vvhich is therone dryed and baked vve must first of all therfore madefye moysten the same vvith a little vvarmed vvyne and thervvith soacke the same because the ligament may be taken revolved therof vvithout payne yea or els also in the vvindinge of of the same comming on the vvounde vve might ther everye time cutt it of because in soe doing vve might by peecemeale take avvay the same vvithout in any sorte hurtinge of the Patient ⧠How we shall dresse the broken Armes hippes and legges Chap. 5. Our māner of dressinge of al brokē legges may be assimilated and compated vvith the manner of the auncient Chyrurgianes AL thoughe that our common practise of the dressinge of all broken Legges seemeth to be alienate and to differ from the manner of doinge of the antique auncient professors Chyrurgiās it is notvvithstanding in such sorte that vve easyly can compare them together All the auncient physitions Chyrurgianes have binne of opiniō that in the Fractures vve ought to vse a dubble kinde of Ligament Namelye inferiore ligamentes vvhich they called Hypodesmidas superior ligatures vvhich they called Hypodesmous they have these names because of their situatione because some of them are tyed and bovvnd vnder some agayn above And as touchinge the inferioure ligamētes Hippocrates maketh mention of tvvo sortes Tvvo sortes of inferior or vnderligamētes VVherof the first the shortest beginneth one the fracture layinge alvvayes the one end contradictorilye therone because it should not vvholy lye on the place of the payn vvhich ligament must be tyed round about the fracture then be reduced vpvvardes vvhere he as thē endeth This ligament must closelye be vvounde together because so the fluxiō vvhich might chaūce to sincke into the disseased parte might the better be kept therout The seconde ligament vvhich allmost must be as longe agayne as the first is allso begunne one the same manner to vvitt on the fracture layinge onlye therone a turne or tvvo vvinding dovvnevvardes to crushe therout the bloode vvhich might chaunce to sincke into the fracture vvith circumvolutiōs vvhich must be layed a little more a parte the one frō the other then in the first ligament they vveare for vve must take heede of makinge to greate expressiones of bloode in the endes of the Armes or legges that vvithout imflammatiō they can not receave much therof and the ligament being come dovvne must vvinde the same vpvvardes agayne to come agayn to that place vvher vve did beginn because both these ligamentes might hould fast and the muscles be brought into theire naturall situation vvhich through the tvvo formost ligationes might be brought therout Subdivisiō of the seconde inferior ligature Other auncient Chyrurgianes make of this nethermost ligature tvvo ligationes vvherof the one is the surest the seconde for the fractures vvhich beginneth one the brokē parte having therafter made one or tvvo circumvolutiones then is the foresaved ligature reduced dovvnevvardes The other vvhich may be the thirde for the fractures must be begunne on the beginning of the parte endinge supernally vvher the first ligatiō is ended passing over the Fracture Soe that they impose therone thre ligationes all vvhich three vve may call inferior ligamētes The first vvhich ascendeth from the fracture one highe as from the middle of the legge tovvarde the knee The seconde vvhich descēdeth from the fracture dovvnevvardes as from the middle of the legg tovvardes the foote The third vvhich from the extreameste part of the Ioyncte ascendeth superiorlye as frō the the soule of the foote tovvardes the knees But novveadayes folovving our common practise An astringent plaster on the fracture vvhich vve vse before these three ligamentes vve applye first of all one the place of the fracture an astringent Plaster vvhich is made of Bolus of flovver or volatill meale of vvhytes of Egges of Oyle of Roses of a little Terebentine in steade of Cerotū Galeni vvhich the aunciēt Chyrurgians vsed After the first dressing vve vse the Plaster of
the vvounded or hurte entralies not so pungent and sharp but somvvhat more surde and benumde The occasione of the bloodyeflixe is the venoumouse puissance and force Occasion cause of the Dysenteria Dynamis of the acute saulte and mordicant humoures vvhich beinge as it vveare on the iournye to descende right to the guttes but they come recurvared in form of this lettre S. as in the situatione they must passe by manye recurvationes cōcavityes vvher they cleaving fast first of al crudifye and excoriate the foresayed guttes in the end throughe theire acuitye corrode the same as is the cholericke humiditye the melancholycke humors and the saulte Petuita the vvhich is ether ingēdred internally in the guttes or els congregate together in other place are soe driven that vvay as it happeneth commonlye in the Pestilentialle agues in Causo colliqvanti Phthisi Athrophia in the Cacochimia in the inflammatione