an extream troublesome palpitation and beating of his Heart For the removal of this great Distemper there were many Remedies prescribed and administred not only by my self but likewise by the most expert Physitians of our Vniversity there All which when they could not in the least prevail over this contumacious and head-strong Disease by reason of the Patients continuing and persevering in his accustomed ill course of Diet he grew the worse thereby and after some few months were passed in the which by the advice of the Physitians he took no Physick at all for they were willing to commit unto Nature a part of the Cure of this Chronical Affect he began to complain of that part that lieth under his left Shoulder-blade The place of his grief being lookt upon and throughly considered there appeared unto me a notable Tumor soft unto the touch and attended with a beating and when pressed down with the Fingers it was then seemingly wholly hid and non-apparent but these were no sooner taken off but forthwith it returneth as before In short the Disease having gotten deep rooting being now become incurable our Patient within a very short time after departed this life But now that we might get the truth and certainty both of the nature and constitution of this Disease as also of the Cause thereof we dissected that part that was affected with the Tumor out of which there issued forth great store of Blood unsavory and stinking as it was all which Blood being wholly evacuated and throughly cleansed there appeared the prime and principle Artery under the Heart having its original from the great Vein in its ascending up into the Head exceedingly dilated and extreamly torn This Vein descending downward creepeth along through the Region of the Intercostal Muscles the Blood that flowed forth of it being heaped up in the spaces of the Muscles and in tract of time putrefying and corrupting had so vitiated and marred the Vertebra and Rib of that place that it seemed unto us altogether rotten and putrefied And therefore say we some other way and means of the generating of this Tumor is to be sought and found out The Author of the Book of the Medicin Definitions defineth Aneurysma by the relaxation of an Artery And so likewise Fernelius in the seventh Book of his Patholog and Chap. 3. asserteth that Aneurysma is a dilatation of an Artery ful of spiritful blood but all this while they do not express the manner how this is done Neither is it ever a whit credible that Aneurisma is caused by the dilating of both the Tunicles of the Artery but only by the widening of one of them For the Atteries have indeed a double Membrane one external which is slender thin and soft having of straight Fibres very many but of oblique ones very few and of transverse ones none at all the other internal which is close thick and hard having transverse Fibres but wanting straight and oblique ones And therefore if the Internal Tunicle be either broken by extension as easily it may be in regard of its hardness or else if it be opened by Section it doth not easily Cement and close together again because it is hard but now the external Tunicle in regard of its softness doth easily and soon grow together again and because it is so soft and wanteth both oblique and transverse Fibres it is thereupon extended by the Blood and the vital Spirit seeking their passage forth in an imperious and violent manner and so this kind of Tumor cometh to be excited in the which the force and the impetuous violence of the blood and the vital spirit may be discovered by the very touch Neither is that which Platerus objecteth of any weight or moment to wiâ— when he tels us that upon the alone bare Section that he saw made in the skin that covered over the Tumor the blood forthwith at first hid it self but then instantly sprang forth amain and this oftentimes saith he is in so great abundance that it cannot by any one use he what means he wil be any more stanched but that it issueth forth in greater abundance insomuch that the whol stock of Blood being almost spent it hath oftentimes brought a sudden Death upon the sick Person But indeed if we should determine that the Aneurisma proceedeth from the dilatation of these Tunicles of the Artery this Objection would then carry some weight along with it But in regard that according to the truth of the matter we have already asserted and determined that an Aneurysma ariseth from the dilatation of the exterior Tunicle alone of the Artery the internal being opened either by Section or by Rupture we cannot therefore by any means grant that the Arterial blood lieth hid under the whole Skin but because the external Tunicle is extraordinarily extended it cohereth and sticketh so close unto the Skin that it is extended together with it and is in a manner so become one therewith that it is almost impossible to cut the Skin without cutting the external Tunicle of the Artery And so then the result of al that hath been said wil be this to wit The nighest cause of Aneurisma That the proxime and nighest cause of Aneurysma is the opening of the interior Tunicle of the Artery and the dilatation of the external Now it is very frequently opened by Section when unexpert Chirurgeons instead of a Vein open an Artery or when at least together with the Vein they cut through the Artery that lieth under it Now if this at any time happen the external Tunicle in regard of its softness and neer alliance with the Tunicles of the Veins very easily and soon closeth together again but the interior by reason of its hardness remaineth open from whence through the patent and open place the Blood and vital Spirit endeavoreth to break forth and by this means distendeth the external Tunicle and causeth this kind of Tumor The same may likewise happen if the internal Tunicle of the Artery be broken either by the violent and impetuous motion of the Arterial blood or by any violent external cause and the overgreat distension of the Artery the external Tunicle that is more apt for extension being al this while safe and sound But now Whether or no that pulsation of the Arteries of which Platerus maketh mention in his Tract touching the palpitation of the Heart and touching which out of Fernelius and Ludovicus Mercatus we have already treated in the fourth Book of our Practice Part 2. Sect. 3. Chap. 9. may or ought properly to be referred unto Aneurysma I very much doubt For whenas the Membrane of either Artery is then whol and entire it seemeth rather to be an Affect in the Veins of kin to the swoln and distorted Veins that we cal Varices than this Tumor Aneurysma of which we are now treating Signs Diagnostick The Aneurysma is easily known and discerned from Ecchymosis because that in Aneurysma the color
that out of it store of Blood be poured forth unto the Heart overwhelming it and suffocating the heat thereof Thirdly Al the internal wounds of the greater Vessels that cannot by any art be closed upon regard they cause the Blood being plentifully poured forth either out of the Veins or the Arteries that the spirits be suddenly dissipated therefore of necessity they speedily suffocate the wounded person Fourthly All those Wounds are said to be Mortal that suddenly take away the Respiration and hinder the ventilation of the Heart so that the Native heat of the Heart is suffocated and so cause that the Man die even almost in the very same manner as Apoplectical persons are wont to die And such like wounds are especially the Wounds of the Brain but yet not all of them since that there are many Wounds of the Brain that are not Mortal as afterwards we shall shew you and as we have already told you in the first B. of our Practice first part and 23. Chapter But those great Wounds and such as are the Cause that the Animal spirits be suddenly dissipated or that the blood being poured forth of the Vessels the Orifice of the Nerves be quite stopped and so by this means the influx of the Animal Spirits be hindered or that from the same an inflammation of the Brain or a feaver be excited And this is not only done by the Wounds of the very Brain it self but likewise by the strokes and vehement Confusions of the Head by which the Vessels of the Brain and those neer about it are broken and the Blood poured forth of them unto the beginning of the Nerves and there subsisting hinder the influx of the Animal Spirits And this may also happen if the Sinus or hollow places of the Brain chance to be hurt so that out of them blood be poured forth unto the Basis of the Brain and so it is likewise in the Wounds of the Eyes if they penetrate so deep that they open either the Vessels of the Brain or those that are in the Basis thereof or those that are neer about the said Basis of the Brain and so that the Blood poured forth unto the Basis of the Brain hinder the influx of the Animal spirits by compressing the beginning of the Neryes For although that the Blood if it be poured forth above upon the Brain may possibly be emptied forth by perforating and opening of the Cranium or Skul yet nevertheless if it be poured forth unto the Basis of the Brain it is impossible that it should ever be evacuated There seemeth yet nevertheless to be another way whereby the Blood poured forth into the Brain or about the Brain bringeth Death within a vâ—ry few daies if it cannot be evacuated For when as it is without the Vessels it beginneth to putrefie usually about the fifth day from whence feavers deliries and Convulsions are excited so that the man dieth in the same manner almost as one in a Phrensie That which is done by the Wounds of the brain the very same happeneth likewise from the spinal Marrow if it be indeed wholly cut assunder in the superior part thereof for then the motion of all the inferior parts and so of the Thorax likewise is abolished and the wounded persons are suffocated And unto one of these four waies I conceive that al kinds of Mortal Wounds may be referred And therefore if a Wound penetrate into any interior part of the Body so that thereupon the wounded person die within a short space of time we are then to Judg that that Wound was Mortal and if diligent inquiry be made I am of Opinion that it may be referred unto some one kind or other of these Mortal Wounds whether that Wound hurt the vital faculty it self immediatly or else hurt it by the intervening of some other Disease or Symptom For as Nicolaus Boetius writeth out of Felinus in his 323. Decision Numb 10. it is all one whether a Wounded man die of his Wound or of some infirmity caused by the same Which yet nevertheless is so to be understood if the Wound necessarily attract that Disease or that Symptom which is the Cause of Death But as for all the other Wounds whatsoever that cannot be referred unto some one of these manners I conceive that they cannot simply nor necessarily be accounted Mortal The which that it may be made the more plainly to appear we have it now in our purpose in special to weigh and discover unto you the Wounds of all parts that are to be accounted Mortal Now Hippocrates Judgeth the wounds of seven parts to be Mortal What Wounds accounted Mortal by Hippocrates whilest in his sixth Sect. Aphor. 18. he thus writeth Whosoever hath his Bladder out through or his Brain or his Heart or his Midriff or any of his smal Guts or his Stomack or his Liver that Wound is Mortal Which Aphorism notwithstanding in his Coaca or his Tract of Playsters Aphor. 509. he both Limiteth and Amplifieth when he thus saith From a Wound even Death it self may almost happen if any one be wounded in his Brain or in his spinal Marow or in his Liver or in his Midriff or in his Heart or in his Bladder or in any one of the greater Veins Death likewise soon followeth if any extraordinary great Blows be inflicted upon an Artery and upon the Lungs so that the Lungs being wounded the Breath that passeth out at the Mouth is less then that which issueth forth at the Wound But they suddenly perish whosoever they are that have received a Wound in the interior Nerves whether smal or g eat if the Blow or Wound be both Transverse and great but if the Wound be but smal and straight there are some that escape the danger But there is neither Death nor any great dangâ—r impending from those Wounds that are inflicted on those parts of the Body in the which there are none of these or which are as far distant at may be from these Indeed he limits the Aphorism whilest that he doth not simply write that such like wounds are altogether Mortal but almost and for the most part He amplifyeth it whilest that he addeth the spinal Marrow the greater and thicker Veins the rough Artery and the Lungs and the interior Nerves And therfore we wil in order consider the wounds of these parts For it is without doubt that the Wounds of the rest of the Parts are not at all of theâ—selves Morâ—al and this Hippocrates himself teacheth us in the above mentioned Aphorism 509. in Coacis Celsus in his 5. B. and 26. Chap. thus rendereth the foresaid Opinion of Hippocrates He cannot possibly be preserved that hath the Basis of his Brain his Heart his Stomack the parts of his Liver the Marrow in his Back-bone wounded or that person that hath either the middle of his Lungs or the Jejunum i. e. the hungry Gout or any of the smaller Guts or the Stomack or the Reins be
ceased and his strength by degrees returned there being no purulent spittle at all that offered to come forth his Cough likewise and difficult breathing were not very urgent and troublesom neither for the first Week did any heat and thirst very much affect the sick person in the interim the wounds being handled after the Vsual manner there daily flowed forth an indifferent Quantity of well concocted pus or purulent matter These means being continued unto the second month and the External wounds being purified and consolidated the sick person was suddenly taken with a most dangerous suffocation so that he was in great peril of being strangled by an Asthma as it were and he was likewise very much afflicted with a cough Atrophy and Hectick Feaver until at length the imposthume of the Lungs brake and with the Cough five or six pints of purulent matter were cast up at his mouth after which the exulceration of the Lungs being cured by fit and proper Remedies the consumption Fever Hectick and all the rest of the symptoms remitted and the Patient was restored unto his perfect health To wit those Wounds of the Lungs are not mortal in which only the substance of the Lungs is hurt and not the great vessels and such as are not so great that they abolish respiration or suddenly destroy the vital faculty either by their dislipating the sprits through some notable Hemorrhage or else suffocating the heart by pouring out the blood upon the Lungs and upon the heart On the contrary if the wound of the Lungs be great and that not only the substance of the Lungs but likewise the great vessels that are therein to wit those notable and observable branches of the Arterial vein and the veiny Artery be wounded those wounds are mortal being such as in which the blood and vital spirit is poured forth and dissipated or else through the overgreat abundance of the blood the Lungs and heart are oppressed and the Patient suffocated Hippocrates in the place alleadged in Coacis addeth yet another cause of death which yet nevertheless doth not bring so sudden a destruction unto any person as those in the former case even now mentioned where the wound being great it is not the vessels containing the blood that are indeed hurt but the great and rough Artery so that by reason of the largness of the wound there is more breath that goeth forth by the wound then by the mouth for then by reason of the sympathy the heart is affected the vital spirits dissipated the Lungs and heart by the ambient Air altered and offended And indeed those wounds of the Lungs bring death likewise in which either the substance of the Lungs beginneth to be exulcerated and that a Consumption is excited or in which the blood is poured forth into the Cavity of the Thorax where it beginneth to putrefy and where it causeth either a feaver or an Empyema But in regard that this doth not alwaies happen and not at al in some wounds of the Lungs and that likewise when it doth happen there is no necessity that the Patient die for this cause therefore those wounds of the Lungs are not to be accounted necessarily Mortal For Felix Platerus in his 3. B. of Obsrv Page 690. relateth that a certain person that he knew falling into a Consumption from a Wound of the Lungs was yet nevertheless Cured and perfectly recovered A certain Coffermaker sayth he one of our Citizens having from a servant of his received a wound very deep in the lowest part of the Thorax by a prick from the point of a knife by the wound he voided forth a most stinking and loathsom pus or matter by the ill savor whereof the whol neighborhood was infected and offended and likewise some certain smal parcells of his Lungs in which the cartilaginous branches of the rough Artery did manifestly appear which persevering a long time albeit that he was in a manner wholly wasted away yet nevertheless at the length the flowing forth of the purulent matter remitting the wound was closed and he restored unto perfect soundness living after this many years as a foot-post in carrying of letters and thus he prolonged his life for forty years safe and found as we say although as it is very probable he wanted great part of his Lungs in one side The wounds of the rough Artery Fifthly That the wounds of the great rough Artery commonly called Aspera Arteria are not mortal but that they may be cured even the Laryngotomy or Cutting of the Laryinx of which we have spoken before in the Second Book of our Pract Part. 1. Chap. 24. doth evidently demonstrate To wit those of them are cured that are not great and in which the membranes only by which the rings of the rough Artery are fastened and linked together are wounded examples of which Schenkius in the Second Book Of his Observat hath collected And I my self also have twice seen such like wounds cured But if those very cartilaginous rings be wounded by reason of their hardness the part cannot again be made to grow together as formerly as Hippocrates teacheth us in the sixth of his Aphorisms Aph. 19. And in the seventh of his Aphorisms Aph. 28. and Galen in Book 5. of his method of Physick Chapt. 7. And yet notwithstanding such like Wounds do not cause a sudden death but a flow and lingering one while that the Lungs are either altered and weakned by that Air that violently breaketh in upon the Lungs thorow the wound or else that a certain smal gobbet of flesh grow unto the wound which by intercepting the breath at the length choaketh the Person But those wounds alone of the rough Artery throttle the Party in which the jugular veins and Arteries being hurt the blood violently and al at once rusheth into the Lungs intercepteth the breathing and so suffocateth the wounded person which yet nevertheless happeneth not by reason of the wound of the said rough Artery but by reason of the wound of the Jugular vein or the soporal i. e. more plainly the sleep-conveying Artery that is very neer unto it Wounds of the Diaphragm Sixthly Hippocrates reckoneth up the Wounds of the Diaphragm among those wounds that are mortal But Galen in his Book 5. of the Method of Physick Chapt. 9. distinguisheth between those wounds of the diaphragm that are inflicted upon the nervous part therof those that are made in its fleshy part and those he wil have to be mortal but these latter Curable And yet nevertheless in the Sixth of the Aphorism Aph. 18. he writeth that the wounds of the nervous part of the Diaphragm are not alwaies mortal but that the great wounds therein are only so For then it is indeed that those grievous symptoms plainly appear viz. a deliry or stupid dotage difficult breathing Feavers Convulsions and as Aristotle hath likewise observed in his third Book of the parts of living Creatures and tenth Chapt. the
above propounded and set down in the first part Chap. 5. among the defensives in an inflammation The Medicament being layd on the part is to be bound up with a swath that may bind close the vein toward the root thereof and the ligature is not to be loosned before the third or fourth day or indeed it is not to be untyed until the blood be throughly stanched Avicen in his Quart Quarti tr 2. Chapt. 18. tells us of this following medicament that hath in it not only a power of burning but likewise an astringent faculty and a virtue also to generate and breed flesh As Take Chalcanthum Parget made into a very fine powder and sifted thorow a hayr steve of each twenty drams Frankincense powdered six drams Aloes dry Glue of each eight drams Arsenick four drams I had rather here take Mâ—rcury sublimate in regard that many who are ignorant of things Chymical and Metallick of ten times when sublimate in general is mentioned and Mercury sublimate is evermore to be understood there instead thereof these do substitute and appoint Arsenick let them be al beaten into a very fine and smal powder made up in a liniment and imposed upon the orifice of the vessel Some there are that unto this Medicament do add Dragons blood and the excrescence Hypocistis But those internal medicaments that stanch blood are either such as cool and thicken the blood or else they are those we cal Narcoticks The coolers and thickners are prepared of Myrtle Roses Purslane Lettice Berberries Ribes Succory Quinces Pomgranates Tormentil Corals Bolearmenick Sealed Earth Out of which may be made Powders Waters Syrups and from these potions and Electuaries There are likewise some certain things that are sayd to stay the blood by an occult and secret property and thus Strawberry Water is much Commended in al haemorrhages And the Root of Corn-rose or Cockle held under the tongue stoppeth the hemorrhage And some there be that for this purpose commend unto us the roots of that Cichory that hath a white flower And some there are that order the Patient to hold in his hand the Jasper Stone or the Blood Stone Stupefactives are not over commonly to be administred neither indeed at all unless the strength remain firm and entire for fear lest that the powers being already much weakned and fayling by reason of the over great loss of blood should by these stupefactives be farther dejected but if the Patients strength wil admit of it then we may administer one grain or two at the most of Opiat Laudanum But now that the blood when it is stanched may so remain for this the situation of the wounded part maketh very much which ought to be such that the Member may look upward and be free from all pain For pain doth very easily attract the blood and cause it to break forth again and the blood doth more easily flow unto a declining and downward place If yet the blood by this means be not stanched they tell us that we are then to cast upon the vessel pouring forth the blood somthing to tye it withal and especially toward the root thereof by which the branch looks toward the Liver or the Heart and that the veins or Arteryes are to be made naked and bare to be layd hold on with a hook and then presently with a thread of silk especially to be tyed and the thread to be drawn very hard and close upon them and then they appoint that the wound be filled up with flesh before the bond be quite taken off For if the flesh shal not first of al have filled up the place that is about the vessel and have shut the very orifice of the vessel it self the bond falling off the haemorrhage wil again easily follow But the truth is that these things are more easily required and commanded then they are put in practice performed If a vein or an Artery wounded pouring forth blood be wholly cut assunder the blood is then the more easily stanched for the vessel is drawn back and on both sides contracted within it self and so its orifice is covered and shut up by the bodies that lie round about it But the best safest and most easie way if it be rightly ordered of stanching the blood is that which is wrought by Medicaments that stop and stay the Blood and shut up the orifice thereof as they were before propounded by us When the Blood shal be stopt the Wound is scarcely to be opened before the third day And if the Wound be unbound yet notwithstanding if there be yet any further fear of the Bloods breaking forth again the Medicament is not wholly to be taken away if it be not as yet moystened and vitiated by the purulent and sanious matter But if by these it be made so moist that it is ready of it self to drop off another is in this case to be laid on if there be yet any further flux of blood feared And yet notwithstanding we are herein to deal very Cautiously and with all manner of Circumspection and with the one hand that part of the Vessel toward the Root thereof is to be pressed down close together that so the flux of blood may be restrained and with the other hand the Medicament is to betaken off the moist Wound to be clean and dried and a new Medicament laid on But now if the internal Vessels shall be so wounded that they can neither be tied together by any ligature neither yet obstruâ—â—ed and shut up by any Medicaments laid thereon then Medicaments out of those things that have in them a virtue to cool and thicken the Blood and which were but even now mentioned by us are to be provided and a Dyet that is like and answerable thereunto as we have said is to be prescribed Now when the blood shal be fully stanched and shall become clotted then we must use the best of our endeavour to prevent the putrefying of it but that it be rather dissolved which in what manner it is to be performed we have declared before in the 2. Book Part 2. Chap. 6. and above in the first Part and 16. Chap. where what we have written may be seen at large for in this Chapter it is our purpose only to treat of the stanching of the Haemorrhages of Wounds The Dyet The Dyet is likewise so to be ordained that it may stop and stanch the Blood and to this end Meats are to be provided of Rice of Amylum or the fine flour of Wheat Barley Pears Ribes Quinces Services Medlars Lettice Endive The Patient ought to abstain from Wine He must likewise keep himself from Rage and Anger all Commotion of the Minde and over vehement motion and Exercise of the Body and therefore his Adversary that gave him the Wound is not to be admitted into the Room where the Patient is Chap. 15. Of the Wounds of the Nerves and Tendons in general and of the pricking of the
the Liver Ibid. P. 7. Sect. 1. Chapt. 11. Of the Wounds of the Reins Ibid. P. 8. Sect. 1. Chapt. 5. Of the Wounds of the Bladder Ibid. P. 9. Sect. 1. Chapt. 5. Of the Wounds of the Testicles Ibid. Chap. 11. Of the Wounds of the Yard Ibid. P. 10. Chap. 15. Of the Wounds of the Abdomen Book 4. P. 1. Sect. 2. Chapt. 1. We treated of the Wounds of the Womb. Chap. 23. Of the Diseases and Symptoms that happen unto Wounds And now since that it often happeneth that other Diseases as likewise divers symptoms do happen unto Wounds and follow upon them al which yield forth peculiar Indications and so draw the cure to themselves deject and weaken the strength of the Patient and render the Wounds very difficult to be cured and dangerous we ought therefore to treat of those also and to shew you how and by what means they are to be removed and taken way until which be done no Cure of the wound is to be expected Of Feavers And indeed in the first place it happeneth very often that Fevers follow upon Wounds And therefore although I have already treated of Feavers in a peculiar Tract by its self yet nevertheless in regard that it much concerneth us to know and rightly to understand the differences of Feavers that follow upon Wounds that so we may the better remove them we wil therefore herein this place speak somthing of them inspeciall and particularly And therefore first of al we are diligently to inquire what the nature of this Feaver is that followeth upon the Wound and what the Cause of it For these kind of Feavers are very various some of them being every day Feavers having their Original from the great disturbance of the spirits and the boyling heat of the blood by reason of anger Fear and upon all occasions of the humors being disturbed by the motion of the body or the commotion of the Mind And moreover also Secondly these feavers happen while the Pus and especially if there be great store of it is in breeding according to that of the 47. Aphor. of the second Sect. Thirdly from an Inflammation Fourthly and somtimes these putrid Feavers are likewise generated from the putridness that is in the wounded part And fifthly from the store of the vitious humors The first kind of Feavers invadeth the Patient at the first in the very beginning The first kind of seaver from the disturbance of the humors and as I told you before it proceedeth from the passion of the mind and the motion of the body and the disturbance of the blood and spirits following thereupon And hitherto also belongeth most vehement pain which by dsturbing the humors and causing restlesness may both set on fire those humors and the spirits and likewise excite a Feaver Their Signs Now these Feavers are known by this that they invade the wounded person instantly upon the inflicting of the Wound and together with it But yet notwithstanding because that the putrid Feavers may likewise somtimes invade the person immediatly and even from the very first beginning therefore by what Signs these Ephemerae or every day Feavers may be discerned from the putrid we have told you before and the difference will sufficiently appear from what we have written hereof in our first Book of Feavers and sixth Chapter Prognosticks And the truth is these Feavers of themselves bring with them no danger at all unto the sick person and yet Nevertheless neither can they at all promise any safety unto him seeing that then the time of the fluxion and Inflammation that are wont to follow upon the Wound is not as yet overpassed and gone The Cure But now this Feaver requireth not any peculiar Cure but if the Patient will but only submit himself unto the strict Rules of Dyet soon vanisheth of its own accord But yet nevertheless all the Causes thereof if they be yet present or that there be any fear of their returning are to be removed for otherwise they may easily draw upon the person some kinde of danger And in regard that otherwise about the fourth day Inflammations and fluxions are wont to happen these Feavers if they continue so long as until the said fourth day may possibly attract and augment those Evils And then again while the Pus is in breeding A Feaver from the generating of Pus and especially if there be a great abundance thereof generated Feavers are caused as Hippocrates telleth us in the 2 Aphorism Sect. 27. For then whatsoever over aboundeth in the wounded part and cannot be changed into the substance of the part beginneth to putrefie and there is caused as it were a certain kinde of boyling forth of putrefied mattier And yet notwithstanding Nature doth what lieth in her power and what she is not able to turn into the substance of the part she doth what she can so to work and frame it that it may not be altogether corrupted but most of it turned into Pus And therefore from this Ebullition or boyling there is indeed a heat of the blood in the Veins and Arteries communicated unto the Heart which when it is thither come it kindleth a Feaver that is like unto an Ephemera of many daies rather then to putrid Feavers properly so called Signs And therefore the Signs of Putridness are absent and appear not and so likewise for the Signs of an Inflammation and these Feavers invade the wounded person at that time wherein the Pus is wont to be generated and especially about the fourth day The heat is much but withall sweet the pulse great swift and frequent The Urine differeth and recedeth but little from its Natural state and there is no ill and dangerous Symptom Joyned together with it to accompany it Prognostick This Feaver of it self hath no danger at all in it but soon after ceaseth Cure And this that it may so much the sooner be done there is a passage forth to be made for the Pus and this so much the more speedily if the Pus be conteined in a more noble part or in a part that hath consent with some one of the more principal and noble parts and withal we are to endeavour that al the afflux of the Humors may be hindered and prevented And Thirdly Feavers from an Inflammation Feavers are somtimes kindled from the Inflammation that followeth and happeneth unto the wounded part somtimes Quotidians or every day Feavers and somtimes putrid Feavers even according as the Spirits Wax hot and this heat is communicated unto the Heart and also according as the putrid Vapours transfused into the Veins and Arteries do penetate unto the Heart and heat it Signs Now these like Feavers are known from the Signs of an Inflammation touching which we have spoken in the first Part and 5. Chapter But whether the Feaver be a Quotidian or a right putrid Feaver this may be known by the Signs of them both of which we have likewise
man who weighed more than four hundred pound yet notwithstanding this man appeared in publick and to tel you the whol truth in this Person Nature began to assay some certain kind of evacuation of the serous or wheyie humor by the Navel And the very same hath been found to happen unto others also in whom the Body hath attained unto so immense a bigness that they could neither move nor yet so much as breathe freely But now in such like Persons as these there is not an equal augmentation of all the parts of the Body as it is in them who grow and are naturally enlarged but only of their Flesh and of their Fat there is an excessive and over-great encrease The Causes The conjunct Cause therefore of this Tumor of the whole Body is the Flesh and the Fat. And here truly one while the Flesh and otherwhile the Fat is augmented and sometimes they are both alike encreased But the Antecedent Cause is the over-great abundance of Fat and good Blood And for this cause it is that this Tumor is referred unto Tumors proceeding from the Blood And yet notwithstanding the Reason of these is far differing from that of other Tumors arising from the Blood For the conteining Cause of bloody Tumors is the Blood but the conteining Cause of this Tumor is the Fat and Flesh and the antecedent Cause is the Blood The rest of the bloody Tumors that are properly so called spring from the Blood issuing out of the Veins or Vessels into some other places which never hapeneth in this extream and extraordinary corpulency in the which Blood is never known to fall or issue forth into other places but it is evermore put unto the Body But now what the Causes may be that much Flesh and Fat should be generated will easily and soon be discovered if we wel consider the Causes of breeding Flesh and Fat Now then Flesh is abundantly bred in those whom we call Eusarcoi that is Persons of a pure untainted and sound Flesh yet alwaies provided that the material cause of Flesh to wit nourishing Food be not wanting and likewise that the native virtue generating Flesh be as it ought to be vigorous and active That which administers matter towards the breeding of flesh is great abundance of good blood the which to produce and generate meats of a good and plentiful juyce and also a due and right temper of the Liver to wit hot and moist are evermore requisite But now again that much Flesh may be bred from much Blood it is required that there be a sound and healthful habit of Body and a good temperament of the musculous parts in the Body which said temperament is likewise hot and moist Hereunto also as we are to understand very much conduceth an easie or idle kind of life in the which there is not much Blood wasâ—ed as also the suppression of their accustomed bleedings and evacuations of Blood especially in Women As touching the original and increment of Fat many and various are the Opinions and controversies among the Physitians at this very day the which for me in this place to examin were altogether impertinent And therefore in a word we say that Fat is generated from the Oyly and fattish part of the Blood falling from out of the Veins and Arteries into the membranous parts and there digested by the innate virtue and temperate heat of the Membranes That great store of Fat should be bred in the first place the Liver is a principal cause thereof For if by reason of its excellent and perfect temperament it doth not generate either much earthy and cold nor much cholerick and hot juyce but produce a sweet fat and oyly Blood and fil the Veins and Arteries therewith and if this Blood be not consumed or wasted in the habit of the Body but that it stil continue to be more cool and moist then this Blood is there converted into Fat Ease likewise and the intermission of Exercise the retention of accustomed evacuations aliment temperately hot and moist and generally all things which either outwardly or inwardly any waies conduce to the making up of a plentifull and temperate mass of Blood or that have in them an efficacy in qualifying and allaying the over-intense heat of the Blood of the Entrails and of the habit of the Body Hence it is that Galen hath left it upon record that all Bodies tending towards a cold and moist temperament become Fat. And with this of Galen agreeth what Prosper Alpinus in his Book of the Egyptian Physitians Chap. 9. hath written his words are these The Bodies of the Egyptians saith he are hot and dry in regard that they live under the hottest and withall dry position of the Heavens but because they moderate and lessen this heat and driness by their dayly drinking of water by their continual use of meats that have in them a cooling virtue and likewise by their frequent use of Baths which they make for themselves with sweet Water their bodies hereupon become extraordinarily fat to fat that he never beheld in any part of the world in so great a number and generally such extream fat and gross Persons as he saw at Grand Cayre in Egypt For he reports that very many of them are so exceeding gross and corpulent and generally so fat in their Breasts that they have Paps of a far larger size and thicker than the greatest that ever he had observed in any Woman Other things there are which demonstrate unto us the truth of this assertion to wit that a hot temperament of the Liver makes very much for the breeding and augmenting of fat For I my self knew a Person of Honor who after he had been sick and was recovered of a malignant Feaver grew to be so extreamly fat and gross that he could very hardly move or stir himself in any place where he fat and as for the bulk of his body he came never a whit behind him whom we have formerly mentioned Signs Diagnostick As concerning Corpulency therefore it is sufficiently obvious to every mans Eye But then whether or no it only produce some kind of deformity and be no more then a Symptom or else whether it be not to be accounted a Disease or preternatural affect the hurt and offended actions wil evidence unto us of which we wil now speak Prognosticks 1. What the inconveniencies and discommodities are that this over-great fleshiness or as we term it extream Corpulency carries along with it I shal give you an account thereof in the words of Avicen that expert Arabian Physitian For thus he in his fourth Book Part 7. Tract 4. Chap. 5. Superfluous fat saith he is that which hinders the body from and in its motion walking and operation and streightning the Veins with an undue and dangerous constriction whereupon it oppilates and stops up the passages of the Spirit so that hereby it is many times extinguished and for the same reason likewise it is
I may so say by their certain Spider-like interweavings and unto the which the very proper substance of the Vein doth adhere as growing thereunto But in other parts of the Body this flesh is of a far differing nature neither hath it as yet gotten any common name But that you may the better understand us now that we are treating of this subject I know nothing to the contrary but that you may term it a fleshy substance or truly at leastwise we may call it a certain flesh peculiar and proper unto this little part and of a differing Nature from that of the stomach from that of the Liver and likewise from that of the Arteries and Muscles in al which the flesh is not one and the same but as I said much differing Thus far Galen Wherefore that we may determine what the subject of an Inflammation is we affirm it to be any kind of fleshy substance which hath Veins Arteries which contain within them and convey blood the Cause of an Inflammation and are therefore even upon this account opposite to the bones which neither have nor are so much as capable of receiving Veins For in good truth flesh is the chief and principal subject of Inflammation yet notwithstanding the blood if it both diffuse it self into the adjacent parts and likewise draw those parts into a consent and agreement with it self they may then al of them both it they be truly said to be together inflamed of which Galen treats at large in his Book of Tumors Chap. 2. where he thus writes That al that flesh whose affection is now mainly and in the highest degree become an Inflammation should seem to be replenished with a flowing of the blood both the color and the Tumor it self demonstrate whereupon it appears all over humid and extreamly moistened like as is wool and a spunge That filth and putrid matter which flows forth whenas the Inflammation hath gotten a little door or gate as we may so tetm it to cast it out by gives a sufficient testimony unto the truth of what hath been said and I am rightly of Opinion that the skin it self is elevated and extended round about at once and together with the Tumors and swellings of those things that lie underneath it And in tract of time even the skin it self participates somwhat of the aforementioned flux insomuch that the Tunicles of the greater Vessels and also the very Membranes themselves may suffer together with the part inflamed and moreover also even the very Nerves and Tendons in process of time come to partake of this same Inflammation Notwithstanding now and then it chanceth that the parts abovesaid all or some of them if they happen to be wounded or any other way disaffected then the hurtful distemper I mean the Inflammation hath its original from out of those very parts But universally and generally there is not any thing that according to the bent of Nature perseveres to carry it self in al things exactly conformable unto the inflamed part if there be but any the least stop put thereunto but al things together with the flesh participate of the said flux so that oftentimes it reacheth even the very bones like as many times also iâ— is by them when they first of al are affected much promoted and furthered And in his sixâ—h Book of the Method of Physick Chap. 5. he thus writes Neither do I greatly wonder saith he if somthing resembling a Phlegmone shal in a smal proportion chance to accrue even to the bones themselves when broken The which likewise Avicen hath taught us in the 2. of his first Book Doct. 1. Chap. 5. where he acquaints us that Tumors happen unto the Members that are soft and yet notwithstanding that there is a time also when somthing happens unto the bones themselves which is assimilated into the matter of a Tumor or Swelling by the which said matter the Tumors magnitude is exceedingly heightned and its humidity greatly augmented And he adds the reason Neither is it saith he at al to be wondered at or ever a whit exâ—raordinary that that which receives an encrease or addition with nutriment should likewise receive it that is to say an addition with superfluity when either it penetrates into it or shal otherwise befal it as generated therein And in the species of Teeth Galen in his 5. Book of the Composition of Medicaments according to the parts affected Chap. 8. informs us That in the Teeth those things that are redundant and superfluous may excite and stir up in them a like resembling affection or rather passion such as is the Inflammation that appears in and neer about the fleshy parts Yea possible it is not only that the bones should get a thickness from the superfluous nourishment but likewise that another bone should be super-added unto them and grow up together with them Concerning the which Abenzoar in his 2. Theisir Tract 6. Chap. 1. hath these words And now and then saith he the bones are ingrossed and greatly augmented in their superficies either by the depraved corroding humors that are infused into the very bones or otherwise by the thick quittor and mattery filth which passeth over upon them from whence it is that they are hollowed corroded and augmented And again afterwards he wriâ—es more at large upon this subject in these words The bones saith he are somtimes greatned or to use his own word ingrossed beyond Natures intention by reason of an overplentiful and gross course of Diet it being likewise inordinate suddenly and rashly fallen upon and not as rather it should have been successively and by degrees advisedly entered into And long it is not since I heard my Father say that he on a time saw a certain man that had a bone super-added and bred in his back like unto the Harts Horn and that it was not altogether so hard as the natural bones and my Father himself saith he purged this man and emptied forth the gross humors that were in him and after he had so done he then puts upon the bone certain exsiccating or extream drying Medicaments insomuch that the said bone fel forth of the body like as the Hart casts his Horns and as other Beasts shed theirs in the Spring time And I my self also have had a Bone growing upon my Back which bred me extraordinary great pain and I thereupon by Purging freed my self of gross humors and laid upon the Bone Resolutives or Remedies of a dissolving faculty The Causes As for the Cause of this preternatural affect Galen writes that as it is altogether unknown unto the ignorant multitude of men so it is not very wel understood by all that profess themselves Physitians For although as I conceive it is agreed upon by al Physitians that Blood is the Cause of an Inflammation yet notwithstanding lest that as the same Galen writes in the place before alleadged we should seem only to declare our own single Opinion without
