desire to renue the phlebotomy To renue the phlebotomye vve must then lay one the inscisione saulted oyle because that hindereth the curinge of the vvounde and the sault keepeth the blood from coagulation vvherthroughe the apertione of the vvounde is stopped And if soe be the vvounde vveare soe stopped that the bloode vvould difficultlye issue therout vve must not then rigerously stretch out the arme vvhich the patient hath carried on his brest dubbed nether depresse the vayn vvith to great violence to get the bloode therout Because such violēce might cause great payn and inflammatione To renue the phlebotomye but vve must rather vvith a small privett or searching iron remove that blood vvhich therin is exciccated dryed or rather once agayne make an inscisione after that vve have bovvnde the arm somvvhat higher then the elbovve as before vve have sayed Hovv vve ought to open the vaynes or arteryes of the tēples of the head VVhen as vve desire to make an apertione in the vaynes or arteryes of the temples of the head of the foreheade or vnder the tunge vve must then cause the patient gentlye to vvring about his neck a table naptkīne or a tovvell therby to cause the bloode to ascēde on high the vaynes to svvel vvhich vve intend to open Hovv vve ought to open the vaynes of the handes feete And vvhen as vve desire to open the vaynes of the handes or feete vve must bath them in vvarme vvater because throughe caliditye vvarmethe of the vvater the foresayed vaynes might erect themselves the bloode the vayne beinge opened might the better issue out therof ⧠Of the number of vaynes arteryes which commonlye vse to be opened in mans bodye Chap. 4. THe aunciēte professors of Chyrurgerye have observed certayne vaynes vvhich in mans bodye must be opened accordinge as everye divers dissease shall reqvir vvherof the Chyrurgiane must not onlye knovve ther situatione ther divisione or separatione but alsoe the names of the sam because that he doe not mistake the one from the other Vayne of the foreheade They vvhich most commonlye are opened are 41. vvherof ther are in the heade 17 een the first vvherof is called the vayne of the foreheade vvhich is situated in the middest of the foreheade and is opened vvhen as vve have anye inveterated payn in the occipitialle partes of the heade to trouble molest vs. The seconde is called Vena Pupis Vena Pupis vvhich is situated right in the middest of the occipitialle or hinder partes of the heade this vayne is opened agaynst the soporiferousnes payne of the heade vvhich is situated in the foreheade The temporall vayne The thirde is called the temporalle or vayne of the tēples vvherof in each syde ther is on vvhich in divers brāches ascēdeth in the temples of the heade vve open those vaynes agaynst the superfluous lachrimation of the eyes agaynst vehemēt payne in the eares agaynst the Hemicrania vvhich onlye commeth in on syde of the heade Eeare vayne The fourth is called the eare vayne one eache syde one have ther place situatione behinde the eares this vayne is opened agaynst surditye Eye vayn payne vlceration of the eares The fifth is the eye vayne the vvhich in the greate corner of the eye close by the nose vve may perfectlye see shee is opened agaynst all disseases of the eyes eyeliddes The sixt is Nosevayn the nosevayne vvhich hath her place in the middest of the end of the nose betvveene the tvvo grisles or cartilages shee is opened agaynst the heavines of the head agaynst all reumes of the eyes eyeliddes The seaventh Lippevayne is the lippe vayne vvherof one each syde are tvvo in the internall partes of the opermost and nethermost lippe vve opē them agaynst all tumors excrescenses of fleshe agaynst all vlceratiōs of the mouth agaynst the vehement rednes of the face The eight is called Ranularis vena Ranularis vvhich is situated vnder the tunge one each syde on vve make therin an apertion agaynst the Sqvinantie agaynst the incensione of the Almondes of the pallate more other disseases of the throte The ninth is very publique lyinge in the necke and is called the Iugularis Iugularis vayne of the Arabians Gvides on each syde of the necke one Shee may very conveniētlye be opened agaynst tht Sqvinantye agaynst all rheumes of the throte vvhich bringe vs into greate angustnes and trouble In the armes are sixe in every arme three vvhich in the fouldinge of the armes are phlebotomized The first is the head vayn Headvayne Cephalica vvhich is situated highest most outvvardlye in the arme vvhich vve opē agaynst the payn of the heade eyes eares payne svvellinge of the throte The second is the nethermost in the insyde of the arme is called Basilica Basilica being the foundatione of both the other vaynes and is also called Hepatica or liver vayne Hepatica or Liver vayne VVe open this vayn agaynst the stoppinge of the Liver agaynst all inflāmations of the vvhole bodye all disseases vvhich are situated vnder the heade The thirde is the Mediane The Mediane or Mediana as vvell concerninge her situatione as originall because shee taketh her beginninge out of the Heade Liver vaynes as also considering her conditions because vve open her as vvell for all disseases vvhich are situated in the vpper as vndermost partes of our vvhole body and ther trouble and molest vs. In the handes vve have sixe in each hande three Eye vayn in the hande The first descendeth a longest the Metacarpion of the hande and passethe betvvixt the thumbe the first finger vve call her allsoe the heade vayne or the eye vayne VVherfore shee is onelye opened agaynste payne in the heade eyes The seconde is called Salvatella Salvatella or Liver vayn betvvixt the little thirde finger shee is phlebotomized agaynst the yellovve gaundise in all disseases of the liver on the right hande and one the left agaynst all disseases of the milte vvherfore of som in the left hande shee is called the miltvayne Blacke vayne The thirde is alsoe called the Mediane Blacke and Common vayne descendeth by the finger called Medicus Blacke vayne or thirde finger vvhich vayne vve may open vvhen vve can finde nether of the other tvvo In the belly are tvvo in each syde of the bellye one Vena Illiaca vvhich vve call Venam Illiacam or Titillarem demonstratethe her selfe betvveen the hippes the flanckes She vvhich is opened in the right syde agaynst the Dropsye and other disseases of the Liver shee vvhich lyeth in the left syde agaynst the disseases of the Milt In the fundament or privityes of a mā are one each syde tvvo the one vvherof vve calle the Hemorrhoidalle vayne Hemorrhoidall vayne is onlye opened in
vvithout touchinge the Peritoneum and in that sort proceede forevvardes vntill the vvhole vvounde be sovved soe that throughe one edge of the lippe but yet at divers times they thrust throughe the skinne and the musous fleshe and allsoe the Peritoneum The manner of sovvinge of the bellye out of Celsus Amonge all other sortes of sovvinge the vvoundes of the bellye or stitchinge of them this vvhich vve have taken out of Celsus is the least daungerous and the best alsoe easyest to be done That vve must have tvvo threded needles By the left lippe vve must not onderstāde the left syde of the patient for it is the right syde of the vvounde but rather the left syde of the Chyrurgiane vvith one threde the one needle at the one end and the other needle at the other end of the threde vvher of vve must take the one needle in the right the other in the left hande vve must beginne in the end of the superior parte of the vvounde one the left syde first of all pearcinge throughe the Peritoneum then the musculouse fleshe and the skinne dravvinge the needle vvith the threde out vnto the one halfe from invvardes outvvardes then vve must vvith the other needle of the left hande make the seconde stitch right opposite agaynst the first in the right syde of the vvounde beginninge vvith Peritoneo as vve have sayed of the first stitch on this sorte the acuitye or poyncte of the needle is farre enoughe frō the entralles or guttes yet notvvithstandinge the heade close vnto the forasayed guttes VVhen as therfore the needles have pearced passed throughe from the one syde to the other vve must as thē chāge hāds in receavinge agayne of the needles aforesayed take the needle of the right hand in the left hand the needle of the left hand in the right this permutatione or changinge beinge in this sorte effected vve must then agayne thruste throughe the lippes of the vvoūde as al readye hath binne done to vvitt from the internall parte tovvardes the externall soe proceedinge forevvardes as much as is sufficient and allvvayes consideringe that the one stiche be allvvayes layed right opposyte agaynst the other in this sort proceedinge vntill the vvoūd be vvholye sevved vp allvvayes remembringe to leave a little apertione in the bottome of the vvoūde throughe the vvhich the congealed bloode and the threde may be avoyded vvhich apertione vve must alvvayes keepe aperte or open vvith a little leaden hollovve pipe vvhich in the end must be tyede bovvnde vvith a threde because that by chaūce it doe not come to slippe into the bellye of the patient And vve must vvel and dilligentlye note that this suture or sovving allvvayes bedone vvith a goode strōge threde What māner of threde needle vve must haue vvith a needle somevvhat crooked at the poynct layinge the stitches somvvhat closer the one by other then in other vvoundes of the bodye because the stirrīge of the bellye farre sooner causeth the stitches to burst and breake a sunder then in anye other partes of the bodye because alsoe the vvoundes of the bellye are not so subiecte vnto inflammation or incensions as other althoughe that often times the bellye is thrust throughe Chirurgerye THE FOVRTH TREATISE OF THE OPERATIon of Chyrurgerye wherin is discoursede and handelede of the openinges and apertions of Apostemations Contayninge five Chapters Of the generall vvay to open any Apostemations vvhatsoever Chap. 1. Of the tumefactions vvhich vve call Ateromata Steatomata Melicerides Chap. 2. Hovve vve ought to cauterize make any inscisione in the Apostemations of the brest Ch. 3. Hovve vve ought to make the Paracentese and take avvay the vvater from them vvhich have the Dropsye Chap. 4. Hovve vve ought to cure the Hernias aquosas or vvater burstinges Chap. 5. ⧠Of the generall way te open Apostemations Chap. 1. What vve ought to consider before vve make the appertione WHen as vve endevoure to opē anye apostematiōs to lett the matter rūne therout vve must first of all before vve com to the inscisione or apertione consider vvhether the matter might not in anye vvayes be resolved or consumed throughe the forces of the naturall caliditye or heate or els vvhether needes and of necessitye be chaunged into matter VVhen as an Apostematione must needes be brought to suppuratione of matter can by noe meanes possible be consumed or resolved the signes therof are these namelye a burninge heate erectīge of the tumefactione or svvellinge more rednes Signes of suppuratione vvhich is also harder thē before prickinge knockinge or beatinge payne ponderousnes as if there did hange anye heavye thinge at that ioynte And if soe be this apostematione be situated in any principall parte then there is a chillnes and shiveringe thervvith associated the ague allsoe is more violent by day then by night sometimes alsoe the next kernells vvhich are in the bodye situated thervnto come or chaunce to svvel be distempered Signes vvhē the matter is fullye ripened But the suppuratione or resolutione to matter beīge finished or accomplished the tumefactione as thē diminished vve thē sensiblye feele prickinge vvith a little itching therbye alsoe a little deafnes or numnes vvherbye alsoe some times is felte a great prickinge especiallye the matter lyinge verye deepe For the matter lyinge close vnder the skinne there thē demōstrateth it selfe a little heade vvhich in feelinge is softe and vvhen as vve depresse vvith the finger it glideth a syde vvher of the skinne in the superior parte of the same heade openeth it selfe separeteth it selfe from the inferior partes of the same When vvith the lancet vve ought to opē an Apostematione VVhen as therfore all these signes reveale themselyes vve may thē bouldelye freelye opē the Apostematione vvith the lācet vvith out tatryinge anye longer that it might of it selfe breake through because the matter may thē issve forth therat because that through to lōge tarryinge vvith the openinge therof shee doe not come to diminishe into the circumiacent partes make other concavityes Althoughe Celsus sayeth Opinione of Celsus that verye seldome vve ought to make anye inscisione vnder the armepittes or in the flanckes vvhen the matter is ripened come to a full and good suppuratione in like sorte alsoe vvhen the Apostematione is not to greate is placed vnder the skinne but that as thē vve make the apertione vvith Cataplasmes let them of themselves breake throughe vnlesse throughe the intollerablenes and greate dolor or payne of the patient the Chyrurgiane vveare compelled to open the same because sayeth he that if vvith out inscisione or cauterisatione vve make the apertione noe deformed cicatrice or signe therof may remayne VVhē the matter lyeth deepe vve must thē cōsider When the Apostomatione must be opened vvith a hott Iron vvhether the part be synnuishe if soe be
have binne but small for these disseases might per adventure be soe greate that they shoulde be incurable and vveare not conveniente for vs to lay handes one them if soe be vve endevoured to cure them vve might chaunce to make them farre vvorse more vnseemlye then before they vveare VVherfore the Chyrurgiane ought dilligentlye to consider that one such kindes of fissures or splittinges he impose not his handes and especiallye in those vvhich are to vvyde seperated the one from the other vvhere there is to much substāce deficient or vvantinge betvveene them bothe for vvhen a Chyrurgian endevoureth to cure such a dissease then must necessarylye the seiunged and separated partes ether ioyn heale together agayn or els not if soe be they grovve ioyn together the lippe thē is merveylouslye stretched lyeth close to the teethe one the gūmes And if soe be they cā not souder ioyn the on vvith the other the fissure or splitting vvilbe much greater then before it vvas because cōsideringe that vvhich one both sydes vvas taken cutt avvaye through vvhich occasione the patiente as then can farre and much more difficulter eate and also speaketh vvorse because that a cōplete vvhole lippe is verye cōveniēte necessarye as vvell to the commestione as to the loquution speeche In vvhat persons this operatione is daungerous This manuale operatione is verye daungerous in aged persons in those vvhich are vnhealthesame of bodye or in those vvhich as vve commonlye say have noughtye healinge fleshe because that in mās bodye there is noe parte or place vvhere in the Cācker cā sooner come and beinge therin vvherin he may be vvorse cured vvith more difficulty healed The meanes to cure such a dissease is on this manner VVhe must first of all situate the patiēt tovvardes the light vvith our left hāde lift vp the right syde of the cloven or splitted lippe as then cut vvith the crooked lancett in the middle or vpper end of the foresayed syde of the lippe through the skinne alsoe betvveene them both beginninge as highe as neere the nose as possible might be done dravvīge the foresayed lācett vnto or tovvardes beneath or end of the lippe Hovv vve ought to cure the cloven lippes or haremouthes because that the vvhole interiacēt skinne might be cleane therof separated and severed then vve must change handes takinge in our right hāde the other syde of the clovē lippe vvhich is situated in the left syde then vve must cut vvith the left hande even as before vve have done vvith the right because the clovē lippe may on all sydes be cut on the edges be brought to ravv fleshe vvithout leavinge the least parte thereof vntouched vvhich is not cut or made