mencion of all these things where he speaketh of Purgations But some perchaunce will say How then doth not Hippocrates councell vs to take away the bloud for these causes aboue especified By my iudgement he commaundeth them thus but in few wordes and that not without demonstration as he and all the auncients were accustomed to doe Thou shalt vnderstand that it is so if that thou wilt reade againe his words that are these In euery fresh wound except it be in the belly it is expedient to let bloud flow out of it more or lesse For by that meanes the wound shall be lesse grieuous the inflamation lesse and all the places about it But if thou shalt remember hereafter those wordes that he writ when he did entreate if vlcers and also those thinges that he hath propounded in all his other bookes that is to say how that a Phisition ought to be an imitator and follower not onely of nature but also of those things which shal be profitable when they come to their naturall state Then thou shalt plainly vnderstād the minde of Hippocrates and also how that bloud ought to be drawen when wounds be great but if out of such wounds bloud doth not flow especially when as it is a thing most conuenient then thou must adde and supply those thinges that be néedefull and necessarie The matter that followeth he conioyneth it with that which is abouesayde Also it is profitable that from inueterate vlcers bloud doe flow and also from the parts which are about them But forasmuch as he hath said before that bloud should flow from euery gréene wound except that he made mencion now of inueterate vlcers it would séeme to some that he dyd entreate onely of greene and fresh wounds Therefore he did well adde this that is to say how that it is a thing most méete to draw bloud from inueterate vlcers Wherefore now seeing that the doctrine which we haue taken of him is true and firme that is to say how a flux beginning at the contrary parts ought to be drawen how that which is alreadie fixed in the partie ought to be purged either from the payned part or from the part next vnto it therefore it is now easie for vs to conclude of the detraction of bloud how that in the beginning it ought to be done in the part farre of and then in the vlcerate parts Furthermore if you doe adde vnto these which I haue before spoken how that Hippocrates coūselleth to euacuate the superfluous humour and that detraction of bloud ought to be vsed when it surmounteth and that a medicament ought to be giuen which hath vertue to purge humours Chollerike Melancholicke and Phlegmatike Yet haue in remembraunce all these woords how that none of them is the curation of vlcers no not so much as of an vlcer but rather of Cacochimia that is coniunct with the vlcer or of Plethor or of Phlegmon or of Herpis or other like dispositions Neither yet be not forgetfull of this thing that is to say that none of the accidents of the vlcer giueth such proper indication as magnitude In the booke precedent we haue intreated of vlcers wherein we haue declared all the differences of vlcers how many and what they be what is the indication of either of thē Howbeit I haue not sppken in the saide booke how the indication of purging is taken of the vehemencie of the disease bicause it should not be to much prolixitie demonstration Neither in the saide booke I haue connixed the curation of all the bodie with the vlcers but yet I haue declared in this present booke in as much as it was agréeable and vtill for my purpose The seauenth Chapter BVt the firme and perfect demonstration of this kinde of Indication which is taken of the vehemencie of the disease shal be shewed héereafter In like maner the indication which is takē of the age that which is takē of purging humours Likewise the Indication which is taken of the afflicted parts shal be declared in the bookes which follow But as yet we haue onlie made mention of the curatiue Indication that may be taken of the nature of the said parts that is to saie of temperance substance But trulie we haue nothing touched the Indication which is taken of the scituation figure of the partes Therefore we will speake of the indications that be profitable for the curation of Vlcers The part trulie that hath sharpe and quicke senses ought as much as is possible to be cured without dolour or paine But the Anodinon of such remedies is spoken of in the Booke which entreateth of the simple medicaments But he that hath but small senses and those that be not quicke may if the disease require suffer strong medicines But we must haue regard and consideration to the strength of the principall member whereof we will more copiouslie héereafter declare when as we shall haue occasion to speake of Phlegmon But if it be not a principall member surelie without daunger you may minister vnto it such medicines as mittigate and asswage the Gréeks call them Calasticke whereof we will plainlie and more at large declare héereafter At this present we will declare the indication which is taken of the scituation and figure of the partes and then we wil finish and conclude this fourth booke For this cause haue we excogitated and inuented certaine medicines that must be giuen to him that hath his ventricle vlcerate the which medicines must be dronken at once but to him that hath his throate vlcerate they must be ministered at sundry times by little and little because of the passing which bringeth great vtilitie to the vlcer neither they must be ministred so in such case as to him that hath his ventricle vlcerate Likewise we haue declared by the situation and figure of the said part that such medicines ought to be made grosser and thick more clammy than the other because that the throte is a passage of things that is eaten and dronken And for that cause remedies which may conioyne cleane on euerie side of it is most conuenient and not such as are thinne and easie to slide away For the thicke are alwaies about the parts and the clammy doe cleaue vnto it Likewise vlcers that are in the thick intestines haue more néede of medicines which are cast out by the fundament in asmuch as they be next vnto it But the vlcers that are in the thin intestines because they be fardest from the fundament require both medicines that is to say those that are receued by the mouth and those that are cast in by the fundament Now truly the cōmon indication of all the interior parts is that we ought to choose things that be most familiar to the nature of man be they meates or medicaments and to eschew those things which be contrarie vnto it Although to Vlcers which bée in the outwarde partes the vse of such medicaments be
beginnings thou shalt not néede either stitching or hookes but if thou wilt otherwise binde it vse thou either stitching or hookes Few stitches shall in this suffice And thou shalt cure greate vlcers with vehement desiccatiue medicines if thou remembrest that which before is spoken The medicines which doe moderatly drye will abundantly heale small vlcers Déepe vlcers be euer also great therefore they must be rolled with two beginnings and the lippes of it be spedely adglutinated and those which are both verye déepe and also long as they are great two wayes so doe they shew a double indication therefore they require vehement siccatiues Neither ioyne thou the lippes to soone together and rolle it with two beginnings and take déepe stitches In like sort if there come many differences together of which euery one hath his indication it is expedient to vse them all so that they be not contrary But if they be contrary among themselues wée haue heretofore shewed how it behoueth them to be denied of these but wée will more largely set it out hereafter And now it séemeth good in this place to ende this third booke In the fourth which shall follow we will dispute of those affectes which for the more part accustome to follow vlcers and with these there shall be set out the curations of inward causes FINIS THE FOVRTH Booke of Galen called in Greeke 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and in Latine Methodus Medendi The effect of the same 1 The right method of curing malignant stubburne Vlcers 2 What Vlcers be hard to be cured 3 The method of curing an vlcer difficill to be cured by the reason of the intemperancie of the flesh 4 The curation of an vlcer when as the part is exulcerate with a tumour against nature 5 The method of curing another affect when as ill humours doe flow to the particle 6 How a man may know in certaine diseases the originall cause 7 The opinion of Thessalus in the curation of malignant vlcers 8 That of time no indication ought to be taken contrarie to the opinion of Thessalus 9 The curation of malignant vlcers according to the sentence of Hippocrates 10 That an ill affect comming to the vlcer ought first to be cured before the vlcer be taken in hand 11 The curation of those affects that flow to the vlcer according to the sentence of Hippocrates 12 What indication ought to be taken of the scituation and figure of the parts The first Chapter WE haue said that there is one kind of disease that is called solution of continuitie which cōmeth into all the parts of the bodie of mankind howbeit it hath not one name in them all For solution of continuitie in the fleshie part is called an vlcer in the bone a fracture the Gréekes call it Catagma in the nerue a conuulsion the Gréekes call it Spasma There be of the same kindes of Solutions which the Gréekes call Apospasma Regma Thlasma Thlasma in the ligament Apospasma Regma in the veines and muscles because of anie violent stroke or grieuous fall or anie other great motion The solution of continuitie called Ecchimosis in the Gréeke commeth most often with concussion and ruption Sometime solution of continuitie commeth by opening the orifices of the veines in Gréeke named Anastomasis Also it commeth of that which is called of many Diapedisis Other solutions of continuitie happen of Erosion in Gréeke called Anabrosis But it is a disposition alreadie medled and composed with an other kinde of disease that consisteth in the quantitie of the partes as before hath bene shewed when as we did intreate of hollow vlcers which doe procéede of two causes that is to saie of Exition and Erosion It is manifestlie knowen by what meanes exition commeth And if erosion abound inwardlie it commeth of Cachochimia if outwardlie it is done either by strong medicine or fire it behoueth then as is said before to take diligent héede and discerne the simple diseases from the compound for to a simple disease a simple remedie is conuenient and to a compound disease a compound medicine Also we haue said before what method must be kept to cure cōpoūd diseases yet notwithstāding it is not inough to know the generalitie of the said method but to be exercised in all parts thereof Séeing then that in the same is néede by manner of speaking of sundrie perticular methods because that euerie kinde of disease hath his owne methode then that which resteth of the curation of vlcers must bée performed in this booke taking the beginning héere Euerie vlcer is simple and alone without other dispositions and affects with it or it is with some other disposition or diuerse whereof some haue not onelie stirred vp the same vlcer but hath augmented it The other are without which the said vlcer cannot be cured Of thē we haue spoken héere before we shal speake in this present booke of the dispositions which augmenteth the vlcer in the which lyeth double counsaile of curation that is to saie either to take the said dispositions all wholie out of the bodie or to surmount the incommoditie that aboundeth in it The which thing may be easilie done if the dispositiō be little but if it be great the vlcer may not be cured vntill the same disposition be taken awaie Wherefore we must diligently consider what the said affects and dispositions be and how many in number in taking our beginning as is sayd before Euerie vlcer is by it selfe alone or with hollownesse the the flesh being subiect be natural and that there be nothing betwixt the ioyning of the lips that may let the conglutination therof which oftentimes happeneth either by haire a Spiders web mattier oyle or such lyke things that may let the ioyning together And these things are as Symptomata and accidents of the sayd wound which if they be present maye hinder the curation but if they be not they let not but the disposition of the flesh is cause of that which followeth For with the same flesh and by the same lips that were asunder are closed and the hollownesse filled It behoueth then that the sayd flesh be naturall because that these two things may be wel and commodiously made perfect Then it is naturall if it kéepe his owne temperament which thing is common to all other partes for it behoueth that the flesh subiect be wholie temperate as well to close the vlcers as to fill them with flesh But is that enough I praie you Must not the bloud that commeth to it be good also and moderate in quantitie I thinke this trulie to be true For that bloud which is corrupt doeth so differ from adglutination and filling the flesh as also somtime to exulcerate and erode the bodie And if it be ouermuch in quantitie it engendereth excrements in the vlcers as we haue before spoken and hindereth the curation And also there be thrée kindes of vlcers which are difficill and hard to be cured The first aboundeth by the