and in the colliquation of the vvorthyest partes The humors are also irritated and provoacked through causticke and venoumouse medicamentes as throughe the Coloquintida Scammonia or throughe the Sublimated poulder of a Diamante Ravve fruicte causeth the Bloodyflixe Also through anye viciouse acute grosse cibaryes and those vvhich are apte vnto corruptione or els is not sufficientlye dressed Alsoe throughe any fruicte as by cherryes Blackecherryes Plumbes Peatches Coucoumbres Milions such like vvhich vve call Hotatij Fructus vvhich more throughe the constitutione of the ayre vvhich ether is to moyste and pluviouse or raynye to coulde or to hott in others through intemperature and other inordinate victitatione or debacchatione by the vvhich it inseparablelye happeneth as vvell in the VVinter as in the Summer that this dissease of the bloodyeflixe afflicteth man kinde It is right true that this dissease Indicati◠hovv vve may easilye or difficultlye attayn to the Bloodyeflixe oftentimes reagneth in the Prime or vernall time of the yeare and especially in the Harvest or Autumne in the vvhich time the humors doe most impeach hurt vs vvith the qvallityes Havinge observed all these thinges vve must consider one the quantitye and quallitye of the dissease as on the greatnes of the vlceratiō and the superfluitye of bloode and one the greate corrosione and one the violence of the dissease therbye to iudge vvhether the dissease vvith anye facilitye difficulty or impossibilitye may be repelled and cured VVe esteeme the cure of the Dysenterya to be of more facilitye the same beinge in the great guttes or intestines Caecum Colon Rectum thē it being in the smalle entralles Duodenum Ieiunum and Ileum VVe take also the same to be lesse daungerouse in yonge persons and in the men then in yonge children and vvoemen In a longevalle or longe continuing Dysenterye it is a badde signe vvhē the appetite is departed yet a farre more vvorse signe vvhē as ther are associated vnto the same Agues or Imflammationes They vvhich are of most experiēce may iudge of this poyncte As is that vvhich is caused out of anye Apostemation beinge burst out of the Liver or of the Milte vvhich verye rarelye happeneth and yet more rare out of the pulmonicalle Apostemationes vvherof the matter disgorgeth it selfe in the left ventricle of the Harte and soe into the Artery called Aorta the truncke or body of all other Arteryes frō thence into the Vaynes of the Mesentery vvhich are extēded to the entralles the vvhich passage or vvay vve can not then throughe imagination compraehend and vvhich is very obscure And if soe be ther follovved any peculiare thinge therout besides the causticke and venoumouse matter it might thē inferre fearefull daungerouse accidentes to the hart of the Patiēt vvhich is the vvelspring of lyfe the onlye originall of vitall spirites vvhich are diffused over the vvhole body are occasione of the actione motione also all other agilityes of the bodye The evomitiō of the choloricke humors in the beginning of the dissease doe beare vvitnes alsoe of the daunger follovvinge The bloody flixe vvhich is caused out of any melācholicke humors is esteemed to be vvithout anye hope The convulsiō of synnues the Hickough the parbraking are forerunners as it vveare embassadoures of death In like sorte allsoe vvhen vve espye a blacke spott behinde the left eare as bigge as a Vetche vvherbye is great alteratione that allso is a signe of Death as Hippocrates vvithnesseth vnto vs. If soe be this dissease through negligēce or through malice or aulteration or by any other meanes came to be inveterated the Patient as then vvill vvholye consume vvexe so feeble that vvithout great difficultye he shall not be victor therof This therfor is the cause or occasiō the species kindes of this dissease the afflicted opressed parte beinge aperte and knovvne vve must novv proceede to the resanatione of the same The finall end of the curatione is ether generalle or specialle The generall end is to be noted ether on the dissease or on the Physitione as on both the especiallist most principall personages vvhich acte and sett forth the Historye of this dissease In all the kindes of Dysenteria Cure of the Dysenteria the patient must keepe himselfe reposed and quiet because all vlcerationes desire to be quietlye kepte and in ease Notvvithstandinge Hippocrates in his third boocke de Diaeta councelleth that vve shoulde cause the Patient vvhich hath the bloodye flixe to vvalke alsoe cause him to stirre his bodye vvherby he meaneth that vve ought to doe the same before the foresayed Dysenteria become because of the Prophylactica therthroughe to prevent the procreatiō of all badde humors to defend the same out of the intestines cause them to vvithdravve themselves into other externall partes of the bodye Farthermore the patient must allvvayes retayne his stooles as longe as he possibly may or can vvithout