ravv ether in the infierior or superior partes therof that nothinge differinge from a greene freshe bloodye vvoūde before vve assay to stitch them the one vvith the other We must let that parte somvvhat bleede This beinge one such a manner effected and that parte havīge somevvhat bledde vve must as then contracte ioyne together both the cut partes as close and as smoothe as by anye meanes possible vve may and thrust a needle throughe both the foresayed revnited partes thrustinge deepe enoughe through the fleshe suffere the needle to remayne therin one the vvhich vve must rovvnde about vvīde the threde as the Taylers are vvonte to doe vvhē anye vvhere one there apparrell they sticke there needle there to keepe it As farre as the fissure or splittinge be greate vve may as then sticke tvvo needles there in the one vnder the other above If soe be the separated partes of the foresayed lippe can not vvith any facilitye or ease be brought together vve must thē make tvvo inscisions in eache syde of the lipp one informe likenes of a halfemoone both the korners therof tovvardes the vvoūd Vievve the figure before as heer befor in the figure vve may see vvhich inscisiones must onlye penetrate the vpper skinne because that the edges of the vvounde beinge dravvne together might the better ioyne the one vvith the other for vvith anye violence they may not be compelled but rather vvith gentlenes and vvithout any force because that they beinge brought and ioyned the one vvith the other be not agayne vvithdravvne backvvardes It chaunceth alsoe sometimes that the skinne one the on syde of the fissure can not completlye vnite her selfe vvith the other vvhere throughe that place of the vvounde is deformed mishapē because it is not vvholye cooperte coverede seinge therfore that this soe chaunceth vve must as then cut this sayed parte halfemoone vvyse vvithout in anye sorte touchīg the other syde We must nipe of the poyncte of the needle If so be the acuitye or poyncte of the needle vvhich sticketh in the vvounde or lippe sticketh somevvhat lōge throughe the other syde vve must nipe or breake it of vvith certayne pinsers or tonges because it shoulde not pricke or hoocke in anye other place vve must applye theron a plaster of Betonica in those inscisions vvhich are made in the forme of a halfemoone vve must applye therone onlye drye linte because the lippes or edges therof might not heale because that the fleshe vvhich therin increaseth doe not replenishe the vvounde the lippe ther throughe be made broader The foresayed suture is commonlye healed together the seaventh day and soudered the one vvith the other vvhen as therfore vve espye marke that it is soe that they are ioyned the one vvith the other vve must cut of the threde vvhich is vvounde rovvnde about the needle plucke the needle therout cure the remanēt of the vvoūde alsoe the stitches of the needle as necesitye reqvireth the same to be done and effected Lippes vvhich are cleft in tvvo places The lippes are some times splitte or cleft in tvvo sundrye divers places but therō is not soe much consistinge if they be not soe farre separated the one frō the other as if there vveare a noteable peeces cutt therout because othervvyse it is as vvell easilye to be cured as the single fissure If soe be there be any excressēce of fleshe or any cartilage fovvnde aboute the lippes or in anye place vvhich necessarilye is to descided vve must alsoe cut that out because in all places it might be of an aequalle smoothenes Cleaving of the eares and nostrelles As cōcerninge touchinge the fissures of the eares or nostrelles vve must therevvith proceede on such a māner as heertofore vve have sayed of the splittinges and fissures of the lippes Of the vlceratione and excrescence of the gummes called Paroulis and Epoulis Chap. 3. AFter the inflammation or inscensione of the gummes commōlye succede the follovve the an excrescence of fleshe vvhich of the aunciēte professors vvas called Epoulis that especiallye about the checke or hindermost teethe
in there place tye them vvith a gouldē vvyer as is before rehearsed or els vve may set other teeth in ther places vvhich are by art made of Ivory Looke afore in the figure or formes or of any other matters as here before vve have set dovvne the figures and discriptions therof The Frenche Chirurgerye THE SIXTE TREATISE OF THE OPERATIone of Chyrurgerye Contayninge nine Chapiters Of that vvherone vve must consider before vve make an apertion in avayne Chap. 1. Hovv vve ought to phlebotomive or open avayne Chap 2. VVherō vve ought to cōsider after vve have opened the vayne vvhē shee bleedeth Chap 3. Of the number of vaynes arteries vvhich are vsed most cōmonlye to be opened Chap. 4. Of the apertione of the Arteries Chap. 5. Of Anevrisma or broken arterye hovve vve ought to make an inscisione therin after vvhat manner vve ought to binde them Chap. 6. Of the Cirsotomia vvhich is hovv vve ought to make our inscision in the Varices or bursten vaynes Chap. 7. Of horseleeches and of ther vse and hovv vve ought to applye them Chap. 8. Of boxes and hovve vve must applye and vse them Chap. 9. ⧠Wheron we must consider when as we desire to open a vayne or phlebotomize Chap. 1. Intentione porpose of the aucthor MYe purpose and intent is not in this place to discrib vnto you vvhat sicknesses reqvire phlebotomye in vvhat age in vvhat time or season of the yeare in vvhat countrye in vvhat cōstitutiō of the body it must be done of vvhat occasione namelye especiallye vvhether it be for anye simple evacuation or for anye deprivatione or derivatione or for any revulsione In like sorte alsoe in vvhat vayn vve ought to make the apertione vvhat qvantitye of bloode vve ought to detracte out of the same in vvhat sorte and hovv much at one time hovve often after the other or in vvhat time of the sicknes vve must make the apertione in the vayne But my purpose and meaninge is onlye to shevve hovv vve ought to opē a vayne vvheron vve must thinck dilligentlye consider before vve make the apertione therin after vve have opened her vvherone vve ought to not vvhē the blood issveth out of the same This doinge shall the Chyrurgiane be noe lesse vvorthye of prayses because he cā verye excellentlye phlebotomize then the physitione is prayse vvorthye by his perfect knovvledge vvhether the patiēt have neede of phlebotomy or not Why phlebotomye is difficulte daūgerous For although that it seemeth to be a smalle sciēce to phlebotomize aright very vvel yet notvvithstandinge is it oftentimes a difficulte matter verye daūgerouse because the vaynes ar situated somtimes close to the Arteryes yea alsoe thervppen as alsoe are the synnues Accidentes vvhich are caused take ther originall of ther hurtinge of anye vayne synnue arterye or tendone the tēdones If soe be therfore vve chaunce vvith the lancet to hurte a Tendone therafter most commonlye issueth a Spasmus or a Gangrene and mortificatione vvherthroughe the patiēt pitifullye ruefullye and vvith great torment endeth his lyfe If ther be then any arterye touched opened shee verye difficultlye vvil be cured vvherby the patiēt bleedeth to death vvhē as vve descide a vayne qvite asunder both the endes therof are immediatlye retracted and dravvne invvardes the one end this vvay the other end that vvaye soe that vnder the fleshe both of the endes are lost noe bloode cā possibly issve therout if shee be then vvith to great timorousnes feare pricked the skinne onlye vvhervvith shee is covered is as thē inscided the vayn not opened or els if shee be onlye pricked vvith the poyncte of the lancet the bloode as thē issveth therout droppingevvyse and the subtilest bloode onlye cometh out vvher cōseqvently therafter she exvlcerateth Sometimes alsoe lyeth the vayne occulted soe deepe in the fleshe that vve can not vvith the lācet finde thē vvithout great paynes yea also although vve espye them yet throughe there perpusillitye rotūditye they avoyde eschevve the poyncte of the lācet hovv accute subtile soever the same be Soe that ther are oftētimes divers occasions vvherfore phlebotomye is difficulte vvhich to an other vvhich never hath done it seemeth to be very easye Before the Chyrurgian maketh his apertiō in the vayne if soe be the patiēt be restringed bovvnde in his belly hath in a lōge time not bīne at stool vve must thē first of all cause him to vse a Clistere because throughe the phlebotomye the vaynes beīge evacuated emptied doe not attracte dravve vnto thē out of the guttes or entralles any corrupted rottē humors vvherbye anye of the vvorthyest partes might be offende hindered Nether is phlebotomye expediēt Wheron vve ought to cōsider before phlebotomye vvhen as the stomacke is burthened ether vvith anye cruditye of vndigested meat or drincke or vvith anye other viscositye vvhatsoever as also it is vvholye dissvvaded to doe after anye greate evacuatione or anye other occasione vvherby the patient might be debilitated as is superfluous parbrakinge a great laske great abstinence continualle vigilatione and great conversation vvith vvoemen VVhē as therfore the Chyrurgiane in the absence of the Physition hath on all these foresayed thinges dilligentlye cōsidered he must as then deferre the phlebotomye And if it soe chaunced that anye persone to praevent any dissease desired to be phlebotomized he must then cause it to be done vvhē as he is best of courage as beinge freede from all care of sorrovve of ire and besyde all this vve must not phlebotomize anye persone vvhich is to timorouse fearfull of phlebotomye because the afrightednes the feare causeth the bloode to vvithdravve it selfe tovvardes the internall partes of the bodye Hovve vve shoulde convenientlye phlebotomize And the patiēt as yet beinge lustye strōg vve must then cause him to sit in a stoole but if soe he be feeble debile is subiected vnto fayntnes sovvndīge as those are vvhich are of a hott nature vve must in the first let him suppe in a soft dressed egge or a morsell of breade sopped in vvyne then cause him to lye one the bedde halfe sittinge vpright stuff him vnder vvith cushēs as if he sate And above all vve must dilligentlye note that the light of the ayre or shining of the candle doe rightlye shine one the vayne because that through the shaddovv therofe the knovvledg of the vayne of the place vvhere she must be pearced be not vanished out of your sight then must the Chyrurgiane vvith his right hande take the right hand of the patient or vvith his left hande the left hāde of the patiēt out of the vvhich he meaneth to dravve the blood out depressinge the arme sōvvat dovvn vvardes and then vvith his left hand or vvith a vvarmed table naptkinne rubbe the insyde of the arme vvher he
other badde accidentes vntil the Fifteenth day and the moderne and ionge professors vntill the hundred the day The Iurists or lavvyers have constituted and ordayned fifteene dayes for the iudgement of the vvoundes of the Heade to knovve of a certayntye vvhether the patient by occasione of that vvoūde came to dye or not or by reasone of his ovvne faulte or by any other occasione Because therfore that the yonger Chyrurgiane shall not be over rashe in givinge of his iudgement leaste he come te glyde and falle into anye badde reportes or in anye repraehensione As much as appartayneth vnto me I have knovvne some vvhich have continued in a verye good estate vnto the thirteenth fourteenth or vntill the fifteenth day and then have fallen into agues and manye other accidentes by the vvhich they in the end chaūced to dye VVee must alsoe note that all naughtye and badde accidents most of all publishe themselves at the full Moone more then at other times because as then all maner of moysture grovveth and increaseth more then in the decreasinge of the Moone alsoe more in the sommer then in the VVinter The signes and tokens of the deadlye fractures of the sculle are agues in the VVinter The signes of the deadly fractures of the sculle before the fourteenthe daye and in the sommer before the seaventhe day Item a naughtye and badde colloure of the vvounde little matter of the same mortificatione of that vvhich is inflamed slimye or viscouse consistence of that vvhich is corrupted drieth ariditye in the skinne of the heade as it is in a peece of pouldrede fleshe vvith a brouvvne leadishe and blacke colloure vvhich signifyeth the beginninge of the corruptinge and putrifyinge of the sculle vvhich thē vvaxeth ravve as vve may see vvhen it is rotten and grovvne blacke vvheras before it vvas even and smoothe Finallye vve see therin a pale and yellovvishe colloure to vvitt vvhen the foresayede bone is vvholye corrupted rotten throughe the purulent matter vvhich vvas suncke to the grovvnde of the vvounde and vvas there gathered together The patient beginneth to rage he hath little pimples one his tonge he getteth alsoe convulsione of synnues one the contrarye syde of the vvounde some fal inte an Apoplexia vvheron follevvethe deathe The Practitioners of our times have observed in all vvoundes vvhether allreadye therin vveare a Paralisis or els therafter happened thervnto and onethe contrarye syde a Convulsione or somtimes also in the vvounded part a Convulsione and in the other syde a Paralisis sometimes also in both the partes ether a Cōvulsione or Paralisis and somtimes one each syde ether a Convulsione or a Paralisis vvithout the contrarye syde beinge in anye sorte thervvith infected The goode signes of healinge in the fractures of the Heade after that it is trepanede or els after that the brokē parcells of bones are taken out of the Heade are these namelye vvhen that the Membrane of the Braynes hath her naturalle colloure and her naturalle motione stirringe vvhen the engendringe and grovvinge Fleshe is redde VVhen that the patient may easylye turne aboute his Necke and alsoe easylye vvagge his lovver chavve bone But in somuch as the Membrana hath noe stirringe Badde signes and is blacke leadishcolourede lividouse or vvith anye other badde coloure taynted defylede Then the patient ragethe vomiteth exceedinglye falleth into a Paralysis or in Spasmo if that the Fleshe of the vvounde be leadishe colourede the necke the chavvebone bothe of thē stād stiffe all these are verye bad signes And vvhē the vvoōde is at a good estate thē beginneth the fleshe of the Membrane or of the sculle to grovve and to vvax dubble and filleth all the voyde places vvith fleshe that have binne open betvveene the bones yea somtimes covereth even as it vveare vvith pomgranate Kernells the scull it selfe ⧠The tokens howe to knowe which partes of the bodye are wounded Cap 3. TTe vvoundes most commonlye are knovven by ther first aspecte alsoe sometimes the place of the vvoūde certifyeth vnto vs vvhat partes are internallye vvounded But seinge that it often times chauncethe that these vvoundes ' vvhich to our estimatione be not profounde or deepe penetrate vnto the internall partes vve vvil heere therfore recite the signes by the vvhich vve may knovve vvhat internall partes vvithin the bodye aré vvoūded because ther by vve may knovve vvhether the patiēte may be cured of them or not Signes vven the braynes are hurt If soe be that the Braynes or else ther Membrane is vvoūded thē ther issueth bloode out of ther Noses vvith some alsoe out at there Eares commonlye ther follovveth a vomitinge of choler some lye almoste out of the memorye beside thēselves that althoughe you call crye vnto them they give noe ansvvere others seē in ther faces as if they vveare afrighted feared some turne and vvinde there eyes this vvay and that vvaye as if they vveare touched stricken by Gods hāde the thirde or the fifth daye most commōlye they fall into madnes Phrenesie other gette the Spasmū before they dye some there are vvhich plucke the medicamētes from there Heades soe that the vvounde commeth to lye bare vvaxeth coulde VVhē as the backe bone is hurte Sygnes vvhē the backe bone is hurte or vvoūded thē beginnethe the patiēt to be feéble lame in his synnes or else he getteth cōvulsione of synues vvhich is called Spasmus leeseth the sence of feelinge somtimes the patiēt can nether retayne his vrine Sperma or Stole but of it selfe departeth from him If the Harte be vvoūded Signes vvhē the harte is vvoūded ther issueth out of the vvounde greate store of blacke dence or thicke bloode especiallye vvhen the right side of the Harte is hurte But vvhen the left syde of the Harte is hurte then issuethe out of the vvounde fine subtile redde bloode the pulse of the patiēt is verye debile feeble variable is verye pale coloured in his face The coulde svveate in all his bodye bursteth out and hath a verye vnsaverye smelle evē as vve may note in other sicknesses of longe cōtinuance His handes and feete beginne to be coulde out of the vvhich present death ensueth VVhē the Lunges are hurte thē breatheth the patiēt vvith greate difficvltye The vvounds of the Lungs divers times reiterateth dravveth anevve his breath as if he there by sought indevoured to doe him selfe som solace cōforte he voydeth of ten times through his mouth frothye bloode throughe the vvoūde fayre redde vitalle bloode vvith peepinge hissinge breathe he endevoureth for the most parte to lye one his vvoūded syde others often times erecte them in ther bed vvith out anye occasione Some lyinge one the vvounded syde can speeke but turninge thēselves one ther sovvnde syde are quite deprived of there speeche sometimis they are bloesinge in ther faces sometime cleane pale and at the