shall not take an Indication of it after foure â—…neths but that which we haue taken at the verie beginning And for a truth that I may not permit such an vlcer to abide so long time but at the first I will take awaie the cause thereof But I cannot coniecture what may shewe the time more than the number of daies except Thessalus will saie that to haue knowledge of such an vlcer we must tarrie the time but in such a case he sheweth himselfe altogether foolish That is to saie if he confesse openlie that hée knoweth not the first affect which hath inueterated the vlcer Furthermore he must plainlie also confesse the Indication curatiue to be taken of the disease and the knowledge of the disease to be taken of other things But bée it so that time serueth somewhat to the disease neuerthelesse the Indication curatiue is not taken of time But to what purpose serueth it if any Vlcer bée inueterate to do away that which letteth the coition to renue the place which is pained For thou foolish fellow if for the maligne fluxe which the Gréekes call Cachoethae the lippes be affected in such sort what shalt thou profit if thou doe cut them before thou hast prouided to stop the fluxe Trulie thou shalt but make the Vlcer wider than it is as some doe that cure vlcers after the same manner as thou doest For the cause remaining which before made the vlcer harde and flintie thou shalt doe no other thing in cutting awaie the lips but enlarge the vlcer For those which thou cuttest shall be made hard come again as they were before Although that prudent Thessalus hath not added this thing that the partes of the vlcer which are hard stonie and discouloured ought to be cut awaie but commandeth by an absolute sentence that those thinges which hinder the closing of the vlcer ought to be cut awaie and to be renued But if trulie hée had counsailed to take awaie the causes that hinder the adglutination of the vlcer and that this reason were auncient and olde I would not accuse him for it is commanded almost of all the auncient Phisitions which doe write of the curation of vlcers by a certaine reason and Method that those causes which doe excite the vlcers ought to be cut awaie euen trulie as of all other diseases For trulie I do thinke it expedient that the efficient cause remaining which exciteth the vlcers ought first to be taken awaie In other diseases it is not expedient but chieflie there the curation must be taken in hand where the efficient cause remaineth And if the sayd Thessalus hath not spoken of the causes that let the conglutination and hath onelie spoken of the lips as he hath said afterward it appereth that he is ignorant of more than he knoweth of those things which appertaineth to the curation of vlcers But it is possible that this alone is the cause which hindereth the cure of the vlcer And it may as it is aforesaid be the cause that intemperauncie which is without a tumour against nature be in the vlcerate partes and also that it be ioyned with a tomour the which doth not require that the lips should be altogether cut awaie It maye also bée the cause that Varix which is aboue it or that the milt which augmenteth it or some disease in the liuer and beside this the weaknesse of the affected part be nothing else but a manifest intemperancie And besides this a vicious humour in the bodie which the Gréekes call Cacochimia and the chiefest of all the causes which may be to the vlcers an incommoditie Truelie great abundance of humours which the Gréekes call Phlethora resorting vnto the vlcer doeth hinder the curation But if Thessalus be of that opinion that the lippes onelie must be taken awaie I saie that of many things he knoweth but one alone which is so euident that the shepheards are not ignorant thereof for if a shepheard sawe the lips of an vlcer hard flintie wan blacke or a leadie coulour hée would not doubt to cut it awaie Then for to cut awaie is an easie thing but for to cure by medicines is a greater matter and that requireth a true methode Neuerthelesse Thessalus neuer knew howe the lips might be cured by medicines for all men confesse that he hath swarued from this part of the art and as he himselfe hath shewed it séemeth that he had neither experience nor rationall knowledge of medicines which is a manifest thing by the booke that he hath made of medicines before rehearsed But of this one worke consequent wée shall entreate of those things which hée hath not writâ—…n well And now we doe intend with deliberation to speake of the curation of inueterate vlcers of the which he hath before intreated Certainlie it had bene better to haue called them Cachoethae and not inueterate theÌ„ to declare their nature disposition and cause of their generation and the curation of either of them And first to know the common curation of all vlcers for as much as they be vlcers of the which I haue written in the third booke next after the perticular and proper cure of either of them afterward the kinde of the efficient cause as I haue spoken of in this present booke And although Thessalus hath done nothing of all these things yet he doth thinke that the vlcerate place must be renued when it is made like vnto a new wound to cure it as a bloudie vlcer what is he that is exercised in the workes of the Arte that vnderstandeth not euidentlie that such a doctrine hath bene written by him that neuer cured vlcer Is it possible that a man may cure an inueterate vlcer as you may cure a bloudie wound and after he hath made it lyke vnto a fresh wound shall it be in drawing of the vlcer together by rollers or ioyning them by stitches or neither by the one or by the other but by conuenient medicines What is he that knoweth not that an vlcer called Cachoethae is caued or hollow séeing that it is made by corrosion Is it possible O foole and impudent Thessalus that a caued vlcer may grow together and be adglutinated before the cauitie be filled with flesh is not that to cure an vlcer as a gréene wound then hast thou thy selfe written in vaine that hath taken indication to cure caued vlcers not with closing but with the filling of the cauitie But if euery vlcer called Cachoethae were not hollowe of it selfe yet when it is made bloudie in cutting the lips awaie as thou commaundest then of necessitie it is made hollow and requireth great space betwixt the lips euen in such manner that I cannot sée how thou maist make them conglutinate together as a bloudie wound for if thou assaie by force and violence the lippes that are so farre a sonder of necessitie there commeth Phlegmon which letteth the sayde lyppes to close together The which thing I suppose that
not spoken of FINIS AN EPITOME VPpon Galens three bookes of naturall Faculties verie necessarie for the Students both of Philosophie and Phisicke set forth by Maister Iames Siluius Phisition FAcultas is a certaine cause Effectrix place◠in the temperature of a parte in the beginning of simples The faculties gouerning our bodie in the which our life cōsisteth are in number thrée Naturall Vitall and Animall In time Nature vse 1. Naturall is in the liuer dispearsed by the veines into the whole bodie being the third and lowest 2. Vitall is in the heart distributed by the arteries into the whole bodie being the second and meane 3. Animall is in the braine and carried by the nerues into all parts indued with the fence of féeling and voluntarie mouing being first and chiefest Indignitie place and fortitude We must first intreate of the naturall as the nourisher or piller of the rest as we proued in the order of reading or teaching Galens bookes The natural faculties which bee first principall are Generatrix Engenderer Auctrix Increaser Nutrix Nourisher which are called powers Vegitable Arist de animal lib. 2 cap. 4. The first two falties 1. Actio 1. The verie motion actiue is a substantiall forme in Materia or production to substance or procéeding to forme And that is either of all or of part as generation of humours in a liuing creature of bloud through moderate heate of both kindes of choler by immoderate heate of fleame and melancholike humours by a slowe heate and that commeth of some meate more of some lesse in all temperatures And these humours are either naturall or vnnaturall 2. Opus 1. A thing made and finished by action as all parts the bodie fashioned in the womb and by generation complete vnto the which perfection of partes the séede being rightlie once conceiued Generatrix is the chiefe and principall worker Two other faculties 1. Alteratrix The which generallie be hot colde moist and drie in their first and element all faculties and doth change the séede bloud menstruall substance into a man in which is the qualities of féeling tasting smelling and séeing for it is necessarie that out of Alteratrix bones veines nerues and all other partes be made but perticularlie she doth worke vpon that substance by facultie making bones nerues veines c. For of the foure elements mingled doth grow the perticular faculties alteratrix wherof is made the substance of euerie similer parte and so many faculties of alteratiō ther. be in liuing creatures or of planets as there are found similer parts in them 2. Formatrix This facultie verie artificiallie and with great cunning and for some cause dooth fashion the matter which is chaunged so that it may haue an apt figure for placing composition hollownesse wholenesse soundnesse Apophyses Epiphyses and other things necessarie pertaining to the constitution of the bones natures veines arteries c. The which constitution is méete for the action and vse of the parte that after shal be created that nothing be lacking nothing superfluous which otherwise might be in better sorte Auxiliares or helping facultiez as they were hande-maidēs Nutrix Nourisher Austrix Increaser This doe not onely serue for the increase of the young being once ingendred but also from the time that the séede is conceiued for it is méete that the séede be augmented by nutrition that it may suffise to constitute