any further enquiry thereinto we wil therefore make the more accurate search after thereby to find out the Cause of an Inflammation in this manner following There would be no Tumor at any time generated in any part of the Body were it not that either its substance as it were boyling over with heat is poured out or that from without some new substance makes its approach For there are but two only causes to be assigned of the augmentation of the bulk and quantity in any thing whatsoever For either the radical moisture through an internal or external heat is resolved into an aery substance which as it is wel known requires a far greater space room for dilatation then formerly it had or else as we said before some new substance is extrinsecally from some other place superadded thereunto Now therefore of necessity it is that one of these two causes must be present when as in that hot and burning Tumor which we commonly call a Phlegmone the part is lifted up into a greater bulk than is ordinary or agreeable to the intention of Nature But now that the fervency and boyling up of the natural moisture or the effusion thereof is not the Cause appears by this because that every thing that is poured forth and converted as it were into spirits when it is cooled it assumes again its pristine quantity and as we may so express it puts off and laies aside the Tumor as by common experience it is most apparent But as for the parts inflamed let them be never so vehemently cooled yet wil they never return into the former state and condition nor ever cast off the Tumor or Swelling Furthermore if by reason of the effusion of the part and its conversion into spirits a Tumor should be caused in the part inflamed then necessarily upon the incision of the part the spirit should appear which yet as we see is nothing so but that rather there follows an effusion of Blood and the whole place by its colour and the looks thereof seems altogether full of Blood It remains therefore that the accession of some new substance is the cause of a Phlegmone But now that this new substance is the Blood appears from hence to wit that the Phlegmone is exceeding red both within and without Now this red colour is only proper unto and inseparable from the Blood Blood the nighest cause of an Inflammation for there is nothing that waxeth red in the Body beside the Blood and the Flesh which later notwithstanding viz. the Flesh cannot by any means be the cause of a Phlegmone For if the increment of the flesh were the cause of an Inflammation there would be indeed a Tumor or Swelling in the part yet so as notwithstanding the internal heat should remain sound and in an healthful plight without the least distemper and that also it should not in the least vary its pristine nature when as in no one thing that is augmented according to its substance the heat may properly be said to be heightned and encreased so far forth that the increment of the substance and quantity should any way differ from the change or alteration of the qualities But now the case is otherwise in a Phlegmone wherein the colour is changed and the heat grown to be more intense the said colour evidently demonstrating not only the quantity but likewise the quality of the substance Moreover that the Blood is cause of a Phlegmone may be manifestly evidenced by this that the place in the greatest Inflammations especially which now and then happen in Ulcers appears and seems all bloody round about which certainly would never be if blood were not the cause of the Inflammation Furthermore that Blood is Cause of the Inflammation that generating of the Inflammation which happeneth in Wounds doth evidently demonstrate For in new and fresh Wounds the Blood its true at the first flows forth but then afterward being compressed and kept in either by the hand or else with Ligatures or Medicaments that stop the issuing forth of blood or else lastly being suppressed and staid of its own accord it is then reteined either in the Orifice or Cavities of the dissected Vessels and there it is compacted and so wrought that it grows together like as clotted blood useth to do and there by a continued heaping up of the blood abundantly flowing thereunto it lifts up the part into a Tumor or Swelling and causeth an Inflammation An Inflammation what it is Since therefore the Conjunct Cause of an Inflammation is proved to be the Blood preternaturally flowing thereunto it is no hard matter thence to collect that an Inflammation is a preternatural Tumor of the fleshy parts as Galen in the place alleadged takes and understands the name of Flesh arising from the preternatural afflux of the blood and that therupon it must necessarily be hot red extended and accompanied with a kind of renitency or resisting property pain and pulsation or beating The manner how an Inflammation is bred But now that there may not be left to remain any the least obscurity about the nature of an Inflammation we will here add the manner also how a Phlegmone is generated and this we wil do out of Galen who in his Book touching the unequal Intemperies Chap. 3. hath in these words described it it is saith he a hot fluxion or flowing the which when it hath seized upon and seated it self in some muscelly part at first the greater Veins and Arteries are fil'd up and distended and next after them the lesser and so it is carried on untill that at length it arrives even at the least of them In these when the matter of the fluxion is forcibly impacted and cannot therein be any longer conteined it is then transmitted unto the outward parts partly through their own Orifices and partly by a percolation as it were and straining or sweating out of it through the Tunicles and then the void spaces which are betwixt the most principal parts are filled full with the fluxion And so all those parts or places are on all sides very much heated and overspread Those parts or Bodies are the Nerves Ligaments Membranes the Flesh it self and before al these the Veins and Arteries For whereas the Veins and Arteries run along unto each particular part by the which is received both nourishment and vital Spirit so long as the blood flows in a due measure and just proportion and is conteined within those its receptacles the part is not wont to suffer any Inflammation at all but then only when at the length the blood is overcopiously and all on a huddle emptied and poured forth into the substance of the part by the Veins and Arteries By which very thing also a Phlegmone is distinguished from other fluxions in which the matter is diffused without the Veins into the whole substance of the part and there doth distend and dilate it For in a Phlegmone although all the
parts are as I may so say embrued with blood yet notwithstanding there is a certain order observed to wit that some of the parts should sooner receive the fluxion and others of them not til afterward until that at length all of them come to be replenished and distended by the humor Now this kind of order wholly depends upon the natural distribution of the greater Vessels conteining the blood For whereas the Veins and Arteries when they first of all make their entrance into the aforesaid Vessels are evermore the larger and by how much the deeper they are distributed thereinto so much the less they are all this while there ariseth no Inflammation unless it so chance that the blood be emptied forth into those smallest Veins and again happen to fall out of them And this that hath been said manifestly appears unto those that by an exact and accurate inspection take a right view of those very little and almost imperceptible Veins that are branched forth and extended unto that Tunicle of the Eye which Oculists usually call Adnate or Conjunctive For these indeed do evermore convey blood unto the Eye for its nourishment and yet notwithstanding whilest that the Eye is free from distemper they are so exceeding smal that they can hardly be discern'd by the sharpest sighted Eye But then so soon as the Eye is inflamed those slender Veins are preternaturally replenished with blood then they shew themselves and become very conspicuous And it is most agreeable to truth that thus it should be also in al other Inflammations whatsoever they be But as yet there is no Inflammation present albeit the lesser Veins are even filled up with blood until that at length by and thorow them the blood be derived into the remaining substance of the parts which may be done two waies For in the first place the blood is emptied forth by those very smal and most inconsiderable orifices of the Veins by which the Veins do as it were gape open themselves into the surrounding substance of the part that so thereby the blood may through them the more easily drop forth for nutrition or nourishment Moreover likewise it strains and sweats through by the Tunicles of the Veins for even the Tunicles of the Veins are in like manner so framed by nature that they are not without their pores through which if not the blood it self yet certainly the ferosity or wheyiness thereof and its thinner part is exâ—udated or sweated forth by a kind of percolation From what hath been hitherunto spoken the distinction of the conjunct cause from the cause meerly antecedent in an Inflammation is sufficiently apparent For the blood which we have asserted to be the cause of a Phlegmone doth in a double respect take upon it self the virtue and Nature of a cause For either it is the next conteining and conjunct cause of which we have hitherto discoursed to wit as it hath already flown into the part and is irremovably impacted therein so far forth that it actually elevates that same part into a Tumor or else it is the antecedent foregoing cause to wit The antecedent cause of an Inflammation as by reason of its abounding in the body it hath a power of slowing into and by its influx of lifting up the part into a Tumor or Swelling The which antecedent Cause in an Inflammation like as also in other Tumors fals again under a twofold consideration to wit either in regard of the Affect simply considered as it is to follow upon this cause which it hath a power to excite although as yet it hath no being in the body And so a Plethory which is an extream and overgreat fulness of good and laudable blood is very frequently present in the body albeit an Inflammation doth not instantly ensue thereupon Or else secondly it is considerable as preceding and foregoing the affect that already hath a being and is already actually existent in the Body to wit when as the Blood now floweth to the exciting and augmenting of the Tumor Which to speak truth is more rightly stiled the antecedent cause then was the former since that this latter hath respect unto an effect already present but the former relates only unto an affect which hapneth in the future time But this antecedent cause that it may flow together unto the place affected it is thereunto moved and stirred up by other means whilst that it is either transmitted from some where else or else attracted by the part it self for those very causes we have hitherto been treating of and explaining But now for those Causes which we commonly term Procatartick The remote Causes more remote and primitive they are such as either conduce to the breeding of a copious and a plentiful blood as do al meats of good and much juyce an easie and idle kind of life and other such like requisites Or else they are such as render the blood more acrimonious and sharp as do all things that cause heat al acid and tart aliments wrath watchings stirrings and exercises in the extreme or else such as excite and stir up the blood to move unto the part affected as doth the overgreat heat of the part pain proceeding from a wound from a fall from contusion or beating from a fracture from disjoyntures and the like causes or else the weakness and imbecillity of the part affected receiving compared and considered in reference to the vigour and strength of those other parts which transmit the abundant store of hot blood unto the aggrieved part Notwithstanding an Inflammation never happeneth to be generated by a leisurely and gradual storing up of blood but it is evermore bred by a sudden and thronging affluence and influx of the said blood For although it may so chance that some kind of Humor may sensibly and by degrees be collected in some one part which being heaped up as aforesaid may afterward begin to excite a certain kind of pain in the part yet notwithstanding al this an Inflammation is never produced until such time as the pain gives cause sufficient that a more plenteous store of blood should forthwith and very easily make its approach Notwithstanding we are to take notice That although the Blood be the containing and antecedent Cause of an Inflammation yet notwithstanding we say that a Cacochymy or a depraved ill digestion and more especially sharp and cholerick humors are the prime and principal cause that the blood be moved unto the part affected in those Inflammations which are excited without any apparent cause as Wounds Contusions and such like For so it is That when Nature is twinged and pulled by such like Humors and yet notwithstanding is unable altogether to expel them out of the body to the end that she may free the principal parts from the danger impending by reason of them she assays to thrust them forth unto the external and less principal parts the which when it is not able to accomplish
unless it make use of the blood for a vehicle or as we say a Conduit-pipe of conveyance and that the acrimonious humor it self excites a pain in that part into which it is thrust and shut up hereupon it is that there follows a conflux of blood unto that part and from it proceeds an Inflammation And much after this manner the Pleurisie the Peripneumonia or the Inflammation and Impostume of the Lungs the Quinsie the Phrensie the Inflammation of the Ears and Gums the hot Tumors or Swellings in the groins called Bubones Carbuncles and such like are generated and excited The Differences The principal Differences of an Inflammation are taken from the variety of the containing cause and from the great difference of the blood that stirs up and begets the Inflammation For a Phlegmone is said to be for distinctions sake either that which is a true and legitimate one or otherwise that that is not a true Phlegmone but rather a bastard and spurious one The true and legitimate Phlegmone is that which proceeds from good blood and such as is in a due natural temper or at leastwise such as whereof there is more than ordinary store and this is absolutely and simply termed a Phlegmone But the spurious and counterfeit Phlegmone is that which hath its rise and original from corrupt and vitiated blood and such as swerves from its natural temperament and this may be occasioned two manner of waies for if the blood doth neither lose its nature nor change its substance but only hath mingled together with it some other Humors then there are three bastard spurious sorts of an Inflammation that thence arise To wit if Choler be mingled with the blood producing an Inflammation it is then called Phlegmone erysipelatodes if Phlegm Phlegmone oâ—dematodes if Melancholy Phlegmone scirrhodes But if the blood change its substance it then excites not any kind of blood-Tumor for the blood as Galen writes upon this very subject in his 2d Book of the Differences of Feavers Chap. 9. if it be overmuch heated and as it may be so expressed boyled to an extream intense heighth then it s more subtile and fat part is converted into yellow Choler but the more thick part into black Choler or as we usually call it the Melancholy humor The Signs Diagnostick The Signs of Inflammation as may be gathered out of its definition are heat pain a swelling and stretching out of the part a renitency or Resistance a redness of color and a pulsation or beating 1. And in the first place in this kind of Tumor there is present so intense a heat that from it the Tumor hath its very name and denomination and many indeed are the causes wherefore this heat is necessarily raised and stirred up For first of all the blood that through its overgreat abundance excites the Phlegmone is hot which heat it also communicates to the part affected Moreover whenas by the plenty of blood and oftentimes likewise by a certain kind of thickness al the pores are so filled up and obstructed that the hot exhalations cannot sufficiently be sent forth and evaporated neither the heat eventilated or cooled as is ought to be the heat by retention of these exhalations and fuliginous vapors is much encreased Unto which also a third cause may be added to wit putrefaction for the blood contained in the inflamed part assumes at length a putredinous quality by which as is to be seen likewise in other things the heat is excited and communicated unto the part inflamed And this heat is somtimes greater somtimes less according to the greatness and growth of those causes The second sign is Pain for whereas there are two remarkable causes of pain an Intemperies or distemper and the solution of continuity they both of them take place in Inflammations For in truth this extraordinary heat by its distemper first of all excites pain and then the abundance of blood by filling ful and distending the part dissolveth continuity and thus doing is the cause of this pain Again the pain that is thus caused is various much different viz. distending or stretching out pulling or twinging pressing and burdening according to the variety of the parts affected but more especially there is present a beating pain which likewise for this very reason is peculiarly reckoned up amongst the proper signs of a Phlegmone and of which more hereafter In the third place a Distension For when the plentiful store of blood doth not only fill the Veins and Arteries but even the whol substance of the part all things are now distended and stretched out but chiefly the skin the which as it lieth round about al the other parts and hath a Membranous substance must necessarily partake of the distension and the extensive pain 4. Fourthly Renitency or resistance or as the Grecians cal it Antitupia in like manner follows upon this repletion and distension For albeit the inflamed part be not hard in its own nature yet it is so stuffed out and distended with store of blood that now it wil no longer answer the touch neither yield thereunto but resist and withstand it and withal it appears hard unto the touch 5. Fiftly the parts inflamed wax red the blood imparting this color unto them For there is nothing in mans body that assumes this redness of color besides the blood and flesh 6. And lastly In the sixth place there is perceived in the inflamed parts a Pulse and beating pain to wit when with grief and extream irksomness there is perceived a bearing of the Artery in the inflamed part which while the part was â—ound was not to be perceived From whence we are instructed as Galen writes in his sixt Book of the parts affected Chap. 7. that this beating pain doth not happen unto al the parts but only to such of them as have in them certain notable and remarkable Arteries The heating pain how it is caused and that have a part endued with an exquisite sense and when the Inflammation is raised up unto a magnitude worthy of observation Now this Pulsatory or beating pain chanceth from hence that when they are lifted up and distended the parts inflamed by reason of their store of blood do not allow nor afford a due free and sufficient room unto the Artery now distending it self but that themselves are rather stretched out by the Artery lifting it self up which said distension excites the pain And this pulsatory pain is then most of al perceived whenas the Inflammation tendeth toward a suppuration For then the blood boyls as it were and grows exceeding hot from whence it also comes to pass that it assumes and makes use of a larger space of room and so much the more distends the part by the which part the Artery is henceforth much pressed kept down in its motion which we cal Diastole and then afterward hereupon the Artery likewise compresseth and bears down the adjacent and neer neighboring parts that lie round
it should so chance that there be a Tumor in those parts that are ful of Veins and Arteries and such other like cases For there the dangerous flowing forth of the Blood is checked and suppressed by the fire-heated Iron But most frequently it is opened with an Instrument that is fitted expeditely to cut and this knife ought to be sharpened to the utmost that so the Section may be performed without putting the Patient unto any extream and intollerable pain and if possibly it may be done so that the sick party may take no notice thereof But in the accomplishing of this work we must evermore look wel unto it that the Sections or cuttings be no larger than needs must and yet on the other hand not so smal but that they relieve the present necessity I mean that by the Orifice of the incision the Pus may find an open and free passage forth For if the Wound be less than that the corruption may rightly pass out thereat then it wil be requisite that the part be pressed down by which compression pain is evermore excited and the Ulcer is rendered callous and brawny from whence a Fistula may possibly arise But on the other side if the Incision be wider than it needed to have been then both the Cicatrix or Scar will be greater and more unsightly than if it had been artificially made and then likewise the parts subjected wil be altered by the ambient air and now then the part is thereby made the weaker Celsus in his seventh Book and second Chapter gives in charge that the Incision be made after the resemblance of the Myrtle Leaf that is that a simple downright Section be made and that it be so long that when the lips thereof are dilated the Wound may bear a resemblance to the Myrtle Leaf And somtimes one only Section doth not suffice but as Celsus there instructs us greater turnings and nooks are by incision to be made in two or more lines And this also is carefully to be observed That the Section be made according to the fibres that is answerable to the smal strings or hairs of the Muscles Now the Fibres proceed straight forth and for the most part according to the length of the body unless it be in some certain places as in the forehead Now this is therefore to be heeded that so we may not hurt or hinder the motion and action of the member which yet we need not to observe if the Tumor be in the Superficies and close under the Skin but then only when the Pus sticks in the very substance of the Muscle In the first place therefore we must take due heed that we keep at a good distance from the Nerves as also the Veins and Arteries and that we come not nigh them The Instruments we make use of for the opening of Impostumes are very many The first is the Razor then next the Myrtle Knife which they commonly cal the Lancet thirdly a Knife or Instrument resembling the Olive Tree fourthly our Country-men likewise open Impostumes with the Pen-knife or that with which they let blood when they open a Vein But of necessity these Instruments must variously be used according to the great variety and difference of circumstances For if the Impostume be deeply seated and the Skin be thicker than usually then it wil be needful proportionably to make the Section so much the more profound and deep But if it be as we use to say subcutaneous that is lying close under the Skin there will then be no necessity for this so deep an Incision But in regard there are many that wil not admit of Section or Incision we therefore prescribe and administer unto such persons Medicaments whereby the impostume may be opened But those Medicaments are hot al of them of one and the same sort neither of a like efficacy for some of them are weaker and other stronger The stronger sort of them are not over rashly to be administred For they both prolong the Disease and introduce an evil distemper into the part and possibly they may likewise produce divers other ill symptoms And therefore the gentler sort of them are first of al to be administred which do rather ripen the matter and draw it to the highest part of the Tumor and withal do there render the Skin more subtile and cause it to become more tender than truly and properly corrode eat asunder and break the Skin And such are these that follow Take Marsh-mallow roots and white Lillies of each alike one once Garlick Onions rosted under embers the flour of Fenugreek seed dried Figs fat and ful of each two drams the dough of Bread well leavened one dram and an half Oyl of white Lillies Butter Swines fat of each alike as much as wil suffice and make a Cataplasm Or Take Onions Garlick Marsh-mallow roots equal parts of them al boyl them to a softness and when they be wel bruised add the flour of Fenugreek as much as any one part of them the fat of an old Hog as much as will suffice and mingle them wel This following is more forcible Take of sharp and sowr Leaven half an ounce Onions rosted under live coals one ounce Doves Dung one dram black Soap Swines Fat of each alike as much as is sufficient and mingle them The Emplaster Diachylon mingled with Mustard Seed Figs and Salt performs the same with the former But such like Medicaments are more especially applied unto that part in the which the Impostume is sharp-pointed and round about it there is put to somwhat that is maturative or ripening understand it here of simple maturatives as Diachylon which to this end is wont to have a hole made through the mid'st The strongest sort of them are those that we call potential Cauteries the which kind of Remedies we have described in our Institutions among which that is the most efficacious and withall the most safe which is prepared and made out of Lee out of which there is a certain sope prepared touching which we have likewise spoken in our Institutions Now of such a Cautery we are to take a certain smal proportion to the quantity of half a Cicer or Pease and then apply it unto the part after this manner Take the Cloth that is spread over with the Emplaster and cause it to stick close to the Skin then in the mid'st thereof cut a smal hole somwhat narrower and streighter than you intend the Cautery shall be After this take the Cautery and being somwhat moistened with Spittle apply it unto the Skin that appears and lies open to view through the aforesaid hole and afterward lay on another Emplaster upon the former After two or three hours remove the Cautery with the Plaister upon the removal of which the part appears black soft and without any sense or feeling And that this burnt part may be wholly taken away let it be all over throughly besmeared with unsalted or fresh
their Ears with Snow or have plunged as we may so say their almost frozen feet into cold Water or Snow And the same Fabricius in the place alleadged relateth That a Noble man of good esteem and reputation told him that when he travelled in those Regions he himself on a time lighted upon one travelling as he was upon the Road whom finding to be stiff with cold and almost dead he caused to be put into a Cart and having brought him into an Iune his Host the man of the house immediately plunged him over head and ears as we say in cold water which was no sooner done but instantly there issued forth from al parts of him a kind of frostiness in such a manner that his whol body seemed as if it had been al over covered with Ice like as with an Iron shield and then he gave him to drink a Cup of Hydromel putting thereinto the pouder of Cinnamom Cloves and Mace upon which he fel into a swear in his Bed and soon after the sick person returned unto his former state and became perfectly wel recovered The Cure When now the said congelation is asswaged and qualified and the cold for the most part extracted and drawn forth or else hath exhaled of its own accord which is known by this that the pricking pain is much moderated if not quite ceased then the part is to be fomented and cherished with sweet Milk made blood warm in which there have been boyled Rosemary Organy Sage the Leaves of Rue and Bayberries It wil be likewise very commodious this being a remedy that is also very wel known to thrust deep into warm Water in which Rape Roots especially those that were formerly congealed and frozen with cold have been boyled the Hands or the Feet Or Take White Wine one pint Allum an ounce boyl the Allum with the Wine and let the part be wel washed therewith the Decoction also of Lupines is good and helpful and after it let the part be anointed over with Honey in which live Sulphur hath been boyled This is likewise very efficacious Take of the Oyl of Bayes two ounces Honey one ounce Turpentine half an ounce Mingle c. Or Take Turpentine unsalted Butter and Mace of each alike and what you please for the proportion Mingle them c. Or else Let the part be anointed with Oyl of Wax If the part be already exulcerated Allum poudered and mingled with a like portion of Frankincense pondered likewise is very helpful and wel approved of a little Wine being thereto added or the Oyl of Roses boyled in a Rape Root or in the Reddish Root made hollow and the pith taken al out and then squeezed and pressed forth Or else let an Unguent be made of River Crabs burnt with Honey and the Oyl of Roses Or Take Rue the Marrow of a Bull the Vnguent of Roses of each as much as you think fit mingle them c. Or Take Wax the fat of a Hog of each an ounce Litharge of Silver or Lead ten drams the rind of the Pine two ounces of Manna thur is one ounce Oyl of Roses a sufficient quantity Make an Vnguent Chap. 16. Of the Tumor Ecchymoma THere is likewise somtimes poured forth blood the Skin continuing stil whol and sound into the spaces of the parts from whence there ariseth an Affect which by the Greeks is termed Ecchymoma or Ecchymosis and by the Latines Effusio Suffusio Sugillatio For an Ecchymosis is nothing else but Chymeon ecchysis that is an Effusion or pouring forth of the Humors to wit the blood into the next adjoyning spaces by reason of the opening of the Veins to wit if the Skin abiding whol the Veins pour forth that juyce which they contain that is the blood as Galen speaketh in his second Book of Fractures Comment 16. and either the orifices of the Vessels gape which happeneth in an Anastomosis or else the blood doth as it were sweat forth and strain it self out through the Tunicles of the Vessels being rarefied which the Greeks cal Diapedesis or else by contusion the Vessels are loosened which chanceth if one fal from an high place or else be oppressed and over laid by the weight of somthing that is heavy lying upon him or else be smitten and hurt with a club stone stump of a Tree or else lastly that by some violent motion and extension a Vessel be broken Then the Skin remaining who the blood is poured forth into the neer adjoyning spaces whereupon the color of the part is changed and at first indeed it seemeth reddish afterward it becometh Leaden colored then yellowish green blackish whereupon it is that Galen in his Book of Preternatural Tumors Chap. 10. and tenth Book of the Composition of simple Medicaments Chap. 9. maketh two species of this Ecchymosis one which by the general name he calleth Ecchymoma when the part obtaineth a middle color betwixt red and black which indeed may properly be termed Pelidna that is of a livid or leaden color and the Affect may likewise be called Livor to wit paleness or wanness the other he termeth Melasmata that is blacknesses which latter are especially familiar unto old persons as often as their Veins are bruised or opened upon any other cause and these happen upon any smal or sleight occasion like as on the contrary Pelidna and Livores befal Children and those that are young and Women and such as are of a white color But now although oftentimes and indeed for the most part the part is not lift up into a Tumor or Swelling but the Blood poured forth doth so insinuate it self into the spaces of the parts that there is no Tumor at all appearing yet notwithstanding somtimes the part doth swell up if there be great store of Blood poured out and this also is now and then wont to happen after Venefection to wit if the whol Vein be smitten or if the Wound that is in the Skin shall be closed up but that which is in the Vein it self left open and unshut For from hence by that Wound that is in the Vein the blood is poured forth for which when there is no issue or passage open the Wound in the Skin being closed up it is oftentimes under the Skin poured out into the whole Arm and somtimes it exciteth also a certain swelling but however it alwaies dyeth the Skin of a Red and livid or leaden colour Ecchymosis But the Affect is various and different and the Ecchymosis ariseth in a different manner since that the blood is not evermore poured forth without the Veins but oftentimes by reason of the great abundance of the Spirits and Blood the Veins and Arteries that are terminated in the Skin are filled full of blood and thereupon the Body becometh coloured as appeareth out of Hippocrates Epid. 2. Sect. 4. in the end thereof where he writeth thus That all diligence and care must be taken that the passion and anger of the Mind may be
somwhat blackish and that it hath gotten the consistence of a Liniment or if in a Leaden Mortar the Oyl of Roses be stirred about with a Leaden Pestle so long that it likewise wax somthing black and become thick Or Take Oyl of Roses two ounces the Juyce of Nightshade an ounce and half Ceruss or white Lead washed Lead burnt and washed of each one dram Litharge Frankincense Pompholyx or the soyl of Brass of each half a dram White Wax as much as wil serve the turn make an Vnguent Or Take Terra Sigillata or the Sealed Earth of Lemnos Bole-armenick Ceruss of each half an ounce Tutia prepared two drams Pouder of green Frogs three drams Litharge one dram and half Oyl of Roses an ounce and half Oyl of Frogs an ounce Vinegar six drams Wax a sufficient quantity shake and stir them about for a good while in a Leaden Mortar and so make an Vnguent And indeed this is the safer way of curing Cancers that lie hid and secret in the body and such as are not a yet exulcerated For albeit Avìceré command that the lesser sort of Cancers and such as may be perceived be cut up by the very roots and after this excision that the thicker blood should be pressed and squeezed forth on al sides and round about and that the place be afterward feared and burnt with a Cautery that so by this said burning the reliques or remainders may be consumed the Member strengthened and the Hemorrhage or flux of blood hindered yet notwithstanding this kind of Cure hath much danger in it and we ought here to remember that above alleadged 38. Aphorism Section 6. For the Cancer especially if any thing great if it be wholly cut forth and as it were stub'd up by the roots then instantly there wil follow thereupon the Veins and Arteries being cut asunder an extraordinary and dangerous flux of blood which if it be intercepted with a binder then there wil be an extraordinary great and grievous pain excited in the other parts if they be feared and burnt this likewise cannot be done without much inconvenience and yet nevertheless there wil be great danger of its returning The Cure of an exulcerated Cancer But now whereas the most are of Opinion that the exulcerated Cancer is not at al to be attempted or medled with yet notwithstanding it being very inhumane to leave the sick person even in such a Disease altogether destitute of help and assistance there is therefore by Physitians appointed and set down a twofold way and method of curing these exulcerated Cancers the one true and genuine which tendeth to the removal of the very Cancer it self the other only Palliative as they term it which easeth asswageth and in some sor◠qualifieth the Cancer so that the sick person may live with somwhat the less pain and grievance The true Cure is performed either by Incision or Searing or burning Medicaments which indeed are most especially to be administred if the Cancer hath not yet attained unto any considerable growth and bigness or else if it be in those parts where it may without danger be cut forth or burnt It may be amputated and cut away even to the very quick that so whatsoever is vitious and corrupt may be wholly taken away so that there may be no fear left of any remaining contagion And somtimes only cutting wil suffice and by it the whol Cancer may be grubb'd up even by the very roots The amputation being made the blood is not to be suppressed and stopt from flowing before it shal manifestly appear that al thereof that is vitious and corrupt be flown forth out of the Veins afterwards dry Liniments are to be put upon the part that was cut and the Ulcer is to be concocted or ripened cleansed filled up with flesh and a Cicatrice drawn over it and so the Vein to be shut up But somtimes again if the Cancer be over-great and black Choler hath likewise seized upon the greater and deeper Vessels then in this case Section alone wil not suffice but besides the said cutting burning is also to be administred And therefore in the first place that Skin being taken off the Cancerous part it self together with al the blackish Veins is as much as possibly may be to be taken forth and the blood likewise according to the strength of the Patient is not instantly to be suppressed and stopt but rather to be further pressed and squeezed forth that so al the black Choler may by this means flow forth of the Veins After this the place is to be feared with a fire-hot Iron that so the Hemorrhage and bleeding may thereby be stanched and the reliques of the malignant matter wasted and consumed And at length those things that take away the crust cleanse the Ulcer generate and breed flesh and produce a Cicatrice are to be administred But others lest that the sick person should be endangered by the Hemorrhage and extream bleeding or together with the loss of his blood should lose his life also and lest the Chirurgeon by the flux of blood might likewise be hindered in his operation do not in the like manner as aforesaid amputate the whol Cancer and after that at length burn the whol but first of al they cut off a certain part thereof and then after that a sufficient quantity and portion of the blood is flown forth they burn and fear the said part and then again a second time they amputate and cut off another part thereof and again burn it and thus in this manner by turns iterating and repeating the Section and amputation as also the burning and learing they do at length quite take away the whol part affected with the Cancer The Cancer may also be burnt with Caustick Medicaments among which there is commended Sublimate Arsenick But there ought to be a special regard had unto the places and parts that lie round about it neither in this respect may crude Arsenick be without much hazard and danger thus administred That Arsenick is more safe that is poured forth mingled and fixed with Salnitre or the Salt of Nitre But now in regard that the great fear that here especially perplexeth Physitians is touching the recidivation and return of the Affect those Medicaments therefore that evacuate black Choler are often to be repeated and likewise those that have in them a power and vertue to draw forth the Hemorrhoids and the Courses Instead of which if they be wanting some there be that cause Issues to be made But in this case we are not only to administer such Medicaments as prepare and purge forth black Choler but those likewise that resist and oppose poysons and such as are known to be expedient in regard of their whol substance and such as have in them the property and sovereign vertue of Antidotes And for this purpose we are to administer Treacle and Mithridate with Borrage Cichory and the Juyce or Syrup of Sorrel the Broth of
whensoever it is easily and gently pressed together it returneth and it 's altogether hidden like as we see it to happen in Ruptures And this Opinion very many and indeed most of the latter Physitians do follow Yea and Platerus himself likewise who is otherwise wont to take liberty enough in examining the Opinions of the Ancients writeth That Aneurysma doth not only arise from the dilatation of the Artery it yet remaining shut and entire but also that more frequently it not alwaies if it be in the exterior parts it proceedeth from a certain manifest and apparent opening thereof For then the thin and sprightful blood breaking forth of the Artery under the skin lifteth it up into a Tumor or Swelling and there formeth and frameth unto it self a hollow nook and there in the Artery causeth this pullation in this Tumor even almost in the same manner as the Arteries are wont to empty themselves naturally into the hollow nooks of the thick Membrane of the Brain so here they do it preternaturally by pouring forth the blood with and in breathing in its Diastole and in its Systole receiving it in again But this is an Opinion that I could never approve of and therefore in the yeer 1606. when I interpreted Galen's little Book of Tumors I altogether rejected it and I then likewise propounded another which out of those Lectures of mine that noted and famous man Dr. Bernhard of Sweden made use of and Inserted likewise in his Treatise of the Inspection of Wounds For if Aneurysma should proceed from the Effusion of the Arterial blood under the Skin then certainly the said blood would diffuse and disperse it self in length and breadth and round about and would dye and colour the Skin of another Hieu like as we see it to happen in Contusions and in the opening of a Vein when it is not exactly and rightly performed to wit when either the Vein is wholly cut through or else when the Wound thereof by reason of the impetuousness and violence of the Blood is not rightly closed For then the blood is very often poured forth under the Skin even unto the extream and utmost part of the Hand and the Skin is dyed with a Red Green and Yellow colour Which must necessarily happen so much the more if an Artery be opened in regard that the Arterial blood is thinner and floweth forth with a greater force violence which yet notwithstanding never happeneth in Aneurysma in the which that Tumor is conteined within its own Limits and as it were in a Bladder neither is the Skin dyed with any other color And moreover if Aneurysma proceeded from a Blood poured forth under the Skin in progress of time it would so happen that this Blood consisting and abiding in a strange and unfit place would putrefie like as we see it usually doth in Ecchymoma as we told you before in the seventeenth Chapter Antonius Saporta indeed in his first Book of Preternatural Tumors and Chap. 43. doth his endeavor to salve and answer these objections whiles he thus writeth The Blood saith he if it altogether leaveth its own proper Vessels and cast it self forth into a greater Venter or Cavity being left destitute of the influx of the heat that should flow in unto it wil necessarily putrefie but in Aneurysma which proceedeth from the opening of an Artery it is not so far forth left destitute by the heat thereof and by the rest of the Blood that is contained therein that its native heat and colour should perish neither is it expelled forth into any great space or Venter that it should corrupt and putrefie For it is cherished by the vital spirits contained in the Artery since that its matter remaineth yet entire and continued For albeit the Artery be divided and the Blood causing the Tumor doth pass forth yet notwithstanding the Flesh and the Skin that cover the Artery continuing stil whol and entire it doth not alwaies so insinuate it self into any large and ample space that it should be made thereby to putrefie and rendered destitute of the help and assistance of Nature But the truth is he doth not here by all that he alleadgeth acquit and free the Ancients from the aforesaid Objections For if the Blood that is flown forth may be cherished by the vital Spirits and the heat of the Artery why then is not the same done likewise when a Vein is smitten and pierced through and when the Blood the Vein being not as yet consolidated and exactly closed issueth and floweth forth Neither doth the Blood only then putrefie when it is poured forth into a large and sensible Cavity but likewise whensoever it is shed forth under the Skin Furthermore as we have said that Blood which we call Arterial is not poured forth round about as the Vein Blood is which yet notwithstanding it ought much rather to do in regard that it is thinner and more spiritful For it is not sufficient what Platerus writeth that the Blood poured forth under the Skin doth there form and frame for it self a Sinus or hollow nook not unlike the hollow spaces into which the Arteries in the thick Membrane of the Brain do insinuate themselves and that the Skin is instead of an Artery unto that Blood that is poured forth out of the Artery and that the Blood may from thence uninterruptedly repass and flow back again into the Artery without any Corruption For the Sinus's are framed by Nature and so exactly shut up with Membranes that nothing at all can possibly flow forth of them But now the Arterial blood can no manner of way frame for it self any such Sinus but whensoever it falleth forth without the Artery it diffuseth it self every where round about and in regard that under the Skin all things are confluid therefore the Blood easily maketh an irruption into the adjacent parts by that way and passage that is opened the which we may likewise see the Veiny Blood to do which is much thicker and then the said Blood being out of its own and in a strange place soon putrefieth Which appeareth even from that very History that Antonius Saporta writeth as conceiving it to make much for the confirmation of what he had written touching Aneurysma in his first Book of preternatural Tumors and Chap. 43. Neither in truth was that Disease which he there describeth an Aneurysma but only an effusion of the Arterial Blood upon the rupture of the Artery into the places lying neer about it and there corrupting But this is the Story that he telleth us Whenas Johannes Fabri that most acute and sedulous Scribe of the Palace at Montpelier had spent the chiefest part of his youth in riotous and inordinate Revellings and Feastings and in a frequent and unseasonable Drinking of the strongest sort of Wines without any diluting or qualifying the heat thereof he began about the fiftieth yeer of his age to draw his breath with much difficulty and to be affected with
is like unto the rest of the skin and the Tumor is soft and loose and for the most part giveth way and yieldeth unto the compression of the fingers the blood running back into the Artery from whence it instantly again floweth forth There is likewise a Pulse to be felt in an Aneurysma Although that Paraeus hath observed that somtimes in the Aneurysma if it be great there is neither any pulse to be perceived not any return of the blood upon the compression unto the more internal parts and this I also observed my self in a certain Woman but then notwithstanding there is to be perceived a motion and as it were the loud noise of boyling water and that not only when it is pressed down with the fingers but likewise at other times and this hissing or singing noise is not only to be perceived upon the touch of the fingers but also upon the putting of the Ear close thereto which proceedeth from the motion of the vital spirit in its passage through streight and narrow places All which signs proceed not from the effusion of the blood under the skin but from the dilatation of the Artery Prognosticks 1. Al Aneurysma's are very hard to cure 2. Yet notwithstanding those of them that are less and newly arisen wil admit of a Cure But such of them as are old and greater in regard that that blood cannot be driven back by Astringents neither may the Artery be consolidated and so they are no waies to be cured but by Section wil hardly admit of any cure at al. For the Tumor being opened and the Artery as it is necessary being cut the Arterial blood floweth forth together with the vital spirit abundantly al as it were at once and with great violence so that the sick person is oftentimes precipitated into extream hazard and danger of death And there are many remarkable instances that might be given of such sick persons as in the opening of the Aneurysma have died under the hands of unskilful Chirurgeons 3. Neither hath the Tumor that is joyned with an Aneurysma any great danger in it but that the life may together with it be lengthened out for a long time I knew a certain neer Neighbor of mine in whom an unskilful Chirurgeon when he should have opened a Vein cut an Artery and it is now already above thirty yeers that she hath had an Aneurysma as big as a Walnut in the inward bending of the Arm and al this while hitherunto she hath enjoyed and stil even at present doth perfect health as if she ailed nothing at al. And therefore we conclude that better it is somtimes for the Patient to bear and undergo this sleight inconvenience than to submit himself unto a dangerous Cure The Cure And therefore forthwith even in the very first rise of it so soon as ever we perceive that there is an Aneurysma excited for it is not suddenly done but that dilatation of the exterior Tunicle of the Artery is caused sensibly and by degrees let Astringents and Repellers be imposed upon the place affected that so the force of the blood may be abated and qualified and the open hole of the Artery may be shut up For which end and purpose there may likewise very fitly be administred a thin Leaden plate which doth repel thicken and bind close together the loosened Artery There may also be administred astringent Cataplasms and the Emplaster against a Rupture And because that the Aneurysma somtimes also ariseth from the cutting of an Artery we must do out endeavor that if an Artery be cut whether it be purposely done or whether it happeneth by any ill accident that it may immediately shut and close up again and that may right manner which in regard that it is not here so easily effected because of the violent and impetuous motion of the Artereal blood as it is in the Veins therefore we prescribe the following Medicament as very fit and proper for the Consolidating of the Wound of the Artery Take of Frankincense two parts of Aloes one part and an half Mingle them and having shaken them wel together with the white of an Egg tye up all with the Flâ—x of a Hare as much as wil suffice and let them be laid upon the Wound of the Artery And of this kind there are divers other Medicaments to be prepared of the Roots of the greater Comfry Mustick Frankincense Pomegranate Rinds Acacia or binding Bean-tree Hypocistis or the hardened juyce of Cystus Myrtle Gals Aloes sealed Earth of Lemnos Bole-armenick Lapis Hemarites or the Blood-stone and the Emplaster Diachalcitis If in this manner and by these means the growth and encrease of the Aneurysma cannot be hindered there are indeed some that advise and perswade us unto Section and the Tumor being opened the Artery that is to be cut must be intercepted by binding it about with two bands and then it must be dissected between the two bonds and these bonds as they teach us are not to be loosened until that Nature hath covered over the wound with fleshâ— and that now al the fear of the bloods issuing forth and al the danger of an Hemorrhage be past and gone Now as for the manner of cutting the Aneurysma Aegineta acquaints us with it in his sixth Book of Physick Chap. 37. in these words If the Tumor saith he be caused by opening then we use to inflict upon the skin a straight Section made longwaies and then after this the lips of the skin being parted and far sundred by little hooks we make bare the Artery severing it from its Membranes by Instruments very fit for this purpose and then after the transmission of a Needle under it we tie it with two threds and then so soon as we have pricked with a Pen-knife the middle part of the Artery and have evacuated what was therein contained we then betake our self unto the suppurative cure until at length the ties of the threds fal off But now if the dilatation be caused from the rupture of an Artery then it behoveth us as far forth as possibly we can to lay hold upon the whol with our fingers together with the skin then to cast through it beneath that we have laid hold on with the fingers a Needle that may if you please have in it two threds or rather one thred doubled and after the casting through of the Needle and thred we are then to cut in two the every bandle as I may so cal it of the double thred and so to bind about the Tumor on this side and on that with the two threds But if there be any cause to fear lest these threds should slip and fail then in this case there is likewise another Needle to be cast through that may throughout lie and press upon the former and this Needle may likewise draw after it two threds or a double thred and the handle thereof being cut in sunder we then bind about the Tumor with four