must dye therofe it might also bringe the Physicion or Chyrurgiane into the name of beiÌ„ge cruell mercylesse vvher other vvyse the bullet beiÌ„ge dravvne forth it might be that the patient might as yet be curede vvherfore the Chyrurgiane must alvvayes endevoure doe the best he can vvhen he hath forttoulde admonished the frendes of the patient of the daunger because some times greate fearfull vvouÌ„des beyoÌ„de the expectatioÌ„s of all meÌ„ are cured vvherfore vve ought not at anye time to permit or suffer the patieÌ„te vvithout helpe or succoure vvhere ther is anye smalle hope of beinge cured We muste not at anye time leave the patient And all thoughe that all thinges of this our operatione fall not out accordinge vnto oure minde yet notvvithstandinge must not vve leave to effecte that vvhich this arte science reqvireth that vvhich our coÌ„science vvitnesseth vnto vs. Consideration of bulletes Above all that the Chyrurgiane must considere on the vvounded parte he must alsoe farther consider one the differeÌ„ce varietye of bulletes vvhich consisteth in the matter forme qvantitye number and facultye of the same As concerninge touchinge the matter althoughe that the foresayed bulletes most commonlye are of leade yet for all that sometimes the besieged they that skermishe in the feelds are constrayned to vse tinne bullets Copper peeces of iron steel peasen yea alsoe little stones or pebles As concerninge the figure or forme therof they are most commonlye rovvnde although ther are some shotte vvith three corners some foure corners some of other fashons Touchinge the qvantitye ther is great difference concerninge the greatenes of the peeces by the vvhich the bullets are shott As for the nuÌ„ber constitutione of the foresayed bullets ther are some vvhich shoote vvith more theÌ„ vvith one bullet vvith some vvhich are fastened the one vvith the other vvith little chayned Bullets vvith hayle shote vvhich spreade theÌ„selves in the bodye of a man Speakinge of the forces or facultyes of bullets I have not as yet geven anye credite vnto them that sayed the bullets might be poysened because as yet ther hath binne never a famous Chyrurgiane vvhich ever had a venomous shotte vvounde in hande in these our tymes vvhich hath made anye meÌ„tione therofe as is playnlye shevved in the discourse of the disceased the right vvorshipfull M Ambrosius Paré chiefe Chyrurgiane to the kinge his maiestye vvhich hath verye learnedlye discussed as it vveare grovvnded this questione in his boockes of Chyrurgerye ⧠The bullets all other straunge things ought in the first dressinge to be drawne forth soe farre as it is possible to be done of the meanes how to effecte the same Chap. 3. WHen that the Chyrurgiane shall have coÌ„sidered one the parte also a little observed one the varietye difference of bullets he shall chuse a certayne nuÌ„ber of instrumentes vvhich coÌ„tinuallye he ought to have by him especiallye those vvich he supposeth to be most fittest to dravv forth the fore sayed bullet vvith most facilitye ease We must endevoure to dravve forth the bullete at the first dressinge The vvhich he shall at the first dressinge vvithout anye longer delaye vnto the next daye put in vre and practise for the bullet beinge dravvne out shall the patieÌ„t Chyrurgiane alsoe be freed from great daunger the vvhich both of them vvith all right ought to desire and longe for The bullet may alsoe praesentlye vvhile the vvounde is freshe greene be felt vvith the finger or most fitlye vvith the privet or searchinge iroÌ„ vvithout tarryinge vntill the next daye because that the vvounded parte throughe anye concurringe humors svvelleth out of haÌ„de throughe the payne of the vvounde by the vvhich the entrance of the vvounde coÌ„meth to svvelle as alsoe throughe the force of the bullet anye of the MeÌ„branes or TeÌ„dones beinge brused the foresayed entraÌ„ce of the vvounde stoppeth because most coÌ„monlye shotten vvoundes doe not enter right or liniallye into the bodye but turninge alsoe vvith any Membranes or tendones rovvnde about vvounde euen â—â—ngled as alsoe the bullet through his ponderousnes runninge this vvay or that vvay chaunceth to fall into some hollovve place vvhich sometimes frustrateth annihilateth the knovvledge of the Chyrurgiane so that by anye meanes possible he can nether touch nor finde him above all this the foresayed vvounde is the seconde day more sensible tender then vvhen shee is freshe as the patient allsoe vvhile that the vvounde is fresh vvarme is better able to abide the sovvnding or searchinge iroÌ„ or privett that vvhich is more the vvounded havinge obtayned noe time to thincke The vvouÌ„ded feeleth not his vvouÌ„de at the first consider of his vvouÌ„de his harte beinge as yet puffed vp vvith vayn glorye is not as yet at the first dressinge posessed vvith anye timorousnes or feare as he is in the seconde or thirde dressinge vvherfore in his frist dressiÌ„ge vvith more courage patience is able to beare the payne and dravvinge forth of the bullet First of all therfore if so be that by anye meanes vve caÌ„ nether finde nor feele the bullet to acomplisshe effecte this vvorke fitlye convenientlye vvith the leaste trouble payne of the patient vve are constrayned to cause the patient to sit or stande in such a forme posture or collocatione as he sate or stoode vvheÌ„ as the bullet vvas shot into his bodye yea alsoe vvith the same gesture behavioure One vvhat maÌ„ner vve must set the patieÌ„t vvhich he vsed for the chainginge of the forme as vvhen vve fight or vvhen vve are layed aloÌ„ge or vvheÌ„ vve staÌ„de vpright or beinge sett dovvne causeth a greate alteratione in the beinge and situatione of these partes of the patiente because the vaynes arteryes synnues bones muscles may one so manye vvayes fashons be turnede vvouÌ„de as they have divers vses actions vnto the vvhich they at fitt it be ether in the erectiÌ„ge or in the stoupinge or in the turniÌ„ge vvhich often times is the occasione that altough vve search feele for the bullet any muscle lye anye other vvay turned then it did vvhen the foresayed muscle vvas pearcede vvith the bullet the vvouÌ„de in that place most commoÌ„lye beinge stopt soe that for the most part the searchinge iron can not enter that place vvher the bullet lyeth But vvhen vve shall have set the patient on such a manner as he stoode or sat vvheÌ„ he vvas shot theÌ„ come all the partes into the same situatione as they vveare vvheÌ„ he vvas shott vvherfore as theÌ„ the proofe or searchge iron may passe verye easylye vvithout any let eveÌ„ into that place vvheras the bullet lyeth And soe farre forth as the patieÌ„t coÌ„sideringe his greate imbicillitye vveakenes hath not the strengthe to staÌ„de in that ordre vve must as theÌ„ at the leaste ether sittinge or lyinge turne vvinde him on such a maÌ„ner vvhether
place of the bullet and soe dravve him forth of the same for that Chyrurgiane vveare vvorthye to be laughed to scorne vvhich cā not accōplishe his praetended purpose after that he hath soe intolleratlye tormented the patient Albove all this vve must note and marke The bullet somtimes carryeth sōthinge vvith him in to the bodye vvhether the bullet have trayled nothinge vvith him into the vvounde as paper vvoole cottē linnē or anye thinge els of the patients clothinge or apparrell or alsoe anye parcell of the patiētes armour or harnas or anye peeces of vvoode stones or iron vvhich the bullet mightby anye meanes have carryed vvith him into the vvound as such a thinge might vvel chaūce vvhē the bullet anye vvhere agaynst a vval or agaynst on s harnas on the vvhich the fore sayed bullet chaunceth to rebounde breakinge receavinge some smalle parcell of that on the vvhich he plettered carryeth it vvith him into the bodye If soe be ther be anye such like thinge carryed into the vvoūde vvith the bullet vve ought to have noe lesse care of that yea rather more thē one the dravvinge forth of the bullet for such thinges are vvholye cōtrarye vnto nature because they corrupte and rott in the vvounde out of the vvhich needes must follovv some great Inflāmatiōs or Apostematiōs so conseqvētlye the vvounde in a lōge time cā not be cured vvhich othervvyse might easylye be cured much sooner althoughe that the bullet as yet tarryed therine especiallye if that the bullet be of leade because that leade vnitethe maketh it self all one vvith our nature Meanes hovv to knovv vvhether the bullet have takē any thinge vvith him And perfectlye to knovve vvhether the bullet have carryed anye such thīges vvith him vve must cōsider one the harnas if that be any vvheare torne or brokē if it be a mayled doublete hovv manye mayles ther are vvantinge the vvhich one that maketh mayle doublets easylye cā tell you vve must alsoe note the patiētes apparrell his shirte vvhether ther be any greate or small peeces therof torne rēte or vvhether ther be one ōlye hole fovvnde ther. ⧠How we ought to drawe forth those bullets which sticke fast in the bones or in the iunctures or ioynetes of the same alsoe what we ought to note whenas the foresayed bones are crushed beaten to peeces Chap. 4. Those bullets vvhich sticke fast in any bones are verye difficult to be dravvne out THe greatest davnger that consisteth in dravvinge forth of a bullet is vvhen the fore sayed bullet sticketh faste in anyé bone or in anye ioyncte betvveene the bones If soe be the bullet sticke faste in anye bone it is most convenient that as thē vve dravve him forth vvith that instrument vvhich vve call Extractor or Grovvnde dravver vvherof vve must sett the poynt one the bullet vvīde it verye fast in the same vvhē it is therin faste vve must softlye easylye trye if he vvill not follovve turnige the handes this vvay and that vvay the better to make him loose and stirre But if soe be that vve can not soe soone gett out the bullet vve must then suffer him to cōtinue therin some certayne dayes vvith in the vvhich time the externall fleshe vvill beginne to rotte throughe the vvhich the vvoūde vvilbe somvvhat dilated vvyder and the bone vvill somvvhat disclose open duringe the time vve must everye day stirre the bullet vvith the instrumēt lift him vp because that thus doinge the foresayed bullet might by little little be removed Loosed and if that vve perceave that the bullet sticketh to faste can not by anye of the fofsayed meanes bedravvne out then is this the last remedye that vve quite cleane pearce and boare throughe the bone vvith the Extractor or elsi vvith the poynt orpiramide of a Trepane pearce boare agaynst rovvnde aboute the bullet in divers places Elevatorium or vpheaver because ther may be made some place for an Elevatorium on that sorte to lift vp the bullet drevve him therout if that vvith all gentlenes it may by anye meanes possible be brought to passe for vve are in noe vvyse counceled vvith violence or vehemence to effect it And if it be a little and small bullet that he stick in anye place fast as in the middle of the greatest focile of the shinne bone or in the middle of anye ribbe or in the sternon or in anye bones of the heade vve are as then counceled to trepane that bone settinge the Trepane on the bullet soe that the fore sayed bullet be rovvnde about compassed vvithinthe circkle of the Trepane and that then the trepane might abolishe and take avvay all that vvhich retayned and helde fast the bullet On vvhat sorte vve muste dravve forth a bullet out of a ioyncte But vvhen the bullet is any vvhere in anye ioyncte pearced penetratede betvvene tvvo bones as for example in the knees vve must then as easyely as it is possible endevoure vvith the instrument to stirre the bullet hether thether hut allvvayes strayght forevvarde novve tovvarde the hippe and then tovvarde the legge because that therbye vve might the better vnshutt make loose vvith the leaste payne that may be the ligamētes tēdones vvhich cōtayne houlde the ioyncte soe close together by the vvhich apertione and dravvinge forth the space distance betvveene the bones vvilbe a little dilated soe that at lengthe vvith lesse payne trouble vvith the little spoonevvyse bullet dravver vve shal be able to dravve forth the bullets But if vve feared least vve shoulde put the patiēt to some intollerable payne throughe the distendinge of the ligamentes tēdones my councell is as thē that the yonge Chyrurgiane endevoure to follovve and vse the same vvhich I did or have vsed on my lorde of Floyon vvhich in the skirmishe of Maestricht A notable Historye got a shott in his knee the bullet lyinge faste occulte in the iovncte betvveē the bones the vvhich nether I nor anye chyrurgianes of Dō Ihon of the Eeaste coulde finde at the last it seemed good vnto me agaynste the opiniōs of all the reste vve shoulde shutt foulde together the knees of the patient vvhich he doinge vvith some payne the bullet through the fouldīge of the Knees the bones vvhich placed pressed thēselves together vvas drivē therout revealed it selfe externallye vnder the skinne and one the sydes of the foresayed ioyncte vvher I havinge made a little inscisione my selfe have takē the same forth of that place In like sorte if soe be the bullet We must dilate the vvounde if the bone be dilacerated have rebovvnded agaynst anye bone and the bone throughe the violēce therof be broke crushed to divers peeces the bullet as yet remayninge therin or else havinge pearced quite throughe it is as then the surest vvay to dilate the vvounde as