constraygninge himselfe thervnto The Chyrurgian must first of al consider on the vse of the astringent medicamentes What astringent medicamētes the Patient must vse vvhich before repast or comestion are vsed for he cōtayninge the viandes or cibaryes they helpe also to the digestiō of the same but by the astringent thinges I vnderstande meane vvhich are reasonablelye fortifyinge and confortative and those vvhich are helpefulle to the concoctione For it vveare the greatest absurdest error of the vvorlde if soe be in the first especiallye in an vnhealthfulle bodye to vse violent stopping astringent medicamētes for it vveare nothinge els thē to shutt keepe our enimye or theefe vvithin doores VVherfore his viandes or meate drincke What his meates drinckes must be must onlye be Diureticke astringent causinge to voyde vrine because through the vrine especially all aquositye of the blood is evacuated but if so be you perceave that the great toughenes of the acute sharp adusted Pituita or aquosity vvhich is verye retardatelye expelled
constitutione of mans bodye vvherthrough the Ioynctes are throughely soacked moystened because of the humiditye vvhich is disperced throughe the vvhole massa of the bloode soe that by this meanes the vvoundes are better mundified and incarnated and those partes doe increace and pingvifye Effects of Cholera In like sort alsoe doth Cholera or anger and yet also more then the immoderate ioy because heerby besydes all this that in the spirites humors of the bodye is caused greate corrvptione and they throughe theire greate heat caloure chaunce to inflame and by this meanes consequently the vvhole habitvde of the body is replete vvith putride agues hovv little sicke soever the persone be vvhich foresayed agues if they chaunce to afflict the patient vnto death as it oftentimes happeneth vve most commōlye then attribute the same vnto his vvound Accidentes of sorrovve as if of the Chyrurgiane he had not binne vvell handled and not to the ague Is it not evidente enoughe vnto vs vvhat accidentes are caused throughe sorrovv and greefe hovv healthfull sovnd soever the personne be vvhich is thervvith intrapped for she soe reserateth and as it vveare strictly occludeth the Harte that by noe meanes there can engendre anye vitall spirites and hovv fevv soever ther are yet they may not be dispercede vvith the bloode throughe the vvhole body because the same is grosse and tenebrous by the vvhich the vitall virtues and al theire accōplices are debilitated so that in the end a man is in his minde vexed hebede The melācholicke doe hate thēselves the Harte omitteth all ioy pleasure he odiously hateth himselfe fallinge into desperatione and raginge havinge lost his livelye coloure in his face consuming the body vvherby oftentimes must follovv death It vvill not also be alienate vnto our purpose to the a poroving of my sayinges that I heere recite that vvhich the father of eloquence hath vvrittē ad Atticum the vvordes vvherof are these It vveare an excellent matter my good frend Atticus that man could live vvithout meate or drincke but yet a farre more excellellēter matter if so be vvithout anye envie and hate vve coulde Live because those viandes vvhich vve eate doe corrupt nothīg els thē our humours but the trayterous envie and sorrovv doe consume vs evē vnto the bones Envye malice consume the bones corrode the entralls as vve playnlye may behoulde for man sickeneth through some certayne envye malice of the vvhich he by continuance of time dieth Doest thou not knovv by experience that tvvo torturors vvhich vvill deprive a mā of life that the torturer of greefe and sorrovve is the most cruellest yea then of the Gluttonye Effectes of stupefactione Nether may vve heere omitt to recense and speake of the obstupescēce feare vvhervvith the covvardes faynte harted are oftentimes touched and taken This stupor causeth in vs the same accidētes vvhich the sorrovve causeth but somvvhat greater for the time for this fore sayed stupefactione and feare expulseth from him retracteth tovvarde the harte but vvith more festination more raptnes then the sorrovv the bloode the vitall spirites vvherfor vve may perceave that the face in the time of stupefactione feare vvaxeth pale and the externall partes coulde vvith tremblinge of the vvhole body the Belly relaxateth the speech fayleth vvith a greate reverberation of the harte because that throughe the greate quantity of bloode of the spirites vvhich suddaynly doe retire thethervvardes being allmost suffocated can verye difficultlye move it selfe but greatly desireth to be refreshed and discharged of such a sarcinatione so that oftentimes ther follovveth death because the bloode being dravvne tovvardes the Harte suffocateth it selfe there by that meanes the naturall calor and the vitall spirites beīg extingvished Error of the vulgare cōmon poeple vvithout the vvhich the life of man can not be preserved If so