it may thus be known If that which is touched by the Instrument be soft and the Pus that floweth forth be white and in great abundance it then sheweth that the Fistula sticketh in the Skin alone But if it penetrate and reach even unto the Nerve then there wil be great pain perceived when the depth of the Sinus is searcht unto and the Pus that is evacuated is indeed white but then it is very thin and in less plenty and the action of that Member unto which the Nerve tendeth is rendred more difficult If it penetrate unto a Bone there is then present a pain in the very time of making the tryal and discovery and that unto which the lowest end of the searching Instrument reacheth is hard and maketh resistance And the Bone is then indeed found and perceived to be equal and smooth if it be not as yet become rotten and corrupted but if putridness hath seized even upon the Bone it self also it then appeareth rough and unequal unto the touch and the Pus flowing forth waxeth black and is of a very ill savor But if the Sinus reach unto a Vein or an Artery and this Vein or Artery be not indeed corroded and eaten through then there is somthing issuing forth that is like unto Feces or Dreggs For the Blood sweating through by the Pores of a Vein or an Artery is mingled together with the humidity of the Ulcer and thence it is that what floweth forth appeareth feculent or dreggy But if the Vein or the Artery be eaten through then sometimes there wil blood break out and flow forth and this wil be very red and with a kind of leaping or dancing motion and with a tickling if it come from an Artery but more thick and dark if it issue forth from a Vein Prognosticks 1. Simple or single Fistula's that are yet but new begun which are in the fleshy parts alone not deep in young vigorous bodies and such as are of a good Constitution are easily cured but more difficultly those wherein many parts are corroded and eaten quite through such as are old and inveterate without any sense and feeling deep ful of turnings and having divers and different hollow Nooks such as are neerly situate unto noble and principal Members and when they are in old and decaied bodies and such as abound with ill humors 2. And so are those in like manner very dangerous and hardly cured or rather indeed altogether incurable that reach even unto the heads of the Muscles unto the Veins unto the Arteries unto the Nerves the Bones the Joynts and the very Vertebrae of the Back that reach and extend unto the Cavities of the Bellies as the Thorax or the Abdomen or Paunch or even such as penetrate likewise unto the very Bowels themselves as the Lungs Womb Intestines and also unto the very Bladder it self For why such like Fistula's as these either they wil not bear nor admit of any Medicaments or it may happen likewise that the Medicaments cannot possibly attain and reach unto them 3. Yea some certain Fistula's there are that indeed ought not to be cured to wit such as are old and inveterate as having been of long continuance and such as are removed from the noble parts and such as by the superfluous and vitious humors have now of a long time been accustomed to be purged and emptied forth For such like Fistula's as these in regard that they preserve men from divers Diseases are by no means to be closed up because that when they are shut up they cause and procure very many Diseases as Hippocrates hath it in his sixth Book of Epidem Comment 3. Text 39. But on the Contrary if they shal at any time chance to be closed and shut up they are then again to be opened The Cure Now the Cure of these Fistula's is twofold one the true and perfect Cure the other only palliative as they call it or imperfect to wit such as wherein the Fistula is dryed up within and consolidated without the Sinus nevertheless stil remaining Which kind of Cure Galen seemeth to hint unto us in his Book of Tumors Chap. 4. where he hath these words Yet nevertheless saith he the Sinus is streightned and closed together as being throughly dryed by the Medicaments insomuch that the part may seem to have attained unto a soundness no way to be found fault with For evermore indeed if any one continually using an exact and accurate Diet cometh by this means to have his Body very healthful and sound and very free from superfluities the Sinus then remaineth restrained and kept in But so soon as any superfluity is collected and gotten together it is again filled up and so there appeareth to be again the same Impostume that there was from the very first and so again it is evacuated as is fitting with Medicaments and then it is dried and by these means it is restrained and kept in and all this is evermore done with much more ease unto the sick Party then in those that have the Impostume newly begun in them For neither do the parts that are so far divided and separated yet feel or are in the least sensible of pain for now although they are far distant one from another yet nevertheless they are very speedily filled up the Sinus easily and soon receiving that that floweth unto it And the truth is Hieronymus Fabricius ab Aquapendente is of Opinion that this kind of Cure is not altogether to be despised and contemned For sometimes as he writeth this succeeded wel unto him although not alwaies Now the Cure is performed the body being first of all purged and a fitting Course of Diet ordained and afterwards the Tents and Fistula being taken away and a new Spunge throughly soaked in a liquor that is strongly drying being applied and fast bound upon the place such as is the water of hot Baths Ley Lime-water and the like For by this means the mouth of the Fistula shutteth again together so that the Fistula may seem whol and sound which indeed somtimes by the benefit only and operation of the Native heat doth altogether coalesce and grow together again but for the most part it remaineth closed up only so long as there are no superfluous humors collected and gotten together in the body for after that there is any humor again gotten together in the Sinus the Fistula is likewise again opened But now the true and genuine Cure of a Fistula is thus accomplished Universals in the first place are not to be omitted but a Diet is rightly to be instituted and the body throughly purged from all superfluous humors and especial care is to be taken that there may no more of the humor flow in unto the part affected Which being done before we descend unto Topical Remedies there be some that administer certain Potions that may dry the Interior parts and strengthen them and that may prepare the Fistula for Consolidation and
that they contract these Clefts especially about the Joynts yet nevertheless this same happeneth somtimes likewise unto the Feet It may be Cured most speedily and most conveniently by this Unguent Take Litharge of Silver Myrrh and Ginger of ech alike parts bruise and pouder them very small and so with Virgins Wax Honey and common Oyl as much as wil suffice make an Vnguent unto which for the rendering it the more grateful to the smel Musk and Ambar may be added THE FIFTH BOOK THE FOURTH PART Of WOVNDS Chap. 1. Of the Nature Causes and Differences of a Wound AMong the external preternatural Affects of the Body and such as are obvious unto the senses there remain Wounds Fractures and disjoyntings of which we will now speak in order And First of all as touching a Wound that it is a solution of Unity in a part Bone and softer Cartilage is without al doubt and controversie But yet nevertheless it is sometimes taken largely and somtimes in a more strict sence Celsus taketh it in the largest sence of all whn in his fifth B. and sixth Chap. he thus writeth That Wound saith he is far worse and more dangerous which it caused only by a Bruise then that which is made by incisiom and dividing the part so that it is also far better to be wounded by a sharp and keen edged Weapon then by that that is blunt It is taken in a large acceptation when it is attributed unto all kind of solution of Unity made by any sharp instrument whether this solution be made by pricking or by cutting like as Galen in his Sixth B. of the Meth. of Physick the first and following Chap. calleth the pricking of the Nerves the wounding of them It is taken strictly when it is distinguished from a pricking that a wound is the solution of Unity in a soft part made by a Cut from any keen and cutting instrument but a pricking is that solution of unity that is caused in a soft part by a prick from an instrument that is cutting By which it appeareth that the solution of Continuity in a soft part is wider and broader then a Wound whether it be made by cutting or by pricking For Unity may also be dissolved in a soft part by a thing that is not sharp but only hard and heavy and this may be the Skin either appearing whole or even broken likewise which happeneth in those Wounds that are inflicted by Bullets from Guns Moreover also the Unity of the soft part may be dissolved by extension which in special in the similary parts is called Rupture but in the Compound Apospasma to wit when those fibrous Ligaments and Threads by which the parts are fastned together the one to the other being broken the parts themselves likewise become broken A Wound what it is By all which it appeareth that a Wound is the solution of Unity in a soft part caused by a cutting and sharp instrument But if as Guido in the Second B. of his Chirurgery and Fernelius in the seventh B of his Meth. of Physick Chap sixth rightly admonish us the Wound become sordid and foul and that some thing be by the Pus or filthy corroding matter eaten away from the substance of the wounded part then the Wound passeth into an Ulcer or certainly we may very well say that an Ulcer is conjoyned with the said Wound The truth indeed is that Rudius in his B. of Wounds and first Chap. doth impugn this Opinion but al to little purpose For neither is it absurd as he without Reason thinketh that one Disease should be changed into another or that one should be added and Joyned to another The Wound and Ulcer they are both of them the solution of Unity in the soft part buâ— the Wound is made by section of cutting alone whereas the Ulcer is caused within it by Erosion and therefore it is that in an Ulcer there is somwhat that is lost from the substance of the part If therefore in a Wound of any part somthing shall be Eaten away and consumed from the substance of the flesh it is then altogether to be granted that now there is likewise present even an Ulcer also Which nevertheless is not so to be taken as though so soon as ever on the fourth day the Pus or filthy corrupt matter doth begin to appear in the Wound that then likewise an Ulcer may be said to be present For that said Pus proceedeth from the blood that is shed forth without the Veins or some Aliment that sticketh in the Capillary Veins and spaces of the parts neither is there then any thing Eaten away from the substance of the part But if there be so great an abundance of the Pus gathered together whatsoever the Cause thereof be that somthing be Eaten away from the substance of the part then it cannot be denied but that there is an Ulcer likewise present seeing that there are then present all things that are required unto the Essence of an Ulcer and in this Case the Cure is no longer to be ordered as in a single and simple Wound but as in an Ulcer But since that a Wound is to be accounted in the number of Diseases there may be enquiry made and that upon good grounds what actions they are that are hurt thereby Unto which it may be rightly answered that all the Actions of the said part and the severall uses thereof unto which the part is destined are hurt by the Wound whether that part perform those actions either as a similary or as an instrumental part That the Organical Actions may oftentimes be hurt by a Wound to wit when the part destined for motion is Wounded cannot be denied â—t being a thing so manifest since that the wounded Member can no longer be moved in a due and right manner As likewise the Vein that is cut assunder can no longer convey the blood unto the part for the nourishment thereof neither a dissected Artery the vital blood and spirits or a Nerve the Animal Spirits But indeed the truth is that the temperament of the part is not next of all and immediatly hurt by the Wound but yet never the less it is mediatly hurt to wit when the Vessels being cut assunder and the blood poured forth the heat of the part is withal dissipated and the influx of the Blood spirits and heat flowing in this last being so necessary and requisite unto the temperament of the part is altogether hindred For all which Causes the attraction of the part the Concoction the Nutrition and the expulsion is hurt And from hence it happeneth that the temperament being changed there are more Excrements generated in that part then otherwise were wont to be And from thence also it proceedeth that the Pus is not presently generated in the very beginning of the Wound but afterward to wit about the fourth day when the heat of the part that was dissipated is again restored The Use is
likewise hurt in the Wounded parts The Skin being Wounded can no longer cover the parts lying underneath it neither the dissected Peritonaeum the Intestines the Cornea Tunicle of the Eye can no longer contain the Humors neither can the Arteries when they are once cut in sunder any longer contain or convey the Blood neither can the Nerves carry the Animal Spirits The Differences The Differences of Wounds some of them are Essential and others of them Accidental The Essential are taken from the very Nature of the Wound to wit from the form thereof in which respect according to the Figure some of them are straight other of them oblique and these indeed likewise of a very various Figure in respect of their Magnitude some of them are smal and others great some deep others of them only superficial and hither also may this be referr'd that a wound being inflicted either there is â—omwhat cut off from the substance of the part or else there is not any thing at all cut away Although if we would but rightly and accurately Judg of the thing these are no proper and Essential Differences in regard that they are taken not 〈◊〉 the very Essence of the Wound but rather from some certain Accidents that happen thereto to wit the greatness the figure c. From the part affected which is somtimes the Musculous Flesh somtimes a Nerve now and then a Ligament and very often a â—endon now this or that part is affected And indeed in one and the same part there is great respect to be had in what particle of the part the wound is as for example whether the Wound be in the beginning or in the end or else in the middle of the Muscle and whether or no in the Wound of any Bowel the Parenchyma or the Vâ—ssels therein be wounded From the Cause because that the wound afflicted is either by cutâ—ing which is in special call d a wound or by pricking which in special is called a 〈◊〉 or pr â—king or else together with the 〈◊〉 there is likewise present an incision 〈…〉 or else all these three incisâ—â—â— pâ—â—eking and Contusion are Joyned together But the Accidental Differences are such as are drawn from those things that are without the Definition of the Wound Galen in the Third B. of his Meth. of Physick and last Chap. hath reduced them to three Chapters and he teacheth us that they are taken either from the manner of their Generation to wit that there is a total incision or a total disruption or else that there is only a part cut or a part broken Secondly From the situation of the Wound to wit when in a wound obliquely inflicted one part of the Wound is in sight and another part lieth hid under the Skin And â—hirdly From the time that one wound is fresh and new made another old and inveterate There are likewise certain other Accidental Differences we may rather call them improper taken from those things that are conjoyned with the Wound to wit that that wound is poysonous that is inflicted by a poysoned sword or else by the biting of some venemous beast that there hath chanced unto the wound some inflammation or an Eryfipelas or that there is a Fracture or disioynting Joyned therewithall or else that there is conjoyned an Hemorrhage Pain or some other Symptom The Causes We need not say much touching the Causes of Wounds The Causes of a Wound that is made by cutting are al those things that have in them a power of Cutting Swords Glass and the like Of a Puncture or pricking the Causes are whatsoever things are sharp-pointed as Arrows Needles and the teeth of living Creatures Of Ruptures such things as distend the soft parts and pul them into Contrary parts such as the lifting or carrying of some extraordinary weight a Fall Blow lowd speaking and the like Those things that bruise are all things Heavy Hard and Blunt as Stones Wood Lead and among these Leaden Bullets shot out of Guns have in them a power of perforating Chap 2. Of the Diagnostick Signs THe Truth is that the wound it self is of it self sufficiently manifest unto the senses and therefore needeth not any signs whereby it may be known But although that place in the Skin that is wounded be obvious and open to the sense yet nevertheless if the Wound penetrate unto the more inward parts what parts they are that are wounded within is oftentimes very obscure and hidden from us But this may be known first from the situation of the parts Secondly from the Action that is hurt and the Use Thirdly From the supervening Symptoms and Fourthly from the Excrements For if the wound of the Head be so inflicted that it be very deep it sheweth that the Brain is wounded and if the whole Thorax or Chest be run through with a Sword it argueth that the Lungs are likewise wounded and so of all the other parts For the exact and perfect knowledg of which the Scituation of the parts is to be learnt from Anatomy Secondly the Actions that are hurt do demonstrate the Wounded part And so after a Wound received in the Privy parts if the Urine flow forth of its own accord it sheweth that the Sphincter of the Bladder is hurt But here notwithstanding we are wisely and carefully to consider in case any Action be hurt whether the hurt of the said Action be not by Consent of some other part And therefore other Signs are to be conjoyned If a wound being received in the Abdomen the Intestines fall forth it is an Argument that the Peritonaeum is cut a asunder As for what concerneth the Excrements if Chyle flow forth upon the receiving of a Wound it is a sign that the Stomach is wounded or the smal Bowels if the Excrements of the Belly that the greater and thicker Intestines are wounded if Urine flow forth of the Wound then it sheweth that the bladder is wounded if out of the Wound of the Thorax or Chest Air pass forth it is a sign that the Lungs are wounded Whether it be a Vein or an Artery that is hurt and wounded the efflux of the Blood will shew since that what floweth forth from an Artery cometh forth Leaping and Dancing as it were and is more Red then that from the Veins We have notice likewise given us of the part that is wounded from the supervening Accidents And so a vehement pain suddenly happening manifesteth that some Nerve is wounded Chap. 3. Of the Prognosticks and foretelling of the Event of Wounds BEfore the Physitian attempt the Cure of a Wound he ought First to be very Sollicitous and Inquisitive touching the Prognosticks To wit in the first place he ought to foreknow whether the Wound be Curable or altogether incurable And then if it be indeed curable whether the Cure will be easie or difficult and whether or no the wounded person be like to have his former perfect soundness restored unto him or else whether
perfectly Cured albeit that the wounded person die not thereof but a Callousness being brought over it the Pipe still remaineth by which the Urine is voided forth But yet nevertheless it is not long that a man can continue to live with such a like wound and therefore we say here again as we said also before that there is a difference to be made between a wound Mortal and a wound incurable But yet notwithstanding touching al the Wounds of the bowels hitherto mentioned this is to be observed that albeit there have been observed some examples of such like wounds that have been Cured yet that this hath happened very rarely and that among these those are to be numbered touching which Averrhoes saith that in the Cure of Diseases there are somtimes Miracles wrought For when fit and proper Medicaments cannot be applied unto internal wounds but that the whole work must be committed unto Nature if in this Case Nature be not very strong and Vigorous the wounded person is very hardly Cured but for the most part an inflammation Convulsions Faintings and Swoundings and other the like Symptoms supervening the party dieth And therefore Hippocrates saith rightly in the sixth of his Aphorism Aphor. 18. that such wounds are Mortal and in his Coaca that most commonly and for the most part men die of such Wounds And therefore if upon the receiving of such a wound the sick person die within a short time after the Cause of his Death ought to be imputed unto the Wound since that much help is not to be hoped for from the Physitian as we shal also anon shew you And Lastly Hippocrates reckoneth up the Wounds of the greater Veins among those that are Mortal Wounds of the great Veins and indeed rightly But now by the word Phlebae he understandeth both the Veins and Arteries and by Pacheis he meaneth great and lying hid within which elsewhere he termeth Aimorrhous that is to say pouring forth Blood such as are the great hollow Vein and the great Artery and the great branches of these For such veins and arteries seeing that they cannot be shut close by any ligature whatsoever the blood and the spirits plentifully flowing forth of them the strength and powers of the Body are soon dejected or else the blood that is fallen forth without its own proper Vessels if it hath no passage forth but that it be still deteined in the Body it Clotteth together and putrefieth and getteth unto it self a very evil corrupt and Malignant Nature causeth a Gangreen and exciteth most grievous Symptoms and at length bringeth even death it self upon the party And indeed this danger is most grievous and formidable in the Arteries when the Blood and vital spirits being poured forth the powers of the Body are dejected and the mans life endangered neither can the Arteries be easily brought to close by Reason of their continual motion and hard substance And these are the Wounds that as Hippocrates rightly saith are Mortal Of which notwithstanding as I told you before some are simply or altogether Mortal which Prosper Farinaceus Tit. de Homicidis Quest 125. Part 3. defineth that they are such that require not the Care and advice of Physitians but are such of which the Wounded person dyeth that is by Reason of which although they be Cured by all the Art and industry of the most skilful Physician yet nevertheless the Wounded person instantly dieth thereof And others of them are not altogether Mortal and certain in their causing of death which the same Prosper Farinacius defineth to be such of which the Wounded party dieth not suddenly and of which somtimes he dieth not at all But what Wounds of the latter sort are Mortal that is of which although some are now and then cured and recover their perfect health and strength yet nevertheless this or that particular person may truly be said to have died of them will indeed plainly appear from what we said before touching the Mortal Wounds of each single and particular part And yet nevertheless this is likewise to be added that we are especially to Judg by the Event whether any such Wound be actually Mortal or not For although some strong and lusty Boor or a Man otherwise exactly found and healthful shall recover of some such wound yet Nevertheless it will not necessarily follow that therefore an old person a Child a Woman or any other that is but of a weak constitution must recover of the like wound but albeit the former of these was cured of the like wound yet this latter may necessarily die of the same But now whether or no such dangerous Wounds be Mortal in this or that particular person Nicolaus Boerius in his 323. Decision Num. 11. teacheth us how we may discover it by fix Conjectures The first whereof is the shortness of the time to wit if the sick person die very suddenly after the Wound of which space of time albeit there be very many opinions touching it yet notwithstanding he saith that the principal is this if the wounded person shall die within three daies after the wound received But yet however there are some that extend this space of time unto the fifth or even also unto the eighth day But others notwithstanding extend this term even unto the eighth month or a whole year and this seemeth unto me most probable And unto this space of time the Mosaical Law Exod. Chap. 21. seemeth to have respect The Second Conjecture is the persevering of the vomiting and feaver and other Symptoms that from the very first signifyed and threatened death And this is a right Conjecture and according to the Opinion of all Physicians yea even of Galen and Hippocrates himself For those great and mortal Wounds have their Decretory and Critical daies like as Acute Diseases have as Hippocrates tels us 2 Prorrhet in the which good or evil Symptoms are wont to happen And therefore if grievous Symptoms such as are Convulsions Vomitings sobbings Dotages Syncopes and the like which otherwhiles also are wont to presage Death in such as are wounded presently and even from the very first invade the wounded person or else appear upon him on the Critical day and after continually persevere they then signifie that they were necessarily brought upon the Party by the Wound and therefore that the Wound is altogether mortal The third Conjecture is the breadth and depth of the Wound For a Wound that is very great and dangerous in it self may yet although it be great yet not be dangerous if by it no Noble part be hurt The fourth Conjecture is the quality of the instrument with which the Wound is given and by which the person inflicting the Wound is convinced that he had a will and purpose to kil the party Wounded But this conjecture concerneth rather the Court of Justice then the Colledg of Physitians who inquire not so much after the will and intention of the person wounding as simply and
altered and at length the overgreat abundance of the blood is to be lessened and the vitious humors to be evacuated and this may fitly be done either by vene-section or else by purgation And therefore if blood abound in the body Venesection or blood letting so that therebe cause to fear the afflux there of unto the wound it is in this case unless it hath already before much flown forth very fit to open a vein and let forth a due quantity thereof Touching which Celsus in his fifth Book and 16. Chap. saith thus The Physitian ought to take forth some of the blood thereby to cause a dryness And presently he adds let the blood therefore flow forth more abundantly that so there may be the more abundant dryness but if it flow not forth sufficiently let the vein be opened as much as may be if it be so that the patient hath strength enough to bear this loss of blood And this is chiefly to be done in great wounds in which there is cause to fear an Afflux of the blood by reason of the pain of the Wounded part and here in this case blood is likewise to be drawn forth albeit that it doth not over-greatly abound in the body whereupon Hippocrates in his Book of the Joynts in the bruising and wounding of a Rib prescribeth the taking forth of blood out of the Arm where Galen in his Comment upon the place addeth Although saith he there be no extraordinary store of blood abounding in the body yet in those kind of blows and bruises we must have recourse unto vene section and letting out a due quantity of blood And in his second Book or the composition of Medicaments according to the places he commendeth in the first and chiefest place venesection for all pains of the head proceeding from a blow But now that this venesection may perform the whol work and that it may cause not only evacuation but likewise revulsion the vein is therefore to be opened a good distance from the part affected and on the contrary side as else where we have told you touching revulsion Now this is to be done with al speed possibly even the very first day of the wound and indeed before there be any medicament administred that so the afflux of the blood unto the wounded part may be prevented As for the quantity of the blood to be let forth it ought to be according to the store that is in the body and according likewise to the strength of the Patient and his ability to bear it And therefore if there flowed forth much blood before then venesection is to be omitted But if there flowed forth little or no blood before then you may now let forth a due proportion thereof but alwaies according to the strength of the Patient and no otherwise which you may best of al know by the Age of the wounded person the habit of his body the time of the yeer and other Circumstances touching which we have already spoken in its proper place But now if vitious humors abound in the body then there wil be need of purging Purging For it being so that the Wound is so much the more succesfully and more speedily cured by how much the more sound the part is and of a good constitution and that the ill constitution of the wounded part doth much hinder the cure we are therefore by all means possible to do our indeavor that so the vitious humors may not flow unto the part affected And thereupon seeing that by occasion of the Wound it may very easily come to pass that they may flow unto the part affected if they be found in the body they are forthwith to be evacuated And this is to be done in great wounds and where we have cause to fear lest that by reason of pain the depraved humors should rush unto the wounded part as also in those wounds where there is any kind of cutting or dilating to be used and where any bones is to be made bare of its flesh and in a word in al wounds whatsoever wherein the pain is more vehement then ordinary But smal Wounds and such likewise as are free from pain may be cured even without any purging but yet notwithstanding if the belly be bound it is then to be opened and loosened with a Clyster There are some indeed that are utterly against purgations in any wound whatsoever Whether those that are wounded may be purged as fearing lest that the humors being much stirred and disturbed by the sayd purgations should flow so much the more unto the wounded part But Hippocrates admitteth of them as we may see in his fourth Book of affections touching Fractures Text 48. Comment 3. and Galen in the fourth Book of his Method of curing Chapt. 4. and 6. And indeed reason it self perswadeth hereunto For if hot thin and cholerick humors abound in the body they render the blood very apt for motion and then by means of pain and want of rest they easily become hot and are inflamed and so afford an occasion for a feaver But now albeit that all the vitious humors abounding in the body are to be evacuated yet notwithstanding as we have sayd more especially the hot Cholerick and wheyish humors are to be evacuated which are more apt for motion and flowing and such as make much for the generating of inflammations and Erysipelases and such as do very easily excite feavers Even at the very first beginning a purgation is to be appointed to wit before ever there be any afflux excited and that any feaver shall happen But if there hath already happened any feaver purgation cannot then so conveniently and safly but indeed with some kind of danger be instituted and appointed And therefore to purge in Wounds there are most fitly and safely to be administred Manna Syrup of Roses Solutive Rheubarb the Leaves of Sene and of compositions Tryphera Persica Elect. de Psyllio Elect. of Roses of Mesues But we must abstain from the hottest purging medicaments lest that there should thereby be excited an afflux of humors that might dispose the wounded part unto an imflammation But in what manner the purgation is rightly to be ordered we have elsewhere already shewn you Chap. 14. Of the Wounds of the Veins and Arteries and of the stopping the Haemorrhage in Wounds AS touching the wounded parts themselves oftentimes by reason of them there is something that is peculiar to be done in the Curing of wounds How and after what manner the Cure of the wounds of private parts is to be rightly ordered we have already told you in those places which we shall afterward alleadg In the general the wounds of the Veins Arteries Nerves and Nervous parts do require a peculiar and proper kind of Cure The Haemorrage in Wounds And First of all indeed the Wounds of the Veins and the greater Arteries have this peculiar unto themselves to wit that there is alwaies some
notable Haemorrhage to accompany them which oftentimes causeth Faintings and Swoundings and other dangerous Symptoms But now the Blood floweth either out of the Veins or out of the Arteries and of these somtimes indeed out of the greater and sometimes out of the lesser and either out of one alone or else out of many And although that the wound inflicted upon the Vessel be the prime and principal Cause of the Haemorrhage yet it happeneth and that very often also that the blood may indeed now and then be stopt for a while and yet it may afterwards suddenly break forth again and this more especially chanceth upon the Commotion of the minde and provocation to anger And so likewise the presence of the Patients Adversary that gave him the wound maketh greatly for the causing of a new and fresh Haemorrhage in the Wound for which very Cause it is somtimes found by experience that the Blood that was before stanched and stopt begins again to flow forth a fresh And I my self remember that one Brother having wounded another and while the Wound was binding up the Brother that gave the Wound coming in to visit the other albeit that they were now reconciled the Blood suddenly brake forth afresh and this without doubt from the secret commotion of the minde for upon his departure and being forbidden to give any more visits the Blood again stanched Signs Diagnostick But now seeing that the Blood floweth either out of the Veins or else out of the Arteries that which floweth forth of the Veins is more thick more black and dark and less hot and it floweth forth without any great violence and rushing and with an equal pulse and doth far less deject the spirits all things else being answerable then that which cometh forth of the Arteries But now that that cometh out of the Arteries may rather be said to leap forth with violence then to flow and in the pouring out it is more hot and fervent more thin more yellow and more frothy and it is evermore accompanied with some notable change and alteration in the Pulse together with a weakness and dejection of the Patients strength If it be one of the greater Vessels that is opened then the Blood floweth forth in the greater abundance and with so much the greater violence but with far les if it be one of the less Vessels that is opened and wounded But now what Vein or Artery it is that is wounded and whether only one or more of them be wounded this must be known from those that are expert in Anatomy Prognosticks 1. An overgreat Haemorrhage in Wounds is very dangerous for the Blood is the Treasure of the Life and when the vital spirits are called forth it causeth a weakness of the Pulse it being so smal that it can hardly be discerned as also a frequency and inequality thereof and somtimes an intermission therein a fainting and swounding a Syncope an extream Coldness and Chilness of the outward parts and inordinate sweats a Convulsion sighings and sobbings Deliries and at length death it self And hence it is that Hippocrates in the 5. Sect. of his Aphorism Aphor. 3. saith that a Convulsion or Sighing happening upon an abundant flux of the Blood is alwaies very evil and dangerous And in the 7. Sect. Aphorism 9. that a Deliry or a Convulsion also happening from the abundant flowing forth of the Blood is evil and ful of danger And indeed it is so much the more dangerous if a Convulsion be joyned with a Deliry and that the Deliry happen not alone without the Convulsion 2. And this is more especially caused by the effusion of the Arterial Blood in regard that with it there is very much of the heat flowing in as also the vital Spirits that are most chiefly Necessary for the preservation of the life poured forth and dissipated 3. And moreover also for this reason the Wounds of the Arteries are more dangerous then the Wounds of the Veins because that they are more difficultly Cured and Consolidated by reason of their hardness their perpetual motion and the violent rushing forth of the Arterial Blood 4. And those Wounds of the Arteries are yet likewise far more dangerous and bring a long with them a greater Haemorrhage and such as is more difficult to Cure that are inflicted according to the length of the Artery or rransversly or obliquely then those in which the whole Artery is cut assunder as experience it self testifyeth so that indeed and as the Physitians are wont to perswade if the Haemorrhage cannot otherwise be stopt and stanched in regard that the whole Artery is not cut quite through it is then wholly to be cut assunder in a transverse manner For if that the Artery be thus transversly cut in twain it will again be contracted and its orifices will again close and shut and thereupon they wil the more easily meet and grow together again and the sooner be covered and shut up by the circumjacent flesh lying round about it neither will the Wound so gape and stand so wide while the Artery is dilated But if that the Artery be Cut long waies or obliquely or if it be wholly cut assunder any otherwise then transversly since that it is moved with the continual motion of the Dilatation and Contraction by this motion and especially the distention the Wound is more dilated and in every Diastole it gapeth whereupon the Blood is poured and leapeth forth with violence and rushing The Cure As in every over great Haemorrhage so likewise in this that proceedeth from a wound we meet with a twofold indication the one that which the wounded Vessels themselves suggest unto us which requireth a Union and Glutination The other that which the Haemorrhage suggesteth which if it be excessive and overgreat so that it dejecteth the strength and powers of the Body requireth that it be stanched even before ever that the Vessels be shut up and united For whereas unto the Union of the Vessels there is some space oftimes required so that the Patient may in the mean while run a great hazard of his Life the Blood is therefore immediately to be stanched That the Flux of the Blood therefore may be stopt although that the Wound of the Vessel be not as yet grown close together al those things are to be performed which may hinder and inhibite the motion thereof Now the Flux of Blood it impeded if with convenient Remedies and the binding up the orifice of the wound be closed and shut up In which manner if the Blood cannot be restrained and that it also break through the Wound closed and shut up in any manner whatsoever and all by reason of the impetuous violence of the Blood then all those things that do any waies help forward the violent motion of the Blood are to be removed such as are the overgreat abundance of the Blood stirring up and continually provoking the expulsive faculty Anger drinking of Wine hot and thin Humors
as it were continually boyling up and over violent motions of the Body as likewise of an Artery if it be not wholly cut in sunder the motion thereof the declining and downward Scituation of the member and the like and hitherto also may be referred the pain and heat in the part which attracteth the Blood and in this case that that violently and impetuously rusheth unto the wounded part is to be turned another way And first of all therefore that the orifice of the Wound may be closed and shut up we ought to use the utmost of our endeavour that this may be done Now this is to be effected two waies either by the Joyning together of the Lips of the wounded Vessels or by the stopping of the orifice of the Wound The Lips of the Wound may be joyned together either by pressing together with the Fingers the orifice of the Wound so long until the Blood be clotted so that the thick and clotted Blood may it self obstruct and stop the orifice of the Vessel that so the Mouth and Lips of the Vessel may touch and close together or else the orifices are to be drawn close together by Swathes But now it is very rare that we may keep our Finger upon the orifice of the Wound until the Blood be clotted so as to stop and obstruct the said orifice neither hath this any place in the wounded Arteries since that the Arterial blood by reason of its thinness and heat and the motion of the Artery doth not easily if at al Clod in the orifice of the wound Neither also may the Veins if they lie deep be easily drawn and kept close together by Swathes neither yet may their orifices be pressed together with the Fingers And therefore the safest Course is that we do the best we can that so the orifice of the Vessel pouring forth blood may be stopt And this that it may be done artificially let the orifice of the Wound be shut up and closed with the Finger as much as possibly it may be done but if it be so that the orifice it self of the Vessel cannot be reached unto by the Fingers then that branch of the Vein that poureth forth the Blood there in that place whereby it rendeth to the Wound is first of all in the place neerest unto the Wound to be pressed very hard together with the finger and the Wound to be cleansed from al humidity and then after this there is immediatly a Medicament that will stop and stanch the Blood to be imposed Which that it may be rightly and duly performed the wound is not only to be loaden and rashly oppressed a thing wherein I have seen many Chirurgeons greatly to offend with too many astringent Medicaments but we ought to use the best of our endeavor that the very orifice of the wound be instantly and that very close and strictly shut up For unless this be done albeit there be never so many of these kind of Medicaments imposed yet nevertheless if the orifice of the vessel be not close shut up and obstructed the blood wil by it break forth and so make void all the labor and pains the Chirurgeons have been at and all the former provision be it never so great that they have made Now for the stopping and stanching of the blood in this manner there is hardly any thing to be named that wil more conveniently do it as daily experience testifieth then that kind of Mushrom dryed they commonly call it Crepitus Lupi or Woolfs fart that usually groweth and is to be found up and down in Vineyards For it being of a nature most dry as it will no way admit of the flowing forth of the blood which those Medicaments do that are naturally moyst and therefore they are but little or nothing useful for the stanching of the blood so it will ikewise cause that it subsist and stick fast in the vessel But now this is most especially useful and beneficial if it be first with a thread tyed together and a weight layed thereon or else pressed down and kept close together with a press wrung down hard upon it For so when it comes afterward to be imposed upon the wound it again dilateth it self and so stoppeth up the orifice of the wound What Medicaments they are that stanch the Blood But if it be so that you are not minded to confide in this one only remedy then those powders that are known to be Astringent ought first to be strewed and sprinkled upon the wound Galen above all other Medicaments for the stanching of the blood commendeth this that followeth and in the fifth book of his Method and Chapt. 4. he writeth that it is absolutly the best of all that he knew and that he should much wonder if it should be any ones chance to find out a better It is as followeth Take Frankincense one part Aloes one part and half Make a powder and of this powder mingle a sufficient quantity with the white of an Egge to the consistence of hony Make up this mixture in those soft hayrs or flix of a hare and so lay it upon the vessel and the whol wound And afterwards in a fit and convenient manner bind up the wound with a swath and then at length open and unbind it again on the third day While this Medicament yet sticketh unto the wound put yet another upon it but if the former liniment begin of its own accord to fall off then with the singer gently pressing down the root of the vessel to wit that nothing may flow forth of it take away that with a careful hand and put on the other For so long as the Medicament shall be softened by the blood the fluxion cannot be said to be wel and sufficiently stopt See Galen in the place before alleadged There are nevertheless other ponders that are likewise very useful As. Take Bolearmenick Dragons blâ—od Frankincense Aloes Succotrine of each alike equal parts and make a powder Guilhelm Fabricius commendeth this following as having often made use of it with very good success Take of the finest wheaten meal three ounces Dragons blood and Frankincense of each half an ounce Oriental Bole and sealed earth of each two drams Parget six dâ—ams water frogs prepared one ounce Moss of a mans skul half an ounce the soft flix of the hare cut very smal one dram the powder of the whites of Eggs carefully dryed in the Sun the froth of the Sea dried likewise in the Sun a new spunge tosted and torrefyed at the fire of each half an ounce Mingle them and make a very smal and fine powder or Take Moss of the wild sloe tree the root of the nettle and of the herb Dragon of each half an ounce Make a powder and strew it upon the wound or Take Vitriol powdered as much at wil suffice put it into a little linen cloth and lay it upon the wound or Take Aloes Frankincense the finest wheat flower
tumor may he opened or else with an Iron Incision knife that hath not been heated in the fire We very seldom make use of the hot Iron and then never but in cold tumors and that also only whilst the impostume is in those parts that have in them either many or else large Veins and Arteries that so the flux of Blood which we cal the Hemorrhage may the better be pre-cautioned and prevented But as for the Incision Iron that hath not been heated we use it most frequently and that with very good success But if it shall so happen that upon the opening of the Impostume somtimes pain and somtimes an efflux of blood shal ensue and likewise that by reason of the abundant evacuation of the matter or else that by pain and fear a sinking away or swooning should follow in this case we must endeavor that the Section may be performed with the greatest speed and the least pain that possibly may be If an Hemorrhage be feared we must have in a readiness those Medicaments that stop the flux of Blood as Frankincense Aloes the white of an Egg Bole Armenick Pomegranate flowers Dragons blood and the like To prevent fainting and swooning especially in Children Women and other fearful persons we ought to have at hand such Medicaments as are in use against this faintness of mind As also that there may be a right and orderly proceeding in the Section or opening The opening of a Tumor in what manner to be performed the condition of the part the scituation of the Veins Arteries and Nerves as likewise the Nature of the Muscles all these ought to be exactly known and learned by the Chirurgeon from what is written by Anatomists lest otherwise Veins and Arteries should be cut and an Hemorrhage thereby caused or that pain should arise from this hurting and cutting of the Nerves or that hereby the Member should be altogether deprived of sense or lastly that by the hurting of the Muscles the part should be wholly deprived of its motion Moreover also a special regard must be had unto the fibres in the Muscles so that the Section ought to be performed according to the conduct of these fibres that is to say not oblickly or overthwartly for this kind of Section wil greatly annoy the action of the part We must again heedfully weigh and consider in what measure and how great the Section ought to be For if it be over little the Pus or corrupt matter especially if it be thick and cloddy wil have no passage forth without compression of the part which wil both assuredly excite pain and beget a kind of brawny hardness in the part which may be the cause of a Fistula And on the other side if the section be made overgreat and wide there wil then be left remaining a great and unsightly scar and which is worse the ambient Air getting in wil alter the part and therefore the Section ought to be made in such a manner and measure as shal be most requisite for the evacuation of the Corruption and filth And although the section be somwhat with the least it may notwithstanding very easily be dilated by thrusting a tent into the hole thereof To make the Incision we admit of either the Razor or the Knife of Myrtle wood edged on both sides with which the Italians and French open Veins or else that Knife which we cal Phlebotomus which the Germans use or lastly that which we cal Syringotomos an Instrument crooked and of use only in the incision of an internal or a concavous body The incision being made if there be but little filth The evacuation of the Pus or corrupt matter the part is with the finger to be pressed down to the end that it may the more readily flow forth but if there be great store of this filth and matter it is then to be drawn forth leisurely and by little at a time lest haply if it should be evacuated al together suddenly and on an heap as it were much of the spirits should therewithal exhale and thereupon a fainting and swooning should ensue After Incision and the emptying forth of the corruption it will be convenient the first day to strow thereon the dust of Frankincense on the second day to lay thereon some kind of Digestive or other that so if any thing yet remain undigested the compleat digestion thereof may hereby be accomplished And if there be present any filth or any kind of uncleanness which may hinver the growth of flesh shal chance to occur they are forthwith to be wiped and cleansed away As for example Take Turpentine one ounce Honey of Roses half an ounce and of Barley Meal as much as is requisite and so make a mixture and use it for the purpose aforesaid If the Ulcer require yet a more forcible cleansing by reason of its extraordinary nastiness then we ought to use the stronger Abstersives as Vnguentum Apostolorum c. And at length Sarcoticks that is such Medicaments as cause flesh to breed and grow are wisely to be applied and the orisice of the Ulcer to be shut up with a scar Here we are to take notice That somtimes Impostumes may for a long space he hid not only underneath the external Muscles Of Impostumes lying hid two histories but likewise under the more profound yea and the more internal Muscles also Concerning the Impostumes of the Muscles of the lower belly or Paunch we have already spoken in the third Book Part 10. Chap. 7. As touching the Impostumes in the great Muscle Psoa Gulielmus Fabricius in his first Century and sixty third Observation relates two Histories And first he tels us that a certain Matron took her bed complaining of acute and extream pains about her Loyns which was accompanied with a Feaver swooning fits and difficulty of making water And when it was sufficiently understood by the kind of the pain and other signs and tokens to be an inward Impostume for outwardly there appeared not any thing neither could there any thing be discerned by the touch and that this Apostem could be no where but under the Psoa Muscle and when that the sick party was foretold the extream danger and hazard of her life unless the Impostume were opened and the humor caused to flow forth both her self and her friends gave their consent that on one side of the Spina dorsi or back-bone the skin and the exterior Muscles even unto the Psoa Muscle should be opened by an Incision with a Razor which was done accordingly and out there flows a purulent and stinking humor and so after that some certain cleansing and abstersive Medicaments had been for some few months applied she became perfectly recovered The other History which he relates is this In the Year One thousand five hundred eighty five a certain yong man aged twenty seven years or thereabouts as he was descending from the highest pitch of the Mountain Cinecius unto the