daunger in hurtinge of the tendones that consideringe the synnuishe fibers vvhervvith the muscles of the bellye are connectede vvhich in time chaūge themselves into a tendone vvhich vve commonlye call the great synnue What we ought to consider in the suture and so winge of a wounde Chap. 2. Why vve may not in the resovvinge of a vvoūde dravve the lipps or edges close together WE must not at anye time sovve vp a vvounde least in the first shee be vvell purifyed cleansed as vvell externallye as internallye if at the least vvith out any great daunger or perrill it may be effected extractinge and takinge therout all that is contrarie vnto the sayed vvounde as is congealed bloode vvhich comminge to corruptione might cause greate inflāmatione oftē times alsoe a convulsione in that parte throughe vvhich the sovvinge breaketh teareth soe conseqventlye hinderethe the vnitinge healinge of the vvoūde vvherfore in the resovvinge of a vvoūde vve must deligentlye note that vve doe not contracte dravve together on all sydes the lippes or edges of the forsayed vvounde except it vveare in the haremouth in the cleaved or severed lippes of the mouth but must leave some distance betvveene the one the other lippe or in anye place some or other apertione because the matter which gathereth it selfe together in the bottome of the vvounde may issue therout and by that meanes the medicamentes may be therone applied In like sorte the Chirurgiane must in sovvinge consider vse medicoritye and not take to great a qvantitye ether in the length or in the depthe of the fleshe and of the skine throughe the vvhich there might ensue and follovve great payne vvhich vve ought not to esteeme for smalle therof allsoe vvoulde remayne an illfavored vnseemlye cicatrice or scarre As to the contrarye the not deepe sovvinge of the vvounde myght easylye breake and burst agayne then in vayne it vveare sovvede For if soe be that the needle be to neere thrust throughe the edges of the vvoūde thē the threde because of his tenuitye teareth throughe the skinne or fleshe vvhen as vve thruste the needle to deepe and farre from the lippes or edges of the vvounde then there resteth and remayneth a greate parte of the skinne Fleshe vvith Fleshe commeth farre sonner to vnite thē skinne vvith skinne vvhich vvill not be vnited vvherfore indifferentlye vve ought to pearce together as much of the skin as of the fleshe because the fleshe farre sooner and easyer commeth to heale and cure vvith the fleshe then the skinne vvith the skinne and that is consideringe the naturall temperatenes of the foresayed fleshe vvhich is vvarme and moyste And as touchinge the distance of the stitches and soovvinge vve ought not to laye them to close one by the other nether to farre separate sequestred one frō the other as thē they can not retayne the vvounde And vvhen all to nye the other they are layed cause payne through all the stitches and dravvinge together of the same through the vvhich payne is caused a concursione of Humors vnto that place vve must therfore vse a meane therine vvell consideringe the largenes and length of the vvounde but above all vve must marke that vve thrust not throughe or in anye synnues or tendones consideringe the payne the Spasmus and manye other fearfull accidentes vvhich therof might ensue as allreadye vve have sayed Sovving of a vvounde may not be effected vvith anye violence in those partes vvhich vve endevoure to vnite and bringe together but thē is sovvinge laudable vvhen as the skinne stretcheth it allmost together of it ovvne accorde vvheras in this sorte it vvill not be effected or brought to passe easylye that the lippes of the vvound vvith violence must be ioyned it is as then most convenient that vve relay the stitches some distāce one frō the other lettinge them be somvvhat looslye sovved for if it chaunced vve drevve them somvvhat stiflye together the skinne might then easylye rente or teare soe burst a sunder throughe the tumefactione vvhich therof ensueth If that therefore Sovvinge may not by anye violence be done in the lippes of the vvounde vve disire perfectlye to cure a vvounde vve ought as thē soe to dispose of the sovvinge because that in thus doinge the humors bloode matter and the externall ayre might be repelled from the lippes or edges of the vvoūde because such thinges may hinder or at the leaste deferre the curinge of the same and in soe much as the lippes of the vvounde are not vvell vnited the one vvith the other and kept in that stature vnitinge the vvound can verve badlye hardlye be cured And alsoe if the lippes of the vvounde We may in noe vvise sovve the lippes of an inflamed vvounde doe greatlye chaunce to svvell inflame theye shrinck in themselves or els if they be to much brused or plettered vve must not thē in anye sorte resovve it agayne for the suture vvould strayght vvaye breake and soe consequentlye the inflammatione increased but must delay it soe longe vntill the foresayed inflammatione be seaced the vvounde be come to goode suppuratione and matter and is prepared and readye to be vnited brought together What is necessarye vnto the sowinge of a wounde and howe we ought convenientlye to doe it Chap. 3. WHen as the Chyrurgiane desireth aptlye convenientlye to sovve a vvounde he must first of all have in his hande a needle therto a threde and a canulle Cōcerninge the needle shee must be of a reasonable length somtimes right sometimes croocked accordinge as the partes reqvire nether must shee be made of to harde a steele or mettle vvher of they easylye might chaunce to breake but of gentle steele because they might rather bende then breake althoughe shee ought to be stiffe smooth infrangible havīge a sharpe triangled poyncte because that in her entringe she might both cut pricke soe the easyer perce or goe ther through because that in her govvinge throughe she might make a longe little vvound or hole not rounde because those little rovvndes are more difficulte to be cured What forme the needle must have then the longe holes In the heade she must be one both sydes hollovve in form of a gutture because the threde might therinne be hidden buried not hinder the percinge or entrance of the needle in the dravvīge throughe therof because shee then toucheth the bodye in that sort more easyer and softer It vvill not alsoe hinder accordinge to the sayīge of Avicenna that vve somvvhat anoynt the needle vvith oyle vvherbye the payne of the pricke night be somvvhat easyed the foresayed needle enter the easyer What forme the threde must have The threede must be smooth soft rovvnde and vvithout anye knott all eqvivalent vvith the thicknes greatnes of the needle but not in any sorte to thinne least he
chāce to breake or cut through the lippes of the vvoūde VVe may rather take a threde thē silke because the knott of the silke easylye vnlooseth throughe his vveaknes it is right true that the foresayed threde must not be to harde because there throughe he might hurt the vvoūde not to softe least he breake nor chaūce to corrupte before the time the vvounde be fullye healed vvherthrough the lippes of the vvoūd might agayne dissolve vvaxe loose yet notvvithstādinge novve a dayes vve had rather vse a thred of carmosyne silke thē a hempen threde or of flaxe vvhich Galenus disprayseth misliketh in his third booke of methode vvhere he best liketh of a threde of vvollen vvhich may be likened vnto a brovvne threde or a vvhyte silke threde ravve vvithout beinge dyede or coloured Why the threede may not be dyed or coloured because that in the dyinge sometimes is entermingled poysen as in the scarlet dye ther cōmethe Arsenicū The fore sayed Galenus vseth stringes made of smalle guttes as are lutestringes but cōsideringe there moysture they quicklye beginne to svvell rotte vvherfore vve had rather vse a stronge brovvne threde vvhich vve must dravve throughe vvaxe vvaxe it because soe much the lesse he might corrupt rott houlde the faster And to effect this surelye to sovvea vvoūde vve must have a Canulle vvhich one the one end must be roūde splitte vvith a hole partlye because the edge or lipp of the vvoūde vvhich vvith the needle vve vvoulde pearce because that the fore sayed lippe may stay rest it selfe on the pype vvithout stirringe this vvay or that vvay throughe the vvhole to espye vvhen the needle is halfe perced throughe as then to dravve her through vvith her threde vvithout ether the nedle or the thred to dravve the lippes of the vvounde tovvard them because throughe the splitte of the pype it might the the easyer frō thence be removed to rest therō the other edge therafter vvhē she allsoe must be thrust throughe And convenientlye to effect this sovvinge of a vvounde Hovv to sovve a vvounde conveniētlye vve must first thrust through the vpper lippe of the same situatinge at the first the holed ende of the pype vvith the left hande internallye vvithin the lippe of the foresayed vvounde because she may rest therone and not stirre this vvay or that vvay then vvith the right hande vve must thruste the needle throughe the externalle parte of the lippe invvardes then set the Canulle on the externall parte of the nether lippe of the vvounde thrust the needle internallye outvvardes of the foresayed lippe gentlye dravve throughe the threde because as then vve may couple ioyne agayne the lippe together if it be needfull to lay more stitches vve must lay them as is a fore sayed some mē hould the lippes vvith ther fingers in steede of a Canulle The kindes and differences of sowinge or sutures the the time and the methode or rule to take thē away Chap. 4. THe aunciēt Chyrurgianes have invented fovvnde out divers sundrye vvayes of sovvinge of a vvounde Divers formes of sovvinge accordige vnto the diversitye of the vvounde cōsideringe markinge one the vvoūded parte nature or qvallytye of the disseases for the vvoundes of the armes or legges as in those places vve may better vvith more cōvenience vse the dry suture the vvoūdes of the bellye are alsoe on an other fashone sevved then the vvoundes of the guttes The profounde deepe vvoundes are sovved on an other fashon thē the not deepe vvoūdes Alsoe are the debile imbicille persōs sovved one an other fashō as are vvoemē thē those vvhich are robuste stronge by great paynes takinge and labour have a harde skine ther in to eschevve flye the deformitye vvhich after the sovvinge vvilbe seene All auncient professors have vsed Three sortes of sovvinge by the auncient professors have had in esteē thre sortes of sovvinge of vvoundes as naemelye the incarnative the bloode stoppinge the conservative sovvinge The incarnative suture is soe called because that throughe her vnitinge shee ioyneth together the separated partes Incarnative suture her vse five manner of vvayes if soe be vvithout violēce cōveniētlye they may be brought together vve vse this māner of suture in all freshe vvoūdes or in these vvhich are renued And this sovvīge is effected after five māner of vvayes VVher of the first is called Incarnative or knotted sovvinge the knotted suture or sovvinge because that in evetye stitche vvhich perceth throughe both the lippes of the vvoūd is every time cutt of vvith both the endes of the thred above the vvounde is knitte together betvvixt the vvhich stitching vve lay as yet other This suture is done vvith a vvaxed threde as is all readye sayed notinge that bothe the lippes must aeqvallye be ioyned the one vvith the other vvith out that ether the one or the other yelde it selfe more this vvay thē that vvay placinge the firste stich in the middle of the vvoūde vvith a perforation of both the lippes of the vvoūd by the vvhich the threde beinge passed shall one the one syde of the lippe be dravven together above dobblelye knitte to gether cuttinge both endes of the threde shorte of because they should be noe hinderāce vnto the remydyes vvhich vve shall applye The vvhich in the renuinge of the dressinge might be the occasione of payne or brekinge of the stitches vvhē as vvith the plasters vve chaunced to plucke them If the vvoūde he greate vve must as yet lay more stitches in the middle of the Spaciū one both endes of the vvounde so proceedinge forvvardes vntill the vvhole vvounde be layed vvith stitches or sutures everye stich a fingers bredth the one frō the other because at the least the lippes of the vvoūde might be brought close together consideringe duelye perpendinge the generall observatione above mētioned especiallye that the stitches be not layed the one to neere to the other or the one to vvyde frō the other because as heer tofore vve have sayed through the great multitude and throughe soe many prickes they bringe are cavse of vehemēt payne cōtraryly they lyinge to fare the one frō the other the vvoūde as thē beinge not sufficientlye occluded or shutt vp doe little profite cōmoditye therfore they may not be layed to close by on another nether to farre separate the on frō the other they alsoe vvhich are layed to looselye suffer the vvoūde to gape to vvyde they vvhich to fast strictlye dravve together the vvounde cause inflammations cōpell the vvoūde burst open vvherfore heerine vve ought te observe a mediocritye The secōd incarnative suture The seconde incarnative or fleshe making suture is done vvith one or vvith more needles as if soe be the vvounde be greate deep as thē vve beginne to sticke thruste
svvellinge reddishe of coloure or purple coloured To knovve vvheter the Hernia be one both sydes if soe be vve finde all these signes and tokens in both sydes of the Scrotum or bagge of the testicles it is then a signe of tvvo kindes of Hernia to vvitt in everye syde one All these svvelinges of themselves cause noe payne vnles it vveare great spanninge of that parte might chaunce throughe the great tumefactions and that especiallye vvhereas the vvatery moysture lyeth inclosed betvveen the membranes of the testicles Novve to abolishe such aqvositye there is nothinge more profitable and commodious then to make an apertion therinne on this manner as follovveth and succedeth Havinge shaved avvay the hayre Hovve vve ought to make the apertione rovnde about the privityes if soe bo the patient be noe childe vve must then cause him to lye one his backe ether one a bedde or benche beinge vvel stored of linneÌ„ then vve must cause a servant or helper to stande one the one syde of the patient on the other syde of theÌ„ vvherin vve vvill make the apertione vvhich foresayed servant must dravve the yarde tovvarde him then must the Chyrurgian vvith his left hande crushe on the inferior parte of the bagge because that parte vvhich he vvill thrust throughe might shevve it selfe the more stretched and fuller of substance and pricke vvith his right hande vvherin he must have a stronge crooked lancett from vpvvardes Inscisione of the Scrotum dovvnevvardes vnto the concavitye of the bagge of the testicles because that the aqvosity may ruÌ„ne out And if soe be the foresayed humiditye lye inclosed in the meÌ„branes of the testicles vve must as then most gentlye artificiallye once agayne thrust therin dilligentlye notinge that vve chauÌ„ce not to touch the foresayed testicles nether anye of the spermaticke vessels and if the humiditye vveare inclosed in a blather the Chyrurgiane must then vvith his left hande crushe one the inferior parte of the bagge on this manner to drive vpvvardes the svvellinge and the svvellinge beinge there retayned kept vve must coÌ„tinue it in this place least that she sincke dovvnevvardes agayne and vvith the crooked lancet cut in the nethermost part of the foresayed Scrotum vnto the blather or bagge vvherin the humiditye lyeth inclosed let it runne therout as muche as is possible And if soe be it be able to be done vve must take therout some parte of the bagge or blather because it should not heale agayne other vvater therin be engendred then vve must put therin a great tente made of linte vvhich must not be to harde vvounde thervvith to keepe open the vvouÌ„de and not so quicklye heal it for if soe it come to be too soone healed shutt ther might then chaunce to be an other collectione and gatheringe together of vvater soe that it might be right needfull to be sure of the curinge of the same that as much as vve caÌ„ vve cause the membranes to be purified and cleansed of all the humiditye and moysture vvhervvith they are throughlye soaked Some there are vvhich applye alsoe in the superior parte of the Scrotum a potentiall cauterye the operatione vvherof beinge done they theÌ„ make an inscisione in the Escara vnto the concavitye of the Scrotum vvherin the foresayed vvater lyeth inclosed then suffer the foresayed Escara of her selfe to fall out and separate Such an apertione vvhich is made vvith corrosive can not soe easylye be cured soe that in the meane season the vvater hath time enoughe to issue out therat Apertion by the thrusting through of a silke threde Others dravve through the svvellinge vvith a strong needle a silkeÌ„ threede in steade of making an inscisione or applyinge of the corrosive in place of a SetoÌ„ or transforatioÌ„ vvher through the foresayed vvater by little little leaketh out But the