so manie and such parts as be necessary The male séede is first nourished with the female and afterward with a small halituouse portion of the bloud of menstruum Facul auctrices nourishers 1. Actio Is an increasing that is to saie an ampliation of the found partes which were engendered of a liuing creature in length breadth and déepnesse kéeping the proper forme and first continuitie as it is sayde in the 1. li. cap. 5. De generatione This is the worke of nature onelie when as these things which are extended to vs or pulled from vs or are amplified in one measure onelie or not in all together then this facultie beareth rule from the birth vnto the flourishing age and as I saide helpeth the facultie Generatrix in the wombe and is onelie in a liuing bodie 2. Opus The small partes of a liuing creature borne into the world which are brought into a reasonable bignesse and the bodie being little made great Auxiliares or helping faculties Alteratrix Chaunger Coctrix Digester Nutrix Nourisher Of the which we will intreate héereafter more at large Facul nutrices 1. Actio That is nutrition or the perfect assimulation of nourishment with the thing nourished that is when that thing which floweth as the forme of nourishment is put vnto fastned made like vnto all the sound parts of the nourished bodie without anie ampliatiō for the iuyce or humor when it falleth a Vasis euen as certain dew so is it dispersed through all the part which ought to be nourished and by and by it is put or ioyned vnto it and after hauing gotten sufficient drynesse and clammie humour through naturall heate it is glued and fastned it increaseth cleaueth together and is vnited in one The which commeth not so to passe in Anasarca Hidrope when as the nutriment being more watrie and not so clammie by reason of the abundance of thin watrie humours falleth frō the sound parts of the liuing creature at the last it is made like vnto the parte which should bée nourished when it is nutriment in déede other are nutriments in power more proper and remoue The which is not in Leuce 1. Vitiligo 2. Opus All the parts enduring with nourishment so long as is possible Attractrix which draweth vnto the part conuenient qualitie and iuyce This facultie like as the rest being found in some instrument as in the stomacke reines wombe milt bladder purging medicines and Alexiteries is easilie transposed into the other parts Auxili facult helping facul 3. Retentrix The reteiner of the same vntill digestion be done Coctrix Digester in altering and that maketh it like Expultrix Expeller of that which molesteth the part in quantitie qualitie or both But we will intreate of these foure faculties as most principall héereafter more at large 1. Attractrix The drawer of conuenient qualitie and iuyce into euerie parte to nourish the same the which is common vnto all partes that drawe vnto them such nutriment as is most proper for them sometime thorough straight pores as in the stomacke and sometime onelie by the temperature of the parte as almost in all the other partes or else to the voluptuous delectation of the parte whereby the mouth of the matrixe doth drawe the séede of man to the verie end and whereby the gall doth separate and drawe yeolow choler from the liuer but in the Gall yeolow choler is not ingendered as Asclapiades saith like as neither he affirmeth melancholik humour in the splene but of him it is drawen from the liuer to nourish it selfe The reines doe diuide and onelie
CERTAINE VVorkes of Galens called METHODVS MEDENDI with a briefe Declaration of the worthie Art of Medicine the Office of a Chirurgion and an Epitome of the third booke of Galen of Naturall Faculties all translated into English by Thomas Gale Maister in Chirurgerie AT LONDON Printed by Thomas East dwelling betweene Paules Wharfe and Baynards Castle 1586. TO THE RIGHT Honourable Sir Henrie Neuell Knight Lord a Burgauene and his singuler good Lord c. FOrsmuch my singuler good Lord as I haue perceiued you to be naturallie inclined to the art of Medicine and chiefelie to haue vnderstanding in that part which is commonlie called Chirurgerie I haue not beene a little carefull since my acquaintance with your Lordship to further you in the same studie euen to the vttermost of my power and forasmuch as you haue so profited not onelie in the Theorike part but also in the practike I haue thought all my paines labors well bestowed And although I should holde my peace and saie nothing heerein yet a great number of poore men and others which haue bene cured of your Lordship of many sundrie griefes and diseases will set abroade and bewraie your notorious and charitable deedes And forasmuch as your Honour hath better vnderstanding in this worthie arte than a greate manie of those which take vpon them the name of Chirurgions I might verie well saie the most parte And forasmuch as your Lordship beareth such a singuler loue vnto the same arte I am therefore moued to dedicate these my simple trauailes vnto your Honour to bee the patrone and defender thereof for I doe perceiue that now in our time no good enterprise can be gone about but false detraction and enuie is like to ouerthrowe the same which hath mooued mee for as much as you are a noble man the rather to dedicate my trauailes vnto your Honour to bee my aide and succour in the defending of this my small trauaile which I protest I haue not taken in hand neither for vaine glorie neither yet for anie worldlie profit or gaine for since the first time that I beganne to sette out anie parte of this arte in our English tongue I haue both susteined great displeasure and also lost manie profites of those which were in times past my speciall friendes and the greatest matter that they haue to saie against mee is onelie that I goe about to make euerie bodie cunning in the arte of medicine with setting foorth of these my workes in the English tongue but if it shall please your good Lordshippe to vnderstand my bounden dutie first to almightie God of whom I haue receiued the talent and also my dutie to my naturall Countrie whom I ought to profite with my talent according to the saying of our sauiour Iesus Christ which saith He that hideth his talent in the ground and vseth it not to the profit of his neighbour it shall be taken from him againe Wherefore my good Lord I thinke it my dutie to set foorth these thinges for the commoditie of the common wealth of my Countrie What greater profite may come vnto any in the time of neede than to cure his grieuous woundes without which hee should presentlie die to cure his grieuous sores which dooth not onelie eate the flesh but fretteth and rotteth in sunder the great bones with most vehement griefe and paine and also great inflammations and tumours against Nature which taketh awaie the naturall actions of the bodie and molesteth it with most vehement and continuall paine and also curing of broken bones and bones beeing out of ioynt to restore them into their naturall places againe with many other griefes appertaining to the same arte which were heere to long to bee recited And for as much as manie haue taken vppon them the curation of these diseases aboue sayde and haue committed many great errors for lacke of knowledge to no small daunger of Gods people no lesse hurt of the cōmō wealth I haue thought it therefore my bounden dutie to set foorth my onelie one talent in furthering of knowledge euen as the poore widow did which had but onelie one farthing and put the same into the Lords treasure like as that same was accepted with almightie God so I trust he wil accept this my good will according to the knowledge which he hath giuen me so that at the last daie I trust he shall not saie vnto mee thou hast hidde thy talent in the ground and not profited therewith as thou shouldest haue done And also I trust that good men of my Countrie shal haue no cause to haue an euill opinion in mee either through negligence or idlenesse for that they may well perceiue that these trauailes do both require studie and time of setting foorth Now my singuler good Lord if they shall saie it is not good because it is in the English tongue then I must alleadge vnto them the famous men which were the chiefe setters forth of the same art as Hippocrates and Galen amongst the Grecians whatsoeuer they might vnderstand by foreine languages either else gather by reason or by experience or obseruation of time all these whatsoeuer they were they did write them in Greeke which was their owne language tongue to that end they might the better bee vnderstanded and sooner bee learned Also in like manner the worthie Arabians as that noble king Auicen Auerois Albucasis Mesue a great sort more of worthie men which did collect and translate manie noble workes of Medicine out of the Greeke tongue the Ebrue tongue and many other languages into their owne naturall tongue which was then the Arabian tongue In lyke manner the Latinists were no lesse diligent to collect and gather both out of the Greeke and Arabian tongue wrote it in their owne tongue as you may reade in the workes of those famous men Plinius and Cornelius Celsus with manie other more whose workes are manifest at this present daie If these worthie men haue beene moued with good conscience for knowledge sake and for the better maintenance of their common wealth in setting foorth of this art for the reliefe comfort succour helpe and health of those that be sicke and diseased or other waies wounded or hurt in warre or by mischaunce c. Why should not I then without blame or reproch for the furtherance of knowledge and other necessarie things aboue rehearsed set foorth in our English tongue some part of this good and necessarie arte for the instruction and further knowledge of those young students which are desirous to learne the same and to vse the same to the profite of the common wealth in the time of necessitie I doe not meane that honest Artists as Tailers Shoomakers Weauers or anie other handie occupations that they should leaue their artes wherein they are perfect and fal to this art of Medicine for I doe wish with all my heart that politike lawes might be made to constraine euerie man to follow that art in