that such Persons have no refreshment from the breathings in the ambient Air which finding the passages obstructed proceeds not so far as the Praecordia or Entrails to moderate and qualifie their excessive heat and they are in continual fear lest that their Blood should again be driven forth unto the streightned place Whereupon haply they wil give way that a Vein be suddenly opened which may prove very pernicious unto them And truly in this kind of disposition there happeneth unto them an extream dangerous constriction or streightning of their breathing a beating of the Heart Hereupon they are evermore exposed to a sudden death and especially those of them that are fatned in their younger daies for these have alwaies their Veins very smal and much streightned And they are likewise exposed unto the Apoplexy and Palsie and throbbing of the Heart and the Flux Diarrhaea by reason of their humidity they are also subject to fainting and swooning fits and the worst sorts of Feavers neither can they away with fatsting or thirst by reason of the constriction of the passages of breath the vehemency of the cold of their complexion their smal store of Blood and the abundance of their Phlegm And to this moreover may be added that they are whether they be Men or Women issueless and barren the Male being not able to Generate nor the Female to produce the Embryo in the Womb. As also their Seed is little or none at all to wit because it is concocted through the imbecility of the heat although there may be store of Seed in regard of their humidity or moisture yet notwithstanding such as is waterish and in Galens judgment thin and unmeet for Generation or if it be generative it is of Females only And the like may be said of Women that those of them which are fat do not conceive or if they do now and then conceive they forthwith miscarry and lastly their appetite to wit that which is natural is exceeding weak Thus far Avicen 2. The truth is that the Cure of this affect may be hoped for but it is wont to proceed but very slowly neither is it to be compleated in a short time and it is mainly requisite hereunto that the Patient be as we say morigerous and in all points ready and willing to submit The Cure The Cure of this Tumor consists in the removal of the Cause which is an over-great store of Flesh and Fat Now this abundant flesh and fat is taken away by wasting and annihilating what is already generated and then by taking a course that it may not again be multiplied and this may be done if we take care that too great an abundance of Blood be not bred or that which is already in the Body that it be by degrees wasted and lessened Both these intentions are accomplished by those things that heat and exsiccate or dry much For whereas the Liver if it hath a gentle remiss and temperate heat generates great plenty of sweet and Oyly blood and so continually foments matter for the breeding of much fat and store of flesh if now this temperate constitution of the Liver shal be altered and the Liver rendered more hot dry than formerly then instead of good and laudable I mean fat and oyly blood it generates that which is hot and cholerick or that which is serous wheyish waterish And thus it is that Medicaments hot and dry do both retard the propagation of an abundant and oleaginous blood and also they waste and by degrees consume the fat that is there already bred throughout the body But then for the wasting or lessening of the flesh already bred those Medicaments are the most prevalent in which siccity or driness is predominant and the heat in a mediocrity By what hath been said you cannot but understand how that in curing this affect we ought heedfully to observe whether it be the flesh or whether or no it be the fat that offends in the excess and so accordingly fit and proper Medicaments are to be made choyce of and as for such as are undoubtedly exceeding ful of flesh and such generally are al those that have the constitutions and habits of Wrastlers we are not to prescribe unto them such Medicaments as either cause or encrease heat but only such as meerly dry and attenuate and such are Venesection i. e. Blood-letting Purgation abstinence from food and frictions or rubbings In fat persons we may notwithstanding properly enough make use of Remedies that are of a heating Nature but yet so as that in the administring of them we be very circumspect lest that by the overmuch heating we procure some other Disease And therefore when as the blood administers matter for the raising of an abundant store of flesh and fat it is to be forthwith evacuated and diminished And for such as are ful of flesh we may safely enough exact a more liberal and copious evacuation of the blood yet alwaies provided that the evacuation be not proscecuâ—ed unto the extream as Hippocrates cautions us in the first Book of his Aphorisms Aphor. 3. But in those that abound with fat this letting out of the blood ought to be more sparing since that fat persons are more propense unto cold distempers Cupping-glasses also either with or without scarification are very useful and proper for both the one and the other Frequent rough and hard frictions of the whol body are likewise chiefly convenient Pliny in B. 11. Chap. 37. writes That the Son of L. Apronius who had been Consul was contented to have his fatness drawn away from him Fat drawn out of the body of one extreamly fat thereby to alleviate and lighten his body til then immovable of some part of his burden But no man wil easily admit of so desperate and barbarous a Remedy and therefore I forbear to speak any thing more concerning it Exsiccating or drying Baths whether taken by drinking or made use of for the bathing of the body are in this case of singular benefit Frequent purgations with Aloes unto which may be added Mirrh and Nitre are here likewise very convenient and consequently the Pills de Tribus must needs be a proper Remedy Such are also al bitter and hot Medicaments administred as namely Wormwood Myrrh Frankincense Rue Oxymel simplex and Oxymel compositum Oxymel of Squils the Syrup de duabus and de quinque radicibus and generally al things that provoke and expel Urine Wherefore the roots of Asparagus and Fennel and of Parsley and such like ought very frequently to be used This Pouder likewise is much approved of and commended viz. Take Salt of Nitre one dram Allum two scruples Myrrh Frankincense the Rind of the Wood Guajacum the Root of Sarsaparilla of each of these two drams and so make a Pouder Of the which let half a dram be administred in the morning for two months together Also the Salt of Vipers is very effectual for the purpose
about it The Prognosticks In an Inflammation there are two things that it mainly and principally behoves us to presage to wit The termination of an Inflammation Which is threefold its event or termination and then the exact and punctual time of the said termination Now the Event is said to be good when Nature overcometh the matter that breeds the Inflammation which hapneth when either the Tumor is resolved and the matter insensibly exhaled which is the best kind of solution of an Inflammation or else when the matter is suppurated and turned into that which we term Pus being a thick and purulent matter Or otherwise secondly The event may be said to be evil or if ye wil worst of all when Nature doth not overcome and master he peccant matter which hapneth when the Inflammation if it be external suddenly vanisheth and retires back to the internal parts or when the natural heat being overcome and extinguished the Member thereupon becomes putrified and seized upon by a Gangrene insomuch that if it be not forthwith cut off ruine and death it self threaten the whol body Or else in the third place there follows a Neutral Event as some cal it which is absolutely evil when the Tumor is hardened and when upon the resolution and discussion of the thinner parts the more thick and gross parts remaining behind the Inflammation degenerates into a Scirrhus But now which of these events is to be hoped for or expected may probably be guessed at by comparing together the vigour and strength of Nature with the matter that causeth the Disease For if the matter be not overmuch not thick not over deeply scituated not shut up under a hard and thick skin if the body be not greatly impure and Nature be strong then a resolution and an evacuation by an insensible transpiration may be hoped for But if the matter more abound be more than ordinary thick be contained in a deeper place than usually and be pent up under a thicker skin then a suppuration is to be expected That the matter is retreated unto the inward parts may be conjectured by this token to wit When we perceive the Tumor to be diminished albeit there were no repulsive remedies administred and applied to drive back the matter That the extinction and overthrow of the heat is neer approaching may be presaged by this whenas the heat redness of color pain and the pulse or beating is lessened the Tumor notwithstanding still remaining touching which more hereafter when we shal come to treat of a Gangrene But then lastly an Inflammation for the most part then degenerates into a Scirrhus when the matter is over viscous and clammy and hard therewithal and when the Natural heat being strong and vigorous forthwith even in the very beginning of the distemper remedies that discuss and dissipate over forcibly are thereunto applied which said remedies disperse and scatter the thinner parts thereof and leave the thicker still remaining That the time of the Event may be known The times of an Inflammation it is requisite that the times of the Inflammation be first of all known and they are likewise heedfully to be observed by us upon our knowledg of them in relation unto the Cure For unless the times of an Inflammation be well known and considered we may soon run our selves into an Error whilst we administer and apply Remedies that are any waies improper or incongruous unto any one particular of those several times Now then Inflammations like as all other Tumors and Diseases have four times or periods its beginning encrease state or perfection and its decay or declination It commenceth or begins when the parts are replenished with blood and when the swelling pain and stretching out are encreased this we cal the augmentation The state or perfection is then when the Tumor Distension Pain and all the other symptomes are most vehement and in the heighth of their extremity And lastly the declination is then said to be when the matter generating the Tumor is diminished and the pain heat together with the other symptoms are become more remiss and gentle or otherwise the matter is converted into Pus or purulent matter But the truth is these times are some while shorter somtimes longer and the Inflammations are somtimes sooner and somtimes more slowly terminated For as Galen tels us in the sixth Book of the Aphorisms Aphor. 49. that which is of a thinner substance is in a shorter space digested and that which is thick or tough requires a longer time for its digestion but that which is thick and viscous requires a far longer time And that Inflammation which hath seated it self in the fleshy parts is terminated according to the period of acute Diseases to wit fourteen daies for the substance of the flesh is more soft and permeable by reason of its thinness But the substance of the Ligaments Tendons and Nerves being more thick and hard and thereupon with greater difficulty receiving the fluxion for the same cause also doth with more difficulty discharge it self therof and hereupon the Inflammation in those parts is the longer time ere it attain unto its state and perfection and is not so soon curable but yet notwithstanding the Cure is in this case seldom or never prorogued beyond the term of fourty daies if both the Physitian rightly in al points discharge his part and likewise the patient be in al things willing to submit The Indications and Cure Whereas the containing cause of an Inflammation is the blood which hath preternaturally i. e. beyond or besides Natures intention flown in unto the part the Cure is effected if that blood be removed out of the diseased part and then great caution be had that it thenceforth flow no more unto the part affected that so by this means as wel the containing as the antecedent cause may be wholly taken away For whenas the affect cannot possibly be removed without a first removal of that which causeth it and the case so standing that the causes ought to be taken away in the very same order that they follow one the other in therefore we say that the Fluxion must first of all be extirpated The Cure of a fluxion or flowing of the blood Now this intention may be accomplished if care be taken to prevent the bloods abounding in the body and that that which is there in great plenty flow not unto the part affected The benefit of blood-letting in an Inflammation and this with most safety and speed is to be effected by opening a Vein For by this Venesection or blood-letting the great store of abounding blood is diminished and the same is likewise drawn back from the aggrieved place hence it is that there is an exceeding great benefit arising from and following upon this opening of a vein in an Inflammation so that it is seldom or never to be omitted if the strength of the patient wil permit it to be done And indeed hardly can
any other Remedies with safety in this case be applied unless opening a Vein have the precedence and the abundance of blood be thereby diminished For if we administer remedies to drive back the body stil continuing full of blood it is greatly to be feared lest that the matter should not be received by the other parts and thereupon that it should altogether attempt a flowing unto some one or other certain particular part And as for digestives hot as they are if they should be made use of in a body that is full there might be just cause to doubt lest that there should be more matter attracted then discussed and dissipated A Purgation Moreover also albeit a Cacochymy or ill digestion and bad nutriment be not the cause of an Inflammation yet notwithstanding since it is a very rare thing to find a Body that is altogether free from this said Cacochymie it wil be very requisite to ordain a Purgation which compleated other Medicaments also are afterward to be administred with an expectation of more success and greater benefit And as we hinted to you before although Inflammations take their Original principally from the blood yet notwithstanding vitious humors very frequently give an occasion of their being as also doth the aforesaid Cacochymie and indeed herein the hot humors challenge the first place For if by these Nature be at any time stir'd up and provoked and it be so that she cannot of her self expel them then she endeavors to thrust them forth by some and some unto the other parts but when she fals short in the effecting of this also unless she should withall transmit the blood thither and that by an acrimonious humor sent unto the part a pain is excited hereupon a conflux of the blood unto that same part into which Nature assaies to empty forth the vitious humor is caused and so consequently an Inflammation is generated And from hence it is also that from a Cacochymie there is very frequently produced a Pleurisie an Inflammation or Impostume of the Lungs the Squinancy or as we use to term it the Quinsie and that kind of madness which we commonly call the Phrensie Moreover also the blood is abated and no excessive store thereof bred in the body if that meat be not taken in which either by its overgreat proportion or else by reason of its substance afford too much nourishment and exceedingly conduceth to the generating a more plentiful store of blood than is requisite Wherefore let the sick Person abstain from Wine and let him use a sparing and slender Diet which both hindreth the breeding of much blood and if it be already over-much doth by little and little lessen it But that the blood may not flow to the part affected it may be prevented if we deprive it of that which necessity requires that it should have to help forward and facilitate its motion and if we likewise correct the thinness thereof together with its overmuch aptness to motion if we obstruct and streighten the passages through which it ought to be moved and if we recall and draw it back from the part affected The blood therefore that it may be withheld from flowing unto the part affected is to be altered driven back intercepted and derived unto some other place Alteration of the blood The Alteration of the blood is altogether necessary that so if it be overhot thin and fluxile or movable it may be cooled thickned and rendred more unapt and less prone to motion and this Alteration for the most part we ought the rather to procure in regard of the Feaver which almost ever accompanieth the Phlegmone or heat of the Liver For it is a rare thing that they which are infested with an Inflammation of any part should yet not be sensible of a Feaver Wherefore we must use Medicaments made of Succory Endive Violets Lettice Sorrel Barley the greater cold Seeds the juyce of Citron of Pomegranates and such like And if the blood be more than ordinarily hot and thin we ought also then to add those things that have in them an astringent quality and such are Roses Purslane Plantane and the like But here notwithstanding we ought carefully to look to it lest that the Veins being narrow and overstreightned or there being obstructions in the Bowels by the use of these or such like astringents more obstructions should be bred or increased And then again we ought not only to administer contrary Medicaments for the altering of the blood but likewise to remove from the Patient and cause him to omit and forbear the use of such things as either introduce or augment those qualities whose absence we now require as being better than their company For instance a hot Air is to be shun'd surfeits with over-eating and drinking must be avoided and Wine forborn or if any be drank it must be that which is weak and wel diluted all kind of violent motion is to be omitted and rest rather to be indulged Wrath and venereal Embracements ought likewise here carefully to be avoided and abstained from Revulsion or drawing back ought moreover to be ordained Revulsion or drawing back and the humor is to be turn'd away unto a contrary place that is we must so order it that a contrary motion may be procured unto the humor and that it may move unto that part unto which it naturally tends so that it may not flow unto the part affected For that the turning away and drawing of an humor flowing into some part unto that which is contrary may be termed Revulsion we rightly take it for granted and by Hippocrates at the first appointed and ordained The contrariety in Revulsion For as Galen informs us in his fifth Book of the method of Physick Chap. 3. this was the invention of Hippocrates that a Revulsion should be made unto the contrary or opposite places Now although it be much controverted by Physitians what is here to be understood by this word Contrary yet notwithstanding we judg the Opinion of Gaâ—en to be very plain and perspicuous if we wel exâ—mine together what he hath here and there oftenâ—imes written upon this subject and if we take a right view of the conditions that are requisite in a Revulsion But that Galen by the word Contrary understood nothing else but the parts contrary that is far distant and remote from the part affected is every where manifested in his own writings for thus he argueth in his fourth of the meth of Physick Chap. 6. If it be a perpetual standing rule as we have learn'd from him viz. from Hippocrates that a fluxion if but beginning is to be drawn to the contraries but if already fixed in the aggrieved particle it is then to be evacuated either from the particle it self which is afflicted or else from that which is next neighboring unto it we may now hence readily conclude as to the point of this blood-letting that at first i. e. in
the beginning of the distemper it ought to be attempted from a far off but afterwards from the affected parts themselves Now what kind of remoteness and what sort of longitude he understands is explained in his fifth of the Method of Physick Chap. 3. A Revulsion saith he ought alwaies to be carried downward in those affects which are upward and upward evermore in those that are below and moreover also the Revulsion ought to be made from the right side unto those on the left and again in like manner from those unto these and semblably from those places that are internal unto such as are outwardly scituate and on the contrary from these unto those For when as the main scope of Revulsion is not to evacuate those humors which are already conteined in the part affected but those rather that are flowing thereunto and seeing it respects rather the part sending the blood than that which receives it from these premises it necessarily follows that questionless this is required in every revulsion to wit that it should by all means procure a motion contrary unto that which flows that so it may not any longer be moved unto the part affected and for this cause the revulsion must not be ordain'd either from the grieved part or from that next unto it but rather from the opposite yea and so far forth as possible it may be from the places most remote from the affected part And hence also it is that every opposition doth not constitute a contrariety neither hath every kind of opposition any place in a Revulsion but those oppositions alone which Galen in the before alleadged third Chapter of the fifth Book of his Method of Physick recites to wit upward and downward from the right side parts unto the left from the places that are within unto those that are external and so on the contrary Yet if there be only but a very smal inconsiderable distance we cannot safely nor conveniently draw back from the parts more inward to those more externally scituate but then only when the distance is greater But that opposition which is from before and behind or according to the fore parts and hinder parts hath no place in this kind of Revulsion which is so called singly and absolutely For neither if any affect shal chance to be in the backward part of the Head are the Forehead Veins forthwith to be opened by way of revulsion since that may not be done without manifest danger during the continuance of the Plethory and flowing of the humors But enough hath been said of Revulsion in the fifth Book of Institutions Part 2. Sect. 1. Chap. 18. But that we may in few words contract whatsoever hath there more at large been spoken Revulsion twofold and whatever else may be said upon this subject it is in the first place to be taken notice of that Revulsion is twofold one which is accomplished together with the evacuation of the humor such as is that which is effected by Blood-letting and Cupping-Glasses with Scarification the other which is wrought without the evacuation of the humor such as is that which is performed by Frictions or Rubbings Ligatures and Cupping-Glasses without Scarification This latter is never to be practised but when the Revulsion is to be made unto the parts most remote since that if it be instituted in the neer adjacent parts then the humor which is only stirred and not totally evacuated may without any difficulty or resistance rush upon the affected part And it is very rare and scarcely ever known that this kind of revulsion hath place or any thing to do in an Inflammation which requires a manifest sensible and suddain evacuation of the blood Furthermore Revulsion by opening of a Vein as for what concerns Revulsion which is effected by opening a Vein this one thing at least is to be observed which if it be wel heeded many intricate controversies touching the thing now in question may be determined to wit that the utmost endeavor must be used that a contrary motion may be procured unto the blood and that as much as possibly may be drawn back unto that Fountain from whence it flows And since that the Liver is the Fountain and Sourse of the blood and that the greatest store of the blood is conteined in the Vena Cava or great hollow Vein nigh about the Liver we must do our utmost that the blood which flows into the inflamed part may be drawn back towards its Spring-head yea also if it be possible unto the opposite part yet notwithstanding so that the blood which flows may be retracted and drawn back And therfore in every Revulsion this at least is to be wrought that the blood may obtain such a motion as that by it the part affected may not be injured by its immoderate conflux but that it may rather be again recalled from the diseased part But how this may be effected in every part here to declare unto you would be a business too tedious besides we have already elsewhere spoken to this very point in our treating of particular affects Revulsion when to be ordained after what manner And by what hath been said as I conjecture it is sufficiently apparent how and in what manner a revulsion is to be ordained in case of an Inflammation so that there wil not be any great need that we should add much as touching the right and due administration thereof For whereas revulsion is then only suitable and proper unto the Humors when they flow and unto them alone and not unto those which have done flowing and have seated themselves in the part affected it is hence manifest that it ought to be instituted and appointed in the very first rise of the distemper Notwithstanding this is not so to be understood as if in the first appearing of an Inflammation we were instantly to put revulsion in practice for if either there be no great store of blood or if its rushing in upon the part be not over violent and impetuous Medicaments that drive back and derive will be sufficient But then only is Revulsion to be put in practice when there is great plenty of blood and a more than usual violent and forcible rushing thereof unto the part affected and according to the greater or less proportion of this abundant blood and the more or less vehemency of its motion so answerably ought the Remedies and Medicaments that are prescribed for Revulsories or drawers back to be ordained so much the more or less strong and forcible But now that Revulsion which is made with an effusion or emptying forth of the matter must needs be greater than that which is made without it But amongst all the Remedies which we term Revulsories or drawers back the most prevalent and efficacious is the opening of a Vein which said Venesection doth more effectually or less strongly draw back accordingly as the Veins that are opened be greater or less The greater
the same end and purpose are convenient the Oyl of Roses and Myrtles the Unguent of Roses the cooling Santaline Cerecloath prescribed by Galen And this likewise that followeth is an excellent Remedy and in frequent use with Chirurgeons viz. Take the Whites of Eggs and Rosewater of each alike let these be well shaken and throughly mingled together then let Linen Clouts be wel wet and soaked therein and so laid upon the part Or Take Barley Meal which boyl in Vinegar and the juyce of Plantane and lay it upon the grieved part Galen in his second Book to Glauco Chap. 2. commends a Cataplasm of Housleek Pomegranate Rinds boyled with Wine and so made up with Sumach and Barley Meal For this Cataplasm as saith Galen is absolutely the best in such like affects and also very effectual to al those purposes we intend it for For it drives back that which flows in dries up what is therein contained and fortifies the Members scituate round about Or it may be thus compounded Take Housleek three ounces Barley Meal two ounces Pomegranate Rinds one ounce Sumach ten drams bruise what is to be bruised and then boyl them all together in Wine for a Cataplasm Galen likewise made use of the Plaister Diachalciteos dissolved with the Oyl of Roses or Myrtle This likewise is profitable Take Plantane Roses Lettice Purslane of each alike one good handful boyl them in Water unto which put a little Vinegar to mingle therewith and then add Barley meal Or Take the juyce of Housleek Plantane and Roses of each one ounce and half Barley meal one ounce Vinegar half an ounce Oyl of Roses as much as will suffice boyl them into the form of a Pultise Or Take Pomegranate rinds red Saunders of each half an ounce Bolearmoniack two ounces Barley meal one ounce Housleek one ounce and half Oyl of Roses and Myrtle of each as much as is sufficient and make a Cataplasm Where there is need of a stronger Repulsion and if the part wil admit of it those Remedies that are somewhat more forcible are to be used As Take Bolearmoniack Dragonsblood of each one dram the Root of the greater Comfrey half an ounce Barley meal two ounces make a powder which as occasion shall require is with Rose-water and the white of an Eg made into the form of a Cataplasm and so laid on Intercepters and Defensives Those things that Intercept which are also commonly called Defensives are the same with Repellers and only differ in respect of the place whereunto they are applied For drivers back are applied unto the very place inflamed but Intercepters and Defensives unto the parts and waies by which the humor flows unto the affected part that so it may be intercepted in its passage and that the way may be shut up against it that so it reach not unto the aggrieved part And indeed these are most commodiously applied to those parts that have little or no Flesh and unto those in which the Vessels do more appear and are conspicuous as in the joynts and above the joynts As for instance if the inflammation be in the Hand they are then applied unto the Wrist if betwixt the Wrist and the Elbow they are then to be applied above the Elbow if in the Shoulder to the highest part thereof if in the Foot above the Ankle-bone if in the Leg above the Knee Their Quality Now all Intercepters are cold dry of an astringent or binding faculty among which notwithstanding since there is no smal difference as erewhile was said of Repellers we ought to use the gentler sort of them in the more tender bodies where the fluxion is not great the Veins smaller and in the Winter time But those of them that are more forcible are to be made use of in stronger Bodies where the fluxion is greater the Vessels wider and in the Summer time But Medicaments that intercept are to be administred after a different manner For either the juyces as of Quinces Pomegranates Plantane Housleek the Bramule or Blackberry bush or else the decoction of Saunders Pomegranate Flowers Myrtles Sumach Roses or Rosewater Plantane Housleek or Vinegar and Oxycrates are used and linen Cloaths are wel moistened in them and then applied to the Joynts and the parts betwixt or else lastly astringents being pulverized and mingled with proper liquid Remedies are to be administred The Vulgar or common Defensive is made after this manner viz. Take Bolearmoniack Dragons Blood Lemnian or sealed Earth all the Saunders of each one ounce Oyl of Roses and Myrtle of each a sufficient quantity of Wax a smal quantity Vinegar of Roses one ounce mingle them and boyl them till the Vinegar be all consumed Yet notwithstanding the Oyls and Wax are deservedly and not without cause to be suspected in these prescriptions For by their fat unctuous or oyly substance they mollifie the parts and they likewise overheat them if they long stick upon them And therefore it wil be more safe to apply the aforesaid or such like powders mingled only with Rose water or Oxycrate and if we would have them to be somwhat more forcibly astringent mingled with the white of an Egg well beaten and shaken together For by this means they stick and cleave the more tenaciously unto the part and cause a constriction thereof As Take Bolearmoniack Dragons Blood of each an ounce Flowers of red Roses Pomegranate flowers Myrtles red Saunders Pomegranate rindes of each an ounce make a Powder hereof which afterward mingle with the white of an Egg and Rose water or Vinegar as much as wil suffice And last of all we may also in this place make use of derivation Derivation which hath respect unto the blood that hath indeed already flown in yet notwithstanding as yet is only poured forth without the Veins into the void spaces of the part but as yet fluctuats or flows to and again in the Veins Neither indeed can the blood possibly be derived which is already impacted in the part or that already begins to be concocted or to be turned into Pus or quittery matter since that it is now become more thick than formerly and consists as having taken up its abode in that place out of which it cannot easily flow back and thereupon is rendred the unfitter for motion and the more earnestly and greedily retained by Nature until it be there digested and concocted From whence wil easily appear at what time the derivation ought to be ordained and administred to wit indeed in the very beginning of the Inflammation and yet notwithstanding not instanly upon the very first onset of the Disease but toward the augmentation thereof when its beginning is now at hand to wit when by means of Revulsion and Evacuation already both prescribed and administred the blood is rendered not over abundant and that which is doth not as yet pertinaciously and fixedly adhere unto or stick in the parts but as yet continues to be fluxile
and apt to flow Wherefore that we may rightly understand that which is on all hands taken from granted to wit that during the consistency or continuance of the Inflammation derivation ought to be administred this is not to be taken as meant either of the state or as we cal it the perfection of the distemper or of its declination but rather of the latter part of its beginning In derivation what to be observed Now in Derivation that community and correspondence that is between the Veins and the part affected of which we have formerly made mention is especially to be observed For if the blood that is in the Veins of the affected part ought to be drawn thence unto the neighboring parts by derivation then in this case we must evermore make choyce of such a Vein to effect it by as hath the neerest commerce and vicinity with the part affected the which if it be opened brings along with it an apparent and admirable benefit But now for the measure and proportion that we ought so heedfully to take notice of observe in letting blood by way of Derivation Hippocrates informs us in Book 7. of the Course of Diet in acute Diseases chap. 10. The blood saith he must be drawn away so far forth and so long until it flow forth more red and much yellower or that instead of a ruddy color it appear to be of a livid or leaden-like color For as Galen there tels us whatsoever blood is contained in a Phlegmone that same will be changed in its color through the abundance of heat but the rest will all of it continue alike in all parts of the body And for this cause that blood which is contained in that side that is afflicted and inflamed with a Phlegmone must needs be much more red and ruddy than that which is dispersed and diffused throughout the whol body especially if the body be pituitous or Phlegmy Now if the blood that is diffused into the whol body appear to be al of it of a more ruddy color than ordinary without doubt then that which accompanieth the Phlegmone boyled and burnt as it is must needs be changed into a black hiew And from hence it is that a change in the color denotes and signifies a translation of the blood from out of the part affected which said change notwithstanding is not evermore to be expected if strength be wanting in the Patient And after such like waies as these may the Humors that flowing forth together unto a part generate there a Phlegmone be removed from the aggrieved part Among the which before mentioned notwithstanding those Medicaments that drive back and derive very much conduce like as the other for the removal of the humor that flows amain into the part affected For Repellers although their principal scope be to repress the humor that flows in and is as yet contained within the Veins of the part yet notwithstanding they have a power also to drive and thrust back again into the Veins to cast out of the part those humors likewise that are newly fallen forth without those Veins and as yet not it removably fixed in the place whither they are fallen For neither is it a thing impossible that the Humors that are fallen out of the Veins should again retire back into them even as many sorts of Tumors in the skin evidence unto us the truth hereof which now and then in a cold season suddenly vanish away and disappear And so likewise derivation albeit it hardly cal back those Humors that are fallen forth without the Veins yet notwithstanding as for the blood which fluctuates in the Veins of the inflamed part it hath a power sufficient to draw it unto the neighboring parts and by them to evacuate it Notwithstanding Evacuation since that by the alone use of Repellers and Derivers al the whol matter is seldom evacuated out of the part inflamed but that after the use of them for the most part somwhat is left remaining behind this ought in another manner and by other means to be evacuated Now this evacuation is accomplished after a twofold manner either insensibly and by an imperciptible transpiration which the Grecians cal adelos diapnoe or else sensibly and manifestly The matter is evacuated insensibly by Diaphoreticks or Sweaters as likewise by those that we term Digestive Discussive and resolving Medicaments The sensible evacuation is performed by scarification and the opening of the part after suppuration or as we commonly term it maturation of the peccant humor We will therefore in the first place treat of the former manner of evacuation and declare our opinion touching discussive Remedies But now Discussion since that resolution or discussion is nothing else but an evacuation of the humor by an insensible transpiration it wil from hence easily be made to appear that what is to be discussed ought to be thin or fluxile and not over clammy and thick neither the skin it self too much shut up and condensed For if the matter be over thick it cannot then be easily resolved into vapors but if the skin be too thick and compact like as also if the matter stick in a place over deep when all or any of these happen then the matter causing the distemper finds not easily any way for its passage forth neither can any Remedies but what are very forcible penetrate unto the place affected Discussives what they are for their quality Moreover since that al digestive Medicaments are hot in their operation as by and by we shal further shew you they are therefore to be administred not over hastily in the very beginning of the Inflammation but then we ought rather to make use of Repellers for the reasons before mentioned But the Inflammation approaching now nigh unto or if ye will while it is yet in its passage towards its augmentation some kind of digesting Medicaments ought to be mingled with the Repellers and so al along the quantity of the Discussives ought evermore to be encreased until at length in the declination they alone come to be administred Now the truth is al Digestives or Diaphoreticks are hot for the Humor cannot be resolved attenuated and converted into vapors but only by heat But of such things as are hot there is a very great difference for some of them do only rarefie or open the orifices of the Vessels other of them cut the Humors and a third sort there is that attracts and draws them and last of all there are others that are of a burning quality Now the Diaphoretick Medicaments differ from them all and have in them this proper and peculiar faculty to resolve the Humors and to convert them into vapors Which said quality of theirs may not so easily be described by their Causes but it is rather discovered by the experience that we have of their effects so that what cannot be defined by reason that same is supplied by experience and use But
Disease and that there be present and apparent the signs of a good Crisis or judgment for then in this case according to Hippocrates his Precept Book 1. Aphorism 20. there ought nothing to be moved but the whole business is to be committed to Nature and means must be endeavored that either the Bubo may be discussed or else that it may most speedily be maturated and brought to a ripeness But then if in truth the Bubo be critical and that the Crisis notwithstanding be an imperfect one the humor is then yet further to be attracted unto the part affected by the application of Cupping-glasses or by Medicaments made of Leaven black Soap old Hogs grease the Rosin of the Pine Tree Diachylum with Gums and such like Again If there be a Bubo generated no other Disease preceding neither then as hath been said is Natures motion in the least to be impeded But yet notwithstanding the great abundance of blood is to be lessened by the opening of a Vein which yet is so to be instituted that Natures motion to the part affected may be holpen forward and furthered rather than hindered If also which very often chanceth vitious Humors shal happen to be conjoyned together with the blood they ought to be evâ—cuated The remaining part of the Cure in al these Bubo's which are not malignant and contagious is to be ordained and ordered like as in other Inflammations Yet notwithstanding this one thing is wel to be observed in the first place because that such Digestives as are administred ought to be of the stronger sort and more forcible than in other Inflammations in regard that the Glandules are parts that are more cold than ordinary and more ignoble than the other and have not any exquisite sense we advise therefore that a Cataplasm be made of Barley meal and Lupines mingled with Honey Or Take the Roots of white Lillies Marsh-mallows the wild and spirting Cowcumber of each one ounce the Leaves of Pellitory of the Wall and Parsley Leaves of each an ounce and half boyl them in Wine unto a softness and then bruise them well being throughly bruised and passed through an hair sieve add of the meal of Lupines two ounces Oyl of Camomile and white Lillies of each a sufficient quantity and so make a Cataplasm If the Humor be not digested it ought to be converted into Pus and the Bubo is to be maturated or ripened and this for the most part is the safest course For unless this be done as I have often observed after some short interval of time a new Bubo is wont to arise either in the same or some other part Now the very same Maturatives that are wont to be propounded and prescribed in an Inflammation are here to take place and to be made use of The Pus or filthy corrupt matter being bred the Tumor is then to be launced that so the Pus may most speedily be evacuated and the truth is the section or cutting ought then to be appointed and instituted in the Groyn in a transverse or overthwart manner since that the Tumor being cleansed after this fashion the skin may the more easily coalesce and come together because that whilst the Thigh is bending the Skin is united The Pus being evacuated and emptied forth the Ulcer is to be made clean flesh to be generated and at length the Ulcer is to be shut up with a Cicatrice or Scar as we use to cal it Touching the Cure of a Pestilential and French Bubo we have already spoken in its own proper place Chap. 9. Of the Tumor Furunculus THere is a certain kind of Tumor neer of kin to an Inflammation which we term Furunculus but by the Greeks it is named Dothion or Dothien and by the Germane Blutschwer to wit as Celsus defines it in his fifth Book and Chap. 28. a little acuminated oâ— sharp-pointed swelling together with an Inflammation and pain and especially then when it is now already converted into Pus And it hath its original from a thick and vitious blood as Galen instructs us in his fifth Book of the composition of Medicaments according to the part affected yet notwithstanding the blood not so burnt and corrupted as in a Carbuncle the which Nature severing from the rest expels and drives it forth as offensive and useless unto the superficies of the body And thus the Furunculus ariseth in the Skin and in the fleshy parts that are under the Skin But there seldom breaks forth one alone but for the most part many of them break forth together But now of these Furunculu's there is a certain difference For some of them are mild and gentle which only invade and seize upon the Skin others of them are malignant which descend deeper or otherwise as Paulus Aegineta writes in his fourth Book Chap. 23 of Furunculu's one sort of them is benign and harmless another kind of them mischievous and dangerous And then it is truly said to be gentle and dangerless when it resides only in the Skin but mischievous and destructive and not to be cured without great difficulty whenas its Roots being deeply fixed it breaks out upon the Skin These Furunculu's are somtimes likewise said to be Sporadick that is such as here and there privately seize upon and differently afflict the sick person when they come not after an ordinary manner and somtimes also they are Epidemick or Universal Signs Diagnostick The Signs of a Furunculus are a smal and inconsiderable Inflammation in the first beginning thereof and a Pustule or blister by degrees and by little and little growing forth and stil tending towards an acute and sharp point not exceeding the bigness of a Pigeons Egg with a certain kind of pain and redness of color whenas it hath arrived at its state and perfection which happeneth much about the eighth ninth or at the furthest the tenth day and a Furunculus differs from an Inflammation in respect of its smalness in dimension and then again the matter which is in a Phlegmone or Inflammation is good blood whereas in a Furunculus it is thick and vitious and from a Carbuncle it differs in that the matter of a Carbuncle is worse and more adust or burnt and thereupon attains not unto a suppuration whereas a Furunculus may attain unto maturation and may be suppurated If the Furunculus be Epidemical and Pestilential it is then black and green and there is present to accompany it a malignant Feaver together with other evil symptoms The Prognosticks 1. In a Furunculus as Celsus gives us to understand in his fifth Book and Chap. 28. there is little or no danger at al yea even although there be no means made use of for the cure thereof For why it waxeth ripe and attains unto a maturation of its own accord and so breaks forth But the pain accompanying it causeth us the rather to put sitting remedies and medicines in practice that so the Patient may the more speedily be freed therefrom