apertione vvhich is least dauÌ„gerous of these three foresayed is the inscisioÌ„ vvherof noe or at the least verye small accidentes can ensue if soe be she be done expertlye and one a convenieÌ„t place It appeareth according as vve have above tought in the openinge of Apostemations that the apertion of the Scrotum or bagge reqvireth to be done in the inferior partes of the same The apetione is better to be done above 〈◊〉 vnder notvvithstandinge experieÌ„ce teacheth vs that ther happeneth farre more payne inflammation vnto it vvhen the inscisione is made belovve theÌ„ vvhen she is done made above tovvardes the flaÌ„ckes for ther is lesse dauÌ„ger of hurtinge of the testicles above or ther membrane because it is situated more inferior vvher all the fibers of the foresayed ScrotuÌ„ doe finishe end vvherfore they are verye sensible paynfull So that Celsus Paulus couÌ„cell vs that vve should make the inscisioÌ„ close by the flanckes A dubbâ—â— inscisione in a â—â—â—ble Hernia VVheÌ„ as therfore this species and kinde of Hernia is double vve must then make doe such an operation one both sydes especiallye vvhen vve se that they doe not in any sort assvvage THE FIFTH TREATISE OF THE OPERATIon of Chyrurgerye wherin is discoursede and handelede of the disseases of the nose of the mouth contayninge seaven Chapiters Of the Polipus Chap. 1. Of the Haremouth Chap. 2. Of the vlcerationes of the excresceÌ„ce of the fleshe of the gummes called Paroulis ende Epoulis Chap. 3. Of the tunge tyinge or of the shortnes or brevitye of the tunge vvhich the Greeckes call Anciloglossum of the vlceration Ranula vvhich is allsoe called Batrachos Chap. 4. Hovve vve ought to cauterise and cutt of the Vvula or pallaet of the mouthe Chap. 5. Of the svvellinge of the almondes of the vlcerations of the same Chap. 6. Hovve that vve ought to dravve breake or cutt of teethe Chap. 7. Of the Polipus Chap. 1. Roote originall of the Polipus SOme men there are vvhich have a certayne excresceÌ„ce of fleshe in the nostrells vvhich resumeth her originalle out of the bone Etmoidis or Chribleus out of the bones of the nose This excrescence happeneth or commeth to a man by little little at once and at the last she vvaxeth soe bigge huge in qvaÌ„titye that she stoppeth the vvhole nostrells sometimes alsoe hangeth dovvne to the lippes by the vvhich the patient is mervelouslye molested as vvell in speakinge as breathinge Sometimes also shee grovveth in the entraÌ„ce or conductione through the vvhich the ayer the breath are dravvne into the throte the vvhich vve may easilye see vvhen as the patieÌ„t openeth his mouthe behinde the pallaet of the mouth in such a greatnes somtimes that she stoppeth the throate vvherthroughe the patient coÌ„meth in the end to be choÌ„aked if that in time vve doe not prevent it And because such an excresceÌ„ce of fleshe most commonlye is softe and pale havinge divers small sproutes not mislike vnto the feet of the fishe Purpura it is therfore of the Greeckes called Polipus
allso in our langvage Polipus There are noe sortes of Polipus vvhich being venoumous Noe sortes of Polipus can throughe Chyrurgery be cured have neede of the operatione of Chyrurgerye because vve may not touch thē in like sorte vve may not touch those vvhich are infected vvith the Cancer because ther nature is thervvith polluted they ther through spoyled The yōge Chyrurgiane may knovve them by there sensiblenes Signes of a venomous Polipus because they are verye dolorous full of payne extreame hard beinge allmost purple coloured vvith a very stinckīg odoure or smelle on the vvhich the Chyrurgiane shall doe nothinge but must be handled as if it vveare the Cancker to vvitt throughe koolinge dryinge throughe mollifyinge medicamentes throughe the vvhich her excrescence may be praevented Signes of a tractable Polipus That Polipus vvhich is insensible or vvhere there is little or noe payne vvhich is vveake loose tractable vvithout beīge irritated pale or vvhich is of a reddishe coloure those vve may throughe the operation of Chyrurgerye take in handes Hovve vve ought to cure the Polipum To the effectuatinge of vvhich the aunciēte Chyrurgiās those vvhich have follovved there doctrine have effected this operatione cruellye enoughe for some there are vvhich vvith an instrument cutt rovvnde or circkle vvyse this Polipum vvhich to that end purpose therto they have caused to be made and is called in greeke Polyticon Pathion vvithout touchinge of the cartilage or grisle vvhich beinge effected they dravve forthe the foresayed descided Polipus vvith an instrument much like vnto an eare picker or els vvith some kinde of hoocke then they cure heal the vlceratiō as it reqvireth to be don And as cōmonly there remayneth some little peece of roote in the bones Etmoides of the nose the vvhich they scrape of alsoe from the foresayed bones turninge thrustīge therin vvith an instrumēt to fetche all therout that by any meanes possible might tarrye and remayne therein An other manner Others endevour to consume annihilate the foresayed Polypum vvith certayne causticke or vstive medicamētes as vvith Aqva fortis vvith oyle of vitrioll or vvith the liqvefacted moulten corrosive in the vvhich they dippe madefye little smalle tentes vvhich they lay therone vvith or throughe a little pipe because they shoulde not hurte the nose one the internalle or inner syde Others ther are vvhich vvith an actuall cauterye cauterize it vvhich throughe a pipe they thrust therin Others after the exāple the four famous Chyrurgians An other manner to cure the Polipum vvhich not beinge of opinion that in noe vvyse or in anye sorte vve vveare able to cauterize the Polipus vnto his roote because he is soe deepe ingraffed they thē make an inscisione one the one syde of the cartilage of the nose vnto the bone of the same havinge in this sort discovered denudatede the Polipū vnto his roote or first ofspringe originalle then they there cutt cauterise him stitch together agayne the sayed inscisione as vve are commonlye vsed to doe in the hare mouthes The vvise Learned man Guido de Cauliaco liketh commendeth this or such like operatione but in noe vvise counceleth to stitch vp the inscision before the foresayed Polipus be vvholy eradicated rooted out because if soe be that anye parcell therof remayne it agayne increaseth vvhich happening he to be soe all the trouble paynes of the patient hath binne done for nothinge to noe purpose All vvhich operations beinge as sufficiently and completlye effected as they possible may be yet for the patiēt they are tedious trouble some as often times vve have vvith our eyes behelde vvhich to speake the very truthe indeede they have never attayned vnto ther perfecte and former health agayne but rather farre vvorse then better vvherby vve vveare moved to trye make experiment of a far more ominous and more convenient operatiō to the curinge of this dissease vvhich consistethe in the vvhole eradicatione of the same The manner hovve to drovve out the Polipus more certayner convenienter through extirpatione To the vvhich end and purpose it seemeth vnto vs convenient that vve situate dispose the patient on the most convenient māner vve may in a seate tovvardes the light the Chyrurgian vvith his left hande openinge the nostrell vvherin the Polipus is situated shall vvith his right hande thrust therin the flat tōges as deepe as possibly he may vvhich tonges must be sōvvhat broade like a Duckes bil vvhervvith he must nipe the foresayed Polipū gentlelye vvith both his handes turne vvinde the same thervvith alsoe dravve tovvardes him a little not at one plucke because the roote vvhich is fast setled in the foresayed bones might alsoe follovve the foresayed Polipus at one time be dravven forthe and extirpated vvhich I my selfe may vvith the truthe alleadge to have done vvith verye little payne Mr. Sourlin a verye experte Chyrurgian hath assured me that he alsoe divers times hath done it one the same manner vvithout anye inconvenience Admonitione for the Chyrurgiane But the Chyrurgyane must consider that he doe not advēture on such an operatione then in that Polipus vvhich is tractable and not canckerouse vvhich is greate enough to be griped vvith out breakinge to be extirpated vvherfore if it be not great enoughe vve as then let him grovve increase And soe farre forth as the foresayed Polipus drevve himselfe vpvvardes avoydinge the nipinge of the little tōges vve must thē dravve it dovvnevvardes vvith a little hooke because as then vve may the better take houlde therone the operatiō beinge finished ther ensueth an effluxiō of bloode presētlye therafter vvhich vve shall permitte suffer to bleed because that parte may be therof released vnburthened vve must then cause the patiēt through his nose to snufle vp redd vvyne that as oftentimes a daye vntill such time as it be internally cured vvithout applyinge any pingveditye or oyles thervnto ⧠Of the haremouthe or splitted and cloven lippes Chap. 2. Coloboma Curtum THe cleavinge or splittinge vvhich daylye vve see in the lippes in the eares and in the nose is of Galen called Coloboma in Lattin Curtum vvhen as these partes throughe anye naturall dissease are splitted or clovene as if there vveare a peece cutt out To regenerate anye substance is a vvorke of nature and not of the Chyrurgiane It is impossible that vve should ingendre anye other matter restore the substāce vvhich therin is vvantinge because it is the vvorke of nature not of the Chyrurgiane but he may bringe the separated partes the one by the other and cause such a substāce vvhich in that parte is deficiēt vvantinge shall seeme as it vveare there in ingendred soe that verye hardlye vve shall espye marke such an vnseemlines deformitye especiallye if the slitte
thruste her forth of his mouth rubbe or vvipe his finger thervnder oftē times vvith his teethe crushe her vp tovvardes the roofe of the mouth because that the foresayed ligament or mēbrane doe not chaunce to ioyne grovve fast agayne therō Hovve vve may hinder the healinge for as the stirringe removinge vp dovvne are a hinderāce vnto the healinge of the same soe is all so qvietnes stillnes an occassion of the vnitinge cōbinatione of the same yea he must alsoe in the night seasō lay a compresse vnder his tunge there by to hinder delay the curinge of the vvounde vvhich easilye sleepinge might chaūce come to passe that because the tunge nether by eatinge nor by speakinge is in anye sorte stirred or moved Some of our aunciēt professors Membranous ligament or tunge tyinge to prevent the daūger of bleedinge in such an operation thruste through the membranous ligamēt or through the cicatrice vvherby the tūge is kept boūde tyed a needle vvith a threde vvhich by degrees they dravve plucke together vntill such time the membrane heervvith be cut a sunder VVhen as vve vvould cut the tunge tyednes in yonge childrē vvhich are nuely borne Hovv vve ought to cutt the tunge tyinge of yonge children vve must first of al vvith the finger lift vp the tūge vvith the poyncte of the scissors descide and cutt of the membrane vvhich is situated vnder the tunge thē vvith the finger vvipe a little sault therin rubbe it vvithout doinge anye thinge els there to commaundinge the nourse to doe the same once or tvvice more The vlceratione Ranula and the orginall therof It may alsoe chaunce that the speech is impedited hindered by reason of some vlceratione vvhich commeth vnder the tūge called Batrachos or Ranula in vvhich vlceratione ther lyeth a vvaterishe humiditye therin inclosed vvhich often times is not dislikinge vnto the vvhyte of an egge as vvell consideringe the consistence therof as concerning the colour allvvayes commonlye beinge included in a little membrane like vnto the vlceratione Ateroma manye other coulde vlcerations or svvellinges In have seene such manner of svvellinge tumefactions soe greate and soe often times after they have binne thruste through to lett out the matter returne agayn that the patiēt by reasō of the greatnes coulde not speake yea allsoe in davvnger ther throughe of styfelinge or smotheringe soe that I have knovvne them to have binne opened foure times in one daye and at everye season a hādefull of matter to issue therout like vnto slime and the vvhyte of an egge The vvhich hath binn soe difficult to be cured that in the end vve have binne compelled to applye ther one an actualle Cauterium in vvhich large and vvyde apertione vve have imposed layed in linte being madefyed and made vvett in oyle of vitriolle by the vvhich at the last the patiēt is sovvndlye and completlye cured Novv to cure this dissease vve must first of all make an apertione vvith the crooked lancet accordinge to the length of that parte and not thvvart or crosseover to give issue passage to the humiditye matter to runne out vvhich is the occasione of this tumefactione or vlceratione and if soe be this svvelling returne the surest remedye as thē is the actuall cauterye Hovve vve ought to cure this vlceratione his return agayne To vvhich intent vve must vvel and conveniētly situate the patiēte cause his heade to be stayed helde by his servant vvith the one hande one his heade and the other vnder his chinne there aboute vvhere the foresayed vlceration is situated because partlye there throughe it may be elevated and lifted vp for the Chyrurgiane vvith more ease facilitye to attayne to his purpose vvhen as vvith the lācet or vvith the cauterie vve vvill make ther in an apertione For those partes beinge tender softe hovv little soever they be crushed yet notvvitstādinge yeeld thēselves invvardes vvher throughe the apertion might be hindered fayled and all our laboure be lost bestovved in vayne The patient therfore in this sorte beinge settled and disposed and beinge by some servāt helde faste must opē his mouthe then shall the Chyrurgiane vvith his left hande lay a peece of lattinne or a silver plate vnder the tunge of the patient vvhich hath a hole in the middest therof right on the place vvhere vve desire to make the apertione then must the Chyrurgiane take in his right hande a glovvinge or redde hotte Cauterium vvhich he must sittuate right one the hole of the foresayed peece of Lattinne thrust the same into the concavitye of the foresayed vlceration in soe doinge are the circumiacent partes defended from all combustione or burninge the vlceratione verye convenientlye opened This apertion beinge on such a manner effected brought to passe vve must cause the patient to vvash his mouthe vvith a mouth-vvater or gargrise vvhich must be made of barley-vvater of Plantine and of honie-vvater ⧠Howe we ought to cauterize cutt of or bynde and tye the pallate or Vvula of the mouth Chap. 5. NAture hath in the posteriore partes of the mouth created a spongiouse carnall or fleshye dugge as thick rovvnd as is the end of a shaft or qvill as easilye vve may see vvhen as vve open the mouth This reservinge his naturall proportione the Greeckes as thē call it Gargareon the Latinistes Gurgulio Gurgulio vve the pallate of the mouthe but the same beinge amplifyed and grovven greater then naturallye it is through the discendinge of any superfluous humors beinge of one crassitude above beneath it is as then of the Greeckes called Chiou in Lattin Columella Columella as if vve vvoulde say a little pillaer but if soe be it be belovve rovvnder it is as then of the aunciente professors called Staphila of the Lattines Vva Vva and of vs the sincking or fallinge of the pallate It hath sometimes such a longitude depending one the tunge that the patient allvvayes supposeth to have somvvhat in the throt vvhich verye vvillingly he vvoulde svvallovve That vvhich is blacke Wen vve ought not to cutt avvay the pallate vve must not in anye vvyse meddle vvith or take in handes in like sorte alsoe the same being vvholye inflamed because as then vvith out daunger vve can by noe meanes possible descide and cutt it of because of the superfluous bleedinge vvhich conseqventlye follovveth vvherfore as then vve ought rather to vse all such medicamentes as still and assvvage payne vvhich moysten and madefye and gentlye fortifye strenghthen the patiēt But if soe be that there be noe inflammatione the pallate be thoroughe soaked vvith humors is vvaxed verye longe vvhyte pale and sharpe Thre meanes or vvays to cure this dissease vve must as then cutt it of as vve must alsoe doe vvhen it is above thinne and belovve thicke This dissease may