these sixe things not naturall Therefore it may be saide Necessitas non legem habet therefore there ought no lawe to bée made against that thing that must be of necessitie As for example of necessitie we must eate drinke that we may liue Therefore it were tyrannicall to forbidde vs to eate and drinke for they be proper things for vs whereby we doe liue But yet the abusing of meate and drinke may be spoken against and good and iust lawes made for the reformation thereof In like manner for abusing the arte of Phisicke or Chirurgerie there hath béene good and wholesome lawes made héertofore and I trust in our Lord God shall be hereafter againe But to commaund from them the knowledge of their arte or anie parte thereof or other necessarie instruments or medicaments wherewith they should cure their grieued and wounded Patients which other wayes must of necessitie perish or else not bée cured at all Such commaundements or lawes were tyrannicall and not to be well thought of for that they should let the workes of mercie in this most excellent arte of curing to be ministred vnto the people orderlie for their safegard curing of their diseases There were much to be spoken of these sixe vnnaturall things which maketh nothing for my purpose héere in this place for that I intend nothing but to proue that these bée necessarie instruments for the Arte of Chyrurgerie by certaine examples as you haue heard for these things are spoken of at large not onelie in many worthie bookes which are set forth by Hyppocrates and Galen but also in all other worthie mens bookes that haue written of this art at large as it may appeare at this present daie Some men might héere aske a question why these are called not naturall things for it is to be thought that sléepe meate and drinke moouing c. should be naturall But forasmuch as both health and sicknesse doth come by these things therfore they be called not naturall They bée not called against nature for sicknesse the cause of sicknesse and the accidents that follow sicknesse those be called Praeter naturam against nature Neither may they bée called naturall for the that sicknesses cōmeth by thē But they are indifferētly called not natural These things are so necessary for our bodies as I haue said before that we do not onlie liue by them but the matter substanticall of our bodies after generation is increased and mainteined by them and also all the humours and temperaments with the spirits and other things contained in the same bodie should vtterlie cease if it were not but for those sixe thinges Thus I conclude with these examples aforesaid to proue this part to be necessarie for the art of Chirurgerie doubting nothing but those that be learned men and men of reason will so iudge for so haue the auncient fathers before our daies appointed it to be Now that you may the better come to the perfect knowledge of these things I thinke it good to declare vnto you some of the bookes which both Hyppocrates and Galen haue written Hyppocrates de elementis Hyppo de Aqua Aere regionibus Hyppo de flatibus Hyppo de vrinarum differentijs Hyppo de ratione victus salubris Hyppo de ratione victus prauatorū Galen de sanitate tuenda Galen de imperica dieta sub figuratione Galen de aqua Gal. de ptissana Galen de Euchimia Caccochimia Galen de attenuante crassante victu with many more bookes written by most excellent men sence their times which were superfluous here to be rehersed for as much as these are most necessary to be vnderstoode and sufficient for the profe hereof And thus I commit this part vnto your friendly iudgement procéeding vnto the fourth part called Semiotica Semiotica is an other part perteining to the arte of Chirurgerie which part doth iudge by signes and tokēs what the diseases are and what be their natures and what humors or other things be the cause therof and whether they may be cured easely and in short time or whether they be hard to be cured must be cured in longer time or if they cannot be cured at all Or else whether it is not necessarie that it be not cured at all least worse diseases should come by the curation of them and specially this part is necessarie about the curatiō of wounds to know which are deadly and which are not deadly and also which are maymed and which are not maymed and to foresée daungerous and perillous accidents which might chaunce vnto the woūded man as paralisis conuulsions gangrena spasalus and manie other more daungerous diseases which the Chirurgiō ought not onely to foresée by meanes whereof he might resist the same But also when any of the greuous accidēts doe happen he might make a good and a true prognosticatiō what might happen after these greuous and perilous sicknesses and also in wounds that chaunceth in daungerous places to prognosticate and declare the great perill thereof vnto the sicke and gréeued pacient or else vnto his friendes as it shall be thought most conuenient for except he make a true and a iust prognostication he shall get vnto him selfe dishonestie and cause the worthie arte to be euil spoken of This parte of the Arte can not be attained vnto without great knowledge and long experience and also a most excellent wit For Hyppocrates sayth in his Aphorismus that this part is the most hardest he saith that the lyfe of man is short the arte of medicine long the occasions to minister medicines many prouing of experiments perillous but iudgement and prognostication of sicknesse to be most difficult and hard Wherefore Hippocrates and Galen did will all men that would auoyde slander and euill name to beware wise in prognosticating and not to be rashe and quicke How many men haue gotten dishonestie for lacke of knowledge of this parte of the Arte and by mistaking of the Symptomata and accidents it were wonderfull to number them And also how many sick men haue béene ouerthrowen and vndone for lake of knowledge of the same parte it is not to be spoken Wherefore this part is most necessarie and requireth most diligent and exacte studie as it doth appeare both by Galen and Hippo in Galen where he hath written vi bookes de differentiis causis morborum Symptomatum which doth chiefely perteine to this parte of the Arte. And also that most excellēt and worthie man Hippocrates hath written two diuine workes wherein is conteined diuers bookes the one called his Aphorismus and the other his prognostications which are the most worthiest bookes that euer were written for him that shall practise in this Arte for therein may he learne the diuine iudgement of Hippo. And also how to prognosticate rightly which two thinges doe most chiefely and principally appertaine to the Art of Chirurgery Thus I haue declared vnto you the foure principall parts or as we may tearme
be these Dogmatists which are not able by reason to vnderstand the naturall principles of bodies but of these Thessalions voide of method what doest thou yet speake Therefore those which cure by right method doe finde apt remedies for euerie kinde of vlcers as also conuenient diet they do most apparantlie declare by the things it self how much it profiteth and how great light it doth bring to the arte of curing the Treatise of nature it selfe declareth for I haue not once declared vnto you how that sometime they which goe from one medicine to another doe let slip and neglect that which is profitable and that with some one of their remedies which they haue vsed the same vlcers haue béene cured therefore they haue worthilie despised the facultie of such remedies which because of the vntimelie vse they haue séene not onelie the profite but much for to hurt and that in the first vse it hath done no euident thing Furthermore thou hast séene no lesse the grieuous pains of the eies to be healed either with bath either with drinking of wine either with foments either with letting of bloud eyther with purging vnto which these common sort of Phisitions haue applied no other thing than these medicines which are made of Opium and Mandrake and Henbane bringing great daunger vnto the eies inasmuch as they taking no other thing awaie for the present but the paines it selfe these doe kill the sence as thou hast knowen many by the vse of these medicines when they haue bene too much applied neuer after to haue come to their naturall state and that first their eyes were dim and they haue hardly séene after to be vexed with suffusion which is called Hipochysis or with too greate dilatation of the ball of the Eie named Mydriasis or with Tabes or Corrugation called Rhetiosm Thou hast knowen also being with me from sixtéene yéeres of age neuer to haue seene vnder anie maister this worke but to haue excogitated it by reason and how long time I did consider that Aphorisme of vnalayde wine or bath or foment or letting bloud or purging taketh away the paines of the eyes And what trust I had by the rest of Hippocrates laborers that there was nothing in this Aphorisme either false or might not be brought to passe that was it which stirred mée to search vntill going Hippocrates way I found by what meanes I should discerne when and how euery of the forenamed should be vsed By which reason I made manifest to many which haue séene the like things of how great force the medicinall methode is and how great occasion of euill they are which haue not obserued the olde arte of Phisicke haue builded new sectes and now truely although from the beginning I haue refused it yet by entreating you haue compelled mée to take al this whole worke in hand which I pray the gods may be profitable by others truely I haue small hope aswell for the contempt of good letters which now do raigne as also for the admiration of riches estimation and ciuill power vnto which whosoeuer doe turne himselfe is not able to finde the truth in any thing But these things shall be determined as pleaseth the gods and we now for our power shal restore the Methode of curing which was found of the auncient Phisitians being now neglected repeting againe the disputation which we haue begunne of the hollow vlcer and of the first inuention of those things which doth fill an vlcer with flesh let that suffise which hitherto we haue saide and let vs graunt if they will vnto the Empericks all that they say And for the vse of things foūd out I haue often shewed to thée in themselues and now nothing lesse I will go about to demonstrate by reason how these Empericks cannot by certaine reason go vnto another medicine whē they haue nothing profited with the first and that rightly chaunceth for when as they know not the cause of the vnhappie successe of the first medicine neither can declare the lyke in the second and when they are ignorant of the cause wherefore the first medicine doth not his affect neither are able to vnderstād why it taketh no place this thing truely being not knowen they cannot reasonably go to another when as they cannot in the same medicine perceiue the like cause The third Chapter NOw therfore let vs set out Hyppocrates waie and the true method of curing an hollow vlcer surelie it behoueth to begin thus that is of the substance of the thing therefore séeing that an hollow vlcer that is our scope that the flesh which is lost may be restored it is néedfull to knowe that the thing which engendereth flesh is good bloud nature as I may tearme it being the workman and author notwithstanding it is not sufficient to name simplie Nature vnlesse we consider also whose nature and where For it is manifest that Nature it selfe is the ingenderer of flesh of those bodies that be subiect whereas flesh is to be made and surelie it is declared that the nature of euerie bodie doeth consist of the temperament of hot cold moist and drie therefore it is manifest that the iust temperament of these in those parts whereas we shall restore the lost flesh is as it were the workman And first of all in euerie hollow vlcer these two things are to be considered whether the bodie being subiect be in iust temperature that is to saie whether it be according to nature For we haue declared that health of similer bodies is the iust temperature of the foure qualities and whether the bloud that floweth to the part be good or else but indifferent for if either of these doe offend there are trulie many affects against nature notwithstanding there is now put to vs but onlie the hollownesse in the fleshie parts Therefore let vs imagine the part to be sound and the bloud which floweth to the parte to be frée from fault either in qualitie or quantitie surelie these thinges béeing as is sayde there is no impediment but that flesh shall prosperouslie growe and that without the helpe of anie outwarde medicine for both causes which ingender flesh béeing present and nothing outwardlie hindering then it cannot bée but that flesh must bée ingendered But in the first engendering of flesh there must of force spring a double excrement as we haue shewed in our commentaries of Nature that there followeth euerie mutation of the qualitie of the nourishment an excrement grose and thicke and another thin And these excrementes chauncing euer through the whole bodie that which is thinner is inuisible by persperation notwithstanding it is forthwith visible as often as the naturall heate diminisheth or that hée vseth more large diet than is méete or that there happeneth to the creature more vehement motion The other excrement is the filth that is sent to the skin Furthermore in vlcers the thinner excrement is called Sanies in Gréeke Icor the groser is named Sordes and the