it as being such as is produced by the most corrupt blood The next unto this is the wan and yellowish Those that are less malignant and consequently the less to be feared are such as have in them a reddish color to wit such in which the blood hath not as yet altogether lost and changed its Nature but that it hath as yet retained somwhat of its native heat and color 2. Those Carbuncles likewise that are smal are less pernicious than those that are great and from a very little Pustule they suddenly acquire and get an extraordinary greatness 3. And so are likewise those that are alone than such as have other Carbuncles conjoyned with them 4. Of al other those are most destructive and deadly which after they have once begun to wax red do immediatly vanish again For the matter being transferred unto the more inward parts often if not evermore proveth destructive and deadly 5. There are some also who conceive that this is likewise throughly to be considered to wit Whether the Pestilent Carbuncle arise before the Feaver or else whether or no the Pestilent Feaver going before it at length break forth For they conceive that the Carbuncle that breaketh forth before a Pastilent Feaver is more safe provided that no Symptoms follow thereupon in regard it is an evidence that Nature is strong and able to expel the Pestilent Poyson before the Feaver ere ever it can seize and surprize the heart And on the other side that to be more dangerous which at length breaketh forth after a Pestilent Feaver forasmuch as the Heart being seized upon it hath its original from the poyson and the corrupt humors now diffusing themselves into al parts of the body 6. The place also manifesteth when the danger is more or less to be feared For those are evermore accounted evil and pernicious that stick fast in the Emunctories and neer unto the Noble and Principal Members But here most especially the strength and natural powers are to be regarded and we are wel to consider whether they be strong or else but weak For that strength that is but weak and languishing may be soon over-powered and vanquished even by a smal Disease Whereas on the contrary that that is more vigorous oftentimes overcometh and mastereth even that disease that in it self is strong and powerful The Indications The Indications in a Pestilent Carbuncle are different from those in a Carbuncle not pestilent In a Pestilent Carbo or Carbuncle the fervent heat of the blood is wholly al the body over to be restrained and withal the Heart at the same time is to be fortified against that malignity which as we have said is here very seldom absent The rest of the Cure is to be directed unto the Carbuncle it self But now in a Pestilent Carbuncle there is a more poysonous and pestilent quality appearing than in the fervent heat of the blood yet neither is this to be sleighted or neglected The Cure And therefore as to what belongeth unto the Cure of a Carbuncle there are two things that we are especially to regard and have an eye unto the Antecedent Cause or the fervent and corrupt blood that is in the whol body and the Conjunct Cause or that same Humor that now exciteth the Carbuncle A convenient Diet therefore being ordained and a moderation observed in those things we cal not natural the extream fervent heat of the blood is by opening a Vein to be taken away And yet this Venesection is not rashly to be made use of in al manner of Carbuncles but if it hath any place at al it is most chiefly in that that is not pestilent touching which likewise that assertion of Galen in his fourteenth Book of the Method of Physick and of other Authors who conceive that the blood is to be drawn forth even until the sick person faint and swoon is to be understood But in a pestilent Carbuncle nothing is rashly to be attempted that may weaken and deject the Natural powers of which there ought to be the most special regard had in the plague and in pestilent Feavers amongst the which Venesection unto fainting and swounding is not the last but rather the first which together with the Spirits evacuateth that humor that is most agreeable and friendly to Nature and even that most excellent and precious Treasury of the life Nay indeed moreover even somtimes when the pestilent Carbuncle is just then breaking forth we cannot safely enough institute and ordain Phlebotomy For whereas the Carbuncle somtimes breaketh forth not instantly upon the very first invasion of the Plague and pestilential Feavers but often afterward on the fourth daies or haply on some other daies the Natural powers wil not then bear the said Venesection in regard that they are now dejected by the disease and have therefore entered the Lists are now conflicting with the said disease But now what Veins are to be opened sufficiently appeareth from that which we have spoken above touching the evacuation of the blood touching Revulsion and Derivation in the Cure of an Inflammation This only is here to be observed that we must beware lest that whilst we evacuate the blood we do not lead and draw the same either unto any noble Member or else through any noble Member lest that the said Member should be affected with its malignity And therefore we say that that Vein is to be opened by means whereof the blood may rather be drawn toward the part affected than drawn back from it Wherefore if the Carbuncle shal be about the Head or the Arm-holes or in the Breast the neerest Vein in the Arm of the same side is then to be opened But if it be below the Liver then the Ankle Vein or the Ham Vein of the same side And this Phlebotomy ought to be put in practice instantly and in the very beginning before the Feaver get strength and the Natural vigor be too much dejected But now in regard that by this blood-letting the naughty corrupt humors can scarcely be evacuated therefore some conceive that there is need of purgation by which the said depraved humors may be evacuated lest otherwise the Native heat should be suffocated and extinguished by them and that Nature may afterward the more rightly moderate the expulsion and that so the part affected may not be corrupted by the great abundance of the Humor flowing thereto But then we ought to be extraordinary careful lest that by the purging Medicament the Humor that Nature endeavoreth to thrust forth unto the external parts be drawn unto the internal and this is most of al to be feared in a pestilent Carbuncle We conceive indeed that it may more safely be ordained and appointed in a Carbuncle that is not malignant But when a Feaver is therewith joyned and that an acute one the crudity of the matter then for the most part forbids it and to speak truth there is hardly a Carbuncle to be found in which
provoked and stirred up both for the repairing of the clour and the pouring in of blood And to tel you the truth in what place soever there is such an effusion of Blood it may in general be called Ecchymosis yet notwithstanding Paulus Aegineta in his fourth Book Chap. 30 according to the diversity of the parts affected reckoneth up three kinds or species all which may be called by their several distinct and peculiar names The first is those which we call Hypopia and by Hippocrates named Hypophthalmia that is Subocularia to wit palenesses or wannesses under the Eyes Now it is termed Hypopion from Ops that is the Eye because it appeareth under the Eyes and it is an Affect differing from that we call Hypopyon the difference lying in this that the former is written by ω and ι the latter by ο and Ï… from Pus which the Greeks call Pyon because it is a collection of Pus or purulent matter under the Cornea Tunicle The second Species is Hyposphagma which some in special term Suggillatio to wit an effusion of blood into the Adnata or Cornea both of them Tunicles of the Eye touching which we have already spoken in the first Book of our Practice Part 1. Sect. 2. Chap. 32. The third Species is that which is caused by the Contusion or bruising of the Nails this Species Hippocrates calleth Hyponychos and the Latine Authors term it Subungulus in regard that it is an Affect under the Nails Contusion Somtimes with Ecchymosis there is likewise conjoyned a Contusion yea and somtimes also there is so great an abundance of Blood poured forth that it being collected under the Skin and the Muscles it there causeth a certain hollowness and lifteth up the part into a Tumor or Swelling There is also somtimes according to the Nature of the part conjoyned therewith a pain from whence it happeneth that more blood floweth thereto and by this means an Inflammation yea and sometimes likewise at the length a Gangrene is excited There is to bâ—â—â— a notable History of this in Johannes Philippus Ingrassias in his Jatropologia When in the yeer 1537. in an Hippomachie or Tilting as we call it the Marquess of Terra Nova ran with the Baron of Volaterran it so chanced that the armed Knee of the Marquess by reason of the Fury and extraordinary fierceness of their Horses gave so great a blow upon the bare and unarmed Leg of the Baron that the Contusion or bruise that followed thereupon was so great and grievous that the Baron died thereof four daies after By reason of this his so sudden and unexpected death the Physitians were question'd and called to an account for that they had not rightly and as was fitting managed the Cure In whose behalf and defence Johannes Philippus Ingrassias wrote those two Books of Apology under the name and Title of Jatropologia There is likewise extant in Gulielmus Fabricius Cent. 2. Observat 83. another History which you may there see shewing how dangerous Contusions may be The Signs Suffusions and these Suggillations are easily known For the very colour it self and the Swelling if at least there be any fal under the sense and are apparently to be seen The Causes are known by those things that went before and such as are likewise present For if any external Cause went before as a Blow a Fall and the like the Physitian may understand it from the relation of the Patient But if none of these shall happen we are then to consider the Blood in the Body and well to weigh by what means it becometh thus peccant and offensive Prognosticks 1. Although in truth these Ecchymomata are for the most part void of all danger and the blood that is yet thin may easily be dispersed yet if this be not done and that the blood be deteined any thing long in the part affected out of its own Vessels it then may prove to be of dangerous Consequence in regard that by this means there may be excited both a Corruption of that very part that is affected and likewise a damage and detriment unto the whol Body For the Blood being clotted together unless it be forthwith insensibly discussed or turned into Pus which is necessarily done where the Flesh is withall greatly bruised so that hence the part yet continueth soft it putrefieth and corrupteth and breedeth a Gangrene and very frequently bringeth Death and Destruction upon the sick Person 2. But there is great danger threatned and nigh at hand when the part affected continueth not any longer green or wan but inflamed and becometh very red hard and distended Of which we related that former notable History out of Ingrassias The Cure As for what therefore concerneth the Cure we wil first of all treat of the Cure of that Ecchymoma that followeth upon a Contusion For even this also very often happeneth and whoever he be that knoweth the Cure of this he shal have a sufficient store of Medicaments with which he may cure the rest since that the discussing Medicaments that are here to be drunk have their place likewise in the other First of al therefore if the contusion be great we must use the best of our â—kil and care to prevent and hinder the afflux of blood unto the place lest that thereby an Inflammation should be excited This is to be done by Venesection for which cause Galen commands That in a fal from on high and in beatings and bruisings a vein be opened and that although the blood doth not greatly abound yet that by opening a Vein it be drawn forth lest that an Inflammation should be excited from whence not only evil symptoms but oftentimes also even death it self hath its original And the truth is this Venesection is forthwith to be ordained and put in practise withal at the same time Defensives and Repellers are likewise to be placed neer about the part that may impede and prevent the influx of blood into the part affected such as are made up of Bole-armenick Terra sigillata or Sealed Earth of Lemnos Dragons blood Roses Myrtles the Nuts of the Cypress Tree Galls Pomegranate flowers Roots of the lesser Consound and the like As for instance Take Bole armenick Terra sigillat of each an ounce and half Chalk half an ounce let them boyl in Vinegar after they be boyled Take Pouder of red Roses the pure sine flour of the Root Consolida or Consound of each half an ounce and with the Oyl of Myrtles make a Cataplasm Or only which is likewise in common use the white of an Egg shaken together with Rose water and with burds or the courser part of flax applied unto the place affected Or Take the white of four Eggs the Oyl of Myrtle and Roses of each one ounce Bole armenick Dragons blood of each half an ounce Cypress Nut two drams a little Vinegar Mingle them c. And this is also here to be taken notice of that there be not many
moist and clammy Medicaments administred for by reason of such humid things applied the blood fallen forth out of the Veins is easily putrefied whereupon divers il and dangerous Symptoms are afterward wont to arise But in very truth when from a fal from some high place beating and bruising and the like Causes the blood is not only gotten together under the Skin and the external parts but oftentimes also is poured forth into the more inward parts after the same manner as it is in the Circumference of the Body when the Vessels are opened or broken which said blood is there clotted and corrupted and is wont to cause Inflammations and the worst sort of Feavers dangerous Symptoms and very frequently death it self we must therefore use the best of our endeavor that the clotting and growing together of the aforesaid blood may be hindered that it may be dissolved and that it may be evacuated by stool urine or sweats and that with al due and possible speed For when once the blood hath gotten a putridness the Malady is not so easily cured nor indeed at al without the most exquisite and singular extraordinary Remedies Wherefore so soon as there is any the least suspition that the blood is fallen forth without the Veins into the more inward parts and that it cannot be dissipated by external Remedies we must then use these things following to wit Rheubarb Rhapontick Terra sigillat Sperma Ceti in the Shops termed Patmasitty the Eyes of Crabs Mummy red Corals Harts-born Madder such as the Dyers use in coloring with the Waters of Cherefoyl Carduus Marjoram St. Johns wort Fumitory Alkekengy Card. benedict Scabious the Syrup of Sorrel Syrup de Acetositat Citri Vinegar and the like which what they are will appear further from the following Receipts and Prescripts Take Rheubarb Terra sigilat Bole armenick Mummy of each one dram make of these a Pouder of which give one dram at once with the Water of Cherefoyl or Shepherds-Pouch Or Take Terra sigillat Crabs Eyes of each one scruple Sperma Ceti Goats blood prepared Angelica and Gentian Roots choyce Rheubarb of each half a scruple seeds of Carduus Bened. seven grains Cloves three grains Make of these a Ponder for two Doles to be taken at twice and drunk with the following Waters Take the Water of the Infusion of Lavender one ounce the Waters of Cherefoyl St. Johns wort Strawberries of each one ounce and half Wine Vinegar half an ounce for twice Or Take Terra sigillat Madder Mummy great Comfrey Rheubarb of each a scruple mingle them and make a Pouder Or Take Rheubarb the Root of Madder Mummy Crabs Eyes the seed of Carduus Mariae or Mary Thistle the Root of round Aristolochia or Birthwort of each one dram mingle and make a Pouder give hereof a dram at once with the Syrup of Sorrel Some there be likewise that commend the Water of Nuts They commonly administer one dram of Sperma Ceti dissolved in Vinegar or some fit and convenient Water There are likewise some that make use of Unguents and that with good success also which are likewise taken into the Body and are therefore stiled Potable as for instance the Potable red Unguent of the Ausburg Practitioners Or Take Green Sanicle four ounces the Leaves of Betony Fennel seed Juniper Berries unripe of each three ounces the Root of Elecampane of the greater Comsrey Rue Ground Ivy Rosemary Rhapontick root of each two ounces all these being shred very smal let them be stirred about and incorporated with three pound of fresh Butter Set them then in the Sun for eight daies afterward put thereinto one Cyath or little Cup ful about two ounces of Sanide Water then boyl it til the water and juyces be quite consumed and then let the Butter thus incorporated and moistened with the Juyces be pressed forth and kept for use The Dose is half an ounce twice a day to be taken with warm Beer the place affected may likewise be outwardly anointed with the same yet not at the first beginning and appearance of the distemper but some while after Or Take these Herbs Wormwood Southernwood of each two handfuls the Herb Ladies Mantle Motherwort or Mugwort the lesser Comfrey the lesser Sage Germander the lesser Centaury Crosswort Fennel Strawberries Fenugreek Ground Ivy or Aleboof Hyssop Lavender Milfoyl Marjoram Balm Bugle Penyroyal Pyrole or Winter green Pimpernel Rosemary Sage Sanicle Savory Spicknard Betony Vervain of each one handful the roots of Marsh-mallows Clove-gilliflowers the greater Consound Angelica Pimpernel and Tormentil of each of these one ounce These Herbs and Roots gathered green in the month of May or June boyl in six pound of May Butter adding thereto as much Wine as you judg sufficient let them boyl together until they be boyled enough stil taking heed that they burn not to and in the end adding of the Oyl of Bayes fresh and new four ounces Sperma Ceti half a pound Make herewith an Unguent of a green color the Dose is one ounce in Vinegar or Beer and this may likewise be outwardly applied unto Wounds Or Take the Roots of Tormentil Dittany Sanicle the greater Consound Consound Sarracen of each two ounces Castoreum one ounce that sort of it that is offensive by reason of its unpleasing tast may be omitted Madder three ounces May Butter three pound red Wine as much as will suffice mingle and boyl them till the Wine be consumed herewith make an Vnguent adding thereto of Sperma Ceti one ounce As for the Topicks at the first beginning some Astringents are to be mingled with the discussive Medicaments For when the Tunicles of the Veins out of which the blood is poured forth are somwhat bruised they ought then to be a little strained together bound fast and condensed lest that the new matter drawn thither by pain be poured forth since that if in the beginning only Digestives be administred they wil not only discuss the blood poured forth of the Veins but attract and draw unto the part that blood that is in the bruised smal Veins Afterward that the little contused or bruised Veins may return unto their Natural state Digestives alone are to be made use of For this end and purpose some there be now this indeed is the best kind of Remedy especially for those that are beaten that wrap about the sick person the Skin of a Ram new flaid off and whilst it is yet hot besprinkled with Salt Myrtle Berries and the Pouder of Water-Cresses or if such a skin may not conveniently be gotten they anoint the Patient with the Oyl of Roses of Myrtles and of Earthworms with which they mingle the Pouder of red Roses or Myrtle Berries and the day following such a like Liniment may be administred Take Vnguent Dialthaea three ounces Oyl of Earthworms Camomil and Dill of each one ounce Turpentine two ounces the meal of Fenugreek the pouder of red Roses and Myrtles of each half an ounce Saffron one scruple make
yet notwithstanding several and different affects as Cardanus in the place alleadged hath very rightly determined And therefore Experience is to be consulted 2. From Experience Now Zacutus Lusitanus in the place before alleadged bringeth in and produceth this Experience He there writeth That a certain poor woman having had a Cancer exulcerated in her Breast for many yeers together and lying in bed with her three sons they were all infected with the like contagion that she after five yeers dying two of these her three sons seized upon and dispatcht by this Disease departed this life but the third somwhat stronger of constitution than the other two after that the Cancer had been cut away by the hand of the Chirurgeon with much pains and ado was cured and healed An Answer to the aforesaid Experience But this being but one example Experience is yet further to be consulted and the rather in regard that it may be here objected that those her sons might contract this Disease not by contagion but from an hereditary infection The Cure As for what therefore concerneth the Cure of a Cancer not exulcerated in the very first place and this indeed is generally to be practised in al Cancers whatsoever before any thing else be done we are to use our diligent endeavor to prevent the encrease of black Choler and that none be generated for the future and that what is already in the body may speedily be evacuated The breeding of black Choler and the Melancholy Humor is to be hindered and prevented by the Patients abstaining from those Meats that may any way yield and afford matter to the black Humor such as are al things that are thick feculent salt bitter and such are old cheese flesh that is thick old salt or smoak-dried Garlick Onions Mustard Pepper and al other Spices Let the sick person likewise shun and avoid al those things that do any way conduce to the generating of the black Humor such as are Grief and sadness of the heart overmuch watching and want of rest and the like But rather let the Patient use a Diet that is moderately moistening and cooling viz. Ptisan of Barley Lettice Mallows Borrage Succory the four cold Seeds Veal Wether Mutton Kids flesh Chickens Reer Eggs River fish the Whey of Goats Milk and such like Furthermore If there be any adust Humor already generated in the Body let it be with al speed evacuated And therefore in the first place if it be at al requisite blood may be drawn forth by opening a Vein In Women the provoking and bringing down their Courses wil be most proper and convenient and in men let the Hemorrhoids be opened if it may be done After this let the body be throughly purged with those Medicaments that eâ—â—cuâ—te the black adust Humor among which there is especially commended Epithymum we vulgarly cal it Mother of Tyme black Hellebore Fumitory and the Compounds thence derived viz. the Pils of Fumitory and the Confection Haâ—â—ech But now that the Purgation may the better succeeâ— that thick and gross Humor is first of al to be prepared yea moreover wheras the whol Humor may not at once and al together be evacuated then the Purgers and Preparers are often to be repeated by turns and successively Now for this Affect those things that are very proper and convenient are the Syrup of Apples of Fumitory of the Juyce of Borrage and Bugloss Syrup of Lupulus or the Hop or other Compound Medicaments like unto these Neither wil it be amiss or any whit incongruous likewise to strengthen the Heart and the Liver and if there be any distemper chanced unto either or both of them to amend and rectifie it by Medicaments or Borrage Bugloss Roses Citrons Sanders Corals Margarites Pearls and those other Medicaments that are made and compounded out of these And then in the next place we are to apply our selves unto the very part affected And 1. By Topicks the Matter that hath flown in is a little to be driven back again and discussed and the part is to be confirmed and strengthened and those Medicaments that have in them a power and vertue of Repressing Corroborating and Disucssing are to be applied For by this means so much of the Cancer as is already generated is quite taken away and likewise the further growth and increase thereof is prevented But now let those Medicaments have in them a mediocrity or mean of strength and vertue and let them not be sharp and biting For if the Medicaments be over weak they then afford no help or benefit and again if they be too strong and violent they then indeed either repress or discuss the more thin parts but for the more thick they do not only leave them behind but also render them the more unapt and unfit to be afterwards discussed and dissipated There is for this use and purpose very convenient the Decoction or Juyce of Nightshade and of the several Species of Endive and Succory But more especially there are commended the Cockle-fish boyled River Crabs or Crevishes and principally green Frogs out of which there is a most excellent Oyl to be distilled for the moderating of the pain and the healing of the are Cancer the destillation is by descent after this manner Take Green Frogs living either in the Reeds or in pure and cleer Waters fill their mouths with Butter and afterward put them into an Earthen Pot that is glazed and having in its bottom many little holes Let this Pot be put into another Pot and that other Pot put into and surrounded with the Earth in the which it is to be as it were shut up and then let as wel the Pot that hath the Cover as that Pot which is put into it be carefully luted and stopt that so nothing may exhale Afterward let the fire be kindled round about the Pot on every side and the Oyl wil destil into the lower pot which is to be taken forth and together with the Pouder of the Frogs mingled for the making of an Vnguent Others there are that make up an Unguent with the Ashes of Crabs or Crawfish mingled together with Coriander seed and the Oyl of Roses And here likewise we are to make use of the greatest part of Metallicks washed and so becoming altogether without any biting quality their power and vertue being here of singular use such as are Lead Tutia or Pompholyx Litharge Ceruss Antimony Lead is chiefly and most highly commended by al and it may likewise be administred any manner of way Whereupon it is that al those Medicaments that are to be applied in the Cancer are most fitly and properly made up in a Leaden Mortar with a Leaden Pestle touching which Galen is to be consulted see in his 9 Book of the Faculty of simple Medicaments and the Chapter of Lead which is made by rubbing together two Leaden Plates whereon the Oyl of Roses hath been poured so long until the Oyl become
accord like unto Phlyctaenae or Blisters somwhat reddish which being broken there issueth forth a bloody filth and matter They do not greatly excruciate the Party in the day time but by night they torture and torment him with a pain that is more then usual in an Ulcer But yet although Paulus and Aetius define Epinyctides by little Ulcers yet notwithstanding without all doubt they understand Pustules degenerating and turning into Ulcers Neither are they generated only of Cholerick and bloody filth and corruption but likewise from other humors also And therefore Pliny in his Book 20. and Chap. 6. calleth them pale and wan Pustules and such as disquiet in the night time But Celsus in the place alleadged doth most cleerly and plainly describe them in these words It is saith he the worst of all kind of Pustules that is called Epinyctis It is wont to be in colour either somwhat pale and wan or somwhat black or else white About this there is also a vehement Inflammation and within there is found a snotty and nasty exulceration The colour is like unto its humor from whence it ariseth The pain that it causeth is greater than its bigness and transcendeth its magnitude for it is no bigger then a Bean. And it likewise ariseth in the eminent parts and most commonly in the night time for which cause it hath this name Epinyctis imposed upon it by the Greeks There are some that conceive these Epinyctides to be Essere of the Arabians but they are mistaken as it wil appear by the Chapter following for Essere unless it be very much scratched and clawed poureth forth no humor at all The Causes The Causes of this Tumor are a Salt and wheyish humor and Flegm together with which there is somtimes mingled some of the Blood and Cholerick Ichor and now and then likewise some of the black Choler From whence also it is that the colour is not alwaies one and the same and by reason of the Flegm therwith mingled the Pustule being opened there is found within a certain snotty and filthy exulceration And the Tumor is almost if not altogether such as that which causeth the Carbuncle but only that there is here no malignity present neither is the Tumor likewise here so great as it is in a Carbuncle neither is it as we told you out of Celsus bigger then a Bean. But that it is more exasperated by night the Cause hereof is a black humor that is wont to be moved more in the night and the nocturnal cold which shutteth and closeth up the Pores of the Skin Signs Diagnostick It is not at all needful that we declare the signs and tokens of this Tumor since that it may be sufficiently known from the aforementioned description of Celsus The Prognosick To tel you the truth these Tubercles are not dangerous and they denote the strength of the expulsive faculty yet notwithstanding they are very grievous and troublesome by reason of the pain they cause and they bring restlessness likewise upon the Party in the night time and they signifie that an adust and vitious Juyce doth superabound in the body The Cure And therefore the naughty a vitious humor is to be evacuated and if the blood too much abound a Vein is then to be opened and withall there is such a kind of Diet to be prescribed that may not generate and breed an adust humor As for Topical Remedies such a like Bath or Lotion may be appointed Viz. Take Mallows Violets Pellitory of the Wall Bearsfoot of each three handfuls Nightshade one handful Marshmallow seeds and the four cold seeds wel bruised of each one ounce boyl them in sweet water for a Bath Paulus and Aetius commend the liquor of Laserpitium with salted water in regard that it drieth without any corrosion at all as also the Leaves of the Hemlock or Henbane bruised and pounded smal together with Honey as likewise the Green Coriander and Nightshade bruised and mingled together or the Leaves of the Wild Olive bruised For those Ulcers that spring and arise from Pustules this following Medicament is very proper and convenient Take Ceruss half an ounce Litharge one ounce and half Fenugreek seed half an ounce Roses two drams the Juyce of Endive as much as wil suffice let them be mingled and stirred together until they attain unto the thickness of Honey or a Liniment But let there be a careful abstinence from whatsoever is sharp acid and salt Terminthus Some there are that refer likewise Terminthus unto these Epinyctides But it doth not yet sufficiently appear what this Tumor Terminthus of the Ancients is properly but only what we have from Galen who in Epidem 6. Comment 3. Text. 37. thus writeth that the name of Terminthi doth signifie certain black Pustules arising especially in the Thighs derived from the likeness and resemblance they have in figure colour and bigness with the fruit of Terminthi that is Cicers as they vulgarly render it but as others and that more rightly the fruit of the Turpentine Tree Chap. 26. Of Essere THere is also a certain kind of Tumor which we but very seldom meet with in the writings of the Greeks and Latines but oftentimes mentioned by the Arabians and now then likewise by the Physitians of our own time such especially as live neer us in our own Country which they cal Essere Sora and Sare to wit when litcle Tubercles inclining to a red colour and somwhat hard do suddenly and unexpectedly seiz upon the whol Body together with an extraordinary troublesom itching Just as if the Party had been bitten and stung by Bees or Wasps or Gnats or stung with Nettles and yet notwithstanding so that after a long time they vanish again the Skin likewise without the issuing forth of an ichorous excrement or any other moisture whatsoever recovereth its former smoothness and colour There are some indeed that refer these kind of Tubercles unto the aforesaid Epinyctides of the Greeks but they are here in mistaken For Epinyctides and Essere are Tumors altogether differing one from the other in regard that Epinyctides pour forth out of them a certain humor which Essere doth not but vanisheth without any kind of humor issuing there from Moreover the Epinyctides according to the name they have thereupon Imposed on them do afflict and grieve the Patient most of all in the night time but the Essere very rarely break forth in the night but for the most part in the day time The way and Method of Curing them is likewise very various and different It is somwhat doubtful whether or no this kind of Tumor was at all known to the Grecians since that we meet not in any of their writings with the true and proper kind of this Tumor neither do they make any the least mention hereof unless haply there be any that will refer this Tumor Essere unto Exanthemata that are without any Ulcer Serapio in the fifth of his Breviary
and Chap. 8. maketh a twofold sort of this Tumor differing according to the Nature and quality of their Causes The one he deriveth from cholerick blood the other from a salt and nitrous Flegm but this more rare Others there are that assert that this kind of Tumor doth arise from an exhalation or vapour of hot fervent Blood or else the admixture of the Cholerick and Salt humors The Causes Whosoever knoweth and understandeth the Nature of serous wheyish humors wil not deny that such like Tubercles may possibly be excited from serous or wheyish humors being such as are sharp and easily moved and likewise such as without much ado vanish and are discussed Which appeareth and may be confirmed even from hence that this Malady may be and is removed especially by Venesection or blood-letting which said Venesection doth chiefly and principally qualifie and allay that extream and fervent heat of the serous and wheyish part of the blood Yet notwithstanding the itch that is somtimes greater and somtimes less likewise teacheth us that there is not one alone difference of this wheyish humor but that somtimes this said whey is more mild and moderate and somtimes again more sharp and hot somtimes thinner and somtimes thicker as likewise thus much which I my self have very often observed that these Tubercles while the the Patients are in a hot place they then break forth and appear and that when they expose themselves unto a cold Air the Essere then vanish and as soon again on the contrary to bud forth in the cold Air and to vanish in a hot place the former whereof seemeth from hence to happen to wit because the humor is very thin and moveable and therefore is instantly driven in again by the cold ambient Air but the latter because the Humor is not altogether so movable and thin but somwhat more thick which for that very cause cannot transpire in a cold Air but in a hotter Air it wil transpire or breathe through But this wheyish and thin Humor is for the most part generated from the fault of the Liver which from some preternatural cause is disposed to generate and breed this humor Now that said Humor waxeth extreamly hot from the Causes Procatartick as they cal them that stir and move the blood And this happeneth likewise in the Winter time and in cold Regions rather than in hot Signs Diagnostick It is easily known by those notes and marks that are above mentioned to wit there somtimes goeth before an Ulcerous Lassitude and then there break forth in the whol body itchy Pustules as if the party had been pricked by Bees or stung with Nettles The Prognosticks 1. These Tubercles vanish of their own accord within a very short space although there be no course taken for the curing of them and they are not suppurated neither doth there issue forth of them any humidity at al. And if this should somtimes so happen yet this chanceth rather by reason of the scratching of them and also from the vehemency of the Itch which is extream troublesom to the sick persons than by means of the Tumor 2. Somtimes these Essere go before Cholerick Feavers and therefore such as are very frequently molested and grieved with these Tubercles ought not in any case to neglect the Cure lest that they fal into Feavers and some more grievous Disease The Cure For the most part there is no need at al to administer Topicks but if the fervent heat of the Blood and Humors be by Venesection and the administring of Medicaments that alter qualified and kept under the Tubercles wil then soon vanish and the smoothness and Natural color will forthwith return unto the Skin To wit in the first place a Vein is to be opened and so much of the blood drawn forth as the state and condition of the body requireth And afterwards if there be any need at al thereof the Cholerick and wheyish Humor is to be drawn forth by Tamarinds Myrobalans Rheubarb afterward let there be administred the Juyce and Syrup of Pomegranates Ribes Syrup de Agresta or Varjuyce Whey with the Emulsion of the four cold seeds and the like Milk tart and sowr c. It is likewise very requisite to put the sick person into a Bath of warm Water Let his Diet likewise be cooling and moistening Chap. 27. Of Scabies or Scabbiness SCabies or Scabbiness ariseth likewise from adust matter as doth also the Itch that is as it were a certain Praeludium and forerunner of Scabbiness and the like Affects Now Scabies by the Greeks and Latines is called Psora an Affect sufficiently known in the which there is not only present some kind of foulness and deformity of the body but a distemper also even of the very Skin together with a swelling and exulceration from whence it is that the actions of the Skin are likewise hurt But more especially in the Scabies or Scabbiness the top and utmost part of the Skin is affected insomuch that out of it as Galen tels us in his fourth upon the Aphorisms and the 17. Aphor. there is some such like thing cast forth that beareth a likeness and resemblance with the casting of Serpents From whence it likewise differeth from the Itch for in the Itch there is only a roughness of the Skin in which there is nothing that fals off notwithstanding the scratching whereas in the Scabies there is not only a roughness of the Skin but likewise a distemper with a swelling from which by scratching the bran-like bodies are easily and readily separated and together with them divers Ichores likewise and filthy purulent Excrements The Causes But what the Cause of the Scabies is in this Authors seem not so wel to agree Galen in his Book of Tumors Chap. 1. 3. tels us that Sabies also and Lepra are Melancholick Affects and likewise in the seventh Sect. Aphor. 40. that Cancers Elephantiases Lepra's and Psora's are al of them Melancholy Affects and the same he also tels us in other places But Avicen in the seventh Book of his fourth Tome Tract 3. Chap. 6. writeth that the matter of Scabies is the blood with the which Choler is mingled and that converted into Melancholy or salt flegm and with him the other Arabian Physitians agree But the very truth is that although in the Scabies the humor be not alwaies one and the same yet in every Scabies there is some kind of mixture of the adust and melancholy hot and dry humor And furthermore there is one sort of Scabies that is moist another that is dry The moist in the which there sloweth forth a certain matter that is moist and withal rotten filthy and purulent but the dry is that in which there is but little or none of the aforesaid matter cast forth And concerning this latter it is that Galen seems to speak as being such wherein that melancholy humor doth more superabound But Avicen and the rest of the Arabian
therefrom Touching the Quartan we have spoken before where we treated of Feavers There are oftentimes other Feavers long continued and sufficiently dangerous and likewise very often intermingling Feavers but for the most part they are inordinate Feavers that arise in this manner and by this means Of this I here cured in the yeer 1636. in the month of April a certain man of a melancholy Constitution An example of a continual Feaver from the Scabs retiring inwardly and who had withal likewise a continued Feaver together with a sore and very grievous Cough by means of which he cast forth and brought away much Spittle and somtimes also great store of blood he was likewise afflicted with a difficulty and shortness of breathing insomuch that there was now great cause to suspect and fear a Phthisis or Consumption Now having for eight daies made use of Medicaments to very little purpose I made a further and more strict enquiry into the Cause of the Disease and then the Patient gave me to understand which until now he had concealed from me that before he was taken with this Disease he had the Scabies or scabbiness as we cal it the which was no sooner vanished and gone but this Feaver and Cough followed thereupon The which I no sooner came to understand but that I used the utmost of my endeavor by Medicaments made of Fumitory and such like to cause the Scabs again to break forth Which I had no sooner effected and administred such other Medicaments as I thought fit but both the Feaver and the Cough ceased and the man is yet living and perfectly sound without any the least fear of a Consumption I have told you elsewhere of a certain Student Another example of blindness from the same cause this man affected with this Scabies after and immediately upon the striking in of the Scabs became instantly blind and for two daies could see nothing at al this his blindness was likewise accompanied with an extraordinary streightness of the Breast difficulty of breathing and black Urines This man upon the use of fit and convenient Medicaments that were administred to evacuate the adust humor as Fumitory and such like within four daies recovered his sight again The same party a quarter of a yeer after being again afflicted with the same Malady did not lose his sight as formerly And likewise of the Epilepsie but had one fit of the Falling-sickness But yet notwithstanding having had fit and proper Medicaments prescribed him he again recovered I have likewise seen many that from Scabbiness have been surprized and invaded with prickings and shootings in the Breast And many other discommodities and inconveniences arising from the same cause with the bastard Pleurisie and dangerous stitches and likewise with the Cachexy I knew also a youth aged fourteen yeers that upon the unseasonable use of inunctions against the Scabies to made his Urines black lost his sight and at length being seized upon by the Epilepsie and the fits thereof being become very frequent in the end he died thereof Wherefore we say that this Scabies is no way to be sleighted neither driven inwardly or up and down and if it arise from any internal vice of the humors and the Cacochymy then externall Medicaments are by no means to be administred before the use of Purgers and other internal necessary Medicaments But now what hath been said touching the Scabies or Scabbiness The same is likewise to be taken and understood touching the Achores in Infants the same is likewise to be asserted touching the Achores or running sores in the Head yielding a thin excrement in Infants Concerning these Hippocrates in his Book of the Epilepsie or Falling sickness which he calleth Morbus Sacer writeth thus Those Infants saith he that have Vlcers breaking forth upon their Heads and upon their Ears and upon the rest of their Body and such as spit often and abound with Snot these are they that in the progress of their age live most at ease For hither floweth and from hence is likewise purged forth that Flegm which ought to have been purged in the Mothers Womb and these Infants that are thus purged are never seized upon by the Falling sickness Whereas on the conâ—rary iâ—â—â—ther the Physitians or the Women-Doctors as they call them do without due caution and unseasonably administer astringent and Repelling Medicaments and therby heal up the said Achores the Infants must then unavoidably fal into Feavers the Epilepsie Convulsions the vitious humor retiring and running unto the internal parts and somtimes likewise they within a very short space even die hereupon The Cure Now therefore in the first place there is a due care and regard to be had in point of Diet and there must be a totall abstinence from those Meats that generate adust and salt humors Viz. all things that are salt sharp bitter Oyls themselves and whatsoever partaketh of an oyly Nature and on the contrary Meats of a good and wholsom Juyce are constantly to be fed upon And this may also be observed and taken for a general rule that it is more convenient that the food that is given unto Persons that are thus affected to wit with Scabbiness be rather boyled than either rost or fried For what is either roasted or fried doth especially generate a more sharp and dry humor After this the acrimony sharpness of the humors is to be qualified and tempered and the distemper of the Liver is especially to be reduced unto its pristine Natural state and the salt and sharp humors are likewise to be evacuated And therefore in the very beginning the first waies and passages as we term them are to be purged and emptied as for example Take Electuar Diatholic half an ounce Powder of prepared Sene half a dram and so with Sugar make a Bole. If there be present any extraordinary store of Blood that the humors are overhot it wil then be very requisite and proper to open a Vein in the Arm. For Nature is wont to expel the vitious humors out of those greater internal Veins unto the external branches and those that lie under the Skin which from thence a Vein being opened are together with the Blood evacuated Afterwards in a moist Scabies from salt Flegm Preparatives are to be administred of Cichory Agrimony the Hop and Maiden-hair and Purgers of Agarick Rheubarb and Sene Leaves In a dry Scabies Preparers of Fumitory Borrage Bugloss Violets and Purgers of Epithymum we commonly call it Mother of Tyme Polypody Sene black Hellebor from whence for this present purpose various forms and Receipts may be made and compounded As Take the Roots of Cichory one ounce Polypody sowr Sorrel the inward rind of the black Alder Tree of each half an ounce of Sassafras wood rasped Liquorish of each two drams Fumitory Sorrel Agrimony Scabious of each one handful Epithymum the Flowers of Borrage and Bugloss of each half a handful Raisins