intendeth to make the apertione Dubble bande in Phlebotomye And then binde the arme dubble a little above the elbovve vvith a little narrovve liste of vvollen clothe not to stiffe nor to loose because to looselye bovvnde or to stifflye tyed doe both of them hinder the bleedinge thē must the patiēt shutt his hand close vvherby as vvell throughe the binding as throughe the closinge of the hāde the vaynes lye fast stedfastlye in the fleshe and not move this vvay or that vvay vvhē vve should pearce them vvherthroughe also they rayse themselves and svvell the more throughe the bloode that by this meanes is dravvē thether vvardes by the vvhich alsoe vve may the easyer see and feele them ⧠How we ought convenientlye to make an apertione in the vayne Chap. 2. HAvinge dilligētlye considered all these thinges if the Chyrurgiane Continvance of the manner rightlye to phlebotove determine to phlebotomise in the right arm he must then take houlde one the foresayed arme vvith his left hande by the bendinge of the arm or about that place vvherin vve purpose tO make the apertione lay his thumbe one the vayne a little belovve the place vvher vve vvil pricke because that soe he may hovvlde the vayn stedefaste vvithout glidinge this vvay or that vvay because sometimes the vayne beinge spanned like a little cord might chaunce to rovvle glide vnder the lancet And because the foresayed vayne is oftentimes implete vvith vvinde vētosityes shee therefore yeeldeth slideth avvay vnder the lancet vvherthroughe vve can not fullye pearce her by this meanes the apertione falleth to small all this beinge in this sorte noted vve must vvith the first finger of the right hand feele vvhere vvith most convenience vve might make the apertione setting an impression on the skinne above the vayne vvhere vve purpose to pricke vvith the nayle of your finger then immediatlye take the lancet in the right hande vvhich betvveene our lippes vve must have in a readines vvith the vvhich vve finelye must make our apertione in the vayne causinge the poyncte and acuitye of the same gentlye to enter into the concavitye of the vayne not abruptly and rudely vvith a hastye thrust And to make this apertione vvith more certayntye vvithout tremblinge of the handes the Chyrurgiane must take the lancet in the middle vvith his thumbe his first finger sufferinge his hande vvith three of his fingers to rest on the arme so lay his thumbe and his first finger vvhich hould the lācet one the thumbe vvhich houldeth fast the vayne on this sort to hould fast his hande vvith out anye tremefactione to vse the same Some there are vvhich annoynt the place vvherin they intende to phlebotomise vvith a little oyle or vvith freshe butter thervvith somvvhat to mollifye soften the skinne soe vvith more ease and vvith lesse payne to pearce ther throughe To mollifye the skinne Others annoynte the acuitye of ther lancet vvith oyle because shee might the easyer perforate the same cause lesse payne the perforatione or vvounde might better contayne it selfe apert the blood if soe be it vvear grosse might the subtiler vvith more ease have his passage If soe be then that the apertiō be made vvith one thruste it is thē good but if not vve must immediatly give an other pricke ether a little belovve the same or els a little above the sam if the vayne sufficiētly demōstrateth her selfe If therfore the apertiō be to small the blood issue out of the same to subtilelye soe that vve feare that vve shall not dravve sufficiēt blood enough therout then immediatlye vve must thrust into the same hole or apertione agayn a little dilate the same because that oftentimes throughe to small an apertion the grosse bloode congealeth before the apertione and ther conseqventlye exvlceratethe Why vve must give a staffe to them in ther hāde vvhich vve Phlebotomize Havinge convenientlye brought to passe this apertione vve must then give the patiēt in the hande of that arme vvherin he is phlebotomized a roūd staffe partlye therō to rest his arme as alsoe to turne rovvnde the foresayed staffe in his hande because by this meanes the bloode might the better shoote out the vvhich if it doe not rightlye issue out vve must thē marke if the ligature be not the cause therof as if it vveare to harde tyede vvhich as then vve must a little districte and make it loose vvithout vvholye looseninge of the same Broade narrovv lancets The Chyrurgiane must alsoe have divers lancets vvherof the one must be a little broader then the other The broade lancets are verye necessarye vvhen as the vaynes lye highe exalted vvhen vve desire to make an ample apertion The smalle narrovve lancets are verye necessary vvhē as the vaynes lye profoūdlye occulted in the fleshe and also vvhen as in the highe exalted vayne vve desyre to make a smalle apertion because sometimes the sicke personne reqvireth a great festivous phlebotomy to the vvhich end vve must make an ample apertione as vve must alsoe doe if vve coniecture the bloode to be grosse dēce vvhen the patient is lustye and stronge Contrarilye if soe be vve retract dravve back the bloode vvhich supernaturallye hath issued out of any parte of our bodye as in those vvhich spitt bloode or those vvhich bleede much out of the nose as then vve must make our apertion smalle because that great evacuation of blood is not necessarye for them because through there noses they have avoyded sufficient then onlye in such accidētes vvher in is onlye reqvired a regressione of bloode Besydes it is necessarye expediēt that in the foresayed evacuatione and sicknes vve suffer the bloode to issve longe enoughe out of the apertione of the vayne vvhich the patient shoulde not be able to suffer if the foresayed apertione vveare ample because ther vvould issue to much blood othervvise therout In the Phrenesy vve ought to make but a small apertione VVe are also in phlebotomye vrged to make a small inscisiō in those vvhich are troubled vvith Phrenesye in those vvhich are grovvne madde because that little vvounde might vvith all expedition be cured agayne because that such raginge franticke persons vvill all vvayes make loose the ligature or dressing before vvear therof avvare vvherof they might com in daunger of bleedinge to death but the apertione being smalle although they loosen the arme yet notvvithstandinge they can not violently bleede because in such a small apertione the bloode congealeth occludeth stoppeth the vvounde VVe ought to make in smalle vaynes a smalle apertione in greate vaynes an ample apertione for if so be vve make in a greate vavne a smalle apertion thē shoulde necessaryly follovve that the blood vvhich coagulateth in the small vaynes be a hinderāce vnto the issuinge or runninge out of the bloode Touchinge the forme
thre foulde meanes to cure the Fistles of the fundament vve vvill not heere treate of anye thinges belonging vnto the medicamentes but onlye speake of the Chyrurgerye to the curing of this dissease the vvhich on a threefoulde manner is taught vnto vs as vvell in the curatione of the internalle as externalle Fistles to vvitt ether throughe ligature inscisione or through Cauterye Although Avicenna vvith more others are of opinione that vvith anye of these foresayed remedyes vve ought in noe sort to meddle ther vvith vnles they vveare too intollerable and molestiouse vnto the patiēt but that vvith cleane linnen vvith Cotten and vvith decent and convenient lavamentes vve ought to sustayne them But for all this not vvithstanding I vvill heere discribe vnto you our vse and customes of the auncient Chyrugians Novv therfore as vvell to cure the publiqve and patent Fistles as the occult and hidden vve must cause the patient conveniently to lye namelye that the patient must lye one his backe vvith his legges on highe retayning and houldinge the foresayed legges close vnto his belly and this is the maner and customes of ayncient Chyrurgians But vve novve a dayes cause the patiēt to stande on both his legges vvith his heade lyinge on a bedde disioyninge separatīge the foresayed legges vvyde the one frō the other vvhich alsoe of tvvo servantes or stāders by must soe be helde least that he agayne might chaunce to shut them The patient being thus situated tovvardes the light vve shall then thrust the middlemost finger of the left hande into the fundamente havinge vvith some certayne oyle anoyncted your finger and pared close your nayles and in our right hande vve must have a privet or searchinge irō in forme of a needle in the vvhich at the on end ther of must be a threde vvhich foresayed needle or Privet vve must thrust into the Orificium of the Fistle vntill vve sensibly feele the same on our finger and then vvith our finger recurvate the end of the foresayed needle neatlye conveniently reduce the same vnto the fundamēt and then dravve the same therout dilligentlye observinge that internally vve hurte or vvoūde nothinge Hovv vve must bind a publique or patent Fistle and the threde alsoe beinge passed throughe the fundament vve must then cut of the foresayed needle from the threde tye the endes of the foresayed threde both together dravvinge the same reasonable fast and close together and vvith a slidinge knott binde the same together because daylye vve might knitt the same closer and continuinge this same soe longe in this sorte vntill such time as vve shall have cutt avvay all the thred vvhich vvas remayninghe betvveene both the Orificia and both the apertions become to one and the threde conseqventlye vvithout anye more dissectione of the same shal be taken thereout But vve perceavinge the Fistle to have no issue in the concavitye the arsegutt and the needle doth not come out agaynst our finger beinge in the foresayed arsegutt and that ther as yet is some pellicle or membrane betvveene them both the needle havinge a reasonable sharpe acuitye or poyncte vve must thrust the foresayed threded needle or Privett bouldlye and audaciouselye therthroughe into the foresayed concavitye of the Arsegutt because vve might also dravv the foresayed thred therout as alreadye above vve have mētioned VVe must alsoe heere farther note that this privet or needle must ether be of goulde or silver because shee may the easyer internallye in the foresayed gutt be recurved VVe vse heervnto a silver plate vvhich thervnto expressely vve caused to be made as this same plate the foresayed Privett or needle before amōgst the figures of the instrumentes are also defigured and sett dovvne vnto vs. The threde must be of course thred the same being tvvisted thre or foure times dubble And because that vnto some the dissectione of this simple threde falleth somvvhat tediouse they annoyncte the same vvith some Causticke medicamētes Gvido Opinion of Gvido effecteth this dissection vvith a rescindent actuall Cauterye to praevent the same that it pearce noe deeper then it ought he thrusteth in the fiistle a hollovv Privett on the vvhich concavitye he vvith the foresayed Cauterye pearceth the skinne and in like sort alsoe cutteth throughe the fistle bringeth dirimateth avvay vvith it the callositye praeventeth also the fluxione of bloode It is surer to make an inscision in the fistle thē to tye it Others vvil not in anye sorte have the fistle cauterized nor bovvnde tyed but vvill only have that same to be inscided vvith a croocked lancett vvhich is betvveene both the Orisicia to vvitt of the fistle and the excrementall or arsegutt that alsoe vvhich internallye is grovven callouse they vvill have it to be crudifyed and made ravv or excoriated as vve are vsed to doe in the haremouthes yet daylye experience teacheth vs that the ligature is more certayne thē the inscisione vvherin vve neede not to take avvaye the callosity because it oftētimes chaūceth that vve endevoringe to remove and take avvay this callositye vve discide and cutt of any of the Fibres of the muscle Spincter vvhich beinge vvounded or hurte the patient ther after can in no sorte restraygne his stooles or excrementes It may seeme admiraculouse strange vnto some that I vvrite that the fistle may be cured throughe the ligature onlye vvithout removinge the callositye because it seemeth oppugnant vnto reason because all combinatione healinge together is caused throughe the ioyninge or touching of vveake thinges together yet I dare affirme that all those vvhich I have seen tyed have bin perfectlye and sovvndlye cured vvithout in any sort to have touched or removed the callositye Novv to come to the operation of the hidden fistles havinge situated the patient as before is sayed vve must then applye therin the Speculum Ani opening the fundamēt thervvith vvith the least payn vve cā as vvyde as is possible allvvayes annoynctinge the foresayed Speculum vvith oyle throughe the vvhich sayed apertione the Orisicium of the vlceratione may appeare be apparēt vnto vs be-tvvixt vvhich concavityes or braunches vve must thrust in a privet vvhich must be of a reasonable thickenes or crasitude like vnto a small little needle vvherevvith vve are vvonted to make our stitches vvhich must be blunte in the one end must vvith a threede be threded vvhich foresayed needle or privet vve must thrust vnto the bottome or grovvnde of the fistle vvhich penetrateth vnto the skinne as vve easily may feele vvith our finger on the vvhich vvith the croocked lancet vve must make an inscision the needle beinge in this sorte passed through the Speculū Ani beinge taken avvay vve must then dravve out the needle and cutt her from the thred and tye bothe the endes therof together Other say vve ought besides the privett internallye to make an inscisione throughe the vvhol Fistle vnto the other hole