vlcer is made moist by the thinner excrement in like sort as by the groser it is made filthie and for that cause it néedeth two kind of medicines that is to saie exicatiues to expell or drie that which is moist and mundificatiues to purge the filth Now then séeing that nature ceaseth no time truelie there can be no time found in which both these excrements may not be gathered together in an hollow vlcer Wherefore there shall be no time in which thou shalt not vse both kindes of medicines that is to saie which shall exicate and mundifie And now we haue found out of what kinde the medicine ought to be but that is not sufficient for it is néedfull to inuent some perticular which is to be applied to the vlcer Now by what method and howe shall they be found out forsooth by the same which is set out in our bookes of the faculties of simple medicamentes for we haue shewed in them certaine medicines desiccatiue certaine humectiue certaine refrigeratiue and certaine to make hot yea and certaine by coniunction to make hot and drie or to refrigerate and moist or to heate and moist or to refrigerate and drie and that there is in euerie of them a difference more or lesse but in multitude infinite Notwithstanding they be contained within limites to their vse which doe easilie comprehend them in the first order or degrée or second or third or fourth now of what degrée shall that medicine be which is méete to engēder flesh which must both moderately dry and also mundifie truely of the first degrée for that medicine which surmounteth this degrée doth not onely cōsume the aboūdaunce of the humor flowing to the part but doth also deuoure the bloud flowing letting the part to be restored cōsuming the flesh or the matter wherof the flesh groweth surely it is declared that such be Olibanum and the meale of barly beanes Eruum and Iris and Aristolochia and Cadmia and Panax Pomphilix and we haue shewed that all these differ among themselues more or lesse and that some of them abound onely in simple qualities and other some in compound For Aristolochia and Panax doe drye more than the rest and also by nature are more hot barley and bean flower doth much lesse drye than these and haue no heate at all Olibanum doth moderately heate but doth lesse dry thā these in so much as in certaine bodies it dryeth not at all The meale of Eruum and Iris and Aristolochia and Panax are in a meane But now let vs repeate againe that wée haue profitably touched Olibanum in bodies of moist nature is able to engender flesh but in dry natures he cannot for it is néedefull to consider that there is a two folde difference of the first indicatiōs that which is according to nature shewing the cōseruation of it selfe further doth also require things lyke to it selfe and that which is against nature declaring the taking away of it selfe and also requiring things contrary for euery thing perisheth or is ouercome of his contrary and in his contrary And truely the Vlcer how much it is to moist doth so much the more require medicines which doth drye But the nature of the bodie how much it is more moist so much the lesse it requireth a medicine which doth excicate wherefore if there be any vlcers in which there is like humiditie because they are in a bodie of dryer tēperament truely it is requisite the more to be excicate that which is in a moister temperature doeth so much lesse néede drye medicines as there is difference betwéene nature and nature For it behoueth the flesh that is engendred to be like that which was there before Therefore whereas the flesh is dryer than in times past it is conuenient that the new be made dryer so that it ought to be the more largely to be dryed how much the more it shall be drye so much the more shall the medicine which shal be applyed haue a dissicatiue vertue but in a moist nature there is so much lesse néede of a medicine dissicatiue how much the flesh is lesse drye Therefore like as Olibanum hath such temperament cōcerning the nature of mans bodie that is agréeable to a temperate meane nature but it doth somewhat more largely drye These that be moyster in like sort as it is to moist for them that be most drye so that of right Olibanum maketh mattier both in certaine Vlcers and also natures doth not engender flesh and in certaine it doth engender flesh Therefore if thou dost marke thou shalt finde the successe aunswerable vnto reason for in a moister nature it may engēder flesh in a dryer it cānot Doest thou not therfore perceiue of how many Theoremes or intencions of curing he hath néede that will cure an vlcer by a right Methode for after that it is found out that the fault is in moisture altogither it sheweth foorthwith that ther must be prepared a dissicatiue medicine but for that there are of drying medicines some that dryeth more and some lesse that which is expedient must be taken partly of the diuersitie of the vlcers partly of the nature of the sicke Therefore he that will rightly cure an vlcer must not onely cōsider the nature of the body but also to haue learned all the speculation of medicines diligently and also to know the signes of bodies which are of dry or moist temperament Now therefore consider what great rashnesse is of pronouncing these Methodicians which think that they haue done sufficiently to the curing of an hollow Vlcer if they vnderstād that it must be filled with flesh Truely the way of curing cōsisteth not in this but in finding that out which shall fill it with flesh but that shal fill with flesh quod he is alreadie founde by experience then confesse that which shall cure to be founde out by experience neither doe they vainely boast neither extoll the Methode although experience is cōdemned yea of the Empericks themselues which is without certaine limitation for they write in their commentaries of medicines in this manner An Emplaister for those that haue soft bodies and for children and women they know how that Olibanum in such natures can engender flesh and fill hollow Vlcers so that there be no other accidence notwithstanding where such bodies are moist and because of their moystnesse require moderate drying Medicines or that there is some other cause of the successe they cannot tell Againe they shall finde an other medicine written for olde folkes and another against those Vlcers which will hardly be brought to a cicatrice and hath the sides swollen called in Gréeke Oxthothe and they write in all their cōmentaries curatiue many other seperatiues for which as néere as we can inuent a conuenient medicine to the propertie of curing nature for seperations in euerie Arte go about to deuide that which is proper from that which is common and how much any doth diuide
for that they onely are the woorkes of medicines Wherefore thou must haue the more regard of the iust teÌ„perature of the vlcerate partes as often as thou wilt either incarnate or glutinate or ciccatrise the motions of nature are to be obserued which euery of these rehearsed doe follow but otherwise they shall not be obserued except the part be founde according to nature as if there were inflammation With an vlcer no man will atteÌ„pt either to incarnate or conglutinate or ciccatrise before the inflammation be expelled so in lyke sorte I suppose that if there be onely intemperatenesse without inflamation we shall not hope for any of the foresaid before this be cured Therfore hereof spriÌ„geth again a certain indicatioÌ„ of the finding out of medicines which were before coÌ„prehended for all they were siccatiâ—… but they did differ among themselues by reason of excesse and defect it is not before defined how forsoth they should make hot or refrigerate But the Methode as it were enforceth to search out also this thing But it behoueth to marke not onely whether it doe exciccate but also whether it doe greatly heate or refrigerate Wherefore thou shalt eschew the vse of Altercum and Mandrage and Meconium although they excicate as much as is méete for an vlcer because they vnmeasurably refrigerate Resin and Pitch and Asphaltus although they doe moderately exciccate yet they be moderately hot therefore no man will vse these alone neither otherwise than mixed with other which doe gently refrigerate making of all one temperate medicine But if these thinges are thus as truely they are it is conuenient also to marke the temperature of the ayre for this being as a certaine medicine comming outwardly to our bodies if it be to hot or colde it hindreth the cure Therefore diligence is to be had that the medicine doth helpe the excesse of it Therefore Hippocrates vseth medicines of colder facultie in the hot times of the yeare and in colde times hotter medicines And here truely thou art not ignorant howe a certaine dul methodician did coÌ„fesse that he did marke how the ayre about the pacient was affected in heate and colde and yet not to suffer the times of the yere to be regarded as though the names it selfe of the times of the yere did either profit or hurt and not their temperament or that the olde wryters for this cause had not respect to it But I thinke it abundantly shewed that who so will by a certaine methode cure an Vlcer he must of force both come to the first Elements and also consider the times of the yeare and the temperaments of bodies not onely in the whole but also in euery part Againe we must repeat that that hath béen spoken of indication which is taken of moist and dry for like as the moist nature requireth moister medicines and dryer natures drier medicines so here the hotter nature requireth hotter ayre the colder requireth colder For that in those which are against nature and those which are according to nature there is a contrarie indication For those that are according to nature shew the lyke those that are against nature contraries If wée will conserue them these must bée of force remooued The ninth Chapter ANd thus I suppose that I haue cléerely taught that he who shall well cure an vlcer must consider the complection of bodies times of the yeare natures of partes also that the first indication curatiue is taken of the onelie effect but for all that the remedies cannot be thereby found out except we first do ascend to the elements of bodies and way the patients temperament not onely of the bodie but also of the sicke part and considering with these the temperature of the aire which truelie doe both pertaine vnto the present state and also vnto regions that there are together in one curation contrarie indications how to vse them it shall be set out héere after more largely notwithstanding now also it shall not be from the purpose to speake also in this place thereof in few wordes for I do think no meruaile although the patients complection be moister and yet the part affected to be drier or contrariwise that the part be moister the teÌ„perature of the whole bodie drier in like sort than the part is of contrarie temperament in hotnesse coldnesse with the whole bodie therefore like as if the whole bodie were in meane temperature which we haue called best we shuld not neede to alter anie thing in medicines touching the nature of the Pacient so whereas the bodie is soone drier or moister or hotter or colder than is requisite it behoueth so much to increase the force of medicines as the bodie is declined vnto natural intemperatnesse We haue not forgotten to thinke what naturall temperatures is what is against nature