Scrofulae that are in Swine which we call the Swine pox The Breath stinketh the Voice is hoarse shril and obscure by reason that the Lungs and the parts serving for Respiration are filled and beset about with thick adust humors and by reason also of the driness and roughness of the Trachaea Arteria or the great rough Artery In the Hands the Muscles are extenuated especially between the Thumb and the fore Finger for whereas those Muscles are naturally lifted up into an hilly and manifest swelling the depression of them and their being emaciated happening by reason of the defect of aliment becomes the more manifest and remarkable in them the Nails are cleft there is present a stupidity and want of feeling in the Ankles and the Calves of the Legs and in the Feet also so that although the sick Persons shall be pricked with Pins or Needles in those places yet they feel it not in regard of the vitious matter filling up and obstructing the part hindering the access of the spirits The same likewise somtimes befalleth the Fingers and Toes in the which there is also perceived a coldness and a certain privation of al sense and feeling and somtimes likewise that stupidity and sleeping as they cal it chanceth unto the whol Skin between those Fingers and extendeth it self even unto the Arm from the Foot it extendeth it self even unto the Knees the Thighs and the Hips yea moreover the sense of feeling is diminished throughout the whol body in Elephantiack Persons For all the Nerves and Pores being obstructed and in a manner shut up by the thickness of the humors will not allow and afford any passage unto the Animal Spirits In some certain places under the Skin there is perceived and felt a kind of stinging such as is caused by Emmets or Pismires as if Nettles were rubbed thereupon and likewise a certain kind of itching and tickling as if there were Worms creeping there and this is by reason of the adust fumes and burnt vapors ascending up under the Skin The Skin it self is wholly Unctuous and Oyly so that Water poured upon it wil hardly stick and abide by reason of the melting of the fat under the Skin and the effusion of fat excrements thereinto Others there are that unto these signs add other signs also They advise us to take some few grains of Salt and to cast it upon the Blood because that if the Blood be infected the Salt is presently resolved and melted but on the contrary if the Blood be not infected They command us likewise to cast this Blood into the purest and clearest Water and if it swim at top it is corrupted but the contrary if it sink to the bottom Others there be that take the Blood and putting it in a clean Linen Cloth they wash it for if there then appear in it certain blackish rough and as it were sandy bodies it argueth a leprosie But there are other signs also of this Malady and indeed there is scarcely any evil mischief or inconvenience that is not annexed thereunto and in the which there is hardly any thing within or without that is sound But yet notwithstanding the Face is especially to be considered neither is any one rashly to be accounted Leprous unless the figure of the Face be corrupted And therefore since that in some Common-wealths there is instituted and appointed an Annual Examination and Search in and about these Elephantiack persons and that this is the chief if not the whol business of the Physitian he ought therefore to use the utmost of his endeavor and to be very cautious that through imprudence or by a rash and precipitate Judgment he do not cause such to be exiled and banished from al society that are not infected with this Disease and on the other hand for those that are infected therewith that he do not permit them to live and converse with such as are sound to the great endangering of them And this he may easily do if he have in his eye al the signs before recounted and mentioned and if he wil likewise but duly weigh and consider which of them are proper unto them and inseparable from them and what they have common with other Diseases In the serious examination of al which Franciscus Valeriola hath taken extraordinary pains in the sixth Book of his Enarrations Enarrat 5. the Reader may do wel to consult the place alleadged We must not here also pass by in silence that which Marcellus Donatus hath in his first Book of the History of things wonderful in Physick Chap. 4. by which we have occasion given us to think and conjecture how great the corruption of the blood may possibly be in those that are Leprous Annibal Pedemontanus saith he having been for two yeers vexed and afflicted with an incurable Lepra he was at the end thereof taken and surprized with a Pleurisie and having a Vein opened this strange thing befel him the hot Vrine that came from him being in quantity more than the pot could wel hold and upon which there swam a blood at least six ounces in weight so soon as it was cooled was by the said blood thickned in such a manner just as if the water had been Milk and the blood the Curd thereof so that in its consistency it seemed to be very like unto curdled Milk yet still retaining its own proper color of the which there was not one drop indeed to be found that was severed from the rest and not curdled The cause hereof is given by the Author before cited who conceived it to be and imputeth it unto the thickness and clamminess of the blood which being throughly mingled with the Water the actual heat of both of them assisting and furthering the distribution in their mingling together when it had abated of its great heat and was now become cool gave the occasion of the said coagulation or curdling And he conceiveth likewise that here the very same thing happened that cometh to pass when the smal parts and pieces that are cut from Hides and Skins are boyled in Water for the making of Glew For so soon as ever that Water is cooled it instantly is thrust and forced close together by reason of the clamminess and sliminess of the juyce and the like also happeneth in some kind of meats that we eat that are made of Calves feet and the feet of other living Creatures Prognosticks 1. By al which iâ— appeareth That this Malady is most grievous and dangerous hard to be cured and the truth is not at al curable unless it be taken in hand in the very beginning and first rise thereof neither then without much ado and difficulty For an Elephantiasis inveterate and confirmed wil at no hand admit of any Cure For if a Cancer being but a particular disease only wil allow of no cure how much less wil the Elephantiasis that is an universal Cancer of the whol body admit and receive any And
of Caraway of Cummin Annis Fennel Carrot Millet or Hirse Juniper Berries and Bay-berries Camomil Dill Rue Calaminth Marjoram as for example Take Seeds of Caraway Fennel and Cummin of each one ounce Rue Calamint and Camomile flowers of each one handful and half Millet seed three ounces then make a little bag or two which throughly moisten in warm Wine and apply them by turns one after the other Or Take of Rue and Betony of each one handful Parietary half a handful boyl them in Ley until they be soft and bruise them then add pouder of Camomile flowers and Bean Meal of each two ounces boyl them and make a Cataplasm Or Take Oyl of Rue and Camomile of each one ounce the destilled waters of Caraway Fennel Cinnamom of each half a scruple a little Wax and make an Vnguent Chap. 42. Of Tumors proceeding from the solid parts falling down into or resting upon some other parts in general THere remaineth now to be spoken of the last kind of Tumors which the solid and living parts excite For these if out of their own proper place they fal down into another place or else rest and lie thereon they then elevate the parts incumbent and more especially the skin and so by this means they excite a Tumor or Swelling But now the Bones are those that principally do this For these if in either their disjoyntings they fal out of their proper places or seats or if being broken they change their scituation they then lift up the part incumbent into a Tumor But there is no need that we speak any thing in special and particularly touching these kind of Tumors For like as they proceed from and depend upon disjoyntings dislocations and fractures so they are by them wel known and these being cured they vanish And hither likewise belongeth Gibbosity touching which we have already spoken in our second Book of the Practice of Physick Part 2. Chap. 21. There is likewise mention made by Galen in his Book of Tumors Chap. 14 15. and 14. of the Method of Physick Chap. 17. of a peculiar sort of Tumors arising from the Bones and this he calleth Exostosis you may cal it Exossatio to wit Emmencies and standings out of the Bones and especially those of the Temples and in other parts also but as touching these in referred unto Nodi and Cornua Tumors above propounded Chap. 38. there is no need at al that we speak any thing further here in this place Furthermore there are Tumors oftentimes excited by the soft parts moved out of their places and falling down And hither belongeth that kind of Tumors that the falling forth of the Vvea causeth of which we have already treated in our first Book Part 3. Sect. 1. Chap. 25 Hernia or Rupture of the Intestines of which likewise above in the third Book Part 2. Sect. 1. Chap. 6. and the Umbilical or Navel Hernia touching which also we h ve spoken sufficiently in the same place Part 10 Chap. 2. And lastly the Uteâ—ine protidency and Hernia and of this we have spoken likewise before in the fourth Book Part 2. Sect. 2. Chap. 16 and 17. There remain yet only two sorts of Tumors having their original from the living parts the one from the Arteries the other from the Veins of which the former is termed by the appellation of Aneurysma and the latter by the name of Varices which Tumors we shal speak unto and explain in the two following Chapters and with them we wil conclude and shut up this Tract of Tumors Chap. 43. Of Aneurysma ANeurysma which is so called not from the Greek word Neuron but from Anaeureumein which is as much as to dilate above which word the Latines likewise retain being not provided of a better and more proper for as for those that the Arabian Interpreters make use of such as these Hyporisma Emborisima Emborismus Aporisma they al of them have their original from the Greek word corrupted that this Aneurysma I say is a Tumor arising from an Artery preternaturally affected is a thing our of al doubt and controversie For although the Author of the Medicin Definitions saith that Aneurysma is a relaxation of a veiny little Vessel yet notwithstanding without al doubt the word Venosum is there taken for Arteriosum that is to say Veiny for Arterial since that it is a thing generally wel known that the Ancients did oftentimes cal the Arteries by the name of Veins But now what this Aneurysma is and from what cause it ariseth is a thing not altogether so manifest and evident Galen indeed in his Book of Tumors Chap. 11. writeth thus touching this Aneurysma But now saith he a mouth being made in an Artery the Affect is called Aneurysma Now this happeneth when the Artery being wounded the skin that lieth neer unto it cometh unto a Cicatrice but yet the Vlcer of the Artery still remaineth the said skin being neither conglutinated neither together brought unto a Cicatrice neither filled up with flesh And the same Galen in his fifth Book of the Method of Physick Chap. 7. hath left this written Vnless saith he flesh produced do first fill up the place that is neer about the Artery cut asunder but that there still remaineth some void and vacant place then verily there followeth that Tumor we call Aneurysma Other Greek Physitians there are that are of the same Judgment and Opinion with Galen For thus Aetius writeth touching this Anourysma Tettab 4. Serm. 3. Chap. 10. Anecurysma happeneth in every part of the Body but more frequently in the Throat where it produceth that Tumor we cal Bronchocele It befalleth oftentimes unto Women in Child-bed by reason of the violent detention and holding of their breath but it happeneth likewise in the Head nigh unto the places of the Arteries and in the rest of the body also where ever the Arteries are wounded like as when ignorant and unexpert Physitians intending and attempting to open a Vein in the Arm do withal prick and oftentimes cut asunder the Artery lying underneath it The very same is told us by Paulus Aegineta in his fourth Book and Chap. 53. The same Opinion is borrowed from the Greeks by Avicen the Arabian as appeareth by what he writeth in Quart quarti Tract 2. Chap. 16. And when the place of the Artery saith he is not from above coarctated and conjoyned close together after the solution of its continuity and that it findeth a voidness or vacuity then the thing comes even to an Emborismus which is named the Mother of Blood And a little after thus he writeth And very many times saith he the Artery is not indeed covered over with flesh but that which containeth the Artery is incarnated and covered with flesh and is coarctated and closely conjoyn'd upon it Wherefore the blood cannot have nor make any superfluous course yea somthing goeth out of it even unto the ends of the skin which it receiveth and taketh in the quantity and
threds or else the Tumor being opened about the midst of it after the emptying forth of what is therein contained we cut off the skin that being left remaining that was tied about and then a long spleen-like Plaister wel moistened in Wine and Oyl being laid thereon we conclude and perfect the Cure by Liniments But who is he that seeth not that this kind of Cure is not only cruel and so cruel that few or none wil submit unto it but that it hath likewise much danger in it and yet for al that doth not heal the sick person For although the Artery be bound about yet notwithstanding after the threds are loosened there is cause to fear lest that either an Haemorrhage follow or else that a new Aneurysma be caused And therefore the more secure and safe course is only to bind hard and press together the Tumor with Bands and Medicaments that so it may not gain any further augmentation Chap. 44. Of the swoln Veins caled Varices VArix with the Greeks Kirsos this being the name given unto it by the Greek Physians only for we find Aristotle in the third Book of his History of living Creatures Chap. 11. and 19. and Plutarch in the Life of Caius calling it Ixia as Galen in his tenth Book of the Method of Physick and last Chap. defineth it and as out of him Paulus Aegineta hath transcribed it in his sixth Book Chap. 82. and Aetius Tetrab 4. Serm. 2. Chap. 48 is the dilatation of a Vein this said dilatation of a Vein being called Varix as that before mentioned dilatation of an Artery was termed by the Greek Physitians Aneurysma of which in the foregoing Chapter But now these Varices happen in divers parts of the body but most frequently in the Thighs and yet notwithstanding somtimes likewise in the Temples as Paulus telleth us in the place before alleadged and somtimes in the lowest part of the Belly under the Navel and oftentimes also about the Testicles and the Cods which said Tumor is in special called Kirsocele The Causes They are generated from great store of Melancholly blood which as Galen writeth in his Book of black Choler Chap. 4. Nature oftentimes transmitteth unto those Veins that are in the Thighs by the which being distended and dilated they are rendred Varicose or swoln up and the skin that toucheth upon these kind of Veins in process of time becometh of a blackish color But now as for such in whom there is only great store of blood flowing in that is not Melancholy it resting indeed and wholly relying upon those Veins which there in that place are naturally more weak than elswhere doth dilate them but scarcely even dye them of such a like color as it happeneth when Melancholy blood shal produce these Varices For such are in very great danger if any one assay to cut forth the Veins affected of being surprised with Melancholly For this is frequently seen to happen not only in Varices but even in the Haemorrhoids also that consist of the same kind of humor even as the coming of them upon those that are mad is wont to be a freeing and discharging of them from their madness as Hippocrat in the sixth of his Aphorisms Aphor. 21. And yet notwithstanding scarcely ever doth good blood though it abound never so much by its great plenty alone produce and cause Varices as it doth if it be both plentiful and withall if it be thick which by its weight tendeth downward unto the Thight Whereupon it is also that the Varices have not their being until the ripeness of age as Hippocrates in Coac praenot toward the end teacheth us in regard that a thick and melancholly blood is not generated sooner in the Body And likewise Pliny in his eleventh Book and Chap. 45. writeth that the Varices happen in the Thighs of Men only and very rarely in Women Such likewise as are bald in these the Varices become not great but for such as while their baldness is upon them are afflicted with these Varices these come again to receive their Hair Hippocrat in the sixth of his Aphorisms Aphor. 34. Which yet notwithstanding Galen asserteth to be a falshood in his Comment unless haply any one wil understand this of that affect that Physitians call Madarosis that is the shedding or falling off of the Hair For this Affect since that it hath its original from vitious humors as likewise the Alopecia hath and also that we call Ophiasis if those very depraved humors being translated into the Thighs do cause the Varices the sick Persons may then possibly recover and receive their Hair again For if at the first the loss of the Hair proceeded from vitious humors their corrupting and corroding the very roots of the Hair then questionless these said humors taking now their course into some other place the Hairs will again return unto their naturall State The more remote Causes all those that make for then generating and breeding of thick and melancholly blood and especially the Spleen when it is distempered maketh much unto and helpeth forward the generation of these Varices And that likewise which much furthereth the flowing of the aforesaid humors unto this part may be comprised under on of these Heads to wit either a blow or streining overmuch long and tedious foot journeys extream hard labor and the like Signs Diagostick These Varices are easily known whenas swelling Veins is the very superficies of the Members and especially of the Thighs appear unto the very sight it self and the part affected appeareth either Leaden coloured or black and the Tumor being pressed down seemingly retreateth back but forthwith returneth again Prognosticks 1. These Varices of themselves carry little or no danger in them neither bring they any unto the Party thus affected but they rather preserve and free such as have them from other Diseases especially Melancholly Diseases touching which Hippoc. in the sixth of his Aphorisms Aphor. 21. thus writeth If Varices or the Haemorrhoids happen unto such as are mad they are thereby freed of their madness and the whole Body is by them throughly purged from all flatulent Blood 2. But if they be unseasonably taken away as Galen in his Book of Venesection against Erisistratus and Chap. 6. and in his Book of black Choler and Chap. 4. teacheth us Madness the Pleurisie the pain of the Reins the Haemorrhoid Flux the Cough and spitting of Blood the Apoplexy Cachexy Dropsie and other Diseases arise 3. Sometimes these Varices do pass into the Elephantia of the Arabians touching which we shal speak further in the next following Chapter The Cure Unless therefore the Varices be of the biggest size and that the Veins and the Skin by reason of their extension be so extenuated that there be great cause to fear a Rupture a profusion of blood and Death it self and again unless they be inflamed and extreamly painful or that there be present some great and
malignant Ulcer they are by no means to be healed lest that these being removed some more grievous Evils befall Since that those things only may be said to heal that do altogether free the Party and not those things that generate another Affect more dangerous then the former as Galen teacheth us in the sixth of his Aphorisms Aphor. 26. And therefore if it like you to Cure these Varices this ought to be done with great Caution there must be some of the blood let forth the Body must then be purged and that not only once but twice or thrice and whatsoever is amiss in the Liver and the Spleen if they be ill affected and administer cause unto the Varices is first of al to be corrected And afterward we are to make use of Astringent Drying and Digestive Medicaments as also of Swath-bands and Ligatures that may thrust forth the blood from the inferior parts unto the superior These things if they profit not but prove successless the Ancients were then wont to betake themselves unto Section or Cutting Oppius is our Author as Pliny relateth it in his eleventh Book and Chap. 45 that Caius Marius who had been seven times Consul was the one man that standing suffered these Varices to be taken out of him the one man saith he I cal him because that as he was the first so he was the only man in those times But after him there were others also that suffered the same to be done unto them standing and even without any bonds For so Cicero tels us in the second Book of his Tusculane Questions towards the end thereof But in good truth saith he Caius Marius a Countrey-man but yet a man every inch of him when he was cut of the Varices at the very first forbid them to bind him Neither before Marius was there ever any heard of that was cut without being bound Why therefore were others afterwards His Authority and Example caused it so to be Seest thou not therefore that the Evil of this Affect was more in Opinion then it was really and in Nature And yet notwithstanding that this Affect was not without its sharp biteing pain the same Marius sheweth for he yielded up only one Thigh whereas they were both of them affected to be cut and not his other Thigh that ailed altogether as much so that he as a resolved man was contented to suffer pain but then as a Rational Man he refused to undergo a greater pain then there was necessary Cause for the whole of what thou art taught by his Example consists in this viz. that thou carry a Commanding power over thy self And of the same thing Plutarch writeth in the life of Caius Marius He may be for an example unto us saith Plutarch in that when he was diseased in both his Thighs and having them bothful of these Varices and bearing the deformity of them with a very ill will he took unto him a Physitian for the curing of one Thigh only in the cutting whereof he did not so much as blinch or once stir his body neither was he heard so much as once to sigh but when in silence and with fixed Eyes he had rendred himself to be cut he was not at all affraid during the time this cutting took up to suffer and undergo certain intervals of pains caused by pauses and delaies But yet he would not in the least consent unto the Physitian requiring him to render yield up his other thigh to be cured but thus he said I know wel that the Remedy can no waies countervail these so great pains And haply these are those things of which Seneca in his eleventh Book Epist 79. saith He that whilest he was suffering those Varices to be cut forth continued al the while reading of a Book But yet at this day there is hardly any one that wil admit of this Remedy for the removal of that deformity that is caused by these Varices As for the manner of cutting them out Paulus Aegineta in his Book 6. Chap. 82. teacheth us how it ought to be performed The man being washed saith he and a string tied about on the upper part of his Thigh we command him then to walk and then when the Vein is filled ful with writing ink or with a Colliry we mark it according to its scituation the length of three fingers or somewhat more the man being then laid upon his back with his Thighs extended we then bind about another String above the Knee and by this means the Vein being elevated into a considerable heighth we cut with a Panknife in that very place which we marked no deeper then only through the Skin that so we may by no means divide the Vein and then the Lips of the Section being distended with little hooks and the Membranes being excoriated and fleyed off by those crooked Penknives that are provided in Watery Ruptures and the Vein being altogether made bare and naked and laid open to the view on all sides we then loosen the Thighbands and the Vessel being elevated by a little hook we cast under it a Needle drawing along in it a double Thread and cut in two the nook of the Thread and then the Vein being divided in the midst by a Venesectory Penknife we evacuate and let forth as much of the blood as is needful then after this with one of the threads we tie close together the upper part of the Vessel and the Thigh being extended straight forth by the expression or hard pressing of the Hands we empty forth that blood that is in the Thigh and afterwards we again beneath tie the vessel close together or we cut off and take quite away that part of the Vein that lieth between the bonds or otherwise we permit it to remain until that at length together with the bonds it fal out of its own accord then putting in dry Liniments and a long spleen-like Emplaster after it hath been throughly moystened in Wine Oyl being laid thereupon we bind it down close and so we cure it by the continued course of suppurating Medicaments that are to be administred and applied in the nature and after the manner of Liniments Neither am I ignorant that some of the Ancients used none of these bonds and Ligatures for some of them presently cut forth the Vessel so soon as ever they had made it naked and bare and certain others of them with violence draw forth and break off the said Vessel so soon as they have extended it from the bottom But the truth is that before mentioned way of Manual operation is absolutely the best and of all other the most secure Moreover as for the Varices that consist in the bottom of the Belly we handle them in like manner as likewise those that consist in the Temples Thus far Aegineta Cornel. Celsus in his seventh Book and Chap. 31. telleth us of a twofold manner and Method of curing these Varices by Chirurgery when he
thus writeth Every Vein saith he that is hurtful either withereth and wasteth away upon its being burnt or else it is cut forth with the hand If it be straight or if though it be transverse yet notwithstanding if it be simple or else thirdly if it be not overgreat it is the better burnt If it be crooked and be as it were implicated into certain Orbs so that many of them are as it were involved and folded one within the other it is then more convenient to take them forth The manner of burning is this The Skin having first an incision made upon it then the discovered Vein is to be a little pressed with a thin and blunt piece of Iron heated red hot and great care must be had lest that the sides of the orifice it self be burnt which to draw back again with smal hooks wil be no very hard matter This is to be done by interposing welnigh four fingers in a rank throughout the whol Varix and then there is to be imposed thereon such a Medicament whereby those things that are burnt may be healed But then it is to be cut forth after this manner The Skin like as before having an incision made in it upon the Vein the orifice is to be kept open with a little hook and with a penknife the Vein is to be drawn a little and loosened from the body and here great care must be taken lest that in the doing of what went before the Vein it self receive any hurt and under it a blunted hook is to be cast and there being interposed almost the same distance as we shewed you above in the same Vein there is the very same thing to be done as abovesaid which said Vein whither it tendeth is easily known by the extended hook And so soon as the same hath been done wheresoever the Varices are the Vein being brought unto some one place by the hook is there to be cut off and then after this in that place where the little hook is next unto it it is there to be drawn forth and there again it is to be cut off And so the Thigh being on al sides freed from the Varices then the mouths and orifices of the incisions are to be united and strictly closed together and upon the same there is to be imposed a conglutinating Emplaster Avicen Book 3. Fen. 17. Tr. 1. Chap. 18. cutteth the Skin until the Varix appeareth and this he doth indeed longwaies and not ei her obliquely or transversly and then he extracteth and draweth forth al the blood that is in it and then he cleanseth it by cutting it in length But somtimes as he writeth it is to be drawn forth with a Needle and so to be cut He addeth moreover that a drawing of it out with a Cautery is better than the cutting of it forth But in regard that the Cure of Varices by excision or cutting forth is not only rough and very difficult but also because that for the most part it is not attended with an happy success by reason of the flux and effusion of blood that hindereth the operation therefore Hieronymus Fabricius ab Aquapendente in his Treatise of Chirurgical Operations teacheth us how we may cure these Varices in another manner that is far better to wit without the extraction and drawing them out on this wise Since that there are saith he three things to be considered that concur unto the constituting of Varices viz. The Blood that floweth The Flux thereof And the Dilatation of the Vein therefore there are three things likewise that are shewn and pointed out hereby to wit That the flowing Blood is to be intercepted That which is already flown in to be evacuated And the widened Vein to be streightened and made narrower For the intercepting of the course of the blood in the beginning and the end of the Varix we ought to cast a bond and tie upon it which is done either by that we cal Sella recurvata or by a Hook or by laying hold upon the vein with the top of two fingers and lifting it up thereby and then transmitting a needle drawing a thread along with it through the lower part of the vein and there tied together upon which part the skin is to be cut that so the vein may appear and may be tied and it is not to be cut when it hangeth forth unto the external parts We might likewise administer the same means and use the very same way to intercept the blood that Farriers use in intercepting the blood in Horses that is to press the Vein close together with a little thin Iron Plate fastened unto the Vein with a pair of Tongs But then for the Evacuation of the blood that hath already flown in Hippocrates in his Book of Vlcers about the end thereof teacheth us how and in what manner this is to be done In the place alleadged he giveth in charge that the Varicose or swoln vein be not cut with any great and wide gâ—sh lest that thereby a great Vlcer be caused by reason of the influx of the Varix but rather as Hippocrates saith the Varix it self is again and again to be pricked whensoever we have any opportunity and shal find is to be fit from which said prickings the blood that hath already flown in and filleth the swoln Vein is evacuated and emptied forth and this is done by degrees and by little and little and not al at once and on a huddle as it were and with much danger unto the Patient But however it is evacuated if not wholly yet at least so much thereof even to the greater part of it that the vein may withal likewise sink and fal down in some one part or other This being accomplished we come then unto the third and last scope that is the astriction and streightening of the dilated and over widened vein For my own part I am wont to make up a Medicament of Tragacanths macerated in the Wine of Pomegranates or the juyce of unripe Grapes and then after this I add the Pouder of Bole-armenick Mastick and Dragons blood in equal portions until the Tragacanths being melted or softened become as thick as Wax so that in the hollow of the Hand they may be reduced unto the shape and form of a Candle which being done I put the Medicament longwaies upon the Varices and above upon it the rind of a Reed that by its Cavity may answer unto the Convexity of the Medicament and that may the better keep down the Medicament it is to be laid on in the length of it and to be tied about the Thigh with bonds or else with a narrow Swath-band for so both by this compression of the Swathband as also by the astriction of the Reed and the Medicament the Varices have been oftentimes so streightened and close bound that they have seem'd even to consume and wither away I have now and then likewise made use of the
condensed Juyce of Hypocistis or the excrescence of the Plant Cystus And lastly I have somtimes made use of a more mild and yet more gentle kind of Chirurgery and especially when the Varix hath been but smal and inconsiderable For laying aside the Ligaments and the compunctions or prickings of Hippocrates I made use only of the Medicament before mentioned according to the length of the Varix and binding it down with a part of the Reed tied fast thereupon or else a Spunge somwhat long and writhed and of the thickness of the Varix bound about with a thred and moistened in the juyce of Pomegranates or of Hypocistis and then rightly tied and bound on with a narrow Swathband and for this purpose very beneficial likewise are the unripe fruits of the Wood Guajacum wel bruised and imposed all which by their astriction do intercept the blood and bind the veins together and by their much dying they likewise evacuate And lastly for preservation of the part I made use of a hose or buskin made of a dogs skin which was to be put on and exactly fastened on about the Thigh Thus Fabricius Gulielmus Fabricius in his fourth Cent. Observ 85. relateth a History as also the Cure of a monstrous Varix The story is this There was saith he a certain extraordinary strong man who had in his left Leg a malignant and inveterate great Ulcer together with a Varix of a vast magnitude For in thickness it was equal unto that part of the Arm that is next unto the Wrist and it was welnigh a span long Now it began in the very Ham and descending toward the Foot it made a Ring and two Circumvolutions But that which was here worthy of observation was this That so soon as ever the man lift up his Leg any thing high forthwith the blood drew back and no sooner did he put it again upon the ground but it again descended and that in an instant and moment And in short the blood did ebb and flow no otherwise than as if it had out of some narrow pipe been cast forth somtimes into this and somtimes into that part As for the Cure he thus proceeded in it Having appointed unto the Patient a fit course of Diet and several times likewise purged his body and having also opened a Vein in the Arm of the same side he placed the sick person upon a Bench and then in the very Ham he gently separated the Skin from the Vein it self Then with a thread twice doubled and put into the Eye of a crooked Needle he woond about the Varix and in the lower part of the Varix he proceeded in the very same manner But before he tied the thread and made fast the knot he caused his Leg to be taken off the Bench and set upon the ground and this he did to the end that the blood according to its custom might flow downward At length he first of al tied the thred hard in the upper part of the Varix and then he fastened it with a knot thus he did afterward likewise in the lower part This being done with a Penknife he maketh an incision in the almost uppermost part of the Varix that so the blood that was contained in the Varix as in a long and little bag might the better flow unto it But when the flux of blood proved to be greater than what was proportionable unto the greatness of the Varix and that he attentively and exactly viewed the place there was found a blind passage which from out of the lower part of the Ligature entered into the Varix This passage whenas it could not be tied with a thread he first applied unto the entrance thereof some of the Escharotick Unguent and after that he applied in great abundance his own Pouder together with the white of an Egg for the stanching of the blood flowing from it and al these things he bound fast on with a Swathband throughly moistened and wet in Oxycrate and thus he left it even until the day following At length he cured the Wounds that himself had made after the manner of others And so this man by Gods gracious assistance became perfectly whol and sound Chap. 45. Of the Elephantiasis of the Arabians WHat kind of Affect Elephantiasis and Elephantia of the Greeks is as likewise Lepra of the Arabians we have told you before in the 40. Chapter to wit that it is a malignant Tumor of the whol body and as it were an universal Cancer And of that Tumor Avicen in his third Book Fen. 3. Tract 3. Chap. 1. And Rhases in his sixth Book to Almansor and Chap. 35. have discoursed at large But as for the Elephantia of which the Greeks speak not one word the Arabian Physitians make frequent mention thereof Elephantia of the Arabians as being neerly allied unto the aforesaid Varices and having its original from them and being only a Tumor of the Feet Of this Elephantia Avicen treateth in his third Book Fen. 22. Tract 1. Chap. 18. where he likewise handleth Varices Rhases in his ninth Book to Almansor Chap. 93. Yet notwithstanding Haly Abbas dissenteth from these and followeth the Greek Physitians in the eighth Book of his Theoric Chap. 15. and in the fourth Book of his Practice Chap. 3. Which last saith that Elephas is a disease corrupting al the Members of the Body and as it were an universal Cancer But neither do we find this Author alwaies in one and the same opinion for in the eighth of his Theoric Chap. 18. we have him writing thus Those Vlcers saith he that arise in the Feet and in the Thigh are called Elephas And the Elephantiack Disease is a melancholy Apostem that appeareth in the Thighs and in the Feet and the sign thereof is this that the shape and figure of the Foot is like unto and much resembleth the figure of an Elephants foot All the rest of them treat of Lepra and Elephantia apart and severally and they say that Elephantia is a Tumor of the Feet arising from melancholy and flegmy blood and from Varices by reason of which blood the feet of the sick person are in their figure and thickness very like unto the Feet of an Elephant And this kind of Tumor is oftentimes to be seen in the highway Beggars that get their livelyhood by asking relief in those publick and common places Signs The Affect it self is manifest enough whenas the Thighs of the sick persons are tumid and much swoln very red and sometimes wan and leaden colored and oftentimes black and for the most part ful and abounding with Ulcers Prognosticks But it is very rarely cured not only because such as are herewith affected are for the most part of the meaner sort and condition and therefore are not able to allow themselves Physick but also because that from al parts of the body there are abundance of Humors thrust forth thither viz. unto the Feet The Cure And
Part 4. chap. 4. of the Inflation of the Liver ibid. Part 6. Sect. 1. chap. 3. of the Tympany ibid. Part 6. Sect. 2. chap. 4. of the windy Rupture ibid. Part 9. Sect. 1. chap. 7. of Satyriasis and Priapismus ibid. Sect. 2. chap. 3. of the Inflation of the Womb Book 4. chap. 10. of the Inflation of the Head Tract of Infants Diseases Part 2. chap. 6. Touching those Tumors that arise from the soft parts when they are removed out of their own proper places we have likewise spoken of them in special and first of all of the falling down of the Vvea in the first Book Part 3. Sect. 2. Chap. 25. of the Hernia of the Intestines Book 3. Part 2. Sect. 1. Ch. 6. of the Umbilical Hernia ibid. p. 10. Ch. 2. of the falling forth of the Womb and the Uterine Hernia B. 4. Part 1. Sect. 2. Chap. 16. and 17. And moreover as touching the Scorbutick Atrophy Of the Atrophy in general we have written sufficiently thereof in its proper place But now whereas we have in the general spoken of the augmentation of magnitude in the whol body and in general above Chap. 4. those things therefore which may in general be further spoken of the Atrophy we think it nor amiss to subjoyn them here in this place When the Body is not nourished so much as it ought to be Certain peculiar Species of an Atrophy but is diminished and lessened by reason of the denying of food unto it this may indeed in the general be called an Atrophy But yet notwithstanding the peculiar Species of an Atrophy have likewise their peculiar names That which proceedeth from the Ulcer of the Lungs is properly called Phthisis and Tabes that is from an Hectick Feaver is named Marasmus and Marcor And that which happeneth without these causes is called in general an extenuation of the Body We here in this place use the word Atrophy in a general signification and under it we will comprehend all and every preternatural Extenuation of the Body by reason of the defect of Nutriment But now an Atrophy is twofold Atrophy in general what it is the first is of the whol Body the other of some one particular part as of the Arm the Foot c. The Atrophy of the whole in general so taken is a preternatural extenuation of the whole Body by reason of its being frustrated of its food and its being denied its due and requisite Nutrition The Causes As touching the Causes of an Atrophy this in the first place is to be taken notice of viz. that the Cause that invadeth the whole body is either in its own quality and disposition according to Nature or else it is preternatural And then likewise that which is Natural or according to Nature is the Marasmus as we cal it in old age and in aged Persons For there was never yet that living Creature born or brought forth than was not obnoxious to old age and which in old age did not wither and consume away But since that this Atrophy cannot by any Art whatsoever be prevented we wil therefore in this place speak only of that Atrophy which happeneth preternaturally unto some Bodies alone and not unto all in general But now whereas there are two things that concur and are necessary unto Nutrition 1. By reason of the Nutriment to wit Nutriment and the nourishing faculty in both these likewise the Cause of Nutrition diminished and consequently of an Atrophy is to be sought after In regard of the Aliment the body consumeth and wasteth away by reason of its either defect or vitious quality which we may cal its pravity For if there be not dayly as much of this Aliment again taken into the body as is every day insensibly discussed then the body wasteth But if there be indeed a sufficient store and stock of blood treasured up in the Veins yet notwithstanding this is vitious and naught and either it is not at all attracted by the parts or if it be attracted yet can it not be assimilated The body is extenuated and pineth away in the defect and want of Food and Nutriment when in place of that Substance that is dayly wasted and diffused by an insensible transpiration and exhalation there is no other Nutriment or at least not a sufficient store thereof substituted and supplied Now whereas the blood is the proxime and nighest Nutriment of the whole body there the Nutrition is especially hurt through the defect and failing of the blood Now the blood faileth first of all in regard of some default and error in the first Concoction when there is not a sufficient quantity of Chyle from whence the blood ought to have its original generated and bred in the Stomack and this may happen unto such as are sound and in perfect health by reason of a dayly and continued scarceness of Food and their frequent spare Diet but it happeneth in such as are sick and unhealthy when by reason of the want of appetite it being now much dejected and weakned they are averse from all kind of Food and refuse to make any or else when by reason of their Disease they are fed with but little Food and that likewise not much nourishing Which may also happen if the Food that is taken in be presently sent and driven down into the Guts either Crude or Raw or else turn'd into Chyle and so is by the Belly ejected without its ever coming unto the Liver The same may likewise happen if by reason of any Disease whatsoever in the Stomack its Concoction being thereby much weakned the Chyle that is generated be either but little in quantity or that which is as bad or worse imperfect and not sufficiently elaborated Moreover Nutrition may be hindred because of the hurt of the sanguifying faculty to wit when by reason of something amiss in the Liver or Spleen the blood that is generated is impure and not good and this cometh to pass in the Cachexy Leucophlegmatia Tympany the Dropsie Ascites the Scorbutick atrophy and the long lasting Scabbiness Now as for the Causes of Sanguification they have been already in the third Book of our Pract. mentioned and explained From whence it happeneth that albeit there be a sufficient quantity of Food taken into the body yet notwithstanding there followeth no Nutrition and this again happeneth for two Causes to wit because either there is no aliment appointed by Nature for the nourishing of the parts or if there be any appointed for this purpose yet notwithstanding it cannot be rightly assimilated There is no aliment appointed unto the parts either because the Chyle is not so exactly elaborated in the Stomack that it may be converted into good blood or else because although the Chyle be sufficiently and rightly elaborated in the Stomack yet by reason of some fault in the Liver it is not converted into good blood or else because that although there be Chyle generated
in the Stomack and that accordingly blood be bred in the Liver yet it is oftentimes discussed and wasted by some certain Causes such as are overmuch exercise Watchings Cares Griefs and Diseases which melt away dissolve and discuss the aliment so that there is too great an evacuation hereof by the Belly by Sweats and by the flux of Blood and such likewise are immoderate Rest Meats and Medicamens that dry excessively Fevers especially such of them as are acute and Malignant But the Nutriment is not rightly assimilated by the parts in regard of some vitious quality it hath in it by reason of which it cannot be assimilated by the parts and so likewise the Nutrition may be frustrated by some external error or else by reason of the Object to wit because the Blood is such that it cannot by the nourishing faculty be perfectly overcome and assimilated But now in regard of the faculty there is not a sufficient Nutrition â— In regard of the nourishing faculty by reason of some defect and want of native heat and radical moysture For Nature maketh great use of this Native heat as of the next instrument in nourishing And this especially happeneth by reason of the preternatural affects of the Heart and principally its heat and driness whether it be that the Heart be primarily affected as it is in the Hectick Fever or else that it suffer through some default of the neighboring parts as it happeneth in the Ulcer of the Lungs For whereas the nourishing faculty as we said erewhile maketh great use of the innate and Native heat as its principal Instrument in reteining Concocting agglutinating and assimilating and it being so that the innate heat is cherished by the heat that floweth in if the temper of the Heart be not right and as it ought to be then the heat that floweth in and consequently the innate heat likewise wil be much amiss and not rightly tempered and so it can be no fit Instrument of the nourishing Faculty And that that Hectick Feavers do but slowly and sensibly bring to pass this the burning and melting Feavers accomplish in a very short time by the heat whereof not only the aliment and substance of the body is consumed and melted away but likewise the temperament both of the Heart and also of the whol body is converted into that which is more hot and dry The same happeneth by reason of over hard labors cares long continued diseases and in general al causes that are able to consume the Radical moisture and weaken the Native heat Now this Atrophy happeneth especially in the softer parts The subject the fat and the flesh and indeed the fat is first of al wasted and then afterward the flesh is likewise extenuated But now as for the harder parts such as are the Membranes Cartilages and especially the Bones although these may also in the like manner be dried yet notwithstanding they cannot possibly be so extenuated and diminished that thence the whol body should decrease And hence it is likewise that the said extenuation and Atrophy of the body doth appear especially in those parts in which there is much fatness and where there are more or greater Muscles as in the Eyes and Temples The particular Atrophy The Atrophy that happeneth in the parts is various It happeneth oftentimes privately in the Limbs the Arms and the Thighs And hither belongeth the Atrophy of the Eye The causes thereof which are the same As for the Cause of the particular Atrophy like as the Causes of the Atrophy of the whol body consist in some one principal Bowel whose action is necessary for the nutrition of the whol Body or is indeed universal and such as may exsiccate and dry the whol body so in like manner the particular Atrophy of any one part hath a private cause or at least such a one as belongeth unto that particular part Yet notwithstanding the Causes are the same as of the universal Atrophy to wit the weakness of the Nutritive Faculty The weakness of the Nutritive Faculty and the defect of Aliment The Faculty is hurt when the part is over cooled and left destitute of its proper heat For if this happen the part can neither attract nor retain not alter nor assimilate the Aliment Now the part is refrigerated and the heat decayed and rendered dul and unfit for action not only from the external Air as also from cold water but likewise it may proceed from overmuch rest in the Palsie or else from the streightness of the passages through which the Spirits flow in The defect of nutriment The Nutriment faileth especially by reason of the narrowness of the passages through which it floweth unto the part that needeth it And this happeneth for the most part from external causes when the Veins that carry the blood unto the part for its Nutriment are pressed together by the bones when they are loosened and out of joynt or else from some certain Tumor that is nigh unto it or by the brawniness and hardness of the flesh or else lastly when the Veins that convey the Nutriment are cut in sunder See likewise Galen's Book of Marcor a Species hereof arising from an Hectick Feaver Signs Diagnostick The extenuation of the whol body as likewise of some one particular part thereof is visibly apparent to the sight so that there wil be no need of many signs For if the whol body be greatly wasted by an Atrophy then the Face fals away and becometh lean the Temples fal down the seat of the Eyes is rendered hollow and deep the Nostrils become sharp and such kind of Face because that Hippocrates describeth it in his Prognosticks they commonly cal an Hippocratical Face Al the Ribs are conspicuous the shoulder blades and the Chanel bones stick out the Neck is extenuated and the Larynx or the top of the cough Attery buncheth forth the Belly falleth down the Buttocks become withered and weak the Thighs Arms Hands and Feet are emaciated and grow lean But in regard that the Atrophy hath its dependance upon many and several causes they are therefore al of them to be inquired into that so the Cure of them may the more rightly be proceeded in And therefore enquiry must be made whether external Causes to wit tasting cares grief over hard labor and the like went before If we find no such thing we are then to make enquity into the internal Causes to wit whether there be present a Hectick or any putrid Feaver or whether there had not been one a little while before and likewise a discovery must be made touching the Stomach Spleen and Liver in what state and condition they are for by the Diseases of the Bowels it may easily be known what the Cause of the Atrophy is Prognosticks 1. By how much the more the Atrophy is but recent and newly begun by so much the more easily it is cured but by how much the longer it hath