be that anye bodye beinge vvounded through perturbatiōs of the mind doe chaūce to dye the vulgare commō poeple vvill not attribute the occasiō of death vnto chose praecedent or praenominated occasions but farre more to the negligence and ignorance of the Chyrurgian vvhich hath not intreacted him as it vveare convenient he had done Feare and nicenes doe impeach health although that those vvhich have a more sovvnder iudgement of such occasions vvill iudge clane contrarye thervnto and others The like also may be sayed of those vvhich vvill not allovv of the vvill and intente of the Chyrurgian nether of anye other remedyes vvhich vveare commodious and proffitable for his health beinge ether to timorous or delicate to suffer any apertion vvhich for his disease had binne necessarye to administre issue passage to some corrodent matter or parcells of bones that lye there praepared readye to be taken out vvhich by theire remansione in that place doe also corrupte the finitimate partes doe alter permutate the remanent part of bone and corrupt the Marrovve vvherby the health can not suddaynlye follovve as the Chyrurgiane is exoptatinge vvishinge for the same yea also by this meanes oftentimes remayne incurable by vvhich occasione the Chyrurgiane The Historye of Duke d'Aumalle aftervvardes Duke of Guyse vvith his Patient must hope for that vvhich his Patient vvill not suffer and yet notvvithstandinge is required of his disease And to this end Du Bellay reciteth in his memoryes that the Duke d'Aumall sonne to the Duke a Gvyse being mortally vvoūded vvith a splīter of a laūce vvhich pearced his Eye sayed to the Chyrurgians intreate or handle not my sonne as a Prince or mightye Lord but as a Pioner or servant vvhich vvas alsoe an occasione of his resanation because he suffered Contemplation of instrumentes that the tronchone of the Launce vvhich stucke clean through his heade to be vvith force and violence dravvne therout And if therfore vve desire to enter into the contēplatiō of the diversityes of instrumemētes vvhervvith the vvoūdes are made vve shall then finde sufficient occasion to establishe the vnexspected death considering onlye the matter vvherof the vvoundes are receaved as vvell of the small as greate vvoundes Those vvhich have vvritten of Agriculture Whervvith the vvounde is made must be cōsidered or tillage Gardening as Cato Plinius Columella say that theris greate difference vvhether a tree be vvith an Iron knife engraffed or vvith a knife of Bone And vve make little or noe differēce vvhether our bodyes are vvounded vvith Leade Iron or Brasse seing that brasse being mixed vvithe the matter of our vvoundes resolveth it selfe into viriditye vvhich corrodeth the fleshe and causeth somtimes such an inflammatiō that death therafter follovveth Nether is it sufficiēt that in shorte time vve have accommodated this mettle vnto our ruine but novv by little and little vve make it four cornerde vvhich is farre more daungerouse thē if it vveare rounde because throughe the quadrangulatenes therof it rescindeth cutteth breaketh
melanckolye disseases In the legges are eight in each legge four vvherof the first is called Vena poplitis Vena Poplitis situated in the hockes or fovldinge of the knees is opened agaynst all disseases of the nethermost part of the bellye The second Saphena or mother vayne Saphena or Mother vayne vvhich vve opeÌ„ one the insyde of the legge vnder the anckle in all disseases of the kidnies of the vvombe to provoacke in the vvoemen ther monthlye sicknes or mestruousnes in all runninge of the raygnes and in Venus botches or as vve call them in lattin Bubones The third is the Schiaticke vayn vvhich externallye demonstrateth her selfe above the aÌ„ckle vvhich is only opened agynst the dissease called Sciatica The vayn Sciâ—tica The kidnye vayne agaynst all payne and doloure of the hippes and flanckes The fourth is the mediane or kidnyevayne situated belovve the foote and is phlebotomized agaynst all disseases of the kidnyes Amongst all the other vvhich are most coÌ„monlye opened are those three vvhich in the foulding of the arme are phlebotomized to vvit the head vayn Basilica the mediaÌ„ Basilica or liver vayne is daungerous to be phlebotomised VVe must dilligeÌ„tlye coÌ„sider that vvhen vve make an inscisioÌ„ theriÌ„ that vnder the Basilica or Liver vayne lyeth an artery or great harte vayne vnder the Median a synnue or tendone of the muscle Biceps or both of these together but vnder the Cephalica is nether synnue artery or tendone sitvated Cephalica or head vayne is opened vvithout daunger vvherfore amoÌ„gst all other vaynes ther is none vvhich vvith lesse perril dauÌ„ger may be opened If so be that through mischauÌ„ce in opening of the vayne Basilica vve chauÌ„ced to hurte the artery vvhich ther vnder is sitvated as I have knoovvne to have chauÌ„ced vve must praeseÌ„tlye for the stoppinge and restrayninge of the bloode and to