for wée haue spoken of that inother our works but chieflie in the booke which is intituled of inequall temperatures admit therefore that the whole complection of the sick bodie is more moist and for that cause require medicines lesse deâ—iccatiue that the affected part is in the number of those which are more drie such we haue said be the parts lesse fleshie as about the fingers ioynts also the parts about the eares nose eies téeth And to be briefe wheras there are many cartilages cotes ligaments bones nerues for héere is no fat or flesh or but verie little the indication within these is héere taken of the nature of the part is contrarie to that which is taken of the nature of the whole bodie wherfore if so be that howe much the complection of the Patient is more moist than is requisite so much the parte affected is more drie we shal neither adde neither yet subtract from the medicine but we must vse such a medicine as we wold apply to the vlcer made in the parte of meane temperature and where the bodie is moderatlie temperate but if the part be so much the more drie than is requisite as the temperameÌ„t of the bodie is moister we must so much increase the drinesse of the medicine or the temperament of the part excéede the temperament of the whole as if the exulcerate part excéed in drinesse foure parts the iust temperatnesse that the patients nature is thrée degrées moister it is manifest that the part which is nowe vlcerate requireth a medicine one degrée drier than where as the part is temperate it is euident that all these are taken by coniecture and that he shal best coniecture which is exercised in reasoning of these trulie in all such there are together at one time contrarie indications neither shall I néed to speake also of those indications which are taken of hot colde because they may be vnderstood by the which is spoken Trulie in other the indications are separated by times in which there are finished it behoueth also chieflie in the beginning of the curation that one to cease
or all is not séene or séene also of the generation for that is all cut or all broken or part cut and parte broken and if thou wilt perceiue the differences of the place in which the vlcer is as in the end of a muscle or beginning of a muscle or middest of a muscle or that the skinne is vlcerate or that the vlcer be in the liuer or bellie they be forsooth differences of vlcers not taken of the proper nature of them but of the places in which they are but when anie saith the vlcer is not infected with inflamation or pressed with supercrescent flesh or hollow and thinketh that they be like those which lately I rehearsed he must of force be deceiued in the curatiue method for in Gréeke Phlegmon Elcos by the forme of speech hath the like figure of interpretation with a little vlcer but yet that which is meant thereby is not alike for déepe and hollowe when we speak of an vlcer we shew these proper differences but Phlegmon is not at all the difference when as the part may be infected with inflamation yea whereas there is no vlcer so that I thinke it lawfull to chaunge the forme of spéech if thou wilt saie an vlcer with inflamation to haue come to anie man thou shalt goe néerer than to the nature of the thing and shalt interpret it more cléerely but not if thou shalt saie some with bignesse and some with littlenesse to be made for thou maist speake more euidentlie and after the nature of the thing if thou shalt saie he had a great vlcer and a little so that if it maye be done that the forme of spéech be chaunged both more conuenient to the nature of the thing and more manifest to the hearers we shall not leaue of whereby it may lesse be done for the waie to flie deceit in things is that to vse defined spéech therefore what methode may we appoint in such there is to be noted a certain precept and as it were a scope wherby the diligent may easilie discerne by and by whether anie speaketh of the difference of anie affect of the ioyning of another affect Therefore let this be to thée a difference that which may seuerallie and by it selfe stand that shall neuer be difference of anie other affect therefore magnitudge littlenes equalitie inequalitie time and figure be of the number of those which happen to other but an vlcer inflamation Gangrena and corruption maye stande seuerallie and by themselues There are certaine affects of our bodies against nature as chance necessarily to affects for vnto al these it followeth necessarily that they be either little or great or equall or inequall or new or olde or they appeare euidently or they are hid not séene To be infected with inflamation is not of the sort which happen to an vlcer as neither to begin to putrifie or infected with Gangrena all those be in the number of diseases for they are affects against nature corrupteth the action Againe there are other as it were differences of vlcers spoken of as a tormenting vlcer a filthie vlcer But héere also is some compound shewed but after another sort than was spokē of an vlcer infested with inflamation or a rotten vlcer for héere inflamation and putrefaction be affects their dolour filthinesse be of the kind of accidents in like condition whē we saie Cachochimō vlcus that is an vlcer infested with ill iuyce or an vlcer vexed with sluxe or corosion the cause is coupled with the affect And hereby it is manifest that the first simple imfirmities void of cōposition be as it were the elements of the curatiue method which is now instituted Wherefore the rather I haue numbred all such infirmities in our cōmentaries of the differences of infirmities Trulie all is one whether thou call thē the first or simple when that which is first is simple that which is simple is first therfore elementarie There is an indication taken of the differences although not of all for a new or olde vlcer sheweth nothing although some thinke contrarie but these deceiue themselues not otherwise than in the order of diet where they affirme that there is one indication in the beginning another in the augmentation another in the vigor another in the declination of which seeing héereafter I shal more largely intreate ther is no cause why héere I should make more words yet for all this I wil here ad the shal serue the time present They think that a new vlcer whē as it is frée frō anie other affect hath no accident ioyned with it doth shew another curation than an old vlcer But that is not so for in that it is onelie an vlcer and no other thing it is such a one as hath no hollownesse or dolour or filth and is free from euerie other affect doth onelie require the cure of an vlcer whose end set by vs is either vnition or adglutination or coition or continuation For I haue a thousand times said that thou maist cal it as thou pleasest so that the thing it selfe be not chaunged therefore this kinde of vlcer whether it be new or olde requireth alwaie the same curation That difference which is taken of the time sheweth nothing proper at all But if the vlcer hath hollownesse déeplie hid vnder the skinne it behoueth to consider whether it be in the higher part that the matter may readilie flow out or in the lower part so that it is there stayed The cure of that vlcer where ther is no fluxe is like the cure of other But it behoueth that we make certaine issuing out where there is none and that is two waies either the hollownesse being cut in the pendent place onelie opened both the nature of the partes and also the bignesse of the vlcer shal shew when as either of them must be done for if the places themselues make the cutting dangerous and the vlcer shall be great it is more conuenient to open in the pendent place but otherwise it is better to make incision and wheras there is an issue let the rolling be begun aboue and end beneath We haue héeretofore spoken that the difference of vlcers which is taken of all the wounded partes is verie necessarie to shew the cure but the indication was of similer this which I now speake of is as it were of instrumentall trulie we will in the bookes following speake more largelie of that indication which is as it were of similer bodies or as of instrumental Now we must goe to the proper differences of vlcers and define of it whether it be ouerthwart or right or déep or shalow or little or else great Vlcers made ouerthwart for that their lips do gape more and are asunder do require to be more diligently ioyned therefore we must vse both stitching and hookes Those that are made in the length of the muscle if thou bind it with a roller of two
the bladder matrixe and Intestines and lungs which you must vse in euerie of them taking the kind of the medicine of the substance of the sicke parte but first considering the affect and taking the waie of vsing them of the forme and scituation and héereof sprang clisters for the mouth in Gréeke called Otenchitas and Clisters for the Matrixe named Metrenchitas Catheteras and the Clisters for other partes Vlcers in the stomacke breast and lungs are cured by those medicines which are eaten and dronken the Vlcers in the Intestines are two waies cured for those that are next to the stomacke are cured by those medicines which are eaten and dronken and those which are lower in the intestines are cured by iniections made when neither that which is ministred by low by Clisters can come to those Vlcers that are néere vnto the stomacke neither that which is receiued at the mouth can in full strength come to the lower partes and so the Vlcers in the breast and lunges are more hardlie cured than those in the stomacke for that they are further off and there the strength of the medicine somewhat abated and for this cause the medicines receiued at the mouth ought to bée stronger than those which are presentlie applied to the Vlcer and for that cause the Phisitions haue excogitated most strong and cutting medicines whereas they will purge the mattier in the breast and lunges yea verilie such as would ciccatrize the Vlcer if it were in the stomacke Also that this is throwen out by coughing that is taken of the forme of the partes because these haue no such passage as the matrix bladder eare nose and mouth and hereof commeth it that the stomacke may be purged two waies vpward by vomite and downward by the stoole for this kinde of Indication is taken of the Instrumentall partes inasumuch as they be instrumentall like as those that are to bée exiccated are taken of the nature of the similer partes of the affectes themselues againe such as in Vlcers because our disputation was of them but that they are to bée dried as is before set out and also if they will purge mattier in the stomacke they cannot without daunger prouoke vomite for if there bée fleame fixed in it to cleanse it by Oximell and rootes but they shall more safelie vse deiection when it is perlllous least hée that vomiteth shoulde teare that is vlcerate and should attract some ill iuyce from the partes adiacent and for this cause the Vlcers of the lungs are most harde to bée cured because thou canst not purge them but by coughing and if thou prouokest the cough thou tearest the partes so that the ill by mutuall successe cōmeth to a circle or as we may terme it made worse for those partes which are torne doe againe make inflammation and secondlie the inflammation must bée maturated and the mattier againe requireth to bée purged so that of all these the cure is made difficill both for that those medicines which are conuenient cannot touch the Vlcers as they may in the stomacke and that in the midde waie they loose well néere their vertue And further because by respiration they are mooued and are rent by coughing wherfore when as anie vessell in the lunges is