ought to be such a course taken that nothing unbefitting or inconvenient may happen nor any hurt be offered unto the Ulcer Moreover in regard that it cannot well be but that there wil somwhat of the Blood that is poured forth of the Veins and somthing of the humors likewise stick in the Pores of the parts that so therefore this may be Concocted and converted into Pus Digestives or suppurating Medicaments are to be made use of which in softer Bodies ought to be more mild and gentle such as are those that are provided of the Oyl of Roses and the Yelks of Eggs and in those bodies that are not so soft but harder to be wrought upon they are made of Turpentine the Oyl of Egs the Oyl of Roses the Oyl of Mastick the Yelks of Eggs in Bodies that are more dry they are made of Rosin Turpentine or Rosin of the Fir Tree the Powder of Frankincense the powder of Linseed Wheat flour Fenugreek and Hens fat After this Cleansers are to be made use of Yet notwithstanding it often so happeneth that with one Medicament we satisfie two ends and Scopes to wit both concoct and Cleanse Whereupon it is that then in this case suppurating Medicaments are to be mingled with Detersives or Cleansers and so the Suppuratives are made more hot and more dry then otherwise they are wont to be Yet nevertheless in this commixture there is a regard to be had unto the times since that in the beginning Suppuratives in the end Detersives ought to prevail And indeed it is more safe forthwith in the very beginning to mingle Abstersives with Suppuratives then to use Suppuratives alone by themselves For Nature is never idle but even in the beginning betaketh her self unto the generating of Flesh and to this end she separateth the excrements which are therefore to be wiped away neither must we be easily perswaded to make use only of Suppuratives since that it may then happen that by the use of them the Ulcer may be rendred more moist and sordid which haply might be the Cause why Galen in the Cure of Ulcers maketh no mention at al of Suppurating Medicaments And therefore most commodiously unto these Suppuratives or Digestives as they are usually called there are presently added Frankincense Rosin Turpentine and Rosin of the Fir Tree Oyl of Mastick the Juyce of Smallage and the like But now such like Medicaments as these may be made in a various and different manner according to the various Constitution of several Bodies In a Body that is soft and moist let such a one as this following be made Take Oyl of Roses one ounce Turpentine two ounces the Yelk of one Egg and so mingle them c. That following is yet more dry Take Oyl of Mastick and of Turpentine of each half an ounce the Yelk of one Egg and so mingle them c. This following is yet stronger Take Rosin of the Fir Tree one ounce Oyl of Roses six drams the Powder of Frankincense one dram mingle c. If there be need of more abstersion then Take Honey of Roses one ounce Turpentine half an ounce the Juyce of Smallage one ounce the Powder of Frankincense and Barley flour as much as wil suffice mingle c. The Ulcer being once cleansed Sarcoticks that is to say Medicaments that breed Flesh are to be made use of touching the faculty of which we have already spoken in the fifth Book of our Institutions Part 1. Sect. 1. Chap. 9. Now these are of a threefold rank and order In the first rank there is the Meal or Flour of Barly of Fenugreek and of Beans Fra kincense Manna of Frankincense In the second rank there are Rosin Turpentine Rosin of the Fir Tree and of the Larch Tree Honey clean scummed Honey of Roses Aloes the Meal of Lupines of the bitter Vetch Oâ—obus Pompholyx or the soil of Brass In the third rank and order there are the Meal of the Vetch Ervum raw Honey the Roots of Aristolochy of Flower-eluce Myrrh Antimony Chalciâ—is or red Vitrioll Among the Compounded there are these Viz. Vnguentum Basilicum the greater the less of Galen Vnguentum Aureum de Tutia de Matrisylv 1. Touching the Emplaster that is made of Hydrelaeon Oyl and Water and the Spume or Froth of Silver see Galen in his first Book of the Composit of Medicam according to the kinds Chap. 6. Or Take Myrrh Aloes of each half an ounce Frankincense one ounce Mastick half an ounce Gum Elemi two drams Turpentine one ounce Colophony half an ounce Make an Vnguent according to Art And therefore out of these the Physitian may make his choice of such Medicaments as are most fit and convenient for every several and particular Constitution For the body by how much the more moist it is by so much doth it require Medicaments that are less drying and Abstersive and on the Contrary the Body when it is more dry it then requireth the stronger sort of drying Medicaments And so likewise in the colder times and seasons of the yeer we are to use those Medicaments that are somwhat Warmer but in the hotter seasons of the year the Medicaments that we make use of may be less hot For if we apply Medicaments that are weaker then is fitting then there will be great store of Sanies the thinner sort of Corruption gathered together in the Ulcer and the Flesh that is generated wil be soft and slaggy But if they be overstrong and overdrying the Ulcer wil then be rendred dry and the Lips thereof will become very red the flesh will be consumed and sometimes the Excrements of the Ulcer will be bloody and a certain kind of mordication or biting wil be perceived in the part But if the part be rendered exulcerated and dry as naturally it is wont to be and that neither Sanies nor Pus slow forth of the Ulcer and that there appear a good colour in the Flesh it is then a Sign of a fit and convenient Sarcotick Medicament And here likewise the very form of the Mediment it self ought to be regarded For they are wont to be applied either liquid or humid or Dry. In bodies hard and dry and when a harder flesh is to be generated the Sarcotick Pouders that are to be sprinkled upon the Vlcer are most fit As Take Frankincense halfe an ounce Dragons Blood Colophony of each two Drams and make a Pouder Or Take Frankincense half an ounce Aloes two drams Dragons Blood and Sarcocol of each one dram make a Pouder But if the Bodies be softer we use those Medicaments that are most And yet nevertheless touching the preparation of Liniments and Unguents it is to be observed that they be not too soft For such as these are melted by the heat of the part and so easily flow about and spread all abroad And therefore if the Ulcers be not very deep for in such those Medicaments are required that can penetrate â—ven unto it but that they
Mortification the Radical humidity being consumed and the Native heat dissipated ariseth from thence ulcers hard to cure are likewise from thence excited the motion of the part is abolished and there are filthy and deformed Cicatrices left remaining 2. Burning by Lightening is likewise very dangerous and for the most part deadly 3. By how much the purer the Body is by so much the more easily is the burning cured But if the Body be either Plethorick or Cacochymical then from the pain and heat there is very easily caused an afflux of the humors and from thence Inflammations putrid ulcers and other evils are excited 4. The Burning is likewise somtimes more and somtimes less dangerous according to the Nature and condition of the parts affected For if there be but only one part burnt there is then less danger than if many parts or the whol body be burnt For when many parts or the whol body be burnt it is very rare that the persons thus burnt should ever be perfectly wel and sound but most commonly they die miserably by the very vehemency of the Symptoms 5. If the burning be so deep that it reach even unto the greater Veins Arteries and Nerves it is then dangerous For when the exsiccated Vessels are contracted and shut up the blood and the spirit cannot then flow unto the affected part from whence there is caused an Atrophy a Gangrene and a deprivation of sense and motion 6. The burnings of the Abdomen are not cured without much difficulty for the Skin is there softer and those Muscles by reason of their various motions are variously extended and contracted 7. If the burning reach even unto the Intestines it is then deadly 8. The burning likewise of the Groyns is very dangerous since that those places are moist and therefore the more fit to receive the afflux of humors 9. The burnings of the Eyes are also dangerous For although they be but light yet notwithstanding they may produce either a stark blindness or a deprivation of the sight or at least a dimmution thereof 10. If the hairy parts be ever a whit grievously burnt they alwaies continue smooth and slick for hairs are never generated in that hard Cicatrice that is brought over the affected part The Cure Indeed some there are that from the ordinary and wel known Axiom of Physitians viz. That Contraries are the Remedies of Contraries are of opinion that such Members as are burnt ought so be cooled and therefore they think that unto those parts that are burnt there must Coolers be immediately applied But this their opinion hath its original from that vulgar but false Conceit viz. That the burning is only an alteration and the introducing of a hot quality whenas notwithstanding the very fire it self and likewise its Atomes are communicated unto the part that is burnt and an Empyreuma as al of them are forced to confess is produced for what indeed else is this Empyreuma which al of them tel us ought to be called forth then the smal parts or particles of the very fire that have penetrated themselves into the burnt part and Experience it self teacheth us That cold things wil not cure burnings but that on the contrary by the said Coolers the fiery particles being thereby thrust down much lower the pain is wonderfully augmented and inflammations yea and the Gangrene it self and the Sphacelus excited but that such things as are hot and that cal forth the Empyreuma are very helpful from whence likewise it is as we al wel know that the burnt parts are not to be plunged into cold water but rather to be put somwhat neer unto the fire Which although that Platerus seem to find fault therewith yet use hath tâ—ught even the very vulgar the truth of this and Aristotle long since took notice hereof as appeareth in his Sect. 2. Problem 56. Neither are those things that are applied hot applied in the nature of Anodynes since that al Anodynes wil not do it as by and by in the Cure it wil appear but only those of them which have virtue and power in them of calling forth the Empyreuma But now similitude and likeness begetteth attraction and the external fire calleth forth the incrinsecal fire that is to say that very fire that it self conveyed into the burnt part as Ambrose Parry tels us very truly in his Book 11. Chap. 9. In the Cure therefore of Burnings let the first care be to cal forth the Empyreuma to wit in the same manner like as we have told you in Part 1. Chap. 15. touching Kibes that the cooled parts are not rightly cured if they be put neer unto the fire or plunged into hot water since that hence the pain becometh so much the more intense and vehement yea and that oftentimes a Gangrene and Sphacelus are excited but if they be first rubbed with Snow or dipt into cold water then the cold is drawn forth so if the Empyreuma be called forth by those things that are hot which is done by means of the similitude or likeness then this Malady is soon taken away Which that it may be rightly done the Cure is to be instituted and ordered according to the degrees of the Burning above propounded First of al therefore if the Burning be but light The Cure of a light burning we must prevent what we can the breeding and arising of Pustules or blisters for if this be done the sick person is then already freed from al the evil of the burning But now this is to be speedily done and therefore whatsoever Medicament we have ready at hand we must forthwith make use thereof and therefore the Member if the nature and condition thereof wil so bear it is to be put a little neer unto the fire or else deeply plunged into hot water or else fomented with a Spunge or a Linen cloth doubled and then wel soaked in warm water that so the Empyreuma by reason of the likeness may be extracted or else immediately a Linen cloth dyed in Varnish is to be imposed upon the burnt Member or a Linen cloth wel wetted in the Ley or water in which unslaked Lime hath been extinguished And then presently Onions bruised in a Mortar with Salt are to be laid upon the burnt part or else this Unguent Viz. Take of a raw Onion one ounce and half Salt Venice Sope of each half an ounce mingle them in a Mortar pouring in unto them as much of the Oyl of Roses as wil suffice and make an Vnguent Or Take Venice Sope three ounces raw Onion one ounce Salt six drams the Oyl of Eggs half an ounce Oyl of Roses and sweet Almonds of each one ounce and half the Mucilage of Quince seeds one ounce mingle them and make an Vnguent Or Take the green Rind of the Elder tree or the first shoots of the Elder let them he wel bruised and then boyled in Butter that is new and unsalted and then strain them Or Take Vnslaked Lime
likewise by evacuating and emptying forth of the peccant and depraved humors either by opening a Vein or by purging Medicaments if need require and that the nature of the Disease and the strength of the Patient wil bear it but we are here alwaies to take heed how we give those things that are too strong the Malignity is to be expelled and the depraved matter to be driven forth from the more inward unto the external parts and such a like Cure almost is here to be instituted as is wont to be in malignant Fevers to wit there are Medicaments to be administred of Citrons Sorrel Roses Borrage Water Germander Carduus benedict Dittany of Crete Swallow-wort Angelica Treacle likewise and Mithridate And we must do our endeavor that a Sweat may be provoked by these medicaments and that the Poyson may be driven forth from the Noble members unto the exterior parts Which that it may the more successfully and more easily be done the malignant matter is likewise by Topicks to be drawn forth unto the external parts Where we are also to take notice that if poyson stick outwardly unto the body as it happeneth oftentimes from the strokes of poysonful Creatures then Defensives are to be administred lest that the Poyson creep broader and spread it self unto the more interior and Noble parts But if the malignant matter be bred in the body then Defensives are by no means to be administred but the said Matter is only to be called forth unto the external parts unto which end Scarifications may be administred unto the part affected Cupping-glasses likewise and Leeches may be applied and moreover the part also may be washed with the Decoction of those Medicaments that resist malignity and putridness such as are Wormwood Rue Dittany Asclepias or Swallow-wort Angelica and especially Water Germander which is of a most soveraign virtue in all Gangrenes and that that hath in it an extraordinary power to preserve from putridness And others there are that to attract do make use of the Raddish root the Seed of Cresses and the like But if Poyson shal chance unto the body from without and shal either by a blow biting or any other touch be transufed into the part affected then those Medicaments that do strongly attract the Poyson dry it up and consume it are to be made use of for which end and purpose an actual Cautery may most fitly be administred The part affected being either scarified or burnt then there are further to be applied those Medicaments that resist putridness and prevent the Necrosis or Mortification and such as do also attract and draw the offensive and depraved matter as an Emplaster of the aforementioned Medicaments with which we may likewise mingle Leven and Garlick roasted in the Embers And at length the Gangrene being in a fair way of recovery if there hath happened any Ulcer from the scarification or burning it is then to be cleansed by Medicaments of the Juyce of Smallage and Honey of Roses unto which if need be there may be added some Spirit of Wine and other things are moreover to be done that are fit and convenient for the Ulcer A Gangrene from Inflammation Thirdly The Gangrene that is wont to follow upon great Inflammations and to arise from the abundance of blood and humors that suffocate the Natural heat of the part is cured in this manner First of all the Diet that is appointed ought to be slender and such as is cooling The blood and humors that flow overmuch into the part are to be emptied forth of the whol body by opening of a Vein Scarifications Cupping-glasses Purgers and other convenient Remedies and lest that they should any longer flow into the affected part they are to be drawn back and derived unto some other place and round about the part affected there is some kind of Defensive to be applied as we told you above in the first Part Chap. 5. touching an Inflammation And then immediately the blood and humors that are corrupted in the part and suffocate the Native heat are to be evacuated out of the part affected that so the cause may be taken away and the former heat and vigour may be restored unto the Member Wherefore the part must presently since that there is danger in delay and the blood that hath already begun to be corrupted by reason of its abundance and thickness can hardly be digested or dissipated by Medicaments be scarified with many sections and these ought to be made deep enough and of the corrupted blood a sufficient quantity to wit great store and plenty thereof is to be evacuated And yet nevertheless in the greatness and depth of the Incisions we ought to have respect unto the greatness of the Affect it self and according as the Affect is more or less nigh unto putridness and a Sphacelus so thereafter the Incisions are to be moderated Some likewise there are that apply Leeches or the lesser sort of Cupping-glasses if the blood be not sufficiently and plentifully evacuated by scarifications alone The Incision being made the part is to be washed with salt water or a Ley unto which we may likewise add Lupines or Aloes and boyl them together that so if any of the thicket blood continue yet sticking in the part it may be washed off and that the Reliques or Remainders of the putrid matter may be evacuated and al possible resistance made against the putridness And for this end this Decoction following may be made use of with the which the affected Member as often as any new Medicaments are applied is to be washed Viz. Take of the strongest Ley and of the best Vinegar of each one quart of Water Germander Lupines Wormwood bruised of each half a handful of Flowerdeluce root round Aristolochy and Swallow-wort of each half an ounce let them all be boyled to the consumption of the third part unto the streining add of Aloes and Myrrh pulverized half an ounce and then let them boyl once or twice again at length add Hooney of Roses one ounce Spirit of the best Wine three ounces Mingle them c. When the part is washed then the Aegyptiack Unguent is to be laid on which here is reputed the most excellent of all the rest as being a most efficacious Remedy for the taking away of putridness and for the separating of the dead flesh from the sound But if the Corruption be more then ordinary then Gulielmus Fabricius compoundeth such a like Remedy as this following which likewise resisteth malignity Take Rust of Brass three ounces of the best Honey and with the Decoction of Wormwood and Water Germander scummed one pint Vinegar of Squils six ounces Alum and Salt Armoniack of each half an ounce the Juyce of Rue and Water Germander of each two ounces boyl them to a good thickness and afterwards add of the best Treacle and Mithridate of each half an ounce Camphire one dram and mingle them This Water is likewise very useful if
and dressed up her hair somwhat long as her custom was with warm ordinary Spring water But upon the very first pouring on of the water all the Locks of one side of the Head as it were all besmeared with Birdlime become on a sudden so intricate and intangled that afterward as long as she lived they could by no means wit or device be extricated and severed as formerly but continued thus in long entangled Locks very frightful to behold even unto her dying day And this we conceive to be wrought meerly by Witchcraft But I think this to be very rare and that this Vice proceedeth from some internal Cause we are taught even by this that in those places Bruits likewise are taken with this affect But now what kind of humor that is we shall find it very difficult to explain Very many there are and indeed the most who refer the Cause of this malady unto a certain viscid and slimy humor But these fal short of the truth For in many bodies and many Regions likewise these viscid Clammy humors are generated which yet notwithstanding produce no such Disease For neither may these pains of the Limbs Convulsions and other Symptoms be referred only unto a viscid humor neither can any reason be rendered why this matter should be thrust forth only unto the hairs and unto no other parts But what the Nature of this humor is the nourishing of our body and the generating of other Diseases may in some measure instruct us For although all the parts are nourished by the blood yet nevertheless as divers Plants do from the same Earth attract each one of them that Aliment that is proper and familiar unto them as Hippocrates testifieth in his Book de Natur. human Text. 31. even so likewise one of the same Mass of blood contained in the Veins every one of the parts attracteth unto it self that Nutriment that is most familiar unto it It happeneth moreover that if the blood be less pure that excrementitious aliment is carried more unto one part then unto another And this is plainly to be seen even in the Joynt-Gout Arthritis where that same serous wheyish matter salt and tartareous or cal it how you please is carried more unto the Joynts then to the fleshy parts A proof of this we have likewise from the stone Osteocolla which is very fitly administred in the fractures of the Bones where we find that the very bones themselves attract unto them the said Stone so that it is by experience found that from the overmuch use thereof there have grown forth Callous substances extraordinary great and unsightly of which see Gulielmus Fubricius in his first Century and Observat 91. And therefore I am of Opinion that in those places where this Disease is Epidemical the fault is in the Genius of the place and in the Waters which flow down from the mountains of Hungary into Polonia and in Bisgoia if this Disease be likewise familiar in that Region from the Alps which supplieth unto the hair an abundant Nutriment but unto al other parts of the body such an aliment as is altogether unuseful and which is worse very hurtful which when Nature expelleth unto the hairs the rest of the body is thereby freed from all other grief whatsoever and the hairs alone become vitious And I am the more confirmed in this my Opinion by what was related unto me by the aforesaid Illustrious Lord Count Nicolaus Sapieha that he knew a Boor in Polonia that by bathing Cured such as were troubled with this Disease by the use of which the first seven daies the sick persons became very hairy all their body over the hairs breaking forth in all parts which upon continuing the use of the same Bath for seven daies more fell off again and so the Diseased persons recovered their health And indeed that some Waters have in them an extraordinary and admirable virtues will every where appear unto us in the Writers of Naturall History So in the Alpes Styria and Carinthia by the fault of the Water the Tumors Bronchocelae and Strumae we cal this last being a swelling in the Neck the Kings Evil the former being a swelling in the throat are Natural and as it were bred together with the Inhabitants the vitious matter being thrust forth unto the Glandules in the Neck and into no other places And yet nevertheless I would not have it thought that I do hereby altogether exclude the Air which it must be confessed hath likewise a very great power in altering our bodies and it causeth that in these or those Regions and bodies these or those humors are generated Although it be likewise true that the said Air hath not this power from it self but that it receiveth the same from whose vapors that are lift up and raised from the Waters and out of the Earth which the Water washeth upon and passeth through And for this reason it is that this Malady is not general and Universal throughout the whole Kingdom of Polonia but only familiar unto some certain places thereof in regard that it alwaies spreadeth and rageth there and yet is not from thence dispersed into any other Regions and this Disease Hercules Saxonia acknowledgeth to be Endemick but he wil by no means have it to be Epidemick as we may see in the tenth Book of his Practice of Physick and Chap. 7. of Plica But we have already told you in the second Book of our Institutions Part 1. Chap. 11. that he did not wel understand and therefore could not rightly describe unto us the Nature of a Disease Epidemick and Endemick Now the said Matter is carried unto the hair not as some would have it in the form of vapors but together with the blood it self which as it is of all other parts so it is likewise the Nutriment of the hairs as we told above in the tenth Chapter Which appeareth even from hence that the hairs in the Plica if at any time they be cut they yield forth blood That notwithstanding what hath been said there are now and then some certain persons even in the neer neighboring Regions that are likewise troubled with this Disease this may possibly proceed either from the natural neer allied Genius of that place or else from the Parents For look as Arthritical persons beget the like so also it is not impossible but that those which are affected with the Plica may transfuse into their Issue a vitious disposition unto the generating of the same Disease and Experience teacheth us the truth of this The Son of the aforesaid Lord Count Sapieha when he was six yeers of age had at the first some few intangled Locks of hair among the hairs on his head and the same hath also happened unto others I knew a Souldier an old man that had a Plica in the hinder part of his Head who being demanded as touching the Cause of the Disease for he was a German and horn at Thuringia
wounded or he that hath the greater Veins or Arteries about his Jaws cut assunder And they also very hardly recover their former soundness that have any part of their Lungs or the thick part of their Liver or the Membrane that conteineth the Brain or the Spleen or the Matrice or the Bladder or any Intestine or the Midriff wounded These likewise are in extream great danger in whom the Swords point hath pierced even unto the greater Veins that lie hid and concealed within in the Arm-pits or in the Hams And those Wounds are also dangerous wheresoever there are any of the greater Veins in regard that they soon spend a man by the extraordinary effusion of Blood And this happeneth not only in the Arm-pits and in the Hams but likewise in those Veins that reach even unto the Aâ—se and the Stones And besides these that Wo end is also evil and dangerous that is in the Groins or in the Thighs or in the void places or in the Joynts or between the Fingers As also whatsoever wound it be that hath hurt any Muscle or Nerve or Artery or Membrane or Bone or Cartilage But now because that Hippocrates what he had said in the sixth B. of his Aphorism Aphor. 18. to be Mortal and Deadly that in his Coaca Aphor. 509 he explaineth by saying that they almost die let us therefore see what â—ounds of these parts are simply Mortal and what not And first of all Hippocrates in the Sixth Book of his Aphorism Aphor. 18. reckoneth up the Wounds of the Brain among the Mortal Wounds The Wounds of the Brain and yet nevertheless in his Coaca he limits it and writes that for the most part this is so For all the Wounds of the Brain are not Mortal For Galen himself saw when such Wounds were Cured in the 8. B. of the Vse of the parts and 10. Chap. and in the sixth of the Aphor. Aph. 18. And we have instances thereof in Valleriola in his 4. B. of Observat and 10. chap. and in his 5. B. of Observ chap. 9. and in his sixth B. of Obser ch 4. in Gulielm Fabricius his 4. Cent. Observ 1 2 and 3. and he there giveth us a long Catalogue of the Physitians who had seen some Wounds of the Brain Cured In Johannes Andreas a Cruce in his first B. of Wounds Tract 2. chap. 14. of a hurt and wounded Brain Yea Moreover it hath been observed that after the loss and perishing of some smal part of the Brain yet nevertheless the wounded person hath perfectly recâ—vered for the confirmation of which we have many Histories given us by Divers Physitians Anton. Musa Brasavolus in his Comment upon the 18. Aphor. of the sixth Sect. of Hippocrates Nicolaus Missa in his first B. Epist 11. Fallopius in his Tract of the Curing of Wounds chap. 45. Franciscus Arcaeus in his first B. of the Curing of Wounds and 6. chap. Johannes Andreas a Cruce in his first B. of Wounds Tract 2. chap. 14. Ambrosius Paraeus in his 9. B. and 22 chap. and others all which or at least the greatest part of them have been collected by Schenckius in his first B. Oserva 40. and 42. And well worth Observation also are the Histories of the most dangerous Wounds of the Brain that are extant in Cabrolius his Obse vat 16 22 and 34. in Henricus Petraeus his 2. Tome of Harmonic Disputat Disput 36. Quest 10. in Gulielm Fabricius every where very frequently in wounding of the Heart did long survive For although it hath indeed been observed that Tumors and Ulcers have been found in the Heart yet those seeing that they arise and grow by degrees life may somtimes for a while persist together with them although that in the conclusion even these also bring Death unto the Party But wounds in regard that they suddenly disturb the very frame and Oeconomy of the Heart the life cannot therefore long persist with these And albeit Galen in his 2. B. of the Decrees of Plato and Hippocrates and 4. Chap. relateth that sacrifices at the Altar after the heart hath been cut forth have been heard to cry yet notwithstanding this lasteth so long only as the vital spirits are remayning in the Arteries which being exhausted soon after the Beast fals down and dieth For as Aristotle writes in his third B. of the parts of Animals and 4. Chapter the Heart alone of the Bowels and of all the parts of the Body will not admit of or bear any great injury and this for very good Reason For when the very principium or principal part of all is corrupted and injured it cannot then possibly afford any aid and assistance unto those other parts that depend thereupon And more especially as hath been said the left ventricle of the Heart which is the storehouse and treasury of the Blood and the vital Spirit being wounded the wounded person immediatly perisheth But if the right ventricle of the Heart be wounded that the wounded person may in this case lengthen out his life for some short time is confirmed unto us by a strange but yet true History that we may finde written in a Table hanging up against a Wall in the Library of the University of Groning and as it is described by Gothofredus Hegenitius in Itinerario Frisic Hollandico Page 16. in these very Words Nicholaus Mulerius health to the Reader It hath hitherto been beleeved that the heart being wounded no man could possibly lengthen out his life no not for the short time of one hour Which opinion both Reason and Experience confirm For seeing that our life dependeth upon the safety of the spirits whose Store-house and Fabrick is Scituated in the very Heart the Heart being wounded the said treasury and fabrick that it Scituated in the same must of necessity be wounded likewise But I thought good here to relate unto you a very Memorable History a History I say of a certain Soldier who being wounded at the Heart yet lived above fifteen daies after the like whereunto we meet not with in any of the observations of either Ancient or Modern Physitians Andreas Haesevanger being a Soldier enrolled in the City Garison under the most Illustrious Count William of Nassau Chief Governour of Frisia Groning Omland c. received a wound in his breast from a fellow Soldier of his in the year 1607. the two and twenty day of August in the evening and he died the eighth day of September following an hour after Sun-rising it being the sixteenth day from that whereon the wound was given him The Body of this dead Soldier by the command of the Governour of the City Garison for the discovery of the Nature of this his wound was opened and examined by my self and two Chirurgeons Gaspar and Luke Hulten there being present and looking on that valiant and most Noble Bernhard Hoornkeus there looking on likewise some others both of the meaner and better sort of Soldiers We had no sooner opened the
miraculous unto many men as well Courtiers as Citizens And thus this Boor in the space of a few weeks by the use of fit and convenient remedies administred unto him by that most expert Chirurgeon without any further sickness and trouble alwaies eating wel and drinking and sleeping as somtimes he told me himself by the blessing of God and the liberal Charity of many people toward him in his low and poor condition contrary unto the determinate assertion of Physical Aphorisms fully recovered his wonted perfect health and soundness and not long after he married a Wife But those wounds of the Stomack are especially mortal that are inflicted upon the superiour orifice thereof in regard that it hath those considerable Nerves that arise from the sixth Conjugation of the Brain and thereby obteineth a very neer consent with the Brain and Heart so that it being wounded most grievous Symptoms may very easily be excited And Benivenius in his tenth B. of the hidden Causes of Diseases that are curable Chap. 110. reporteth that a certain Fuller with one blow of his fist upon the Stomack of a young Man smote him so violently that he immediatly died thereof Eightly The wounds of the smal Guts The Wounds of the smaller Guts are by Hippocrates accounted and reckoned up among those that are Mortal And more especially the wounds of the Jejunum or hungry Gut among al the wounds of the Intestines are especially Mortal by Reason of the greatness of the Vessels and the almost Nervous substance of the Tunicle of that Gut from whence for the most part there follow great torments and pains of the Intestines Sobbings and Faintings as is to be seen in the Histories related by Valleriola in his 2 B. Observat 8. and 9. And indeed the wounds of the smaller Guts are then most especially incurable when the said Guts are wholly cut assunder in a transverse manner since that the Lips thereof standing wide one from the other cannot possibly by any means be Joyned and made to grow together But now the wounds of the thicker Guts are less dangerous and especially if they be not great and that oftentimes such like wounds have been Cured appeareth from the many extant Observations of Physitians which Schenckius in his Observations hath Collected Ninthly VVounds of the Liver Hippocrates likewise accounteth the wounds of the Liver in the number of such as are Mortal which yet nevertheless wanteth a limitation For Aegineta hath truly told us in his 6. B. and 28. Chap. that the Liver having been wounded and a part thereof cut away yet that the wounded person may be preserved And Gemma relateth in the first B. of his Cosmocrit and 6. Chap. that a Spanish youth a great part of whose Liver brake forth by the wound of the right Gut was yet notwithstanding Cured And Bertinus also in his 13. B. and 7. Chap. writeth that a Noble person after a wound inflicted neer about the Region of his Liver and a smal part of the substance thereof drawn forth and cut off yet escaped and became sound again And the same hath likewise been observed by others Guilhelmus Fabricius in his 2. Cent. Observ 34. relateth that a certain Helvetian thirty years old in a Duel was with an Helvetian Sword hurt in that part that is opposite unto the Liver and that he received a very great wound one span long and that hereupon there was taken from him a good big piece of his Liver And yet nevertheless this Man notwithstanding the superveising of most grievous and violent Symptoms by the blessing of God was perfeâ—â—ly recovered And Matthias Glandorpius in his Speculum Chirurgic Observ 34. Page 160 hath a History of a youth dangerously wounded in his Liver who yet nevertheless recovered perfect soundness And yet notwithstanding we say that they only recover who have the superficies alone or the substance of their Liver only wounded without any hurt at all of the great Vessels For if there be wounded any one of the greater Vessels the wounded person cannot possibly escape and by reason of the large effusion of the Blood the Man before that the wound can be Sodered and Agglutinated dieth And of these some indeed for a very short time have their life protracted but others of them die in an instant or at least in a very short space For as Hippocrates in his 5. Epidem telleth the story a certain person having had a dart thrust into his Liver immediatly the colour of a dead Carcass was dispersed all his Body over his Eyes sunk in his Head a difficulty of breathing together with an aestuation or sudden vehement passions followed after this and the same day he died Another Boy being strucken upon his Liver by a Mule died the fourth day after and before his Death he was troubled with a short and thick breathing neither understood he any thing but all the while until he died lay under a feaver Wounds of the spleen Tenthly The Wounds of the Spleen are almost of the same Nature and alike dangerous as those of the Liver For if only the Parenchyma of the Spleen be wounded without any hurt of the Vessels the wounded person may possibly escape But if the Vessels of the Spleen be wounded such like wounds are not only dangerous but also deadly and Mortal For seeing that the Spleen hath stâ—re of Veins and especially of Arteries these being wounded by Reason of the great effusion of Blood and Dissipation of the Spirits the wounded person must of necessity perish VVounds of the Bladder Eleventhly The Wounds of the Bladder are likewise found in Hippocrates his Catalogue of Mortal Wounds But yet nevertheless here also a distinction is requisite For a smal wound is soon sodered together by the intervening of flesh as Galen in the 6. of the Aphorism Aph. 18. and Experience teach us But if the whole Bladder chance to be cut quite through which wound Hippocrates calleth Diacope the Wound is then yet more dangerous And indeed that is most especially perillous which is inflicted at the very bottom of the Bladder and the Nervous paâ— thereof for by Reason of the sharpness and extremity of the pain the inflammation following thereupon and the continual feaver the party dyeth soon after But as for these Wounds that are inflicted at the Neck of the Bladder which is fleshly they are Curable as we are taught even by the Cutting of the Stone And yet nevertheless it hath been observed that the Bladder wounded even in the very bottom thereof hath likewise been Cured the truth of which we have confirmed unto us by those examples we meet with in the Observations of Schenckius For the whole Bladder is not altogether Nervous but the Exterior Membrance thereof is more fleshy whereupon Hieronymus Fabricius ab Aquapendente and Spigelius account the said Membrane for the Muscle that shutteth the Bladder But it is very rare that such a like wound of the Bladder is
most grievous Epileptick Convulsion which in the space of â—our or five hours ended his life And I my self also remember a certain Student stout hearted enough otherwise Who being by a Chirurgeon to be let blood in my presence and at my command as the Surgeon was about according to the custom to bind his Arm and began but to move his Instrument toward the vein he fainted away and fell from the seat wherein he was sitting before ever the Lancet was put neer unto his Arm whenas Nevertheless he had neither fever nor any other Disease that might any waies cause and occasion this swounding of his Eightly and Lastly an Inflammation following upon a Wound may render that Wound Mortal if it be internal For indeed an Inflammation doth not necessarily accompany Wounds yet notwithstanding because that in internal Wounds those Medicaments cannot possibly be administred that were wont to be applied in external if any internal part especially if it be more Nervous and of an exquisite sense shall chance to be wounded then a pain is excited and thereupon an afflux of Humors and from thence an Inflammation a feaver a Gangrene and other Evils do arise that destroy the Wounded person within a very few daies And from hence it is that the Vulgar do likewise in Wounds observe the seventh and the nineth day because that within these daies those Symptoms are wont to supervene and in these daies to bring the greatest danger unto the sick Party Some there are that add yet another Cause to wit the influence of the Stars And so Franciscus Vallesius in his Comment upon the 95. Text. B. 4. of Hippocr his Epidem saith that the Malignant Aspect of the Stars and Constellations is the Cause why light and very sleight Wounds are oftentimes likewise rendered Mortal And the very same Quercetan also tels us in his Third Chap. Touching Wounds made by Guns and that for this very Cause the Wounds of the Head are for the most part wont to be Mortal at Ferraria and Florence But this Cause is not to be admitted of neither can there any Reason be easily rendered why at Ferraria the wounds of the Head should be mortal and not so in the neer neighbouring Rhodigium or Bononia And from these Fundamentals no doubt it is that Civilians likewise take upon them to pronounce what Wounds are of themselves and in their own Nature Mortal and what not Nicolaus Boerius in the place alleadged N. 18. propoundeth six Conjectures from which it may be Collected that the Wound was not Mortal of it self but that it was made such by Reason of some accident happening thereupon The first is if the Wounded person died not until a longer time after then wounded persons are wont precisely to prolong their Lives The Second is this if there were present no dangerous Symptoms in the beginning of the Wound or if there were any present and remained for a while the sick person notwithstanding was not much the worse for them but that he was able to perform all kind of Actions in such a manner as they are not able to do that are mortally wounded For if he shall appear to be in a fair way of Recovery and then afterward die it is to be beleeved that he died upon some other Cause and not from his Wound All which notwithstanding are to be understood only of a Wound that is not of it self Mortal The third Conjecture is if the sick person in the Course of his life were not so ordered as wounded persons ought to be but that he exposed himself unto the cold Air addicted himself unto excessive drinking were often distempered with passions of the mind immoderate Anger frequent affrightments and overmuch addicted to Venery The fourth if the Physitians were of opinion and that they adjudged the Wound not mortal who as men experienced in their Art ought to be beleeved The fifth is if the wounded person had no Physitian with him or if any were sent for unto him he was one altogether ignorant and unskilful which is al one as if he had had none at all Which yet nevertheless as hath been said is only to be understood of a Wound not simply mortal in it self For if a Wound be in it self mortal albeit there were no Physitian sent for yet nevertheless we are not thence to collect that the wounded person might have been cured The sixth and last Conjecture is if the wounded person be of a strong Nature For in this Case if due care be taken in the preserving of the said Natural strength and vigour the sick person very seldom miscarrieth But if the Wound being not mortal the wounded person die and that in a short time we ought to collect that he died not of his wound but that he died from some other Cause as we said before And this is the Judgment of all Physitians in general touching Wounds both mortal and not mortal But yet there ariseth another Question among the civil Lawyers to wit whether the person that inflicteth the Wound may be found guilty and condemned of Homicide For these do not only as Physitians weigh and consider the quality and Nature of the wound but the minde and intention also of the party wounding and other Circumstances likewise touching which we may see more in the Books of these Civilians The Rest of the Prognosticks Now although that out of what hath hitherto been said may easily appear what is to be foreknown and foretold touching the event of wounds yet nevertheless we think it not amiss here to add somwhat more as touching the premises For although that other Wounds besides those we have already spoken of do not indeed suddenly destroy and kil the person yet nevertheless some of them are far more dangerous then other and even of these some are more easie some more difficult to Cure And this in the first place is to be learnt from the very substance of the part For the fleshy parts of all other are most easily brought together and sodered again the rest as the Veins Arteries Nerves Tendons and Membranes with more difficulty They may be united and made to grow together again but it will be more slowly Galen in his 1. B. of the Seed and 13. Chap. tels us than himself saw the Veins in the Head and those both many of them and great ones also grow again and in his 5. B. of the Moth. of Physick Chap. 7. that he saw an Artery also united Secondly from the Action and Use of the part For the more Noble the part is in regard of its more necessary Use and the Action that it performeth for the good of the whole Body so much the more dangerous are the Wounds of that part And those parts likewise that are in continual motion will not be brought to grow together again but with much difficulty And the more exquisite likewise the sense of the part wounded is the more easily upon its being Wounded