the curing of the arterye vvithout leavinge anye Aneurisma Remedye for a vvouÌ„ded arterye cleave a bean in tvvo peeces laye the one halfe of the beane one the apertione of the vayne vvith a coÌ„presse therone gentlye tyed vvithout visitinge of the same in thre or foure dayes or once offer to touch it If so be in the apertion of the mediane vve chaunced to pricke the subter situated synnue or tendone vve must then immediatly phlebotomize the patient in the other arme and vve must droppe in the vvounde of the pricked synnue a little hott oyle of Terpentin and a little vvoolle beinge dipped therin vppon the same therby to keepe the apertione aperte then lay a playster of Diacalcitheos rovvnde aboute the vvounded parte of the vvhole arme vvhich hath biÌ„ne liquefacted vvith oyle of roses and vineger Of the Arteriotomia or apertion of the Arterys or hartvaynes Chap 5. COncerning the Arteriotomia or apertione of the Arteryes the praedicessors auncient professors vveare vvont to effect it especialle behinde the eares in the temples of the heade agaynst all continuall rebellious fluxions Rheumes of the eyes in like sort alsoe agaynst all diseases of the heade vvhich have takeÌ„ ther originall froÌ„ hotte dampishe or subtile rheumes as yet novv a dayes vve doe but not vvho lye as they vveare vvonte to doe in openinge of the same for soe farre forth as if the Arterye be small they then cut her cleane a sunder they also cut a peece therof avvay both the endes are dravven invvardes vvher by shee as then bleedeth noe more And if the Arterye be greate violentlye beateth it is the surest vvay that vve tye her vnder above and then betvveen both those ligations cut her of but the thredes vvhervvith vve binde her must be stroÌ„g closly tyed because that through the continvall beatinge of the arterye the thredes looseÌ„ the arterye openeth if so be it be not stiflye bovvnde because that she should not chaunce to corrupt before the inscision be replete grovveÌ„ full of flesh vvher through the mouth of the foresayed artery is stopped Hovv vve vse novv adayes to to open an artery But novv a dayes vve only make a simple inscision in the artery in such a manner as vve make an apertion in the vaynes vvithout cutting of the same clean of having dravven as much blood therout as vve desire vve theÌ„ lay a litle playster of masticke on the apertion a litle compresse tyed theron rovvnd abovt the vvhole head as close as is possible I knovve right vvell that ther are some vvhich houlde this apertione of the arteryes verye suspecte because it caÌ„ hardlye be stopped agayne and in doinge this ther remayneth a cicatrice in those partes vvhich are situated rovvnde about the foresayed arterye before the same is fullye cured and ther throughe often times an Aneurisma caused vvhich is verye troublesome Aneurisma is a daungerous dissese and daungerous for the patient But I may vvith verity affirme it to be true that oftentimes I have seene opened the arteryes of the temples of the heade vvithout any of the foresayed accidentes beinge happened thervnto the vvhich I couÌ„cel the yonge Chyrurgiane to doe it onlye in this place because such an inscisione is more fitter lesse daungerouse theÌ„ the vvhole cuttings of and ligature of the same ⧠Of the swellinge Aneurisma and of the meanes howe to binde and cut of the same Chap. 6. Discription of the tumefaction Aneurisma THis tumefactione Aneurisma is caused most commonlye throughe the dilatation of an arterye vvhich only vve must vnderstande of the smalle Aneurismata beinge impossible that the arterye shoulde so dilate as it vveare vnshutt in the greate Aneurismata vvhich oftentimes vve see vvherfor vve vvill rather say and houlde vvith the opinione of the auncieÌ„t professors that Aneurisma is then caused vvheÌ„ as the bloode and the vitall spirites are repulsed out of the arteryes throughe the apertion or orificia of the same vvhich vve call Anastomosin or els vvhen as the tunicle of the arterye is burst it be ether throughe a vvounde or by anye other occasione as vve may se vvhen as the Chyrurgiane purposinge to opene the vayne in the elbovve by chauÌ„ce prickethe the arterye vvhich is theruÌ„der sitvated the skiÌ„ne vvhich is theroÌ„ lyinge cicatrizeth it selfe and the perforatioÌ„ of the artery through her coÌ„tinvalle reverberatioÌ„e tarrieth vncured opeÌ„ is not stopt or vvith anye carnall substance replete as beinge vnprofitable for anye vse in noe sorte can be bound so close as the arterye of the temples of the heade but throughe the blood vitalle spirites vvhich by degrees issue therout are congregatede vnder the skinne soe conseqventlye cause the svvelliÌ„g supposinge they verye vvell did knovve therin to be matter or any other slimye substance or viscositye for vvhich reason they have made an apertione therin vvhervppon a little time therafter death hath follovved because of the bloode and of the vitall spirites vvhich in