the hippe Hovv vve ought to dravve forth a deade Childe then discide cut of the same in the foresayed ioncte And if so be the heade did first repraesent it selfe vve must then thrust both our fingers into the mouth therof in place of a hoocke tovvardes the roofe and so as gentlye as is possible dravve the same tovvardes you If soe be the belly therof be svvollene or hath to greate a heade and the same fulle of vvater vve must then vvith our finger a little crush theron because the aquosity might soacke therout and the svvollen partes by this meanes be diminished and vnsvvollen if soe be that our handes vveare not sufficient to dravve out the Childe or to finde the belly to let out the sayed Aquosity vvhich ether is retayned in the heade in the Brest or in the bellye vve must then gently vvith our right hande bringe therin a little curved and croocked knife vvhich vvithin the curvednes therof is sharpe and cutttinge the acuitye or povncte therof being closely inclosed betvvixt his fingers After vvhat fort vve may dravve forth the aquositye out of a deade Childes bodye vvhich he must houlde verye close together vvhervvith vve must make an inscisione ether in the Heade in the Breste or els in the Belly by this meanes to dravve forth the vvater vvhich is therin cōtayned And then vve must take a hook vvhich on the same fashon as is afore sayed vve must bring therin vvherof vve must fasten the poyncte ether in the eyes or in the mouth or in the Clavicles vvheron vve must then dravve as violentlye as the cause reqvireth to be done dilligentlye cōsideringe that the hooke breack not through let his houlde goe through the violente pluckinge of the same doe not chaūce to hāge take houlde in the VVombe to the vvhich intēt vve must vvith as much iudgemēt cōsideration dravve the same as is possible onlye vvith one hande vvhich muste be vvithin the VVombe Novv if the Childe be so thick so grosse A monstruouse Childe that vvholy to dravv it out is impossible for vs or els if it be a Monster or tvvo Childrene faste together vve must as then by parcels dravve them out cuttinge the Heade thereof in peeces then plucke out first the the one peece then the other then the Brest the Armes and the legges allvvayes makinge that it be cut in the ioynctes vvithout breakinge any bones for although they be tender yet the splinters therof might chaunce to hurte the vvombe soe that it is allvvayes the surest vvay vve cutt of the Armes and legges in their ioynctes It chaūceth also sōtimes that vve dravvinge forthe the Childe by the legges that onlye the head tarrieth therin vvhich therafter vvithout great difficulty vve cā not get it out thē vvith extreame daunger because the same rovvleth vp and dovvne in the concavitye of the vvōbe this therfor being happened ther must as then a servant or one of the standērs bye vvhich is experimented in such affayers sittīg one the left syde of the vvoman crushe vvith both his handes one the bellye of the vvomā beinge covered vvith a vvarme cloth on this manner to depresse dovvnevvardes the heade of the childe and ther in that place to contayne and keepe the same Hovv vve may dravve forth the heade of the deade childe as yet remayninge in the vvōbe And the Chyrurgiane vvhich sitteth on the right syde of the vvoman must vvith his light hande bringe the hoocke therin as is already sayed vvhich he must faftē in the heade ether in the eyes in the mouth or in the apertione of the heade dravve the same by little little therout as if as yet the vvhole bodye remayend therin If soe be the foresayed head vveare to great vve must then in like sorte alsoe cutt the same in peeces and dravv therout the peeces first the one then the other The Childe beinge dravven therout vve must dilligentlye consider that vve doe not breake a sunder the navell because it may serve for a conductor leader vvhich vve must allvvayes feelinge the same and suffering it to glide throughe our right hande must follovve vntill vve be come to the matrice vvhervvith the Childe vvas covered in the foresayed vvōbe hauinge found the same vve must gentlye rovvnde about separate her vvher vve finde her to befastened then dravve her forth vvith al the cōgregrated blood therī if therbe anye least that there it might chaunce to putrifye havinge thus finished all this the vvoman as then shall ioyne and shutt her hippes together agayne and must then circumligate the bellye as is required and necessarye In this forerehearsed daunger is oftentimes incident vnto the vvoman a farre more lamentable and pitiful accident to vvitt a discendinge and sinckinge do vvnvvardes of the vvombe vvhich betvveen the hippes sincketh out throughe the vvhich the vvoman can not goe The māner to elevate agayn the suncke discēded Matrice If soe be therfore this chaunced vve must gentlye and easilye by degrees thrust in agayn the same as vve have sayed of the guttes or entralles being sunck out vvherof vve must cause the disseased and sicke vvoman to keepe her bedde some certayn cōtinuance of time vvith her buttockes a little exalted and if soe be the Matrice in her risinge chaunced agayn to sincke out vve must then agayn thrust in the same And to praevent her that she doe not agayne sincke out of the bodye vve must thē thrust in the Matrice a Pessarium like a rovvnde Apple vvhich must have a hole in the middle therofe as heer before amongest the instrumentes vve may see it defigured vnto vs vvher vve shall alsoe finde the forme the figure the manner of vsinge the same ⧠VPpon what occasione the externall partes as Armes and legges are and must be extirpated or cutt of and in what place it must be done Chap. 4. When vvhye the externall part must be saved of THe externalle membres of mās bodye as are Armes legges are cutt or savved of vvhen as they are sqvised plettered and brokē the Vaynes Arteryes Synues vvholy be lacerated cutt of Or els vvhen they concerninge any externalle occasione are hurte or indammaged vvherby they sōtimes vvholy come to be mortifyed that suddaynlye or els somtimes alsoe by degrees so that somtimes ther ensueth such a Gangraena or mortification that not only the fleshe all the other mollifyed partes of the foresayed ioyncte doe mortify corrupte but alsoe the Bones themselves soe that ther is noe hope at all of any health then onlye throughe the extirpatione of the same fearinge least that the foresayed Gangraena shoulde farther infect pollute all the circumiacent partes vvherethroughe the patient might suddaynlye chaūce to dye Notvvithstandinge the Chyrurgiane may not in anye forte aproch vnto his exstreame last remedye before he have tryed all other remedyes to ease
foresayed vaynes have bīne retayned in the supersituated partes although it semeth not that the foresayed parte is in any sorte corrupted or putrifyed then onlye soacked throughe vvith some certayne venoumousenes vvhertroughe sometimes that parte hath binne prepared as it vveare to some mortificatione or Gangraenatione that vve supposing to take houlde one the vaynes vvith the Crovvesbill and soe to bind them doe most commonlye chaunce to breake betvveene the Crovvesbill or els hovv gentlelye soever vve knit the threde together one that sorte to tye them are throughe the tyinge of the threde notvvithastndinge cutt a sunder vvherthroughe vve are in the end constrayned to vse the actuall Cauterye Galenus And not vvithout occasione Galenus testifyeth vnto vs to be a thinge verye expediente necessarye to stench and restraygne the bloode throughe actualle Cauteryes vvhich throughe anye corruptione hath corroded throughe the vaynes because they nether are able to suffer the Crovvesbill therby to be dravvne out nether the tyinge bindinge It is also the most surest vvay to cauterize all that vvhich throughe the Gangraena is corrupted or els that vve applye theron any Causticke medicamentes as vve are vsed to doe one the originalle of al corruptions VVherfore if so soe be the Chyrurgian have anye suspicione of anye venoumousenes vvhich after the extirpation might be dravven invvardes tovvardes the finitimate partes theraboute it is as then the surest remedye that to the restraygninge and stenchinge of the blood he have in praeparatione and readines three or fovr fervent glovvinge cauteryes vyhich he must applye on the Orificia of the descided vaynes Hovv throughe cauterisatione vve should restraygne stēche bloode vvithout houlding or depressing the same to harde theron because thus doinge ther may be left behinde a goode Escara And if it chaunced that the bloode throughe the applicatione of one cautery vveare stenched it is then sufficiently cauterized nether must vve anye more cauterize the same Vayne prosecutinge of the same on the other vaynes Instructiō hovv to restraygne bloode throughe ligature Contrarilye vve beinge constrayned to extirpate anye membre beinge verye much plettered and broken vvhich throughe noe Gangraena or corruptione is putrified it is as then most conveniēt to restraygne the blood throughe takinge hould of the Vaynes or Arteryes vvith the Crovvesbill compraehendinge allsoe some parte of fleshe thervvith vvhich vvith a good stronge threede vve must binde together as allsoe the fleshe vvhich vvith the threde is tyed is an occasione that the ligature must be the more certayner and surer And as Galen findeth it goode to stench the bloode throughe actuall cauteryes vvherby is anye corruptione or putrefactione in like sorte alsoe he commendeth the ligature in the effluxione of bloode vvherby is noe corruptione Accorde to agree the right vvorshipfull Mr. Gourmelen Mr. Pare or anye venoumousnes VVhich right vvel may be an agreemēt betvvixt to great personages of our time vvher of the on is a Physicione and the other a Chyrurgiane because of a certayne dispute vvhich they had concerninge this matter of the meanes vvhich vve ought to vse in the restraygninge of bloode as they have agitated most inmicisiously this disputatione the one agaynst the other vvithout the one vnderstandinge the other The bloode therfore throughe the foresayed meanes beinge stenched restraygned vve must as then strovve some restringēt poulder one that parte and applye therone divers drye plumaciolles or flatt tentes and therone an ordinarye restringent or defensive plaster layinge rovvnde about the stumpe a plaster of Refrigerans Galeni because that the foresayed defensive shoulde not chaunce to cleave too fast therone and soe binde the parte as it requireth and then curinge the same as a simple vvounde allvvayes dilligentlye consideringe that vve doe not take avvay the Escara vvhich throughe the foresayed Cauteryes is made nether the threedes allsoe vvher vvith the Vaynes have binne tyed if soe be at least ther be anye It happeneth allsoe sometimes Of the dressinge after the bloode is stopped that the Vaynes after that they have binne cutt of doe dravve themselves invvardes soe that vvith the Crovvesbill in noe sorte vve can take houlde therone It might allsoe chaunce that the tyed Vayne might chaunce to vntye vvherthrough the patiente is charged vvith a nevve effluxion of bloode If soe be anye of these accidentes chaunced and come vnto your handes and it seemed best vnto you to Cauterize the Vayne then to binde her or els rather to binde then to Cauterize her and such a mischaunce or accident happened into your handes vnexpected and not beinge therone provided vvithout havinge anye Cauteryes in are adines the right vvorshipfull Mr. Pare councelleth vs very fitlye to stench the bloode The vvhich if in tvvo or thre or four Vaynes it chaunced or Arteryes at one time then must the servant of one of the circumstantes lay the endes of his fingers one each vayne one gentlelye crushinge the same one the Orificia of the Vaynes because as Galen sayeth the Chyrurgiane may have time to restraygne the bloode And then take a needle of a fingers length or longer and of a reasonable crassitude vvhich is very sharpe and rescindent as heere before is defigured vnto vs beinge threded vvith a stronge threde vvhervvith the vayne after this sort follovvinge must be tyed Havinge first of al considered vvhere the bleeding Vayne is situated Hovv vve should doe this ligature to stenche the blood you must thē thrust your needle therthroughe beginninge on the skinne a good fingers bredth higher then the vvounde one the syde of the Vayne makinge the same to come contradictorilye out of the vvoūde to vvitt one the syde alsoe somvvhat lovver then the Orificium of the Vayne because the threde may be thervnder ther to circumcingle the same sufferinge the end of the threde to hange one the skinne vvithout extractinge or vvholye dravvinge out of the same Then you must agayne thrust the same needle inter nallye in the vvounde one the other syde of the vayne because in soe doinge the threde vvhich vvith both his endes is come forth externallye on the skinne may take houlde on the foresayed vayne vvith some certayne portione of fleshe soe through both the stitches of the needle passages of the threde may stifflye be bovvnde together throughe both the endes of the foresayede threde layinge betvveen the thredes a little compresse of lether tvvice or thrice dubbled as thick as a little finger becaus ther through the payne might be praeventede vvhich through the foresayed stiffe bindinge might be caused because the knott through the continuance of time should not cut throughe the skinne A certayne ligature VVhen as this ligature is convenietlye done shee as then is verye certayne vvhich allso may be done in all partes of the bodye vvher ther is anye fluxione of bloode as in greate vvoundes of the Armes of the Hippes or of the Throte Heere before
amongste my Instrumentes of Chyrurgerie you shall finde them defigurede vnto you How we shoulde extirpate the superfluous corruptede fingers separate those which are growen conioynede together Chap. 6. The hand is an instrument of instrumentes THe hande vvhich is an instrumente of instrumentes is dividede in five fingers And it somtimes allso chaunceth that besydes the thumbe or the little finger ther grovveth a sixte finger vvhich is all carnall or fleshye or els composede of some smalle bones Yet is nether the one nor the other complet vvhether ye consider ether their figure or their magnitud greatnes as beinge agaynst the course of nature vvherthroughe they are an impediment to the actiones of the hand It may allso vvell chaūce the one finger of the hande to be pletterede vvithout beinge able to keepe the same from Gangraenatione Besydes this ther commethe in the endes of the fingers somtimes a certayn vlceratione Curation of the Panaris or Paronichia vvhich is callede Panaris or Paronichia The vvhich cause such vehemente payne throughe the venoumouse matter that therthroughe the bone corrupteth rotteth yea the inflammatione allso beginneth moste commonlye in the bone The vvhich to remedye before that the bone be corruptede vve muste make an inscision in the end of the finger according to the length therof begīning at the extreameste end of the ioyncte vnto the bare bone because the venoumouse matter vvhich lyeth inclosede betvvene the bone and the pellicle vvhich covereth the same mighte have some or other issve The inscisione beīg done vve muste suffer it to bleede as longe till it of it selfe restraygneth stoppeth thē thrust the finger in good Aqvavitae vvherin vve must before dissolve a little Treackle And if so be notvvithstandīge all these remedyes the finger as yet corrupted farther and must be extirpated vve may thē verye aptlye effecte the same vvith our rescindent or cutting pinsers vvhervvith vvithout great payne vve may vvith Hovv vve may remove the superfluous fingers one nipe clippe it of Ther are other vvhich lay the finger on a little blocke of vvoode as thē vvith a rasor hevv it of On this manner also vve may extirpate the superfluouse finger vvherin ther is anye bone And soe farre forth as if the fingers vveare from the nativitye and birth or through combustione or els throughe anye vlceratione healed and ioyned together vve must then vvith a rasor separate them the one from the other and accordinge to the length ther of cutt them asunder and then vvith an exsiccating plaster being separated cure thē and soe skinne them by vvhich meanes every finger vvill separatlye heale If soe be that there came anye vlceration in the finger after the vvhich there follovveth a deformed Cicatrice vvherthroughe the finger grovveth croocked VVe must then trye theron some mollifying remedyes to cause the finger thervvith to rectifye grovve straight And if soe be by noe meanes it vvilbe soe as it sometimes chaunceth vvhen the foresayed Cicatrice is great and inveterated ether the sinnues tendones or skinne have binne hurt vve must not therfore proceede vvith the same as a thinge vvhich is incurable for if soe be vve cutt ether the one or the other the finger therafter should nether be able to bende nor stretch out yet is it necessary that the bendinge proceede before the stretchinge out and the stretching out or rectifying of the same before the recurvatione soe that he shoulde allvvayes be right and verye inconvenient as beinge better that he be reasonable croocked then right because of the inconvenience vvhich ther throughe vve receave For vve supposinge to shut close the hande and to fasten on any thing this finger as then should stand right out But vvhē it is onlye the skinne vvhich maketh the Cicatrice throughe the vvhich the finger is recurved vve must then cleane cutt of the same for as it beinge harde callouse can not be throughe the finger erected and stretched forth Curation of a croocked finger Havinge therfor novv rectified this finger by this meanes vve as thē make a nve Cicatrice therone must note that in the generation of the foresayed Cicatrice the finger doe not chaunce to be agayn recurved or shrincke vp agayne A finger-case of lattinne or of silver to the praevētīg of the vvhich I knovve noe better meanes after