of the wounded part be by all manner of means preserved 6. That all the symptoms and whatsoever may possibly hinder the uniting and Coalition of the part may be taken away and removed And thus although that a wound only considered as a wound is one simple Affect and seemeth to indicate and require one only uniting yet nevertheless the very truth is that there are herein couched very many indications as before we told you Chap. 5. Of things extraneous and from without that are to be taken forth of the VVound IN the first place therefore we must use our endeavour that there may be nothing extraneous in the wound that may hinder the union and glutination thereof And therefore first of all the blood is not instantly to be suppressed and we must permit whatsoever we find sticking in the lesser veines cut assunder freely to flow forth For so by this means there will both a less quantity of Pus be generated and all the danger of putrefaction and inflammation be prevented Which is likewise very well known by him who out of simple wounds is wont either to extract the blood by sucking it forth with his mouth or to squeez it out by the compression of the wounded part with his finger Moreover when there are any hayres neer about the wound they are to be shaven away lest that they fall within the lips of the wound Thirdly if sand or earth or any such like thing stick within the lips of the wound it is to be cleansed away with wine Fourthly if there shal be any Clods of blood in the wound seeing that they may hinder the uniting excite pain and putrefying may cause a fever they are therefore to be wiped away with a piece of a soft Linen Cloth or a lock of wool or if need require they may likewise and must be taken forth with an iron instrument In which action notwithstanding we must use no manner of violence at the first setting upon the cure neither is all the Clotted blood at once to be taken forth and especially if a Hemorrhage be feared since that the clods of blood may stop the orifices of the veins and the vessells may grow together under them but this is to be deferred until the second or third dressing when we have afterward nature her self which beginneth to expel whatsoever is extraneous helping and assisting Fifthly the little broken bones likewise if any such be in the Wound are to be taken forth In the first dressing nevertheless only those things are to be taken forth that are altogether free and loose so that they may be taken out of the Wound without offering any violence thereunto but as for such smal pieces as yet stick fast unto other bones in these Natures endeavour is to be expected and so it wil soon be seen whether she intend to unite these fragments that are broken with the rest of the bone or else whether she purpose to make a separation Sixthly if Glass be broken in the wound it is to be taken forth and this is also to be done if any other kind of Weapon or Arms wherewith the wound is inflicted stick in the Wound But before we assay the extraction of the said weapons we are to look and consider whether or no the wounded person be likely to live after the drawing forth of those things aforesaid For if there be no hopes of life remaining there is no such taking forth of any thing to be attempted no not of the weapon it self lest that the Chirurgeon should be thought to have hastened on the parties death and lest the wounded person dye under the very hands of the Chirurgeon which happeneth sometimes in the wounds of the Heart of the Brain the basis thereof especially the Vena Cava or great hollow vein or the great Artery For it hath been observed that such wounded persons though the weapon hath been left in the wound have yet lived for the space of a whole day but that upon the drawing forth of the weapon by reason of the Hemorrhage following thereupon they have instantly died But where there is any hope that the sick person may be recovered of his wound we ought then to labour that first of al the weapon be drawn forth For the weapons as likewise leaden bullets although they may somtimes stick very long in the body yet notwithstanding it is a very rare thing that a wound should be perfectly cured the weapon stil secretly abiding in the body But now to draw forth the weapons aright is a thing of much difficulty The drawing forth of the Weapons and this difficulty ariseth especially from the place into which these weapons being thrust into the body have penetrated And therefore for him that wil attempt rightly to draw out the weapons forth of the body there are two things mainly necessary First wel to consider and mind the substance and nature the figure situation and connexion of each several part of the body and then Secondly to know the diversity of the weapons from their matter magnitude and figure and it is likewise altogether necessary in the drawing out of the Weapons to be cautious that the veins Arteries Nerves and tendons be not torn or violated For as Ambrose Parry saith truly it would be a thing very shameful and much unbecoming an Artist that the hand of the Chirurgeon should do more hurt then the iron weapon But that the weapons may the more fitly and expeditely be drawn forth let the wounded person be set in such a posture and figure as he was in when he received his wound Which if it cannot altogether be done yet lying along let him so be placed that he may come as neer as is possible unto that figure Now the Weapons are taken forth in a twofold manner How many ways the Weapons may be drawn forth either by extraction or impulsion that is to say either the same way that the weapon went in or else that way that it tendeth It is extracted the same way that it was thrust in either without making any section or else by a section made in the part For if the weapon hath not pierced very deep if it hath not passed thorow the great vessells and Nervous places and if that either right opposite unto it or the way that it tendeth it hath bones veins arteries or nerves and lastly if there be no great fear of any danger to follow upon a wide opening of the part then in this case it may be drawn back the same way by which it pierced into the body and that without any section at all But if there be any danger and cause to fear lest that the body may be torn if the weapon be drawn back the same way by the which it entered in the wound is then to be dilated either by section or else even without it to wit with that instrument which Celsus in his fifth Book and Chap. 7. calleth Ypsiloeides or
Spiders cobwebs Bolearmenick the soft flix of a ha e of each one dram make a powder Or Take A dead Nettle and having beaten it into a very fine powder strew it upon the wound Neither are we to desist from the use of those Medicaments until the flesh that is bred is so produced about the vessel that it shut up the orifice thereof For unless this be done there wil yet be alwaies great cause to fear an haemorrhage Magatus his Water against the hemorrhage Caesar Magatus in this first Book and 61. Chapt writeth that this water following being wel mingled together with the whites of Eggs throughly beaten doth perform wonderful effects Take Juice of Plantane of the sowr unripe Grape of Quinces of sharp and tart Pomgranates vinegar made of black wine of each one pound the Juice that is newly pressed forth of Asses dung one pound the whites of thirty Eggs wel beaten together The herb Horstail Strawberry leaves Mousear Adders tongue the herb Trinity winter green the herb Perewinkle Wild Tansey Bears ear the leaves of al these new and fresh gathered one handful the new and fresh Roots of the greater consound one pound the greater Centaury half a pound Pomgranate Rinds and flowers unripe Galls of the Oak Gum Arabick Tragacanth Sarcocol White Frankincense of each half an ounce Roots of Tormentil Bistort Bolearmenick Sealed earth Dragons blood Earth of Samus of each of these three drams bruise what is to be bruised and powder those things that are to be powdered and so mingle them and after a three days maceration in a double vessel let there be a water drawn forth according to Art But I doubt much whether or no this destilled water wil have in it any considerable Astringent virtue in regard that that part of simple Medicaments in which the astringent power doth chiefly lie can hardly ascend thorow the Alembick More efficacious is that water that is destilled from Alum after the manner following Take of the best Alume as much as you please The Alum Water powder it and put it into a Buls or Oxe bladder and so put it into a kettle of hot water that the Alume may be dissolved Destil this water by an Alembick and continue the work so long even until the feces reside in the bottom And these are again a new to be dssolved in the Oxe bladder until the whol substance of the Alume shal by destillation be convertedl into water But if the blood shal not be stanched by these Remedies Whether in case of an Hemorrhage we may use Causticks there are some that use Causticks that bring a crustines over the Wound and so by the benefit of it shut the Orifice of the vessel But the truth is this way is not safe enough but ful of peril For seeing that so much of the Particle as is burnt into a crust so much there falleth away of the Natural flesh from the part when the crust falleth off the orifice of the vessel is again left naked and bare of flesh so that there is oftentimes a new haemorrhage excited and not easily stanched Of these we may most safely make use of such of them as being burnt retain stil a caustick virtue and being not burnt have in them a notable astringent power but very little of the Caustick faculty whereby they burn and such a like medicament is crude vitriol which therefore some crude as it is do beat into a powder The virtue of vitriol in an Haemorrhage and so sprinkle it upon Wounds for the stopping of the haemorrhage But others there are that dissolve it in water and then they moysten linen clothes lay them upon the wound And moreover Calcanth which some call shoomakers black either pulverized or else dissolved in a convenient liquor is of singular use in wounds where the orifice of the vessel cannot be closed either by compression or by that mushrom before mentioned which they commonly call Crepitus Lupi or even by burning be there never so great need thereof But this Calcanth especially if dissolved in liquor penetrateth even thorow the very vessel that is hurt But here notwithstanding we are to beware that the nerves if any be neer be not hurt And therefore into such like deep Wounds if there be any Nerves in the wounded part other Medicaments that have a power to stanch blood are rather to be cast in by clysters that have little ears affixed to them or some other fit and convenient instruments .. In the interim notwithstanding it will be likewise very requisite to administer certain general or as they cal them universal remedies that make for the stopping and stanching of the blood to wit drawers back intercepters and certain internal Medicaments that stay the blood Those things that draw back are first Venesection venesection appointed in the contrary place which may then only be put in practise when the hemorrhage is not great and the strength of the Patient but little impayred But yet nevertheless that so the Patients strength may be the better preserved and the revulsion performed with the more expedition the blood is not at once to be evacuated but at several times But if the Patients strength wil not bear venesection in this case Cupping-glasses both dry and scarifyed as need shal require are to be applyed in the remote and opposite places But now Intercepters are administred Intercepters to the end they may drive back and incrassate the blood while it is in flowing unto the part that they may make more narrow those waies and passages by the which it floweth But now such intercepting Medicaments are to be applyed unto the vessels by which the blood tendeth unto the wounded part and so above upon the part toward the root of the vessel and more especially where it possibly may be done in the exterior parts where only the veins lie hid under the skin and are not covered with much flesh touching which Hippocrates in his fifth Section Aphoris 23 giveth us this advice We ought saith he to make use of some cold medicament in those persons that have at present any blood flowing from them or that are likely to be troubled therewith and this medicament is not indeed to be applyed unto the same place but unto those places from whence it flâ—weth if there be any inflammations or burnings of the parts that tend unto a red or bloody colour by reason of the fresh and flourishing blood that now appeareth therein unto these very parts let it be administred Now these intercepters are made of Medicaments that are cold and Astringent as Posca a compound of vinegar and water harsh wine the water of Roses of Plantane of the Oak and of night shade Barly meal the powder of Myrtles Bâ—learmenick Dragons blood Mastick the flowers of red Roses Pomgranate flowers and the whites of Eggs of which there are divers Medicaments to be made the forms whereof are
communicated unto the spittle and by it may as easily be imparted unto the Wound and this happeneth much the rather if so be the Man be Frantick And if there were altogether nothing of virulency in the Wound that is inflicted by the biting of one of these living creatures yet notwithstanding the very contusion it self which rendereth all wounds whatsoever the more dangerous and the more difficult to be cured maketh those wounds the more grievous For since that the teeth of the said Animals are not so sharp as a sword or some other kind of Weapon while they wound they do withal likewise bruise and cause a Confusion in the part they fasten upon Prognosticks But now how dangerous these wounds also may be that are caused by one mans biting of another Guihelm Fabricius teacheth us by three Examples and instances that he giveth thus in his 2 Century Observat 84. and 85. The first whereof is of a certain Merchant who a midst his Cups by anothers biting was wounded in the very tip of the right forefinger whose whole right hand upon the same biting became inflamed and a Gangrene soon after began to follow with Convulsions an extreme burning feaver a Syncope and continual restlesness The second instance is of a Physitian who rashly and inconsideratly putting his finger into the mouth of a Phrantick woman to the end he might feel her tongue had it bitten by this mad woman and upon this biting he became extremly afflicted with a vehement pain not only in the said finger but in the whol Arm also The last example is of a man that being by another furious and enraged person sorely bitten even unto the first Articulation of his Thumb he likewise was in stantly taken with a vehement pain al that Arm throughout and soon after there followed a feaver and a Syncope Matthias Glandorpius in Specul Observat Chirurgic Observ 49. relateth the like History of a certain person who by another mans teeth the man being much enraged was wounded in his thumb about the first Joynt from whence there arose a most extreme pain an Inflammation of the whol hand a Continual fever a restlesness of the body frequent faintings and swoundings and a very intense pain of the head And evermore the wounds are dangerous both in themselves by reason of the contusion as also because that the spittle of the furious and enraged Animals hath somwhat of malignity Joyned with it and they are so much the more dangerous if any of the Nervous parts such as are the fingers shal chance to be bitten The Cure In regard that as we have said in every wound that is inflicted by the biting of any living Creature there is present a Contusion and this somtimes greater and somtimes less according as the teeth of those Creatures are more sharp such as are the teeth of a Dog Ape and Squirrel or else less sharp as those of a Man Horse Ass c. and that from this Contusion the pain is caused therefore there ought a regard to be had both unto the Contusion and the pain And therefore in the first place the blood is carefully to be pressed and squeezed forth of the wound and opening of a vein or purgation according as need shal require is to be instituted and to prevent the greater afflux of the humors and the Malady from being communicated unto the superiour parts some Defensive of Oxycrate or some oâ— her the like is to be imposed upon the superior part but unto the Wound it self for the asswaging of its pain the promoting of the suppuration and the keeping of the Wound open such a like Medicament as this that followeth is to be applyed Take One Egge butter half an ounce Saffron one scruple Oyl of Violets and Roses of each two drams and mingle them or Take Marshmallow Roots one ounce and half the leaves of Mallows flowers of Camomile and Melilote of each half a handful Wormwood two pugils boyl them to a softness and let them be wel bruised and mashed together when they are wel bruised add unto them the yelk of one Egge oyl of Roses and Camomil of each as much wil suffice and make a Cataplasm If there be any fear that there is some kind of virulency in the Wound then we may ad Scordium as also Treacle and therefore such an unguent is to be provided Take The Basilick Vnguent and fresh butter of each half an ounce Treacle one dram oyl of Roses one ounce the yelk of one Egg and mingle them And moreover that what is bruised may be wholly converted into Pus we are to use Honey of Roses Rosin Turpentine with the yelk of an Egge or the Basilik Vnguent or if any Malignity be feared this that followeth Take Pounder of Myrrh Root of Round Aristolochy Orrace of Florence and Aloes of each one dram Angelica half a dram Treacle dissolved in the spirit of Wine two drams with hony of Roses make a Liniment And at length the Wound being wel wiped and cleansed it is to be filled up with flesh and so shut up with a cicatrice as in other cases is wont to be done If a Gangrene be feared as nigh at hand then the Cure is so to be ordered as we sayd before touching the Gangrene Glandorpius his father in the case before alleadged besides general and internal remedies was wont to administer these Topicks First of all with this Unguent he anoynted the filaments and then he imposed them hot upon the Wound with the Citrine Emplaster As Take Venice Tuâ—pentine often washed one ounce the powder of Earthworms two scruples Frankincense half a dram the yelk of one Egge and mingle them The hand even unto the wrist was anoynted with the Oyl of Roses The pain increasing he applyed warm this following Cataplasm Take Scordium or Water Germander the herb Sauce alone or Jack by the hedg of each four pugills or smal handfuls Wormwood the tops of St. Johns wort Sage Marjoram of each two pugills Red Roses three pugils flowers of Camomil and Melilote of each one pugil the pith of Rie bread three ounces bran one ounce the meal of Lupines one ounce and half with a sufficient quantity of Wine make a Cataplasm adding in the conclusion oyl of Rue six drams oyl of Roses with Earthworms an ounce and half the yelk of one Egge Saffron one scruple and mingle them The pain yet for all this little or nothing remitting about the hand wrist and the Elbow he applyed this Defensive Take The Vnguent of Roses Champhorated or with Camphyre and the Santaline Oyl or the oyl of Saunders of each half an ounce oyl of Roses with the Juice of Night-shade three drams Bole Armenick two drams powder of red Roses one dram Rose vinegar as much as wil suffice and mingle them The pain somwhat abating there was then discovered a Nerve or rather a black Tendon and upon this he strewed the following powder Take Roots of round Aristolochy
flame it self penetrateth unto the Pouder or else that the Bullet striking against Iron or some Stone is kindled by the sparks of Fire just as we see it to be in the striking together of the Steel and the Flint-stone Fourthly if instead of the Leaden bullet either Papper pellets or pellets of Hurds be ram'd into the Gun and then shot forth there will not appear any the least tokens of any burning in them caused either by the Gun-pouder or else from the vehemency of motion but only that somtimes they are sullied by the Gun-pouder and made a little black and they are oftentimes drawn forth of the very Wounds as whole and entire as they went in Fifthly Those who are thus wounded do not feel any heat or burning from these bullets but only a pain from the bruising and tearing of the flesh Sixthly That those bullets are not made hot either by the flame of the Gun-pouder or else by the swiftness of their motion we are sufficiently assured of it even by this that a bullet made of Wax and shot forth of a Gun doth not at all melt but that it even pierceth through a two inch board or any piece of Wood two Fingers thick And from this alone it may appear very manifest-that those bullets whatsoever it be that they do it is not by the power and virtue of any Fire that they have in them but what they effect is meerly by their force and violence But now that I may a little open unto you my thoughts The Decision of al the opinions and give my Judgment touching this Controversie I conceive the third Opinion well weighing the Reasons that are brought for it to be the most agreeable to truth But those Arguments that are brought for the two former Opinions may easily be answered For the first of the three who defend that those Wounds are poysonous they do not prove it by this that first of all grievous and dangerous Symptoms do infest those that are wounded in this manner For all those Symptoms may possibly proceed from a Contusion if it be not rightly Cured or if it be overgreat and that there be from hence a putridness excited For when that bullet doth with the greatest violence that may be penetrate through those parts against which it hitteth it dashet together all whatsoever lieth in its way briuseth and teareth it by which said violence not only the Capillary Veins and the Arteries and Nerves that be every where up and down dispersed throughout the flesh are rent and torn but the greater Vessels likewise are battered and broken insomuch that the Natural flux of the Blood and the Spirits is hereby hindered whereupon the bruised parts being deprived of their Natural and Vital heat are easily corrupted and soon putrifie Neither can it truly be said that the trembling of the Heart and the like Symptoms do happen unto all that are thus wounded But as for what they say in the second place that Alexipharmaca or Counter-poysons have been somtimes found very good and commodious for the person thus wounded we answer that this is not true of all Wounds made by Gun-shot but of those only when by the Contusion and the great putridness following thereupon and the neer approaching of a Gangrene the Heart is hurt by the putrid Vapors ascending from the Wound through the Arteries and thereupon it is by Alexipharmick and Cordial Medicaments to be defended from them and withal strengthened But that those Wounds are a long time to be kept open this is not therefore to be done that so the poyson may be evacuated but that the Pus that is continually generated from the bruised parts may be emptied forth which is done too slowly in regard that in such Wounds as these there is very much of that that is bruised And Lastly for what they alleadg that in many battles the most of those that have been wounded either they have Died or else they have been preserved with very great pains and much difficulty this did not therefore happen because that the Wounds inflicted by Gun-shot were poysonous since that in very many other battles no such thing hath been observed but it happened from hence to wit either by reason of the bad and unhealthful Constitution of the Air or else from the vitious and unsound Constitution of the Body and the great store of depraved Humors in these wounded persons such as is most commonly wont to be in those that follow the Camp But now in special and particularly the poysonousness of those Wounds cannot be proved to arise either from the Gun-pouder or from the bullet For as we also told you before neither is the Sulphur nor the Nitre nor yet the Coals all or any one of them poysonous and therefore surely of these there can nothing be compounded that is poysonous And that Sulphur and Nitre may be safely administred appeareth out of Dioscorides his 5. B. and 83. Ch. and out of Hippocrates in his B. of the Nature of Women and others both Ancient and Modern Now the kindling and inflaming of these and the Fire following thereupon would rather dissipate this poyson if any such were present then any waies produce it Neither do those that make this pouder stop their Mouths and Nosethrils by reason of any poysonous quality that it hath but to keep out the pouder that is otherwise very troublesom when it gets into the Mouth of Nosethrils neither yet do all that make pouder stop the aforesaid places although some do for the reason I have given you And moreover much less can this poysonousness be produced from the Lead For although it being long deteined in the Body and there resolved like unto other Metals if it contract any rustiness it may possibly do hurt but yet nevertheless that in this its moment any passage through the Body there should be any poyson imprinted by it upon the Body this can no way be And as we told you above these bullets have somtimes been known to lie in the Body for many yeers together without any inconvenience or hurt yea and moreover from lead there are many very useful Medicaments to be made for External Ulcers But this we easily and of our own accord yield unâ—o and readily grant them that those Bullets as also all other Weapons may be infected with poyson For although the Lead be thick enough yet nevertheless since that Iron that is yet far more solid may be infected with Poyson why may not Lead also be poysoned Now that Iron may be infected with poyson there is no doubt at all to be made the truth whereof is sufficiently testifyed by the Histories both Ancient and Modern of those Nations that as yet use Arrows And this we are assured of by Dioscorides in his sixth Book and 21. Chapt. and by Paulus Aegineta in his sixth B. and 88. Chap. and by Virgil in the tenth B. of his Aeneids and elsewhere as also by Ovid in his
already spoken in our first B. of Feavers and especially that in the Quotidian the Signs of putridness disappear in the Urine whereas in putrid Feavers they appear therin And so the heat in putrid Feavers is far greater and sharper then in Quotidians and so are also the Symptoms more grievous and withal there is a greater dejection of the strength and powers of the Body Prognostick Now these Feavers in regard that they wholly depend upon the Inflammation they are therefore greater or less according to the greatness of the inflammation and so likewise more or less dangerous Cure These Feavers are taken away and Cured upon the removal of the Inflammation like as al other Symptomatick Feavers touching which we have already spoken in their proper place And therefore we ought in the first place to do our endeavour that by coolers and other convenient altering Medicaments this Feaver may be Cured lest that otherwise a putridness be excited in the Humors or if there be now already present any putridness that it may be restrained and kept under And Fourthly There happen likewise feavers unto Wounds Feavers from the putridness of the Humors kindled even by the putridness of the Humors that are in the Wound it self as being neerly related and allied unto those things that are raised and have their rise from the Pus or thick purulent matter Signs Such Feavers as these are known from the Quantity quality of the Excrements of the wound For there floweth forth great store of Sanies and this resembleth somthing that is putrid rather than good laudable Pus and it is of a various and evil colour and of a very unsavoury and offensive smel And although there should not flow forth any great store of Pus or Sanies yet nevertheless if the matter that floweth forth be naught and corrupt if the colour of the part be changed and if there be present any pain and heaviness in the part it is then indeed a sign and token that there is present a vitious matter and that it hath not been sufficiently purged forth But in the mean time there will be present and appear the signs of a Feaver which will shew unto us in the Urine the Notes and Marks of putridness or it may be they shew us none according as the matter is more or less communicated unto the Veins and Arteries Prognostick And as for these kinde of Feavers they are more or less dangerous according as the putridness is greater or less and likewise as it is in a part more or less noble and accompanied with more milde and gentle or else more sad and grievous Symptoms and according as there may be made a passage for the more easie or more difficult flowing forth of the vitious matter Cure The Cure consisteth in this especially that the putridness in the part affected be with all speed and as much as may be restrained and kept under and that by all means possible there be a way and passage made for the vitious matter to flow forth For the putridness being taken away and removed the Feaver soon after easily vanisheth of its own accord And Lastly There is also a kinde of Feaver A Feaver from the vitious preparation of the Humors which ariseth in wounded persons from the storing up and the great provision that hath been made of vitious and naughty Humors and the ill preparation of them For if the wounded Body be impure it may then easily be that a Feaver may be kindled in it upon the occasion of the Wound Now this is done in a twofold manner and upon a double account First of all from the commotion and disturbance of the Spirits and Humors after the receiving of the Wound For as in Bodies otherwise impure there are Feavers oftentimes kindled from the passions of the minde and Commotion of the Body even as we see it to befal Women that have hard labour in Child-bed so the very same may likewise happen in those that are wounded And furthermore a Feaver is also kindled from a putridness in the wounded part For as in Child-bearing Women there are Feavers oftentimes kindled from the retention of the Secundine and the blood that usually floweth from them after the Childe is born and this so much the more easily if their Bodies be impure even so if any putridness be kindled in the wounded part and that the depraved Vapors communicated unto the Veins do finde any vitious Humors in these Veins then a Feaver ariseth thereupon Now these Feavers are various according to the different preparation of the vitious Humors somtimes intermitting and sometimes continual according as this treasury of the vitious Humors is laid up either without the Vena Cava viz. the great hollow Vein or else sticketh fast in the same and indeed for the most part they are Tertians either continued or intermitting single or double and very rarely Quotidians and most seldom Quartans Signs These Feavers are known in that both the heat and the Urine and the pulse do all of them discover sure signs and tokens of a putridness But now whether these Feavers are kindled only by the commotion and disturbance of the Humors or else from the putridness in the wounded part it is known by this to wit that if the Feaver proceed meerly and only from the Commotion of the Humors then such a Feaver invadeth the person immediatly and in the very beginning and there is no vitiousness or fault at all to be found in the Wound But if it proceed from any putridness in the Wound then the Feaver appeareth not instantly and at the very first but after a short time and then there are Signs and tokens of Putridness in the Wound it self But then for the Nature and Quality of the Feaver it is to be known from the proper Signs of Feavers Prognostick Of these Feavers some of them are more dangerous then other some as we have already told you before in its proper place touching Feavers and intermitting Feavers they are of themselves altogether void of danger but the Continual are somwhat more dangerous and that likewise more or less according to the quality and condition of the putridness But yet because that these Feavers happen and follow upon Wounds they al of them therefore bring some danger along with them more or less For whereas the wounded part was weak before now the Feaver happening thereupon increaseth the debility and so augmenteth the danger thereupon depending and thus it may very easily come to pass that at the part affected there may be a fluxion excited or else by reason of the heat weakned upon the aforesaid Cause very many Excrements may be generated in the part and from hence other evils may be excited Their Cure Now as for the Cure of these Feavers albeit that they are occasioned by the Wound yet nevertheless because that the vitious provision of Humors is the principal cause of them therefore these Feavers are
to be cured in that manner we told you of in its own proper place Touching the Inflammation Now very often there happeneth unto Wounds an Inflammation and somtimes likewise an Erysipelas And indeed an Inflammation doth most commonly if not evermore follow upon the inflicting of a Wound and more especially in the Nervous parts in regard that the afflux of Blood unto the part affected stirreth up and causeth a pain therein and moreover because that the Blood when it cannot sufficiently flow forth from thence it putrifieth and very easily exciteth an Inflammation which is prevented by a due and sufficient efflux of the Blood touching which Hippocrates thus writeth in his B. of Vlcers If there flow forth of the Wound Blood more or less according to the strength of the wounded person then both the Wound it self and those parts that are neer about it are the less troubled and affected with any Inflammation that shall follow upon the Wound And therefore if there be any cause to fear an Inflammation and if the blood hath not sufficiently flown forth then forthwith a Vein is to be opened in the opposite place and the Blood is to be evacuated according to the strength of the sick person and as he is well able to bear it Yea and moreover if there be already present an Inflammation and that the Patients strength will bear it and necessity so require Venesection and Purgation are both of them to be administred according as there shall be need If the Inflammation be excited from pain then we are to endeavour that the said pain be taken away and withal that the afflux of Humors be repressed Avicen for this use highly commendeth the Cataplasm that is made of the Pomegranate boyled in astringent Wine then bruised in a Mortar and so made up into the form of a Cataplasm There may likewise a Cataplasm be made of the meal of Barley of Sea-lentiles Mouse Ear and Oyl of Roses But if the Inflammation be not removed by these the rest of the Cure is then to be performed as we shewed you before in the first Part Chap. 5. Touching an Inflammation Of the Erysipelas If an Erysipelas follow upon the Wound this will soon appear from those Signs that we gave you in the first Part and 7. Chapter touching an Erysipelas And in what manner it is to be cured is manifestly declared by those things that are there spoken of And the truth is Hippocrates in his B. of Ulcers teacheth us that whensoever an Erysipelas shall follow upon an Ulcer that then the Body is to be purged And indeed if it be so that Choler abound lest that there should be an afflux thereof unto the Wound it will be very expedient wholly to evacuate the same And yet notwithstanding because that the Erysipelas which we cal Rosa hath its original rather from the thinnest of the Blood and that part of it that is peculiarly corrupted Sudorificks are therefore most especially useful as there we told you Hippocrates was wont to impose upon the part affected the Leaves of Woad or the Juyce thereof with Clay We may likewise apply unto the place affected Cataplasms of Barley meal and Eldern Water and other the like such as we have there mentioned to wit in the place before alleadged Of the Super-excrescent Flesh And sometimes likewise it so happeneth that the Flesh becometh Luxuriant and proud as we term it and groweth forth beyond all reason and measure which hidereth the production of the Cicatrice and its covering over of the Wound or at least it causeth the same to be unfightly and deformed But this happeneth through the unskilfulness or want of care in the Physitian who administred Medicaments that were not sufficiently drying And therefore what Flesh we finde to be superfluous we must take it away that so the Wound may be shut up with a Cicatrice But now this is the work of the Physitian who is to consume the superfluous Flesh with Medicaments that are sufficiently strong in their drying cleansing and if need so require somwhat Corroding likewise But now what those Medicaments are with which this may be done we have told you before in the 2. Part and 7. Chapt. whither we refer you Of all which Medicaments there mentioned the most useful and principal is the Green Water there spoken of which both consumeth the superfluous flesh and likewise bringeth the Cicatrice over the Wound when it is cured Of the Haemorrhage There happen also many Symptoms unto Wounds which partly deject the strength of the Patient and partly render the Curing of the Wound more difficult then otherwise it would have been And first of all there oftentimes happeneth indeed an extraordinary great Haemorrhage and profusion of the Blood which doth not only deject the strength and Spirits depriving the Patient oftentimes of his Life but it likewise very much hindereth the Cure For so long as the Flux of Blood lasteth there can nothing at all be done in the Cure Now that said Haemorrhage happeneth upon the wounding of the greater Veins as also the Arteries not only the greater of them but the mean and middle sort of these Arteries But touching this Symptom we have already spoken above in the 14. Chapter where you may see further Of pain with the VVound And oftentimes likewise there is an extraordinary vehement pain following and accompanying the Wound For although there be indeed hardly any Wound without pain yet nevertheless very usually this pain is tollerable and such as the Patient can wel bear But somtimes it is vehement and altogether intollerable which happeneth more especially when the Nerves and the Nervous parts are hurt and Wounded and an extream vehement pain arising immediatly upon the inflicting of the Wound is a sure and certain Sign and token that either a Nerve or a Nervous part is wounded The Cause Now this pain is excited in Wounds somtimes by reason of Errors committed by the Patient in the Course of his Dyet whiles he eateth all manner of bad and corrupt food as Cabbage and Cole-worts salt Fish Swines flesh or the like whiles he exposeth the wounded part unto the cold Air and moveth it overmuch by exercise And somtimes also this pain happeneth by the Carelesness of the Chirurgeon who administreth Medicaments that are overhot and too sharp hindeth the part too hard and streight placeth â— not aright thrusteth into the Wound Tents over long or thick leaveth the Pus over long in the Wound and suffereth some piece of bone to prick and molest the part that lieth next unto it And somtimes also without any of these Causes a pain may be excited by an internal afflux of the Humors and this pain oftentimes invadeth the wounded person suddenly and with a certain unwonted coldness and Chilness and this is oftentimes a very shrewd sign of some great Inflammation instantly to follow or even of a Gangrene very nigh at hand and this especially if together with the pricking
the Physitian endeavour that there may be a sufficient supply of a matter fit for the breeding of the Callus Unto which end the Food administred unto the Patient let it be somwhat more plentifully given then formerly and let it be of a good and somwhat a Tenacious Juyce such as proceeds from Rice Wheat and the like But because that before the twelfth day there is scarcely ever any Callus generated or that so much as beginneth to breed and moreover that at first there are many Symptoms to be feared therefore this ful Dyet is not presently to be allowed of in the very beginning but a more sparing Dyet is to be observed yea and if need require blood is to be drawn forth by opening a Vein or purgation to be ordered unto the Patient and then after this in the end as we said before when the Callus beginneth to be generated a more ful Dyet is to be allowed him And there are wont likewise some Medicaments to be administred inwardly which conduce much unto the more speedy generating and producing of the Callus as the Pouder and Juyce of Agrimony Roots And very many there are that commend most highly the Osteocolla stone before spoken of of which beaten smal into a pouder they oftentimes give one dram with Comfrey Water But in such as are young and those that are of a good habit this Callus groweth and increaseth too much by this ful Dyet wherefore it is not to be allowed unto them without much caution but only unto such as are more stricken in yeers Touching which thing as also touching the use of Meats viscid and tenacious which most Physitians conceive are to be appointed in Fractures you may read Guilhelm Fabricius in his 1. Century Observat 90. 91. and 92. There may likewise be Decoctions prepared of the Roots of Consound both the greater and the less Dragon-wort Agrimony and Primeroses As Take Roots of Consound and Dragon wort of each one ounce Storks bill one handful Savine half a handful Mace half an ounce Zedoary and Galangal of each two drams boyl them in Wine in a double vessel and let the Patient drink twice a day of the straining The same Fabricius in his 3. Centur. and 90. Observat makes use of this Medicament Take the Ossifrage Stone carefully prepared one ounce Choice Cinamom three drams Sugar two ounces Mingle and beat them into a very fine pouder give two drams hereof in Flesh broth every day in the morning And for external Remedies he commendeth such as these Take Oyl of Earth-worms two ounces Grains of Juniper two drams the Juyce of Earth worms one ounce Mingle them and make a Liniment with which anoint the Fracture Or Take Vigo's Emplaster for broken bones two ounces Oxycroceum half an ounce the Osteocolla stone prepared one ounce and half Earth worms prepared and poudered one ounce with as much of the Oyl of Earth worms as will suffice make an Emplaster and lay it upon the place affected When the Callus that is bred is come unto its Just magnitude it is then to be confirmed by Medicaments that Corroborate and therefore such an Emplaster as this is to be laid on Take Oyl of Roses two ounces Wax three ounces and half the Pouder of Rosin three ounces Colophony Mastick Frankincense of each half an ounce Cypress Nuts and the Root of Madder of each one dram Saffron half a dram Mingle them and make a Ceroteâ— which may be spread upon a Linen Cloth or a piece of Leather and so applied The Diet. And as for matter of Dyet there ought to be likewise a good and an exact Course such as before we told you of in Wounds For if Nature be not offended either by the quantity or the quality of the Food she will then more rightly discharge her Office and part in the generating of the Callus And indeed some there are who appoint Meats viscid and clammy of the Feet Heads and intestines of some of the Creatures But we may well fear lest that from such like Meats as these there may be bred a thick and viscous Chile that may afterwards breed obstructions in the Liver and the Veins and may infect the whole Mass of Blood like as Guilhel Fabricius gives us an instance of this very thing in his first Cent. and 92. Observation in a certain person a man fourty yeers old who by the use of such kind of meats fell first into a Cachexy and soon after into a Dropsie and of this Dropsie he died And we have sufficiently found by experience that many sick persons in this Case have without the use of any such Food been perfectly recovered Chap. 2. Of a Fracture with a Wound THe main and chief Difference of a Fracture and that which very much varieth the Cure is a Fracture with a Wound Now this happeneth when the sharp Eminencies or points of the broken bones do perforate the flesh that lieth upon them Which whensoever it happeneth the Member is made shorter then it was before but when the naked and bare bones are restored again unto their proper places the Member then returneth unto its pristine Longitude And yet nevertheless somtimes these like fractures happen by some cutting Weapon when by it not only the flesh but even the very bone it self is Cut. But now in these Fractures with a Wound the bone is somtimes made naked and somtimes again it is not left altogether bare and moreover somtimes also we fear the falling out of the bone or some Fragment thereof but then somtimes again we fear no such thing Prognosticks 1. But now such like Fractures are yet far more dangerous if they happen to be with the Flesh and Skin lying over it remaining stil whole and sound For that perforation exciteth a pain and an Inflammation of the Skin and Flesh and so the Muscles that are now affected with this Inflammation are forced to suffer a double extension one that is caused by the Inflammation the other that which happeneth unto them from these things that befal them while they are returning unto their former length 2. But now this danger is so much the greater by how much the parts that are broken and shattered are more noble and principal as the Muscles Nerves Veins and Arteries 3. And from hence it is that a Fracture in the Thigh and Shoulders with a Wound and the falling out of a bone is the most dangerous of all touching which Hippocrates thus in his third B. of Fractures Text 47. But they seldom or never escape saith he whose bones either of the Arm or Thigh have fallen outwardly for as these bones are very great and very ful of Marrow so likewise there are besides these many other things wounded that are of very great moment to wit the Nerves Muscles and Veins whereupon also it is that if you put them back Convulsions are wont to be excited but then again if you do not put them back into their
to the Pecten and the neck of the Joynt is sustained in its Cavity again on the outer side the buttock appears hollow because the head of the Thigh is fallen to the inner part and the Thigh towards the Knee is forced to look outwards to the outer part in like manner the Leg and Foot whenas in all luxated bones one extreamity alwaies looks to the contrary part to that which is fallen forth They whose joynt is fallen forth after this manner and not reduced when they go they wheel about their Thigh outwardly for whenas the faulty Thigh is made longer and by reason of weakness they cannot readily bend the bone and by reason of pain they refuse to do it it remains that they must bring it about See more of these things in Hippoc. 3. de artic from t. 68. to t. 105. al which for brevities sake I would not transcribe hither Prognosticks 1. There is great danger in the Thigh lest that it be hardly reduced or being reduced that it fall out again Celsus l. 8. c. 20. 2. An old Luxation of the Thigh which hath already contracted a callus and in which the bosom is filled up with humors is judged incurable 3. If by reason of the plenty of the humor collected in the Cavity that Ligament be preternaturally extended that it cause the Thigh to be moved out of its seat or if the same Ligament be so relaxt by the humor that it cannot contain the bone in its seat although the bone be reduced yet it staies not in its place but fals out again viz. if the humor remain but if the humor be dried up the Joynt may remain in its seat of which Hippocrates 6. Aphor. 60. They who being troubled with a long continued pain of the Hip have the head of the Thigh fallen forth of the Hip their Thigh wasteth and becomes lame unless they be burnt 4. The same comes to pass if that Ligament be broken 5. If the luxated Thigh be not reduced the neighboring parts are wasted by degrees for both the Arteries and Veins are streightened and comprest that there is not a free passage open for the blood and spirits to those parts and because the part is not moved after its due manner the heat fadeth whence the nourishment of the part is not rightly accomplisht and the Thigh-bone is not encreased according to the proportion of the rest of the bones The Cure Whereas after the same manner almost as the Shoulder is joyned with the Shoulder-blade so the Thigh is with the Hip-bone so the way of reducing them both is almost the same The Patient must be placed upon a Bench or Table putting a Pillow or Bed under him with his Face downward if the Luxation be made outward or backward with his face upwards if inwards and upon his side if forwards and this reducing is done somtimes only with the Hands without any extension as first of all either let the head of the Thigh be so long wheeled about the Loyns till it come into its Cavity which way notwithstanding is not so safe or secondly to wit in a Luxation made to the inner part let the Thigh most quickly and strongly be bent to the Groyns and by this means let the head of the Thigh fallen forth be forced outward into its place but if no good be done by these waies the Patient must alwaies be so placed that the part into which the head of the Thigh is fallen be uppermost but that from which it is departed lowermost afterwards convenient extension must be made and at length the Thigh must be forced into its Cavity alwaies a way contrary to its falling forth but how a lawfull and convenient extension is to be made either with the hands to wit in soft bodies a new luxation or with Reins Ropes and the like to wiâ— in strong bodies and an old luxation doth sufficiently appear from those things which are said in the precedent patt c. 11. of the Fracture of the Thigh and truly the extension may be common to the four species of a luxated Thigh but the manner of forcing and restoring the head of the Thigh into its place varies according to the variety of the parts to which it is fallen for that which is fallen inwards must be forced outwards that outwards inwards and so of the rest when the bone is reduced which is known by the free motion of the Thigh and without any pain the Medicines of which we spake formerly in general c. 1. must be laid on the Joynt and with rowling the Joynt must be kepâ— in its place straw beds also as in Fractures must be applied and both Thighs be kept in its place straw beds also as in fractures must be applied and both Thighs be bound that the luxated Member may be kept in its place and this provision must not be loosed before the fourth day and let the Patient keep himself long enough in bed nor let him walk lest by unseasonable walking the bone fal forth again See more in Hippocrates Paulus Aegineta l. 6. c. 119. Ambrose Parry l. 15. from c. 39. to c. 48. Chap. 10 Of a Luxation of the patel Bone THe Thigh in its lower part hath two eminent heads tending to the hinder part with which it is inserted into two bosoms of the leg-bone only superficial ones and no waies deep and pargetted over with a smooth cartilage it hath moreover in its hinder part a certain bosom into which the bunching forth of the Leg-bone that stands forth betwixt its two bosoms is inserted but lest that by reason of this looser Articulation which is by a Ginglymus the Knee should be subject to frequent Luxations on the fore part the patel bone is set over the bone of the Thigh and Legg and firmly joyned to them by benefit of the thick Tendons of the Muscles extending the Leg besides on the out side of the greater bone stands the Bracer which at its upper part in the inner side hath a bosom covered with a Cartilage by which the little side head is received which subsists at the upper Appendix of the great Bone but at its lower part with its acute angle 't is inserted into the external and oblong bosom of the lower Appendix of the great Bone and makes the outward Ankle whenas therefore here concur many Articulations also many Luxations may happen A Luxation of the Knee-pan And truly first of al The Patel Bone whenas it hath no obstacle on the sides hindering its dislocation may be most easily luxated to the upper lower outward and inner part but never to the hinder part in regard that the bones of the greater Focil and Thigh which it covers do hinder it The Causes The Causes of this Luxation are a fal from on high jumping blows and an undecent distension of the Leg. Signs Diagnostick The Luxation of the Patel Bone is easily known by the sight and touch and the Thigh cannot rightly be