ruptured if it be not adglutinated before there commeth inflammation knowe thou that afterward it is incurable The xij Chapter BVt the vlcers which are in the inward cote of Aspera Arteria chieflie which are néere Larinx or else in it these may bée cured and we haue healed diuerse which were so affected trulie we finde the curation of these vlcers by this occasion in the beginning of this great Pestilence which I praie God may once cease a young man who had béene sicke nowe nine dayes all his bodie brake out full of vlcers which happened well néere to all that escaped that daie he coughed somewhat the daie following when he had bathed him he forthwith coughed more vehementlie and therewith voided a little crust named Ephelcis and the man had manifest féeling of an vlcer in Aspera Arteria that is in the necke néere vnto Iugulum and he also opening his mouth we looked in his throate if that there were anie vlcer in it but we could sée none and truelie the patient should manifestlie haue felte it by the going downe of the meate and drinke if anie had béene there and wee also to bée more certaine made him take certaine things with Vineger and Mustard but none of these did bite him and yet hée felt dolour and paine in his necke in which place hée was so vexed that hée was constrained to coughe wée perswaded him all that wée might that hée should resist it and not cough which thing hée did and that with the more ease For that which dyd irritate was little and wée by all possible meanes gaue diligence to ciccatrize the Vlcer applying outwardlie medicines exiccatiues and hée lying vpright wée gaue him moist of those medicines which are good in such lyke vlcers bidding him to holde it in his mouth and by little and little to let it flowe into Aspera Arteria he so dooing saide he felt manifestlie the force of an astringent medicine aboue the Vlcer whether that the force of it by transumption was sent thether or whether the medicine it selfe in forme of a dew floweth through the Arterie as it were strained to the Vlcer the patient himself was voide of the knowledge in Phisicke being of the number of those which cure by vse and exercitation emperiklie Therefore hée sayd that hée felt both the medicine flow into the arterie and that it also sometime prouoked coughing but he did much striue and staied the cough and hée of his owne accord being taken with the sicknesse at Rome remained thrée dayes after the nine daies were past after taking shippe first hée sailed through a Riuer to the Sea the fourth daie after hée came by shipping to Tabia and vsed the milke which hath a meruailous vertue and not without cause commended Of which somewhat to speak the time it selfe giueth occasion and not onelie of that milke we will speake which is at Tabia but also of all other milke neither must we onelie helpe those which are in Italie but all other Nations as much as we can Wherefore touching the milke in Tabia there doe come many things touching his praise both the place it selfe béeing of sufficient light and the aire compassing about béeing drie and the healthfull fodder for the Cattell and this also may anie doe by arte in other places if anie shew the hearbes and shrubbes in an hill somewhat high which may make the milke both astringent and healthfull of which we wil héereafter shew examples But yet thou canst not also make the aire ambient in like sort therfore thou maist choose the likest there as thou art The aire shall bée most like where there are such things like it the height of the hil moderate thirtie furlong
in this is one of the two necessarie either to get out the inflation or to inlarge the wound the first is better I suppose if it may bée done thou shalt doe this no other waie than by remouing the cause which brought the inflatiō but what cause is that trulie the refrigeration of the aire ambient Wherefore the cure must procéede of heating thinges therefore it shall bée conuenient to heate the Intestine with a hotte Spunge put in hot water and afterward expresseed out and in the meane time to prepare auster Wine made hotte for that doeth more heate than water and strengtheneth the Intestine but if the inflation of the Intestine ceaseth not by this meanes thou must cut so much of Peritoneum as is inough to put in the Intestine conuenient Instrumentes for this Incision are Springotoma that is to say such as serue the Incision of Fistulas Kniues which are double edged or haue sharpe pointes are to be refused the conuenient placing of the Patient is when the wound is made in the lower parte if hée lie vpwarde and when it is in the vpper partes if hée lie backwarde in both these one thing is to bée regarded that the Intestine which is out bée not pressed of those that are within and that shall this waie bée done as if the wounde bee in the right side to bende the bodie to the contrarie parte if in the lefte then to the right side in such sorte that the wounded parte alwaie bée higher than the rest and this is profitable also both in great and meane wounds for that is a common aduice in all But the reposition of the Intestines into their place when as they are fallen out in a great wound doeth verilie require a perfect minister for he ought to compasse outwardlie all the whole wounde with his handes and to presse inwardlie and to gather together and to leaue the place bare to him that stitcheth it and also to compasse moderatlie that which is stitched vntill all the wound bée stiched Now wée will next teach the aptest waie of stitching such woundes in Abdomen because it behooueth that Abdomen doe close and ioyne with Pentoneum you must beginne from the skinne and thrust the néedle from without inward and when as it hath gone through both the skinne and the muscle called Rectum leauing that Peritoneum which is vnder it thou shalt from within thrust thy néedle outward by the rest of Peritoneum and so by the rest of Abdomen putting the néedle from within outwardlie and when it hath gone all through this againe this Abdomen is to be thrust through from without inwardlie and when thou hast left that Peritoneum which is vnder and come to the contrarie parte thou shalt also thrust this through from within outwardlie and with all the Abdomen that is next after this beginne heere againe and stitching it with the Peritoneum of the contrarie side and againe putting it through the skinne next the néedle is to be put in that part inwardlie and stitching that Abdomen with the contrarie Peritoneum and againe going through the skin and thus againe and againe till it be done and vntill the whole wound be stitched the space betwixt the stitches ought to be most smal which pertaine to the kéeping fast of those parts which be vnder but this smalnesse is not sure inoughe to the strength of the skinne and kéepe it from breaking which is the spaces betwixt the stitches wherefore eschuing the excesse of both let vs choose a meane betwixt both and this also is as it were a common thing in all wounds that is the substance of the thréed it selfe wherewith wée stitch for that which is too harde must of force teare the skinne that which is to softe is presentlie broken in lyke sort if thou doest thrust thy néedle through the edges of the wound the rest of the skinne béeing most little is constrained to teare when it is violentlie brought together but if thou goest farre from these thou leauest much of the skin vnglutinated and although these things be common to all woundes yet they are especiallie to bée eschued in the stiting of Abdomen and the stitching of Abdomen ought to bée done this waie rehearsed for if anie doe suppose that he may make Peritoneum to close with Abdomen but it will scarcelie growe with him because it is neruous or else as manie vse which ioyne them together that be naturallie of affinitie as Peritoneum to Peritoneum and Abdomen to Abdomen and that shal be in this sort it behoueth to begin of the Abdomen next vs from without inwardlie to thrust a néedle through it onelie letting passe both sides of Peritoneum of the contrarie part from without inwardlie drawe the néedle through both lips after put that backe again and thrust it from within outwardlie through the contrarie Abdomen this waie differeth from the common and vsuall stitching which at once thrust the néedle through foure sides because it altogether hideth Peritoneum vnder Abdomen Now let vs speake of medicines truelie those ought to bée of the same mattier that they are which are named Enema which we haue in the bookes going before shewed to vnite the wound of other partes ligature outwardlie is chiefelie héere necessarie the last parte of the curation in these differeth much from the other for the space betwixt the flankes and arme pittes ought to bée wholie couered with softe Wooll dipt in Oyle moderatlie hotte and yet more sure if thou put in by a Clister into the Intestines some such like thing and if anie of the Intestines be wounded that which is outwardlie to bée done must bée performed in manner aforesayde but that which is iniected must bée auster and red Wine bloud warme and so much the rather if it bée pearced through to the inward partes And the thicke Intestines are easilie to bée cured as on the contrariwise those that bee thinne bée harde to be healed yet Ieiunium is altogether incurable both for the bignesse multitude of the vessells and also for that his coate is verie thin and neruous Further because this Intestine receiueth all the pure coulour and is next the liuer of all the rest And thou mayst boldlie cure the woundes of the stomacke which are in the lower fleshie partes for it may happen to take good successe not onelie for that these partes are thicke but also for that the medicines which doe cure doe easilie rest in this place But the woundes which are in the mouth of it and in Gula inioye but onelie the medicines which touch them in the going downe the sensiblenesse hindereth also the cure of those which are in the mouth of the stomack But it is easier to learne the way which he vsed in curing of the woūds in the stomacke than other deadly wounds for I toke not in hand to write these workes for that intent I woulde not anie man should not reade