he be cured that ther one vve vveare a finger case of lattinne or of silver one the plaster one the combustion This fingercase must be covered vvith Taffatye or vvith anye other decent substance conveniently vvith a bande fastened above on the hande vvhich fingercase shall doe more commoditye helpe thē all the splintes vvhich vve might applye theron The thūbe or the finger beinge vvholely lamed Ther happeneth alsoe a dissease cleane contrarye vnto all other disseases of the fingers especiallye in the thumbe having receaved therone a blovve on the Tendones vvherby the same is erected agayne the foresayed Tendones beinge cutt of can in noe sort be agayne elevated nether stretched forth vvherthroughe he lyeth in the hande immoveable and can not be stirred The same chaunceth alsoe in the hande havinge receaved anye vvounde in the hande one the Tendones or alsoe above the hande vvhere throughe the hande hangethe falleth dovvnevvardes as is she vveare paraliticke and of her selfe is not able to be lifted vp As touchīg therfore the thumbe the fingers vve must ether have a thumbcase or a finger case vvherthroughe they must be heaved vp And for the hande a glove vvherthroughe the hand may be helde vp VVhich in the boocke of Mr. Pare are discribed THE EIGHT TREATISE OF THE OPERATIone of Chyrurgerye wherin is discoursede and handelede of the Cauteryes and of the Setonne Contayninge five Chapiters VVhat a Cauterye is the Species and differences therof Chap. 1. Of the inventione vse of the Cauteryes in vvhat disseases and one vvhat places vve may applye them Chap. 2. Of the Potentialle Cauteryes and hovv vve should make them Chap. 3. On vvhat manner vve ought to applye the Potentialle Cauteryes Chap. 4. Of the Seton hovv vve ought to applye it Chap. 5. ⧠What a Cauterye is of the Kindes differences therof Chap. 1. HAvinge vvith my selfe resolved purposed to vvrite sōvvhat of the Cauteryes it is first expedient and necessarye that vve knovve vvhat a Cauterye is hovve manye kindes and Species therbe therof vvhat theire vse is on vvhat bodyes on vvhat disseases vve ought to applye them and the manner hovve vve shall applye the same The name of a Cauterye may be vnder stoode in tvvo sortes Therfore to vnderstande theire nature vve must first knovve vvhat vve by the name Cauterium vnderstande For it may be vnderstoode one tvvo sortes or vvayes Simplely and not Simplelye Symplely consideringe the instrument the Causticke matter vvhich adureth in anye parte as Galen in his sixt of the simples in his
to separate vve must make a crossevvise in scisione therin Other suffer her of her selfe to separate vvithout inscisioue Some inscide her rovvnde and then lift her vp so cut her loose from vnder But vve desiringe through the application of a Cauterye to make an apertiō for the evacuating of any matter vve must not onlye thē inscide the foresayed Escara but also pearce somvvhat deeper therin vntil such time as vve have sovvnded the matter to give her passage Divers meanes to keepe open a Fontanel vvhich throughe a potentiall cauterye is made If soe be the Cauterye be applyed to make a fōtanelle vve must then cause the Escara throughe the sayed remedves to separate and keep open the hole or the foresayed vlceratiō as greate as the rotunditye of a bullet to the effectuatinge of vvhich some vse a great Pease vvhich throughe the great humiditye vvhervvith shee is soacked svvelleth as thick as bigge agayn as she vvas before by the vvhich meanes vve may keep open the apertione as longe as pleaseth vs others make little pellets of elder pithe of Rhabarber of Agarico of the blacke neesinge roote of a Gallenut of Gētian some of goulde or of sylver beinge hollovve concavoyse but the most convenient fittest vvhich I have experimēted are made of vvhyte vvaxe amongst the vvhich is mixed verdegriece Cantharides hermodactilles a little auripigment adding thervnto a little pirosin This kinde of little Balles vveare invented of Mons r. Hubert Chyrurgiane to the kinge one of the most expert Chyrurgians of our times What cōtinuance vve may keepe opē the vlceration Touchinge the time of keepinge open these Fōtanelles Celsus teacheth vs in his fourth boocke and 22. Chap. that it is oftentimes necessarye for the Chyrurgiane to exvlcerate the partes of the bodye vvith a glovvinge Cautery beinge as it vveare an aeternall prohibitione that vve should not suffer such vlceratiōs so quicklye to close agayn as of themselves they vvoulde but that vve must sustayn and keepe them apert opē till such time as the dissease vvhich throughe this apertione vve intend to cure be vvholye finished and cured Of the transforation or seton and of the manner how we ought to apply it Chap. 5. Setō Properlye taken THe transforation or the Seton may in tvvo sortes be vnderstoode properlye and improperly vve simplely vnderstand it cōsidering the threde vvhich vve dravve cleane through the skinne vvith the needle vvhich threde in aunciēt time vvas made of course hayre as of horsehayre or any other such like vvhich of the latinistes is called Seta But vve novv a dayes make our threde of silcke of Cotten Setō improperlee vnderstoode or of Course yarne Improperly vve vnderstand by the Setō a logestretchinge vlceration in anye externall parte of the body vvhich is clean thrust throughe the dubble skinne and that throughe agilitye and dexteritye vvith a glovvinge Cauterye VVe apply especiallye the transforatiō In vvhat partes vve ought to apply the Seton or the Seton in thre partes of the body to vvitt behinde cleane through the Necke although some to follovv the direct concurrence of the fibers applye the same in the length therofe In the Navle and in the Scrotum vvhen as it is full of matter ventosity as it oftentimes is vvonte to happen in the Dropsye This transforatione is vsed ether for any regressione of humoures or for an evacuation The vse of the Seton or expulsione of the same For vve applyinge the foresayed transforatione behinde in the necke it then revelleth and dravve the backe agayne those humors vvhich concurre tovvardes the Eyes vvith those allsoe vvhich runne tovvarde the Mouth and the Brest and retayneth allsoe those humours vvhich descende and sinck behinde in the Backebone and in the Hippes He beinge dravven through the Navle or Scrotum he then dravveth ther throughe all the Aquositye and ventositye vvhich is therin contayned It is novve adayes also applyed on tvvo manner of vvayes namelye vvith Pinsers Tvvo sortes of applycation of the transforation and vvith an actuall Cauterye or through the Needle onlye The transforation vvhich onlye is layed in the Necke must be applyed betvvixt the seconde the third Vertebram VVhich conveniently to effecte vve must cause the patient to sit on a little stoole and least that the transforatione should cōpraehend more one the one syde then one the other vve must denotate a line vvith Inck in the middle of his neck or els on the same parte vvher vve vvill apply the tranforatiō Hovv vve ought to apply the transforation behinde throughe the necke causing the patiēt to hould his heade on highe and leene backevvardes over because therby the skinne might be the looser and stretch the farther commaunding then one of the servantes or standers by that vvith one of his handes he take hould one the skinn close by the hayre as deep as he cā ether according the lengthe or thvvarte over the skinn follovving the line vvhich therī is made liftīg the same in the middle on highe vvhich thē the Chyrurgian vvith his lefte hand shall take hould one in the middest of the same and elevate it because that he vvith his right hande vvith a rounde vvell cuttinge threded needle vvhich must be threded vvith a thicke threde may thrust cleane throughe the same the foresayed thred beinge in this sorte thrust therthroughe vve must cutt him of close to the Needle The transforation vvith an actuall Cautery But if rather you desired to effecte the foresayed transforatione vvith a hott Iron the skinne beinge lift vp on both sydes through some servant or through the Chyrurgiane vvith his Pinsers vvhich he must houlde fast in his left hande dilligentlye consideringe least he take houlde thervvith of anye Muscles of the Necke vvhich are situated vnder the foresayed skinne as to that purpose intent he must cause the Patient to bende his necke hould his heade vp or on highe right by this meanes to knovve vvhether anye of the foresayed Muscles are compraehended of the Pinsers or not VVhich beinge done the Chyrurgyane must nipe shut close together the foresayed pinsers theron applyed therby to benumme dissipate the senses feelīg vvhich through the hott iron might be caused as thē vvith a triāgled glovving cautery thrust throughe the hole of the pinsers soe throughe the elevated skinne alsoe The vvhich foresayed skinne being in this sorte perforated immediatlye agayn being dravven therout vvithout suffering the skinn to fal vve must thrust throughe the perforatione a needle vvith a thicke dubble threede vvhich threde must be soacked in the remedyes above rehearsed for the Cauteryes or els at the leaste being made fatt in some Digestive then the sayed threde being dissected and cutt of vve must suffer him to remayne therin as is above rehearsed applye therone a Playster of Refrigerans Galeni for the first or seconde daye and then a
ligamentes vvhich are too loose they are profitable for nothinge cause that the restauratede partes vvhich are sitvatede move therout as the broken Legges the dislocatede membres yea allso the lippes of the vvoundes vvhich are insertede and brought together throughe the loose ligature doe agayne separate the one from the other And finallye in one vvorde to conclude the mediocritye of ligatione is a greate solace and comforte to the Patient as he vvill then vvith his ovvne mouth testifye VVe must note that all ligatures muste not in a vvoūd so faste be ligatede Wherone in Ligatione vve ought to consider as in a Fracture lesse in a Fracture vvhich is vvithout a vvounde then in a simple vvounde VVe must allso harder more violenter binde ligate on the vulneratede parte one the fracture thē on any of the approximate nexte adioynīg partes therby to repell drive back agayn the humors vvhich doe theron sinck and allso crushe out those vvhich are suncke into the finitimate partes vvhich is leaste shutte for in so doinge vve keepe those partes occludede liberate free from all inflammations Farther more in the end of the ligatione vve espye a tēder tumefactione out of vvhich vve may iudge that the parte is reasonablye shutte if so be the tumor be harde obduratede blackishe it is then a signe that the parte is too stiflye tyed And vvheras at all vve perceave anye tumefaction it is a signe that the ligament is too looselye tyede ⧠Of the kindes differences of the ligamentes Chap. 2. Tvvo sortes of ligaments in generall HIppocrates gennerally hath made tvvo sortes of Ligamēts vvher of the firste is that vvhich of it selfe by his virtues did prosper First kind of ligature opitulate the curinge of the disseases and vvithout the vvhich they can not be cured becaus that vvith out the same the parte can not be contaynede in his statione or forme vvherin shee must be contayned to be cured to be praevented that ther happen noe fluxione vnto the parte nether the matter beinge therin congregatede vvithout the sayede ligature coulde not be driven expellede therout As vve may note on the ligamentes vvhich in the vvoundes of the Heade vve vse vvhich allso in all concavouse vlcerations vve vse in Fractures in dislocatiōs recurvatione of Ioynctes in the separatinge of those partes vvhich agaynst nature lye the one above the other in the reductione of the separatede partes in the apertione of the partes vvhich are to closelye occludede shutte agaynste the minde of the Chyrurgiane vvill combine themselves together The secōd sorte of Ligament The seconde ligament is that vvhich is ordaynede not onlye because of it selfe it is commodiouse profitable but Per accidens bye chaunce it is but onlye vsed to contayne keepe the remedyes compresses on the disseasede parte as on a great dolorouse inflammatione on a greate Apostematione or on any other dolorouse parte Redivisiō of the first kind of Ligature And touchinge the ligature vvhich of it selfe is profitable commodiouse ther of ther are tvvo kindes vvhich of the vse vvher vnto they are ordaynede are taken vvhich is ether to cōtayne the partes as close in their naturall being because therthroughe they may be combinede vnitede vvherfore this ligatione is called the agglutinative or incarnative ligatione Or els to praevente the fluxione vvhich might chaūce to come to that parte expell the same therout vvhich is molestiouse troublesom vnto him vvherfore he is called the expulsive or repellinge ligature The incarnative or conglutinating ligation Icarnative Ligament is commōly vsed in this form on the vvounds To vvitt that vve roule vp the rovvler or ligature on both his endes vnto the middest therof vvherof in each hāde vve must take the one end beinge rovvled vp laying that parte of the ligamēt vvhich is not rovvled vp on the other syde of the vvounde reducinge both the endes of the ligatione vvhich vve have in our hands above on the vvounde that ther throughe vve might adioyne bringe together the separated partes lippes of the vvounde crossinge the foresayed ligature in forme of a Burgundiane crosse or in forme as in the margine is set dovvne vnto you Then vve must reduce both the endes to the parte bringinge one end tovvardes the superiour parte of the membre because therby the fluxione may be praevented the other end on the inferior parte that the bloode therthrough vvhich is suncke and discended into that parte might be depressed and crushed out and the fore sayed Ligature must be of such a breadthe that vvhen as he is rovvled vp applyed on the vvounded parte may not onlye compraehende the vvounde but alsoe both the endes of the same If soe be the vvoūde vveare ample greate and the ligature cōsidering his latitude Nota. coulde not be accommodated vve must as then compraehende but the one halfe of the vvounde the other halfe therafter Such a Ligament therfore must be reasonable closelye vvounde but allvvayes a little stiffer one the vvounded parte Hippocrates as Hippocrates vvilleth vs to doe yea also in the vvoundes vvith Fracture because there throughe might be expressed and crushed out the bloode vvhich in that parte is suncke least that there shoulde happen anye inflammatione thervnto then an Apostematione The expulsive or repellinge ligamente Expulsive Ligamēt is verye much vsed in Fistles in concavouse vlcerations thervvith to expell the matter vvhich is discending to the grovvnde or bottome of the same vvhich throughe the longe retentione internallye corrodeth that part Admonitione This ligature is allso verye commoeiouse in the Varices or bursten vaynes in tumefacted Legges but vve may not vse it in Fistles nor in any concavouse vlcerationes vnlesse first of all they be putrifyede their callositye taken therout nether in inflammationes This ligamente is imposed Hovv vve may make the expulsive ligament vvith the one end being revolvede rovvled vp begīning vvith the sovvnde part vvhich is sitvated close to the bottome of the Sinus vvhere he muste be somvvhat more dravven together shutt then is reduced agayne tovvard the vvounded parte tovvarde the mouth or apertion of the concavitye vvith out bindinge the same to stiffe consideratione of the inferiour parte As if the Sinus be in the legge the bottome of the same vnder the Knees is alsoe higher hath his issu in the crassitude of the calfe vve must them beginne to binde one the Knees finishe in the inferiore partes therof Contrarilye if soe be the inferior parte of the Legge the issue therof be by the Knees vve must thē beginn the ligatiō by the foote end the same close to the Knees But if vve desire to vse this Ligature in greate Armes and great Legges vvhich are Varicouse vve