patient changeth his bed or goeth to the stoole it shal be good because nothing shal want to the Treatise héereof to cōmend much Glottocomon of which they make the one side also the table in which they place the foote to be moueable for that it may serue to the bignesse of euerie member And this shall be sufficient to vnderstand of the other fractures with these which Hyppocrates hath commanded The sixt Chapter HIppocrates trulie hath writtē a whole booke of those wounds which happen in the head in which he hath set out all thinges which héerein are to be done we hauing finished this worke will goe about to explicate his workes at this present Trulie for that in these Commentaries we haue added more than the he hath spoken and defined that he left vndefined It behoueth that we speake first of the hollow cutting instruments called Gneliscus next of Phacotus after of the narow cutting kniues and last that we intreate of the vse of medicines therefore there are some fractures of Cranium which commeth to the second table called Diploen some to the inward part of the bones some are simple fractures some are contusions and some the marks of those wherwith the stripe was made remaine the simple fractures which come to the second table those néede the narow kniues before spoken of It is requisite both to haue many of them also differing in bignesse least the should want which is most apt for the purpose and the bone affected being made bare as the manner is you shall first vse the broadest knife next another which is narower so the rest orderlie vntill you come to the narowest and this is to be vsed in the second tables Afterward both these so to the end it must be cured with drying medicines which for that cause are called Cephalica those are made of Iris illiriaca and meale of Eruum and Manna Aristolochia and the rinde of the roote of Panax and to conclude all such medicines as mundifie without corrosion for the generation of flesh is the worke of nature it selfe there the patient in that behalfe hath no néed of the art of medicine that the flesh which doth engender may close cleue about to euerie part of the bone the shall chieflie followe if there be no filthinesse vpon it neither yet anie oyle or fatnesse therefore this one thing which the Phisitions helpe to the production of flesh in the hurt patients the all the place be drie euerie part of the affected bone pure all these are cōmon of all fractures when as the flesh beginneth to grow of the fractures which come to the coates of the braine if it be onlie a simple fracture the narow kniues before remembred must be vsed but if the fracture be with contusion the which is contused must be cut out first pearcing it through with Teribles or Trappons and after with kniues or at the beginning with Cylciscos as néede doth require But the which is done with Teribles is dangerous because while they more boldlie vse it they doe often hurt Dura mater which is the next bone Also that which is done by Cicliscos is not without fault when that it doth immoderatlie shake that which requireth rest Therfore it liketh me best if the fractures be great the bones fractured vehemently to vse Cicliscos for with small incision thou maiest make space with lenticuler Exciscories if the bones be sure and firme they must be pearced through with a Terible And certaine because they should not erre haue deuised such Teribles as cannot sinke downe and for that cause are named Abaptista there goeth round about a circle a little standing out somewhat aboue the sharp end of the Terible Trulie it is conuenient to haue many such Teribles seruing to the thicknesse of euerie Cranium for to a thicker Cranium a longer Terible is conuenient I do cal it so whose space frō the point of the Terible the circle extant compassing it is longer to a thinner Cranium a shorter Terible this also is that which hath a lesse space betwixt the point the ring the goeth out And trulie whether I shal call these more dangerous or surer than the other but they vse those that are called Choenicidas but vse thou with good successe Cicliscos if thou bée not skilfull of those things which maye deceiue thée neither yet more fearefull than needeth first those that are broader then those which are narrower vntill thou come to Dura mater But that bone which must bée cut out is not to bée made bare round about with the Ciclisce but on that part chieflie where the fracture is most grieuous for besides other the pannicle it selfe doeth most spéedelie separate from the bones that are vehementlie affected so that there is no feare of touching that which is alreadie separated for if thou hast once made one part bare settest thy knife which hath in the end a blunt and light forme of a lentle which is like a pease and the edge erected in length when as you haue set the broade part of the lentle vpon the pannicle strike it with a mallet so then thou shalt diuide Cranium for doing thus all things come to passe as we would haue thē for one cannot wound the pannicle yea though he did it slipping touching it onelie with the broade part of the lentle which if it doth anie where cleaue to Cranium the roundnesse of the lentle doth without daunger take that awaie for the instrument it selfe called Lentle cutting Cranium followeth at his back it going before so that thou shalt not finde out another waie of pearcing which shall bee lesse daunger or yet more spéedie For thou wilt chieflie praise this in most vehement Fractures which manie of the later Phisitions doe call Eupei somata and Camaroseis Eupei somata are when in the middest they indeauour or to take a péece of the bone forth the coate or Membrana remaining bare Camaromata which haue the same part exalted wherewith he did take awaie the fractured bones from the part affected are such as most spéedelie cut an hole out when as the ende of the Instrument called Lentle doeth easilie enter in and those which are farre gone from the naturall habite we shall prepare with an Instrument called Ostagran Some of the bones which are vehementlie crushed béeing lifted vp and turned to that parte chiefelie that we maye put in the instrument called lentle which done all things after that néedeth followe with securitie and spéedinesse that thou mayest almost rehearse that famous saying in which all things are well Dimidium facti qui bene caepit habet that is he which hath begun a thing wel hath halfe brought it to passe for héere thou hast not the halfe of the whole but rather the whole or else but little lesse when as thou hast put in the Instrument called a Lentle And this is the best
manual tractation of fractures in Cranio called Chirurgia Now I will héereafter shew how much of that is to bée cut awaie that is affected that which is vehementlie fractured is to be all taken awaie and if certaine fragments come out further from it as sometime it is séene to happen it is not expedient to follow these to the end being assured that hurt or damage shall follow to them that haue it if all other thinges be rightlie done wée doing so not once or twice but often haue had our desire And the Indication of doing things is héere also taken of the nature of the affected partes for the ligature which in other fractures reason hath found out to kéepe backe inflammations thou canst not vse to the head Therfore thou canst not staie that which floweth neither expulse out of the affected partes that is in them contained without which remedies none of the other bones can bée conserued sound For imagine that in the arme the bone is broken vnto the marowe and that none afterward doe vind it as it becommeth a Fracture it must follow necessarilie that not onelie the matter which is gathered outwardlie vnder the skinne and muscles but also which is in the marow doth both first and principallie corrupt the marrowes it selfe also with it the whole bone Séeing that when all things are rightlie done this doth sometime chance How then may not such things happen to the head séeing that it cannot haue the ligature which is due to Fractures and also the matter sinketh downe in such sort as all lieth vpon the coate or pannicle in other Fractures when it is well rolled it is so farre that it suffereth no superfluous moisture to be gathered in the affected bone that it maketh the member leaner than for his naturall constitution The waie that is excogitated by ligature cannot both so exact the fractured bone the parts about it that they shall neither be inflamed or yéeld anie mattier neither is there anie medicine which in other partes can without ligature as we haue said kéepe the fractured bone drie frée from superfluities Wherefore we had néede first to make bare some part of the Fracture wherby we may mundifie wipe awaie the Sanies from the coate and when the time of inflammation is past and all is exactlie drie then to incarnate and ciccatrize the place Our talke is not héere naked voide of matter as the Sophists which knoweth not the workes of the art do demand why the fractures of the head hath no Callus they haue O good sirs a Callus and you be so mad that you do assigne causes of that which are not as though they were we in times past did sée the bone of the fore part of the head broken which next followeth this is called Os temporis in which it happeneth that the commissares are ioyned as it were like scales in it there was most long and manifest Fractures which I nothing touching but cutting out the bone of the fore parte of the head did cure the man that he now hath liued many yéeres but if I had in like sort let alone the bone of the fore part of the head the coate vnder it would sure haue putrified then the fracture to haue engendered Callus for if no Sanies should flow inwardlie from the affected parts it shuld haue bene néedlesse to haue cut out the bone therefore they as their manner is doe trifle for I truelie in another hauing the like fracture did thinke to let the higher bone alone and to take out that which was in the sides whereby the Sanies might flow out But when I did marke both the thicknesse and the hardnesse of the bone I did iudge it better to take out the bone than for regard of the fluxe to finite vehemently the braine and I also thought that it might happen that if there were a great hole in the side that the braine might perchance come to this part Further there that not in one place is in the sides a springing of nerues and that of no small quantitie when as in the high bones of the head there neuer springeth the least nerue of all and I being by these things warned did abstaine frō taking out the bone that was in the side of the head and it euer had Callus and if it were rightlie cured and now trulie there resteth that wée séeke out what is our principall scope of all both medicines and eke of all our diligence when as the bone is perforated whether that which is most delicate and answerable to the pleasure of the Patient which now the most part vse or else that which is héereto repugnant that is that which is done by most vehement exiccatiue medicines which Meges Sidonius doth praise and a certaine Citizen of ours doth alwaies vse insomuch that he forthwith applied to the bare coate or pannicle an emplaister called Isen and vpon this outwardlie Oximell trulie this old man was sufficientlie exercised in this part of the art but I did neuer sée anie other vse them neither yet durst I doe so Notwithstanding I can thus much witnes with Eudemus for that was the olde mans name they rather escaped which were of him cured than of those who vsed delicate medicines and I had also gone about to trie the like waie of curing if I had continuallie remained in Asia but séeing I haue bidde at Rome I doe followe the manner of the Citie committing the greatest part of such workes to those whom they call Chirurgions But iudging the nature of the things it selfe I conceiue that such certaine determination to be confirmed by our experience The auditorie cunduit which stretcheth not onelie vnto Dura mater but also toucheth the nerue which goeth from it to the braine this although it be so néere doth abide as it is said most vehement medicines Therefore it is no meruaile if after the perforation of Cranium Dura mater before it is much molested with inflammation doth desire most strong medicines hauing naturallie as it were a drie substance FINIS Thomas Gale vnto the friendlie Reader IT is requisite that euerie one that vseth this art of Medicine in the curation of diseases or sicknesses not onelie to know the diuisions natures of the same but also to knowe the names by meanas whereof euerie one of the same may be knowen from another and chieflie in this part for the better vnderstanding of Tumours against nature wherin Galen hath taken great paines not onelie in their true diuisions but also gathering together their most apt and auncient names giuen vnto them by the olde writers And if anie names did lacke for such sicknesses as raigned in his daies he did deuise most apt and conuenient names for the same Aristotle saith whosoeuer is ignorant in the tearmes of his art that he is ignorant in the whole arte Therefore it is necessarie for those that professe so noble an art as